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New Research: Lack of Long-Term Commitments Will Hamper Progress in Countries with High Smoking and Mortality Rates

Of 31 countries surveyed, only Thailand reached the sustainability threshold; country plans for long-term sustainability, national tobacco control programs and policies urgently needed

February 5, 2023 (New York, NY)—Tobacco use kills more than 8 million people each year. Addressing the wide-ranging health and economic harms of tobacco use requires long-term commitments from governments, especially in emerging economies where tobacco use is at its greatest. Today, Vital Strategies and The International Union Against Tuberculosis and Lung Disease released The Index of Tobacco Control Sustainability (ITCS) data evaluating the sustainability—long-term planning, resource commitments and enduring polices—of national tobacco control programs in 31 countries where tobacco harms are the greatest. Findings reveal that every country but one are falling short.

“The tobacco industry is perhaps our most enduring public health menace,” said Gan Quan, Senior Vice President, Tobacco Control, Vital Strategies. “The uptake of the most effective tobacco control policies can be slow, allowing for new users to get hooked on the tobacco industry’s deadly products. The Index of Tobacco Control Sustainability offers countries individualized benchmarks and goals to ensure the critical building blocks for tobacco control sustainability are in place, and for those that aren’t, to plan action accordingly.”

The ITCS is a set of 31 indicators: policies, structures and resources that are important factors for a sustainable national tobacco control program. The greater the number of indicators a country has in place, the greater its ITCS score and likelihood a country is to have a sustainable tobacco control program. The most heavily weighted indicators include having least four MPOWER policies in place, an annual national tobacco control budget, a national tobacco control law, and tobacco taxation at least 75% of retail sales price. The World Health Organization’s MPOWER is a package of six practical measures designed to help countries implement effective tobacco control.

“Without plans for long-term sustainability, national tobacco control programs and policies will not be strong enough to fight the relentless tactics of the tobacco industry,” said Prof Guy Marks, President and Interim Executive Director of the International Union Against Tuberculosis and Lung Disease. “Sustainability is multi-factorial; it is not solely dependent upon financial resources. Every country can and must get closer to reaching better functioning programs that will reduce tobacco use effectively.”

Key Findings of the 31 Countries Assessed:

  • Only Thailand scored over 100, achieving the sustainability threshold.
  • Fourteen countries are progressing (scored between 70-99) and despite a higher score still have gaps in its policies and structures.
    • Bangladesh, Brazil, Cambodia, Chad, Ethiopia, Georgia, India, Indonesia, Madagascar, Myanmar, Nepal, Philippines, Uruguay and Viet Nam.
  • Sixteen countries are in the low category (scored between 0-69) and require further efforts to put in place the structures and policies that will improve the durability of national tobacco control.
    • Bulgaria, Burkina Faso, Cameroon, China, Colombia, Costa Rica, Cote d’Ivoire, Ecuador, Ghana, Mexico, Niger, Pakistan, Poland, Tanzania, Timor Leste and Zambia.
  • Since 2016, when the first Index launched, India, Vietnam, Philippines, Brazil remain progressing; Indonesia and Myanmar moved from low to progressing; China, Pakistan, Mexico and Poland remained in the low category.
  • Nine of the 31 countries have achieved the primary indicator of at least four MPOWER policies: Brazil, Bulgaria, Costa Rica, Ethiopia, Georgia, Madagascar, Mexico, Thailand and Uruguay.  
  • Nine countries have an earmarked annual tobacco control budget that met the per capita threshold. This stable funding creates capacity to work on other structural and policy developments.
  • The ITCS uses two taxation indicators: tobacco taxation at least 75% of retail sales price, and tobacco taxation increases faster than inflation plus gross domestic product growth. Eleven of the 31 countries have at least one of these tax measures in place. Only Madagascar has both tax indicators in place.
  • Twelve countries have a full policy for their ministry of health making all tobacco industry interactions transparent. 
  • Only four countries have both robust policies in ministries of health and across government departments, and 13 countries are still missing laws banning tobacco industry corporate social responsibility programs. This gap should encourage governments to develop these protective policies as a priority, ensuring their investment in other areas of tobacco control will not be undermined.

This ITCS report captures a snapshot in time, identifying both strengths and areas requiring action in the development of national tobacco control in 31 countries in 2022 and 2023. The primary intention for the ITCS is that it be used by bodies such as national tobacco control units, national advisory committee working groups, and national tobacco control coalitions to assess and monitor the sustainability of their tobacco control programs and plan action accordingly.

The full report can be found here:

About Vital Strategies

Vital Strategies believes every person should be protected by an equitable and effective public health system. We work with governments, communities, and organizations around the world to reimagine public health so that health is supported in all the places we live, work and play. The result is millions of people living longer, healthier lives.

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About The International Union Against Tuberculosis and Lung Disease

Established in 1920, the International Union Against Tuberculosis and Lung Disease (The Union) is committed to creating a healthier world for all, free of tuberculosis and lung disease. The Union is the world’s first global health organisation and a global leader in ending tuberculosis (TB). Its members, staff, and consultants work in more than 140 countries.
The Union strives to end suffering due to tuberculosis and lung diseases, by advancing better prevention and care. It seeks to achieve this by the generation, dissemination, and implementation of knowledge into policy and practice. The Union aims to ensure that no one is left behind, people are treated equally and we have a focus on vulnerable and marginalised populations and communities.