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Higher tobacco taxes can reduce cancer burden

Last year, four cabinet ministers were reported to be on treatment for diseases of the heart and blood vessels. Sadly, two of them eventually died. One of them was former Health minister Stephen Malinga.

In the same year, cancer claimed the life of the then deputy Chief Justice Constance Byamugisha, and former Vice President Mustafa Adrisi died from diseases of the same category. In Parliament, the deaths were multiple.

Rev Diana Nkesiga of All Saints church recently publically acknowledged that cancers were the most reported cause of death at funeral services conducted at this church. In general, Uganda is in the throes of a new epidemic of non-communicable diseases (NCDs) which include cancers, diabetes, plus diseases of the heart and blood vessels.

The World Health Organization projects that NCDs will be the leading cause of death in low and middle-income countries such as Uganda, by 2030. In a major 2013 report on NCDs in sub-Saharan Africa, the World Bank projected the cases of cancers alone to double between 2008 and 2030.

The only common risk factor associated with all these NCDs is tobacco use, and it is also the most preventable. To be clear, NCDs are also caused by physical inactivity, unhealthy diets and genetic factors, among a multitude of risk factors.

Tobacco use is one of the leading causes of death globally. It claims more lives than Aids, malaria and tuberculosis combined. The commonest cancer in the world today is lung cancer. Tobacco use has been determined to cause 71 per cent of all lung cancer cases. There would be 21 per cent less cases of heart disease globally if people didn’t smoke.

As the world commemorates the World No Tobacco Day on May 31, it is an opportune moment to reflect on Uganda’s burgeoning NCDs epidemic, and to reflect on the role of tobacco use in this largely-preventable epidemic.

Although tobacco use is often construed as a public health issue, it is also about poverty and development. According to the latest Uganda Demographic and Health Survey (UDHS), tobacco use is more common among the two lowest income groups in Uganda and those with least education.

A study in Bangladesh by Debra Efroymson and others concluded: ‘’average male cigarette smokers spend more than twice as much on cigarettes as per capita expenditure on clothing, housing, health and education combined. The typical poor smoker could easily add over 500 calories to the diet of one or two children with his or her daily tobacco expenditure.’’

In 2010, Uganda had household expenditure of Shs 357bn spent on tobacco products, which was more than the government budget for health of Shs 310bn. Many smokers want to quit but are unable to due to nicotine-dependence – thanks to one of the ingredients wired into cigarettes.

But a lot can be done to reduce tobacco use’s contribution to the current NCDs epidemic in Uganda.  Probably, the most effective tobacco control measure is increasing taxes on tobacco products such as cigarettes. WHO has selected [raising] tobacco taxes as this year’s World No Tobacco Day theme.

In South Africa, a 10 per cent increase in taxes on tobacco was followed by eight per cent reduction in cigarette consumption. Low-income earners are the most sensitive to cigarette price increase. If a stick of cigarettes cost Shs 150 and you added Shs 50 in tax, at Shs 200 it would be more costly to smoke.

Young people are even two to three times more responsive and studies show that higher taxes and prices are most effective in preventing youth from moving beyond experimentation and into regular tobacco use.

Uganda has one of the lowest taxes on cigarettes in East Africa, and is way below the recommended tax rate it committed itself to when it signed the WHO’s Framework Convention on Tobacco Control in June 2007.

Parliament needs to pass the Tobacco Control Bill 2013, to provide a legal framework for these life-saving increases on tobacco taxes.Tobacco tax increases serve the twin goals of reducing tobacco consumption and increasing government revenue.

zakumumpa@yahoo.com
The Author is a J2J Lung Health Fellow of the International Union Against Tuberculosis and Lung Disease.

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