Friday, May 2, 2014

Why increasing tobacco taxes can reduce the increasing cancer and heart disease cases in Uganda

Last year four cabinet ministers were reported in the press to be on treatment for diseases of the heart and blood vessels. Sadly, two of these cabinet ministers eventually died from these ailments in the same year. This included a former health minister. In the same year,cancer claimed the life of the then Deputy Chief justice.Again last year,a former Vice President 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 are the most reported cause of death at funeral services conducted at the church. Uganda is in the throes of a new epidemic of non-communicable diseases (NCDs)-the 'big four'namely; cancers, diseases of the heart and blood vessels, diabetes and chronic respiratory infections. This of course, is in addition to the already existing AIDS, malaria and Tuberculosis epidemics. The only common risk factor associated with all the NCDs is tobacco use. Tobacco use has been known to cause all these diseases. To be clear, NCDs are also caused by physical inactivity, unhealthy diets and genetic factors among a multitude of risk factors. The World Health Organization(WHO)projects that NCDs will be the leading cause of death in low and middle income countries like Uganda by 2030. In a major 2013 report on NCDs in Sub Saharan Africa, the World Bank projects the cases of cancers alone to double by 2030. The most preventable risk factor for all these diseases in tobacco use. Tobacco use is the leading cause of death globally and 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% of all lung cancer cases. If people didn't smoke, there would be 71% less deaths from lung cancer, 21% less cases of diseases of the heart and blood vessel globally. As the world commemorates the World No Tobacco Day on 31st May, it is an opportune moment to reflect on Uganda's burgeoning NCDs epidemic and to reflect on the role of tobacco use and in this largely preventable epidemic. Although tobacco use is often constructed as a public health issue, it is also actually about poverty and development. According the latest Uganda Demographic and Health Survey (UDHS),tobacco use is more common among the two lowest income groups in Uganda and those with the least education. Households where the breadwinner is a smoker spend less on education and health. In several studies conducted, expenditures on tobacco can mean less food on the table or less milk or kilos of maize purchased for a household.In fact children in households of smokers have poorer diet quality than those from non-smoking households. I have a smoker friend who confided in me that smoking does affect how much food he buys at home. In other words, because he spends money on cigarettes he buys less litres of milk for his children than he would have wanted. You see, tobacco use is an addiction and that it is how it is exactly intended by the tobacco industry . Many smokers want to quit but are unable to due to nicotine-dependence-thanks to one of the ingredients wired into cigarettes. A study in Bangladesh by Debra Efroymson and others found that ''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'' But lots 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. Indeed, this year, WHO has selected the increase on tobacco taxes as theme of the World No Tobacco Day. In South Africa, a 10% increase in taxes on tobacco was followed by a 8% percent reduction in cigarette consumption. As we noted earlier, tobacco use is highest among the poorest and they are the most sensitive to cigarette price increases following a hike in tax. If a stick of cigarettes cost 150 shillings and you added 50 shillings in tax, at 200 it would be more costly to smoke. In fact studies show that among low income earners,an increases in taxes has resulted in reduction in demand for cigarettes. Young people are even 2 to 3 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. When I was in secondary school many youth were hard pressed to buy cigarettes because of prices and an increase would deter smokers or at least mean less sticks purchased. Uganda has one of lowest taxes on cigarettes in East Africa and is way below the recommended tax rate it commited itself to achieve when it signed the WHO's Frame work Convention on Tobacco Control in June 2007. Tobacco tax increases serve the twin goals of reducing consumption and increasing government revenue.

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