Tax as cancer control

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Published: 12 Dec 2016
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Francis Thompson - Executive Director, Framework Convention Alliance

Dr Thompson speaks with ecancertv at the 2016 World Cancer Congress about taxation of tobacco products as a means of cancer control in different global regions.

He gives the example of higher taxes of tobacco and sugary products in the Philippines as part of a pivotal moment in their nations health care, and considers where these models might be applied in the future.

Dr Carlos Castro discussed the Colombian perspective on tobacco control and political involvement more in his ecancer interview here.

Tobacco tax is one of those areas that, from the point of view of the evidence, it’s absolutely clear that tobacco taxes are the single most important intervention that we have in tobacco control. In fact, in many cases of countries that have been quite successful it’s at least half of the overall impact of everything that we do in tobacco control. The session was focussing on that, first because it’s really important but secondly also because there are lots of people in the wider cancer community who may be aware in principle that increasing tobacco tax is a good thing but are probably not aware of a number of things: one, just how significant it is and how good the evidence is on it and, secondly, may not be aware that they can do anything about it because, of course, there’s a general assumption that somehow only tax experts or economists are qualified to go and talk to Finance Ministers. In practise, despite what people may think, Finance Ministers actually do care, even if it’s not their primary task, they do care about the health impact of what they do. So if you can tell them that raising the tax in a way that’s going to bring them lots of revenue is also going to save hundreds of thousands of lives that’s a really significant bonus for them and a really significant argument in favour.

Are you looking at any specific regions?

My end of it was the global experience in the sense that what we had… First of all, the FCTC has one article about taxation which is relatively general but then they did decide, as they’ve typically done for other articles, to actually negotiate detailed guidelines about overall tax policy. So that was essentially tax policy recommendations for the world and I talked about that part. Then we had one main national example which was from the Philippines which is fairly well known, both because it is, in terms of percentage terms, one of the largest tobacco tax increases anyone has had but the other interesting thing about the tax increase in the Philippines is that it was actually tied directly to increasing healthcare coverage for the poor. So it was tied to a measure to move towards universal health coverage and it was also a tax not only on tobacco but also on alcohol products. So it’s obviously attracted a lot of interest because those are all topics that are on the agenda at the moment. So that was the main example that we talked about but I did talk about a few other national examples like Brazil which is an interesting case for a number of reasons, one of them being that it is a country that actually has quite a good record on tobacco control at the same time as being the world’s number one exporter of tobacco leaf. So there’s a large tobacco growers lobby in Brazil and despite that they’ve been quite successful on the whole range of tobacco control measures – smoke free spaces, advertising ban, also significant tobacco tax increases.

What are your thoughts on doctors becoming more involved with politics?

It depends obviously on the doctor but I think that particularly for people who deal a lot with cancer there does come some point, specifically with lung cancer which is almost entirely caused by smoking, where it’s difficult for many doctors to not at least wonder about the particular end of that. Because obviously you can offer care to lung cancer patients and you can do your best possible job on that but, as you probably know, the prognosis for lung cancer is generally not that great, depending on when you detect it. I think many doctors at some point look at that and say, ‘Well, if only I had done something or someone else had done something earlier in the process when that could have been stopped.’ That seems a fairly obvious extension of the job of doctors which is to tell people what they need to do to improve their health. So it seems incumbent on doctors to play that role in society. Obviously there are many doctors who feel they are too busy or feel it’s not their role but there also are doctors who just feel they’re not qualified. On that point one of the things that came out in our session was that although there are some technical aspects to things like tobacco taxes it’s not rocket science, it is something that a normal educated person can read up a little bit about and credibly go and talk, for example, to Finance Ministry people about the proven health benefits of increasing tobacco taxes. That is something that medical associations can do and in many countries do do and obviously many individual doctors around the world who play quite key roles in advocating for that sort of thing.

Where do you see this taxation model being applied to next?

It’s not just an element for research, in the case of sugar sweetened beverages there are quite a number of countries now that have tried that. The one that’s best documented at this point is Mexico which they have shown a fairly immediate impact in terms of consumption in Mexico and that is the country which, perhaps surprisingly, I believe has the highest per capita consumption of fizzy drinks in the world. So, yes, those kinds of measures are applicable. Obviously there’s going to be I suspect, if this becomes more widespread, a long discussion in nutrition circles and there has been some of that already because nobody actually needs to smoke but everybody needs to eat. So you have to try to figure out what to tax at what rates. There has been some discussion, for example, in the case of food that maybe you also need to take some of that money and subsidise the healthy foods that may or may not be accessible in terms of price, particularly to poor people. So there’s certainly a lot of work to be done on that but it’s certainly very promising and the nutrition folks have been looking at that.

There are a whole bunch of other ones, though, like obviously alcohol is fairly widely taxed and often follows similar patterns to tobacco in terms of which countries have a long history of taxing it. But it’s been much less discussed in recent decades in much of the world as a health measure and that certainly seems like one that there’s useful work to be done. But there are lots of other things – people talk about green taxes, I would suspect without having spent a lot of time looking at the research that carbon taxes are also, in fact, physical fitness promoting. Obviously if you encourage active transport you’re more likely to have higher levels of physical fitness and so on. So that whole area of using taxes for health is one where it would be really, really good to have a lot more people working on that. At this point some of the economists who have been working on tobacco taxes specifically have, in fact, been branching out and doing some of that work but we’re nowhere close to having a global public health community that’s talking through all of these issues with perhaps the urgency that those things need.