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Tackling the cancer of tobacco

By Henry Zakumumpa

Why increasing tobacco taxes can reduce the increasing cases of cancer and heart disease 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) which include cancers, diseases of the heart and blood vessels and diabetes.

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 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 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. There would be 21% less cases of heart disease globally if people didn’t smoke.

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 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 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 the least education.

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’’

In 2010, Uganda had high household expenditure of Shs357 billion spent on tobacco products, which was more than government budget for health  of Shs310 billion.

Many smokers want to quit but are unable to due to nicotine-dependence-thanks to one of the ingredients wired into cigarettes.

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.

WHO has selected the increase on tobacco taxes as this year’s World No Tobacco Day theme.

In South Africa, a 10% increase in taxes on tobacco was followed by a 8% percent reduction in cigarette consumption.

Low income earners are the most sensitive to cigarette price increases following a hike in tax. If a stick of cigarettes cost Shs150 and you added Shs50 in tax, at Shs200 it would be more costly to smoke. 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.

Uganda has one of 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 Frame work 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.

Henry Zakumumpa is a J2J Lung Health Fellow of the International Union Against Tuberculosis and Lung Disease

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