Lisa Jane Wood is an Associate Professor at the University of Western Westralia and has worked in the area of tobacco control for more than two decades. she has been involved in a range of research relating to the way in which our social and built environments impact on health, with a particular focus on mental health, social determinants of wellbeing and reducing health inequalities. Most of her research is multidisciplinary.
Increasingly her research is focused on the prevention of health disparities through more upstream intervention into the social determinants of poor health.
Very recently she came to Bangladesh conduct a training programme on "Sustainable Funding for Tobacco Control " (Pilot Course in Bangladesh) as a Technical Consultant - The Union, Asia Pacific Region (based in Australia). She has shared her thoughts with the Daily Observer relating to Tobacco control and health promotion.
Excerpts :
Observer: Why sustainable funding is necessary for tobacco control?
Lisa Wood: Tobacco is the largest preventable cause of death and disease and kills around 6 million people each year. In many countries including Bangladesh, the health, social and economic burden of tobacco is still increasing, and so long term secure funding for tobacco control is essential to curb this. Governments have many competing priorities and struggle to invest the money needed to reduce smoking and its harms, so new ways of finding funds for this are needed. Taxing on tobacco one of the most effective ways of generating an ongoing source of funds for tobacco control and health promotion.
Observer: How sustainable funding will work in tobacco control and health promotion?
Lisa Wood: Health promotion has been defined by WHO as "The process of enabling people to increase control over their health and its determinants, and thereby improve their health". Tobacco is so addictive, so helping people stop smoking and preventing young people from starting is a high priority for health promotion. In many countries sustainable funds raised from tobacco taxes are also being applied to other high priority health promotion issues. This makes sense as our ultimate goal is for people to be able to live healthier happy lives, and people who use tobacco often have other unhealthy behaviours.
Observer: Bangladesh imposed 1 per cent health surcharge. What could be best way to use this money in to Tobacco control or health promotion?
Lisa Wood: This is a new source of money and a new Foundation should be created that can spend those funds on effective tobacco control initiatives as a first priority as this is the biggest preventable cause of health problems in the country. But, if there is not yet the capacity to spend all of this money on tobacco control, then it could also be used to tackle NCDs also. The experience from other countries is that it is important to focus on one or two high priority issues when a Foundation is first established - don't 'spread too thin'.
Observer: Do you think only 1 per cent health surcharge is enough on TC and health promotion?
Lisa Wood: No it is not enough but it is a very good start! Even if all that money was spent on tobacco control, it would only equate to about 12 taka per person, which is not very much (when compared to the enormous health care costs which result from tobacco related diseases in the country). Bangladesh government is to be commended on the surcharge however, and in future could consider raising the percentage tax on tobacco to at least cover part of the health care costs, or introduce a tax on sugar, fatty foods or alcohol as has also been done in some countries.
Observer: What do you think about the tobacco control measures in Bangladesh? Are you hopeful about having a sustainable tobacco control programme here anytime soon?
Lisa Wood: Tobacco control seems to have great momentum in Bangladesh and some great champions within government, civil society and the community. It is wonderful to see that Additional Secretary of Health, Roxana Quader so supportive of the importance of the Health development surcharge being set aside to improve the health of Bangladesh people and strengthen tobacco control in this country. It would be great if a clear decision to allocate surcharge funds to tobacco control could be made soon, and then Bangladesh can establish a Health Promotion Foundation or Board to use the funds to accelerate tobacco control activity in this country, like Vietnam has done recently.
Observer: Bangladesh's dilemma is it has resource constraints on the one hand and , on the other it gets a large amount of revenue from the tobacco companies, which it needs to make up for the shortage in development funding. In such a situation what is the possibility of an effective tobacco control programme?
Lisa Wood: The enormous health costs of treating tobacco caused diseases, and the immense social costs of families seeing addicted tobacco users suffer and die, outweigh any perceived benefit of tobacco as a revenue source for governments. It has been shown that reducing tobacco use can contribute to many of the UN sustainable development goals, including poverty reduction, health, and more sustainable agriculture. So raising tobacco taxes to discourage smoking, and investing those taxes back into health make good economic sense for governments.
Observer: In Singapore, anti-tobacco campaign had positive result. In US drop in the prevalence rate among male smokers was substantial but among female smokers, the rate was not as encouraging. Everywhere the tobacco control programme is facing one hurdle or another and overall prevalence rate remains frustrating. What is the situation in your country? How do you compare the two scenarios--yours and ours?
Lisa Wood: Tobacco is one of the most addictive drugs and it is not easy for people to quit, especially if there are still social influences to smoke and the product remains very cheap as it is here in Bangladesh. So reducing the prevalence of smoking takes time.
In Australia we now only have about 12% of the population smoking, and not many young people take up smoking anymore, due to the combined influence of high taxes on tobacco, strict advertising bans, large scale mass media campaigns about smoking harms, strong smoke-free laws, graphic health warnings on packs and now plain packaging.
Bangladesh can achieve these things also if new money from the surcharge is injected into tobacco control. But Australia still has its challenges also; the tobacco industry is fighting the pack warnings, and cigarettes can be bought at so many places, we need to tackle the availability of tobacco next in our country.