The grand G20 Summit-2023 has been just concluded in the Indian Capital, participating nations discussed ways to handle the humongous crisis that wreaked havoc following the pandemic and why it was imperative to improve essential health services.
So what did the global leaders do? The health ministers met on 18-19 of August in Gandhinagar, the capital city of Gujarat to discuss global priorities.
They committed to strengthen the foundation of the global health architecture, keeping the World Health Organisation (WHO) at the centre, to achieve what they claimed in their own words as Universal Health Coverage and implement One Health Approach.
The basic idea was to improve pandemic preparedness and strengthen surveillance systems for infectious diseases. The members had a long list to display, saying they would be focussing on polio eradication, AIDS, tuberculosis, malaria, hepatitis and water-borne and other communicable diseases.
But there was no concrete statement on tobacco, one of the biggest menaces across the world and deaths related to tobacco. The leaders did not discuss if the world should scientifically discuss ways to control tobacco. An estimated 1.3 billion still use tobacco after decades of tobacco control. This is a huge number because tobacco kills up to half of its users. Let’s look at the figures. An estimated 8 million people die across the world each year due to tobacco-related causes, and 200 million years of life are lost.
Let me get into the details of what the global leaders did while discussing the big bucks issue of health. Says a portion of the joint declaration: “Building on the lessons from COVID 19 pandemic, we arrived at a consensus to build more resilient, equitable, sustainable and inclusive health systems. We reaffirm the importance of strengthening national health systems by putting people at the centre of preparedness and equip them to respond effectively.”
Why did the nations not discuss tobacco, especially when the nations recognised the central and coordinating role of WHO in global health architecture? Didn’t the nations know the big global debate on tobacco was very important, almost imperative because the debate is fraught with many inconsistencies?
And let’s look at the flip side of it. Nations are working towards increasing the share of assessed contributions to 50 percent of WHO’s 2022-2023 base budget, which takes into account the importance of monitoring budgetary proposals as well as progress on reforms for efficient operation.
So why should genuine debate on tobacco be left out? Why shouldn’t nations look at scientific reasons to control tobacco consumption? How can the global One Health approach work if tobacco is not included in the agenda? The G20 nations said they welcome research and development on health issues, has someone told them the debate on controlling tobacco consumption continues to be very lopsided because the tobacco lobby is too rich and powerful and crushes any arguments that float against its interests?
G20 nations have said in their declaration that they recognise the potential role of evidence-based Traditional and Complementary Medicine (T&CM) in health, and take note of WHO’s efforts in this direction including global and collaborating centres, and clinical trial registries.
But that has not happened in the tobacco debate, scientific evidence that helps control tobacco consumption has always been on the backstage. Worse, India has not seriously debated what should be done with the tobacco companies, bidi companies and other oral tobacco products for generations. State-owned companies own big shares in top tobacco companies in India.
And look at India
An estimated 1.2 million Indians die from tobacco related diseases. And this is happening when the global public health has set as a goal a “smoke free” future by 2040 in countries where 5 percent or less of the adult population smoke tobacco.
The Indian health ministry is struggling to keep the deaths low but its policies and decisions are not science-based. Repeated studies have highlighted the huge deficits in some of the most crucial decisions of the health ministry but that has not moved the decision makers.
More importantly, India should have realised that some of the nations with a big smoking population continue to fall woefully short of the global public health targets.
Ever since the WHO Framework Convention on Tobacco Control (WHO-FCTC) treaty was signed 18 years ago, tobacco demand has declined. But what is worrying is that this is far too slow. Worse, the change has not taken place at all in many low and middle income countries (LMIC).
Global experts on tobacco are unanimous that nations with tobacco-problem need to take lessons from countries which have done wonders in controlling the menace of tobacco. These nations should have instantly picked up some of the projects initiated by the Swedish government and see how the Swedes have succeeded and where others have fallen short.
See how it is working in Sweden
India, in comparison, is 630 percent bigger than Sweden. So what would work in Sweden may not necessarily work in India. But what is stopping the health officials in India to pick up lessons from Stockholm?
The Swedish government’s decision to make alternative smoke-free nicotine products widely accessible, acceptable, and affordable, has produced great results. Sweden’s smoking prevalence has fallen to nearly 6 percent. Has it helped the smoking population of Sweden? It has. Very effectively, Sweden has been able to successfully combine tobacco control and harm reduction strategies.
Now, India and other high tobacco consumption nations should have effectively studied the Swedish formula and effectively implemented it in the billion-plus nation. And one needs to remember that this is exactly what is called for in the WHO-FCTC, where Article 1(d) calls for: ‘tobacco control’ which means a range of supply, demand and harm reduction strategies that aim to improve the health of a population by eliminating or reducing their consumption of tobacco products and exposure to tobacco smoke.
So, effectively, there should be a big call to the WHO and global public health to study the harm reduction strategies so successfully employed by Sweden. Nations with a huge population of smokers must work diligently to curate updated databases of tobacco-attributable deaths and epidemiologically sound methods to calculate the “size of the prize for public health”.
Has it happened? The answer is a big No
Countries like China and India must work towards this mission and ensure some million life years are saved. These nations must impress upon world health bodies like the WHO why it is important to share authentic data on tobacco-related deaths and how key health metrics can be set (like it happened in Sweden). There should be global debates on tobacco control and there should be more accurate databases and methods.
The world, and also WHO, must take note that Sweden is about to become the first WHO member state to become “smoke free” and its tobacco control and harm reduction strategies deserve to be studied and replicated.
Only then, millions of lives can be saved around the planet.
—The author, Shantanu Guha Ray, is a senior journalist based in New Delhi. The views are personal.
(Edited by : C H Unnikrishnan)
First Published: Sept 16, 2023 8:43 AM IST
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