A photo of a person with their back to the camera, standing in front of a cigarette dispenser.

This entry is part 2 of 3 in the series CRUK Global

Over the past 20 years, the use of tobacco has fallen from 1.4 billion to 1.3 billion people globally. This progress is thanks to the efforts of advocates around the world enacting the policy change needed to protect individuals from tobacco’s harmful effects.

We want to ensure that policy changes around tobacco control in the UK, that we have helped work towards, are achievable in other countries, especially those facing a growing tobacco epidemic.

It’s important to be part of the international effort to reduce the burden of cancer globally. So we are working with partners in other countries to advocate for policy change – especially low and middle-income countries (LMICs). This is to help ensure tobacco policy change that protects individuals from this health-harming product can become a reality in all settings, and more cancer cases are prevented. Our partners are starting to see the results of their work, especially the Nepal Development Research Institute, who have successfully advocated for increases in tobacco tax in Nepal.

The global tobacco landscape

Smoking is known to cause over 15 types of cancer. Campaigns, including our own call for plain cigarette packaging, have been key to motivating governments to act against a product that kills up to half of its consumers when used as intended.

Progress has undoubtedly been achieved across the world. In fact, 3.9 billion people live in countries that benefit from the large graphic warnings on cigarette packs that we are familiar with in the UK.

Plain packaging and graphic images make up a small portion of the policies recommended by the World Health Organisation to reduce tobacco consumption. The policies are outlined in the Framework Convention on Tobacco Control (FCTC). The FCTC was the fastest ratified treaty in the history of the United Nations. And with 168 countries as signatories, it was also the most widely ratified. It’s been estimated that 37 million lives have been saved because of the tobacco control policies included in the FCTC framework.

However, progress in tobacco control policy and the implementation of the framework has not been equal. As high-income countries successfully introduced tobacco control policies, LMICs have become a target for an industry that seeks to maintain its profits. It’s known that 80% of the world’s 1.2 billion smokers live in LMICs and one tobacco company sells 70% of its products in Asia, Africa, Eastern Europe, and Latin America.

Tobacco use still kills 8 million people per year and LMICs bear the greatest burden of the tobacco epidemic. In fact, by 2030, it is predicted that 80% of all tobacco-related deaths will occur in LMICs.

Investing in civil society

Our role in progressing tobacco control in the UK has exemplified the role that civil society, and a strong evidence base, can play in supporting the implementation of policies to improve health. Our global work invests in civil society organisations such as non-governmental organisations, and research institutions including universities and think tanks in LMICs. Funding these organisations enables them to conduct the research needed to generate evidence and importantly, use the evidence to advocate for tobacco control policies.

However, there is not a one-size-fits-all approach to policy change. It must be context specific, especially when there are greater barriers. The tobacco industry fights hard to preserve the regulatory environment it profits from, and often uses misinformation and other tactics to interfere with policy making processes and deter politicians from introducing life-saving tobacco control policies. These behaviours are seen more often in LMICs where there is more for the industry to lose if tobacco control policy is strengthened.

Investing in civil society and generating the evidence required to achieve and implement tobacco control policy helps to counter the industry’s actions, and to advocate for the policies of the FCTC to be implemented. Involving as many stakeholders as possible, across all sectors that are harmed by tobacco, creates a cohesive and powerful voice that can drown out the noise from the tobacco industry.

Tobacco tax in Nepal

One example of our impact globally is the success of our partners in Nepal. We fund the Nepal Development Research Institute (NDRI) in Nepal, who along with the support of the international development agency Kivu International, have contributed to an increase in tobacco tax of 50%. Taxing tobacco is regarded as a best-buy intervention to reduce tobacco consumption; for every 10% increase in the cost of tobacco, there is a decrease in consumption of 4-8%. The WHO recommended tax level on tobacco is 75%.

Dr Jaya Gurung, Senior Research Specialist at NDRI outlined the importance of introducing such measures in Nepal;

‘‘When the project started, tobacco was very much a ‘second order issue’ – Nepal had high smoking prevalence rates, the lowest tobacco tax rate in the region, and tobacco control was not an issue at the forefront of anyone’s mind. With CRUK’s support, this has started to change.’’

The change comes as a result of an advocacy campaign that centred around the expected announcement of a new budget by the government. The advocacy campaign was a highly organised initiative that utilised connections with the government and partnered with other civil society organisations to publish multiple media pieces to raise public awareness.

‘My proudest achievement so far on this project is that tobacco tax has increased by 50% over the past two years. Through a combination of locally tailored research and politically informed advocacy, we have successfully convinced policy makers of the benefits of tobacco tax,” says Gurung.

“Of course, there is still much to do. There will be an election in Nepal in November this year so we will have a new set of politicians and policy makers to engage with. At the same time, the tobacco industry continues to fight back against efforts to tackle tobacco with misinformation and political lobbying. That is why this year we have built a coalition of organisations who are collectively working to raise the salience of tobacco control amongst the public, ensure that electoral candidates are committed to improving tobacco control, and advocate for policy makers to continue to take action in line with NDRI’s locally tailored, evidence-based recommendations. With another 18 months left of the programme, I’m excited to see what more we can achieve.’’

Adapting and amplifying our impact, globally

Our work on tobacco has been a key component of the International Cancer Prevention (ICP) programme since 2016. In that time, it has evolved from funding the generation of evidence for tobacco control, to investing more broadly in civil society organisations that can translate that evidence into meaningful policy change, as exhibited by NDRI in Nepal.

To date, our work has spanned over 30 countries.

But it’s not always been plain sailing. We’ve had to change our approach in response to an ever-changing global environment.

Despite tobacco consumption costing the worldwide economy $1.4 trillion in healthcare expenditures and lost productivity each year, tobacco control has become less of a priority for many governments as they grapple with urgent problems. We’ve even witnessed tobacco companies utilise the Covid-19 pandemic to gain access to policymakers through inappropriate ‘corporate social responsibility’ campaigns.

However, we’re well-placed to champion global tobacco control efforts, and support organisations to deliver incredible advocacy campaigns that will result in life-saving policies being implemented. We’re a formidable presence in the tobacco control community, and we have our supporters to thank for giving us the mandate to improve the cancer burden for everyone. To reiterate our mantra, we cannot say we have beaten cancer until we have beaten it everywhere.

Beth Turner is a policy and advocacy advisor, in Cancer Research UK’s Global team