Ideas to Action:

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In the latest issue of the Journal of the American Medical Association, visiting fellow Tom Bollyky and coauthor Lawrence Gostin make the case (gated) for increased U.S. engagement on global tobacco control. Tobacco use is currently the leading cause of disease and premature death in the world, tallying more deaths than HIV/AIDS, TB, and malaria combined. The world’s 1.2 billion smokers account for one-third of the adult population and each year expose 700 million children to secondhand smoke at home.

While the United States has demonstrated its commitment to cutting U.S. tobacco use, most recently with graphic warning labels for cigarette packages, U.S. efforts on the international stage are lacking. Arguing that U.S. leadership on tobacco control is in our national interest, Tom and his co-author propose the following strategies for increased engagement:

Make Tobacco Control a Global Health Priority…

The Obama administration has wide scope to fully integrate tobacco into the Global Health Initiative (GHI) and its development strategy. The 2011 G-20 meeting in France and the UN High-Level Summit on Non-Communicable Diseases provide excellent opportunities for U.S. leadership. Beyond the health and development sectors, the United States should refrain from seeking or granting tobacco tariff reductions and exclude tobacco related investments from future trade and investment agreements…

Expand Resources for Global Tobacco Control…

The United States should seek a G-20 commitment to institute a surtax on tobacco consumption. Surtax revenues should go into a dedicated fund administered by the WHO, World Bank, or an  independent body modeled on the Global Fund. The surtax could be modest on a per-product basis, with WHO estimating that a $.05-per-pack voluntary solidarity levy in high-income countries would generate $4.6 billion—more than quadrupling current global tobacco control funding…

Creative Incentives for FCTC Implementation…

The Center for Global Development’s Cash-on-Delivery Aid concept, for example, encourages institution-building and local solutions whereby a funder and recipient agree on mutually desired outcomes, with payment tied to units of confirmed progress. Here, the outcome could be linked key indicators in global tobacco surveillance surveys from WHO and the Centers for Disease Control and Prevention, with the G-20 surtax funding the payments. Cash-on-Delivery Aid would align the incentives of local leaders with tobacco control objectives and increase appetites for improved surveillance and technical assistance…

Increase Technical Assistance, Surveillance, and Support…

The United States should work with its G-20 partners to use surtax resources to scale up technical assistance, which is squarely within developed countries’ areas of expertise. The United States should seek to leverage and support international antitobacco activities at the Bloomberg Initiative, the Bill and Melinda Gates Foundation, and the Framework Convention Alliance, coordinating tobacco control with other donors such as the Global Fund and UN Women.

The JAMA article builds on Tom’s recent report published by the Center for Strategic and International Studies. As projections estimate one billion total deaths from tobacco in the 21st century with increasing numbers from low- and middle-income countries, this is an important moment in international tobacco control. At CGD, we are watching to see how the U.S. will respond.

 

CGD blog posts reflect the views of the authors drawing on prior research and experience in their areas of expertise. CGD does not take institutional positions.

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