Tackle chronic diseases using stricter regulation
Employees of a Serbian company smoke cigarettes outside their office in Belgrade on November 11, 2010. Serbia introduced on Thursday tough anti-tobacco measures, the strictest ever in the Balkans country, where some 33.6 per cent of adults smoke.
Over the 20th Century, tobacco smoking killed around 100 million people, most of whom lived in today’s rich countries. But that is changing; the health burdens of smoking are moving from high- to low- and middle-income countries. Some estimates suggest a billion people could die from tobacco use this century.
Investments in targeting health threats like tobacco, alcohol and salt have largely, until now, been the preserve of wealthy countries.
Elsewhere, the focus was on eradicating the infectious disease. But as people live longer, non-communicable diseases (NCDs) are claiming more lives everywhere while receiving a fraction of health funding.
In Kenya, some 115,000 people die each year from chronic diseases. Poor countries should keep fighting illnesses like malaria, TB and HIV/Aids but urgently need to also increase focus on chronic disease risks.
Alongside many other promises in the Sustainable Development Goals (SDGs), we have promised to eradicate chronic diseases by 2030.
Unfortunately, we’re failing. A new peer-reviewed study by my think tank, the Copenhagen Consensus, together with several Nobel laureates and more than 100 leading economists, shows tax and regulation policies to fight chronic diseases can deliver outstanding social benefits for relatively small investments.
There are two very effective ways to reduce the death toll from smoking. One is through a simple tobacco tax. The other is tobacco regulation, including bans on advertising and smoking in public places.
Taxes make smoking costlier; hence, more young people will never start, more smokers will stop or reduce their consumption, and there will be fewer second-hand smoking deaths. It also raises large and reliable funds for the government.
The direct cost of changing legislation is quite small. Raising the tobacco tax across low- and lower-middle-income countries to four times the sales may cost just $45 million. Of course, it will confer a relatively large loss to present-day smokers, almost $500 million.
The cost up to 2030 would be a sizeable $462 million. But this policy would also significantly reduce smoking, saving more than 1.5 million lives. Every dollar in cost would achieve a phenomenal social benefit of $101. Because they will likely save more than 300,000 lives, tobacco regulations deliver a spectacular benefit-cost ratio of 92.
Tighter regulation
Alcohol kills 300,000 and 1.6 million people annually in low- and lower-middle-income countries, respectively. It contributes to a large number of diseases and causes 700,000 accidental deaths and immense social damage.
Tighter regulation can reduce harmful consumption and avert 150,000 deaths over the rest of the decade. Every dollar spent will deliver $76 of social benefits. An alcohol tax can generate large benefits at $53 back on the dollar.
Lowering unhealthy salt intake—like the United Kingdom, Finland and Poland have done—through regulations that gradually reduce the salt content in processed foods is another sound investment.
The WHO says we should consume a little less than one teaspoon of salt a day but people take much more. This leads to high blood pressure, heart disease and strokes, causing almost two million deaths yearly.
For poor countries, enforcing salt regulations will be more expensive at over $400 million but the approach could avoid almost half a million deaths, delivering $36 of social benefits for each dollar spent.
Dr Lomborg is the president of the Copenhagen Consensus and Visiting Fellow at Stanford University’s Hoover Institution. [email protected]. @BjornLomborg www.lomborg.com.
