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Research to Policy Action

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Call To Action

Investing in Tobacco Control is Investing in Cancer Control. A significant component of this investment should be high-quality, collaborative research to provide the evidence base for sound policymaking.

One of the critical components of the success of global tobacco control over the last few decades has been its strong evidence base. The print edition of the Tobacco Atlas and this website not only benefit directly from this work by seeking to put meaningful pieces of this research together in a cohesive collection, but are living testimonials to its high quality and deep impact. It is very important to note that this base did not appear magically; rather, hundreds of researchers across the globe have helped to build this strong foundation upon which policymakers can make well-informed and suitable policies. One key part of this dynamic has been so-called “local” research that helps to provide a more contextual evidence base for policymakers and other advocates in specific countries or regions. One of the most effective models has been the ongoing promotion and support of truly collaborative research, often among researchers of different skills but just as importantly from different parts of the world, often “south” and “north” sharing experiences and expertise.

Importantly, there are successful programs that promote this kind of collaborative research among experts from low- and middle-income countries (LMICs) and high-income countries to reach these goals. For example, the National Institutes of Health (NIH), Fogarty International Center (FIC) and its partnering Institutions at NIH, established the International Tobacco and Health Research and Capacity Building Program (TOBAC). The program has sought to build a network of global tobacco researchers in LMICs, build capacity in research and reduce the burden of tobacco consumption in LMICs. The TOBAC Program has contributed significantly to tobacco control evidence, capacity building efforts, and informed policy advancements in the LMICs. The success of the funded projects demonstrates the ability of a relatively small number of research grants to advance tobacco control efforts on an international scale. We showcase three projects in the modules below — from Argentina, Hungary and China — to demonstrate the outstanding and impactful work that researchers are doing around the world.

Both the Center for Global Health (CGH) at the National Cancer Institute (NCI) and the American Cancer Society are striving to reduce the global cancer burden by collaborating with international partners, facilitating research and supporting countries in implementing their cancer control plans. With this broad goal in mind, in one module below we explore cancer control planning and in a companion module provide resources for planners to utilize. We also explored these themes in depth in a recent Webinar, available for viewing.


This post was drafted by Jeffrey Drope and Ted Trimble

Building capacity for tobacco control research in Central and Eastern Europe

Resources

Sources

Team of Hungarian researchers:
Balázs Péter, MD PhD Semmelweis University (PI of subcontract)
Pénzes Melinda, M.D. Semmelweis University
Urbán Róbert, Ph.D. Eötvös Lóránt University
Bodrogi József, Ph.D. Health Solutions, Inc. (formerly Corvinus University)
Kovács Gábor, M.D. National Korányi Institute for TB &
Paulik Edit, M.D., Ph.D. Szeged University
Horvath, Ildiko, Debrecen University
Lomnici Zoltán, Ifj. Dr., Pázmány Péter Catholic University,Faculty of Law and political sciences
Nagy Katalin Prof. Dr, Szeged University, Dental school, dean
Prof. Dr. Nagymajtényi László. Szeged University
Fogaraczi-Grenczer, Andrea, PhD, Semmelweise University
US team:
Kristie Foley, PhDWake Forest Department of Social Sciences & Health Policy
Todd Rogers, PhD Research Triangle Institute, International
Doug Easterling, PhD, Wake Forest School of Medicine
Mark Wolfson, PhD, Wake Forest School of Medicine
John Spangler, MD MPH, Wake Forest School of Medicine

Tobacco Control in China: Health and Economics

One key focus of recent NCI-funded research in China has been the application of economic analysis of tobacco tax policies in order to build the evidence base for increasing tobacco taxes. Findings of this study led by Dr. Teh-wei Hu were reported by the official Chinese newspaper, China Daily, and provided to the relevant Chinese government agencies.


In May 2015, the Chinese government raised tobacco taxes, so that the share of tax in cigarette prices increased from 49% to 54%. The predicted outcomes of the tobacco tax increase include:

  • Cigarette price increase by about 1 RMB (0.16 USD) per pack
  • About 3.5 million smokers quitting smoking
  • Additional 100 billion RMB (16 billion USD) tax revenue
  • Reduced cigarette sales by between 2 billion to 2.25 billion packs
Resources

Sources

Source for cigarette price and inflation data: The Economist Intelligence Unit’s World Cost of Living Survey

Source for per capita cigarette consumption: Euromonitor International’s Passport Database

Source for predicted policy outcome: Xu Y.B., Another Round of Tobacco Tax Reform, Tobacco Industry Will Face Major Revolution (in Chinese) http://www.yancaotx.com/article-105-1.html accessed on 6/16/2015.

Project’s collaborators in China:

  • Ministry of Health: CDC
  • Fudan University, School of Business
  • Sichuan University, School of Public Health and Department of Economics
  • State Administration of Taxation
  • Chinese Association on Tobacco Control
  • Ministry of Finance
  • Ministry of Agriculture
  • University of International Business and Economics
  • Central University of Finance and Economics
  • Yunnan University of Agriculture

Collaborators from international organizations:

  • World Health Organization
  • World Bank
  • International Union Against Tuberculosis and Lung Disease
  • Tobacco-Free Kids

Collaborators in the United States:

  • University of California, San Francisco
  • University of California, Davis
  • University of California, Los Angeles
  • Georgetown University

Argentina's Special Tobacco Fund

Established in 1972, Argentina’s Special Tobacco Fund (Fondo Especial de Tabaco or “FET”) is financed through the tobacco excise tax (around 10% of the final price of cigarettes sold in the country) and which represented a total amount of USD 426 million in 2015. The FET provides direct subsidies to tobacco growers (according to the volume and quality of tobacco crop production) and indirect subsidies through plans sent to tobacco growing provinces to promote and improve tobacco farming and production.

2015-10-20_184105

A project led by Beatriz Champagne at the Inter American Heart Foundation (IAHF) and Dr. Veronica Schoj at the Fundación Interamericana del Corazón Argentina (FIC Argentina) funded by NIH’s Fogarty International Center, aims to evaluate rigorously the impact of the FET on tobacco control and tobacco economy. Among its main outcomes are the following findings:

  • The FET promotes and supports five key elements of tobacco production: the production itself, by promoting the farming of Virginia and Burley tobacco crops; the tobacco growers, by providing direct subsidy and health insurance coverage; the productive circuit, by facilitating security for financing schemes and trade; associativity, by providing incentives to the association of tobacco organizations; and the tobacco social environment, by fostering social and economic development in tobacco-growing areas.
  • Nevertheless, the main beneficiaries of the FET’s subsidies are, by far, the big tobacco growers. As an example, in 2012, and with only 2,587 tobacco farmers (mostly big producers), the provinces of Salta and Jujuy received 2/3 of the FET.
  • The FET is not helping enough to small growers (that represents the 90% of the tobacco growers in the country) to enhance their economic development neither helping them to access to their own land when they are lessee.
  • The FET also failed to facilitate the crop substitution and diversification for small tobacco growers.
  • Because the FET volume is related to domestic tobacco products consumption, any policy addressed to reduce tobacco epidemic is considered a threat for tobacco growers. That is why the FET has been and is still a major obstacle for ratification of FCTC and for the implementation of more effective tobacco control policies in Argentina. The big tobacco growers (throw their strong relationship with political power in tobacco grower provinces) block legislation and tobacco control policies at national level.

This project has facilitated capacity building and promoted dialogue among key stakeholders within the government, academia and civil society to question the FET in order to discuss a better use of this fund to effectively reduce inequality, improve the living and working conditions of small tobacco growers, promote crop diversification and substitution and to move forward tobacco control policies to protect public health.

 

Resources

Sources

Since 2012, the InterAmerican Heart Foundation (IAHF) and the Fundación Interamericana del Corazón Argentina (FIC Argentina) have carried out a project funded by Fogarty International Center through its initiative “International Tobacco and Health Research and Capacity Building Program (TOBAC) (R01)” (grant no. 5R01TW009288).

This grant allowed us to explore the situation of the tobacco economy in Argentina and generate scientific evidence for the promotion of tobacco control policies, with important results in three areas: 1) tobacco taxes, 2) subsidy to the production of tobacco leaf (FET), and 3) the living conditions of small tobacco growers and obstacles posed to crop diversification and substitution.

Cancer Control Planning in Low- and Middle-Income Countries

The field of global health has largely focused on addressing infectious disease burdens in low- and middle-income countries (LMICs). These efforts have led to longer life spans, thereby leading to aging populations who face greater incidence of non-communicable diseases (NCDs) such as diabetes, heart disease, and cancer. Increasing numbers of deaths from cancer in LMICs are not just a result of growing and aging populations but also increased prevalence of risk factors such as tobacco use.

Cancer is a global epidemic and a leading cause of death across the globe. In 2008, 7.6 million people died from cancer worldwide. This is more than the deaths caused by AIDS, TB and malaria combined. Of the people that died that year, 64% occurred in LMICs, a disproportionately high burden of cancer incidence and cancer mortality. If we don’t act now to prevent cancer by strengthening health systems, it is estimated that by 2030, the number of cancer deaths worldwide could be as high as 13.2 million, with 69% in developing countries.

Challenges in providing cancer prevention and treatment in LMICs are severe given the high cost of cancer control services and the tight health systems funding in developing countries. Cancer control services includes cancer prevention, screening, rapid diagnostics, treatment, survivorship and palliative care. In developing countries where resources are limited, research and cancer control planning are particularly important, because they provide the evidence needed to invest each dollar wisely and save the most lives possible. But, one of the very “best buys” in cancer control (and many other NCDs) remains tobacco control. Thus, always bear in mind that

Tobacco Control is an Important Part of Cancer Control Planning

Resources for Tobacco Control in Cancer Control Planning

  1. The US National Cancer Institute: http://www.cancer.gov/ Specific resources include:
    • The Tobacco Control Research Branch leads and collaborates on research, and disseminates evidence-based findings to prevent, treat, and control tobacco use: http://cancercontrol.cancer.gov/brp/resources.html
    • Research funding announcements associated with Tobacco Control Research: http://cancercontrol.cancer.gov/brp/funding-opportunities.html#tcrb
    • Developing and Implementing National Cancer Control Plans: A webinar presented by the National Cancer Institute, Center for Global Health. https://webmeeting.nih.gov/p4x8h8v6frf/
    • Cancer Control P.L.A.N.E.T. (Plan, Link, Act, and Network with Evidence-based Tools) is a web portal that provides access to data and resources that can help planners, program staff, and researchers to design, implement and evaluate evidence-based cancer control programs. http://cancercontrolplanet.cancer.gov/
    • Research-Tested Intervention Programs (RTIPs) is a searchable database of cancer control interventions and program materials and is designed to provide program planners and public health practitioners easy and immediate access to research-tested materials. http://rtips.cancer.gov/rtips/index.do
  2. The International Cancer Control Partnership Portal is an online one-stop shop for cancer planners and policymakers. http://www.iccp-portal.org/
  3. Union for International Cancer Control’s second edition of the National Cancer Control Planning (NCCP) toolkit for civil society organizations (CSOs) intends to help develop and implement an effective national cancer control plan. http://www.uicc.org/national-cancer-control-planning-nccp
  4. The World Health Organization’s Cancer Control Knowledge into Action WHO Guide for Effective Programmes is a practical guide for program managers on how to plan overall cancer control effectively, according to available resources and integrating cancer control with programs for other chronic diseases and related problems. http://www.who.int/cancer/modules/en/
  5. Health in All Policies is written for policy-makers worldwide, at the national level within all government sectors influencing health. Health in All Policies (HiAP) is an approach that seeks synergies and avoids harmful health impacts, in order to improve population health and health equity. http://www.euro.who.int/__data/assets/pdf_file/0007/188809/Health-in-All-Policies-final.pdf
  6. The US Centers for Disease Control and Prevention (CDC) National Comprehensive Cancer Control Program resource page, includes a Cancer Plan Self-Assessment Tool, a Collaboration Guide for Pacific Island Cancer and Chronic Disease Programs and an Evaluation Toolkit. http://www.cdc.gov/cancer/ncccp/toolkits_index.htm
  7. The WHO-IAEA National Cancer Control Programmes Core Capacity Self-Assessment Tool facilitates the evaluation of the countries’ capacity of cancer control plans and programs, and can be used on a regular basis to monitor the progress of plans and programs at the national, regional and global levels. http://www.who.int/cancer/publications/nccp_tool2011/en/
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