Unity towards stronger control on tobacco

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Disclaimer: Despite serving as moderator for this upcoming tweetchat on sin tax and tobacco control and taxation, the views on this post are my own and do not represent a collective stance of #HealthXPh.

In the midst of all the news we receive through conventional and social media these days, hearing the following words from my foreign counterparts in health policy research was certainly a breath of fresh air.

“We should follow the lead of the Philippines.”

I was the only Philippine academic delegate in the international health economics conference organized by the Indonesian Health Economics Association (InaHEA) last September, where one of the topics discussed was tobacco control and taxation. As a country with intricate economic links to the tobacco industry, Indonesia has been finding it difficult to fully ratify the Framework Convention on Tobacco Control, an international agreement signed by 181 UN member states, which lays out policy actions designed to eliminate widespread tobacco use by putting attention to its health, environmental and economic impacts.

Spending the week in Surabaya, Indonesia’s second largest city, it was easy to see why. Part of our city trip was a visit to a tobacco museum of one of its biggest tobacco firms, a testament to the historical and as yet unbreakable link between Surabaya’s history and the tobacco industry itself.

This led me to ask my colleagues, “If your country’s health sector really wants to control tobacco use, then why do you have these museums? I think your struggle also needs to look at your cultural links with tobacco.”

I got this reply: “Yes, that is true, but we need to unite first.”

In my limited experience as a health policy researcher, I learned that this is one of the critical yet elusive success factors to any policy intervention: unity. Indonesia shares with us the reality of being middle-income countries with the need to stimulate economic growth to reduce poverty and provide a better quality of life, while being constrained to accept industries and economic interests that challenge environmental sustainability and public health. If there are stakeholders that are bound to be adversely affected, unity is compromised. My Indonesian colleagues point fingers at this sad reality: many areas have not diversified their economies enough to divest themselves of tobacco industry.

This is why the experience of the Philippines in upholding the sin tax law inspires them; we too have historical links with the tobacco industry, but we had our way of inspiring unity towards a common goal. Discussion on this efforts brings me close to home.

I grew up in Pangasinan, part of the Ilocos region, a bailiwick of the tobacco industry, where tobacco is part of the regular crop rotation, and where many areas have dedicated plantations. Communities in my region depend on profits from selling their tobacco produce. Nonetheless, in recognition of the national effort in reducing tobacco, the National Tobacco Administration, the government tobacco production regulator, has instituted programs that aimed to assist farmers in diversifying their income sources and provide scholarship programs for dependents of tobacco farmers. It has also undertaken studies aiming to discover new uses of the tobacco crop to sustain its demand, while reducing and eventually preventing its use for smoking.

Local government has been supportive of the FCTC endeavors too, as politicians acknowledged the need to balance economic interest and public health, though challenges remain whenever there are conflicts with other statutes that encourage growth of Virginia tobacco in the northern Luzon provinces, in particular, with how the collected revenues are spent. Despite these challenges, unity with these stakeholders was critical in ratifying the bill and its eventual implementation, especially with how it provides incentives and advantages.

Nonetheless, an existential question remains: how can we sustain this unity? This question comes at a time when there is a growing call for the sin tax law to be reformed, in line with the increased push to fund social services and programs of the government. There are two sides emerging in this renewed push: one advocating reform in pricing, and the other advocating further study on the matter. This emerging dichotomy requires a closer look on how we can achieve unity. In addition, these policy proposals require striking a delicate balance, that can only be achieved by clearly delineating the interests at play, future directions, and ways towards achieving unity.

Nevertheless, there are non-negotiables in this matter. If the eventual desire is to eliminate tobacco dependence in the Philippines, then communities must be adequately engaged, incentives for not choosing to grow tobacco must be provided, and local economies must be stimulated to diversify. While I agree too that there should be no deals with the tobacco industry, there should definitely be deals with local business stakeholders, and more importantly, farmers and their communities, which would allow them to shed connections with the tobacco lobby. Policymakers must also be engaged, as part of a social movement that points out shared advantages, and does not antagonize or create divisions.

Finally, we come now to the end users, who create the demand for tobacco products, and who are at the receiving end of health risks from tobacco use. If public health is indeed the interest of this renewed push, there should not just be an effort to raise tobacco prices, but a strengthening of policies and strategies towards preventing smoking in public places, and discouraging its continued use and sale. The executive order implemented earlier this year is clearly a positive step, but the eventual goal must be clear: we must eradicate uses of tobacco that are detrimental to health.

While we are at it, let’s continue to discuss these questions this Saturday, 4 November, as #HealthXPh talks about expanding control and taxation on tobacco.

1. What factors led to the initial success of the Sin Tax law?

2. How can the current Sin Tax law be further improved?

3. How can we unite policymakers towards stronger tobacco control and taxation?

In closing, unity is an important component in our renewed push towards becoming warriors for health, while also making sure that other social determinants that influence public health are covered and adequately addressed.

This will definitely a fresher, and more sustainable, breath of fresh air.