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The commitments of the FCTC are integrated into the United Nations Sustainable Development Agenda 2030 Goal 3 to “ensure healthy lives and promote well-being for all at all ages.” Global efforts to monitor and strengthen implementation, such as WHO’s MPOWER package and the Tobacconomics Cigarette Tax Scorecard, show only modest progress toward fulfilling FCTC obligations, but these resources also provide countries with concrete guidance on how to improve their policies.

In response to the growing global toll from tobacco use—8.7 million annual tobacco-related deaths, mostly in low- and middle-income countries, and at least US$ 1.8 trillion in annual economic costs—governments around the world united at the turn of the 21st century to develop a strategy to combat the global tobacco epidemic. In 2005, the World Health Organization Framework Convention on Tobacco Control (FCTC) entered into force, and it has since been adopted by 182 Parties covering 90% of the world’s population. The FCTC sets forth a comprehensive strategy of obligations and guidelines for implementing both supply- and demand-focused measures to curb tobacco use. The Protocol to Eliminate Illicit Trade in Tobacco Products, which entered into force in 2018 and has been adopted by 64 countries, builds on Article 15 of the FCTC treaty to provide a more extensive set of commitments to minimize illicit tobacco products.

Adopted in 2015, Goal 3 of the United Nation’s Sustainable Development Goals (SDGs)—“Ensure healthy lives and promote well-being for all at all ages”—enshrines both the commitment to outcome targets, like reducing premature mortality from noncommunicable diseases by one-third by 2030 (Target 3.4), and the means to achieve them, such as strengthening the implementation of the FCTC (Target 3.a). Integration of the FCTC in the SDG Agenda 2030 provides national planning opportunities for governments to demonstrate fulfilment of their treaty obligations to implement tobacco supply measures—such as sales restrictions to minors, alternative livelihoods support, and illicit trade controls—as well as demand-reduction measures such as smoke-free policies, packaging and labeling provisions, marketing bans, cessation programs, and raising tobacco excises taxes. Together, such policies have contributed to the decrease in global smoking prevalence from 22.7% in 2007 to 19.6% in 2019.

Although tobacco taxation is the most effective and cost-effective measure to reduce tobacco use—in addition to its capacity to generate additional revenue that can be allocated to human development and economic growth—it is the least adopted measure globally. A 2019 analysis on the impact of tobacco taxes by the Task Force on Fiscal Policy for Health found that increasing the price of tobacco by 50% worldwide over the next 50 years would result in 27.2 million lives saved and US$ 3 trillion in additional government revenue. To place this amount in perspective, a 2017 WHO analysis found that an additional US$ 371 billion per year in spending on health is needed by 2030 to reach health system targets under the SDG Agenda 2030 in 67 low- and middle-income countries. Additional revenues from increased taxes on tobacco could be used to help meet these spending needs.

Set against the backdrop of continuing efforts to increase domestic resource mobilization to fund the SDGs and strengthen public health systems in light of the ongoing COVID-19 pandemic, the combined health and revenue impacts of taxation have sparked a renewed interest in the use and design of health taxes. International organizations such as United Nations agencies, the International Monetary Fund, the World Bank, and the Organisation for Economic Co-operation and Development have increased their technical assistance to countries on health taxes, exemplified most recently by the establishment of a Subcommittee on Health Taxes by the United Nations Committee of Experts on International Cooperation in Tax Matters.

References

Percentage of total deaths attributable to tobacco use among both sexes, by World Bank Income Group 2019:

GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020, 396: 1223-49.

Financing required to achieve SDG health targets:

Stenberg K, Hanssen O, Edejer TT, Bertram M, Brindley C, Meshreky A, Rosen JE, Stover J, Verboom P, Sanders R, Soucat A. (2017). Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries. Lancet Glob Health. 5(9):e875-e887.

Revenue and health projections from 50% tobacco price increase:

Summan A, Laxminarayan R. (2018). Estimating Global Effects of Tobacco, Alcohol, and Sugary Beverage Taxation. Background Paper for the Task Force on Fiscal Policy for Health. New York: Bloomberg Philanthropies.

Global treaty on tobacco control:

World Health Organization. (2003). WHO framework convention on tobacco control. Geneva: WHO.

Progress on MPOWER measures from 2007-2020:

World Health Organization. (2021). WHO report on the global tobacco epidemic, 2021. Geneva: WHO.

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