MDGs and tobacco: a glimmer of hope—but only if matched by dollars

Many agencies and countries have great expectations for the poverty reduction targets of the millennium development goals (MDGs). These were adopted at the Millennium Summit of the United Nations in New York in September 2000 with the aim to “ensure that globalization becomes a positive force for all the world’s people”. The eight goals of the MDGs are specifically targeting issues regarded as critical to progress in reducing poverty including eradicating poverty, achieving universal education, promoting gender equality, reducing child mortality, improving maternal health, combating HIV/AIDS, malaria and other diseases, and ensuring environmental sustainability. As conceived, the MDGs had a strong focus on poverty reduction, but the aim to improve health outcomes for marginalised millions was virtually silent on tobacco control.

The recent publication of The millennium development goals and tobacco control: an opportunity for global partnership is a welcome contribution to fill many of the initial gaps in the MDG goals impacted by global tobacco use. Since 2000, the World Health Organization and other UN agencies have done considerable work on the adverse role that tobacco use has not only on health but also on communities, economies, and the environment. Esson and Leeder give a very brief introduction to the impact of tobacco on health and then seek to establish the link between tobacco and poverty in each of the eight MDGs. The book summarises one of the economic arguments that often rates highly with governments: “Tobacco has a negative impact on the balance of payments of many countries. Two-thirds of 161 countries, where data are available, are net importers of tobacco, losing more hard currency in cigarette imports than they gain in exporting tobacco.”

After giving an overview of the relationship between tobacco use and the MDGs the book divides issues into six sections: the WHO Commission on Macroeconomics and Health (CMH) and the WHO Framework Convention on Tobacco Control; up to date information on consumption in developing countries. Two sections cover the links between tobacco and poverty at the national and individual levels covering the first seven of the MDGs. A section addresses the need for global partnerships in development and resourcing, particularly in funding mechanisms, for achieving the MDGs, and another summarises ways in which the current goals can be enhanced by a focus on strengthened tobacco control related to the particular goals or targets.

Developing countries

The book points out that focusing on tobacco use in developing countries has often seemed a distraction. The data from developing countries is often poor, agencies often see water and sanitation as more critical than tobacco, the economic and health costs are seen as an issue in high income countries rather than those with limited health and economic impact data, and the developing countries often see the cultivation and production of tobacco as an economic benefit.

The authors, Katherine Esson and Stephen Leeder, have brought together a compendium of useful research and information in a way that can have greater impact with policymakers and governments. This includes a review of the trends in global numbers of smokers, the transition of health impacts from tobacco to developing countries, and the role of trade liberalisation. The book fills a major gap in the MDGs and can assist tobacco control advocates and policymakers to ensure inclusion of tobacco control goals in country policy and strategy reviews. The issues must be placed on the agenda of planning agencies, decision makers, and politicians.

A summary of the key issues from this report was usefully included in the August 2005 publication by WHO of Health and the millennium development goals. In July 2004 the United Nations Economic and Social Council (ECOSOC) passed a resolution indicating how pivotal this issue is by stating, “…tobacco control has to be recognized as a key component of efforts to reduce poverty, improve development and progress towards the Millennium Development Goals (MDG). Tobacco control needs to be included in the programmes of countries working on achieving the MDGs. Tobacco control also needs to be a key component of development assistance programmes in general.” Without this inclusion, it’s unlikely that the majority of developing countries will achieve their desired MDGs.