The research and capacity building activities within this programme are organised around addressing three questions. These centre on core tobacco control issues that directly engage with broader challenges in global health and development, constitute priorities in the implementation of the Framework Convention of Tobacco Control (FCTC), and respond to local needs identified by our research partners and by government officials.
The overall design of the research is intended to balance feasibility and coherence with responsiveness to locally identified priorities. Research in each of the countries will therefore address at least two of the priority areas identified above, creating efficiencies in training and support and enabling the development of comparative research across country contexts. In addition, each country team has identified locally significant research issue(s) in tobacco control, focusing on topics such as smoking cessation and smoke-free public places.
Raising the price of tobacco products via taxation is the most effective of the core policy measures in reducing tobacco consumption, yet it is the least used. There is also a striking inequity in the global adoption of WHO recommended best practice of ensuring that tax should account for more than 75% of pack price. Whereas over one-third of High Income Countries have adopted such an approach, this drops to only 9% of Low and Middle Income Countries, and while cigarettes have become less affordable in both high- and middle-income countries, affordability has been increasing in low-income contexts. Enhancing taxation regimes has been explicitly identified as a key policy priority in 2016 FCTC implementation reports (http://www.who.int/fctc/reporting/en/) submitted by Bangladesh, India, Sri Lanka and Uganda and by a needs assessment conducted in Ghana.
Enhanced tobacco taxation has been recognised as capable of making important contributions to strengthening domestic resource mobilization and generating additional financial resources (SDGs 17.1 and 17.3).
The Protocol to Eliminate Illicit Trade in Tobacco Products (ITP), the first Protocol to the FCTC, was adopted in 2012. It requires countries to develop tools to secure the supply chain, establish an international tracking and tracing system, improve law enforcement and promote international co-operation. The ITP cannot come into effect until after the fortieth ratification, with an additional seventeen ratifications currently required.
Only one of the countries for which research is proposed in this programme has acceded to the ITP (The Gambia), though work towards ratification has been identified as a tobacco control priority by the governments of both India and South Africa. In addition to protecting government revenues, ITP implementation is significant to efforts to reduce bribery and corruption and to strengthening national institutions and international cooperation to prevent crime (SDG Goals 16.5 and 16.a).
In identifying a fundamental conflict of interest between public health and the tobacco industry, the FCTC is unique among international conventions in recognising scope for an industry to undermine its intent. FCTC Article 5.3 thus requires parties to protect the “setting and implementing” of public health policies “from commercial and other vested interests of the tobacco industry”. This commitment is widely viewed as the centrepiece of the FCTC and of international tobacco control, yet very limited implementation means its promise as a means of promoting effective health governance has been viewed as “almost entirely unrealised”. Legislation or guidance to support effective implementation of Article 5.3 is currently being developed by the governments of India, The Gambia and South Africa, while industry interference has also been identified as a principal barrier to progress by Ghana and Uganda. In establishing good governance for health, protection against tobacco industry interference in health policy has the potential to promote both strong institutions (SDG 16) and policy coherence for sustainable development (SDG 17.14).