By: Renaud Meyer, Resident Representative, UNDP in Thailand and Dr. Daniel Kertesz, WHO Representative to Thailand
While Thailand tackles its third wave of the COVID-19 epidemic, the country has been facing another, even more deadly epidemic for many years: tobacco use.
Since the beginning of the pandemic, the COVID-19 virus has claimed around 700 lives in Thailand as of mid-May 2021. During the same period, tobacco has killed nearly 80,000, or 100 times more people.
Every year, May 31st marks World No Tobacco Day. This year’s theme is ‘Commit to Quit,’ aimed at empowering tobacco users to succeed in stopping tobacco use through policy and society-wide support.
Over 10 million people smoke tobacco in Thailand. And now is the best time to quit and support quitting. Quitting can save your life and that of loved ones: smoking and exposure to second-hand smoke can cause chronic health conditions such as heart disease, stroke, cancer, diabetes, and lung disease, which increase the risk of severe COVID-19 outcomes.
It is never too late to quit. Lungs begin to work better within just two weeks of quitting tobacco.
However, given the highly addictive nature of tobacco and its enormous socioeconomic aspects and impacts, quitting is very often beyond individual action. It requires an integrated approach where the 'whole-of-government' and 'whole-of-society' create an enabling policy and social environment to support tobacco users to quit.
Quitting can keep households from facing or deepening poverty, by preventing financial hardships in low-income households through extra expenditures and lost income opportunities associated with disease, disability or premature death of breadwinners. In Thailand, people in the bottom 25 percent spend 17 percent of their income on tobacco: it diverts significant household resources from productive investments that can help lift and keep people out of poverty, such as food, education, and agricultural inputs. The impacts are even severer today when many are losing income due to the economic impact of the pandemic.
Tobacco also inflicts a massive economic cost: a 2020 study by the Chulalongkorn University estimated that Thailand lost THB 93 billion (USD 3 billion) from tobacco use in 2017, equivalent to 0.65 percent of its GDP or 17 percent of its current health expenditure. Thailand’s contracting economy coupled with swelling COVID-related expenditures cannot afford unnecessary losses, particularly when the loss is due to preventable causes such as tobacco use.
In short, quitting tobacco makes health, economic and development sense.
Over the recent decades, Thailand has made remarkable achievements on tobacco control, notably since the country joined the WHO Framework Convention on Tobacco Control, the first international public health treaty adopted in 2003.
Thailand, for example, is the first country in Asia to roll out plain cigarette packaging, which puts the logo-free brand name in standardized format alongside graphic warning to make smoking less attractive. Thailand also bans electronic cigarettes as well as smoking and cigarette-butt littering on its most popular beaches, which protects not only the health of tourists and locals, but also the country’s vital economic resources: beautiful beaches, pristine oceans, and diverse marine life.
Gaps exist, however, particularly in tobacco taxation. Thailand received a score of merely 1.75 out of 5 in the most recent Tobacco Tax Scorecard, which assesses the performance of tobacco tax policies across 174 countries. As the extent and frequency of tobacco tax increase fall behind inflation and income growth, tobacco products in Thailand are more affordable today than in 2008. Different tax rates for different tobacco products (e.g. manufactured cigarettes vs shredded tobacco for roll-your-own cigarettes) allow switching to lower-taxed products instead of helping people quit when taxes are increased.
Tobacco tax increase presents the single most effective, proven, pro-poor measure to help stop youth from starting smoking and motivate tobacco users to quit, particularly the poor and youth, who are highly price-sensitive. It also brings many other benefits: boost labour productivity and economic growth; decrease avoidable public expenditures and increase government revenue; reduce poverty and inequality; and mitigate environmental damage. These development gains can accelerate Thailand's progress toward achieving the Sustainable Development Goals (SDGs).
The Royal Government of Thailand recognizes these gaps and intends to act. Unfortunately, the implementation has been delayed. Strengthening tobacco taxation is win-win: it can empower Thailand to better cope with the COVID-19 crisis, by helping smokers to quit, thereby decreasing the risk of worse COVID-19 outcomes; and by generating additional revenue for COVID-19 response, part of which could be allocated to supporting tobacco quitting and helping tobacco farmers shift to alternative crops or livelihoods as in the Philippines.
To examine the cost of non-communicable diseases (NCDs), for which tobacco is the leading risk factor, the UN Interagency Task Force on the Prevention and Control of NCDs, WHO and UNDP in partnership with national stakeholders are developing an investment case at the request of the Royal Government of Thailand. NCDs account for 74 percent of all deaths in Thailand and are strongly associated with COVID-19 related deaths. Tobacco control must be an integral part of the COVID-19 response.
World No Tobacco Day reminds us that the whole-of-government and whole society must work together to stop the tragic loss of lives due to tobacco. Now is the time to act.