New research identifies 31 factors that national tobacco control programmes need in order to be sustainable. Published now in the BMJ's Tobacco Control, authors at The Union draw on ten years’ experience assisting governments around the world to build programmes to reduce tobacco use. The study develops an Index of Tobacco Control Sustainability to be used by countries to establish their current level of sustainability and to identify priority areas for development.
As well as financial inputs, the index identifies legal structures, capacity-building, measures to prevent tobacco industry interference and taxation frameworks as essential for ensuring the future security of tobacco control programmes. Data gathered from 52 tobacco control experts in seven low and middle income countries in diverse regions of the globe were used to build the index.
‘Public health programmes are often perceived to require finance first and foremost to ensure their future security. What this index shows is that sustainability is multi-faceted – money is only part of the picture,’ said Dr Ehsan Latif, co-author of the study and Director of the Department of Tobacco Control at The Union. ‘This index can help governments take an incisive look at how their tobacco control programmes are currently set up, and to ensure they prioritise work to put all the key factors in place.’
The list of indicators was drawn up using technical reports from tobacco control projects around the world and submitted over the last seven years to funders at the Bloomberg Initiative to Reduce Tobacco Use. Tobacco control experts working for governments and civil society organisations then assessed whether the 31 indicators accurately reflected their experience of national tobacco control programmes in their respective countries. The 52 participants were from China, Chad, Mexico, Pakistan, Georgia, Indonesia and Bangladesh. Across all seven countries there was a high level of consensus on the importance of the indicators.
‘We were surprised that these indicators resonated across the board, as our participants were from diverse regions and countries with different legal, financial and governance structures. From this we can see that our index offers a robust set of indicators that can be used globally,’ said Dr Angela Jackson-Morris, co-author of the study and Head of The Union’s Tobacco Control Grants Programme. ‘Data on the relative importance of the various indicators were then gathered during a series of interviews and focus groups. These results enabled us to assign a weighting to each of the indicators – important, critical and acutely critical.’
The weighted indicators were then given numerical values to create a scoring system for the index. The Union is set to carry out a first tranche of assessments in a range of low, middle and high income countries later this year to establish a benchmark to assist countries to check the relative sustainability of their tobacco control programmes.
‘The Index of Tobacco Control Sustainability will be developed into a toolkit and made freely available to all governments around the world. The Union can help carry out the assessment and technical assistance on each of the indicators, should a country identify a need,’ said Dr Jackson-Morris. ‘We hope that this will be a valuable tool that helps secure this vital public health work into the future. Over the last ten years there has been significant progress globally to reduce tobacco use, but much remains to be done. Unless curbed, the tobacco epidemic will continue to wreak devastation upon the health of populations and economies.’
The authors extend their thanks to Anne Jones OAM, Dr Jorge Laucirica, Dr Gan Quan, Fouad Aslam, Dr Tara Singh Bam, Ishrat Chowdhury, Daouda Adam and Dr Jean Tesche of The International Union Against Tuberculosis and Lung Disease (The Union) and Dr Nuka Magdakelidze of the Government of Georgia for their assistance in coordinating and facilitating the country Focus Groups, and to the Focus Group participants in the seven countries. We also thank Richard Parker, Senior Statistician, University of Edinburgh, Centre for Population Health Sciences, for advice; and Mithun Nair (The Union). The Union’s work on tobacco control is supported by ‘The Bloomberg Initiative to Reduce Tobacco Use’.