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      Social determinants of tobacco use: towards an equity lens approach

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          Abstract

          Tobacco is the only commercial product that eventually kills nearly half of all long-term users. The prevalence of tobacco use is disproportionately high in lower socioeconomic strata and vulnerable groups (such as adolescents) within and across countries. Given its highly addictive nature, tobacco use perpetuates poverty and loss of opportunities, thus undermining the UN Sustainable Development Goals. Moreover, by shaping the national and international context, globalization and governance impact on the tobacco epidemic and underlying disparities. Therefore, socio-economic gradients, which influence predisposition to tobacco uptake and cessation, must be confronted. Here I argue that tobacco prevention and control must be addressed through a lifelong, equity lens approach. This approach describes the essential need for every individual to have equal access to informative prevention and cessation services independent of income, occupational status, social stratum, or residence. I also contend that rather than being occupied with “research on research”, the focus should shift to how to practically implement the existing accumulated, cogent body of scientific evidence in a societally equitable manner. Finally, in line with the core dilemma of “who really governs the policies that shape our health?” raised by the WHO’s Director General, it is time for civil society either on its own or in partnership with local authorities to formulate policies that implement the “health for all” imperative rather than the currently dominant “wealth for some”.

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          Most cited references38

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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            Tobacco taxes as a tobacco control strategy.

            Increases in tobacco taxes are widely regarded as a highly effective strategy for reducing tobacco use and its consequences. The voluminous literature on tobacco taxes is assessed, drawing heavily from seminal and recent publications reviewing the evidence on the impact of tobacco taxes on tobacco use and related outcomes, as well as that on tobacco tax administration. Well over 100 studies, including a growing number from low-income and middle-income countries, clearly demonstrate that tobacco excise taxes are a powerful tool for reducing tobacco use while at the same time providing a reliable source of government revenues. Significant increases in tobacco taxes that increase tobacco product prices encourage current tobacco users to stop using, prevent potential users from taking up tobacco use, and reduce consumption among those that continue to use, with the greatest impact on the young and the poor. Global experiences with tobacco taxation and tax administration have been used by WHO to develop a set of 'best practices' for maximising the effectiveness of tobacco taxation. Significant increases in tobacco taxes are a highly effective tobacco control strategy and lead to significant improvements in public health. The positive health impact is even greater when some of the revenues generated by tobacco tax increases are used to support tobacco control, health promotion and/or other health-related activities and programmes. In general, oppositional arguments that higher taxes will have harmful economic effects are false or overstated.
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              Globalisation and the prevention and control of non-communicable disease: the neglected chronic diseases of adults.

              The growing global burden of non-communicable diseases in poor countries and poor populations has been neglected by policy makers, major multilateral and bilateral aid donors, and academics. Despite strong evidence for the magnitude of this burden, the preventability of its causes, and the threat it poses to already strained health care systems, national and global actions have been inadequate. Globalisation is an important determinant of non-communicable disease epidemics since it has direct effects on risks to populations and indirect effects on national economies and health systems. The globalisation of the production and marketing campaigns of the tobacco and alcohol industries exemplify the challenges to policy makers and public health practitioners. A full range of policy responses is required from government and non-governmental agencies; unfortunately the capacity and resources for this response are insufficient, and governments need to respond appropriately. The progress made in controlling the tobacco industry is a modest cause for optimism.
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                Author and article information

                Journal
                Tob Prev Cessat
                Tob Prev Cessat
                TPC
                Tobacco Prevention & Cessation
                European Publishing on behalf of the European Network for Smoking and Tobacco Prevention (ENSP)
                2459-3087
                02 March 2017
                2017
                : 3
                : 7
                Affiliations
                [1 ]The Johns Hopkins University Advanced Academic Programs (AAP), Baltimore, USA
                Author notes
                CORRESPONDING AUTHOR Alexios-Fotios A. Mentis, The Johns Hopkins University, AAP 3400 North Charles Street - Wyman Park Building S - 612 Baltimore, MD 21218, United States of America. E-mail: amentis1@ 123456jhu.edu
                Article
                7
                10.18332/tpc/68836
                7232809
                32432182
                ee2055e8-2cf0-4edb-a57e-6d313151df21
                © 2017 Mentis A

                This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 International License.

                History
                : 24 August 2016
                : 02 February 2017
                : 07 February 2017
                Categories
                Review Paper

                tobacco,social determinants of health,health equity,public health,development agenda,globalization,governance

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