Over the course of the 20th century, tobacco smoking killed around 100 million people, most of whom lived in today’s rich countries. However, that picture is changing, and the health burdens of smoking are now moving from high-income to low- and middle-income countries. Some estimates even suggest that one billion people could die from tobacco use over the 21st century. Investment in targeting health threats like tobacco, alcohol, and salt have largely, until now, been the preserve of wealthy countries. In poorer countries, a much bigger focus has been on eradicating infectious disease. However, as people live longer, non-communicable diseases are claiming more lives everywhere in the world while only receiving a fraction of health funding. In Rwanda, some 33,000 people die each year from chronic diseases. In poor countries, we should keep fighting illnesses like malaria, tuberculosis, and HIV/AIDS, but we urgently need to also increase our focus on chronic disease risks like tobacco, alcohol, and salt intake. We have promised to tackle chronic diseases by 2030 along with many other promises in the so-called Sustainable Development Goals. Unfortunately, we’re failing. On current trends, the world will be half a century late delivering across all its promises. The reason is clear: politicians decided to make an impossible 169 promises. Having 169 priorities is indistinguishable from having none. This year, the world will be at halftime for its 2030 promises, yet it will be nowhere near halfway. It is time to identify and prioritize the most crucial goals. My think tank, the Copenhagen Consensus, is doing exactly that: Together with several Nobel laureates and more than a hundred leading economists, we have been working for years to identify where each franc can do the most good. A new, peer-reviewed study shows that tax and regulation policies to fight chronic diseases can deliver outstanding social benefits for relatively small investments, something most countries in principle support. There are two very effective ways to reduce the death toll from smoking. One is through a simple tobacco tax. The other is tobacco regulation, which can include bans on advertising and on smoking in public places. Tobacco taxes make smoking costlier, which means that more young people will never start, more smokers will stop or reduce their consumption, and there will be fewer second-hand smoking deaths. It also raises large and reliable funds for the government, something that many governments in the global South struggle to secure. We know from many real-world examples that higher taxes reduce tobacco consumption. The direct cost of changing legislation is quite small. Raising the tobacco tax across low- and lower‒middle-income countries to four-times the sales cost is estimated to cost just US$45 million. Of course, it will also confer a relatively large loss to present-day smokers, worth almost half a billion dollars. In total, the cost up to 2030 would be a sizeable US$462 million. However, this policy would also significantly reduce smoking and thereby save more than 1.5 million lives. In monetary terms, every dollar in cost would achieve a phenomenal social benefit worth $101. Similarly, tobacco regulations have very small administrative costs and larger smoker losses, but because they will likely save more than 300,000 lives, they deliver a spectacular benefit-cost ratio of 92. Alcohol regulations are also a sound investment. Alcohol kills 300,000 people annually in low-income countries and 1.6 million in lower‒middle-income countries. It contributes to a large number of diseases and causes an additional 700,000 accidental deaths globally, as well as causing immense social damage. Tightening alcohol regulations can reduce harmful consumption and avert 150,000 deaths over the rest of the decade. Each dollar spent will deliver $76 of social benefits. Alternatively, an alcohol tax can generate large, if slightly lower, benefits at $53 back on the dollar. Lowering unhealthy salt intake – like the United Kingdom, Finland and Poland have done – through regulations that gradually reduce the salt content in processed foods – is another sound investment. According to the WHO, we should consume a little less than one teaspoon of salt each day, but almost everywhere in the world, people consume much more. This leads to high blood pressure, heart disease and strokes. It causes almost two million deaths each year. For the world’s poorer countries, enforcing salt regulations will be more expensive at over US$400 million, but this approach could avoid almost half a million deaths, delivering $36 of social benefits for each dollar spent. We will not deliver on all the global promises for 2030 — that much was clear even when they were originally penned. However, the data now show that we will likely not deliver on any of the main goals because we have promised everything to everyone. It is time to focus our remaining efforts on the best investments. Here, our research shows that some of the very best investments lie in the regulation for tobacco, alcohol, and salt, which can deliver outstanding benefits at low cost. Bjorn Lomborg is President of the Copenhagen Consensus and Visiting Fellow at Stanford University's Hoover Institution. His new book Best Things First is now available for pre-order.
