Leaders of cities in Asia Pacific commit for united local actions to meet global health goals

Shobha Shukla / Bobby Ramakant *

6th Summit of the Asia Pacific Cities Alliance for Health and Development (6th APCAT Summit)

#EndTobacco is an essential part of the bedrock for Universal Health Coverage

Can we deliver on the promise of health for all unless we fix the gaping and widening punctures that are causing epidemic-proportion of preventable diseases and untimely deaths? No one needs to suffer from preventable illnesses or die from curable diseases. Tobacco use kills over 8 million people worldwide every year. While ‘Big Tobacco’ industries become richer, it is the governments and the people worldwide who are not only dealing with mountainous health crises but also becoming more vulnerable to fritter away whatever progress they have been able to make towards the United Nations Sustainable Development Goals and targets.

That is why in lead up to 2021 Universal Health Coverage Day, Mayors of several cities across the Asia and the Pacific region, met at the 6th Summit of the Asia Pacific Cities Alliance for Health and Development (6th APCAT Summit), and called for integrated and equitable health responses, stronger action against tobacco, preventing non-communicable diseases, and protecting lung health.

The Mayors, and other delegates of 6th APCAT Summit endorsed the Declaration which commits subnational leaders for stronger action for advancing tobacco control, preventing non-communicable diseases, leveraging synergies between Covid response and other health and development responses, and firewalling health and development policies and programmes from industry interferences. Moreover, it highlights the needs of sustaining routine vaccination programmes, TB control and preventing mother to child transmission of viral hepatitis during pandemic to prevent a secondary health crisis.

“I ensured tobacco control activities continued during the pandemic as those who suffered severe Covid disease have been heavy smokers as well. Stopping smoking is part of Covid prevention protocol campaign in Bogor City” said Dr Bima Arya Sugiarto, Mayor of Bogor City in Indonesia, and co-Chair of APCAT. “Tobacco control is an issue that requires multisectoral cooperation” said Francis A Garcia, Mayor of Balanga City in Philippines, and co-Chair of APCAT. That is why Mayors and other subnational leaders who are best placed to synergise multisectoral response locally for advancing tobacco control and prevention of non-communicable diseases, have united as APCAT. As of now “subnational leaders of 78 cities from 12 countries in Asia Pacific region form APCAT”.

Over 180 countries worldwide have ratified the global tobacco treaty (formally called the WHO Framework Convention on Tobacco Control (FCTC). Article 5.3 of the treaty is a legally binding promise to stop tobacco industry interference in health policy. “During Covid pandemic, the tobacco industry tried to intensify their corporate social responsibility campaigns and build relationships with the government. Countries need to incorporate the Article 5.3 of the FCTC into their domestic laws in order to prohibit influence of tobacco companies over tobacco control policies making” rightly said Dr Gan Quan, Director for Tobacco Control, International Union Against Tuberculosis and Lung Disease (The Union).

“Health is a political choice that should ensure leadership, accountability and sustainability for the effective implementation of public health policies and programmes and prevent current and future pandemics”, said Dr Tara Singh Bam, Asia Pacific Director of The Union.

The Declaration underlines that “the inequitable and uneven rollout of vaccines against Covid has made us even more vulnerable because of the heightened risk of serious outcomes and death among those who are unvaccinated (especially tobacco users or those with tobacco-related co-morbidities). Also, the risk of more mutations as the virus circulates in our population is a looming threat.” Dr Guy Marks, President of The Union said “We must ensure that no-one is left behind, people are treated equitably, and we have a focus on vulnerable and marginalised populations and communities. The problems are complex, but the solutions are in the policy makers' hands."

“The double pandemic of the Covid and non-communicable diseases, places us in an unprecedented crisis that cannot be solved by a single country or stakeholder. Only by scaling up global cooperation to bring together governments, WHO and other UN agencies, civil society, academia, and the private sector can we make progress towards a successful recovery and achieve SDG target 3.4, and universal health coverage” said Dr Svetlana Akselrod, Director of WHO Global Platform for non-communicable diseases.

Subnational leaders commit for stronger local integrated responses for health and development

Subnational leaders of the 6th APCAT Summit recognized how the Covid response has severely jeopardized health and development programmes of several nations in the region. For instance, the alarming drop in routine immunization of children in several nations due to Covid has increased the risk of vaccine-preventable illnesses.

The Declaration underpins: “Health and social security are the central cog-in-the-wheel to accelerate progress towards all goals and targets of the SDGs. More scientific evidence is emerging to show that those most at risk of dying or becoming extremely ill from Covid are those with pre-existing non-communicable diseases. Tobacco is a leading common risk factor for major non-communicable diseases (heart diseases and stroke, cancers, diabetes, other chronic respiratory diseases, etc), accounting for over 70% of untimely deaths globally, and it also increases the risk of communicable diseases, including TB.”

Subnational leaders committed for:

* Sustaining effective implementation of tobacco control programs that include smokefree environments; a complete ban of tobacco advertising, promotion and sponsorship; promotion of larger graphic health warnings with plain packaging on tobacco packs; smoking cessation programs; and a ban on electronic cigarettes, heated tobacco products, shisha and similar products

* Ensuring prevention and treatment services for non-communicable diseases are not only sustained but scaled up with their inclusion in Covid responses as part of health security, and co-design and implement solutions with input from civil society, consumers and affected communities

* Continuing scale up of delivery of routine care, supplies of essential medicines and technologies, screening and diagnosis, access to resources, and supportive services for ongoing management of tuberculosis and other lung diseases

* Preventing interferences and rejecting funding, logistics, donations or grants from, and partnerships with, any entity related to any unhealthy commodity industries (such as, but not limited to, tobacco, alcohol, sugary and sweetened beverages)

* Working with national government and policy makers to raise taxes and prices on unhealthy commodities (such as, but not limited to, tobacco products, alcohol, sugary and sweetened beverages)

* Leveraging every possibility of partnership and integrated health and development responses so as to advance progress on scaling up of Covid vaccination, routine immunization, adult vaccination for vaccine-preventable illnesses, among others

* Addressing the challenge of viral hepatitis as a major public health threat in the Asia Pacific region through elimination of mother to child transmission by raising public awareness and strengthening health systems through public and private partnerships

* Adhering to public health and scientific expertise for effective prevention and management of Covid, and by rebuilding our cities in a way that improves the public health system through One Health and Partnership for Healthy Cities approach.

"We commit to doing everything to harness the power of our city governments to ensure that tobacco control, prevention of non-communicable diseases, TB control, elimination of viral hepatitis, routine immunization and scaling up Covid vaccination are effectively implemented and measured, along with other health and development initiatives, and the recovery from Covid is healthy, equitable and sustainable" reads the Declaration endorsed by all subnational leaders from Asia Pacific region and other delegates of 6th APCAT Summit.

Indonesia is one of the nations that has not yet ratified the global tobacco treaty. However, significant progress in advancing tobacco control has happened due to commitment and leadership of subnational leaders. “Despite setback the pandemic imposes; Indonesia is committed to reduce youth smoking prevalence. To achieve this, Ministry of Health continues to advocate to impose the highest attainable taxes on tobacco products, adopt 90% pictorial health warnings on tobacco packaging and forbid the selling of single stick of cigarette and regulate electronic cigarettes,” said Budi Gunadi Sadikin, Minister of Health, Indonesia.

Governments worldwide have promised to deliver on Universal Health Coverage by 2030. With only 108 months left to meet the targets, we must ensure the world is on track to deliver on the promise of health for all for everyone, where no one is left behind. While we strengthen health systems and scale up public health services equitably to reach everyone, we also have to ensure no one suffers from a disease that is essentially preventable – and address risk factors effectively that make our people vulnerable to these illnesses and premature deaths. In addition, governments must hold those industries legally and financially liable which are making people suffer and die untimely of diseases that are essentially preventable, or treatable or curable.