In Ethiopia, the burden of infectious diseases — such as HIV/AIDS and tuberculosis — has meant that noncommunicable diseases have been deprioritized in policy and research programs. NCDs made up two-thirds of the global burden of disease in 2015 and yet only 1.3% of all development assistance for health was allocated to address them. A financing gap persists between money allocated towards NCDs and the global burden of disease.
Tobacco is the world’s leading cause of preventable death, causing 1 in 6 of all NCD deaths. And it is a growing risk in low- and middle-income countries, where, by 2030, more than 80% of the world's tobacco-related deaths will occur.
80% of the world’s 1.1 billion smokers live in LMICs.
— WHOBetween 2016 and 2017, Japan Tobacco Inc. purchased majority shares in Ethiopia’s National Tobacco Enterprise Share Company, granting it a monopoly on import and export of tobacco products up until 2025.
In Ethiopia, almost 65% of the population is aged 25 and under. This young demographic, and children in particular, are most likely to start smoking and become addicted to nicotine. Knowing the tobacco industry’s ambitions for growth in Ethiopia and its well-documented tactics marketing its products to young people in Africa, the potential for damage by tobacco on human health and economic development is huge.
Our situation in Ethiopia is not uncommon and — in LMICs, where 80% of the world’s 1.1 billion smokers live — there is a need to address and generate more research to understand this public health threat.
The United Kingdom’s government-funded Global Challenges Research Fund, is a five-year £1.5 billion ($1.8 billion) funding mechanism for official development assistance that aims to address the Sustainable Development Goals through research collaborations between the U.K. and the global south. This includes the University of Edinburgh-led Tobacco Control Capacity Programme, a collaborative research partnership — funded by U.K. Research and Innovation via the Global Challenge Research Fund — helping to build the evidence base to support policy change in tobacco control. It aims to maximize impact through capacity-building and equitable partnerships.
These are lessons we can learn from this program on how to effect change via partnerships within the NCD space.
1. Collaborate and learn from the ‘global north’
GCRF drives collaboration between some of the most renowned research institutions in the U.K. and LMICs to co-create context-specific solutions that can drive policy change. A prime example of this is the TCCP, which is implementing effective tobacco control and filling the gap in context-relevant research, most of which so far has been conducted in high-income countries.
Though a global treaty exists to provide an internationally coordinated response to combatting the tobacco epidemic through policy — the World Health Organization’s Framework Convention on Tobacco Control — Ethiopia and other countries represented on the TCCP, are currently at different stages in the development and implementation of the policies recommended in the treaty. There is a clear opportunity to learn from our colleagues in the U.K. who have helped to drive the implementation of effective tobacco control programs and policies over the years.
TCCP has demonstrated the value of collaboration across geographies by creating opportunities for colleagues to travel and meet in different countries. Face-to-face meetings are important, not only for developing connections across a global research team but also for idea generation. With researchers on the program from different academic disciplines, some of the strongest problem-solving conversations and have developed in in-person meetings.
This model of finding opportunities and forums for research fellows to meet and learn from each other has helped to facilitate knowledge exchange from a south-south and north-south perspective, and vice versa. As a result of such collaboration, my own team plans to research the implications of JTI’s purchase of the National Tobacco Enterprise in the design and implementation of tobacco control policy in Ethiopia.
2. Collaborate and learn from the ‘global south’
Big tobacco, global health, and the limits of shared value
Derek Yach, the president of the Foundation for a Smoke Free World, believes that after 100 years of undermining policy, obscuring science, and destroying human health, big tobacco can still change.
Solutions to global problems, such as tobacco control, need global voices. With the TCCP covering seven countries from Bangladesh to Ghana, research fellows on the program have a wealth of opportunities to learn from each other and truly realize south-south collaboration. The global reach of the program has also created opportunities to collaborate on pieces of work and share learning.
For example, regional communication workshops will bring my colleagues together in two locations to plan and share learning on research translation and dissemination. The opportunity to learn more about others’ plans in Uganda and India, for example, will support my own efforts to think about how I will communicate my research at home. It is activities like this, and opportunities to learn about what has worked well in similar and different contexts, that will help to build the enduring partnerships the GCRF’s aims to achieve.
3. Apply learning to local contexts
A core feature of GCRF is its explicit aim to strengthen research capacity, which aligns closely with the capacity-building objective of SDG 17 on partnerships. Programs such as TCCP that prioritize building a research community increase the likelihood of evidence-based policies that can help to prevent avoidable deaths from NCDs in the future.
It’s important that programs that aim to build research capacity take note of this in the way that the TCCP has. In Ethiopia for example, we have a different policy environment for tobacco control than the U.K., which has a great deal of experience in implementing the WHO Framework Convention on Tobacco Control compared to Ethiopia, who comparatively only recently ratified the treaty.
Programs that aim to build sustainable research capacity should learn from the global north and south and offer mechanisms to apply learning in different contexts. For example, by attending training on tobacco tax at the University of Cape Town with my colleagues on the program, I was exposed to the different challenges and opportunities faced across the different countries and considered the learning around tobacco control I could take to implement in my own context.
In just a few weeks’ time, countries will meet in New York to discuss progress on the SDGs. Programs such as TCCP are invaluable for academics to help generate enthusiasm and commitment to pursue research that can play a role in addressing some of the world’s most pressing challenges. But future initiatives must be well-resourced, genuinely collaborative, and inclusive to achieve the long-term impact they set out to achieve.
About the authors
Selamawit Hirpa
Selamawit Hirpa is a research fellow at the University of Addis Ababa, School of Public Health. She is part of the Ethiopia research team under the Global Challenges Research Fund Tobacco Control Capacity Program. Her research focuses on smoke free legislation, tobacco taxation, and tobacco industry interference.
Rob Ralston
Rob Ralston is a research fellow in the global health policy unit at the University of Edinburgh. His research focus is on global health governance and the role of unhealthy commodity industries in policymaking.
Priscilla Tiigah
Priscilla Tiigah is a policy and research advisor on Cancer Research U.K.’s international cancer prevention program, which focuses on tobacco economics research in low- and middle-income countries. Cancer Research U.K. is a partner of the Tobacco Control Capacity Program.
