GCRF: Tobacco control capacity programme

Tobacco use is the leading cause of preventable death in the world. Globally, smoking kills more people every year than HIV, tuberculosis and malaria combined. By 2030, more than 80% of the world's tobacco-related deaths will occur in low and middle income countries (LMICs). Preventing people from starting to use tobacco, and encouraging users to stop, is a global priority. The World Health Organisation is addressing this through an international treaty, the Framework Convention on Tobacco Control (FCTC), which has been signed by 181 countries and sets out the policies countries should adopt to prevent smoking. The United Nations (UN) sees the FCTC as so important that when it set up 'Sustainable Development Goals' it included the FCTC in Goal 3, which is about improving health and wellbeing for all the world's people. Goal 3.10 says that the implementation of the FCTC should be strengthened in all countries.

However, while a number of high income countries (HICs) have made good progress in FCTC implementation, this is not the case in all LMICs. Signing the treaty is not enough: governments need to be helped to introduce good policies and enforce them. However, few LMICs have the capacity, or in some cases the staff with the right skills, to carry out the research and advocacy necessary to design, implement and achieve compliance with good tobacco control policies. Also, most existing research on tobacco has been conducted in HICs, and is not always relevant to LMICs. Thus we need to train and support researchers in tobacco prevention in LMICs, with skills in economics, clinical medicine, public health and the social sciences, for example.

This proposal is about filling these gaps, building on some good work already under way. Our proposed programme will be undertaken in two parts of the world (South Asia and Sub-Saharan Africa) where progress on tobacco control has not always been good, and where the tobacco industry is active in attempting to undermine measures that work. We propose to build research capacity in several LMICs, thought a programme of research designed to address local priorities in each country, supported by a programme of training in research and impact. It will focus in particular on three issues relevant to UN SDG 3 but also other UN goals on peace, justice and strong institutions (SDG 16) and partnerships (SDG 17). These are: tobacco taxation (which helps reduce tobacco use and provides money for governments to build the economy); preventing illicit trade in tobacco (by protecting tax revenue, reducing corruption and helping to reduce crime) and preventing tobacco industry interference (which aims to prevent or undermine national implementation of FCTC measures). Studies will be conducted on these topics as well as additional priorities chosen by countries (like building evidence for 'smokefree' clean air policies, putting health warnings on tobacco packets and services to help people stop smoking).

To do this work we have put together a team including UK academics, researchers in LMICs, and charities working to reduce harm from tobacco. The programme will be led by the UK Centre for Tobacco and Alcohol Studies, a UK Centre for Public Health Excellence. The team also includes research organisations in Bangladesh, Ethiopia, The Gambia, Ghana, India, South Africa and Uganda, and can be expanded to include other LMICs if resources allow. Support is included from Cancer Research UK, the world's largest independent cancer charity. Additional help will come from other supporters including the FCTC's Framework Convention Alliance and the American Cancer Society. Funding will be used to support a network of early career (post-doctoral) researchers and teams in LMICs and the UK. Extensive training opportunities and support to carry out high quality research on policy and practice in each country and internationally, and to establish strong research partnerships for the future, will be provided.

Tobacco use is the leading cause of preventable death in the world. Globally, smoking kills more people every year than HIV, tuberculosis and malaria combined. By 2030, more than 80% of the world's tobacco-related deaths will occur in low and middle income countries (LMICs). Preventing people from starting to use tobacco, and encouraging users to stop, is a global priority. The World Health Organisation is addressing this through an international treaty, the Framework Convention on Tobacco Control (FCTC), which has been signed by 181 countries and sets out the policies countries should adopt to prevent smoking. The United Nations (UN) sees the FCTC as so important that when it set up 'Sustainable Development Goals' it included the FCTC in Goal 3, which is about improving health and wellbeing for all the world's people. Goal 3.10 says that the implementation of the FCTC should be strengthened in all countries.

However, while a number of high income countries (HICs) have made good progress in FCTC implementation, this is not the case in all LMICs. Signing the treaty is not enough: governments need to be helped to introduce good policies and enforce them. However, few LMICs have the capacity, or in some cases the staff with the right skills, to carry out the research and advocacy necessary to design, implement and achieve compliance with good tobacco control policies. Also, most existing research on tobacco has been conducted in HICs, and is not always relevant to LMICs. Thus we need to train and support researchers in tobacco prevention in LMICs, with skills in economics, clinical medicine, public health and the social sciences, for example.

This proposal is about filling these gaps, building on some good work already under way. Our proposed programme will be undertaken in two parts of the world (South Asia and Sub-Saharan Africa) where progress on tobacco control has not always been good, and where the tobacco industry is active in attempting to undermine measures that work. We propose to build research capacity in several LMICs, thought a programme of research designed to address local priorities in each country, supported by a programme of training in research and impact. It will focus in particular on three issues relevant to UN SDG 3 but also other UN goals on peace, justice and strong institutions (SDG 16) and partnerships (SDG 17). These are: tobacco taxation (which helps reduce tobacco use and provides money for governments to build the economy); preventing illicit trade in tobacco (by protecting tax revenue, reducing corruption and helping to reduce crime) and preventing tobacco industry interference (which aims to prevent or undermine national implementation of FCTC measures). Studies will be conducted on these topics as well as additional priorities chosen by countries (like building evidence for 'smokefree' clean air policies, putting health warnings on tobacco packets and services to help people stop smoking).

To do this work we have put together a team including UK academics, researchers in LMICs, and charities working to reduce harm from tobacco. The programme will be led by the UK Centre for Tobacco and Alcohol Studies, a UK Centre for Public Health Excellence. The team also includes research organisations in Bangladesh, Ethiopia, The Gambia, Ghana, India, South Africa and Uganda, and can be expanded to include other LMICs if resources allow. Support is included from Cancer Research UK, the world's largest independent cancer charity. Additional help will come from other supporters including the FCTC's Framework Convention Alliance and the American Cancer Society. Funding will be used to support a network of early career (post-doctoral) researchers and teams in LMICs and the UK. Extensive training opportunities and support to carry out high quality research on policy and practice in each country and internationally, and to establish strong research partnerships for the future, will be provided.

By working collaboratively we aim to build capacity to address the tobacco epidemic in LMICs. In the UK, our research centre (UKCTAS, involving 13 Universities) has conducted research that has directly informed policies to drive down smoking rates and benefit health and the economy for the last 8 years. This would not have been possible without the strong links we have with policy-makers, practitioners and the public. We will use this experience to work with our LMIC colleagues, many of whom are building similar links. By conducting research in LMICs on three key themes (tobacco taxation, reducing illicit trade, and addressing tobacco industry interference, as well as other local priorities) we should be able to provide data and specific examples which will help make the case for better implementation of the FCTC, which will result in reductions in tobacco disease and death and also help generate revenue for governments through taxation which aids other development priorities.

To maximise impact we have integrated a structured series of engagement opportunities into our bid. In this process we will have considerable assistance from Cancer Research UK who are highly active in tobacco control nationally and internationally, and a partnership like this with a large NGO will assist with translating what we do into practice. We also have support from the Framework Convention Alliance who are tasked with helping more than 100 countries with FCTC implementation. Engagement opportunities are as follows.

1. Initial stakeholder event in each LMIC country (8 in total as we are involving 2 regions of India) for 30-50 people from governments, NGOs, health, welfare and education professionals, WHO offices and the public. We will involve them in shaping individual studies to be conducted within the programme and maintain contact throughout.
2. Communication Skills Workshops for academics in the team over 3 days with a skilled communications consultant and CRUK to provide training on preparing briefs for key organisations, publishing and working with the media.
3. Individual meetings in country with key government officials and professional groups
4. Second stakeholder workshop in each country/region in the final year with similar groups as in year one, to present research findings, discuss how the research can be used, how the skills developed in the team could inform future research on other health and development priorities and how the programme can be sustained.
5. An evaluation of the programme led by CRUK seeking the views of the teams involved and stakeholders in-country and internationally.

We will also publish our work in academic journals, collaborating on publications across UK and LMIC teams at all career levels. We have costed for support to produce online and social media resources (UKCTAS and in-country website content, social media feeds) so that our work can reach a wider audience beyond those involved in our planned events and training opportunities. As the programme develops we also intend to liaise with other funders active in supporting research and policy on preventing non-communicable diseases, and with other new LMIC partners, to identify options for the future sustainability and continued impact of our work.