NETTA Interviews: Guillermo Paraje | Campaign for Tobacco-Free Kids
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Guillermo Paraje Interview

November 29th, 2018

*Guillermo Paraje is Professor at the Adolfo Ibañez University in Chile. Winner of the WHO World No Tobacco Day Award. He was a member of the Presidential Advisory Commission for the Reform of the Private System of Health Insurance. His research areas includes health economics (reform of health systems, economics of addiction, among others) and economic development.

In your opinion, what is the main contribution in research on the tobacco economy that Latin America and the Caribbean have made?

I believe that research on the tobacco economics is beginning strongly in the region now. There are several groups that are working continuously and with high quality. I believe that the studies that are being carried out on smuggling in the region are a recent important contribution and, in this matter, we must highlight the work that is being done in Colombia. In some cases, these studies are novel in the area, even internationally. Just the one from Colombia that compares the effect of the increase in taxes on contraband.

If I had to mention one work as the main on this area in terms of the impact it has had on the public discussion, I would mention the work developed by the Institute for Clinical Effectiveness and Health Policy (IECS) on burden of disease and direct costs of tobacco use in several countries of the region.

Despite evidence of tobacco tax effectiveness to improve public health and revenue collection, why do you think many governments in the region have not yet adopted a tobacco tax policy in line with Framework Convention on Tobacco Control recommendations?

The fundamental reason is the lobby of the tobacco industry that has gone from being, in some cases, direct to being very subtle and more hidden. That has not been completely corrected and we have failed to show that these situations are illegal and that they constitute a public health problem. Another reason is that we do not know or have not reach the authorities in charge of the economic policy with our evidence. The fact that non-traditional tobacco control institutions such as the World Bank or the Inter-American Development Bank, with their arrival to the Ministries of Finance, are involved in these issues can help to change this. In other cases, there is a lack of local evidence for the discussions that must take place.

Civil society organizations are fundamental. They are in charge of <<translating>> the scientific evidence and connecting the academy with parliamentarians, the press and civil society.

What kind of efforts should researchers make to translate that knowledge, about the benefits of tobacco taxes, into policy actions?

I think we should present our results in forums where economists are dedicated to other disciplines to socialize not only the results but the issues. We should try to publish the results in good scientific journals with open access and advocate on that basis. And it is essential that the researchers make contact with NGOs and the press of the countries so that civil society knows about these issues and exerts the corresponding pressure.

The idea that tobacco taxes are a measure, above all, to generate income, still predominates in many leaders of the region. Do you think that much emphasis has been placed on the revenue objective, leaving aside the public health vision?

It is possible that this idea that tobacco taxes are important because of the income they generate has a long tradition in the region where these taxes were implemented long before the current emphasis on public health vision began. I believe that in recent years our effort has increased to point out that along with the revenue there is a significant positive effect on population health and health expenditure, which is growing in all countries. It is something that, without a doubt, we must reinforce.

How Civil Society Organizations in the LAC region could collaborate to this aim?

Civil society organizations are fundamental. They are in charge of <<translating>> the scientific evidence and connecting the academy with parliamentarians, the press and civil society. I think that in some countries, like Chile, these organizations have been largely responsible for the positive changes that have existed recently. This, very often, has been achieved in situations of financial scarcity for them, so the merit they have had is even greater.

What is the Chilean Academy contributing to this debate and what do you think has been the country's biggest advance in tobacco tax issues?

The academy has made important contributions such as presenting evidence of the impact of tax changes on consumption, the impact of spending on tobacco in the households decisions' to invest in education, the impact of health warnings on consumption , estimates of contraband, etc. These contributions have accelerated recently but we must accelerate even more the production of scientific evidence.

What does it mean for you to have been recognized with the World No Tobacco Day Prize awarded by WHO in 2018?

It is a compliment and a very big and totally unexpected pride. It certainly encourages me to reinforce my commitment to this issue and increase my effort.