Submitted by Dr. Tony Gale (Retired)

Dr. Tony Gale (Retired)

This letter is a response to articles in the media discussing the concerns of the Minister of Finance about the urgent necessity of reducing recurrent government expenditures, as well as the concerns of the Minister of Health about the high and unsustainable costs of our hospital and other medical services.

A single measure, i.e. legislation prohibiting the production, marketing and sale of tobacco products on the grounds that they are lethal could be a remedy for both these concerns.

It would not be difficult to enforce such legislation; since only 6% of Males and 1% of Females in Barbados are tobacco smokers, and tobacco consumption is no longer socially acceptable in Barbados.

Let me explain.

According to actuarial studies by economists of the Centre for Communicable and Non-Communicable Diseases in the USA and the World Bank, the net loss caused by tobacco consumption in the USA is $3,391. per person per year and each packet of cigarettes costs the nation $7.18 in medical costs and reduced productivity.

Similar Actuarial studies have never been done in Barbados or the Commonwealth Caribbean but taking into consideration the differences in the prevalence of smoking between the USA and Barbados (22.7% vs 7%), the differences in the size of their populations (USA 284,797,000 vs Barbados 268,792), the annual costs of treating tobacco related diseases in the USA and Barbados, and the differences in the value of their currencies USA $1 = Barbados $2), the annual economic losses caused by the tobacco industry in Barbados can be crudely estimated to be at least $120,000,000. This is ten times more than the tax revenues currently collected from the tobacco industry.

This estimate is a measure of the magnitude of the economic burden imposed on the people of Barbados by the tobacco industry and the immense economic benefits to be derived from prohibiting the manufacture, marketing and sale of tobacco products. It is also likely that demonstrating the huge benefits of prohibiting the production and consumption of tobacco products would stimulate interest of both consumers and public and private policy makers in other measures designed to promote the pursuit of health at all levels of society e. g. the prevention and reduction non-communicable diseases. At least 60% of the morbidity and mortality in Barbados is caused by non- communicable diseases other than tobacco consumption; so since it is likely that the economic losses caused by these diseases annually is at least $360,000,000. Preventing and reducing these diseases, therefore, would obviously be preferable to the pursuit of “blue sky” scenarios such as medical tourism and the privatization of medical services currently advocated in the media and other public fora by persons who sanctify the market economy as the sole source of a prosperous, healthy and happy society.

The evidence to support these “blue sky” scenarios has never been stated explicitly. But contrastingly the success and benefits of the tobacco control program of the Barbados Cancer Society and similar programs in other countries are well recognized and well documented. For instance statistical analysis shows that since 1982 when this program was started the Barbados Cancer Society the prevalence of tobacco consumption has declined from 18% to 7%, and the annual cost of treating tobacco related diseases has declined by $102,579,750 from $167,845,500 in 1982 to $65,276,750 in 2015.

Similar programs in the USA, notably in California have produced equally impressive benefits. And according to an article in the journal PLOS Medicine August 26 2008 by James Lightwood, Alexis Dinno and Stanton Glantz; “The Effect of the California Tobacco Control Program on Personal Health Expenditures”, for every dollar invested in Tobacco Control measures, there has been a 50 Fold reduction in personal health expenditures, and a corresponding increase in the productivity in all sectors of the economy, public or private.

Are there any investments in Barbados, public or private that have produced or could produce such large economic benefits?

CONCLUSION
I believe that the pursuit of health not the pursuit of profit is the key to health, happiness and sustainable prosperity. And Furthermore that this shows that when Jesus of Nazareth, who was sent by God The Father to redeem Mankind told his disciples “That to him that hath it shall be given, but to him that hath not it shall be taken away”, his words applied not only to Spiritual Health but to all manifestations of health in our world, namely mental health, emotional health, social health, economic heath and above all the health of our Environment.

D.A.Gale, MB. ChB. Birmingham University, 1949

Retired General Practitioner,

Former Honorary Director Tobacco Control Program

Barbados Cancer Society, (1985 to 2008)