Executive Summary

• Tobacco is a massive global issue: 8 million annual deaths and 230 million annual DALYS (15% and 9% of global totals respectively).
• There are evidence-based policies—outlined by the WHO’s MPOWER framework—that countries can adopt to reduce tobacco use.
• Policy advocacy for implementing MPOWER measures in neglected countries can avert DALYs with cost-effectiveness matching GiveWell's top charities.
• Since starting in mid-September, Concentric Policies has engaged with seven ministries of health, met with four, and received a partnership request from one to develop a multisectoral plan for noncommunicable diseases.
• Closing our Year 1 funding gap ($21,000) is critical for building the necessary capacity to support our government advocacy plans in 2024.

About Us 

Concentric Policies is a nonprofit focused on preventing and controlling noncommunicable diseases. We support the adoption of evidence-based health policies in countries underserved by large NGOs and the international community. Through collaboration with governments, civil society, and citizens, we aim to reduce the unhealthy consumption of tobacco, alcohol, sodium, and sugar. Concentric Policies provides free assistance by engaging stakeholders, strengthening the evidence base through research, and offering technical assistance throughout the policy process.

Concentric Policies was launched through Charity Entrepreneurship, a London-based incubator that turns well-researched ideas into high-impact organizations. Charity Entrepreneurship has helped launch over 30 charities that are now reaching over 20 million people annually with their interventions. 

Problem 

• Annual deaths from tobacco were 6 million in 2013 and rose to 8 million before the pandemic.
• Today, more people are killed annually by tobacco usage than malaria, HIV, and neonatal deaths combined… twice over.^[1]
• In addition, tobacco usage increases healthcare expenditures, decreases productivity, exacerbates inequality, degrades the environment, and contributes to child labor.
• This EA Forum post from World No Tobacco Day covers these harms in more detail.

Solution 

The WHO’s MPOWER framework provides cost-effective demand-reduction measures to help countries reduce tobacco consumption. Since MPOWER was introduced globally 15 years ago, an estimated 300 million less people are smoking than might have been if smoking prevalence had stayed the same.^[2]

Tobacco taxation is the most effective (and cost-effective) intervention for reducing tobacco consumption, yet it is the most neglected intervention.^[3] Tobacco has an average price elasticity in LMICs of around -0.5, meaning that for a 10% increase in the retail price of tobacco, consumption decreases by 5%.^[4]

Opportunity 

The number of countries that have adopted at least one MPOWER measure at the highest level of achievement has grown from 44 in 2008 to 151 in 2022. However, only a handful of nations have full compliance with MPOWER guidelines and 44 countries remain unprotected by any of the MPOWER measures.^[5] Despite nearly every country signing the WHO’s treaty on tobacco, only 13 nations outside of Europe meet the WHO’s recommended minimum of taxing tobacco at 75% of retail value.

Since starting work in September, we have learned and reaffirmed the following: 

• Some governments are not aware of the potential ROI from comprehensive implementation of the MPOWER framework
• Consolidated funding in the tobacco control space has led to only a dozen or so of the highest-burden countries receiving the majority of resources  
  • Many smaller countries do not receive any attention from major tobacco control organizations  
• Tobacco control efforts can absorb more funding; the burden greatly exceeds the scope of work being done by the tobacco control space.
  • Civil society and domestic advocacy groups often split their efforts across a wide range of health issues

Potential Impact

We estimate 130,000 to 262,000 DALYs could be averted by increasing national tobacco taxes in a high-burden country. Some of the non-health benefits of reduced tobacco consumption include increased government revenue for other services, increased household disposable income (which often is used on education and nutrition), increased GDP (through decreased healthcare costs and increased productivity), and less pollution (cigarette butts are the most littered item in the world).

Cost-effectiveness

Cost-effectiveness estimates for a 20 percentage point tax increase on tobacco in most countries range from 2 USD to 50 USD per DALY averted. The expected value fluctuates depending on the probability you assign for success. CE’s 2022 report found a weighted probability of 27%.

For our pilot, we estimate a 20 percentage point tax increase on tobacco would have an expected cost-effectiveness of 50 to 300 USD per DALY averted. A policy win in these countries would most likely range from 20 to 100 USD per DALY averted.

Research conducted by Charity Entrepreneurship, Open Philanthropy, the Centre for Exploratory Altruism Research, and Concentric Policies has projected the expected value of health taxes (on tobacco, alcohol, and sugar) and sodium reformulation to be above or on par with GiveWell’s cost-effectiveness bar.

Traction 

• Received a partnership request from a ministry of health to help develop a multisectoral NCD plan 
• Identified an opportunity and implementation partner to scale a tobacco cessation program in a high-burden country. Based on our initial model, we have moderate to high confidence this program could avert a DALY for under $100 in expectation.
• Made contact with a prominent national politician and are developing alliances with two up-and-coming politicians
• Developed relations with technical experts and major institutions in the field, including WHO and World Bank
• Spoken with government, civil society, and public health stakeholders in over 20 countries 
• Raised over $16,000 from non-EA donors 

Funding Gap

Based on our Year 1 budget, Concentric Policies’ current funding gap is approximately $21,000. This support would enable us to hire a program officer and spend additional months in-country. Without additional funding, our probability of securing policy wins will be substantially reduced.

We are also exploring leads beyond the scope of the funding gaps's focus i.e. traditional policy advocacy. To fully act on the most promising leads, which we are currently working to verify, we anticipate capacity to absorb more funding beyond the stated funding gap later in 2024. Given present uncertainties on these opportunities, we are not seeking to fundraise past our original funding gap at this time.

You can donate through our website or reach out to us to discuss the impact of a donation in greater detail.

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To learn more or provide feedback, feel free to reach out at info@concentricpolicies.org or book a call with us.

1. ^{^}

   https://docs.google.com/spreadsheets/d/1RAJxcAaWe2HU6D6_sfzyE4krp7IT8OPpnLd0TPDbr2M/edit?usp=sharing

2. ^{^}

   https://iris.who.int/bitstream/handle/10665/372043/9789240077164-eng.pdf?sequence=1

3. ^{^}

   2021 WHO technical manual on tobacco taxation policy and administration; 2016 NIH monograph on the economics of tobacco and tobacco control.

4. ^{^}

   https://cancercontrol.cancer.gov/brp/tcrb/monographs/monograph-21

5. ^{^}

   https://iris.who.int/bitstream/handle/10665/372043/9789240077164-eng.pdf?sequence=1