Global Tobacco Control:
U.S. Efforts Have Primarily Focused on Research and Surveillance
GAO-19-533R: Published: Aug 8, 2019. Publicly Released: Aug 8, 2019.
According to the UN’s World Health Organization, tobacco use is one of the leading causes of preventable deaths. It kills over 8 million each year—almost three times the total deaths from tuberculosis, HIV/AIDS, and malaria.
We reviewed U.S. global tobacco control efforts for 2015-2018. We found U.S. funding mainly supported research and surveillance—for example, tracking tobacco use. The Department of Health and Human Services provided 95% of this funding—about $39.5 million—and the U.S. Agency for International Development provided about $2.1 million. The Department of State helped fund UN health organizations involved in tobacco control.
Estimated Numbers of Deaths Caused by Tobacco Use and Three Major Diseases, 2017
Bar graph showing more than 8 million deaths by tobacco compared to around 3 million for malaria, HIV/AIDS and TB combined
What GAO Found
In fiscal years 2015 through 2018, U.S. agencies' funding for global tobacco control primarily supported tobacco research grants and surveillance activities. The Department of Health and Human Services (HHS) and the U.S. Agency for International Development (USAID) obligated about $41.6 million for 47 awards to address global tobacco control. HHS provided the majority of this funding—about $39.5 million (95 percent of all U.S. funding)—for 41 awards primarily focused on research and surveillance. Additionally, HHS component agencies—the National Institutes of Health, the Centers for Disease Control and Prevention, and the Food and Drug Administration—participated in knowledge sharing and technical assistance. USAID funded six research awards, totaling about $2.1 million. The Department of State (State) did not fund any global tobacco control awards directly but is the largest contributor to the World Health Organization (WHO) and Pan American Health Organization (PAHO), which pool U.S. contributions with funding from other members to implement global tobacco control efforts.
Why GAO Did This Study
The United Nations' WHO has reported that tobacco use is one of the world's leading cause of preventable deaths, killing over 8 million people each year—almost three times the number that die from tuberculosis, HIV/AIDS, and malaria combined. The majority of those deaths occur in low- and middle-income countries.
To address this problem, WHO's Framework Convention on Tobacco Control (FCTC) was adopted by the World Health Assembly in 2003 and came into force in 2005. The FCTC's stated objective is to protect people from the consequences of tobacco consumption and exposure to tobacco smoke by providing a framework for implementing tobacco control measures at the national, regional, and international levels. While the U.S. government is not bound by FCTC provisions, HHS, USAID, and State engage in global tobacco control efforts.
GAO was asked to review U.S. global tobacco control efforts. In this report, GAO describes U.S. agencies' funding and activities for global tobacco control in fiscal years 2015 through 2018. GAO reviewed data and documentation from HHS, USAID, and State and met with officials from each agency. GAO reviewed obligations data covering all grants, contracts, and cooperative agreements from HHS and USAID and examined award documentation for both agencies' global tobacco control awards. In addition, GAO reviewed documentation and interviewed officials from WHO and PAHO.
GAO is not making any recommendations.
For more information, contact David Gootnick at (202) 512-3149 or firstname.lastname@example.org.