Statistics
The global state of smoking in 5 charts
Tobacco use kills 6 million people a year – that’s one person every six seconds.
http://blogs.worldbank.org/opendata/global-state-smoking-5-charts
If left unchecked, this number could rise to 8 million a year by 2030. It’s why efforts such as plain packaging laws highlighted in my colleague Patricio’s blog and this year’s World No Tobacco Day are so important.
I’ve taken a look at tobacco use estimates from the WHO’s Global Health Observatory below to get a better idea of where smokers are, how smoking rates have changed over time, and how they vary between men and women. You can find all the data and calculations behind the charts below here.
There are over a billion smokers worldwide
As you’d expect, there are large numbers of smokers in the world’s most populous countries, but it’s in the smaller and relatively richer countries of Europe where you find some of the highest smoking rates.
Smoking rates increased in 27 countries between 2000 and 2015
In a number of mostly low- and middle-income countries, smoking rates increased between 2000 and 2015. In Indonesia for example, the rate went up by almost 30% over the period, making the country home to more than 70 million smokers.
In the majority of countries, smoking rates are lower than 15 years ago
But in most countries with available data, smoking rates have been falling and often substantially – from richer countries like Denmark, Norway, Iceland and Canada to poorer countries such as Bangladesh, Uganda and Nepal.
In almost every country, smoking rates are much higher among men than women
The figures above have all been based on the average smoking rates for men and women. When you disaggregate the data, you see that in almost every country (Nauru and Sweden being the exceptions) smoking is more common among men than women, and often by a huge margin.
There are bigger changes in smoking trends among men than women
I grew up in Japan in the early 90s and as child I could see how prevalent smoking was among men. I even remember my schoolteachers going out for cigarette breaks between classes and at lunchtime! It’s impressive to see the more than 30% decline in smoking among men there in the past 15 years and you see similar trends among men in many countries around the world.
But as noted in the second chart, there are 27 countries where smoking rates went up, and those trends are especially pronounced among men. As my colleague Bassam writes, changing attitudes towards smoking is a hard but important problem – healthy lives matter for individuals and economies.
So there you go, five charts about smoking. Did any trends or figures stand out for you?
Data used in this post:
Smoking prevalence rates from the WDI for men and women in 2012
Total population and percentage of populaiton aged 0-14
Tobacco use data from World Health Organization
Kicking the habit: percentage of smokers in Hong Kong at new low, survey reveals
10.5pc of population indulged in habit last year as prevalence fell, but more women still smoke, Centre for Health Protection study finds
The percentage of smokers in the city last year dropped to its lowest level since records began 33 years ago, a study has found.
According to the survey of 10,000 households by the Centre for Health Protection, 10.5 per cent of the population above the age of 15 are daily smokers.
In 2008, the figure was 11.8 per cent and 10.7 per cent in 2012.
Undersecretary for Food and Health Sophia Chan Siu-Chee attributed the decline to effective tobacco control measures.
“The smoking prevalence in Hong Kong is amongst the lowest in the region. The government will continue to work towards bringing the figure down to a single digit,” she said.
The survey also showed that the smoking prevalence among young people between 15 and 19 dropped significantly – from 2 per cent in 2012 to 1.1 per cent last year.
However, Chan noted that the figure for female smokers saw a slight increase from 3.1 per cent in 2012 to 3.2 per cent.
“Research has shown the reasons that compel women to smoke are different from men. Therefore traditional methods for helping them to quit smoking may not work as well,” said Chan.
“We will review our current set-up and see whether we need to come up with specific services and measures targeting women.”
The survey also looked at the prevalence of electronic cigarette users in the city.
While e-cigarette usage in Hong Kong remained very low, the centre noted that 9 per cent of secondary school students have tried the devices, a trend Chan described as “worrying”.
“We are seriously considering prohibiting the import, manufacture, sale, distribution and advertising of e-cigarettes through legislation,” she said.
The undersecretary added the government is currently working on the details of the legislation but did not set out a timetable for when they will table the proposal at the Legislative Council.
Aside from regulating electronic cigarettes, Chan said the government is also aiming to start a legislative process on enlarging health-warning signs on tobacco products to cover 85 per cent of the packaging this year.
Another area Chan said authorities would continue to work on is the expansion of statutory no-smoking areas.
On March 31, the areas will be further extended to eight bus interchanges.
“Some suggested all bus stops in Hong Kong. Others suggested near schools and hospitals. So we have to consider all these factors and then we will work out a plan accordingly,” she said.
Chan declined to give an answer on whether tobacco tax would be increased in this year’s budget, only saying the current rate in Hong Kong is comparable to the World Health Organisation’s recommendation.
________________________________________
Source URL: http://www.scmp.com/news/hong-kong/health-environment/article/1909667/kicking-habit-percentage-smokers-hong-kong-new-low
E-cigarettes and smoking cessation in real-world and clinical settings
A systematic review and meta-analysis
https://www.ncbi.nlm.nih.gov/pubmed/?term=E-cigarettes+and+smoking+cessation+in+real-world+and+clinical+settings%3A+a+systematic+review+and+meta-analysis.
Abstract
BACKGROUND:
Smokers increasingly use e-cigarettes for many reasons, including attempts to quit combustible cigarettes and to use nicotine where smoking is prohibited. We aimed to assess the association between e-cigarette use and cigarette smoking cessation among adult cigarette smokers, irrespective of their motivation for using e-cigarettes.
METHODS:
PubMed and Web of Science were searched between April 27, 2015, and June 17, 2015. Data extracted included study location, design, population, definition and prevalence of e-cigarette use, comparison group (if applicable), cigarette consumption, level of nicotine dependence, other confounders, definition of quitting smoking, and odds of quitting smoking. The primary endpoint was cigarette smoking cessation. Odds of smoking cessation among smokers using e-cigarettes compared with smokers not using e-cigarettes were assessed using a random effects meta-analysis. A modification of the ACROBAT-NRSI tool and the Cochrane Risk of Bias Tool were used to assess bias. This meta-analysis is registered with PROSPERO (number CRD42015020382).
FINDINGS:
38 studies (of 577 studies identified) were included in the systematic review; all 20 studies with control groups (15 cohort studies, three cross-sectional studies, and two clinical trials) were included in random effects meta-analysis and sensitivity analyses. Odds of quitting cigarettes were 28% lower in those who used e-cigarettes compared with those who did not use e-cigarettes (odds ratio [OR] 0·72, 95% CI 0·57-0·91). Association of e-cigarette use with quitting did not significantly differ among studies of all smokers using e-cigarettes (irrespective of interest in quitting cigarettes) compared with studies of only smokers interested in cigarette cessation (OR 0·63, 95% CI 0·45-0·86 vs 0·86, 0·60-1·23; p=0·94). Other study characteristics (design, population, comparison group, control variables, time of exposure assessment, biochemical verification of abstinence, and definition of e-cigarette use) were also not associated with the overall effect size (p≥0·77 in all cases).
INTERPRETATION:
As currently being used, e-cigarettes are associated with significantly less quitting among smokers.
FUNDING:
National Institutes of Health, National Cancer Institute, FDA Center for Tobacco Products.
Running away from “Tobacco Road”
Earlier this fall, my oldest son invited me to watch him run his first half marathon in Durham, North Carolina. While standing at the starting line, facing hundreds of runners of different ages, I could not help but be amazed by the irony of the situation: In the midst of a region in the United States known as “tobacco road,” there was tangible evidence of a significant, healthier turn in people’s norms and behaviors.
http://blogs.worldbank.org/health/running-away-tobacco-road
Why the irony, you may ask? After the U.S. Civil War in the 19th century, the tobacco industry became the backbone of North Carolina’s economy, and the city of Durham developed rapidly as a tobacco manufacturing center. Although cigarettes are no longer manufactured there, its historic district, where the race took place, still preserves the physical legacy of tobacco factories, which have now been converted into upscale apartment buildings and retail spaces.
While North Carolina is still the top tobacco-producing area in the United States, over the past two decades, tobacco employment, and the number of tobacco farming, processing and manufacturing establishments have declined steadily across all segments of the tobacco value chain in the U.S. In 1992, the U.S. tobacco industry employed over 80,762 people in 2,144 establishments. By 2012, this number had dropped to 42,531 workers in 1,955 establishments, a decline of 47.3% and 8.8%, respectively.
The continuous decline in the relative economic importance of the U.S. tobacco industry is due in large measure to the translation of medical and public health evidence, and knowledge about the negative health effects of tobacco use, into effective public policy measures, such as smoke-free laws and tobacco tax increases, which make these products unaffordable. Education campaigns and cessation programs have also helped to reduce the social acceptability of smoking and have changed consumption patterns. And funding from the 1998 Master Settlement Agreement–an accord between the state Attorneys General of 46 states, five U.S. territories, the District of Columbia, and the five largest U.S. tobacco companies, which requires the tobacco industry to pay the states approximately US$10 billion annually for the cost of health care for tobacco-related illnesses — is being used to support crop diversification away from tobacco.
Beginning with the first U.S. Surgeon General’s report on tobacco released in 1964, a broad consensus now exists that tobacco use is the single-most preventable cause of death and disease in the United States. As documented in the Healthy People 2020 report, for every person who dies from tobacco use in the United States, 20 more people suffer with at least one serious tobacco-related illness. Overall, smoking in the United States kills about 480,000 Americans a year and costs nearly $280 billion a year in health care costs and lost productivity.
Thanks to widespread application of anti-tobacco policy measures, smoking rates have declined significantly. Survey data from the U.S. Centers for Disease Control and Prevention (CDC) show a significant downward trend in current cigarette smoking among adults in the U.S.: from 42% in 1965 to 19% in 2011.
In spite of the significant progress achieved over the past 50 years, the 2014 Surgeon General’s report warns against complacency. The list of illnesses caused by smoking has grown, and smokers today have a greater risk of developing lung cancer than they did in 1964, even though they smoke fewer cigarettes, due to changes in the design and composition of cigarettes that raise health risks. It is notable that, for the first time, women are as likely as men to die from many of the diseases caused by smoking.
As the tobacco industry and tobacco use in the United States gradually but inexorably continue to fade away, there are other deep-seated and far-reaching changes taking place in social and cultural norms, attitudes and behaviors that have had an impact on the population’s health.
Scientific evidence and knowledge about the health benefits of regular physical activity, for example, are influencing youth and adults alike to participate in moderate and vigorous physical activities, such as running. Events such as the Durham Half Marathon reflect the “running/jogging/walking boom” that has grown over the past decade. Since 2004, Americans’ estimated total running/jogging participation (6+days/year) has increased 70% to a record of nearly 42 million people, across both genders.
Public health warnings and advice on effective ways to deal with the growing U.S. obesity and diabetes epidemic are also making more people cognizant about the food they eat. CDC data show that improvement in eating habits, including reductions in the average number of daily calories children and adults consume; a decline in the amount of soda Americans drink by about one-quarter since the late 1990s; and a rise in physical activity, have all contributed to the fall in the rate of new diabetes cases by about one-fifth, from 2008 to 2014.
On the trip back home from Durham, I concluded that all of us who are involved in supporting the realization of universal health coverage across the world now have a tremendous opportunity to contribute to the attainment of longer lives, free of preventable disease, disability, injury, and premature death. But to do so effectively in today’s era of competitive priorities and vested commercial interests, we need to advocate and support sound policymaking by disseminating and adapting to specific country contexts, good practices such as the ones observed in the United States. We also must bring evidence to bear on the broad social and economic benefits of public health action, as well as the costs of inaction.
We have a ways to go, but “running away from tobacco road” is a step in the right direction.
Making the public health case for tobacco taxation
Let’s be clear. Tobacco use, and its negative health, social and economic impact, is not a global problem that is simply going away.
http://blogs.worldbank.org/health/making-public-health-case-tobacco-taxation
As documented in a recent study, despite significant reductions in the estimated prevalence of daily smoking observed at the global level for both men and women since 1980, the actual number of smokers has increased significantly over the last three decades as the result of population growth. In 2012, it is estimated that close to one billion people were smokers, up from 721 million in 1980.
Clearly, tobacco use is a global epidemic. If we do not want to be passive spectators to the unhindered growth of this threat to global health, then political will at the highest levels of government needs to be galvanized, coupled with sustained support from civil society and international organizations. This is required not only to shine light upon this deadly but entirely preventable threat, but more importantly, to promote effective and sustained action to deal with it.
A new World Health Organization (WHO) report on tobacco taxation, launched today in Manila, raises a troubling question for policymakers across the world: If, as shown by scientific evidence, tobacco is a leading global disease risk factor, why then are so few governments levying appropriate levels of tax on cigarettes and other tobacco products?
The importance of this question is accentuated by the widely accepted fact that raising taxes on tobacco products is one of the most cost-effective measures to reduce consumption of products that kill, while also generating substantial domestic revenue for health and other essential programs—investments that benefit the entire population.
Findings in the report show that while only 33 countries impose taxes that constitute more than 75% of the retail price of a pack of cigarettes—the taxation level recommended to have an impact on consumption —most countries that do tax tobacco products have extremely low tax rates. And some countries do not have a special tax on tobacco products at all.
Given this situation, the WHO report is a much-needed and timely “call to arms.” It encourages governments to look at accumulated country evidence worldwide, and not simply the tobacco industry’s arguments, and to use tax measures to increase the retail price of tobacco products as one of the best available public health policy measures.
The report outlines some important lessons about how to effectively implement this policy measure to achieve the public health objectives of tobacco taxation, based on empirical evidence:
- While nearly all countries tax tobacco products, an excise tax is the most important type of tobacco tax, since it applies uniquely to tobacco products and raise their prices relative to prices for other goods and services.
- Simpler tobacco tax structures are more effective than complex ones, since tiered tax structures are difficult to administer and can undermine the health and revenue impacts of tobacco excise taxes.
- Use of specific excise taxes enhances the impact of tobacco taxation on public health by reducing price gaps between premium and lower-priced alternatives, which limits opportunities for users to switch to less-expensive brands in response to tax increases. Taxing all tobacco products comparably reduces incentives for substitution.
- Ad valorem taxes are difficult to implement and weaken tax policy impact. Since they are levied as a percentage of price, companies have greater opportunities to avoid higher taxes and preserve or grow the size of their market by manufacturing and selling lower-priced brands. This also makes government tax revenues more dependent on industry pricing strategies and increases the uncertainty of the tobacco tax revenue stream.
- Specific excise taxes need to be adjusted for inflation to remain effective.
- Tax increases should reduce the affordability of tobacco products. In many countries, where incomes and purchasing power are growing rapidly, large price increases are required to offset growth in real incomes.
- Strong tax administration is critical to minimize tax avoidance and tax evasion, to ensure that tobacco tax increases lead to higher tobacco product prices and tax revenues, as well as reductions in tobacco use and its negative health consequences.
- Regional agreements on tobacco taxation can be effective in reducing cross-border tax and price differentials and in minimizing opportunities for individual tax avoidance and larger scale illicit trade.
And, I will add, international trade agreements, such as the proposed Trans-Pacific Partnership, which is being negotiated by 14 countries (Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, the United States, and Vietnam), could help curb smoking globally if related public health measures adopted by participating countries are protected from the threat of litigation from the tobacco industry.
The report also warns countries against accepting the industry’s argument that illicit trade of tobacco products will thrive if taxes on tobacco products are increased. Accumulated evidence shows that this argument is flawed. While high taxes may create incentives for illicit trade, different country experiences show that illicit trade can be controlled by legal means (e.g., use of prominent tax stamps, serial numbers, special package markings, health warning labels in local languages, adoption of uniform tax rates nationwide that facilitate successful collection at the points of manufacture and import) and by increased law enforcement (e.g., improving corporate auditing, better trace and tracking systems, and good governance).
The report makes the point that controls over the distribution chain (from monitoring of production and/or distribution to licensing of all parties involved in manufacturing, distribution and retailing), improved technologies, and better use of data help to reduce illicit trade and complement tobacco tax reforms.
We at the World Bank, working with WHO and other partners, such as the Bill & Melinda Gates Foundation and Bloomberg Foundation, are committed to support countries in the implementation of tobacco taxation measures as outlined in this report. Effective tax regimes that make tobacco products unaffordable represent an important intervention to tackle the growing burden of noncommunicable diseases and a potential important domestic revenue stream for helping finance the UN’s Sustainable Development Goals (SDGs) across the world.
Good News from the Global War on Tobacco Use
Last week, I participated in the 16th World Conference on Tobacco or Health (WCTOH) in Abu Dhabi–a scientific event where the latest developments in tobacco control were presented.
http://blogs.worldbank.org/health/good-news-global-war-tobacco-use
While there was general agreement that the World Health Organization 2005 Framework Convention on Tobacco Control (WHO FCTC)–the first global treaty negotiated under the auspices of the World Health Organization–is an effective tool for tobacco control, there was concern that implementation at the national level has fallen short of objectives.
I prefer, however, to see the glass half full rather than half empty. Let me explain why.
It should be clear to all of us that the WHO FCTC is a global framework that commits countries that have ratified it to move forward on tobacco control. This is in itself a tremendous achievement. To help make this a reality, WHO introduced MPOWER, a package of effective policies and interventions to assist countries in reducing the demand for tobacco. The MPOWER package includes: Monitor for tobacco use; Protect people from tobacco smoke; Offer help to quit tobacco use; Warn about the dangers of tobacco; Enforce bans on tobacco advertising, promotion and sponsorship; and Raise taxes on tobacco products.
As shown at the conference, MPOWER is increasingly being implemented worldwide. WHO estimates that 2.3 billion people in 92 countries – one-third of the world’s population – are now covered by at least one MPOWER measure, up from 1.3 billion people in 48 countries in 2007.
More specifically, the 2012 WHO data show that:
2.8 billion people in 54 countries (40% of the world’s population) are covered by effective tobacco use surveillance;
1.1 billion people in 43 countries (16% of the world’s population) are covered by complete smoke-free legislation;
1 billion people in 21 countries (15% of the world’s population) are offered appropriate cessation support;
1 billion people in 30 countries (14% of the world’s population) are exposed to strong graphic health warnings;
694 million people in 24 countries (10% of the world’s population) live in countries with complete tobacco advertising, promotion and sponsorship bans; and
530 million people in 32 countries (8% of the world’s population) live in countries with sufficiently high taxes on tobacco products.
More importantly, according to WHO 2014 estimates, the implementation of the WHO FCTC over 2005-2015 has contributed to reduce smoking prevalence among males and females aged 15 years and older, from 40% to 35% , and from 9% to 6%, respectively. And, as documented in a recent study, evidence from 41 countries show that the effective implementation of MPOWER measures can help avert 7.4 million premature deaths by 2050.
Substantial and regular increases in tobacco excise taxes that raise prices and make tobacco less affordable have been shown to be the most cost-effective measure, since prince increases are estimated to lead to a reduction of 7 million smokers and to 3.5 million smoking-attributable deaths averted.
To highlight the tangible progress being made in tobacco control in low- and middle-income countries, the winners of the 2015 Bloomberg Philanthropies Awards for Global Tobacco Control announced at the conference reflect good practices and results achieved in each of the MPOWER categories:
• Monitoring: Brazil Ministry of Health and National Institute of Statistics implemented the Global Adult Tobacco Survey in 2008, the first country to do so in the Americas, and the subsequent introduction of MPOWER measures into their existing national survey, creating strong technical capacity to monitor tobacco control.
• Protecting: Regional Advocacy Life Center (“LIFE”) of Ukraine led and coordinated support for the 2012 countrywide smoke-free law and comprehensive anti-tobacco advertising, promotion, and sponsorship bill.
• Offering help to quit: Uruguay’s Ministry of Health has been a leader in global tobacco control for nearly a decade. In 2008, the new Tobacco Control law mandated that all health care providers offer cessation support.
• Warning: Nepal’s Ministry of Health and Population passed a comprehensive law comprised of large, graphic health warnings, bans on tobacco advertising and sponsorships, and a smoke-free law, all while facing immense pressure from the tobacco industry.
• Enforcing: KONFOP, a Russian NGO, was a leader in the passage of 2013 tobacco control legislation in Russia, which is among the strongest comprehensive tobacco control legislation in the world.
• Raising tobacco taxes: The Philippines Department of Finance and Department of Health played a critical role in passing the Sin Tax Law in 2012, which made it more efficient to raise the tobacco tax by simplifying the country’s tax structure and channeling the revenue to help expand universal healthcare across the country.
Also at last week’s conference, Michael Bloomberg and Bill Gates launched a US$4 Million Anti-Tobacco Trade Litigation Fund to help governments that pass tough anti-smoking laws defend against international trade suits and increase public awareness of legal threats from the tobacco industry. And one of the most inspiring sessions addressed Australia’s move to mandate plain or standardized packaging for tobacco products in 2012, in spite of strong opposition from the tobacco industry. There were also a lot of discussion on how to best support agricultural diversification and end tobacco crop dependence.
While tobacco control remains a difficult challenge in a large number of countries (about 1 billion people are current smokers), I left the conference convinced that significant inroads have been made in the first 10 years of the WHO FCTC toward the 2013 World Health Assembly target of reducing tobacco use prevalence globally by 30% by 2025. But, as I noted in my presentations at the conference, reaching that target will require that we continue working on tobacco control across the world as a moral and development imperative. If we do that, we will also be able to honor the legacy of loved ones who have suffered and died prematurely due to lung cancer or other tobacco-related diseases.
The seven salvos of sin (taxes)
Tobacco kills one-third to one-half of all people who use it, on average 15 years prematurely. The World Health Organization (WHO) has a target of a 30% reduction in smokers by 2025; but this is one target that would be great to exceed. Alcohol-attributable cancer, liver cirrhosis, and injury caused 1.5 million deaths globally in 2010.
http://blogs.worldbank.org/health/seven-salvos-sin-taxes
Recently, the representatives of ministries of finance and ministries of health, as well as a host of civil society organizations and international organizations, met in Manila to consider lessons to be drawn from the international experience surrounding so-called sin taxes.
What is a sin-tax? It is a tax that is levied on products or services that are socially costly, thus adding to their price and contributing to state revenue. These type of taxes are levied by governments to discourage individuals from partaking in such activities without making the use of the products illegal. To have so many countries from the East Asian region come together at the World Bank-organized event in Manila, sitting together, was itself a symbol of the emerging interest and consensus around issues concerning sin taxes.
Taking a cue from the catchy campaign around seven wins to advance the recent successful passage of a major Sin Tax Reform in the Philippines, and based on the discussion in Manila, I suggest we consider the seven salvos of sin taxes, as follows:
It’s mainly a health issue; it’s only secondarily a taxation issue. The health consequences of continuing to smoke are dire — tobacco is projected to cause 1 billion deaths in the 21st century, ten times what it did in the 20th century, or currently 5.4 million per year. Therefore, any delay is a costly delay; there should be a ‘bias for action,’ striving to make smoking less attractive to those susceptible to engaging in it. East Asia in particular has cigarettes that are affordable. They are packaged (including by single stick) to minimize access costs. This region accounts for a lion’s share of the world’s smokers. Indonesia, alone, accounts for 5% of the world’s smokers, with two-thirds of men and about 7% of women smoking, and quite heavily, as well as a distressing 18% of children age 10 to 14 years.
Market segments matter. The behaviors across the market segments are quite distinct, with noteworthy differences in elasticities across product categories and prices, for example. Smokers may be inclined to shift between (down) product categories, especially when a price increase is induced through the levying of an additional tax or increase in tax rate. Cigarette companies manage their product categories and packages to offer new attractions to smokers across the different market segments.
Arguments against increasing tobacco tax rates are spurious. The industry – represented by growers, manufacturers, distributors and advertising outlets – are collectively a special interest. They mount arguments to try to galvanize public opinion, or create some forms of fear. One of the most often used is the suggestion that increased rates lead to smuggling. In such circumstances, it is important to reframe the argument. The issue is improving tax and customs administration so as to stamp down on illicit trade, rather than being held hostage by such trade and some poorly specified notion of smuggling.
Earmarking can help. Generally, public finance practitioners do not like earmarking, as it can contradict the general efficiency objectives of the public budgeting process. But this is one area where I am prepared to support earmarking in its soft form.
Earmarking can assist in making the argument for sin taxes compelling to the public; it can build trust in the public budgeting system, something which is needed in many countries in East Asia. Definitions concerning the soft and hard forms of earmarking are not uniform. In fact, earmarking as an idea seems to be malleable and ductile. These are strengths, not weaknesses. Institutional development has shown numerous cases where jurisdictions have started with earmarking, but through time have moved away from that, as confidence has emerged in their public budgeting processes. Health promotion – based on the idea that prevention is better than cure – sprang to life in the 1980s; it has made a valuable contribution to public health and should be supported by earmarked taxes. Earmarked taxes can also be applied for general public health purposes. For example, Philippines, Thailand, Egypt, and the UK earmark sin taxes for health.
Tax design matters a bit. It is desirable to have automatic annual adjusters built into the law so that excise taxes keep pace with rising incomes and aspirations. It is also noteworthy, that as with many taxes, more tiers create more tears. In other words, the more tiers for differentiating the types of tobacco products (maybe origin, price or quality) the more complicated the tax structure and the more wiggle room given to the tobacco industry for maneuver. Indonesia probably has the most complex (and industry-friendly) tobacco excise regimes in the world. Specific design features can make practices like ‘front-loading’ more difficult for the tobacco companies to sponsor. The challenge to reduce smoking requires numerous other interventions, as well as the use of taxation.
Build an evaluation system into the reform package. The public sector worldwide is beset by good ideas, but around which governments often fail to build tracking systems to measure the changes in behaviors (good and bad). The best time to design these systems is at the start; the Philippines is a good example of doing that. Their sin tax reform is controversial; one way to manage that controversy is with good data about the effects of these reforms. This means building into the reform package, evaluation and data collection on both the effects on the taxation side and also the spending side.
It’s a special time for tobacco taxes. The global move toward universal health coverage, the growing awareness associated with smokers’ health, the revenue need and the institutional appetite for these forms of taxes have probably never been stronger. Cigarette taxes can boost tax intake considerably. Even at current low rates, Indonesia collects more than 1% of GDP in cigarette tax revenue. For countries looking at the transition from lower middle-income status to higher income status – to escape the so-called middle-income trap – arguably, it is a reform that shows institutional maturity and a society that is making the transition to the generally higher performing public institutions associated with higher incomes. The Philippines case showed that, notwithstanding an entrenched industry and integration with growers, real reform can take hold.
Cigarette graphic warning labels and smoking prevalence in Canada
Cigarette graphic warning labels and smoking prevalence in Canada: a critical examination and reformulation of the FDA regulatory impact analysis.
https://www.ncbi.nlm.nih.gov/pubmed/24218057
Abstract
BACKGROUND:
The estimated effect of cigarette graphic warning labels (GWL) on smoking rates is a key input to the Food and Drug Administration’s (FDA) regulatory impact analysis (RIA), required by law as part of its rule-making process. However, evidence on the impact of GWLs on smoking prevalence is scarce.
OBJECTIVE:
The goal of this paper is to critically analyse FDA’s approach to estimating the impact of GWLs on smoking rates in its RIA, and to suggest a path forward to estimating the impact of the adoption of GWLs in Canada on Canadian national adult smoking prevalence.
METHODS:
A quasi-experimental methodology was employed to examine the impact of adoption of GWLs in Canada in 2000, using the USA as a control.
FINDINGS:
We found a statistically significant reduction in smoking rates after the adoption of GWLs in Canada in comparison with the USA. Our analyses show that implementation of GWLs in Canada reduced smoking rates by 2.87-4.68 percentage points, a relative reduction of 12.1-19.6%; 33-53 times larger than FDA’s estimates of a 0.088 percentage point reduction. We also demonstrated that FDA’s estimate of the impact was flawed because it is highly sensitive to the changes in variable selection, model specification, and the time period analysed.
CONCLUSIONS:
Adopting GWLs on cigarette packages reduces smoking prevalence. Applying our analysis of the Canadian GWLs, we estimate that if the USA had adopted GWLs in 2012, the number of adult smokers in the USA would have decreased by 5.3-8.6 million in 2013. Our analysis demonstrates that FDA’s approach to estimating the impact of GWLs on smoking rates is flawed. Rectifying these problems before this approach becomes the norm is critical for FDA’s effective regulation of tobacco products.