Prabhat Jha Updated on Dec 29, 2007 – SCMP
A global killer is ripping through the world’s poorer countries largely unchecked. Within 25 years, it will cause 10 million deaths a year – far more than malaria, maternal deaths, childhood infections and diarrhoea combined. At least half of the dead will be aged 30 to 69, losing about 25 years of life expectancy. The culprit? Smoking tobacco. The same addiction that became the top preventable cause of death in western countries has made big inroads in developing nations. Given current trends, smoking will kill about 1 billion people in the 21st century, mostly in developing countries. In India, smoking cigarettes triples the risk of death from tuberculosis in men and from respiratory disease among women.
We know now that quitting works: even those who stop smoking in their forties lower their risk of death remarkably, and those who quit in their thirties have death risks close to those of lifelong non-smokers.
So cessation by the 1.1 billion current smokers would lower tobacco deaths over the next few decades. Tobacco tax increases, the dissemination of information about the health risks of smoking, smoking bans in public spaces and workplaces, prohibition of advertising and promotion, and cessation therapies help smokers to quit and prevent youngsters from starting. Of these, tobacco taxes are as close to a silver bullet as exists in public health. Indeed, they are probably the single most cost-effective intervention for adult health in the world. A tripling of the excise tax would roughly double the price of cigarettes, preventing about 3 million deaths per year by 2030.
Most developed countries began to take tobacco control seriously in the past two decades, reducing male tobacco-related deaths. But effective tobacco control measures are not under way in developing countries. Taxes are about 80 per cent of the street price of cigarettes in Toronto, but less than 30 per cent in Beijing or New Delhi. And knowledge of the health risks from smoking is low: 61 per cent of Chinese smokers in 1996 thought tobacco did them “little or no harm”.
Spurious economic arguments against tobacco control, debunked in the west, are still commonly repeated in the finance ministries of developing countries.
Money not spent on tobacco can be spent on other goods and services. Tax increases lower consumption and raise revenue: a 10 per cent higher tax means about 7 per cent higher revenue over the medium term. These funds can be a precious resource in fighting poverty.
In China, a 10 per cent higher price would reduce consumption by 5 per cent, and raise enough revenue to pay for a basic health package for 33 million poor rural Chinese.
One common argument against tobacco control – that if people are not harming others, governments should not interfere – is at odds with both common sense and the evidence. In countries with good information about tobacco risks, by the time child smokers become adults, more than 80 per cent wish they had never started.
The agenda is clear. Governments must take tobacco seriously as a leading killer of adults worldwide. International poverty goals must include tobacco control. There are hopeful signs: more than 160 countries have signed the World Health Organisation’s global tobacco control treaty, and the Bloomberg and Gates Foundations are stepping up funding for its implementation.
If the proportion of adults in developing countries who quit smoking increases from below 5 per cent today to 30 to 40 per cent by 2020, then 150 million to 180 million tobacco deaths would be avoided before 2050 – half of these in productive middle age.
Benjamin Franklin once said, “In this world, nothing can be said to be certain, except death and taxes.” Yet we have a tax that could prevent hundreds of millions of premature deaths. It is time to use it.
Prabhat Jha is research chair of health and development at the University of Toronto
