Efforts to reduce cigarette smoking and thereby the burden of tobacco related diseases has been a long standing public health challenge. Tobacco consumption in most high-income countries such as Britain, Canada, the United States, and Australia has fallen over the past 20 years. Furthermore, the demand for tobacco is projected to continue falling in developed countries. By contrast, tobacco consumption in developing countries is increasing. Cigarette smoking is now a rapidly emerging public health concern in the developing world.
A recent article in the daily news (Cigarette taxes lead to big drop in smoking) highlighted the success of high cigarette taxes in reducing the prevalence of smoking in South Africa, particularly among the poor and the young- the two most vulnerable groups in a population.
The direct relation between raising taxes on cigarettes and reduced prevalence of smoking is not a novel phenomenon. Such increases in taxes have been implemented in different parts of the globe at varied points in time. It is quite straight forward- as the cost of smoking increases financially the number of people who smoke decreases. Less people smoking is a good thing for everyone!
Is raising taxes on cigarettes the most effective strategy in reducing the prevalence of smoking? Should raising cigarette taxes be the sole area of our focus? Are they other determinants of smoking that scream for our attention?
When I first thought about this approach, it seemed fraught with contradictions. After all, aren’t governments benefiting from smokers by raising cigarette taxes? When smokers quit smoking, how does the subsequent reduced revenue stream affect government programs paid for by cigarette taxes? Don’t governments really need smokers to provide this tax money? If so, what incentive is there for them to try to reduce smoking rates?
In other words, governments win when they raise cigarette taxes and they lose tax money when smokers quit smoking.
Anti-tobacco advocates would argue that raising the tax of cigarettes drives down smoking rates, and generates revenue for anti-tobacco programs. How much of the cigarette tax money is going toward smoking cessation and prevention programs anyway?
I would argue that higher taxes might even encourage people to smuggle illegal cigarettes and avoid paying the tax. Raising taxes on cigarettes is no doubt an effective public health intervention to curb smoking rates and lead to a drop in smoking-related illnesses over time, which in turn reduces the health cost burden on states. However, it must not be the only way.
Tobacco is responsible for creating a vicious circle of poverty in the world, especially in developing countries. In developing countries, many of the poorest smokers spend significant amounts of their income on tobacco instead of basic human needs such as food, shelter, healthcare and education. In addition to the economic burden (both on individuals and nations) of treating smoking-related illnesses and the consequent lost productivity, tobacco farmers often become trapped in a cycle of poverty and debt after being forced to sign crippling contracts with the tobacco industry.
From a public health perspective, it is vital to also identify and focus on the various determinants of smoking initiation as well. Identification of these determinants will aid in understanding not just the economical factors but also the social and behavioral factors impacting smoking rates in developing countries.
There is a need to focus on designing multiple interventions to achieve not just a large drop in rates of smoking but also a sustained drop in smoking rates. The increase in cigarette taxes must just be one strategy among our repertoire of interventions. Therefore, alongside policy changes, interventions must be designed to continue to focus on:
- Improving education and awareness
- Focusing on the susceptible groups within a population
- Restrictions on smoking in public spaces
- Banning of advertising, promotion and sponsorships
- Stringent Packaging requirements
- Tax smoke-less tobacco products (such as gutka, naswar and paan) together with cigarettes
Related Articles:
Dawn: Pakistan among top four countries with rising tobacco use
University of Capetown: Cigarette taxes lead to big drop in smoking
Dawn: New Tobacco Taxes to Boost Revenue, Discourage Smoking
Another well written and informative article! Keep up the great work. I look forward to these interesting essays.
Thank you Pete!