Global Efforts to Combat Smoking

An Economic Evaluation of Smoking Control Policies

Rajeev K. Goel, Michael A. Nelson

• Publisher: Routledge
• Year: 2017
• Print ISBN:
  9781138356993
• eBook ISBN:
  9781351157384
• Topic: Business
• Subtopic: Business General
• Index: Business

Tobacco is reported to be the second major cause of death in the world and there is ever-increasing interest in the costs of smoking, especially in the light of evidence of the health effects of second-hand smoke. This book brings together the findings of economists on the effectiveness of price and non-price policy initiatives to combat smoking and draws conclusions regarding the efficacy of the various policy measures. The authors evaluate the relative effectiveness of price-based smoking control policies (i.e. tax) in relation to non-price strategies (including advertising restrictions, sales restrictions, territorial restrictions and health warnings). They review evidence not only from the US but also from around the world, drawing important conclusions for developing countries where smoking is on the rise. The book will be essential reading for policy makers, health practitioners and researchers in health economics.

Chapter 1
Overview of Global Tobacco Use and Related Policy Issues

Introduction

In recent years, there has been heightened interest among the public and policymakers regarding the costs of smoking, especially in light of the evidence on the health effects of second-hand smoke (Manning et al., 1989). Tobacco is reported to be the second major cause of death in the world. In the USA, for example, smoking related premature deaths are estimated to be about 400,000 per year and an additional 3,000 premature deaths are due to second-hand smoke. It is estimated that by the year 2030 worldwide death toll due to smoking will be around ten million annually (Mackay and Eriksen, 2002, pp. 36-37; also see Jha et al., 2006). Another disturbing statistic is that about half of the people who smoke today will eventually be killed by tobacco (Saffer and Chaloupka, 1999, http://www.who.int/tobacco/health_priority/en/print. html). Beyond this, tobacco consumption inflicts substantial indirect costs on society, including productivity losses, increased health care expenditures related to tobacco-related illnesses, fires caused by smoking, and so on.¹

In spite of these alarming health effects, smoking across the globe remains significant. Jha et al. (2002) report that approximately 47 percent of men and 11 percent of women smoke globally, with 80 percent of all smokers residing in low- or middle-income countries. According to the United Nations (FAO, 2003, Chapter 2.2.1) tobacco leaf consumption in developing countries grew 3.1 percent annually between 1970 and 2000.² In contrast, consumption in developed countries declined 0.2 percent annually during the same time period. By the end of the century, consumption in developing countries constituted 70 percent of the overall market. China alone consumed 35 percent of all tobacco globally. These general trends are expected to continue over the remainder of this decade, although the growth rate in consumption in developing countries is projected to slow down (FAO, 2003, Chapter 3.2).

In the last four decades governments across the world have tried to control cigarette consumption (smoking) using various measures. From 1970 to 1995, the World Health Assembly unanimously adopted 14 resolutions to control tobacco consumption (WHO, 1996). Roemer (1993, p. xi) reports that at the beginning of 1990s more than 90 countries and territories had national anti-smoking legislation. Initially these policies were driven from concerns regarding the health of smokers, while more recently the health of nonsmokers (dangers of second-hand smoke) has also been a concern. Recently, the World Health Organization has negotiated an international treaty to impose worldwide restrictions on tobacco marketing, consumption and smuggling (Framework Convention on Tobacco Control, www.who.int/mediacentre/releases/2003/prwhal/en/print.html).

In spite of all this attention, we lack an adequate global understanding of the causes of smoking and what policy initiatives are effective to control tobacco use. Are the various smoking control measures equally effective across developed and developing nations? Most of the research that has been conducted on tobacco has focused on developed countries, with the preponderance of analysis based on data from the USA. There is a crucial need for shifting focus to other countries, especially developing nations, where consumption has been on the rise.

In this book we synthesize the economics literature on the effectiveness of price and non-price policy initiatives in combating smoking.³ While a majority of the literature deals with the USA we have incorporated comparable studies, when available, from other countries as well. This international comparison is interesting since some countries (notably Canada and New Zealand) have more restrictive smoking control policies than the USA. Our analysis is unique in that we do not merely aim to provide a summary of the literature. Rather, our main focus is to draw conclusions from the extant literature regarding the effectiveness of alternate policy measures in checking smoking and to provide directions/suggestions for extending the scope of government intervention to other tobacco products.

A Look at Global Smoking Prevalence

Demographics are an important aspect to be considered in determining the consumer behavior with regard to tobacco products. Gender, age, ethnicity, religious background and education can have an impact on smoking behavior. For example, young people are more susceptible to be influenced by tobacco advertising and might also have a different responsiveness to price changes than adults due to the habit forming nature of the product. Smoking might also be more socially acceptable in certain cultures than others.

Table 1.1 provides some demographic statistics and how cigarette smoking changed between 1965 and 2004 in the USA. We see that smoking prevalence-defined as the percentage of adults (18 years and over) that are current smokers - declined for all demographic groups during this period. For the overall adult population, smoking prevalence was nearly cut in half, falling from 42 percent in 1965 to around 20 percent by 2004. The rate of decline was lower for women than for men, but the base of female smokers in 1965 was much lower (33 percent) compared with men (52 percent). Ethnically, smoking prevalence for whites and blacks is nearly identical, while the rate for Hispanics is lower. Not surprisingly, adults with a college education (16 years or more) have considerably lower smoking rates than the general population.

Table 1.1 Smoking prevalence in the USA

Longitudinal data on smoking prevalence globally are not available. What evidence is available suggests that smoking prevalence has now peaked for males in both developed and developing countries and is expected to slowly decline in future decades. For women, a similar trend is observed in developed countries, but smoking prevalence is still increasing or at least has not fallen in several southern, central, and Eastern European countries (Mackay and Eriksen, 2002, pp. 24-27).

Smoking prevalence varies a great deal across countries and between youth and adult populations. In the next few tables we describe this diversity by summarizing how smoking prevalence varies among nations of the world according to 1) the geographic region where they are located, 2) their stage of development, and 3) by the primary religion of the country. Data on smoking rates for adults and youth, and by gender, for individual countries can be found in Appendix 1.1.

Individual countries reveal some interesting differences in smoking rates. Nearly half the adult population in Bosnia and Herzegovina, Guinea, Kenya, Mongolia, Namibia, Nauru and Yugoslavia smokes, while less than a tenth of the adult population smokes in Barbados, Libya, Rwanda and the United Arab Emirates. Further, there appear to be large differences in smoking rates between males and females in Armenia, Azerbaijan, Belarus, Cambodia, Cote D'Ivoire, Gambia, Indonesia, Kazakhstan, Lesotho, Morocco and Zambia.

International data on smoking prevalence and annual consumption by geographic region (unweighted country averages for 2001 or nearest available year) are presented in Table 1.2. The data reveal that the incidence of adult smoking is highest in Eastern Europe and Central Asia, especially for males.⁴ For example, nearly half of all males (48.6 percent) are smokers in this region. This is nearly double the number of male smokers in North America (Canada and the USA).

Table 1.2 Smoking trends by geographic region* (2000 or most recent year)

Smoking prevalence rates among women remain consistently below those for males in all geographic regions. There is considerable variation in smoking rates in females across regions, yet the pattern is quite different from males. The highest incidence of this (female smoking) is in Western Europe (24.7 percent) and in North America (22.3 percent), where ...

Table of contents

• Cover
• Half Title
• Dedication
• Title
• Copyright
• Contents
• List of Figures and Tables
• Foreword
• 1 Overview of Global Tobacco Use and Related Policy Issues
• 2 Cigarette Demand and Price-Based Policies
• 3 Cigarette Demand and Influence of Related Products
• 4 Tobacco Smuggling
• 5 Cigarette Advertising and Bans
• 6 Health Warnings
• 7 Territorial Smoking Restrictions
• 8 Economics of Smoking Cessation
• 9 Comprehensive Tobacco Control Policies
• 10 Policy Issues and Directions for Future Research
• Bibliography
• Index