The health, poverty, and financial consequences of a cigarette price increase among 500 million male smokers in 13 middle income countries: compartmental model studyBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1162 (Published 11 April 2018) Cite this as: BMJ 2018;361:k1162
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Voltaire’s warning “May God defend me from my friends: I can defend myself from my enemies.” Could fit with the research article about benefits of taxing cigarettes and the accompanying editorial.(1,2) Indeed, taxes are a smokescreen!
First, tobacco control policies must be comprehensiveness, not cherry-picking. Why the two most effective measures, banning menthol and reducing nicotine content, have not been implemented yet in any county?
Second smokers pay large amount of taxes (in most developed countries it is more than 80% of cigarettes prices, a rate which did not account taxes paid by the industry and the tobacconists for their business). The tobacco industry only get tips, it is the producer not the dealer.
Third, smokers also yield major cost savings due to their premature death. MacCord and Novotny claimed that” the tobacco industry muddied” when claiming expenditures for smoking related illness can be offset by decreased public benefits due to shorter lifespans of smokers.(3) In fact, flaws and biases come from cross-sectional studies about cost of care due to tobacco which grossly failed to account for total life-span. Healthcare expenditures increase with age (average spending on 60 year olds is twice as high as the spending for 40 year olds and 80 year olds have on average six-times higher expenditures than 40 year olds).(4) As smokers die an average of 10 years earlier than non-smokers, medical expenditures are lower for smokers than non-smokers. Moreover, smokers are frequently from low-income/education, populations with limited access to care. Frequently prevention can increase health-care spending.(5) Last, medical expenditures fail to include long-term nursing care, a major issue in our ageing societies. Similarly, smokers also yield major cost savings in pension payments due to their premature death. Smokers social role cannot be overlooked.(2)
Could it be an accident that smoking prevalence has been plateauing for so long in France, at 35%, (daily 29%) in 2015? No governments have allowed a relevant (10%) increase in cigarettes taxes from 2004 to 2017 (in a wealthy country as France a 10% increase in taxes is needed for a 4% decrease in sales). The one this year will cover a five years period! The policy is first aimed at increasing revenue, not at decreasing the burden of smoking.
Third, the concern for developing countries is at best naive. There, tobacco farms are a key issue for economy. Tedros Adhanom Ghebreyesus, the present WHO DG, when being Ethiopia’s Foreign Minister failed to speak out against: a) the US$510 million deal of his government with Japan Tobacco International; b) the British American Tobacco advertising campaign authorized by his government.(6) The Ethiopian government, through its tobacco monopoly web site, clearly states that its aim is to expand its tobacco fields and increase the number of smokers.(http://addisstandard.com/behind-the-smokescreen-of-ethiopias-surging-tob...) In 2016, WHO choose India for the 7th meeting of the Convention for Tobacco Control. India policy is clear: “Tobacco Board is committed to accomplishing its role - the expressed will of parliament - for the smooth functioning of a vibrant farming system, fair and remunerative prices to tobacco growers and export promotion.”(https://tobaccoboard.com/indexeng.php) Indeed, tobacco is a lifeboat for the economy, India ranks third in the world for commercial crop grown.
From 1980 to 2004 the annual decrease in the prevalence of daily smoking was on a fast track, reaching 2%. Since 2004, the year of the WHO’s Convention for Tobacco Control, it has levelled off and the 2012 annualized rate of change in prevalence of daily smoking is now almost null.(7, see Fig 1b) WHO’s Convention for Tobacco Control is a scrap of paper because WHO has been failing to act for better compliance, either for basic requirements (the 6th session of the Conference was held in Moscow with 179 countries but 46 of them were only tourists as they failed to produce their self-assessment report (http://www.who.int/entity/fctc/reporting/2014globalprogressreport.pdf?ua=1) or for the most serious issues such as obvious violations of the article 5.3 of the Convention, which requires members states to protect public health policies from the influence of the tobacco industry.(8)
1 Global Tobacco Economics Consortium. The health, poverty, and financial consequences of a cigarette price increase among 500 million male smokers in 13 middle income countries: compartmental model study. BMJ 2018;361:k1162.
2 McCord GC, Novotny TE. The benefits of taxing cigarettes in middle income countries. BMJ 2018;361:k1433.
3 Braillon A. Smoking-attributable medical expenditures: Time biases and smokers' social role. Prev Med 2015;81:294.
4 Melberg H O. Are healthcare expenditures increasing faster for the elderly than the rest of the population? Expert Rev Pharmacoecon Outcomes Res 2014;14:581-3.
5 Temple NJ. Why prevention can increase health-care spending. Eur J Public Health 2012;22:618-9.
6 Ashall F.Questions around the candidacy of Dr Tedros Adhanom Ghebreyesus for WHO DG. Lancet. 2017;389:e10.
7 Ng M, Freeman MK, Fleming TD et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA 2014;311:183-92.
8 Braillon A. The Framework Convention on Tobacco Control. Lancet 2016 7;387:1907.
Competing interests: AB, a senior tenured consultant , was illegally sacked by the Ministry of Health in 2009 while his boss was sued for libel by the tobacconists union. (Witton J, O’Reilly J. Tobacco scientist wins case against illegal sacking. Addiction 2012;107:1714-5)