Editorials
New Zealand reverses landmark tobacco controls
BMJ 2023; 383 doi: https://doi.org/10.1136/bmj-2023-078799 (Published 08 December 2023) Cite this as: BMJ 2023;383:e078799Linked Opinion
Sunak’s smoke-free generation: spare a thought for the tobacco industry
Tobacco, the goose that laid the golden eggs: wealth of the budget vs health of the people?
Dear Editor
McKee and Hopkinson rightly point the finger of blame on New Zealand’s new government and its finance minister for the repeal of the groundbreaking anti-smoking law passed in 2022.(1) However, the authors' comments about the interplay between the health of the people and the wealth of the budget may be less accurate, stating “direct costs of smoking to societies through increased spending on healthcare and social care, as well as reduced productivity, which substantially exceed tax takes”.(1)
Firstly, smokers pay a large amount of taxes (on average 80% of cigarette price in most EU countries, not to account taxes from the industry and tobacconists' business).
Secondly, smoking may yield cost savings due to their premature death. Biases come from cross-sectional studies failing to account for total life-span. Indeed, prevention can increase health-care spending (2) as healthcare expenditures increase with age: average spending at 60 years old is twice as high as the spending at 40 years old and at 80 years expenditures are six-times higher than at 40 years.(3) Furthermore end-of-life costs, last 12 months of life, account for a modest fraction of total medical spending: 8.5 percent in the US.(4) As people who smoke die an average of 10 years earlier than non-smokers (5) total medical expenditures for people who smoke may hardly be higher than non-smokers, and the contrary is feasible. Of note, those who smoke are frequently from low-income/education, populations with limited access to care. Last, premature death results in less long-term nursing care, a major issue in our ageing societies, and less pension payment.(6)
Incidentally, people who smoke also have a lower individual carbon footprint than non-smokers.
Australia, with a daily smoking prevalence of 11.6%, is firstly seeing its tobacco tax revenue grow. Total federal revenue from tobacco products (millions, current dollars) rose from 5.0 in 2001 to 12.6 in 2023 with an expectation of 14.7 in 2027 (Table 13.6.5 in 7). Australia has no plan to copy New Zealand’s blueprint to become the first nation to reduce nicotine content, the key measure for preventing youth addiction and promoting the tobacco endgame.
References
1. McKee M, Hopkinson NS. New Zealand reverses landmark tobacco controls. BMJ. 2023;383:e078799. Published 2023 Dec 8. doi:10.1136/bmj-2023-078799
2. Temple NJ. Why prevention can increase health-care spending. Eur J Public Health 2012;22:618-9.
3. 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.
4. French EB, McCauley J, Aragon M, et al. End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported. Health Aff (Millwood). 2017;36(7):1211-1217. doi:10.1377/hlthaff.2017.0174
5. Jha P, Ramasundarahettige C, Landsman V, Rostrom B, Thun M, Anderson RN, McAfee T, Peto R. 21st-Century Hazards of Smoking and Benefits of Cessation in the United States. New England Journal of Medicine, 2013;368(4):341–50
6. Braillon A. Smoking-attributable medical expenditures: Time biases and smokers' social role. Prev Med 2015;81:294.
7. Greenhalgh, EM, Scollo, MM and Winstanley, MH. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2023. Available at
https://www.tobaccoinaustralia.org.au/chapter-13-taxation/13-6-revenue-f.... Accessed 13 December 2023.
Competing interests: No competing interests