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The health benefits of taxing tobacco

Cancer of all types is a growing cause of disease in low and middle-income countries and smoking tobacco is a major contributing factor to many cancers. Smoking is also a prime cause of poor health and chronic lung diseases like emphysema. Unlike in countries with higher GDP, there may be poor medical facilities to diagnose and treat people with early stage disease and drugs are often expensive and beyond the reach of patients suffering a range of lung conditions caused by their habit.

One of the things we are focusing on at Cancer Research UK is the best way to prevent people from starting smoking and helping smokers to stop. One well-established rule is that demand for tobacco products goes down when prices go up. This holds true in the developed world as well as the developing world. The principle of placing tax on tobacco products is a win-win situation, with patients at high risk smoking less and governments being able to raise extra revenues. We believe that where possible this revenue should be ring-fenced to fund universal health coverage. This is working well in the Philippines for example, when they imposed their so-called ‘sin taxes’ on tobacco and alcohol.

Unfortunately, we do need more evidence to strengthen our case and persuade governments to try taxation as a deterrent, often in the face of contradictory opinion from powerful tobacco lobbies. Manufacturers and suppliers may have a great deal of influence with government finance ministers and they champion the view that higher tobacco prices will just lead to an increase in the amount of illicit non-taxed tobacco products.

For this reason, the International tobacco control programme at Cancer Research UK invited researchers to put together expressions of interest to carry out some vital research to explore whether raising taxes on tobacco affects the extent of the illicit trade in tobacco products. At this point, we are considering proposals from a South African university.  We are planning to review their proposals in early October with work planned to start in early 2017. I know that there is plenty of interest from many governments around the world in this research that feel that they have a health time bomb which needs to be defused as soon as possible.

The idea is that the researchers will estimate the extent of the illicit trade before taxes are increased, then four months after, which is roughly how long it takes for the market to settle down after a tax rise, and then approximately 12-months after the first survey which should allow us to establish if a relationship exists between the two variables.

This study should contribute to evidence which can help governments make informed decisions about how the illicit trade in tobacco products may respond under certain contexts to higher tobacco taxes.

Although taxation is a key aim of our programme, there are other effective measures like advertising bans and putting tobacco products out of sight in shops. Plain packaging is another option to de-glamorise smoking and make it less attractive to new smokers.  It is also important to think about ways to inform and educate people in countries where incomes are low. Public health campaigns are useful but it can also be a good idea to harness existing community networks like churches, community groups and online resources. Where smoking is an important part of the local culture, new cultural norms may have to be championed.

The latest figures suggest that if you smoke there is a two in three chance that you will live 15 years less than someone who doesn’t smoke. With scary statistics like these, it is vital that we get the message about best practice to reduce smoking rates to all parts of the world.

Dr Alastair Bradstock is speaking today the RSM conference on cancer control in low and middle-income countries.

Dr Alastair Bradstock
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