Abstract
A new report from the World Health Organization and the NCI estimates that the worldwide cost of smoking—due to health problems and lost productivity—exceeds $1 trillion annually, with the biggest economic burden falling on low- and middle- income countries. That's because proven interventions, such as tax and price increases, are vastly underused in many nations.
The worldwide cost of smoking exceeds $1 trillion annually in healthcare expenditures and lost productivity due to tobacco-related illnesses, according to a recent report from the World Health Organization (WHO) and the NCI. The biggest economic burden falls on low- and middle-income countries, where about 80% of the world's 1.1 billion smokers live, and where rapid population growth has led to an overall increase in smoking.
According to the Economics of Tobacco and Tobacco Control, a 700-page monograph on global tobacco use and control efforts, the growing number of smokers threatens to derail the WHO's global target of a 30% relative reduction in tobacco use by 2025. The report estimates that tobacco-related deaths will increase from 6 million to 8 million per year by 2030, with more than 80% occurring in developing countries.
Despite the magnitude of the problem, however, proven interventions are vastly underused. “We've seen a lot of progress on tobacco control, but tobacco use is still very high worldwide,” says the report's co-editor Frank Chaloupka, PhD, of the University of Illinois at Chicago. “We need to make better use of effective interventions, including significant tax increases, smoke-free workplace policies, and comprehensive bans on tobacco advertising, promotion, and sponsorship.”
Raising excise taxes and retail cigarette prices has the most potential to reduce tobacco use. According to one study, an increase of about 80 cents per pack internationally would yield $140 billion in revenue and increase cigarette prices by 42%, leading to a 9% decline in smoking.
However, much of the revenue raised through excise taxes is not used to combat the smoking epidemic, the authors note. Of the $269 billion in government revenue generated globally in 2013 and 2014, less than $1 billion was invested in tobacco control.
“In the United States, for example, many states are not doing enough in terms of prevention,” says Graham Warren, MD, PhD, of the Medical University of South Carolina in Charleston, who serves on the American Association for Cancer Research's Tobacco and Cancer Subcommittee. “Tobacco tax revenues could be an enormous source to fund tobacco control efforts but that money is often used for other purposes.”
Besides tax and price increases, many countries must do more to stop the illicit tobacco trade, which is driven by weak tax administration and corruption, says Chaloupka. Also problematic is the continued marketing of tobacco products to vulnerable populations, including young people.
Under the WHO Framework Convention on Tobacco Control, signed in 2005, countries can collaborate on tobacco control, says Chaloupka. More than 180 nations have joined the public health treaty, which documents key measures to limit supply and demand and offers strategies to prevent industry interference in policy making.
The WHO/NCI report offers overwhelming evidence that the adverse effect of smoking on health far outweighs its economic benefit, says Warren.
“We have unequivocal data that smoking causes adverse health outcomes, shortens life spans between 13 and 15 years, and decreases work productivity,” he notes. “The cost of treating tobacco-related adverse outcomes, including cancer, far exceeds the total revenue generated by tobacco sales in any nation or worldwide.” –Janet Colwell
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