A call to governments worldwide to triple tax on tobacco in order to prevent premature deaths from lung cancer and other disease is made in a review article published online January 1 in the New England Journal of Medicine.
"The two certainties in life are death and taxes. We want higher tobacco taxes and fewer tobacco deaths," commented senior author Sir Richard Peto, FRS, from the University of Oxford, United Kingdom, who was involved in one of the first epidemiologic trials to establish the damage caused by smoking.
Together with Prabhat Jha, MD, DPhil, from the University of Toronto, Ontario, Canada, he notes that, "Price is the key determinant of smoking uptake and cessation."
The authors explain that tripling inflation-adjusted specific excise taxes on tobacco would, in many low- and middle-income countries, approximately double the average price of cigarettes (and more than double the price of cheaper brands). This would encourage people to stop smoking or to reduce their consumption, and would help to prevent others from starting, they say.
The result would be a reduction of cigarette consumption by about a third, they suggest. (This would meet the target that has been set by the 2013 World Health Assembly to decrease the prevalence of smoking by a third by 2050).
We want higher tobacco taxes and fewer tobacco deaths, Sir Richard Peto
This "would prevent several tens of millions of tobacco-attributable deaths during the next few decades," they write, "
mostly among people who are already alive, both by helping smokers to quit and by helping adolescents not to start."
About 200 million tobacco-attributable deaths would be prevented by 2100, they estimate.
Scheme Has Already Worked
The authors cite the case of France and South Africa to show that the proposals they outline would work.
From 1990 to 2005, France tripled inflation-adjusted cigarette prices by raising taxes by 5% or more every year in excess of inflation. In that same period, cigarette consumption in France was halved.
"Today, the ratio of former smokers to current smokers in France comfortably exceeds the European average," they comment.
South Africa has also halved consumption of cigarettes over a similar period of 15 years, also by using large tax increases, the authors note.
Several other countries have also been using large increases in specific excise taxes on tobacco to reduce smoking, including Mauritius, Mexico, the Philippines, Poland, and Turkey.
Other interventions to reduce smoking have also been effective, the authors comment. They cite bans on tobacco advertising, bans on smoking in public places, and prominent pictorial health warnings and plain packaging (so far introduced only in Australia, although it is now planned for New Zealand and is being reconsidered in the United Kingdom).
However, the authors maintain that without large price increases on cigarettes, a one-third reduction in smoking would be difficult to achieve.
Hiking up the taxes would also have the additional benefit of increasing money coming into governments, which could be used to fund tobacco-control programs or broader health efforts, they comment. "Much of the revenue from the 2009 U.S. taxation increase of 53 cents per pack of 20 cigarettes is allocated to expand children's health insurance," they note.
The authors have disclosed no relevant financial relationships.
N Engl J Med. Published online January 1, 2014. Full text
Poster Comment:
In addition a buck or two needs to be added to a pack to pay for the cost of fighting fires caused by careless smokers.