There is good justification for governments to intervene to reduce tobacco use. Policies aimed at reducing demand for tobacco products are effective in reducing tobacco use. Tobacco control policies do not harm the economy. These are among the conclusions of a new study, Curbing the Epidemic: Governments and the Economics of Tobacco Control, released by the World Bank in 1999 and published in Spanish by PAHO and the World Bank in 2000. The report summarizes global evidence on effective measures to reduce tobacco use.

Why Should Governments Intervene?

• Most smokers are not fully aware of the risks of tobacco use: They do not know all of the health risks, they underestimate their chances of contracting a tobacco-related disease, and they underestimate the harm caused by tobacco use relative to other behaviors.
• Most smokers become addicted to tobacco when they are very young, usually in their teens. At this age, they are less able than adults to make sound decisions about what usually becomes a life-long addiction. If and when they understand the nature of nicotine addiction and the health consequences of smoking, the addiction makes it very difficult for them to quit.
• Smokers may impose the cost of their smoking on others. The costs are financial, when publicly-financed health care systems must provide care for diseases caused by smoking, and physical, when non-smokers are exposed to harmful tobacco smoke in homes and public places.

What Works to Reduce Tobacco Use?

The most effective interventions are those that reduce the demand for tobacco use. These include tobacco tax increases, consumer information, restrictions on advertising and on promotional activities such as sports and concert sponsorships by tobacco companies, restrictions on smoking in public places including workplaces, and targeted support for quitting smoking.

• Tobacco taxes represent one of the single most effective measures to reduce tobacco use. An increase of 10 per cent in the real price of tobacco products can be expected to lead to a 4 per cent decrease in consumption in high income countries, and an 8 per cent decrease in low and middle income countries.
• Consumer information, such as release of research on the health effects of tobacco use, health information on tobacco packages, mass media campaigns, and school education programs, can reduce tobacco use. Public release of health information has been found to be effective in developed countries and usually has the most impact when knowledge of health effects is low. Health information on tobacco packages is also effective, particularly where the information is specific and takes up a significant portion of the package. Studies in several countries have found that package warnings influenced many smokers to cut down or to try to quit. Mass media campaigns, particularly when combined with activities at the community level, are also effective. School education programs have been found to be less successful as effectiveness dissipates over time, particularly in the absence of other interventions, and when compared with more cost-effective interventions.
• Restrictions and bans on tobacco promotion are effective, but must be comprehensive to have a significant impact. This means that both direct and indirect advertising, such as promotion through event and other sponsorships, and through tobacco logos on non-tobacco goods, need to be covered, and all media (electronic, print, outdoor advertising, and point of sale) need to be included. Studies suggest that comprehensive bans on promotion could reduce consumption by 6 or 7 per cent.
• Restrictions on smoking in public and workplaces are usually put in place to protect non-smokers, but evaluations in Canada and the US show that they are extremely effective in reducing consumption, on the order of 4 to 10 per cent. They influence smokers to cut down, provide an incentive for attempts to quit smoking and, by influencing perceptions of the social acceptability of smoking, may deter smoking initiation.
• Although all of the above measures lead to increased quitting, support for smokers trying to quit is very important. Success at quitting smoking is greatly increased with behavioral or pharmaceutical support. These measures can have a significant impact on population tobacco use rates only if they are widely available and used.
• One supply-side intervention that is effective in reducing use is control of tobacco smuggling. Almost one-third of all exported cigarettes are sold as smuggled products. The widespread availability of smuggled cigarettes undermines government taxation policies designed to reduce demand for consumption, and deprives governments of tax revenue. Smuggling is not only a function of differing levels of taxation between countries, it is closely related to the level of corruption in a country.

What Doesn't Work?

Most interventions designed to decrease the supply of tobacco, such as the prohibition of tobacco, restrictions on sales to minors, crop substitution, and tobacco price supports, are not effective at reducing tobacco use. An important exception to this rule is the control of smuggling, as described above.

Some countries are hesitant to implement tough tobacco control measures because they fear resulting job losses, that tobacco tax increases will decrease government revenue and cause smuggling, and that tobacco control is not cost-effective.

Analyses of both developed and developing countries have found that tobacco use reduction will not result in job losses, as money not spent on tobacco will be spent on other goods and services. Almost all of these analyses predict that employment would actually increase if tobacco consumption were eliminated. Even in countries and regions for which tobacco production and export is a leading industry, declines in tobacco production will be gradual simply because of increased consumption due to population growth. There will be time to prepare for economic transition by diversifying economies and developing alternatives for tobacco producers.

• Increased tobacco taxes will not result in decreased tax revenue in the short and medium term, because demand is relatively inelastic. Consumption will fall proportionately less than revenues rise. Increased taxes may lead to increased smuggling only if there is a large price discrepancy between neighboring countries and if measures to control smuggling are not implemented. Reducing taxes in response to smuggling will reduce revenues far more than combining high taxes with law enforcement. When Canada reduced tobacco taxes in 1994 as a response to smuggling, government revenues fell dramatically.
• Tobacco control measures are highly cost-effective public health interventions in terms of money spent relative to years of life saved, comparing favorably with child immunization and integrated management of the sick child.

For more information contact:

Heather Selin (202) 974-3383; selinhea@paho.org

Bryna Brennan (202) 974-3457; brennanb@paho.org