1
|
Devaux M, Dorfmuller Ciampi M, Guignard R, Lerouge A, Aldea A, Nguyen-Thanh V, Beck F, Arwidson P, Cecchini M. Economic evaluation of the recent French tobacco control policy: a model-based approach. Tob Control 2024:tc-2023-058568. [PMID: 39084903 DOI: 10.1136/tc-2023-058568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/18/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND One in four French adults smoked daily in 2021, compared with one in six in Organisation for Economic Co-operation and Development (OECD) countries. To strengthen its tobacco control policy, in 2016, France has started implementing a policy package that includes a 3-year gradual price increase, plain packaging, an annual social marketing campaign promoting cessation and the reimbursement of nicotine replacement products. This study aims to evaluate the health and economic impact of this policy package. METHODS The long-term policy impact on disease cases, healthcare expenditure and gains in labour participation and productivity was evaluated by using the OECD microsimulation model for Strategic Public Health Planning for Non-Communicable Diseases. The model was fed with historical and projected trends on tobacco smoking prevalence as produced by the policy package. RESULTS Over the period 2023-2050, the policy package is estimated to avoid about 4.03 million (2.09-11.84 million) cases of chronic diseases, save €578 million (365-1848 million) per year in health expenditure and increase employment and workforce productivity by the equivalent to 19 800 (9100-59 900) additional full-time workers per year, compared with a scenario in which the intervention package is not implemented. The intervention cost is estimated at about €148 million per year. For each euro invested in the policy package, €4 will be returned in long-term savings in healthcare expenditure. CONCLUSIONS The tobacco control policy package implemented by France, targeting smoking initiation and promoting tobacco cessation is an effective intervention with an excellent return on investment.
Collapse
Affiliation(s)
| | | | - Romain Guignard
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | | | | | - Viêt Nguyen-Thanh
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | - François Beck
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | - Pierre Arwidson
- Santé Publique France, The French Public Health Agency, Saint-Maurice, France
| | | |
Collapse
|
2
|
Spencer G, Nugent R, Mann N, Hutchinson B, Ngongo C, Tarlton D, Small R, Webb D. Equity implications of tobacco taxation: results from WHO FCTC investment cases. Tob Control 2024; 33:s27-s33. [PMID: 38697660 PMCID: PMC11103284 DOI: 10.1136/tc-2023-058338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/19/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Across time, geographies and country income levels, smoking prevalence is highest among people with lower incomes. Smoking causes further impoverishment of those on the lower end of the income spectrum through expenditure on tobacco and greater risk of ill health. METHODS This paper summarises the results of investment case equity analyses for 19 countries, presenting the effects of increased taxation on smoking prevalence, health and expenditures. We disaggregate the number of people who smoke, smoking-attributable mortality and cigarette expenditures using smoking prevalence data by income quintile. A uniform 30% increase in price was applied across countries. We estimated the effects of the price increase on smoking prevalence, mortality and cigarette expenditures. RESULTS In all but one country (Bhutan), a one-time 30% increase in price would reduce smoking prevalence by the largest percent among the poorest 20% of the population. All income groups in all countries would spend more on cigarettes with a 30% increase in price. However, the poorest 20% would pay an average of 12% of the additional money spent. CONCLUSIONS Our results confirm that health benefits from increases in price through taxation are pro-poor. Even in countries where smoking prevalence is higher among wealthier groups, increasing prices can still be pro-poor due to variable responsiveness to higher prices. The costs associated with higher smoking prevalence among the poor, together with often limited access to healthcare services and displaced spending on basic needs, result in health inequality and perpetuate the cycle of poverty.
Collapse
Affiliation(s)
| | - Rachel Nugent
- RTI International, Research Triangle Park, North Carolina, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Nathan Mann
- RTI International, Research Triangle Park, North Carolina, USA
| | | | - Carrie Ngongo
- RTI International, Research Triangle Park, North Carolina, USA
| | | | - Roy Small
- HIV, Health and Development Group, United Nations Development Programme, New York, New York, USA
| | - Douglas Webb
- United Nations Development Programme, Amman, Jordan
| |
Collapse
|
3
|
Prust ML, Forman R, Ovbiagele B. Addressing disparities in the global epidemiology of stroke. Nat Rev Neurol 2024; 20:207-221. [PMID: 38228908 DOI: 10.1038/s41582-023-00921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Stroke is the second leading cause of death and the third leading cause of disability worldwide. Though the burden of stroke worldwide seems to have declined in the past three decades, much of this effect reflects decreases in high-income countries (HICs). By contrast, the burden of stroke has grown rapidly in low-income and middle-income countries (LMICs), where epidemiological, socioeconomic and demographic shifts have increased the incidence of stroke and other non-communicable diseases. Furthermore, even in HICs, disparities in stroke epidemiology exist along racial, ethnic, socioeconomic and geographical lines. In this Review, we highlight the under-acknowledged disparities in the burden of stroke. We emphasize the shifting global landscape of stroke risk factors, critical gaps in stroke service delivery, and the need for a more granular analysis of the burden of stroke within and between LMICs and HICs to guide context-appropriate capacity-building. Finally, we review strategies for addressing key inequalities in stroke epidemiology, including improvements in epidemiological surveillance and context-specific research efforts in under-resourced regions, development of the global workforce of stroke care providers, expansion of access to preventive and treatment services through mobile and telehealth platforms, and scaling up of evidence-based strategies and policies that target local, national, regional and global stroke disparities.
Collapse
Affiliation(s)
- Morgan L Prust
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
| | - Rachel Forman
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Bruce Ovbiagele
- Department of Neurology, University of California-San Francisco School of Medicine, San Francisco, CA, USA
| |
Collapse
|
4
|
Zhang Z, Huang M, Chen T. Probability and predictors of long-term smoking relapse among Chinese adult smokers: A longitudinal study. Prev Med Rep 2023; 36:102482. [PMID: 37920593 PMCID: PMC10618515 DOI: 10.1016/j.pmedr.2023.102482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
Numerous smokers attempt to quit smoking, but most cessation efforts prove unsuccessful. Scarce evidence exists regarding predictors of long-term relapse in China. This study aims to evaluate the probability of relapse and examine factors may contribute to relapse among Chinese adults. A dynamic cohort of 6,036 observations on 2,378 adult quitters was constructed from the China Family Panel Studies in 2010, 2012, 2014, 2016 and 2018. The life table method was employed to calculate the probability of relapse for long-term smoking abstinence. Multivariate complementary log-log survival models were developed to examine the predictors of smoking relapse. We found that the probability of relapse decreased as the duration of abstinence increased, with rates of 49.07 %, 20.05 %, 10.29 %, and 6.63 % at 2, 4, 6, and 8 years of abstinence, respectively. The cumulative probability of relapse within 8 years was 65.89 %. Age ≥65 years, higher educational attainment, respiratory disease, and a satisfying lifestyle were associated with a reduced likelihood of relapse. Conversely, higher occupational prestige, alcohol drinking, cohabitant smoking, and greater future confidence were associated with an increased risk of relapse. These findings demonstrated that the probability of relapse decreased progressively over time, with most relapses occurring in the initial two years following quit attempts. Predictors of Chinese quitters' relapse behavior in our study were similar to those in previous studies. Drinking and cohabitant smoking were identified as strong predictors of relapse in this population.
Collapse
Affiliation(s)
| | | | - Ting Chen
- School of Public Health, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| |
Collapse
|
5
|
Hong Q, Su J, Hong P. Tobacco excise tax reform: From the perspective of "tax to control tobacco" policy in China. HEALTH ECONOMICS 2023; 32:2260-2277. [PMID: 37365696 DOI: 10.1002/hec.4728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023]
Abstract
The consumption of tobacco is harmful to health and has huge social costs. "Tax to control tobacco" is a widely implemented tobacco control measure all over the world. In order to examine the achievements of two tobacco excise tax reforms in China in 2009 and 2015 on controlling tobacco consumption, we first establish an intertemporal consumption model for addictive goods, and then validate the effectiveness of the two tobacco excise tax reforms using a Continuous Difference-in-Differences Model based on the panel data from 294 cities in China from 2007 to 2018. The results show that the tobacco excise tax reform in 2015 considerably reduced tobacco consumption, while the reform in 2009 did not, providing empirical evidence on the importance of "price links to tax" for tobacco control. Additionally, the study discovers that the tax reform has a heterogeneous effect on the age of smokers, the price of cigarettes, and city size.
Collapse
Affiliation(s)
| | - Jie Su
- Peking University, Beijing, China
| | | |
Collapse
|
6
|
Paraje GR, Jha P, Savedoff W, Fuchs A. Taxation of tobacco, alcohol, and sugar-sweetened beverages: reviewing the evidence and dispelling the myths. BMJ Glob Health 2023; 8:e011866. [PMID: 37813440 PMCID: PMC10565262 DOI: 10.1136/bmjgh-2023-011866] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/05/2023] [Indexed: 10/13/2023] Open
Abstract
The article reviews the large body of evidence on how taxation affects the consumption of tobacco, alcohol, and sugar-sweetened beverages (SSB). There is abundant evidence that demand for tobacco, alcohol, and SSB is price-responsive and that tax changes are quickly passed on to consumers. This suggests that taxes can be highly effective in changing consumption and reducing the burden of diseases associated with consuming these products. Tobacco, alcohol, and SSB industries oppose taxation on similar grounds, mostly on the regressivity of taxes since regressive taxes take a larger percentage of income from low income earners than from middle and high income earners; but also on the effects taxes might have on employment and economic activity; and, in the case of tobacco, the effects taxation has on illicit trade.Contrary to industry arguments, evidence shows that taxation may have short-term negative financial consequences for low-income households. However, medium and long-term financial benefits from reduced healthcare costs, better health, and welfare largely compensate for such consequences. Moreover, taxation does not negatively affect aggregate economic activity or employment, as consumers switch demand to other products that generate employment and may compensate for any employment loss in taxed sectors. Evidence also shows the revenues generated are generally spent on labour-intensive services. In the case of illicit trade in tobacco, evidence shows that illicit trade has not increased globally (rather the opposite) despite increases in tobacco taxes. Profit-maximising smugglers increase illicit cigarette prices along with the increases in licit cigarette prices. This implies that even when increased taxes divert some demand to the illicit market, they push prices up in the illicit market, discouraging consumption.
Collapse
Affiliation(s)
- Guillermo R Paraje
- Escuela de Negocios, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago de Chile, Chile
| | - Prabhat Jha
- CGHR, Centre for Global Health Research, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Alan Fuchs
- World Bank, Washington, District of Columbia, USA
| |
Collapse
|
7
|
Guindon GE, Abbas U, Trivedi R, Garasia S, Johnson S, John RM. Socioeconomic differences in the impact of prices and taxes on tobacco use in low- and middle-income countries-A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002342. [PMID: 37756265 PMCID: PMC10529577 DOI: 10.1371/journal.pgph.0002342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023]
Abstract
There is indisputable evidence that increases in taxes that raise tobacco prices reduce tobacco use. Consumption taxes on manufactured tobacco products, however, can be regressive in socioeconomic status (e.g., when the ratio of tax paid to income is lower for higher-income groups than for lower-income groups). Nevertheless, if the poor or less educated are more price responsive, a change in tobacco tax may be progressive in socioeconomic status. Existing reviews clearly indicate that populations with lower income or education are more responsive to tobacco tax and price changes than higher-income and more educated populations in high-income countries. Research pertaining to low- and middle-income countries was, however, limited and inconclusive. We conducted a review of quantitative studies that examined if socioeconomic status modified the association between prices and taxes and tobacco use in low- and middle-income countries. We searched two electronic databases, two search engines, and two working paper repositories. At least two reviewers independently screened articles for inclusion, extracted detailed characteristics, and assessed the risk of bias of each included study. Thirty-two studies met our inclusion criteria. Overall, we found that the evidence in low- and middle-income countries was too limited and methodologically weak to make any conclusive statements. Our review highlights a number of data and methodological limitations in existing studies. The most important limitation was the lack of formal assessment of socioeconomic differences in price responsiveness. Only seven of 32 studies assessed statistically whether own-price effects were modified by socioeconomic status. Many modelling studies have examined the distributional effect of a tax increase on tobacco use, while assuming a strong own-price elasticity gradient in income. The poor were generally assumed to be more responsive to price by a factor of two to five, relative to the wealthy. Although there are theoretical reasons to expect poorer individuals to be more responsive to monetary prices than wealthy ones in low- and middle-income countries, our review provides little empirical support.
Collapse
Affiliation(s)
- G. Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Umaima Abbas
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Riya Trivedi
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Sophiya Garasia
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sydney Johnson
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Rijo M. John
- Rajagiri College of Social Sciences, Rajagiri PO, Kochi, Kerala, India
| |
Collapse
|
8
|
Huang V, Head A, Hyseni L, O'Flaherty M, Buchan I, Capewell S, Kypridemos C. Identifying best modelling practices for tobacco control policy simulations: a systematic review and a novel quality assessment framework. Tob Control 2023; 32:589-598. [PMID: 35017262 PMCID: PMC10447402 DOI: 10.1136/tobaccocontrol-2021-056825] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/27/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Policy simulation models (PSMs) have been used extensively to shape health policies before real-world implementation and evaluate post-implementation impact. This systematic review aimed to examine best practices, identify common pitfalls in tobacco control PSMs and propose a modelling quality assessment framework. METHODS We searched five databases to identify eligible publications from July 2013 to August 2019. We additionally included papers from Feirman et al for studies before July 2013. Tobacco control PSMs that project tobacco use and tobacco-related outcomes from smoking policies were included. We extracted model inputs, structure and outputs data for models used in two or more included papers. Using our proposed quality assessment framework, we scored these models on population representativeness, policy effectiveness evidence, simulated smoking histories, included smoking-related diseases, exposure-outcome lag time, transparency, sensitivity analysis, validation and equity. FINDINGS We found 146 eligible papers and 25 distinct models. Most models used population data from public or administrative registries, and all performed sensitivity analysis. However, smoking behaviour was commonly modelled into crude categories of smoking status. Eight models only presented overall changes in mortality rather than explicitly considering smoking-related diseases. Only four models reported impacts on health inequalities, and none offered the source code. Overall, the higher scored models achieved higher citation rates. CONCLUSIONS While fragments of good practices were widespread across the reviewed PSMs, only a few included a 'critical mass' of the good practices specified in our quality assessment framework. This framework might, therefore, potentially serve as a benchmark and support sharing of good modelling practices.
Collapse
Affiliation(s)
- Vincy Huang
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Anna Head
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Iain Buchan
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Simon Capewell
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| |
Collapse
|
9
|
Kooshkebaghi M, Dargahi H, Emamgholipour S. The role of taxation measures in the management of harmful products, services, and practices in Iran: a qualitative study. BMC Public Health 2022; 22:2307. [PMID: 36494705 PMCID: PMC9733354 DOI: 10.1186/s12889-022-14673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIM Levying a tax on harmful products, services, and practices can affect consumer choices, effectively preventing diseases and reducing health care costs. The goal of this study was to investigate the role of taxation as a powerful financial tool in the management of harmful products, services, and practices to maintain and improve public health and preserve the financial sustainability of the health care system. MATERIALS AND METHODS This qualitative study was conducted in 2020-2021. In order to collect information for this study, semi-structured interviews were conducted. Using purposive and snowball sampling methods, 38 managers, policymakers, economists, and key experts were interviewed. Data were analyzed using the content analysis method. The transcribed interviews were further imported into MAXQDA for classification, and relevant codes were extracted. FINDINGS In this study, 6 main themes and 19 subthemes were labeled. The main themes included 1) objectives, effects, and requirements of the taxation of harmful products, services, and practices, 2) definition, instances, elasticity, and grading of harmful products, services, and practices, 3) Problems in controlling harmful products, services, and practices, 4) controlling harmful products, services, and practices, 5) traffic violations and accidents, and social harms, and 6) tax revenue use and the share of health care. The effects of taxing harmful products include reduced access to these products, reduced demand for harmful products, and the promotion of public health. CONCLUSION Harmful products, services, and practices have major health and financial implications for individuals, families, and society. To improve public health, the demand for these products and services can be controlled through taxation measures to push consumers toward less harmful alternatives.
Collapse
Affiliation(s)
- Mahdi Kooshkebaghi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Dargahi
- Department of Health Management and Economics, School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sara Emamgholipour
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Kooshkebaghi M, Emamgholipour S, Dargahi H. Explaining specific taxes management and use in the health sector: a qualitative study. BMC Health Serv Res 2022; 22:1220. [PMID: 36180837 PMCID: PMC9524337 DOI: 10.1186/s12913-022-08556-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 09/08/2022] [Indexed: 01/22/2023] Open
Abstract
Background and aim Being the major source of revenue and essential economic tool for policymakers to improve public health, taxes contribute to government spending on the development of health care facilities and services. Given the financial challenges facing the health sector together with the public health issues that affect each society, placing specific taxes on some goods, services, and activities can be effective in this regard. The study aims to explain the various dimensions of specific taxes in the health sector and management of these resources in order to achieve the health system goals. Materials and methods This study with a qualitative research design was conducted using semi-structured interviews with open-ended questions in 2020–2021. In total, 38 managers, policymakers, economists, key experts, and other individuals, as informants, were interviewed. Purposive and snowball with maximum variation was also employed. As well, content analysis was utilized to shed light on the data. The transcribed interviews were further imported into MAXQDA for extracting and classifying the relevant codes. Findings In this study, 5 main themes and 23 subthemes were labeled. The main themes accordingly included “Objectives and Conditions of Specific Health Taxes”, “Earmarked Taxes”, “Taxes on Goods and Measures of Harmful to Health”, “Value-Added Taxes”, and “Green Taxes”. Discussion and conclusion Considering the specific taxes in the health sector, i.e., taxes on goods and measures of harmful to health, value-added taxes, and green taxes, all taxation and pricing policies need to take account of the effects as well as the advantages and disadvantages of types of taxes, a country’s economic structure, the conditions of industries and manufacturing enterprises, cultural aspects in society, and peoples’ socioeconomic status.
Collapse
Affiliation(s)
- Mahdi Kooshkebaghi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Emamgholipour
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Dargahi
- Department of Health Management and Economics, School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
11
|
Jiang X, Jackson LJ, Syed MA, Avşar TS, Abdali Z. Economic evaluations of tobacco control interventions in low- and middle-income countries: a systematic review. Addiction 2022; 117:2374-2392. [PMID: 35257422 DOI: 10.1111/add.15821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Tobacco consumption and its associated adverse outcomes remain major public health issues, particularly in low- and middle-income countries. This systematic review aimed to identify and critically assess full economic evaluations for tobacco control interventions in low- and middle-income countries. METHODS Electronic databases, including EMBASE, MEDLINE and PsycINFO and the grey literature, were searched using terms such as 'tobacco', 'economic evaluation' and 'smoking' from 1994 to 2020. Study quality was assessed using the Consensus Health Economic Criteria and the Philips checklist. Studies were included which were full economic evaluations of tobacco control interventions in low- and middle-income settings. Reviews, commentaries, conference proceedings and abstracts were excluded. Study selection and quality assessment were conducted by two reviewers independently. A narrative synthesis was conducted to synthesize the findings of the studies. RESULTS This review identified 20 studies for inclusion. The studies evaluated a wide range of interventions, including tax increase, nicotine replacement therapy (nicotine patch/gum) and financial incentives. Overall, 12 interventions were reported to be cost-effective, especially tax increases for tobacco consumption and cessation counselling. There were considerable limitations regarding data sources (e.g. using cost data from other countries or assumptions due to the lack of local data) and the model structure; sensitivity analyses were inadequately described in many studies; and there were issues around the transferability of results to other settings. Additionally, the affordability of the interventions was only discussed in two studies. CONCLUSIONS There are few high-quality studies of the cost-effectiveness of tobacco use control interventions in low- and middle-income countries. The methodological limitations of the existing literatures could affect the generalizability of the findings.
Collapse
Affiliation(s)
- Xiaobin Jiang
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louise J Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Muslim Abbas Syed
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tuba Saygın Avşar
- Department of Applied Health Research, University College London, London, UK
| | - Zainab Abdali
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
12
|
Chakrabarti A, Memirie ST, Yigletu S, Mirutse MK, Verguet S. The potential distributional health and financial benefits of increased tobacco taxes in Ethiopia: Findings from a modeling study. SSM Popul Health 2022; 18:101097. [PMID: 35620486 PMCID: PMC9127671 DOI: 10.1016/j.ssmph.2022.101097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 03/07/2022] [Accepted: 04/11/2022] [Indexed: 11/12/2022] Open
Abstract
Ethiopia raised taxes on tobacco products in early 2020, increasing the overall price of the typical pack of cigarettes by about 67%. We quantify the potential impacts of Ethiopia's tobacco tax hike on various outcomes-life years, tax revenues, cigarette expenditures and catastrophic health expenditures (CHE). Using parameters like price elasticity of demand for cigarettes and smoking prevalence in Ethiopia from the existing literature and secondary data sources, we model the potential implications of the reform at the population level and for different wealth quintiles. We focus only on men since a small proportion of Ethiopian women smoke. Results indicate that Ethiopia's tax hike could induce a significant proportion of current smokers to quit smoking and thereby save almost eight million years of life in the current population. The reform is also likely to increase tax revenues by USD26 million in the first year after its introduction. The richest quintile will bear the greatest share of this higher tax burden and the poorest will bear the least. Additionally, deaths due to the main diseases associated with smoking will fall. This is expected to avert up to 173,000 CHE cases due to the out-of-pocket costs that would have been incurred in obtaining medical treatment. This analysis highlights that cigarette tax hikes in countries that have low smoking prevalence can reduce smoking even further, and thereby protect against the future health and financial costs of smoking. Importantly, the effects of these policies can be progressive across the income spectrum.
Collapse
Affiliation(s)
- Averi Chakrabarti
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Solomon Tessema Memirie
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, NBH1, 4killo King George VI Street, Addis Ababa, Ethiopia
| | - Seblewongel Yigletu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Mizan Kiros Mirutse
- Federal Ministry of Health of Ethiopia, 1234 Sudan Street, Addis Ababa, Ethiopia
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| |
Collapse
|
13
|
Gibbs N, Angus C, Dixon S, Charles DH, Meier PS, Boachie MK, Verguet S. Equity impact of minimum unit pricing of alcohol on household health and finances among rich and poor drinkers in South Africa. BMJ Glob Health 2022; 7:bmjgh-2021-007824. [PMID: 34992078 PMCID: PMC8739056 DOI: 10.1136/bmjgh-2021-007824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/12/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction South Africa experiences significant levels of alcohol-related harm. Recent research suggests minimum unit pricing (MUP) for alcohol would be an effective policy, but high levels of income inequality raise concerns about equity impacts. This paper quantifies the equity impact of MUP on household health and finances in rich and poor drinkers in South Africa. Methods We draw from extended cost-effectiveness analysis (ECEA) methods and an epidemiological policy appraisal model of MUP for South Africa to simulate the equity impact of a ZAR 10 MUP over a 20-year time horizon. We estimate the impact across wealth quintiles on: (i) alcohol consumption and expenditures; (ii) mortality; (iii) government healthcare cost savings; (iv) reductions in cases of catastrophic health expenditures (CHE) and household savings linked to reduced health-related workplace absence. Results We estimate MUP would reduce consumption more among the poorest than the richest drinkers. Expenditure would increase by ZAR 353 000 million (1 US$=13.2 ZAR), the poorest contributing 13% and the richest 28% of the increase, although this remains regressive compared with mean income. Of the 22 600 deaths averted, 56% accrue to the bottom two quintiles; government healthcare cost savings would be substantial (ZAR 3.9 billion). Cases of CHE averted would be 564 700, 46% among the poorest two quintiles. Indirect cost savings amount to ZAR 51.1 billion. Conclusions A MUP policy in South Africa has the potential to reduce harm and health inequality. Fiscal policies for population health require structured policy appraisal, accounting for the totality of effects using mathematical models in association with ECEA methodology.
Collapse
Affiliation(s)
- Naomi Gibbs
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Simon Dixon
- School of Health and Related Research, University of Sheffield, Sheffield, UK.,Priority Cost Effective Lessons for Systems Strengethening, South Africa (PRICELESS SA), School of Public Health, Faculty of Health Sciences, University of Witswatersrand, Johannesburg, South Africa
| | - D H Charles
- Alcohol Tobacco and Other Drug Use Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Petra S Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Micheal Kofi Boachie
- Priority Cost Effective Lessons for Systems Strengethening, South Africa (PRICELESS SA), School of Public Health, Faculty of Health Sciences, University of Witswatersrand, Johannesburg, South Africa.,Department of Health Policy Planning and Mangement, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
14
|
Fuchs Tarlovsky A, González Icaza MF. Tobacco taxes for improving welfare and distributional outcomes: the case of Georgia. Eur J Public Health 2021; 31:936-942. [PMID: 33734366 DOI: 10.1093/eurpub/ckab029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Georgia has one of the highest smoking prevalence and tobacco-related morbidity and mortality rates in Europe and Central Asia. Nonetheless, tax increases on tobacco products are often opposed due to concerns of regressive fiscal effects. This article provides evidence on the long-term welfare and distributional impacts of increasing cigarette taxes in Georgia. METHODS An Extended Cost-Benefit Analysis is used to simulate the distributional effect of raising taxes on cigarettes. It weighs short-term losses due to higher tobacco prices with long-term benefits related to reduced medical expenses and additional earnings associated with extended life expectancy. Household expenditure data are used to estimate decile-specific price elasticities of demand for cigarettes, accounting for heterogeneous behavioral responses by income-group. RESULTS Consistent with previous literature, cigarettes price elasticity decreases with income. A simulated 50% cigarette price increase would yield positive net gains for the lowest three deciles; increase the available income of the poorest 10% of the population by an average of 1% and, as a result, lift up to 7000 people out-of-poverty in 2017. The effects would be highly progressive. CONCLUSIONS As lower-income households tend to be more responsive to price changes on cigarettes, they stand to benefit most from the health and economic consequences of taxing tobacco. This article shows that in addition to boosting fiscal revenues, increasing cigarette prices would lead to progressive and positive net gains for the poorest households in Georgia.
Collapse
|
15
|
Raei B, Emamgholipour S, Takian A, Yaseri M, Abdoli G, Alizadeh A. Distributional health and financial consequences of increased cigarette tax in Iran: extended cost-effectiveness analysis. HEALTH ECONOMICS REVIEW 2021; 11:30. [PMID: 34389902 PMCID: PMC8364107 DOI: 10.1186/s13561-021-00328-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND To assess the potential impact of a tax-induced cigarette price increase on financial and health outcomes by different socioeconomic groups. METHODS In a modeled condition using pooled cross-section data from Household Income and Expenditure Survey (2002-2017) and Iran 2019 population data, a methodology of an extended cost effectiveness analysis (ECEA) was applied to model the impact on cigarette consumption of hypothetically increased cigarette tax. The methodology was employed to evaluate: [1] health benefits (premature deaths averted); [2] health expenditures regarding smoking-related disease treatment averted; [3] additional tax revenues raised; [4] change in household expenditures on cigarettes; and [5] financial risk protection among male Iranian smokers in a time span of 60 years following a one-time increase in cigarette price of 75%. The Stata version 15.1 (StataCorp., College Station, TX, USA) was used to perform the relevant analysis and estimate regression models. RESULTS A 75% increase in cigarettes price through taxation would reduce the number of smokers by more than half a million, 11% of them in the poorest quintile; save about 1.9 million years of life (11% of which would be gained in the lowest quintile compared to 20% in the highest one); eliminate a total of US$196.4 million of health expenditures (9% of which would benefit the bottom quintile). Such a policy could raise the additional annual tax revenues by roughly US$ 1 billion, where the top two quintiles bear around 46% of the total tax burden. We estimated that the tax increase would avert an estimated 56,287 cases of catastrophic expenditure that wholly concentrated among the bottom two expenditure quintiles. CONCLUSION Increasing cigarette tax can provide health and financial benefits, and would be pro-poor in terms of health gains, Out-of-Pocket (OOP) savings, and financial risk protection against smoking-related diseases.
Collapse
Affiliation(s)
- Behzad Raei
- Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Emamgholipour
- Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Amirhossein Takian
- Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ahad Alizadeh
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| |
Collapse
|
16
|
Verguet S, Kearns PKA, Rees VW. Questioning the regressivity of tobacco taxes: a distributional accounting impact model of increased tobacco taxation. Tob Control 2021; 30:245-257. [PMID: 32576701 PMCID: PMC8077213 DOI: 10.1136/tobaccocontrol-2019-055315] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Tobacco taxes, as with other 'sin taxes', are generally regarded as a highly cost-effective mechanism to reduce consumption but are often considered by policymakers to be regressive, undermining efforts to fully implement them at levels recommended by the WHO due to concerns of fairness. We aim to demonstrate whether there are circumstances in which the impacts of additional tobacco taxes are not regressive, using a standard income-share accounting definition of tax burden. METHODS AND FINDINGS We apply mathematical modelling and explore the hypothetical distributions in the net change in tobacco taxes and cigarette expenditures by income group, following an increase in tobacco taxation. The hypothetical distribution per income group of additional taxes and cigarette expenditures borne by individuals following tobacco tax hikes was calculated with respect to a selection of parameters including: the change in the retail price of cigarettes, the price elasticity of demand for tobacco, smoking prevalence, cigarette consumption and individual income. We determine the range of hypothetical parameter values for which increased tobacco taxation should not be considered to penalise the poorest income groups when examining marginal cigarette consumption expenditures and using an accounting definition of tax burden. CONCLUSIONS Our findings question the doctrine that tobacco taxes are uniformly regressive from a standard income-share accounting view and point to the importance of the specific features of tax policy to shape a progressive approach to tobacco taxation: tobacco tax increases are less likely to be regressive when accompanied by a broad framework of demand-side measures that enhance the capacity of low-income smokers to quit tobacco use.
Collapse
Affiliation(s)
- Stéphane Verguet
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Patrick K A Kearns
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Vaughan W Rees
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
17
|
Cheng KJG, Estrada MAG. Cost-effectiveness analysis of the 2019 cigarette excise tax reform in the Philippines. Prev Med 2021; 145:106431. [PMID: 33493524 DOI: 10.1016/j.ypmed.2021.106431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/13/2020] [Accepted: 01/17/2021] [Indexed: 11/26/2022]
Abstract
In this past decade alone, the Philippines has made major strides in increasing the price of cigarettes. This study estimated the cost-effectiveness of the most recent cigarette price increase of about 29% brought about by Republic Act (RA) 11346 in 2019. A static or a single cohort model was populated with locally-sourced inputs whenever possible. Public payer and societal perspectives were taken wherein the former only considered direct costs and tax revenue gained earmarked for the health sector while the latter adds indirect costs in the form of productivity losses. A 7% discount rate was applied. Increasing the price of cigarettes by about 29% was found to prevent about 1961 tobacco-related deaths which translate to about 34,571 disability adjusted life years (DALYs) saved. Savings incurred from hospitalizations prevented and additional excise tax revenues for health was about USD 367 Million. But when productivity losses averted due to the lives saved and the higher cost of hospitalizations were accounted for in the societal perspective, the excise tax reform yielded USD 415 Million net gain. It would save the public payer USD 10,612 per DALY averted while society at large stand to save USD 11,955 per DALY averted. Tax increases like RA 11346 yield significant revenue that can be used towards public health programs.
Collapse
Affiliation(s)
- Kent Jason Go Cheng
- Social Science Department, Maxwell School of Citizenship and Public Affairs, Syracuse University, 100 College Place, Lyman Hall Rm 309, Syracuse, NY, USA.
| | - Miguel Antonio Garcia Estrada
- School of Economics, University of the Philippines Diliman, Quezon City, Philippines; Congressional Policy and Budget Research Department, House of Representatives, Republic of the Philippines, 3/F Main Building, House of Representatives, Batasan Hills, Quezon City, Metro Manila, Philippines.
| |
Collapse
|
18
|
Abstract
This research chooses the method of narrative literature review to analyze the barriers in implementing tobacco regulatory policies in China and explore the strategies that can overcome these challenges. China is the world’s largest producer and consumer of tobacco products. Although the prevalence of cigarette smoking declined from 34.5% to 27.7% between 1984 and 2015, the reduction over the 30 years has been slow. Therefore, effective tobacco regulatory policies are necessary. However, as the tobacco industry is one of the major sources of government revenue and an indispensable part of the national economy, the implementation of tobacco regulatory policies faces many challenges. In terms of the institutional dimension, the ambiguous attitude of national institutions and tobacco companies’ development strategies impede the enforcement of tobacco policies. In addition, the primary economic barrier to tobacco control is the unwillingness of the government to raise value-added tax on tobacco. Finally, the social customs of exchanging individual cigarettes and gifting packaged cigarettes among adults and juveniles in China hinder the implementation of tobacco regulatory policies. In this case, a combined strategy of top-down and bottom-up approaches can remove these barriers, such as using the authoritative power to control tobacco use and raising non-smokers’ awareness of smoking risks and public education.
Collapse
|
19
|
Using Compensating Variation to Measure the Costs of Taxing Cigarette in Iran. HEALTH SCOPE 2020. [DOI: 10.5812/jhealthscope.108121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The impact of pricing strategies on different socioeconomic groups is not uniform. There is urgency in addressing of characteristics of household demand to make a policy choice in line with development goals. Objectives: This study was done to assess the effect of welfare loss from counterfactual tax-induced cigarette price increases on representative smokers by different expenditure quintiles in Iran. Methods: This analytical study was conducted using pooling cross-sections and compensating variation (CV) to evaluate the costs of taxing cigarettes. The data source used in our study was the Household Income and Expenditure survey (HIES) from 2001 - 2017. We did an almost ideal demand system (AIDS) analysis to estimate elasticities for cigarette demand and compute welfare losses from simulated cigarette price increases by socioeconomic groups. We used STATA version 15.1 (StataCorp, College Station, TX, USA), and Microsoft Excel 2016 to undertake the relevant analyses and estimates. Results: The highest loss was suffered by households of the poorest quintile, who should afford 1.41%, 2.47 %, and 3.20% more budget in the long-run, respectively, as the result of three simulated price increases to stay at the same well-being as before. Conclusions: Concerning direct welfare loss from the cigarette taxation reform in Iran, and focusing on low-income groups, such a policy can be considered as regressive. However, this regressivity can be reduced by informing strategies to redirect sin tax revenues that benefit the poor.
Collapse
|
20
|
Tuvdendorj A, Du Y, Sidorenkov G, Buskens E, de Bock GH, Feenstra T. Informing policy makers on the efficiency of population level tobacco control interventions in Asia: A systematic review of model-based economic evaluations. J Glob Health 2020; 10:020437. [PMID: 33403106 PMCID: PMC7750019 DOI: 10.7189/jogh.10.020437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Economic evaluations of tobacco control interventions support decisions regarding resource allocation in public health policy. Our systematic review was aimed at identifying potential bias in decision models used to estimate the long-term costs and effects of population-based tobacco control interventions in Asia. METHODS We included studies conducted in Asian countries and using a modelling technique to evaluate the economic impacts of one or more population-based tobacco interventions in line with the Framework Convention on Tobacco Control (FCTC). We assessed the structure, input parameters, and risk of bias for each model, and performed a narrative synthesis of the included studies. RESULTS Nine model-based economic evaluation studies of population-based tobacco interventions were identified. About 60% of the criteria for reporting quality were met in all studies, indicating that reporting generally lacked transparency. The studies were highly heterogeneous in terms of the scope, types, and structures of their models and the quality of input parameters. One-third of the models applied in the studies scored a high risk of bias, with problems mostly falling into the following categories: model type, time horizons, and smoking transition probabilities. CONCLUSIONS More data are needed to provide high-quality evidence regarding the cost-effectiveness of tobacco control policies in Asia. Strong evidence at the country level hinges on the availability of accurate estimates of the effects of the interventions, the relative risks of smoking, and the price elasticity of the demand for tobacco. Simple transfers of models built in Western populations do not suffice. PROTOCOL REGISTRATION PROSPERO CRD 42019141679.
Collapse
Affiliation(s)
- Ariuntuya Tuvdendorj
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
- Mongolian National University of Medical Sciences, Department of Health Policy, School of Public Health, Ulaanbaatar, Mongolia
| | - Yihui Du
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Grigory Sidorenkov
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Erik Buskens
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
- University of Groningen, Faculty of Economics and Business, Groningen, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Talitha Feenstra
- University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, the Netherlands
- National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services Research, Bilthoven, the Netherlands
| |
Collapse
|
21
|
Xu Q, Zhou M, Jin D, Zeng X, Qi J, Yin L, Liu Y, Yin L, Huang Y. Projection of premature mortality from noncommunicable diseases for 2025: a model based study from Hunan Province, China, 1990-2016. PeerJ 2020; 8:e10298. [PMID: 33194444 PMCID: PMC7646306 DOI: 10.7717/peerj.10298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/13/2020] [Indexed: 01/02/2023] Open
Abstract
Background In 2011, the United Nations set a target to reduce premature mortality from non-communicable diseases (NCDs) by 25% by 2025. While studies have reported the target in some countries, no studies have been done in China. This study aims to project the ability to reach the target in Hunan Province, China, and establish the priority for future interventions. Methods We conducted the study during 2019–2020. From the Global Burden of Disease Study 2016, we extracted death data for Hunan during 1990–2016 for four main NCDs, namely cancer, cardiovascular disease (CVD), chronic respiratory diseases, and diabetes. We generated estimates for 2025 by fitting a linear regression to the premature mortality over the most recent trend identified by a joinpoint regression model. We also estimated excess premature mortality attributable to unfavorable changes over time. Results The rate of premature mortality from all NCDs in Hunan will be 19.5% (95% CI [19.0%–20.1%]) by 2025, with the main contributions being from CVD (8.2%, 95% CI [7.9%–8.5%]) and cancer (7.9%, 95% CI [7.8%–8.1%]). Overall, it will be impossible to achieve the target, with a relative reduction of 16.4%. Women may be able to meet the target except with respect to cancer, and men will not except with respect to chronic respiratory diseases. Most of the unfavorable changes have occurred since 2008–2009. Discussion More urgent efforts, especially for men, should be exerted in Hunan by integrating population-wide interventions into a stronger health-care system. In the post lock-down COVID-19 era in China, reducing the NCD risk factors can also lower the risk of death from COVID-19.
Collapse
Affiliation(s)
- Qiaohua Xu
- Department of NCDs Control and Prevention, Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Donghui Jin
- Department of NCDs Control and Prevention, Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Xinying Zeng
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinlei Qi
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Yin
- Department of NCDs Control and Prevention, Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Yuan Liu
- Department of NCDs Control and Prevention, Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Lei Yin
- Department of NCDs Control and Prevention, Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Yuelong Huang
- Department of NCDs Control and Prevention, Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan, China
| |
Collapse
|
22
|
Chen S, Kuhn M, Prettner K, Bloom DE. Noncommunicable Diseases Attributable To Tobacco Use In China: Macroeconomic Burden And Tobacco Control Policies. Health Aff (Millwood) 2020; 38:1832-1839. [PMID: 31682483 DOI: 10.1377/hlthaff.2019.00291] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Smoking causes health problems for individuals and imposes a sizable macroeconomic burden on countries. As the world's leading tobacco producer and consumer, China is at the epicenter of this health crisis. However, no studies have examined the macroeconomic burden of all relevant noncommunicable diseases (NCDs) attributable to tobacco or secondhand smoke exposure. We assessed how tobacco-attributable NCDs affect China's productive capacity and estimated that these diseases would impose a total cost of 16.7 trillion yuan (US$2.3 trillion, in constant 2018 prices) in the period 2015-30, which corresponds to an annual tax of 0.9 percent on aggregate income. Secondhand smoke exposure accounts for 14 percent of the burden. If China raised the tax on cigarettes to 75 percent of their retail price and implemented wide-ranging tobacco-control policies, the Chinese economy could save 7.1 trillion yuan (US$1.0 trillion) for 2015-30-the equivalent of adding a 0.4 percent dividend annually.
Collapse
Affiliation(s)
- Simiao Chen
- Simiao Chen ( simiao. chen@uni-heidelberg. de ) is head of the Research Unit for Health and Population Economics at the Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, in Germany
| | - Michael Kuhn
- Michael Kuhn is head of the Research Group on Population Economics at the Vienna Institute of Demography, Wittgenstein Center, in Austria
| | - Klaus Prettner
- Klaus Prettner is a professor of economics in the Institute of Economics, University of Hohenheim, in Stuttgart, Germany
| | - David E Bloom
- David E. Bloom is a professor of economics and demography in the Department of Global Health and Population, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| |
Collapse
|
23
|
Wu DC, Sheel V, Gupta P, Essue BM, Luong L, Jha P. Impact of cigarette tax increase on health and financing outcomes in four Indian states. Gates Open Res 2020; 4:49. [PMID: 33089072 PMCID: PMC7548764 DOI: 10.12688/gatesopenres.13127.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 11/20/2022] Open
Abstract
Background: In India, about one million deaths occur every year due to smoking. Tobacco taxation is the most effective intervention in reducing smoking. In this paper, we examine the impact of a one-time large cigarette price increase, through an increase in excise tax, on health and financing outcomes in four Indian states. Methods: We used extended cost-effectiveness analysis to estimate, across income quintiles, the life-years gained, treatment cost averted, number of men avoiding catastrophic health expenditures and extreme poverty, additional tax revenue collected, and savings to the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) with a cigarette price increase to Indian Rupees (INR) 10 plus 10% ad valorem in four Indian states. Results: With the price increase, about 1.5 million men would quit smoking across the four states, with the bottom income group having 7.4 times as many quitters as the top income group (485,725 vs 65,762). As a result of quitting, about 665,000 deaths would be averted. This would yield about 11.9 million life-years, with the bottom income group gaining 7.3 times more than the top income group. Of the INR 1,729 crore in treatment cost averted, the bottom income group would avert 7.4 times more than the top income group. About 454,000 men would avoid catastrophic health expenditures and 75,000 men would avoid falling into extreme poverty. The treatment cost and impoverishment averted would save about INR 672 crore in AB-PMJAY. The tax increase would in turn, generate an additional tax revenue of about INR 4,385 crore. In contrast to the distribution of health benefits, the extra revenue generated from the top income group would be about 3.1 times that from the bottom income group. Conclusions: Cigarette tax increase can provide significant health and economic gains and is a pro-poor policy for India.
Collapse
Affiliation(s)
- Daphne C Wu
- Centre for Global Health Research, St. Michael's Hospital, Toronto, Toronto, Ontario, M5B 1W8, Canada
| | - Vikas Sheel
- Ministry of Health and Family Welfare, Government of India, New Delhi, New Delhi, India
| | - Pooja Gupta
- Ministry of Health and Family Welfare, Government of India, New Delhi, New Delhi, India
| | - Beverley M Essue
- Centre for Global Health Research, St. Michael's Hospital, Toronto, Toronto, Ontario, M5B 1W8, Canada
| | - Linh Luong
- Centre for Global Health Research, St. Michael's Hospital, Toronto, Toronto, Ontario, M5B 1W8, Canada
| | - Prabhat Jha
- Centre for Global Health Research, St. Michael's Hospital, Toronto, Toronto, Ontario, M5B 1W8, Canada
| |
Collapse
|
24
|
Love-Koh J, Pennington B, Owen L, Taylor M, Griffin S. How health inequalities accumulate and combine to affect treatment value: A distributional cost-effectiveness analysis of smoking cessation interventions. Soc Sci Med 2020; 265:113339. [PMID: 33039733 DOI: 10.1016/j.socscimed.2020.113339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/17/2020] [Accepted: 08/28/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Reduction of health inequality is a goal in health policy, but commissioners lack information on how policies change health inequality. This study illustrates how decision models can be readily extended to produce information on health inequality impacts as well as for population health, using the example of smoking cessation therapies. METHODS We retrospectively adapt a model developed for public health guidance to undertake distributional cost effectiveness analysis. We identify and incorporate evidence on how inputs vary by area-level deprivation. Therapies are evaluated in terms of total population health, extent of inequality, and a summary measure of equally distributed equivalent health based on a societal value for inequality aversion. Last, we examine how accounting for social variation in different sets of parameters affects our results. RESULTS All interventions increase population health and increase the slope index ofinequality. At estimated levels of health inequality aversion for England, our resultsindicate that the increases in inequality are compensated by the health gains. DISCUSSION The inequality impacts are driven by higher benefits of quitting and higher intervention uptake amongst advantaged groups, despite the greater proportion of smokers in disadvantaged groups. Failure to account for differential effects between groups leadsto different conclusions about health inequality impact but does not alter conclusionsabout value for money.
Collapse
Affiliation(s)
| | - Becky Pennington
- Health Economics and Decision Science, University of Sheffield, UK
| | - Lesley Owen
- National Institute for Health and Care Excellence, UK
| | - Matthew Taylor
- York Health Economics Consortium, University of York, UK
| | | |
Collapse
|
25
|
Jain V, Crosby L, Baker P, Chalkidou K. Distributional equity as a consideration in economic and modelling evaluations of health taxes: A systematic review. Health Policy 2020; 124:919-931. [PMID: 32718790 DOI: 10.1016/j.healthpol.2020.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/17/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE/SETTING The extent to which distributional equity is incorporated into evaluations of the (potential or observed) impact of health taxes is unclear. This systematic review of economic and modelling evaluations investigating taxation on tobacco, sugar-sweetened-beverages (SSBs), or alcohol aims to assess the proportion that have considered distributional impact by income or socioeconomic group. Secondary aims included summarising the reported distributional impacts, for both costs and health benefits. FINDINGS Of 4656 search results, 69 studies were included. The majority were economic analyses with epidemiological modelling, with studies on SSB taxes being of the highest quality. Tobacco was most commonly investigated tax, with 37 evaluations. Of these, 12 (32 %) considered distributional equity, with six (27 %) of 22 included SSB evaluations doing the same, and none for alcohol. A tobacco tax favoured lowerincome groups in the distribution of costs in all identified evaluations and for health benefits in nine out of 12 evaluations (75 %). For SSBs, four evaluations (67 %) found costs to favour low-income groups, with three (50 %) for health benefits. CONCLUSIONS Despite recommendations, evaluations of health taxes do not routinely consider the distributional impact of both costs and health benefits. Evaluations for alcohol taxation are particularly weak in this regard. Where investigated, the majority of evidence found tobacco taxation to favour low-income groups, whereas the limited evidence for SSBs is mixed.
Collapse
Affiliation(s)
- Vageesh Jain
- Institute for Global Health (IGH), University College London, UK; Public Health England, London, UK.
| | - Liam Crosby
- Institute for Epidemiology and Healthcare, University College London, London, UK; Tower Hamlets Council, London, UK
| | - Peter Baker
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK; Center for Global Development, UK
| | - Kalipso Chalkidou
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK; Center for Global Development, UK
| |
Collapse
|
26
|
Reddy CL, Peters AW, Jumbam DT, Caddell L, Alkire BC, Meara JG, Atun R. Innovative financing to fund surgical systems and expand surgical care in low-income and middle-income countries. BMJ Glob Health 2020; 5:e002375. [PMID: 32546586 PMCID: PMC7299051 DOI: 10.1136/bmjgh-2020-002375] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 02/02/2023] Open
Abstract
Strong surgical systems are necessary to prevent premature death and avoidable disability from surgical conditions. The epidemiological transition, which has led to a rising burden of non-communicable diseases and injuries worldwide, will increase the demand for surgical assessment and care as a definitive healthcare intervention. Yet, 5 billion people lack access to timely, affordable and safe surgical and anaesthesia care, with the unmet demand affecting predominantly low-income and middle-income countries (LMICs). Rapid surgical care scale-up is required in LMICs to strengthen health system capabilities, but adequate financing for this expansion is lacking. This article explores the critical role of innovative financing in scaling up surgical care in LMICs. We locate surgical system financing by using a modified fiscal space analysis. Through an analysis of published studies and case studies on recent trends in the financing of global health systems, we provide a conceptual framework that could assist policy-makers in health systems to develop innovative financing strategies to mobilise additional investments for scale-up of surgical care in LMICs. This is the first time such an analysis has been applied to the funding of surgical care. Innovative financing in global surgery is an untapped potential funding source for expanding fiscal space for health systems and financing scale-up of surgical care in LMICs.
Collapse
Affiliation(s)
- Ché L Reddy
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alexander W Peters
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Desmond Tanko Jumbam
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Luke Caddell
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Blake C Alkire
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Global Health Equity, Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rifat Atun
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
27
|
Du X, Patel A, Anderson CS, Dong J, Ma C. Epidemiology of Cardiovascular Disease in China and Opportunities for Improvement: JACC International. J Am Coll Cardiol 2020; 73:3135-3147. [PMID: 31221263 DOI: 10.1016/j.jacc.2019.04.036] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/16/2019] [Accepted: 04/22/2019] [Indexed: 12/24/2022]
Abstract
The burden of cardiovascular (CV) disease is very high in China, due to highly prevalent and poorly controlled risk factors resulting from changing sociodemographic structure and lifestyles in its large population. Rapid economic development and urbanization have been accompanied by changing patterns, expression, and management of CV disease. However, the health care system in China lacks a hierarchical structure, with a focus on treating acute diseases in hospital while ignoring long-term management, and primary health care is too weak to effectively control CV risk factors. To address these challenges, the Chinese central government has ensured health is a national priority and has introduced reforms that include implementing policies for a healthy environment, strengthening primary care, and improving affordability and accessibility within the health system. Turning the inverted pyramid of the health care system is essential in the ongoing battle against CV disease.
Collapse
Affiliation(s)
- Xin Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Heart Health Research Center, Beijing, China; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Craig S Anderson
- Heart Health Research Center, Beijing, China; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; The George Institute for Global Health China at Peking University Health Science Center, Beijing, China
| | - Jianzeng Dong
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Changsheng Ma
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
28
|
Summan A, Stacey N, Birckmayer J, Blecher E, Chaloupka FJ, Laxminarayan R. The potential global gains in health and revenue from increased taxation of tobacco, alcohol and sugar-sweetened beverages: a modelling analysis. BMJ Glob Health 2020; 5:e002143. [PMID: 32337082 PMCID: PMC7170424 DOI: 10.1136/bmjgh-2019-002143] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Globally, a growing burden of morbidity and mortality is attributable to lifestyle behaviours, and in particular to the consumption of tobacco, alcohol and sugar-sweetened beverages (SSB). In low-income and middle-income countries, this increased disease burden falls on already encumbered and resource-constrained healthcare systems. Fiscal policies, specifically taxation, can lower consumption of tobacco, alcohol and SSB while raising government revenues. Methods We simulated the health and economic effects of taxing cigarettes, alcohol and SSB over 50 years for 30-79 years old populations using separate mathematical models for each commodity that incorporated country-level epidemiological, demographic and consumption data. Based on data availability, national-level health effects of higher tobacco, alcohol and SSB taxes were simulated in 141, 166 and 176 countries, respectively, which represented 92%, 97% and 95% of the global population, respectively. Economic effects for tobacco, alcohol and SSB were estimated for countries representing 91%, 43% and 83% of the global population, respectively. These estimates were extrapolated to the global level by matching countries according to income level. Results Over 50 years, taxes that raise the retail price of tobacco, alcoholic beverages and SSB by 20% could result in a global gain of 160.7 million (95% uncertainty interval (UI): 96.3 to 225.2 million), 227.4 million (UI: 161.2 to 293.6 million) and 24.3 million (UI: 15.7 to 35.4 million) additional life years, respectively. Conclusion Excise tax increases on tobacco, alcohol and SSB can produce substantial health gains by reducing premature mortality while raising government revenues, which could be used to increase public health funding.
Collapse
Affiliation(s)
- Amit Summan
- Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, USA
| | - Nicholas Stacey
- Priority Cost Effective Lessons for Systems Strengthening, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Evan Blecher
- Health Policy Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Frank J Chaloupka
- Health Policy Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, USA
- Princeton Environmental Institute, Princeton University, Princeton, NJ, USA
| |
Collapse
|
29
|
Luna F, Luyckx VA. Why have Non-communicable Diseases been Left Behind? Asian Bioeth Rev 2020; 12:5-25. [PMID: 33717328 PMCID: PMC7747415 DOI: 10.1007/s41649-020-00112-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
Non-communicable diseases are no longer largely limited to high-income countries and the elderly. The burden of non-communicable diseases is rising across all country income categories, in part because these diseases have been relatively overlooked on the global health agenda. Historically, communicable diseases have been prioritized in many countries as they were perceived to constitute the greatest disease burden, especially among vulnerable and poor populations, and strategies for prevention and treatment, which had been successful in high-income settings, were considered feasible and often affordable in low-income settings. This prioritization has reduced the communicable diseases burden globally but has left non-communicable diseases largely neglected. A new approach is urgently needed to tackle non-communicable diseases. Based on an analysis of potential features which may have underlain the different approaches to non-communicable diseases and communicable diseases until now, including acuity of disease, potential for control or cure, cost, infectiousness, blaming of individuals and logistical barriers, little ethical or rational justification can be found to support continued neglect of non-communicable diseases. Justice demands access to quality and affordable care for all. An equitable approach to non-communicable diseases is therefore strongly mandated on medical, ethical, economic, and public health grounds. Funding must not however be diverted away from communicable diseases, which continue to require attention-but concomitantly, funding for non-communicable diseases must be increased. International and multi-sectoral action is required to accelerate progress towards true universal health coverage and towards achievement of all of the sustainable development goals, such that prevention and access to care for non-communicable disease can become a global reality.
Collapse
Affiliation(s)
- Florencia Luna
- Programa de Bioética, Área Ética, Derechos y Bienes Públicos Globales, Facultad Latinoamericana de Ciencias Sociales (FLACSO), Buenos Aires, Argentina
| | - Valerie A. Luyckx
- Institute for Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| |
Collapse
|
30
|
Nugent RA, Husain MJ, Kostova D, Chaloupka F. Introducing the PLOS special collection of economic cases for NCD prevention and control: A global perspective. PLoS One 2020; 15:e0228564. [PMID: 32027710 PMCID: PMC7004318 DOI: 10.1371/journal.pone.0228564] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Noncommunicable diseases (NCDs), such as heart disease, cancer, diabetes, and chronic respiratory disease, are responsible for seven out of every 10 deaths worldwide. While NCDs are associated with aging in high-income countries, this representation is often misleading. Over one-third of the 41 million annual deaths from NCDs occur prematurely, defined as under 70 years of age. Most of those deaths occur in low- and middle-income countries (LMICs) where surveillance, treatment, and care of NCDs are often inadequate. In addition to high health and social costs, the economic costs imposed by such high numbers of excess early deaths impede economic development and contribute to global and national inequity. In higher-income countries, NCDs and their risks continue to push health care costs higher. The burden of NCDs is strongly intertwined with economic conditions for good and for harm. Understanding the multiple ways they are connected–through risk factor exposures, access to quality health care, and financial protection among others–will determine which countries are able to improve the healthy longevity of their populations and slow growth in health expenditure particularly in the face of aging populations. The aim of this Special Collection is to provide new evidence to spur those actions.
Collapse
Affiliation(s)
- Rachel A. Nugent
- Global NCDs, RTI International, Seattle, Washington State, United States of America
- Department of Global Health, University of Washington, Seattle, Washington State, United States of America
- * E-mail:
| | - Muhammad Jami Husain
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Deliana Kostova
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Frank Chaloupka
- University of Illinois, Chicago, Illinois, United States of America
| |
Collapse
|
31
|
Li WHC, Ho KY, Wang MP, Cheung DYT, Lam KKW, Xia W, Cheung KY, Wong CKH, Chan SSC, Lam TH. Effectiveness of a Brief Self-determination Theory-Based Smoking Cessation Intervention for Smokers at Emergency Departments in Hong Kong: A Randomized Clinical Trial. JAMA Intern Med 2020; 180:206-214. [PMID: 31790546 PMCID: PMC6902195 DOI: 10.1001/jamainternmed.2019.5176] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Clinicians have an opportunity to provide smoking cessation interventions to smokers who present to emergency departments (EDs). The effectiveness of a brief intervention based on self-determination theory for smoking cessation is uncertain. OBJECTIVE To examine the effectiveness of a brief intervention based on self-determination theory for smoking cessation (immediate or progressive) among Chinese smokers presenting at EDs in Hong Kong. DESIGN, SETTING, AND PARTICIPANTS This single-blind, multicenter intent-to-treat randomized clinical trial was conducted at the EDs of 4 major acute care hospitals in different districts of Hong Kong. In total, 1571 smokers 18 years or older who presented at 4 major EDs between July 4, 2015, and March 17, 2017, were randomized into an intervention group (n = 787) and a control group (n = 784). INTERVENTIONS The intervention group received brief advice (about 1 minute) and could choose their own quit schedules (immediate or progressive). The control group received a smoking cessation leaflet. MAIN OUTCOMES AND MEASURES Follow-up visits were conducted at 1, 3, 6, and 12 months. The primary outcome measure, by intent to treat, was biochemically validated abstinence at 6 months. RESULTS Participants (N = 1571) included 1381 men (87.9%); the mean (SD) age at baseline was 47.4 (16.4) years. Among participants who self-reported abstinence at 6 months, 50.3% (85 of 169) had biochemical validation by both an exhaled carbon monoxide test and a saliva cotinine test. Compared with the control group, the intervention group had statistically higher biochemically validated abstinence at 6 months: 6.7% (53 of 787) vs 2.8% (22 of 784) (P < .001), with an adjusted relative risk of 3.21 (95% CI, 1.74-5.93; P < .001). The intervention group also had higher self-reported quit rates at 6 months (12.2% [96 of 787] vs 9.3% [73 of 784], P = .04) and 12 months (13.0% [102 of 787] vs 8.5% [67 of 784], P < .01), as well as higher biochemically validated abstinence at 12 months (7.0% [55 of 787] vs 3.7% [29 of 784], P < .001). The additional cost for each intervention group participant was US $0.47, with an estimated gain of 0.0238 quality-adjusted life-year. The incremental cost per quality-adjusted life-year (US $19.53) fell within acceptable thresholds. CONCLUSIONS AND RELEVANCE This brief, low-cost self-determination theory-based intervention for smokers presenting at EDs effectively increased the biochemically validated quit rate at 6 months. If delivered routinely, such a simple intervention may offer a cost-effective and sustainable approach to help many smokers quit smoking. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02660957.
Collapse
Affiliation(s)
| | - Ka Yan Ho
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | | | | | - Wei Xia
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | | | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
32
|
Hu X, Wang Y, Huang J, Zheng R. Cigarette Affordability and Cigarette Consumption among Adult and Elderly Chinese Smokers: Evidence from A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4832. [PMID: 31805685 PMCID: PMC6927005 DOI: 10.3390/ijerph16234832] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/23/2019] [Accepted: 11/27/2019] [Indexed: 11/16/2022]
Abstract
China is in the midst of an epidemic of non-communicable diseases (NCDs), which has increasingly accounted for a growing share of disease burden, due in part to China's ongoing rapid socioeconomic changes and population aging. Smoking, the second leading health risk factors associated with NCDs in China, disproportionately affects the old population more than their younger counterparts. Using survey data from the China Health and Retirement Longitudinal Study (CHARLS), this study evaluated the impact of changes in cigarette affordability on smoking behavior among middle-aged and elderly (age 45 and older) smokers. Self-reported cigarette price and disposable income were used to calculate cigarette affordability. Cigarette consumption was measured using the number of cigarettes smoked per day reported by the survey respondents. The correlation between cigarette affordability and cigarette consumption was estimated using generalized estimating equations adjusting for demographics, socioeconomic status, geolocations, and cigarette price tiers, as well as year fixed effects. The estimated overall conditional cigarette affordability elasticity of demand was -0.165, implying a 10% decrease in cigarette affordability would result in a reduction in cigarette consumption by 1.65%. The cigarette affordability responsiveness differs by demographics, socioeconomic status, geolocations, and cigarette price tiers. This study provides evidence that tax/price policies that reduce cigarette affordability could lead to a decrease in cigarette consumption among middle-aged and elderly smokers in China. Smoke-free laws, as well as minimum price regulations, may be needed to compliment excise tax policy to target specific smoking subgroups whose cigarette consumption is less sensitive to changes in cigarette affordability.
Collapse
Affiliation(s)
- Xiao Hu
- School of International Trade and Economics, University of International Business and Economics, Beijing 100029, China; (X.H.); (Y.W.)
| | - Yang Wang
- School of International Trade and Economics, University of International Business and Economics, Beijing 100029, China; (X.H.); (Y.W.)
| | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, GA 30303, USA;
| | - Rong Zheng
- School of International Trade and Economics, University of International Business and Economics, Beijing 100029, China; (X.H.); (Y.W.)
| |
Collapse
|
33
|
Yao Y, Nakamura R, Sari N. The educational gap in tar and nicotine content in purchases of cigarettes: An observational study using large-scale representative survey data from Japan. Prev Med 2019; 129:105828. [PMID: 31479656 DOI: 10.1016/j.ypmed.2019.105828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 11/24/2022]
Abstract
The intensity of tobacco use is commonly measured by the number of cigarettes, which is inaccurate because it masks the heterogeneity and substances contained in tobacco. Unlike existing studies, this study adopted the tar and nicotine content of purchased cigarettes as proxies for smoking intensity and elicited socioeconomic disparities from the participants regarding tobacco use. Using a nationally representative consumer panel survey of Japan from 2010 to 2014, we found that socioeconomic disparities in smoking are more pronounced when tar and nicotine content in cigarettes is considered. University graduates purchased 26% fewer cigarettes, and 40% less tar or nicotine than their secondary school-educated counterparts. Low education groups purchased more tar-rich cigarettes, which cost less than low-tar cigarettes. The public health recommendations for reducing socioeconomic health inequalities might be understated because they are drawn from evidence based on the number of cigarettes smoked.
Collapse
Affiliation(s)
- Ying Yao
- Hitotsubashi Institute for Advanced Study (HIAS), Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo 186-8601, Japan
| | - Ryota Nakamura
- Hitotsubashi Institute for Advanced Study (HIAS), Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo 186-8601, Japan.
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Canada
| |
Collapse
|
34
|
Seposo X. Developmental Changes in the Philippine Health System: Accomplishments, Successes and Challenges. Healthcare (Basel) 2019; 7:healthcare7040116. [PMID: 31615140 PMCID: PMC6955948 DOI: 10.3390/healthcare7040116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 11/16/2022] Open
Abstract
The Philippine health system has undergone various changes which addressed the needs of the time. These changes were reflected in the benchmarks and indicators of performance of the whole health system. To understand how these changes affected the health system (HS), this study determined the changes in the Philippine health system in relation to different health domains (health determinants, financing, and management/development). Two HS periods were identified, namely, health system period 1 (HS 1) from 1997–2007 and health system period 2 (HS 2) from 2008–2017. Each HS period was assessed based on three domains. The first two domains were quantitatively assessed based on an interrupted time-series method, while the third one underwent a comparative analysis using two Health Systems in Transition reports (2011 and 2018). This study was able to assess the developmental changes in the Philippine health system. Specifically, the (health determinant) maternal mortality rate (MMR) significantly decreased by three maternal deaths per 100,000 live births, the (health financing) tobacco excise tax increased by 13,855 (in Million PhP) in HS 2, and there was (health management/development) an improvement in access to health facilities. However, there was an indication of retrogressive progress with some challenges in HS 1 which remained unaddressed in HS 2. While it seems promising that the health system has progressed with improvements apparent in both health outcomes (e.g., MMR) and health financing (e.g., tobacco excise tax), such improvements were overshadowed by the inefficiencies, which were not addressed by the current health system (HS 2), thus making it more retrogressive than progressive.
Collapse
Affiliation(s)
- Xerxes Seposo
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan.
- Faculty of Management and Development Studies, University of the Philippines Open University, Los Banos, Laguna 4031, Philippines.
| |
Collapse
|
35
|
Saxena A, Stacey N, Puech PDR, Mudara C, Hofman K, Verguet S. The distributional impact of taxing sugar-sweetened beverages: findings from an extended cost-effectiveness analysis in South Africa. BMJ Glob Health 2019; 4:e001317. [PMID: 31543983 PMCID: PMC6730580 DOI: 10.1136/bmjgh-2018-001317] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Facing increasing obesity prevalence and obesity-related disease burden, South Africa has devised an obesity prevention strategy that includes a recently implemented tax on the sugar content of sugar-sweetened beverages (SSB). We assess the potential distributional impact (across socioeconomic groups) of this tax on type 2 diabetes mellitus (T2DM) incidence and associated mortality and its financial burden on households. METHODS We conducted an extended cost-effectiveness analysis of the new 10% tax on SSBs in South Africa, and estimated: the averted premature deaths related to T2DM, the financial benefits to households (out-of-pocket (OOP) medical costs and indirect costs due to productivity losses averted), the increased government tax revenues and healthcare savings for the government, all across income quintiles. FINDINGS A 10% SSB tax increase would avert an estimated 8000 T2DM-related premature deaths over 20 years, with most deaths averted among the third and fourth income quintiles. The government would save about South African rand (ZAR) 2 billion (US$140 million) in subsidised healthcare over 20 years; and would raise ZAR6 billion (US$450 million) in tax revenues per annum. The bottom two quintiles would bear the smallest tax burden increase (36% of the additional taxes). The bottom two income quintiles would also have the lowest savings in OOP payments due to significant subsidisation provided by government healthcare. Lastly, an estimated 32 000 T2DM-related cases of catastrophic expenditures and 12 000 cases of poverty would be averted. CONCLUSIONS SSB taxation would have a substantial distributional impact on obesity-related premature deaths, cost savings to the government and the financial outcomes of South Africa's population.
Collapse
Affiliation(s)
- Akshar Saxena
- Economics, Nanyang Technological University, Singapore, Singapore
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nicholas Stacey
- SAMRC/Wits Center for Health Economics and Decision Science - PRICELESS SA School of Public Health Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paula Del Ray Puech
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Caroline Mudara
- SAMRC/Wits Center for Health Economics and Decision Science - PRICELESS SA School of Public Health Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Wits Center for Health Economics and Decision Science - PRICELESS SA School of Public Health Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
36
|
Watkins D, Hale J, Hutchinson B, Kataria I, Kontis V, Nugent R. Investing in non-communicable disease risk factor control among adolescents worldwide: a modelling study. BMJ Glob Health 2019; 4:e001335. [PMID: 31139451 PMCID: PMC6509594 DOI: 10.1136/bmjgh-2018-001335] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Exposure to non-communicable disease (NCD) risk factors is increasing among adolescents in most countries due to demographic, economic and epidemiological forces. We sought to analyse the potential health impact and costs of implementing NCD risk reduction interventions among adolescents worldwide. METHODS We identified six interventions targeted at adolescent tobacco smoking, heavy episodic drinking and obesity and supported by effectiveness and cost-effectiveness evidence. Based on a population-level cohort of adolescents in 70 representative countries, we assessed the global mortality consequences of fully implementing these interventions over 2020-2070 using the potential impact fraction approach. We calculated the economic benefits of reduced mortality and estimated the required financial costs, discounting both at 3% annually. We also conducted best-case and worst-case scenario analyses. RESULTS Full implementation of these interventions worldwide could avert nearly 10% of premature deaths among this cohort, translating to about US$400 billion in cumulative economic benefits. Cumulatively, the required costs would be about US$85 billion, suggesting that every US$1 of public money invested would generate US$5 in increased human capital. Tobacco taxes generally conferred the highest economic returns; however, an in-depth analysis of three countries illustrated the potential for different priorities, such as alcohol control, to emerge. CONCLUSION From a life course perspective, implementation of a package of interventions to reduce NCD risk among adolescents worldwide would substantially reduce premature mortality at reasonable costs. Our analysis illustrates the importance of integrating NCD prevention policies into the emerging global agenda for adolescent health and well-being.
Collapse
Affiliation(s)
- David Watkins
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Jessica Hale
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Vasilis Kontis
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | | |
Collapse
|
37
|
Zhang M, Liu S, Yang L, Jiang Y, Huang Z, Zhao Z, Deng Q, Li Y, Zhou M, Wang L, Chen Z, Wang L. Prevalence of Smoking and Knowledge About the Hazards of Smoking Among 170 000 Chinese Adults, 2013–2014. Nicotine Tob Res 2019; 21:1644-1651. [DOI: 10.1093/ntr/ntz020] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/09/2019] [Indexed: 01/19/2023]
Abstract
Abstract
Introduction
Periodic population surveys of smoking behavior can inform development of effective tobacco control strategies. We investigated smoking patterns, cessation, and knowledge about smoking hazards in China.
Methods
A nationally representative cross-sectional survey recruited 176 318 people aged ≥18 years across 31 provinces of China in 2013–2014, using multi-stage stratified cluster sampling methods. The smoking patterns, cessation, and knowledge about smoking hazards were analyzed, overall and in population subgroups, adjusting for sample selection weight and post-stratification factors.
Results
Among men, 60.7% were ever-smokers, with proportions of regular, occasional and former smokers being 46.3%, 5.5%, and 8.8% respectively. Among women, only 2.8% had ever smoked. The prevalence of ever smoking in men was higher in rural than urban areas (63.2% vs. 57.6%) and varied from 39.5% to 67.4% across 31 provinces. Among male regular smokers, the mean daily number of cigarettes smoked was 17.8, with mean age at first starting to smoke daily being 20.1 years. Among current smokers, one-third (32.6% men, 32.1% women) had tried to quit before and 36.8% (36.8% men, 35.5% women) intended to quit in the future. Of the Chinese adults, 75.9% recognized that smoking was hazardous, with the proportions believing that smoking could cause lung cancer, heart attack or stroke being 67.0%, 33.2%, and 29.5%, respectively and with 26.0% reporting that smoking could cause all these conditions.
Conclusion
Among Chinese adults, the smoking prevalence remained high in men but was low in women. In both men and women, knowledge about smoking hazards was poor.
Implications
This study showed that tobacco smoking remained highly prevalent among adult men in China in 2013–2014. Moreover, men born in recent decades were more likely to start smoking at younger ages and to smoke more cigarettes than those born in previous generations. There was a large regional variation in male smoking prevalence, with the least economically developed regions having higher prevalence. In contrast, few women in China smoked, especially among those born in recent decades. The contrasting smoking patterns in men and women is likely to result in an increasingly large gender disparity in life expectancy in the coming decades.
Collapse
Affiliation(s)
- Mei Zhang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shiwei Liu
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ling Yang
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yong Jiang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhengjing Huang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenping Zhao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qian Deng
- Healthy China Research Center, Tus-Digital Group, Beijing, China
| | - Yichong Li
- Shenzhen Sun Yat-Sen Cardiovascular Hospital, Shenzhen, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Limin Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| |
Collapse
|
38
|
Saxena A, Koon AD, Lagrada-Rombaua L, Angeles-Agdeppa I, Johns B, Capanzana M. Modelling the impact of a tax on sweetened beverages in the Philippines: an extended cost-effectiveness analysis. Bull World Health Organ 2019; 97:97-107. [PMID: 30728616 PMCID: PMC6357567 DOI: 10.2471/blt.18.219980] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/31/2018] [Accepted: 11/08/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess the potential impact of a new tax on sweetened beverages on premature deaths associated with noncommunicable diseases in the Philippines. METHODS In January 2018, the Philippines began imposing a tax of 6 Philippine pesos per litre (around 13%) on sweetened beverages to curb the obesity burden. Using national data sources, we conducted an extended cost-effectiveness analysis to estimate the effect of the tax on the numbers of premature deaths averted attributed to type 2 diabetes mellitus, ischaemic heart disease and stroke, across income quintiles over the period 2018-2037. We also estimated the financial benefits of the tax from reductions in out-of-pocket payments, direct medical costs averted and government health-care cost savings. FINDINGS The tax could avert an estimated 5913 deaths related to diabetes, 10 339 deaths from ischaemic heart disease and 7950 deaths from stroke over 20 years. The largest number of deaths averted could be among the fourth and fifth (highest) income quintiles. The tax could generate total health-care savings of 31.6 billion Philippine pesos (627 million United States dollars, US$) over 20 years, and raise 41.0 billion Philippine pesos (US$ 813 million) in revenue per annum. The poorest quintile could bear the smallest tax burden increase (14% of the additional tax; 5.6 billion Philippine pesos) and have the lowest savings in out-of-pocket payments due to relatively large health-care subsidies. Finally, we estimated that 13 890 cases of catastrophic expenditure could be averted. CONCLUSION The new sweetened beverage tax may help to reduce obesity-related premature deaths and improve financial well-being in the Philippines.
Collapse
Affiliation(s)
- Akshar Saxena
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States of America (USA)
| | - Adam D Koon
- International Development Division, Abt Associates Inc., 6130 Executive Blvd, Rockville, MD 20852, USA
| | - Leizel Lagrada-Rombaua
- Independent Consultant, Block 14 Lot 4 Lapulapu Street, New Capitol Estates 1, Batasan Hills, Quezon City, Philippines 1126
| | - Imelda Angeles-Agdeppa
- Food and Nutrition Research Institute, Department of Science and Technology, Manila, Philippines
| | - Benjamin Johns
- International Development Division, Abt Associates Inc., 6130 Executive Blvd, Rockville, MD 20852, USA
| | - Mario Capanzana
- Food and Nutrition Research Institute, Department of Science and Technology, Manila, Philippines
| |
Collapse
|
39
|
Al-Tabakha MM, Alomar MJ, Awad MNG, Fahelelbom KMS. Smoking Patterns and Willingness to Quit: A Cross-sectional Study in Al Ain City, UAE. J Pharm Bioallied Sci 2019; 11:276-283. [PMID: 31555035 PMCID: PMC6662044 DOI: 10.4103/jpbs.jpbs_30_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Tobacco use is the major cause of preventable morbidity and mortality. The main objectives of this study were to identify smokers willing to participate in quit smoking campaigns using social media and to identify smoking habits of everyday smokers in Al Ain City, United Arab Emirates (UAE). Research Design and Methods: Everyday smokers from Al Ain city of the UAE were surveyed in different locations of the city including malls and specialized tobacco-selling shops. They were interviewed using a semi-structured survey and the information was recorded by one assessor. The information gathered included type and frequency of tobacco use, smoking history and habits, quitting history, desire to quit, and the preferred communication platform. Result: A total of 412 regular adult smokers were interviewed in which the majority (95%) reported first smoking at or before the age of 28 years. Participants were mainly UAE nationals (33.7%), Egyptians (14.1%), Syrians (12.9%), and Jordanians (10.9%). Manufactured cigarettes were the main form of tobacco consumption (59.5%), and smoking was mainly solitary (56.3%) and at home (26.3%) and coffee shops (24.9%). The majority of interviewed subjects (76.7%; 95% confidence interval [CI]: 72.4%–80.5%) expressed their interest to quit smoking in the future and 55.3% (95% CI: 50.5%–60.2%) were ready to get involved immediately in a smoking cessation program. Of those, 80.3% (95% CI: 74.6%–84.9%) preferred WhatsApp for receiving smoking cessation motivational education. Conclusion: The majority of smokers started at younger ages, which warrant the age of smoking restriction to be raised to 29 years instead of 18 years by the health authority. Everyday smokers were aware of the potentially hazardous effects of tobacco smoking and many were willing to accept help to quit smoking that involves the use of WhatsApp.
Collapse
Affiliation(s)
- Moawia M Al-Tabakha
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | - Muaed J Alomar
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | - Mariam N G Awad
- Pharmaceutical Sciences Department, College of Pharmacy, Al Ain University of Science and Technology, Al Ain, UAE
| | - Khairi M S Fahelelbom
- Pharmaceutical Sciences Department, College of Pharmacy, Al Ain University of Science and Technology, Al Ain, UAE
| |
Collapse
|
40
|
Wu J, Deaton S, Jiao B, Rosen Z, Muennig PA. The cost-effectiveness analysis of the New Rural Cooperative Medical Scheme in China. PLoS One 2018; 13:e0208297. [PMID: 30532135 PMCID: PMC6287900 DOI: 10.1371/journal.pone.0208297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 11/15/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The New Rural Cooperative Medical Scheme (NCMS) is a universal healthcare coverage plan now covering over 98% of rural residents in China, first implemented in 2003. Rising costs in the face of modest gains in health and financial protections have raised questions about the cost-effectiveness of the NCMS. METHODS Using the most recent estimates of the NCMS's health and economic consequences from a comprehensive review of the literature, we conducted a cost-effectiveness analysis using a Markov model for a hypothetical cohort between ages 20 and 100. We then did one-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulations to explore whether the incremental cost-effectiveness ratio (ICER) falls below 37,059 international dollars [Int$], the willingness-to-pay (WTP) threshold of three times per capita GDP of China in 2013. FINDINGS The ICER of the NCMS over the lifetime of an average 20-year-old rural resident in China was about Int$71,480 per quality-adjusted life year (QALY) gained (95% confidence interval: cost-saving, Int$845,659/QALY). There was less than a 33% chance that the system was cost-saving or met the WTP threshold. However, the NCMS did fall under the threshold when changes in the program costs, the risk of mortality and hypertension, and the likelihood of labor force participation were tested in one-way sensitivity analyses. CONCLUSION The NCMS appears to be economically inefficient in its current form. Further cost-effectiveness analyses are warranted in designing insurance benefit packages to ensure that the NCMS fund goes toward health care that has a good value in improving survival and quality of life.
Collapse
Affiliation(s)
- Jinjing Wu
- Asian Demographic Research Institute, Shanghai University, Shanghai, People’s Republic of China
- Global Research Analytics of Population Health, Columbia University, New York, New York, United States of America
| | - Shelby Deaton
- Global Research Analytics of Population Health, Columbia University, New York, New York, United States of America
| | - Boshen Jiao
- Global Research Analytics of Population Health, Columbia University, New York, New York, United States of America
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, United States of America
| | - Zohn Rosen
- Global Research Analytics of Population Health, Columbia University, New York, New York, United States of America
| | - Peter A. Muennig
- Department of Health Policy and Management, Columbia University, New York, New York, United States of America
| |
Collapse
|
41
|
Li C, Supakankunti S. The Impact of Tobacco Consumption on Rural Household Expenditure and Self-rated Health Among Rural Household Members in China. Subst Use Misuse 2018; 53:1974-1983. [PMID: 29578826 DOI: 10.1080/10826084.2018.1449862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To estimate how tobacco consumption affects household expenditure on other goods and services in rural China and to assess the tobacco consumption affects self-rated health among rural household members in China. METHODS A Seemingly Unrelated Regression was used to assess the impact of tobacco consumption on rural household expenditure. To detect tobacco consumption causing heterogeneity in self-rated health among adults in rural China, this study employed a random effects generalized ordered probit model. 2010-2014 China Family Panel Studies was used for the analysis. The data set included 3,611 households and 10,610 adults in each wave. RESULTS Tobacco consumption households assign significantly lower budget shares to food, health care, dress, and education in rural China. Moreover, self-rated health factor has a significantly positive coefficient with respect to non-smokers and ex-smokers, that is, when the individuals is a non-smoker or ex-smoker, he/ she will be more likely to report his/her health status as positive. CONCLUSIONS The first analysis showed that tobacco consumption crowds out expenditures on food, dress, health care, and education for rural households in China, and the second analysis indicated that non-smokers and ex-smokers are more likely to report their health status as better compared with last year. The results of the present study revealed that Chinese policymakers might consider controlling tobacco consumption since tobacco control can improve not only rural household welfare but also rural household members' health status. Therefore, the tobacco tax policy and brief clinical interventions by the doctor should be implemented in rural China.
Collapse
Affiliation(s)
- Changle Li
- a Faculty of Economics , Chulalongkorn University , Bangkok , Thailand.,b School of Health Management , Inner Mongolia Medical University , Hohhot , China
| | | |
Collapse
|
42
|
James EK, Saxena A, Franco Restrepo C, Llorente B, Vecino-Ortiz AI, Villar Uribe M, Iunes RF, Verguet S. Distributional health and financial benefits of increased tobacco taxes in Colombia: results from a modelling study. Tob Control 2018; 28:374-380. [PMID: 30093415 DOI: 10.1136/tobaccocontrol-2018-054378] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/25/2018] [Accepted: 06/27/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND In Colombia, smoking is the second leading modifiable risk factor for premature mortality. In December 2016, Colombia passed a major tax increase on tobacco products in an effort to decrease smoking and improve population health. While tobacco taxes are known to be highly effective in reducing the prevalence of smoking, they are often criticised as being regressive in consumption. This analysis attempts to assess the distributional impact (across socioeconomic groups) of the new tax on selected health and financial outcomes. METHODS This study builds on extended cost-effectiveness analysis methods to study the new tobacco tax in Colombia, and estimates, over a time period of 20 years and across income quintiles of the current urban population (80% of the country population), the years of life gained with smoking cessation and the increased tax revenues, all associated with a 70% relative price increase of the pack of cigarettes. Where possible, we use parameters that vary by income quintile, including price elasticity of demand for cigarettes (average of -0.44 estimated from household survey data). FINDINGS Over 20 years, the tax increase would lead to an estimated 191 000 years of life gained among Colombia's current urban population, with the largest gains among the bottom two income quintiles. The additional annual tax revenues raised would amount to about 2%-4% of Colombia's annual government health expenditure, with the poorest quintiles bearing the smallest tax burden increase. CONCLUSIONS The tobacco tax increase passed by Colombia has substantial implications for the country's population health and financial well-being, with large benefits likely to accrue to the two poorest quintiles of the population.
Collapse
Affiliation(s)
- Erin Kinsella James
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Akshar Saxena
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Andres I Vecino-Ortiz
- Institute of Public Health, Universidad Javeriana, Bogotá, Colombia.,Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | | | | | - Stéphane Verguet
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
43
|
|
44
|
Sassi F, Belloni A, Mirelman AJ, Suhrcke M, Thomas A, Salti N, Vellakkal S, Visaruthvong C, Popkin BM, Nugent R. Equity impacts of price policies to promote healthy behaviours. Lancet 2018; 391:2059-2070. [PMID: 29627166 PMCID: PMC6642722 DOI: 10.1016/s0140-6736(18)30531-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 01/28/2018] [Accepted: 01/31/2018] [Indexed: 12/21/2022]
Abstract
Governments can use fiscal policies to regulate the prices and consumption of potentially unhealthy products. However, policies aimed at reducing consumption by increasing prices, for example by taxation, might impose an unfair financial burden on low-income households. We used data from household expenditure surveys to estimate patterns of expenditure on potentially unhealthy products by socioeconomic status, with a primary focus on low-income and middle-income countries. Price policies affect the consumption and expenditure of a larger number of high-income households than low-income households, and any resulting price increases tend to be financed disproportionately by high-income households. As a share of all household consumption, however, price increases are often a larger financial burden for low-income households than for high-income households, most consistently in the case of tobacco, depending on how much consumption decreases in response to increased prices. Large health benefits often accrue to individual low-income consumers because of their strong response to price changes. The potentially larger financial burden on low-income households created by taxation could be mitigated by a pro-poor use of the generated tax revenues.
Collapse
Affiliation(s)
- Franco Sassi
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, UK.
| | | | | | - Marc Suhrcke
- University of York, York, UK; Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
| | - Alastair Thomas
- Organisation for Economic Co-operation and Development, Paris, France
| | | | | | | | - Barry M Popkin
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Nugent
- Research Triangle Institute International, Seattle, WA, USA
| |
Collapse
|
45
|
Jan S, Laba TL, Essue BM, Gheorghe A, Muhunthan J, Engelgau M, Mahal A, Griffiths U, McIntyre D, Meng Q, Nugent R, Atun R. Action to address the household economic burden of non-communicable diseases. Lancet 2018; 391:2047-2058. [PMID: 29627161 DOI: 10.1016/s0140-6736(18)30323-4] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 09/04/2017] [Accepted: 01/19/2018] [Indexed: 01/05/2023]
Abstract
The economic burden on households of non-communicable diseases (NCDs), including cardiovascular diseases, cancer, respiratory diseases, and diabetes, poses major challenges to global poverty alleviation efforts. For patients with NCDs, being uninsured is associated with 2-7-fold higher odds of catastrophic levels of out-of-pocket costs; however, the protection offered by health insurance is often incomplete. To enable coverage of the predictable and long-term costs of treatment, national programmes to extend financial protection should be based on schemes that entail compulsory enrolment or be financed through taxation. Priority should be given to eliminating financial barriers to the uptake of and adherence to interventions that are cost-effective and are designed to help the poor. In concert with programmes to strengthen national health systems and governance arrangements, comprehensive financial protection against the growing burden of NCDs is crucial in meeting the UN's Sustainable Development Goals.
Collapse
Affiliation(s)
- Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Tracey-Lea Laba
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Beverley M Essue
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Adrian Gheorghe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Janani Muhunthan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Michael Engelgau
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, VIC, Australia
| | - Ulla Griffiths
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Diane McIntyre
- Health Economics Unit, University of Cape Town, Cape Town, South Africa
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, China
| | - Rachel Nugent
- Research Triangle Institute International, Seattle, WA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
| |
Collapse
|
46
|
The health, poverty, and financial consequences of a cigarette price increase among 500 million male smokers in 13 middle income countries: compartmental model study. BMJ 2018; 361:k1162. [PMID: 29643096 PMCID: PMC5894369 DOI: 10.1136/bmj.k1162] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the impact of a 50% increase in market prices of cigarettes on health, poverty, and financial protection. DESIGN Compartmental model study. SETTING 13 middle income countries, totalling two billion men. PARTICIPANTS 500 million male smokers. MAIN OUTCOME MEASURES Life years gained, averted treatment costs, number of men avoiding catastrophic healthcare expenditures and poverty, and additional tax revenue by income group. RESULTS A 50% increase in cigarette prices would lead to about 450 million years of life gained across the 13 countries from smoking cessation, with half of these in China. Across all countries, men in the bottom income group (poorest 20% of the population) would gain 6.7 times more life years than men in the top income group (richest 20% of the population; 155 v 23 million). The average life years gained from cessation for each smoker in the bottom income group was 5.1 times that of the top group (1.46 v 0.23 years). Of the $157bn (£113bn; €127bn) in averted treatment costs, the bottom income group would avert 4.6 times more costs than the top income group ($46bn v $10bn). About 15.5 million men would avoid catastrophic health expenditures in a subset of seven countries without universal health coverage. As result, 8.8 million men, half of them in the bottom income group, would avoid falling below the World Bank definition of extreme poverty. These 8.8 million men constitute 2.4% of people living in extreme poverty in these countries. In contrast, the top income group would pay twice as much as the bottom income group of the $122bn additional tax collected. Overall, the bottom income group would get 31% of the life years saved and 29% each of the averted disease costs and averted catastrophic health expenditures, while paying only 10% of the additional taxes. CONCLUSIONS Higher prices of cigarettes provide more health and financial gains to the poorest 20% than to the richest 20% of the population. Higher excise taxes support the targets of the sustainable development goals on non-communicable diseases and poverty, and provides financial protection against illness.
Collapse
|
47
|
Prabhakaran D, Anand S, Watkins D, Gaziano T, Wu Y, Mbanya JC, Nugent R. Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition. Lancet 2018; 391:1224-1236. [PMID: 29108723 PMCID: PMC5996970 DOI: 10.1016/s0140-6736(17)32471-6] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 08/04/2017] [Accepted: 09/05/2017] [Indexed: 12/11/2022]
Abstract
Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action.
Collapse
Affiliation(s)
- Dorairaj Prabhakaran
- Public Health Foundation of India, Gurgaon, India; Centre for Chronic Disease Control, New Delhi, India; Department of Non-communicable Disease Epidemiology, London School of Hygiene Tropical Medicine, London, UK; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David Watkins
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Thomas Gaziano
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Yangfeng Wu
- The George Institute for Global Health, Peking University Health Science Center, Beijing, China
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaounde, Cameroon
| | | |
Collapse
|
48
|
Verguet S, Tarr G, Gauvreau CL, Mishra S, Jha P, Liu L, Xiao Y, Qiu Y, Zhao K. Distributional benefits of tobacco tax and smoke-free workplaces in China: A modeling study. J Glob Health 2018; 7:020701. [PMID: 29188029 PMCID: PMC5681709 DOI: 10.7189/jogh.07.020701] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Tobacco taxation and smoke–free workplaces reduce smoking, tobacco–related premature deaths and associated out–of–pocket health care expenditures. We examine the distributional consequences of a price increase in tobacco products through an excise tax hike, and of an implementation of smoke–free workplaces, in China. Methods We use extended cost–effectiveness analysis (ECEA) to evaluate, across income quintiles of the male population (the large majority of Chinese smokers), the premature deaths averted, the change in tax revenues generated, and the financial risk protection procured (eg, poverty cases averted, defined as the number of individuals no longer facing tobacco–related out–of–pocket expenditures for disease treatment, that would otherwise impoverish them), that would follow a 75% increase in cigarette prices through substantial increments in excise tax fully passed onto consumers, and a nationwide total implementation of workplace smoking bans. Results A 75% increase in cigarette prices would avert about 24 million premature deaths among the current Chinese male population, with a third among the bottom income quintile, increase additional tax revenues by US$ 46 billion annually, and prevent around 9 million poverty cases, 19% of which among the bottom income quintile. Implementation of smoking bans in workplaces would avert about 12 million premature deaths, with a fifth among the bottom income quintile, decrease tax revenues by US$ 7 billion annually, and prevent around 4 million poverty cases, 12% of which among the bottom income quintile. Conclusions Increased excise taxes on tobacco products and workplace smoking bans can procure large health and economic benefits to the Chinese population, especially among the poor.
Collapse
Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gillian Tarr
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | | | - Sujata Mishra
- Center for Global Health Research, Saint Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Prabhat Jha
- Center for Global Health Research, Saint Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Lingrui Liu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Yue Xiao
- China National Health Development Research Center, Beijing, China
| | - Yingpeng Qiu
- China National Health Development Research Center, Beijing, China
| | - Kun Zhao
- China National Health Development Research Center, Beijing, China
| |
Collapse
|
49
|
Stacey N, Summan A, Tugendhaft A, Laxminarayan R, Hofman K. Simulating the impact of excise taxation for disease prevention in low-income and middle-income countries: an application to South Africa. BMJ Glob Health 2018. [PMID: 29515917 PMCID: PMC5838397 DOI: 10.1136/bmjgh-2017-000568] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Excise taxes are policy tools that have been applied internationally with some success to reduce consumption of products adversely impacting population health including tobacco, alcohol and increasingly junk foods and sugary beverages. As in other low-income and middle-income countries, South Africa faces a growing burden of lifestyle diseases; accordingly we simulate the impact of multiple excise tax interventions in this setting. Methods We construct a mathematical model to simulate the health and revenue effects of increased excise taxes, which is adaptable to a variety of settings given its limited data requirements. Applying the model to South Africa, we simulate the impact of increased tax rates on tobacco and beer and of the introduction of a tax on sugar-sweetened beverages (SSB). Drawing on surveys of product usage and risk factor prevalence, the model uses a potential impact fraction to simulate the health effects of tax interventions. Results Adopting an excise rate of 60% on tobacco would result in a gain of 858 923 life-years (95% uncertainty interval (UI) 480 188 to 1 310 329), while adopting an excise rate of 25% on beer would result in a gain of 568 063 life-years (95% UI 412 110 to 775 560) and the adoption of a 20% tax on SSBs would result in a gain of 688 719 life-years (95% UI 321 788 to 1 079 653). Conclusion More aggressive excise tax policies on tobacco, beer and SSBs in South Africa could result in meaningful improvements in population health and raised revenue.
Collapse
Affiliation(s)
- Nicholas Stacey
- Priority Cost Effective Lessons for Systems Strengthening, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amit Summan
- Center for Disease Dynamics Economics and Policy, Washington, District of Columbia, USA
| | - Aviva Tugendhaft
- Priority Cost Effective Lessons for Systems Strengthening, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ramanan Laxminarayan
- Center for Disease Dynamics Economics and Policy, Washington, District of Columbia, USA
| | - Karen Hofman
- Priority Cost Effective Lessons for Systems Strengthening, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
50
|
Nakamura Y, Takahashi K, Nomura M, Kamei M. Welfare analysis of a zero-smoking policy – A case study in Japan. Drug Discov Ther 2018; 12:37-41. [DOI: 10.5582/ddt.2017.01062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Marika Nomura
- Department of International Health and Collaboration, National Institute of Public Health
| | | |
Collapse
|