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27 February 2014

To save lives, raise tobacco taxes

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A recent study finds that rising prices is, by far, the best way to tackle tobacco-related diseases while ignoring tobacco industry arguments that higher taxes would affect state revenues

Smoking is the largest single cause of preventable premature death and disease, accounting for some 650,000 premature deaths each year in the European Union, according to official EU statistics. “A lot of ministers of finance and governments are encouraged by the tobacco industry not to raise prices because it only affects the poor and it will reduce revenues, killing the goose that lays the golden egg,” says Luke Clancy a respiratory consultant and director general of the Tobacco Free Research Institute Ireland. “Both these claims are shown to be wrong in our [recent] report,” he adds.

Clancy’s expertise on the issue also comes from his role as coordinator with the EU-funded PPACTE project, which produced new reports on tobacco in Europe. A survey of 17 European countries revealed a high level of support for substantial increases in tobacco taxes. “In every country a majority supported higher taxes, so taxes were popular,” says Clancy. However, many people supported such taxes only if some of the money was used to assist people in stopping. 

He also stresses that nothing in the armament compares to tax rises, including treatment, bans on advertisement and smoke-free areas. The report recommended that tax on tobacco be harmonised across Europe and various forms of tobacco be treated the same. For example, fine-cut tobacco for rolling cigarettes must be taxed at the same rate as manufactured cigarettes. 

The group also recommended that discounted tobacco products be tackled. “In the UK companies can manipulate prices so they get cheap cigarettes onto the market and therefore addict young people and poor people and we are saying that shouldn’t be allowed,” Clancy tells He notes there is even below cost selling of tobacco products. “Even with below cost selling they will increase market share because you are dealing with an addictive product and they will make the money back on you later.”

Experts agree. There is good scientific evidence that rises in price can dissuade young smokers, even if it does not necessarily influence current smokers, according to Armin Fidler, who speaks in a personal capacity and not with his hat as lead advisor for health policy and strategy at the World Bank, headquartered in Washington DC. Asked if the tobacco industry should play a role in public policy on smoking, he says: “Personally, I really don’t think so. When one looks at the behaviour of the industry you see that they have forfeited all good will by their past behaviour. I would not trust the tobacco industry for a moment.” He points to YouTube clip where tobacco companies’ CEOs testifying to [the US] Congress, saying nicotine was not addictive. 

Other experts see positives but also negatives in price increases. “Increasing the financial cost to deter smoking remains the single most important measure, through tax increases and appropriate measures to combat illicit supply,” says Robert West, director of tobacco studies at University College London, UK. Though he believes a comprehensive approach is best, West also acknowledges a downside to increasing taxes on cigarettes. “It increases the burden on poor smokers who cannot stop. This is why it must be accompanied by help with stopping or ensuring that alternatives are available,” including electronic cigarettes, he tells

The trouble in Europe is that tobacco policy varies considerably across countries, which is a problem, according to Fidler, who is based in Washington, DC, USA. Meanwhile, is perplexed by the inaction of some European countries. “What surprises me is that many countries in Europe refuse to take popular action that will save the lives of thousands of their citizens at no cost to the public purse – in fact it would lead to an increase in funds to hard pressed exchequers. The obvious conclusion is that the governments of these countries are motivated by something else and in that respect the huge power and influence of the tobacco industry cannot be ignored.”

Tobacco has a negative effect on public health budgets. Smokers do not bear the cost of their behaviour, which instead is paid by public health funding, in most countries, says Fidler. “Society bears the cost of their behaviour. If smokers fall ill, there are considerable costs to that,” he tells

Finally, Clancy backs higher price. Most tobacco control interventions to not reduce inequality in health, but higher prices do reduce inequality, Clancy says, “Inequality in tobacco is a horrible reality. Poor people suffer more because they are more likely to start young, more likely to spend money on it, more likely to get sick and so more likely to earn less and their children are more likely to smoke.” Education and health warnings have an effect, “but nothing compares to price,” he concludes.

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