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Disease Management & Health Outcomes

, Volume 11, Issue 10, pp 647–661 | Cite as

Global Efforts for Reducing the Burden of Smoking

  • Frank J. ChaloupkaEmail author
  • Prabhat Jha
  • Marlo A. Corrao
  • Vera Luiza da Costa e Silva
  • Hana Ross
  • Christina C. Ciecierski
  • Derek Yach
Review Article

Abstract

Cigarette smoking and other tobacco use impose a huge and growing public health burden globally. Currently, approximately 4 million persons are killed annually by tobacco use; by 2030, estimates based on current trends indicate that this number will increase to 10 million, with 70% of deaths occurring in low- and middle-income countries. Numerous studies from high-income countries, and a growing number from low- and middle-income countries, provide strong evidence that increases in tobacco tax, dissemination of information about health risks from smoking, restrictions on smoking in public places and in workplaces, comprehensive bans on advertising and promotion, and increased access to cessation therapies are all effective in reducing tobacco use and its consequences. Despite this evidence, tobacco control policies have been unevenly applied, partly because of political constraints.

When the tobacco control policies that have been adopted by individual governments were reviewed, upper-middle-income countries had significantly higher total legislative scores than low- and middle-income countries. This suggests a relationship between the comprehensiveness of tobacco control policies and income level. However, there are other factors that may contribute.

A key political tool for addressing political opposition to tobacco control policies is an earmarked tobacco tax. In addition, a key pillar to help overcome some of the constraints against implementing effective tobacco control policies is the Framework Convention on Tobacco Control (FCTC). The FCTC aims to be an international treaty that would commit countries to adopting strong, effective tobacco control policies. The treaty was recently unanimously adopted by the 192 member states of the WHO.

Keywords

Nicotine Replacement Therapy Tobacco Control Tobacco Product Secondhand Smoke Tobacco Control Policy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

This paper was prepared for the WHO’s Commission on Macroeconomics and Health Working Group Five, chaired by Prabhat Jha and Anne Mills. Support from the WHO is gratefully acknowledged. We are grateful to the editors for their helpful comments on a previous draft. Any opinions expressed are those of the authors and not the WHO. The authors have no conflicts of interest directly relevant to the content of this review.

References

  1. 1.
    Peto R, Lopez AD. The future worldwide health effects of current smoking patterns. In: Koop EC, Pearson CE, Schwarz MR, editors. Global health in the 21st century. New York: Jossey-Bass, 2000: 154–61Google Scholar
  2. 2.
    World Health Organization. Tobacco or health: a global status report. Geneva: World Health Organization, 1997Google Scholar
  3. 3.
    World Bank. Curbing the epidemic: governments and the economics of tobacco control. Washington, DC: World Bank, 1999Google Scholar
  4. 4.
    Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000Google Scholar
  5. 5.
    Jha P, Chaloupka FJ. The economics of global tobacco control. BMJ 2000; 321: 358–61PubMedCrossRefGoogle Scholar
  6. 6.
    Jha P, Ranson K, Nguyen S, et al. Estimates of global and regional smoking prevalence in 1995 by age and gender. Am J Public Health 2002; 92(6): 1002–06. Available from URL: http://www.tandf.co.uk/journals/titles/14622203.html PubMedCrossRefGoogle Scholar
  7. 7.
    Taylor AL, Chaloupka FJ, Guindon E, et al. The impact of trade liberalization on tobacco consumption. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 343–64Google Scholar
  8. 8.
    Gajalakshmi CK, Jha P, Ranson K, et al. Global patterns of smoking and smoking-attributable mortality. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 11–39Google Scholar
  9. 9.
    World Health Organization. Making a difference, World Health Report 1999. Geneva: WHO, 1999Google Scholar
  10. 10.
    Peto R, Lopez AD, Boreham J, et al. Mortality from smoking in developed countries, 1950–2000. Oxford: Oxford University Press, 1994Google Scholar
  11. 11.
    National Cancer Institute. Health effects of exposure to environmental tobacco smoke: the report of the California environmental protection agency, smoking and tobacco control monograph No. 10. Bethesda (MD): US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 1999.Google Scholar
  12. 12.
    US Department of Health and Human Services. Women and smoking: a report of the surgeon general. Atlanta (GA): US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2001.Google Scholar
  13. 13.
    Bobak M, Jha P, Nguyen S, et al. Poverty and smoking. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 41–61Google Scholar
  14. 14.
    Lightwood J, Collins D, Lapsley H, et al. Estimating the costs of tobacco use. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 63–103Google Scholar
  15. 15.
    Geist H. Global assessment of deforestation related to tobacco farming. Tob Control 1999; 8: 18–28PubMedCrossRefGoogle Scholar
  16. 16.
    Ballard T, Ehlers J, Freund E, et al. Green tobacco sickness: occupational nicotine poisoning in tobacco workers. Arch Environ Health 1995; 50: 384–9PubMedCrossRefGoogle Scholar
  17. 17.
    Efroymson D, Ahmed S, Townsend J, et al. Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor in Bangladesh. Tob Control 2001; 10: 212–7PubMedCrossRefGoogle Scholar
  18. 18.
    Jha P, Musgrove P, Chaloupka FJ, et al. The economic rationale for intervention in the tobacco market. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 153–74Google Scholar
  19. 19.
    Warner KE, Chaloupka FJ, Cook PJ, et al. Criteria for determining an optimal cigarette tax: the economist’s perspective. Tob Control 1995; 4: 380–6CrossRefGoogle Scholar
  20. 20.
    Kenkel D, Chen L. Consumer information and tobacco use. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 177–214Google Scholar
  21. 21.
    Weinstein ND. Accuracy of smokers’ risk perceptions. Ann Behav Med 1998; 20: 135–40PubMedCrossRefGoogle Scholar
  22. 22.
    US Department of Health and Human Services. Preventing tobacco use among young people: a report of the Surgeon General. Atlanta (GA): US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994.Google Scholar
  23. 23.
    Chaloupka FJ, Grossman M, Bickel WK, et al., editors. The economic analysis of substance use and abuse: an integration of econometric and behavioral economic research. Chicago (IL): University of Chicago Press, 1999Google Scholar
  24. 24.
    Chaloupka FJ, Hu T-W, Warner KE, et al. The taxation of tobacco products. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 237–72Google Scholar
  25. 25.
    Chaloupka FJ, Warner KE. The economics of smoking. In: Culyer AJ, Newhouse JP, editors. Handbook of health economics. Amsterdam: North-Holland, 2000: 1539–627CrossRefGoogle Scholar
  26. 26.
    US Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. Atlanta (GA): US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000.Google Scholar
  27. 27.
    Centers for Disease Control and Prevention. Response to increases in cigarette prices by race/ethnicity, income, and age groups: United States, 1976–1993. MMWR Morb Mort Wkly Rep 1994; 43(26): 469–72Google Scholar
  28. 28.
    Wasserman J, Manning WG, Newhouse JP, et al. The effects of excise taxes and regulations on cigarette smoking. J Health Econ 1991; 10(1): 43–64PubMedCrossRefGoogle Scholar
  29. 29.
    Chaloupka FJ. Rational addictive behavior and cigarette smoking. J Polit Econ 1991; 99(4): 722–42CrossRefGoogle Scholar
  30. 30.
    Becker GS, Grossman M, Murphy KM. An empirical analysis of cigarette addiction. Am Econ Rev 1994; 84(3): 396–418Google Scholar
  31. 31.
    Becker GS, Murphy KM. A theory of rational addiction. J Polit Econ 1988; 96(4): 675–700CrossRefGoogle Scholar
  32. 32.
    Chaloupka FJ, Tauras JA, Grossman M. The economics of addiction. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 107–29Google Scholar
  33. 33.
    Gruber J. Youth smoking in the US: prices and policies. Working paper no. 7507. Cambridge (MA): National Bureau of Economic Research, 2000Google Scholar
  34. 34.
    Ross H, Chaloupka FJ. The effect of public policies and prices on youth smoking. Research paper no. 8. Chicago (IL): ImpacTeen, Health Research and Policy Centers, University of Illinois at Chicago, 2001Google Scholar
  35. 35.
    Harris JE, Chan SW. The continuum-of-addiction: cigarette smoking in relation to price among Americans aged 15–29. Health Econ 1999; 8(1): 81–6PubMedCrossRefGoogle Scholar
  36. 36.
    Emery S, White MM, Pierce JP. Does cigarette price influence adolescent experimentation? J Health Econ 2001; 20: 261–70PubMedCrossRefGoogle Scholar
  37. 37.
    Ross H, Chaloupka FJ, Wakefield M. Youth smoking uptake progress: price and public policy effects. Research paper no. 11. Chicago (IL): ImpacTeen, Health Research and Policy Centers, University of Illinois at Chicago, 2001Google Scholar
  38. 38.
    Tauras JA, O’Malley PM, Johnston LD. Effects of price and access laws on teenage smoking initiation: a national longitudinal analysis. Research Paper no. 2. Chicago (IL): ImpacTeen and YES!, Health Research and Policy Centers, University of Illinois at Chicago, 2001Google Scholar
  39. 39.
    Townsend JL, Roderick P, Cooper J. Cigarette smoking by socio-economic group, sex, and age: effects of price, income, and health publicity. BMJ 1994; 309(6959): 923–6PubMedCrossRefGoogle Scholar
  40. 40.
    Woolery T, Asma S, Sharp D. Clean indoor-air laws and youth access. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 273–86Google Scholar
  41. 41.
    Hopkins DP, Briss PA, Ricard CJ, et al. Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. Am J Prev Med 2001; 20(2S): 16–52PubMedCrossRefGoogle Scholar
  42. 42.
    Evans WN, Farrelly MC, Montgomery E. Do workplace smoking bans reduce smoking? Am Econ Rev 1999; 89(4): 728–47CrossRefGoogle Scholar
  43. 43.
    Jacobson PD, Wasserman J. Tobacco control laws: implementation and enforcement. Santa Monica: RAND, 1997Google Scholar
  44. 44.
    Royal College of Physicians. “Smoking and Health”, Summary and report of the Royal College of Physicians of London on Smoking in Relation to Cancer of the Lung and Other Diseases. New York: Pitman Publishing, 1962Google Scholar
  45. 45.
    U.S. Department of Health, Education, and Welfare. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington DC: U.S. Department of Health, Education, and Welfare, Public Health Service, 1964Google Scholar
  46. 46.
    Townsend JL. Policies to halve smoking deaths. Addiction 1993; 88: 43–52CrossRefGoogle Scholar
  47. 47.
    Saffer H. Tobacco advertising and promotion. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 215–36Google Scholar
  48. 48.
    Federal Trade Commission. Cigarette report for 2001. Washington, DC: Federal Trade Commission, 2003Google Scholar
  49. 49.
    UK Department of Health. Effect of tobacco advertising on tobacco consumption: a discussion document reviewing the evidence. London: UK Department of Health, Economics and Operational Research Division, 1992Google Scholar
  50. 50.
    Saffer H, Chaloupka F. Tobacco advertising: economic theory and international evidence. J Health Econ 2000; 19(6): 1117–37PubMedCrossRefGoogle Scholar
  51. 51.
    Novotny TE, Cohen JC, Yurekli A, et al. Smoking cessation and nicotine-replacement therapies. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 287–307Google Scholar
  52. 52.
    Raw M, McNeill A, West R. Smoking cessation: evidence-based recommendations for the healthcare system. BMJ 1999; 318: 182–5PubMedCrossRefGoogle Scholar
  53. 53.
    Tauras JA, Chaloupka FJ. The demand for nicotine replacement therapies. Nicotine Tob Res 2003; 5(2): 237–43PubMedCrossRefGoogle Scholar
  54. 54.
    Ranson MK, Jha P, Chaloupka FJ, et al. Global and regional estimates of the effectiveness and cost-effectiveness of price increases and other tobacco control policies. Nicotine Tob Res 2002; 4: 311–9PubMedCrossRefGoogle Scholar
  55. 55.
    Jacobs R, Gale HF, Capehart TC, et al. The supply-side effects of tobacco-control policies. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 311–41Google Scholar
  56. 56.
    Merriman D, Yurekli A, Chaloupka FJ. How big is the worldwide cigarette smuggling problem? In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 365–92Google Scholar
  57. 57.
    Joossens L, Chaloupka FJ, Merriman D, et al. Issues in the smuggling of tobacco products. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 393–406Google Scholar
  58. 58.
    Farrelly MC, Pechacek TF, Chaloupka FJ. The impact of tobacco control program expenditures on aggregate cigarette sales: 1981–1998. J Health Econ. In press.Google Scholar
  59. 59.
    Wakefield MA, Chaloupka FJ. Effectiveness of comprehensive tobacco control Programs in reducing teenage smoking in the United States. Tob Control 2000; 9(2): 177–86PubMedCrossRefGoogle Scholar
  60. 60.
    Townsend J. UK smoking targets: policies to attain them and effects on premature mortality. In: Abedian I, van der Merwe R, Wilkins N, et al., editors. The economics of tobacco control: towards an optimal policy mix. Cape Town: Applied Fiscal Research Centre, University of Cape Town, 1998: 185–98Google Scholar
  61. 61.
    Centers for Disease Control and Prevention. Declines in lung cancer rates: California, 1988–1997. MMWR Morb Mortal Wkly Rep 2000; 49(47): 1066–9Google Scholar
  62. 62.
    Molarius A, Parsons RW, Dobson AJ, et al. Trends in cigarette smoking in 36 populations from the early 1980s to the mid-1990s: findings from the WHO MONICA Project. Am J Public Health 2001; 91(2): 206–12PubMedCrossRefGoogle Scholar
  63. 63.
    Peto R, Darby S, Deo H, et al. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case control studies. BMJ 2000; 321(7257): 323–9PubMedCrossRefGoogle Scholar
  64. 64.
    Moore MJ. Death and tobacco taxes. Rand J Econ 1996; 27: 415–28CrossRefGoogle Scholar
  65. 65.
    Evans WN, Ringel JS. Can higher cigarette taxes improve birth outcomes? J Public Econ 1999; 72: 135–54CrossRefGoogle Scholar
  66. 66.
    Fichtenber MS, Glantz SA. Association of the California tobacco control program with declines in cigarette consumption and mortality from heart disease. N Engl J Med 2000 343: 1772–7CrossRefGoogle Scholar
  67. 67.
    Max W, Rice DP, Zhang X, et al. The cost of smoking in California, 1999. Sacramento (CA): Department of Health Services, 2002Google Scholar
  68. 68.
    Corrao MA, Guindon GE, Sharma N, et al, editors. Tobacco control country profiles. Atlanta (GA): American Cancer Society, 2000Google Scholar
  69. 69.
    Klonoff EA, Landrine H, Alcaraz R, et al. An instrument for assessing the quality of tobacco-control policies the ACT-L scale. Prev Med 1998; 27: 808–14PubMedCrossRefGoogle Scholar
  70. 70.
    World Bank. World development indicators, 2000. Washington, DC: World Bank, 2001Google Scholar
  71. 71.
    Abedian I, van der Merwe R, Wilkins N, et al., editors, The economics of tobacco control: towards an optimal policy mix. Cape Town: University of Cape Town, 1998Google Scholar
  72. 72.
    Centers for Disease Control and Prevention. Best practices for comprehensive tobacco control programs. Atlanta (GA): US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1999.Google Scholar
  73. 73.
    Pechmann C, Dixon P, Layne N. An assessment of US and Canadian smoking reduction objectives for the year 2000. Am J Public Health 1998; 88(9): 1362–7PubMedCrossRefGoogle Scholar
  74. 74.
    World Bank. The World development report 1993: investing in health. New York (NY): Oxford University Press, 1993Google Scholar
  75. 75.
    World Health Organisation. Investing in health research and development: report of the ad hoc Committee on Health Research Relating to Future Intervention Options (Document TDR/Gen/96.1). Geneva: World Health Organization, 1996Google Scholar
  76. 76.
    Jha P, Paccaud F, Nguyen S. Strategic priorities for governments and development agencies in tobacco control. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 449–64Google Scholar
  77. 77.
    Sunley EM, Yurekli A, Chaloupka FJ. The design, administration and potential revenue of tobacco excises. In: Jha P, Chaloupka FJ, editors. Tobacco control in developing countries. Oxford: Oxford University Press, 2000: 409–26Google Scholar
  78. 78.
    Pollock D. Forty years on: a war to recognise and win: how the tobacco industry has survived the revelations on smoking and health. Br Med Bull 1996; 52: 174–82PubMedCrossRefGoogle Scholar
  79. 79.
    Hu TW, Xu X, Keeler T. Earmarked tobacco taxes: lessons learned. In: Abedian I, van der Merwe R, Wilkins N, et al., editors. The economics of tobacco control: towards an optimal policy. Cape Town, South Africa: Applied Fiscal Research Centre, University of Cape Town, 1998: 102–18Google Scholar
  80. 80.
    Galbally RL. Health-promoting environments: who will miss out? Aust N Z J Public Health 1997; 21 (4 Spec No): 429–30PubMedCrossRefGoogle Scholar
  81. 81.
    Saxenian H, McGreevey B. China: issues and options in health financing. World Bank Report No. 15278-CHA. Washington, DC: World Bank, 1996Google Scholar
  82. 82.
    Taylor AL, Bettcher DW. WHO framework convention on tobacco control: a global ‘good’ for public health. Bull World Health Organ 2000; 78(7): 920–9PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2003

Authors and Affiliations

  • Frank J. Chaloupka
    • 1
    • 2
    • 3
    Email author
  • Prabhat Jha
    • 3
    • 4
  • Marlo A. Corrao
    • 5
  • Vera Luiza da Costa e Silva
    • 6
  • Hana Ross
    • 1
    • 3
  • Christina C. Ciecierski
    • 1
    • 3
  • Derek Yach
    • 7
  1. 1.Department of Economics and Health Research and Policy CentersUniversity of IllinoisChicagoUSA
  2. 2.National Bureau of Economic ResearchCambridgeUSA
  3. 3.International Tobacco Evidence NetworkChicagoUSA
  4. 4.Centre for Global Health Research, St Michael’s HospitalUniversity of TorontoTorontoCanada
  5. 5.Economics Advisory ServiceWorld Health OrganizationGenevaSwitzerland
  6. 6.Tobacco Free InitiativeWorld Health OrganizationGenevaSwitzerland
  7. 7.Non Communicable Disease and Mental Health ClusterWorld Health OrganizationGenevaSwitzerland

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