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Death and Tobacco Taxes

A global killer is ripping through the world’s poorer countries largely unchecked. Within 25 years, it will cause 10 million deaths a year worldwide –more than malaria, maternal deaths, childhood infections, and diarrhea combined . Over half of the dead will be aged 30 to 69, losing about 25 years of life expectancy. The culprit? Tobacco. The same addiction that became the top preventable cause of death in Western countries has made big inroads in developing countries. Smoking killed 100 million people in the twentieth century, mostly in developed countries. On current trends smoking will kill about one billion people in the twenty-first century, mostly in developing countries.

In India, smoking triples the risk of death from tuberculosis in men and women and may even contribute to the spread of tuberculosis to others. About 1 million people per year will soon die from smoking in China and India. Perhaps 150 million young adults will be killed by tobacco in these two countries alone, unless there is widespread cessation.

But the death tolls of the past need not become the world’s future. We know how to control tobacco use. Cessation by the 1.1 billion current smokers is needed to lower tobacco deaths over the next few decades. Reduced uptake of smoking by children would save lives chiefly after 2050. Quitting works: even those who stop smoking in their 40’s lower their risk of death remarkably, and those who quit in their 30’s have death risks close to lifelong non-smokers.

Tobacco tax increases, dissemination of information about the health risks of smoking, smoking bans in public, complete bans on advertising and promotion, and cessation therapies are effective in helping smokers to quit. Tobacco taxes are probably the single most cost-effective intervention for adult health in the world. A tripling of the excise tax would roughly double the price of cigarettes (as has happened in New York City), preventing about three million deaths per year by 2030. Most OECD countries began to take tobacco control seriously in the last two decades, and have decreased male tobacco deaths since. But effective tobacco control measures are not underway in developing countries. Taxes are about 80% of the street price of cigarettes in Toronto, but less than 30% in Beijing or Delhi. In many countries, tobacco taxes have fallen in real terms. Knowledge of the health risks from smoking is low: 61% of Chinese smokers in 1996 thought tobacco did them “little or no harm.”