Raising taxes key to accelerate tobacco control in South Asia

Prabhat Jha, Javaid Khan, Sujata Mishra, Prakash Gupta

“South Asian countries must prioritise higher tobacco taxation and other control measures to raise the low levels of tobacco cessation and thus avoid millions of premature deaths, say Prabhat Jha and colleagues

On current smoking patterns, tobacco will kill about 1 billion people worldwide this century, including substantial numbers in the South Asian countries. All South Asian countries have signed the Framework Convention on Tobacco Control and have committed to the United Nations (UN) sustainable development goals (SDG), including to reduce premature mortality from non-communicable diseases by one third by 2030. Achieving this goal will depend on effective implementation of the tobacco control measures set out in the framework convention. The most important of these is large increases in the excise tax on tobacco products.”

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  • Nearly 30 per cent of males and about 4 per cent of females age 15 or older in South Asian countries smoke, with notable variation between countries.
  • By 2010, South Asia had roughly 171 million smokers age 15 or older; 100 million are over 35 years. A large proportion of these smokers are males living in India.
  • Smoking generally starts at a later age (about 25 years) and smokers smoke fewer daily cigarettes or bidis (mean daily consumption of about eight sticks) as compared with high-income countries, where most smokers start before age 20 and the mean number of cigarettes smoked a day is more than 15.
  • The hazards of smoking are considerable in South Asia. For example, the loss of life among Indian male cigarette smokers is as great as that of prolonged smokers in high-income countries.
  • Smoking cessation is effective. Those who stop smoking before age 40 avoid about 90 per cent of the excess risk of continued smoking and will regain nine years of life. Those who stop by age of 50 and 60 year regain about six and four years of life, respectively.
  • Smoking cessation rates are quite low in South Asia. Among men, the former smoking prevalence in India and Nepal is below 5 per cent with slightly higher rates in Bangladesh. In high-income countries such as the United States, the prevalence of former smoking is more than the current smoking prevalence by age 50.
  • Increases in tobacco tax are the single most effective intervention to reduce or stop tobacco consumption. A tripling of the cigarette excise tax would roughly double the price of cigarettes.
  •  Price measures coupled with a complete ban on smoking in public places and on tobacco advertising, as well as use of large pictorial warnings or plain packaging on tobacco products can further accelerate smoking cessation.
  • Low levels of excise taxes in South Asian countries are the main for the low price of cigarettes, bidis and chewing tobacco. Tax increases have not kept up with income growth, making them relatively affordable. In India and Bangladesh, the biggest increase in cigarette use has occurred among young and illiterate male adults.
  • South Asia also has 260 million chewers of tobacco, 92 million of whom are women. The very high rates of oral cancer in South Asia are strongly attributable to tobacco chewing. Women who chew tobacco seem to have higher risks of developing and dying from oral cancer than men, despite chewing less per day.
  • Effective implementation of the Framework Convention on Tobacco Control, in particular its tax provisions, could reduce tobacco consumption by at least one-third, save about 35-45 million lives of current and future smokers, and help achieve the Sustainable Development Goals that call for a 30-per-cent reduction in non-communicable disease deaths.