1. Curbing the Epidemic: Governments and the Economics of Tobacco Control Why is tobacco control a public health priority around the World? Dr. Joy de Beyer World Bank Washington DC

2. Why is tobacco control a priority ? Y1.1 billion smokers worldwide, 800 million in developing countries YBy 2030: 10 million deaths/year, and tobacco is likely to be the biggest cause of death worldwide YBurden is shifting to developing world YGlobally, 80,000 to 100,000 youths start smoking every day YSmokers do not know the health risks YTobacco is very addictive, its hard to quit Source: Curbing the Epidemic, 1999

3. World consumption has increased last 5 years, due to increasing consumption in developing world. Source: USDA data 1996-2001

4. Large and growing number of tobacco deaths, especially in developing countries u 1 in 2 of long-term smokers killed by their addiction u 1/2 of deaths in middle age (35-69) World: Annual Tobacco deaths (in millions) 2000 2030 Developed 2 ~3 Developing ~2 ~7 World Total 4 ~10 Source: Peto, Lopez, and others 1997; WDR 1993

5. Unless current smokers quit, smoking deaths will rise dramatically over the next 50 years Source: Peto and others, 1994; Peto, personal communication.

6. Why do Governments Intervene? To deter children from smoking To protect non-smokers from others smoke To provide adults the information needed to make an informed choice To help smokers who wish to quit smoking

7. Tobacco addiction starts early in life Source: Chinese Academy of Medicine 1997, Gupta 1996, US Surgeon General Reports, 1989 and 1994, Authors calculations Every day 80,000 to 100,000 youths become regular smokers

8. Why is tobacco control a health priority in the World? Deter Children from Smoking: Smoking Starts Early Source: Corrao et al, TCCP, ACS 2000, and GYTS 1999

9. Why is tobacco control a health priority in the World? Deter Children from Smoking: Smoking Starts Early

10. Women are a target Glamorous, modern, independent women smoke!! Smoking prevalence by age among Turkish women, 1996 Source: Bilir et.al, 1997 Smoking behavior and attitudes, Ankara-Turkey

11. Smokers dont all know the health risks Opinions on Smoking and Health in Hungary 1996

12. Smokers often regret that they started smoking Ankara-Turkey, 1996 Source: Bilir et.al, 1997 Smoking behavior and attitudes, Ankara-Turkey

13. Smokers pay twice - out of pocket costs are higher than most smokers realize Source: Data from IMF, USDA, WHO and WB sources, calculations by the WB

14. How to Reduce Tobacco Use Higher cigarette taxes Non-price measures: Better consumer information: strong warning labels, counter-advertising & disseminate research findings Comprehensive ban on advertising and promotion Ban smoking in public and work places Cessation help (NRT)

15. Higher taxes/prices, lower consumption –As taxes/prices increase, consumption falls A 10% increase in price reduces cigarette consumption by: –4% in developed countries, –8% in developing countries –People with low incomes (including youth) are more price-sensitive A 10% price increase reduces smoking as much as 10% among youth and poor groups Deters youth from taking up smoking

16. Price Elasticity Evidence As tax increases, consumption decreases Evidence from Turkey Source: TEKEL, and World Bank Calculation

17. As Cigarette Tax Rises, Revenue Increases Tax per pack and cigarette tax revenues in Norway, 1990-1998

18. Comprehensive advertising bans reduce cigarette consumption Consumption trends in countries with such bans v. those with no bans (n=102 countries) Source: Saffer, in Jha and Chaloupka (eds) 2000

19. Loopholes in Turkish Non-Price Measures Consumer information 90 minutes TV programs on tobacco and health- Has anyone seen them? Very late hours, few viewers Research Do researchers have enough sources and support? Cigarette advertising and promotion bans Turkey has comprehensive legislation and enforcement Warning labels and restrictions on public smoking, –but warning labels are too small –are public smoking restrictions enforced?

20. Nicotine is very addictive. Smokers need help! Treating Nicotine Dependence Wanting to quit smoking is an important step Increase smokers knowledge of health risks, benefits of quitting and availability of cessation help Cessation support from health professionals is key Essential: smoke free hospitals and health professionals Cessation treatments should be available and affordable Governments may increase accessibility and affordability of NRTs by: Over the counter (OTC) sales, allowing advertising, licensing Study cost-effectiveness (especially in low/middle income countries) Considering NRT subsidies for poorest smokers NRTs double the effectiveness of cessation efforts Quit lines, community support, etc., work

21. Cessation support from health professionals is key But too many doctors smoke Source: Carrao et.al., 2000

23. Recommendations Governments can control the tobacco epidemic with sound economic and health policies –adopt a comprehensive set of proven measures, tailored to each country –implement and enforce policies –children and adults respond to higher taxes –help current smokers quit –inform the public well –educate & enlist health professionals