2014年-世界发展银行全球_The_Effects_of_Tobacco_Taxes_on_Health___An_Analysis_of_the_Effects_by_Income_Quintile_and_Gender_in_Kazakhstan_the_Russian_Federation_and_Ukraine_34页_1mb

Summary of "The Effects of Tobacco Taxes on Health: An Analysis of the Effects by Income Quintile and Gender in Kazakhstan, the Russian Federation, and Ukraine"

Core Content

This discussion paper analyzes the health impacts of tobacco taxation in Kazakhstan, the Russian Federation, and Ukraine, with a focus on how these impacts vary by income quintile and gender. It aims to estimate the burden of tobacco-related mortality and the distributional health effects of a 30% increase in the average retail price of cigarettes due to excise tax hikes.

Main Objectives

• To estimate the burden of tobacco-caused mortality across the three countries.
• To assess the distributional health impact of a hypothetical increase in tobacco taxation.
• To evaluate the potential health benefits and cost savings from reduced smoking prevalence.

Key Findings

Tobacco-Related Mortality in 2012

• Russia: Smoking caused around 310,000 deaths, representing 14% of total mortality.
• Ukraine: Smoking caused about 70,000 deaths.
• Kazakhstan: Smoking caused approximately 14,300 deaths.

These figures highlight the significant role of smoking in mortality, particularly among working-age populations.

Impact of Tobacco Tax Increase

• A 30% increase in the average retail price of cigarettes could lead to:
  • A 3.5 to 4.0% reduction in smoking prevalence.
  • A substantial decrease in tobacco-related mortality over a 50-year period:
    • Russia: ~600,000 deaths averted.
    • Ukraine: ~140,000 deaths averted.
    • Kazakhstan: ~30,000 deaths averted.

Health Expenditure Reduction

• Reduction in tobacco-related morbidity would lead to:
  • Kazakhstan: Over $50 million in health expenditure savings.
  • Russia: Over $2 billion in health expenditure savings.
  • Ukraine: $180 million in health expenditure savings.

Pro-Poor Health Effects

• The reduction in mortality is expected to be pro-poor, with almost 60% of the reduction concentrated in the two lower-income quintiles.

Methodology

Data Sources

• Kazakhstan: 2012 Household Health Survey.
• Russia: Global Adult Tobacco Survey (GATS), 2009.
• Ukraine: Global Adult Tobacco Survey (GATS), 2010.

Assumptions

• Price Elasticity of Demand:
  • Ukraine: -0.3 (basic), -0.4 (higher).
  • Russia and Kazakhstan: -0.3 (basic), -0.2 (lower), and -0.3 (higher).
• Elasticity of Participation: Assumed to be half of the price elasticity of demand.
• Smoking Prevalence by Income Quintile:
  • Russia: 61% for males, 20% for females.
  • Ukraine: 53% for males, 11% for females.
  • Kazakhstan: 34% for males, 2% for females (lower than WHO estimates, possibly leading to underestimation of health impacts).

Modeling Approach

• A life table technique is used to estimate:
  • Smoking prevalence changes.
  • Changes in mortality and life expectancy.
  • Reduction in public health expenditures.

Distributional Impact

• The poorest income groups are expected to benefit the most from reduced smoking prevalence due to:
  • Higher health risks associated with smoking.
  • Greater sensitivity to price changes.
• The distribution of health benefits is analyzed across income quintiles and gender groups.

Public Health Expenditures

• Treatment costs for tobacco-related diseases are estimated using:
  • Russian regional data (Sverdlovsk region).
  • Indexed to Kazakhstan and Ukraine using WHO per capita public health expenditure data.
• The expected cost savings are calculated based on the reduction in smoking prevalence and the associated decrease in tobacco-related diseases.

Conclusion and Recommendations

• Tobacco taxation is effective in reducing smoking prevalence and averting tobacco-related deaths.
• The health benefits are pro-poor, with significant reductions in mortality concentrated among the lower-income quintiles.
• The paper recommends that tobacco tax increases can be a progressive policy to improve public health outcomes in the region.

Key Information

• Smoking prevalence is traditionally high in post-Soviet countries.
• Tobacco excise taxes are relatively low in these countries, with Kazakhstan having the lowest.
• Price elasticity of tobacco demand is low in Russia and Ukraine, but not estimated for Kazakhstan.
• Health benefits from tax increases are expected to be more pronounced in lower-income groups.
• Life expectancy differences between smokers and nonsmokers are significant, with smokers losing up to 8 years of life in Kazakhstan and 7 years in Russia and Ukraine.
• Reduction in health expenditures is a major benefit of tobacco tax increases, with Russia leading in savings.

Tables Summary

• Table 1.1: Relative risks for various causes of death by gender and age.
• Table 1.2: Sensitivity of average retail price to excise changes.
• Table 1.3: Initial tobacco consumption parameters in 2012.
• Table 1.4: Authors' assumptions for price elasticity and participation elasticity.
• Table 1.5: Estimated treatment costs for selected tobacco-related diseases.
• Table 1.6: Estimated life expectancy differences between smokers and nonsmokers.
• Table 1.7: Estimated tobacco-related deaths in 2012.

Figures Summary

• Figure 1.1: Average excises before and after the considered excise increase.
• Figure 1.2: Average excises before and after the increase in the three countries.

Notes

• The Kazakh health survey may underestimate smoking prevalence, leading to lower estimates of health impacts.
• Health effects are more significant in middle-aged populations.
• The pro-poor nature of the health benefits is a key finding, suggesting that tobacco taxes can be a progressive public health policy.