2017年-世界发展银行全球_Tobacco_Tax_Reform_at_the_Crossroads_of_Health_and_Development___A_Multisectoral_Perspective_228页_3mb

Tobacco Tax Reform Summary

Core Content

This report, Tobacco Tax Reform: At the Crossroads of Health and Development, presents a comprehensive analysis of the benefits and challenges of increasing tobacco excise taxes as a tool for public health, economic development, and poverty reduction. It highlights the importance of tobacco tax reform in reducing smoking rates, saving lives, and increasing government revenues, especially in low- and middle-income countries (LMICs).

Main Points

• Tobacco Use Challenge: Smoking is a major cause of preventable deaths and places a heavy economic and health burden on LMICs. It is linked to significant mortality, chronic diseases, and financial strain on low-income households.

• Economic and Health Impacts:

  • Tobacco kills at least half of long-term smokers and is responsible for more deaths than HIV/AIDS, tuberculosis, and malaria combined.
  • The economic cost of smoking is estimated at over US$1.4 trillion per year, equivalent to 1.8% of global GDP.
  • Poor smokers are disproportionately affected by tobacco taxes, but they also benefit the most from reduced consumption and improved health outcomes.

• Tobacco Tax Imperative:

  • Raising tobacco excise taxes is a powerful policy tool that can significantly reduce smoking rates and increase government revenue.
  • A 50% increase in cigarette prices leads to a 20% decline in consumption.
  • Higher taxes can generate extra US$41 billion in government revenue for LMICs if all developing countries increase excise taxes by US$0.25 per pack.

• Early Wins in Countries:

  • Between 2012 and 2014, over 100 governments implemented tobacco tax hikes, though many were too small to have a substantial impact.
  • Only 28 LMICs had adopted comprehensive tobacco control policies by 2015, including high excise tax rates and restrictions on public smoking and advertising.

• Key Policy Challenges:

  • Equity: Concerns about regressive taxation are often raised by the tobacco industry, but evidence shows that higher taxes are more effective in reducing smoking among the poor.
  • Employment: While the tobacco industry claims job losses, studies show that employment in tobacco is small and that tax increases can stimulate other economic sectors.
  • Illicit Trade: Higher taxes do not necessarily increase smuggling, as the main drivers are lax enforcement and organized crime, not tax rates themselves.

Key Policy Recommendations

• Go big, go fast: Prioritize significant tax increases to achieve rapid public health benefits and fiscal gains.
• Attack affordability: Ensure that tax increases outpace income growth to maintain the impact on consumption.
• Change expectations: Communicate tax hikes as ongoing and not one-time, to encourage quitting and prevent initiation among youth.
• Tax by quantity: Implement taxes based on the number of cigarettes rather than their price to prevent downward substitution.
• Soft earmarking: Link tax revenue to health spending to build public and political support.
• Regional collaboration: Encourage cross-border cooperation to combat smuggling and enhance reform momentum, as seen in the European Union.
• Build broad alliances: Counter industry opposition by involving civil society, researchers, and international partners in policy development.
• Support vulnerable workers: Provide transition support for those affected by tax increases, particularly in agriculture.
• Strengthen enforcement: Focus on improving tax administration and combating illicit trade through proven measures like track-and-trace systems and customs detection.

Conclusion

Tobacco tax reform is a win-win-win policy that saves lives, reduces poverty, and boosts government revenues. It is a critical component of the United Nations Sustainable Development Goals (SDGs) and should be embraced as a development priority. The report emphasizes the need for a global coalition to drive reform and ensure that the benefits of tobacco taxation are maximized and equitably distributed.

Key Takeaways

• Tobacco taxation is a cost-effective public health intervention.
• Higher taxes lead to significant declines in smoking and health improvements.
• The economic benefits of tax increases are substantial and can support development initiatives.
• Equity is enhanced by reducing smoking among the poor.
• Employment is not significantly affected by tax increases.
• Illicit trade is more influenced by enforcement than by tax rates.
• Regional cooperation and multi-sectoral approaches are essential for success.
• Support for farmers and vulnerable workers is necessary to ensure a smooth transition.

Authors and Contributors

The report was led by Patricio V. Marquez and Blanca Moreno-Dodson from the World Bank Group and included contributions from a wide range of experts across public health, economics, and governance sectors. It was supported by the Bill & Melinda Gates Foundation and the Bloomberg Foundation.

References

• Jha, P. (2009). Tobacco kills at least half of long-term smokers.
• Peto, R. and Lopez, A. (2001). Global burden of disease from tobacco.
• Goodchild, M., Nargis, N., and Tursan d'Espaignet, E. (2017). Global economic cost of smoking-attributable diseases.
• IARC (2011). Tobacco use and public health.
• NCI and WHO (2016). Tobacco-related employment trends.
• WHO Protocol to Eliminate Illicit Trade in Tobacco Products.

Final Note

The report underscores that tobacco tax reform is not only a health imperative but also a development opportunity. It calls for greater political will, multi-sectoral collaboration, and international advocacy to expand the global coalition for tobacco control and achieve better health outcomes, reduced poverty, and enhanced development potential.