2003年-世界发展银行全球_Economics_of_Tobacco_Control___The_Maldives_44页_768kb

报告摘要

Summary of Economics of Tobacco Control - The Maldives

Core Content

This document is a Health, Nutrition and Population (HNP) Discussion Paper published by the World Bank in 2003. It focuses on the economic and health implications of tobacco use in the Maldives and provides policy recommendations to strengthen tobacco control efforts. The paper is part of a series on the economics of tobacco control, and it is prepared for the World Health Organization Regional Office for South-East Asia.

Main Points

Country Overview

The Maldives is an archipelago of approximately 1,190 islands, with a population of 269,010 in 2000.
The country has high social welfare indicators, including a near 100% adult literacy rate and low infant mortality (35 per 1000 in 1995).
The per capita GDP in 1998 was US$1,279, twice the regional average.
The economy has been open and outward-oriented, with annual real GDP growth averaging 9% over the past 25 years.
The economy is heavily reliant on tourism and fisheries, both of which are vulnerable to external shocks such as climate change and global market fluctuations.

Health System

The health system is organized into a four-tier structure: central, regional, atoll, and island levels.
Public and private sectors both provide health services.
Public sector includes the Ministry of Health, regional hospitals, atoll health centres, and island-level health workers.
Private sector includes pharmacies, medical clinics, and private hospitals like ADK Hospital.
The Faculty of Health Sciences at the Maldives College for Higher Education provides training for healthcare personnel.
Health personnel in 1999 included 91 specialist doctors, 260 staff nurses, and 459 traditional birth attendants (TBA), with most being expatriates, particularly from India.

Demographics

The population has a young age structure, with 47% under 15 years and only 4.8% over 60.
The population is expected to double in 37 years at the current growth rate.
Population growth averaged 3.2% between 1977 and 1985, 3.4% in 1985–90, and decreased to 1.9% by 2000.
A baby boom is expected as the largest birth cohorts from 1980–90 enter the reproductive age group within 5 years.

Tobacco Market Overview

Trends in Tobacco Trade

Tobacco use is widespread in the Maldives, with cigarettes accounting for 97% of tobacco imports.
Smoking prevalence is 41% among all tobacco users, and chewing tobacco is also common, used by 30% of users.
Tobacco imports have been increasing, but import duties have had a significant impact on reducing smuggling and import volumes.

Tobacco Control Measures

The Maldives has a long history of tobacco control, beginning with a 1942 law that banned tobacco imports.
In 1947, smoking was banned for students and those under 17.
1993–1994 saw the introduction of smoking bans in healthcare facilities and public places.
1994 marked the total ban on tobacco advertising.
Tobacco-free islands may receive trophies and cash prizes.
A large-scale school anti-tobacco programme was launched in 2000.

Prevalence and Consumption

In 1997, 57% of men and 29% of women used some form of tobacco.
Cigarette consumption was 41% of all tobacco users.
Per capita consumption is highest in the 15–49 age group, with 14 cigarettes per day for men and 10 for women.
Bidi and cigar consumption also varies by age and sex, with higher rates among men and younger age groups.

Prices, Taxes, and Government Revenue

Cigarette prices were relatively stable from 1997 to 2000, but rose steeply in 2000.
Import duties on tobacco products were 50% of CIF value until May 2000, when the duty for cigarettes was reduced to 30 laari per cigarette (100 laari = 1 rufiyaa) to reduce price differentials.
This change led to a significant increase in import duty revenues, rising by over 50%.
Tobacco duty revenues accounted for around 4% of total import revenues before the change, and fell below 2% after.

Policy Recommendations

Implement regular real price increases on all tobacco products, with a recommended annual increase of 5%.
Introduce an ad valorem excise tax to support higher tobacco prices.
Strengthen tobacco control legislation and consolidate existing measures to align with the Framework Convention on Tobacco Control.
Revamp the National Tobacco Control Committee to enhance its role in tobacco control.
Enhance surveillance and enforcement to combat smuggling and illegal trade.
Conduct a smoking prevalence survey every five years as part of household surveys.
Implement a smoking cessation programme to increase quit rates.
Improve public health communication through innovative information, education, and communication strategies.
Enhance data collection, including cancer registries and lifestyle-related disease statistics, to better understand the health burden of smoking.
Revise death certificates to include smoking status for improved epidemiological research.

Key Information

Tobacco use is a major risk factor for cardiovascular diseases, respiratory diseases, and cancer, which are the top causes of death in the Maldives.
Smoking is a significant contributor to morbidity and mortality, but tobacco control measures can lead to net economic gains.
Tobacco smuggling is not a major issue, and tobacco control can be implemented without significant economic loss.
Tobacco taxation is a cost-effective tool for reducing consumption, especially among young people and low-income groups.
The Maldives is a model for tobacco control, with effective legislation and public health initiatives.

Conclusion

This paper highlights the economic and health risks associated with tobacco use in the Maldives and emphasizes the importance of tobacco control policies. It provides a comprehensive analysis of the current tobacco market, health system, and demographic trends, and offers policy recommendations to improve public health outcomes and economic efficiency through tobacco taxation, smoking cessation, and better surveillance.