2003年-世界发展银行全球_Appetite_for_Nicotine___An_Economic_Analysis_of_Tobacco_Control_in_Bangladesh_44页_754kb

Summary of Appetite for Nicotine: An Economic Analysis of Tobacco Control in Bangladesh

Core Content

This document is a discussion paper titled Appetite for Nicotine: An Economic Analysis of Tobacco Control in Bangladesh, authored by Zulfiqar Ali, Atiur Rahman, and Taifur Rahman. It was published in November 2003 as part of the World Bank's Health, Nutrition and Population (HNP) Discussion Paper series and is also associated with the World Health Organization (WHO) Tobacco Free Initiative. The paper provides an economic analysis of tobacco control in Bangladesh, focusing on the economic and health implications of tobacco use.

Main Points

1. Tobacco Production and Trade Trends

• Market Shares: In Bangladesh, about 70% of tobacco is smoked in the form of cigarettes and bidis, 20% is chewed, and the remaining 10% is used in hookas, pipes, cigars, or snuff.
• Production Growth: Cigarette production has grown steadily since 1980, while bidi production has grown even faster, increasing by nearly 295% from 1988–89 to 1999–2000.
• Trade Balance: Bangladesh has a persistent negative trade balance in tobacco and tobacco products, with import values being 3–4 times greater than export values.
• Agricultural Use: Only 0.4% of agricultural land is used for growing tobacco, which has decreased slightly from 0.46–0.47% since 1990–1995.

2. Smoking Prevalence

• Gender and Age: Smoking is more prevalent among men than women. Among men, the prevalence is over 40%, while among women it is estimated at 4–5%, though tobacco chewing is more common among women and is largely undocumented.
• Income and Education: Lower-income and less-educated men have significantly higher smoking rates. For instance, in 1995 and 1997, smoking rates were higher among men in lower income brackets.
• Regional Differences: In rural areas, land ownership is correlated with smoking rates, with lower land ownership linked to higher smoking prevalence.
• Poverty and Smoking: Approximately 10.5 million poor men and women smoke in Bangladesh. The cost of smoking is high for low-income individuals, as the money spent on tobacco could be used to improve nutrition.

3. Economic Analysis of Tobacco Use

• Household Expenditure: Lower-income households spend a larger proportion of their income on tobacco. In 1997, the average daily expenditure on tobacco by male smokers could have purchased enough rice to provide an additional 1402 calories per family, while female smokers could have purchased 770 calories of rice daily.
• Price Trends: Nominal prices of tobacco products have increased over the years, but real prices (adjusted for inflation) have fallen, leading to increased consumption.
• Price Elasticity: The price elasticity of demand for cigarettes is estimated at -0.27, suggesting that a 10% real price increase could reduce cigarette consumption by about 3%. However, this result is not statistically significant.
• Tobacco Taxes: Taxes on tobacco are relatively low, accounting for only 55% of the retail price, plus a 15% value-added tax. Increasing taxes could significantly boost government revenue, which currently stands at 7% of total government revenues.

4. Health Consequences and Costs

• Health Impact: Smoking contributes to a range of health issues, including respiratory diseases, cardiovascular problems, and cancer. These conditions are costly to treat and have a significant impact on productivity.
• Data Limitations: Health care costs and indirect costs related to tobacco use in Bangladesh are not well documented, making it difficult to estimate the full economic burden.
• Methodology: The paper outlines the methodology for estimating health care costs associated with tobacco-related illnesses, though data is limited.

5. Recommendations

• Tobacco Pricing: Cigarette and other tobacco product prices should be increased by at least 5% more than the rate of inflation annually.
• Health Warnings: Stronger and more visible health warnings are needed on cigarette packages, bidis, and all tobacco product advertising.
• Advertising Bans: A comprehensive ban on tobacco advertising and promotion is recommended, in line with the WHO Framework Convention on Tobacco Control.
• Policy Implementation: The authors emphasize the need for stronger government policies and collaboration between health and finance ministries to effectively implement tobacco control measures.

Key Information

• Economic Growth and Poverty: Despite economic growth and a decline in the poverty rate, Bangladesh remains one of the poorest countries in the world, with nearly half the population living below the poverty line.
• Malnutrition: The money spent on tobacco by poor people could significantly reduce malnutrition if redirected to food purchases.
• Public Health Efforts: While some efforts have been made to reduce tobacco use, such as banning tobacco advertisements on national radio and television, these have not been effective in curbing overall demand.
• Industry Influence: The tobacco industry in Bangladesh is highly influential, with 15 local companies competing in the cigarette market and British American Tobacco (BAT) playing a major role.
• Health and Demographic Survey: The 2000 Health and Demographic Survey reported a high overall morbidity rate, with lifestyle-related illnesses (including those caused by smoking) becoming increasingly significant.

Conclusion

The paper argues that tobacco control in Bangladesh is not only a public health issue but also an economic one. Increasing tobacco taxes, implementing stronger health warnings, and banning tobacco advertising are recommended as effective and cost-efficient measures. These actions could reduce tobacco use, improve public health, and generate additional government revenue, which could be used to address malnutrition and other health-related challenges.