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policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not
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Terminology used may not necessarily be consistent with ADB official terms.
CONCLUSIONS
Prolonged smokers lose a decade of life
Cessation by age 40 (and preferably earlier)
avoids 90% of the excess risk of continued
smoking
Tobacco is a big cause of poverty and tobacco
control reduces poverty
A tripling of the excise tax on cigarettes
worldwide would cut consumption by 1/3 and
avoid ~200 M deaths
~1 bottle of vodka/day
vs <0.5 bottles/week:
2 x any medical cause
4 x road traffic accident
6 x any other accident
8 x suicide
10 x murder
Source: Lancet 27 June 2009
HIV Vodka No War
Moderate
80 obesity 80
Severe Low-mortality BMI Cigarette Never-
obesity smokers smokers
60 60
Yearly Yearly
dots dots
40 40 10
years
BMI, kg/m2
20 22-25 (~24)
20
30-35 (~32)
40-50 (~43)
0 0
40 50 60 70 80 90 100 40 50 60 70 80 90 100
Age (years)
Source: Peto, Whitlock, Jha, NEJM, 2010
UK Million Women Study: contrast between the relevance of
happiness and of smoking to 10-year all-cause mortality
among women who do not already have a chronic disease
55-64 4
45-54 6
35-44 9
25-34 10
Mortality change:
1970 to 2015:
ANY CAUSE: 60%
SMOKING: 70%
Education level
Source: Jha et al, Lancet, July 2006
ONTARIO, CANADA and UNITED STATES: Risk of a 30-
year-old man dying by age 69 from smoking
(shaded) or from any cause (shaded+ white), 1995-2012
ONTARIO MEN US WHITE MEN
1990s 12%
2010 20%
(25% urban, 15% rural)
1998 Hong Kong + 33%
2030s China 33%
+ Hong Kong male smokers started smoking seriously 20 years before
Source: Chen, Peto, Lancet, 2015, Li, Peto et al, 1998, Lam et al, 2001, Peto 2001
INDIA: Years of life lost
among 30 year old smokers*
(MDS results)
8+ (14) 2.9
10-19
(12) 1.6
20-50
(23) 2.7
Number of individuals 40 32 35 33
averting poverty (Q1/Q5)
Sensitivity analysis- Part 2
Discussion/ Findings:
Progressivity of tobacco taxes (pro-poor) in terms
of health and financial outcomes
Tobacco taxes as a policy tool to improve health
system goals:
Improvement of health outcomes
Expansion of fiscal space (breadth, depth and
financial support of public financing schemes)
Higher tobacco taxes prevents near poor families
from getting impoverishments or incurring
catastrophic healthcare expenditures
Figure 7: Share of marginal tax revenue to
resources per capita to fund SDG 2030
Turkey 16%
Chile 10%
Armenia 8%
Indonesia 7%
Thailand 6%
China 6%
Median 4%
Brazil 4%
Mexico 2%
Vietnam 2%
Colombia 1%
Philippines 1%
Bangladesh 1%
India 1%
Limitations:
Underestimating economic costs since we did not include
non-healthcare costs
Productivity loss, transportation costs, disruption of other regular
household expenditure
Used a medium PE for all countries. But our sensitivity
analysis provides similar results
Did not include the consumer utility or welfare derived
from smoking
No health benefits from reduced smoking is considered in
this analysis
Did not include bidis and other indigenous forms of
smoking tobacco in the analysis
Focused on only male smokers
Misconceptions (1)
Economist in 1997
The public-health rhetoric often implies that smoking must be
daft, because it is deadly. In fact, most smokers (two-thirds or
more) do not die of smoking-related disease. They gamble and
win. Moreover, the years lost to smoking come from the end of
life, when people are most likely to die of something else
anyway. [Then US President] Bill Clinton's mother, who died of
cancer at the age of 70 after smoking two packs a day for most of
her life, might, as Mr. Clinton notes, have extended her life by
not smoking; but she might also have extended it by eating
better or exercising more.
Economist in 2011
Smoking: Time to quit
Misconceptions (2)
Angus Deaton in 2013 (The Great Escape)
Although smokers are ten to twenty times more likely to die of
lung cancer than nonsmokers, the vast majority of smokers do
not die of the disease For example, a 50-year old man who has
smoked a pack a day for thirty years has a 1 percent chance of
developing lung cancer if he quits now and a 2 percent change if
he does not. (WRONG- ABOUT 16% LUNG CANCER DEATH RISK
IN CONTINUING SMOKERS BUT 6% IN QUTTERS BY AGE 50)
@countthedead
Age standardized smoking rate among men by age group, product and
number of smokers (in millions): 1998-2010
Cigarette smoking among illiterate men has seen a 3.6 fold increase.
Mishra et al 2015