Economics of smoking cessation
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7445.947 (Published 15 April 2004) Cite this as: BMJ 2004;328:947
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Dr. Ken Warner of the University of Michigan has extensively studied
the economics of tobacco. Simply put, the money not spent on tobacco
products would be spent on products that don't result in sickness to the
degree tobacco does. It (the money) just doesn't go up in smoke like the
health of its users.
Smokers don't all just die at age 65. Most often they are extensive
users of the health care system for up to ten years of more before they
die...I know, my next door neighbor got ambulance rides to the hospital
many nights for five years before he finally suffocated to death from
emphysema.
Competing interests:
Health Worker
Competing interests: No competing interests
The article by Parrott and Godfrey brilliantly outlined the economic burden of smoking in terms of cost to the healthcare systems, work absenteeism and intervention costs to help smokers quit. There is no doubt in anybody's mind about the deleterious effects of smoking on health and the economy. However, any balanced discussion on the economics of smoking must also include the manner in which smoking contributes to the health (forgive the pun) of the economy.
The British government earns a lot for the public purse through heavy taxation on tobacco products. The article told us about the percentage of gross domestic product (GDP) spent on smoking related illness but did not mention the percentage earned through taxation. Also the tobacco industry helps the economy by creating jobs across the board in manufacturing, distribution, retail and marketing. The profits of all these companies are also taxed. The money saved by not paying unemployment benefit to thousands is surely substantial.
I am personally and as a doctor firmly against smoking and do not want any misconceptions about that. I realise that talking about the economic benefits of smoking is politically incorrect and the net balance is probably still in favour of no smoking, but any debate should include both sides of the story. Whilst we are on the topic of politically incorrect statements, the average life span of a smoker is shorter than that of a non-smoker. What are the economics of longevity for the society in terms of pensions and nursing home care? This cost I am sure is dwarfed by the increased quality of life and the reduced morbity of a non-smoker. But, has there been an economic evaluation of the above?
I again emphasise that I personally am not in favour of smoking and do not believe it is justified by any of the points I have mentioned above. I merely feel that a balanced view in any argument should be put forward by the authors however pollitically incorrect it may sound. I understand that this letter may provoke strong reactions but I hope the debate may aid understanding of why some governments around the world are rumoured to "unofficially" find smoking of economic benefit.
Competing interests:
None declared
Competing interests: No competing interests
Sir, you do not take into account what the state earns from taxes on
tobacco, which in some countries is quite much. Also you do not take into
account the sums, that are not used on treatment and pensions for the
smokers, who die earlier than non-smokers, maybe the state might lose
money from smoking-cessation - who knows?
Yours Jon Eriksen
Competing interests:
None declared
Competing interests: No competing interests
Why does smoking continue? In spite of burgeoning evidence suggesting
its ill effects, increasing awareness in public, initiative of governments
and organisations, [1,2,3] it continues. The alarming thing is that the
tobacco consumption is likely to maintain, and perhaps increase in many
parts of World [4,5]. Comprehensive policies, increasing prices, education
in school and to public, sale and promotion restriction, implementation of
laws and penalties have helped [5.6], but how far these have been
effective?
The reasons why smoking continues lie obviously in the bio-psycho-
social nature of the phenomenon. It is an addicting substance that hooks;
gives pleasure, and smoking is still a socially acceptable behaviour (we
still have designated smoking areas, even in hospitals!). Besides these,
possibly there are emotional and attitudinal factors. More people still
passively endure rather than actively reject this behaviour, even at the
cost of passive smoking. There is apparent lack of emotional reciprocity
communicating – ‘your’ smoking is injurious to ‘my’ health’. People who
object others’ smoking still do it at the cost of being impolite. Most
persons who smoke do not feel awkward or socially inhibited doing so. And
not to forget most adolescents start this habit by being emotionally
pressurised by the peers.
While increasing the awareness, by providing information, it is
important to pay attention to the emotional component that might also help
in preventing smoking. Creating a social attitude to view smoking as an
unacceptable behaviour; making persons feel comfortable to communicate
amicably that ‘your’ smoking is injurious to ‘my’ health; and bringing in
a sense of social responsibility in persons who smoke that they are too
inhibited to continue this ‘unacceptable’ behaviour, are some of the
suggestions. These can be incorporated in the educational endeavours to
control smoking.
References
1. Hill S, Blakely T, Kawachi I, and Woodward A. Mortality among
"never smokers" living with smokers: two cohort studies, 1981-4 and 1996-
9. BMJ, doi:10.1136/bmj.38070.503009.EE (published 5 April 2004)
2. Steve P and Christine G. Economics of smoking cessation. BMJ
2004;328:947-949
3. Sargent RP, Shepard RM, and Glantz SA. Reduced incidence of
admissions for myocardial infarction associated with public smoking ban:
before and after study. BMJ, doi:10.1136/bmj.38055.715683.55 (published 5
April 2004)
4. Subramanian S V, Nandy S, Kelly M, G Dave, and Smith GD. Patterns
and distribution of tobacco consumption in India: cross sectional
multilevel evidence from the 1998-9 national family health survey. BMJ
2004;328:801-806
5. Samarasinghe D and Goonaratna C. Tobacco related harm in South
Asia. BMJ 2004;328:780
6. Jamrozik K. Population strategies to prevent smoking. BMJ
2004;328:759-762
Competing interests:
None declared
Competing interests: No competing interests
Economic Burden from the Smoking Epidemic in Middle Income Countries
Economic Burden from the Smoking Epidemic in Middle
Income Countries
Armando Arredondo, Senior
Researcher
National
of
aarredon@insp.mx
The smoking epidemic imposes a huge economic burden on
all countries, yet most existing estimates for the magnitude of this burden have
been made in high income countries. In middle income countries, the economic
ramifications of the smoking epidemic represent a new challenge for public
health in general and for primary health care programs in particular. The
financing of programs aimed at promoting, preventing and detecting
smoking-related diseases represents an economic burden that these countries had
not considered 1.
For
the users and providers of health services, tobacco consumption has recently
come to be accepted as a high-risk factor for adverse health outcomes. For the health care system, the increased
demand for services arising from epidemiologic changes in smoking-related
health problems represents a new economic burden 2. For health care users,
particularly those with low incomes, this phenomenon has led to catastrophic increases
in health care expenses 3.
Table
1 shows predictions for the epidemiological and economic impact of smoking in
2005, 2006, and 2007 (p<0.05), calculated based on the findings of a
longitudinal study of the Mexican health system. Depending on the disease, an
increase of 20% to 90% in cases is predicted by 2007, and the financial
requirements for providing health care are predicted to increase by 25% to 93%. Thus increased health care services will be required
for patients with respiratory diseases associated with tobacco consumption. In economic terms, the predicted changes in the
number of cases in the coming years highlights the process of internal
competition and adds an element of intrinsic competition in the allocation of
resources to preventive and curative services 4.
If
health care programs and risk factors remain unaltered for the next three
years, the demand for health services will show an upward trend. Even if health resources increase, inaction
on the part of the health system in prevention and promotion will have
financial consequences for both users and providers.
In
terms of health policy, there is a need to identify the financial consequences
of demand for health care services related to tobacco consumption in the short,
medium and long term. Tax policy instruments involving increased taxes on
cigarettes may also be justified and negotiated in order to direct more
financial resources towards health services. This increase would of necessity
have to be generate sufficient funds to offset the
financial consequences arising from increased demand for health services
related to the smoking epidemic.
Table 1: Costs and financial
consequences of smoking epidemic in a national public hospital in
Intervention/Disease Costs in US$ for management of expected cases in 2005-2007
_______________________________________________________________________________________
2005 2006 2007
Chronic
obstructive pulmonary disease 69 520 79 032 89 984
Asthma 454
020 470
305 509
538
Lung cancer
1
441 056 1 578 144 1 653 216
Full
treatment course of nicotine gum 100
360 136
644 192
035
Confidence Intervals 95%.
Box-Pierce
Statistical Test (<0.05)
Exchange rate (June 2004), 11.10 Mexican $ per 1
REFERENCES:
1) World Health Organization. World Health Report 2000,
Making a Difference. Chapter 5: Combating the Tobacco Epidemic, World
Health Organization .
.
2000: 65-80.
2) Editorial. The catastrophic failures of public health.Lancet.2004; 363: 411-12.
3) Arredondo A. and Zuñiga A.
Economic Consequences of Epidemiological Changes in Diabetes in
Middle Income Countries: The Mexican Case. Diabetes Care.
2004. Vol. 27 (1):104-109.
4) Bartechi C, Makenzie T, and Schrier R. The human
costs of tobacco use. New England
Journal of medicine. 1994; 330(13):
975-980.
Competing interests:
None declared
Competing interests: No competing interests