This project is funded through the Economics of Tobacco Control Research Initiative, an IDRC and Cancer Research UK co-funding partnership launched in October 2017. The objective of this partnership is to generate evidence that provides the economic rationale for the prevention of tobacco-related diseases and the research uptake by policy actors that allows the adoption of tobacco-control policies across low- and middle-income countries.
Understanding the processes, organizations and policies to act more forcefully in favour of civil society and the environment
The Global Tobacco Economics Consortium is strengthening the leadership of Mexico, Colombia and India to advance tobacco control policy.
Mexico, Colombia and India represent over 1.5 billion people, with more than 75 million cigarette smokers. Each country has a particular context with regard to the tobacco epidemic, and their response to it, with differences in tax structure, health systems and policy engagement opportunities.
The main goal of this study was to deepen and expand the use of extended cost-effectiveness analyses (ECEA) to rely on local expertise and strengthen research capacity on tobacco economics, provide additional analytic support for local taxation decisions and determine what factors influence the research findings on the development of fiscal uptake and use of data on the impact of fiscal and economic strategies in each country.
This project made a difference because it generated new arguments in favour of increased tobacco taxes (as a public health tool). In addition, in countries with greater geographic, socioeconomic and gender inequalities, tobacco taxes could be a tool to reduce inequality gaps.
Despite a modest drop in the prevalence of smoking, the mortality risks for cigarette smokers are rising rapidly. India had approximately 38 million cigarette smokers and over 1 million deaths annually attributable to tobacco smoking.
Tripling the specific component of the tobacco tax in Colombia would prevent tobacco polluting 1,000 trillion liters of water.
In Mexico, the Ministry of Finance submitted an annual budget for 2020 that included a cumulative adjustment of tobacco taxes from 2009 to 2019 and an amendment for automatic annual inflation adjustment criteria. The tobacco-specific component was adjusted from 35 to 49.44 cents to account for accumulated inflation over the past nine years and an automatic adjustment mechanism was approved based on annual inflation.
The real cost of the tobacco industry and how to have an impact on both health and economic wellness.
Understanding the country and its power for action by bringing together local expertise and strengthening research capacity on tobacco economics.
Teams aimed to improve the relevance of existing data and models. To achieve this goal, a 3-point plan was created:
Clearly map stakeholders. A list of relevant organizations and individuals was created, including government agencies, congress members, journalists and civil society organizations for all the countries concerned. In some cases, details on members were listed, classifying their attitude toward and level of influence on tobacco tax policy. This activity required regular updates throughout the project cycle with the help of the partners in each country.
Design communication pieces, informed by the map analysis. This is an effort to harmonize the data and identify complementary information from partner research or from third parties.
Create an engagement strategy. The stakeholder map provided the information to define an engagement strategy that included different activities (individual meetings, written communications, group meetings, courses, etc.). It also included important dates on the political agenda to best time communications within windows of opportunity.
Accelerating the use of knowledge on the connection between tax increases and tobacco control is likely to have a positive effect on tobacco consumption.
In general, women tend to be more vulnerable members of households when compared to men, with less access to assets, greater constraints, different bargaining strategies and different priorities (Kabeer, 2001; SOAS University of London, n.d.).
Revenue generated by taxation can serve as a source of care for at-risk populations (women and children) to further have a positive effect on society. The goal is to redirect tobacco revenues into something more meaningful for life and development.
By generating a fiscal policy for consumption, the policy aims to create a power dynamic within the household. Women are becoming more responsible for the control of the household spending and what was once considered to be leisure time activity, such as tobacco consumption, will become a cost and therefore may be set aside by the family. Furthermore, a well thought out taxation plan allows a greater portion of expenses to be attributed to family essentials (e.g., health, education, etc.).
N.B: The project put forward a multi-pronged approach that recognizes the need for a diversified strategy to drive multisectoral action on tobacco control. These data are provided in the appendix.
Understanding tax structure and industry tactics make the action more leverageable.
In general, actors (from public and private sectors) were very knowledgeable of the history of tobacco control in their different fields of action (including taxes). However, some of these actors held the roles of activists or decision-makers.
Governments, because of their multiple interests and responsibilities, may challenge data (i.e., will an increase in taxes lead to an increase in illegal trade?). Findings must be precise and clear for decision-makers to implement policy change. Some factors affect a country’s readiness to adopt a new policy, notably political will, the existence of scientific evidence presented in a synthetic and digestible way, tobacco industry interference, competition with other relevant societal issues and conflicts of interest between the executive and legislative branches of government.
Team and partners list
Luz Myriam Reynales Shigematsu, MD, PhD
Methodology and references
Subnational ECEA: The methodology of the subnational ECEA is based on previous published work on the impact of a 50% increase in cigarette prices in 13 countries, funded by IDRC (https://www.bmj.com/content/361/bmj.k1162).
Tax diagnostic: The tax diagnostic tool is a simple MS Excel spreadsheet that allows users to estimate the impact (reduction in the number of adult smokers, smoking attributable deaths, youths prevented from starting, premature deaths averted among youths and increase in revenue) of higher tobacco taxes with varying tax levels.
Tax brief: The tax brief provides recommendations to the Ministry of Finance, with a focus on increasing tobacco taxes. The tax brief includes background on the problem of tobacco use, findings from the tax diagnostic tool and qualitative interviews, and recommendations based on these findings.
Global Consortium on Tobacco Economics: https://www.insp.mx/
Promoting key learnings
Celebrating the culmination of over a decade of partnerships, research and advocacy, a webinar was planned in partnership with Cancer Research UK, “Demystifying the Economics of Tobacco Control: Knowledge, policy and everything in between,” and broadcast live on June 29, 2022.
This webinar represented an opportunity to demystify the process of knowledge translation, to share key learnings from our research teams across the globe and to discuss the emerging opportunities for continued and meaningful impact.
The Call for Concept Notes on the Economics of Tobacco Control in Low and Middle- Income Countries offered up to CAD1 million over a maximum of four years to support evidence-based research on the economic rationale for the adoption of tobacco-control policies across LMICs in four regions: Asia, Latin America and the Caribbean, the Middle East and North Africa, and sub-Saharan Africa.
By targeting collaborative, applied economics research, the Initiative aimed to support the implementation of effective fiscal and other policy measures to help prevent tobacco-related diseases and save lives.