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Why increasing tobacco taxes is good for the poor

Simon Chapman, professor of public health at the University of Sydney, has provided a robust critique of Jennifer Doggett’s recent critique of increased tobacco taxes:

Erstwhile Croakey correspondent Jennifer Doggett has written a piece for ABC-Online challenging the wisdom of  increasing tobacco tax, arguing that it would be regressive and harm the poor (it will “mean they cut back on other essentials, such as food, heating and housing costs.)

I suppose the corollary of this argument is that all caring people should support the lowering of tobacco tax to make it easier for those who smoke most (the poor) to keep on smoking and thus widen even further the smoking caused disease gap between rich and poor. What a perverse way of “helping” the poor while feeling good about social justice.

The poor, along with the young, are the most responsive to tobacco price rises. The heavy smoking Kerry Packer wouldn’t have cared less if he paid $13 a pack or $30, but budget conscious people do.

The responsiveness takes the form of quitting (the poor are quitting at broadly the same rate as the more well off, but from a much higher “ever smoking” prevalence) but also from reducing the amount smoked each day. Between 1980 and  2004, average daily consumption in Australia reduced from 20 (males) and 18 (females) cigarettes a  day to 14 – a 30% decline.

Along the way Jennifer trots out the myth that will not die that “seventy to 80 per cent of people with serious mental illnesses smoke and for people with schizophrenia the smoking rate is 90 per cent”.

A recent metanalysis of all studies of smoking & schizophrenia showed the average smoking prevalence was 62% (range 14-80%) with none topping 90%. (see Chapman S, Ragg M, McGeechan K. Citation bias in the reporting of the prevalence of smoking in people with schizophrenia. Aust NZ J Psychiatry 2009;43:277-82.)

While those with mental illness are under-studied, some evidence suggests that their cessation rates mirror those of the wider community. Yes, they smoke more, but their rate of decline (from a higher starting point) is not dissimilar to everyone else’s.

The only thing one needs to know about why tobacco tax is a the most effective way of bringing smoking down is to look at the tobacco industry’s reaction. Each year, you can set your watch by the predictability of their lobbying.

As Philip Morris put it with such candour as far back as 1983 in an internal memo “the most certain way to reduce consumption is through price”.

Comments 6

  1. Jennifer Doggett says:

    I’m happy to bow to Simon’s far greater knowledge than mine of smoking rates among people with mental illnesses. I also accept that increasing the price of cigarettes will cause some people to reduce or quit smoking, including people from disadvantaged groups, and that their health will benefit from this.

    However, we know that under the price increase being proposed by the Coalition the vast majority of current smokers will continue to smoke (one estimate is between 97% and 98.5%). For some of these people, paying more for cigarettes will mean having less money available for other essentials.

    My experience of working with a group with very high smoking rates and very low disposable incomes (people who inject drugs) is that they are likely to forgo spending money on food and housing in order to afford cigarettes. This can result in other health and social problems, which also have a cost and a negative impact on both them and the community.

    My point is that this cost needs to be balanced against the benefits of the very small reductions in smoking rates projected to result from this price increase.

  2. Simon Chapman says:

    But Jennifer, as I noted, the impact of price also includes reducing how much you smoke across the day .. not just whether you smoke at all. You’re right that the great majority of smokers keep on smoking when the price goes up, but many also “titrate” their smoking by smoking less each day. Such people don’t spend more, but extend the time it takes to smoke the same amount. Do you have a problem with that?

    Australia has not had a real tax rise for tobacco for 11 years (only rises following automatic indexation, intriduced by Keating). There is international consensus, including in the tobacco industry’s internal documents) that the single most effective way of reducing tobacco use is via price. The changes might be “small” but nationally and globally they translate to an unparalleled number of people people quitting.

  3. Becky Freeman says:

    I think the problem here is not whether or not to increase tobacco tax – that’s a no brainer really, taxing cigarettes will absolutely decrease tobacco use. Improving the health of the poorest members of society will not be achieved by doing nothing. But, tax increases accompanied by other measures that also improve the odds of successful quitting will further extend the health benefits of quitting smoking to more people – including the most socially disadvantaged. Tax increases accompanied by a ban on the display of tobacco products at retail, putting all tobacco products in plain boxes that only show health effects and quitting information, banning smoking in all enclosed workplaces, and training health providers to assist smokers to quit.

    It is time to get serious about reducing smoking among the socially disadvantaged – this will not be achieved by one off, half-baked measures. Instead of advocating for no action, the public health community must always be pushing for more.

  4. Stafford Sanders says:

    I’d agree with Becky, tax needs to be part of a broad strategy. And it needs to be based on best evidence, not old mythologies. A recent Quit survey of smokers showed 75% said they’d quit if the price went up by 50%. Sure, not all those would actually quit, but smokers are mostly very susceptible to just a bit of extra motivation – 85% of smokers say they want to quit, so only a small minority of them are the “hardened cases” often spoken about. And I’d say we need to get rid of smoking not just from enclosed workplaces but from all workplaces, enclosed or not – since employees are still at risk from secondhand smoke even in unenclosed workplaces because of their repeated exposure.

  5. annej says:

    I thought the regressive tax argument had been given up as a reason for opposing tobacco tax increases but apparently not yet. The simple solution is to put the tax up after a decade of opposition – and use the billions in government revenue to fully fund a national preventative health strategy based on the evidence. That will include helping disadvantaged smokers to quit.

  6. possoms says:

    “What a perverse way of ‘helping’ the poor while feeling good about social justice.’”

    What’s a perversion is robbing the poor of some of what little money they have in order for do-gooders like Chapman to feel like a fine, upstanding gentleman for sticking his snout into other people’s lives so as to order those lives according to some fine, idealized blueprint he has knocking around in that crypto-fascist brain of his. I thought we had an end to that with the anti-tobacco policies of the Hitler gang. Sadder still, if possible, is that the other posters seem to tag along, taking it for granted that the poor need guidance from their superiors (namely themselves) and have to be treated like children — for their own good — objects unworthy of making their own decisions in matters that pertain to their own personal and intimate lives.

    That’s the true perversion here.

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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017