虽然此项研究的结论完全基于理论模型，但它们已经足够有吸引力——杰哈和同事们已经开始和加拿大国际发展研究中心（International Development Research Centre）以及世界银行探讨可能的实施策略。
Tobacco currently kills more than 7 million people each year, making it one of the world’s most significant threats to public health, according to the World Health Organization. But the best intervention, according to a study published last Wednesday in the BMJ, may be rooted in economics.
Doubling cigarette taxes in 13 middle-income countries across the globe could save almost 450 million years of life and $157 billion in averted medical costs — all by prompting smokers to lay off the habit, and reaping the public health gains that follow, the study says.
To start, the researchers used existing price elasticity data to estimate how raising cigarette taxes could influence the habits of the 490 million male smokers living in the 13 countries included in the study, such as China, India, Mexico, and Brazil. They determined that a 50% price increase would correspond to a 20% downturn in smoking, encouraging millions of men to quit. Those in the lowest economic brackets would be especially likely to quit in the face of price increases, the data says.
Since smokers tend to be concentrated in lower-income demographics, all that theoretical smoking cessation would come with major public health benefits for these populations, explains study co-author Prabhat Jha, a professor of epidemiology at the University of Toronto Dalla Lana School of Public Health. “Over time, the rich have quit in much greater numbers, in proportion, than the poor,” Jha explains, “so the persistent smoking burdens” — such as heart disease and cancer — “are concentrated on the poor in many countries.”
All in all, Jha and his colleagues found that smoking cessation caused by higher prices would save an estimated 449 million years of life across the 13 countries, with the most significant benefits theoretically seen among younger, poorer smokers. Smoking cessation on that scale could also save $157 billion in medical costs associated with smoking-related conditions including lung diseases, cancer, heart disease and stroke. In addition, 15.5 million men in countries without universal health care could be saved from “catastrophic health expenditures,” and 8.8 million individuals — and their families — could be spared from resulting extreme poverty.
“The male is addicted to smoking, he’s the breadwinner of the family, he gets a disease and the family spends a fortune to keep him alive, and usually fails,” Jha says, illustrating a common situation in low- and middle-income countries. “The family’s broke and he’s dead. The male addiction is having enormous consequences on household poverty.”
If you extrapolate beyond the 13 countries included in the study, Jha estimates something like 20 million people could avoid extreme poverty — suggesting that tobacco taxation actually disproportionately benefits low-income people, despite some economic arguments to the contrary. As an added bonus of cigarette taxes, the report says, the 13 countries included in the analysis would see their gross domestic products increase by between 0.1% and 1.1%.
“Tax is a really powerful instrument for addressing income poverty goals,” Jha says. “Because the poor are more price responsive [and are more likely to quit when prices go up], the richest income group ends up paying twice as much of the extra tax as the lowest income group.”
While the study’s findings are all based on theoretical models, they’re compelling enough that Jha and his colleagues are working with Canada’s International Development Research Centre and the World Bank to discuss possible implementation strategies.
That said, Jha cautions against thinking of taxation as a one-size-fits-all solution to public health problems. Heavily taxing sugary beverages or alcohol — two commonly suggested strategies — could come with benefits, Jha says, but each case is different. Cigarettes are unique, for example, in that there aren’t many alternatives on the market; taxing soda, on the other hand, could just push consumers to drink sweetened juices or other products.
“Thinking about taxation approaches to curb unhealthy consumption is a good idea, but tobacco [taxation] builds upon decades of careful research and understanding of what works,” Jha says. “You should be careful to just say, ‘Oh, we’re just going to take from one product and do it to another.'”