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Economics of Tobacco Control in Developing Countries Syed Aljunid MD (UKM) MSc Public Health (Singapore) PhD (Health Econs and Financing) (London) FAMM Professor of Health Economics and  Senior Research Fellow UNU-International Institute For Global Health Kuala Lumpur UNU- International Institute For Global Health  (UNU-IIGH)
OUTLINE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object],[object Object]
Shift towards Non-communicable Diseases/Accidents as Cause of Deaths
Projected Deaths (Millions) and DALYS in 23 Selected Countries Source: Abegunde et all (2007) Lancet 370:1929-38
Leading Cause of Deaths in Malaysian Hospitals  (2008)
Healthcare Costs from Smoking ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Annual Cost of Selected  Chronic Illness in Malaysia (2005) Chronic Diseases Annual Cost (Millions, RM) Ischemic Heart Diseases 1,432 Chronic Obstructive Airway Diseases 2,919 Cervical Cancer 247 Lung Cancer 146
In-Patient Utilisation For Smoking Related Diseases in Malaysia, 2004 IHD CA LUNG COPD Average Average Number of Admissions  1.6 2.4 1.3 1.8 Average Annual Fees (RM)  151.51 213.47 47.50 137.49 Average Length Of  Stay (ALOS) 5.32 6.73 5.67 5.88 Minimum  Length Of  Stay (LOS) 1 1 1 1 Maximum  LOS 19 43 25 43
Total Cost Per Year for Malaysia IHD CA Lung COPD Annual Cost per patient 21,676 42,287 32,172 Nos. of new cases 32,816 2,881 12,776 Nos. of old cases 99,852 1,701 233,857 Total Cost per Year (Nation)(Mill) 630.4 116.6 2,306.0
Annual Cost per Patient (RM) Patients’ Cost Providers’ Cost Total Annual cost IHD 1,362 20,134 21,676 CA Lung 7,758 34,529 42,287 COPD 12,757 19,415 32,172
HealthCare Cost of Smoking for IHD (RM Millions)
HealthCare Cost of Smoking for Lung CA (RM Millions)
HealthCare Cost of Smoking for COPD (RM Millions)
Age Start Smoking Among Secondary School Children in Selangor, Malaysia (2006
Students Exposed to Tobacco Smoke at Home and Outside Home Global Youths Tobacco Survey: 1999-2005
Health and Poverty: The incidence of catastrophic out-of-pocket payments in 59 countries
Risk of Distress Borrowing and Selling During Hospitalisation in India, 1995-1996 Source:  Bonu et al (2005) Health Policy  and Planning  20 :41-49
Prevalence of Daily Smokers: Poorest vs Richest Quintiles in Low and Middle Income Countries
Ratio of Expenditure on Tobacco vs Education in Bangladesh, 1995-96 Efroymson et al (2001): Tobacco Control 10:212-17
Which interventions are effective? Measures to reduce demand ,[object Object],[object Object],[object Object]
Taxation is the Most Effective Tobacco Control Measure   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Source: Chaloupka  et al. , 2000
Tobacco Tax and Economic Impact ,[object Object],[object Object],[object Object],[object Object],[object Object]
Industry clearly understands the impact of tobacco taxation ,[object Object],[object Object],Philip Morris,  “Smoking and Health Initiatives”, 1985
Cigarette price and consumption show  opposite trends (1) Real price of cigarettes and annual per adult cigarette consumption in South Africa 1970-1989   Source: Saloojee 1995
Cigarette price and consumption show opposite trends (2) Source: ImpacTeen, 2003
Youth and the Poor Most Responsive to Tax Increases   ,[object Object],[object Object],[object Object],[object Object],[object Object],Source: Chaloupka  et al. , 2000
Cigarette price and youth smoking show opposite trends Real price of cigarettes and youth smoking prevalence, US, 1975-2002   Source: ImpacTeen, 2003
SEA and Australian Region Source:  Judith Mackay, Michael Eriksen  : Tobacco Atlas
Price of a 20 Cigarettes Pack (International Dollars, 2006)
Non-price measures to reduce demand ,[object Object],[object Object],[object Object],[object Object]
Health information reduces the demand for cigarettes Source: Kenkel and Chen, 2000
Comprehensive advertising bans reduce cigarette consumption   Consumption trends in countries with such bans vs. those with no bans (n=102 countries)   Source: Saffer, 2000
Effect of advertising bans and counter-advertising   ,[object Object],[object Object],Source: Saffer and Chaloupka, 2000
Effectiveness of Smoking Cessation Clinic in Malaysia (2006) KLINIK KESIHATAN % Quiters KK  Bandar Alor Setar 11.8 KK Merbok 17.6 KK Kg Simee 21.9 KK Setiawan 16.1 KK Bakri 24.2 KK Segamat 12.0 KK Selingsing 18.8 KK Pulai Chondong 15.2 All Klinik Kesihatan 17.3
Conclusions ,[object Object],[object Object],[object Object],[object Object]
THANK YOU [email_address] [email_address]

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Economics Of Tobacco Control In Developing Countries

  • 1. Economics of Tobacco Control in Developing Countries Syed Aljunid MD (UKM) MSc Public Health (Singapore) PhD (Health Econs and Financing) (London) FAMM Professor of Health Economics and Senior Research Fellow UNU-International Institute For Global Health Kuala Lumpur UNU- International Institute For Global Health (UNU-IIGH)
  • 2.
  • 3.
  • 4.
  • 5. Shift towards Non-communicable Diseases/Accidents as Cause of Deaths
  • 6. Projected Deaths (Millions) and DALYS in 23 Selected Countries Source: Abegunde et all (2007) Lancet 370:1929-38
  • 7. Leading Cause of Deaths in Malaysian Hospitals (2008)
  • 8.
  • 9. Annual Cost of Selected Chronic Illness in Malaysia (2005) Chronic Diseases Annual Cost (Millions, RM) Ischemic Heart Diseases 1,432 Chronic Obstructive Airway Diseases 2,919 Cervical Cancer 247 Lung Cancer 146
  • 10. In-Patient Utilisation For Smoking Related Diseases in Malaysia, 2004 IHD CA LUNG COPD Average Average Number of Admissions 1.6 2.4 1.3 1.8 Average Annual Fees (RM) 151.51 213.47 47.50 137.49 Average Length Of Stay (ALOS) 5.32 6.73 5.67 5.88 Minimum Length Of Stay (LOS) 1 1 1 1 Maximum LOS 19 43 25 43
  • 11. Total Cost Per Year for Malaysia IHD CA Lung COPD Annual Cost per patient 21,676 42,287 32,172 Nos. of new cases 32,816 2,881 12,776 Nos. of old cases 99,852 1,701 233,857 Total Cost per Year (Nation)(Mill) 630.4 116.6 2,306.0
  • 12. Annual Cost per Patient (RM) Patients’ Cost Providers’ Cost Total Annual cost IHD 1,362 20,134 21,676 CA Lung 7,758 34,529 42,287 COPD 12,757 19,415 32,172
  • 13. HealthCare Cost of Smoking for IHD (RM Millions)
  • 14. HealthCare Cost of Smoking for Lung CA (RM Millions)
  • 15. HealthCare Cost of Smoking for COPD (RM Millions)
  • 16. Age Start Smoking Among Secondary School Children in Selangor, Malaysia (2006
  • 17. Students Exposed to Tobacco Smoke at Home and Outside Home Global Youths Tobacco Survey: 1999-2005
  • 18. Health and Poverty: The incidence of catastrophic out-of-pocket payments in 59 countries
  • 19. Risk of Distress Borrowing and Selling During Hospitalisation in India, 1995-1996 Source: Bonu et al (2005) Health Policy and Planning 20 :41-49
  • 20. Prevalence of Daily Smokers: Poorest vs Richest Quintiles in Low and Middle Income Countries
  • 21. Ratio of Expenditure on Tobacco vs Education in Bangladesh, 1995-96 Efroymson et al (2001): Tobacco Control 10:212-17
  • 22.
  • 23.
  • 24.
  • 25.
  • 26. Cigarette price and consumption show opposite trends (1) Real price of cigarettes and annual per adult cigarette consumption in South Africa 1970-1989 Source: Saloojee 1995
  • 27. Cigarette price and consumption show opposite trends (2) Source: ImpacTeen, 2003
  • 28.
  • 29. Cigarette price and youth smoking show opposite trends Real price of cigarettes and youth smoking prevalence, US, 1975-2002 Source: ImpacTeen, 2003
  • 30. SEA and Australian Region Source: Judith Mackay, Michael Eriksen : Tobacco Atlas
  • 31. Price of a 20 Cigarettes Pack (International Dollars, 2006)
  • 32.
  • 33. Health information reduces the demand for cigarettes Source: Kenkel and Chen, 2000
  • 34. Comprehensive advertising bans reduce cigarette consumption Consumption trends in countries with such bans vs. those with no bans (n=102 countries) Source: Saffer, 2000
  • 35.
  • 36. Effectiveness of Smoking Cessation Clinic in Malaysia (2006) KLINIK KESIHATAN % Quiters KK Bandar Alor Setar 11.8 KK Merbok 17.6 KK Kg Simee 21.9 KK Setiawan 16.1 KK Bakri 24.2 KK Segamat 12.0 KK Selingsing 18.8 KK Pulai Chondong 15.2 All Klinik Kesihatan 17.3
  • 37.
  • 38. THANK YOU [email_address] [email_address]

Notas del editor

  1. Delete – but could you add in here a couple of examples of the effect of tax increases on sales? Again, David/Francis may be able to help you here.
  2. This is the single most important message for us to communicate the policy makers. High taxes work from a public health point of view and from a revenue point of view. What is your view on the reasons the industry forego the opportunity that this elasticicty characteristic affords them. Is it purely to ensure the product is affordable for new entrants (children) ? If so can it be said that the industries priceing policy is determined by their desire to recruit children? Perhaps they have a different take on the elasticity question?
  3. Keep
  4. Ireland has had a partial ban on advertising (electronic media) for many years during that time smoking prevelance was static or rising slightly We recently introduced a further ban on all forms of print media advertising and our current legislation now being chllenged in the courts provides for a complete ban on point of sale advertising. It is helpful to dwell on the requirement that the ban should be comprehensive.