Tobacco: Health and EconomicsDr. Joy de BeyerWorld Bank

International Meeting on Economic, Social and Health Issues in Tobacco ControlKobe, Japan, December 3-4, 2001

Health and EconomicsAt first: focus on Health Impact of tobacco use on healthwhat works, what doesnt to protect healththen: Health OR Economics? (Yes, but)Many stakeholders Health versus economic and social issues ?

today: Health AND EconomicsPolicy-relevant global, regional and country-level evidence-based research

Focus on HealthEffective measures to protect healthHigher cigarette taxes/pricesNon-price measures: Information, research, strong warning labels, bans on tobacco advertising and promotion, bans on smoking in public places incl. workplacesHelping smokers quit: cessation support

Price Elasticity EvidenceAs real price decreases, consumption increasesEvidence from South Africa

Source: Saloojee 1995

Cigarette consumption per adult (in packs)

Real Price

0.7

0.8

0.9

1

1.1

1.2

1.3

0.05

0.06

0.07

0.08

0.09

Consumption per adult

Real Price

Year

1988

1986

1984

1982

1980

1978

1976

1974

1972

1970

Comprehensive advertising bans reduce cigarette consumption Consumption trends in countries with strong bans compared with countries with no bans (102 countries) Source: Saffer, 2000

Chart1

17151635

14701530

Comprehensive ban

No ban

Year

Cigarette consumption per capita

No Ban

Ban

Sheet1

19811991

Comprehensive ban17151470

No ban16351530

Sheet1

00

00

Comprehensive ban

No ban

Year

Cigarette consumption per capita

Ban

No Ban

Sheet2

Sheet3

Sheet4

Sheet5

Sheet6

Bans on smoking in public places(transport, hospitals, schools, restaurants, workplaces)Protect against passive smokinginfo on 2nd hand smoke effects can raise public support Workplace bans promote quitting, reduce smoking intensity (some), and are cost-saving to employersWhat about smoke-free homes ?

Help smokers who want to quit Cessation support Advice from health professionals is key Quit lines, community & family support also work NRTs double the success of quit attempts Governments may make NRTS more affordable and accessible by:Licensing, OTC sales, allowing advertising more studies on cost-effectiveness (especially in LDCs)Considering NRT subsidies for poorest smokers

Focus on HealthThings that dont improve healthMost supply side actions do not reduce tobacco use / improve healthProhibitionYouth access restrictionsTrade restrictions Crop substitutionControl of smuggling is the only exception and is the key supply-side measure

Health OR Economics? (Yes, but)Health versus economic and social issues?Tobacco kills, but tobacco also:generates tax revenuesprovides jobs, incomes and large profitsmay attract foreign private investment generates export earnings in some countriesgives smokers pleasure

Health OR Economics? fears about harm to economies Policy makers (and others) worry that tobacco control will harm the economy:Reduce government revenuesGenerate unemploymentReduce farmers livelihoodsIncrease smugglingCause hardship to smokers and hesitate to adopt and implement strong, comprehensive tobacco measures

Health AND EconomicsFacts and evidence Policy-relevant global, regional and country-level evidence-based researchDo strong tobacco control measures:Reduce tax revenues ? NoRevenues rise as a result of higher taxes.Increase smuggling ? Not exactlyRole of organized smuggling, corruption Cause net job/income losses ? Not necessarily, but needs more researchHurt poor people ? Some, benefit some

Chart Zim

0.0058667355391115.702479339

0.0055135922393372.01631068

0.0052877095412555.849068901

0.0050978456428033.582226212

0.0047404007423795.137979967

0.0045724638439304.943478261

0.0045791001379699.53352685

0.0041513158440504.171973684

0.0037829736400376.838968825

0.0033245522343074.267808219

0.00501645382307.4405

0.0053392308531707.854067197

0.0059672843585983.794728435

0.0060602206627570.775016223

0.0074956803498562.282208423

0.007223992631692.827949228

0.0063182412630450.587723117

0.0056186605610723.964382501

0.0056846847578700.900900901

0.0051250812590409.356725146

0.005624000

0.00405515543796.674776967

0.0030821918408293.555936073

0.0032200358263133.720930233

0.0029992685268505.062179956

0.0042076992306358.349746344

0.0044851658406501.451009723

&A

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Real tax per pack

Real tax revenue

Year

Real cigarette tax rates per pack in constant 1990 Zimbabwe dollars

Real cigarette tax rates per pack in constant 1990 Zimbabwe dollars

Real cigarette tax rates and real cigarette revenue in Zimbabwe 1960-1997

Zimbabwe

Zimbabwe

Zimbabwe

Real tax per packReal tax revenue

19700.0058667355391115.702479339

19710.0055135922393372.01631068

19720.0052877095412555.849068901

19730.0050978456428033.582226212

19740.0047404007423795.137979967

19750.0045724638439304.943478261

19760.0045791001379699.53352685

19770.0041513158440504.171973684

19780.0037829736400376.838968825

19790.0033245522343074.267808219

19800.00501645382307.4405

19810.0053392308531707.854067197

19820.0059672843585983.794728435

19830.0060602206627570.775016223

19840.0074956803498562.282208423

19850.007223992631692.827949228

19860.0063182412630450.587723117

19870.0056186605610723.964382501

19880.0056846847578700.900900901

19890.0051250812590409.356725146

19900.005624000

19910.00405515543796.674776967

19920.0030821918408293.555936073

19930.0032200358263133.720930233

19940.0029992685268505.062179956

19950.0042076992306358.349746344

19960.0044851658406501.451009723

Source: Dept of Customs and Excise and Central Statistical Organisation, Zimbabwe

S. Africa

South Africa

real cigarette excise ratereal cigarette excise revenuereal price (1990) (R)

19604.5069169961444.89129390832.6650666964

19614.49160470731282.53226795022.624635849

19624.47639611351152.10285002222.5951086957

19634.47639611351070.1050830222.5318133616

19644.46631414021085.47723501382.4808184143

19654.45627747921033.46614683612.3935251444

19664.3062833404951.71182744872.436693741

19674.03057617531049.70082889792.5561395127

19684.81159420291092.17012847272.5473412315

19694.79727398211113.23018559192.5355807315

19705.72407755811146.61980752712.505

19715.21575457311146.67660822822.584203666

19725.4105257671249.60748950232.497790224

19735.07516259961059.18360951012.4281894094

19744.73108377931106.65899075192.29301222

19755.36094674561063.5321196692.3068289206

19765.40860215051197.43707326562.324407332

19774.74528301891263.41959835222.3001344196

19784.31759656651243.73911783742.2399633401

19794.05645161291191.45750094222.0991771894

19803.85440613031050.8494382661.9341242363

19814.27659574471090.73586237081.7770040733

19823.58928571431139.91395346321.8760835031

19833.5683060109968.40149059931.8272505092

19843.1622276029893.20797159251.8268839104

19852.7151767152847.97777283721.7409307536

19862.3963302752747.89812406691.6938248473

19872.1064516129706.56919380221.6137026477

19882.1545064378724.44265959751.5870672098

19891.8938679245730.18786423831.6040753564

19901.8069695.421.65

19911.7686628384705.48408381481.4830875976

19921.8361581921766.52269602211.6920563595

19931.7825814536756.7278149381.7782789729

19942.4904355502795.89546134431.8067942675

19952.4229188078862.14077467722.0381231672

19962.4390637611836.5650969529

19973.2374100719898.2528263104

Sources: Central Statistical Services and Tobacco Board Annual Reports

Chart S.Africa

4.5069169961444.8912939083

4.49160470731282.5322679502

4.47639611351152.1028500222

4.47639611351070.105083022

4.46631414021085.4772350138

4.45627747921033.4661468361

4.3062833404951.7118274487

4.03057617531049.7008288979

4.81159420291092.1701284727

4.79727398211113.2301855919

5.72407755811146.6198075271

5.21575457311146.6766082282

5.4105257671249.6074895023

5.07516259961059.1836095101

4.73108377931106.6589907519

5.36094674561063.532119669

5.40860215051197.4370732656

4.74528301891263.4195983522

4.31759656651243.7391178374

4.05645161291191.4575009422

3.85440613031050.849438266

4.27659574471090.7358623708

3.58928571431139.9139534632

3.5683060109968.4014905993

3.1622276029893.2079715925

2.7151767152847.9777728372

2.3963302752747.8981240669

2.1064516129706.5691938022

2.1545064378724.4426595975

1.8938679245730.1878642383

1.8069695.42

1.7686628384705.4840838148

1.8361581921766.5226960221

1.7825814536756.727814938

2.4904355502795.8954613443

2.4229188078862.1407746772

2.4390637611836.5650969529

3.2374100719898.2528263104

&A

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real cigarette excise rate

real cigarette excise revenue

Year

Real cigarette tax rate per pack in constant 1990 currency

Real cigarette stax revenue in millions of constant 1990 currency

Real cigarette tax rate and real cigarette tax revenue in South Africa 1960-1997

US

United StatesUnited States

US

Federal cig. Tax revenueState cig. Tax revenueTotal cig. tax revenueCPIReal tob. tax revenueAverage nomial price of cig.cig tax as % of pricenomial cig. tax ratereal cig. tax ratereal cigarette tax ratereal cigarette tax revenue

19601863.618636000092993692993600011162960001116.29629.637.712702702726.148.612.68460.428533783819600.428533783837.7127027027

19611923.519235000099514499514400011874940001187.49429.939.715518394626.948.312.99270.434538461519610.434538461539.7155183946

19621956.51956500001085646108564600012812960001281.29630.242.427019867526.849.413.23920.43838410619620.43838410642.4270198675

19632010.52010500001132804113280400013338540001333.85430.643.5927.949.313.75470.449519630.449543.59

19641976.71976700001212320121232000014099900001409.993145.483548387128.249.914.07180.453929032319640.453929032345.4835483871

19652069.72069700001327081132708100015340510001534.05131.548.7000317463051.415.420.489523809519650.489523809548.700031746

19662006.52006500001566627156662700017672770001767.27732.454.545586419830.550.815.4940.478209876519660.478209876554.5455864198

19672023.12023100001643039164303900018453490001845.34933.455.249970059932.349.215.89160.475796407219670.475796407255.2499700599

19682066.22066200001915776191577600021223960002122.39634.860.988390804632.848.916.03920.460896551719680.460896551760.9883908046

19692082.12082100002101828210182800023100380002310.03836.762.943814713937.147.717.69670.482198910119690.482198910162.9438147139

19702036.12036100002368077236807700025716870002571.68738.866.280592783538.946.818.20520.469206185619700.469206185666.2805927835

19712149.52149500002594586259458600028095360002809.53640.569.37125925934047.719.080.471111111119710.471111111169.3712592593

19722151.22151200002904379290437900031194990003119.49941.874.629162679440.348.419.50520.466631578919720.466631578974.6291626794

197322212221000003092844309284400033149440003314.94444.474.660900900941.847.619.89680.448126126119730.448126126174.6609009009

197423832383000003225175322517500034634750003463.47549.370.253042596344.544.519.80250.40167342819740.40167342870.2530425963

19752261.12261100003284660328466000035107700003510.7753.865.255947955447.941.419.83060.36859851319750.36859851365.2559479554

19762434.82434800003428902342890200036723820003672.38256.964.540984182849.240.519.9260.350193321619760.350193321664.5409841828

19772279.22279200003483349348334900037112690003711.26960.661.242062706354.337.120.14530.332430693119770.332430693161.2420627063

19782374.12374100003632746363274600038701560003870.15665.259.358220858956.835.520.1640.309263803719780.309263803759.3582208589

19792356.12356100003621625362162500038572350003857.23572.653.12995867776034.520.70.285123966919790.285123966953.1299586777

19802604.42604400003714417371441700039748570003974.85782.448.23855582526333.120.8530.253070388319800.253070388348.2385558252

19812488.22488200003850631385063100040994510004099.45190.945.098470847169.729.920.84030.229266226619810.229266226645.0984708471

19822496.12496100003922180392218000041717900004171.7996.543.23098445681.926.821.94920.227452849719820.227452849743.230984456

19833424.43424400004117825411782500044602650004460.26599.644.781777108494.733.231.44040.315666666719830.315666666744.7817771084

19844749.24749200004232982423298200047079020004707.902103.945.311857555397.832.331.58940.304036573619840.304036573645.3118575553

19854442.54442500004314268431426800047585180004758.518107.644.2241449814104.530.832.1860.299126394119850.299126394144.2241449814

19864430.84430800004422062442206200048651420004865.142109.644.3899817518110.129.932.91990.300364051119860.300364051144.3899817518

19874752.34752300004545529454552900050207590005020.759113.644.1968221831118.928.834.24320.301436619719870.301436619744.1968221831

19884466.54466500004768674476867400052153240005215.324118.344.0855790363129.526.534.31750.290088757419880.290088757444.0855790363

19894237.84237800004995848499584800054196280005419.62812443.7066774194144.126.438.04240.306793548419890.306793548443.7066774194

19904069.84069800005440092544009200058470720005847.072130.744.7365876052153.325.639.24480.300266258619900.300266258644.7365876052

19914754.64754600005769306576930600062447660006244.766136.245.8499706314173.525.644.4160.326108663719910.326108663745.8499706314

199250435043000005924192592419200064284920006428.492140.345.8196151105183.724.945.74130.326024946519920.326024946545.8196151105

199355285528000006045020604502000065978200006597.82144.545.6596539792169.331.453.16020.367890657419930.367890657445.6596539792

199455995599000006506277650627700070661770007066.177148.247.6800067476175.83154.4980.367732793519940.367732793547.6800067476

19955716.85716800007051621705162100076233010007623.301152.450.021660105179.631.656.75360.372398950119950.372398950150.021660105

Chart US

0.428533783837.7127027027

0.434538461539.7155183946

0.43838410642.4270198675

0.449543.59

0.453929032345.4835483871

0.489523809548.700031746

0.478209876554.5455864198

0.475796407255.2499700599

0.460896551760.9883908046

0.482198910162.9438147139

0.469206185666.2805927835

0.471111111169.3712592593

0.466631578974.6291626794

0.448126126174.6609009009

0.40167342870.2530425963

0.36859851365.2559479554

0.350193321664.5409841828

0.332430693161.2420627063

0.309263803759.3582208589

0.285123966953.1299586777

0.253070388348.2385558252

0.229266226645.0984708471

0.227452849743.230984456

0.315666666744.7817771084

0.304036573645.3118575553

0.299126394144.2241449814

0.300364051144.3899817518

0.301436619744.1968221831

0.290088757444.0855790363

0.306793548443.7066774194

0.300266258644.7365876052

0.326108663745.8499706314

0.326024946545.8196151105

0.367890657445.6596539792

0.367732793547.6800067476

0.372398950150.021660105

&A

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real cigarette tax rate

real cigarette tax revenue

Year

Real cigarette tax rate per pack (aveage for all states)

Real cigarette tax revenue in millions of US$

Cigarette tax rate and cigarette tax revenue in the US 1960-1995

As Cigarette Tax Rises Revenue Increases Tax per pack and cigarette tax revenues in Norway, 1990-1998

Source: World bank 1999

Chart16

233615.8480325645

265517.6061007958

274520.4697986577

292120.7163120567

301123.2689335394

321424.2291745194

339124.9338235294

381427.5279682425

386830.5891656781

Cigarette tax revenues

Tax per pack

Cigarette tax revenue in local currency (millions)

Tax per pack in local currency

Sweden regression

SUMMARY OUTPUT

Regression Statistics

Multiple R0.8031586139

R Square0.645063759

Adjusted R Square0.6024714101

Standard Error0.1129200856

Observations29

ANOVA

dfSSMSFSignificance F

Regression30.57934158520.193113861715.14506185730.0000080147

Residual250.31877364310.0127509457

Total280.8981152284

CoefficientsStandard Errort StatP-valueLower 95%Upper 95%Lower 95.0%Upper 95.0%

Intercept8.69793832011.87150829274.64755531880.00009289524.8434975412.55237910014.8434975412.5523791001

lgcigtax-0.32435417850.1271444525-2.55106826970.0172395111-0.5862128968-0.0624954602-0.5862128968-0.0624954602

lgpipetax-0.1958458850.0929031463-2.10806514940.0452191354-0.3871833625-0.0045084076-0.3871833625-0.0045084076

lgdispinc-0.2941486990.1625872693-1.8091742380.0824656811-0.62900321370.0407058157-0.62900321370.0407058157

RESIDUAL OUTPUT

ObservationPredicted YResiduals

14.05615186050.1001986452

24.08571107050.0329706387

34.15784944850.0793428404

44.1237767614-0.0820393969

54.15640005360.0604949881

64.17391520030.0921061566

74.19043941210.0986762543

84.19376982240.0376318817

94.22486665420.0356904668

104.26645406650.0126906918

114.23654727380.0353105395

124.3129616086-0.0787331772

134.3378246384-0.0550046539

144.3151119315-0.0755215598

154.12131252310.1125279762

164.2122959449-0.0109156243

174.19340432850.0108602316

184.16642858520.0249672719

194.14983985130.0453207768

204.13073318110.0352043207

214.1303741123-0.0031605834

224.1625026549-0.0489906492

234.12580083560.0213836631

244.0097521679-0.0972246216

253.9410319968-0.0370933316

263.9891148064-0.1606605154

273.9747303239-0.1287321108

283.8512304248-0.3279642908

293.65471102670.2706631713

Sweden regression

4.15635050570

4.11868170920

4.23719228890

4.04173736450

4.21689504170

4.26602135690

4.28911566640

4.23140170410

4.2605571210

4.27914475830

4.27185781330

4.23422843140

4.28281998460

4.23959037170

4.23384049930

4.20138032060

4.20426456010

4.19139585710

4.19516062810

4.16593750180

4.12721352890

4.11351200570

4.14718449870

3.91252754630

3.90393866520

3.8284542910

3.84599821320

3.5232661340

3.92537419810

Y

Predicted Y

X Variable 2

Y

X Variable 2 Line Fit Plot

Sweden

AustriaBelgiumDenmarkFinlandGermanySpainFranceGreeceItalyIrelandLuxN'landsPortugalSwedenUK

Excise incidence56.9576158.255.655958.357.35859.9757.257655164.36

Tax incidence73.5874.3781.0176.2169.4472.7975.9972.5974.6777.3367.887279.6770.7979.25

Swedengrams per person 15+

cigarettesPipe&roll tobaccocigarettesPipe&roll tobaccoMoist&Snuff

1970104324519701043245393

1971100723319751165190452

1972113521619801155157547

197393321719851059204666

197411102021990980164658

197511651901995736153754

197611911811998518128742

19771122168

19781152159

19791168153

19801155157

19811108154

19821158164

19831106171

19841096205

19851059204

19861059180

19871044166

19881047158

19891016158

1990980164

1991970163

19921006167

1993797161

1994791158

1995736153

1996749153

1997542157

1998518128

1999

BoysSmoking Prevalance among school children (Daily Smokers %)

Sweden (1981-98)Norway (1980-95)Denmark (1985-98)Finland (1981-97)

Boys-2-50-3

Girls-9-303

% share of HH Expenditures on Tobacco in 1996

Tobacco

Workers1.7

Low salary1.2

middle salary0.7

High salary0.7

Farmers &entrepreneurs1.9

Students etc2.2

Pensioners0.9

Smoking Habits of School Children in Sweden 1981-1998

Age 12-13Age 15-16

BoysGirlsBoysGirls

1981211323

19891081217

1998001114

`

1000000

SwedencigarettesPer capitaPipe roll tobacco1000000000Disposable incomelog

Million piecesTaxesMillion SKEcigarette/packTaxes per packtonnesTaxesMillion SKETax/20 gramsDisposable Incomepopulationper capitaCPIReal tax cigarettesreal tax pipeReal Disp.Incomeper/capitacigaretaxpipetaxrealincome

1970102691519642.95841854121568991.262755102938.04E+0611563161887226843211

197199571460612.9326102241495961.28428093651008.10E+0612349171787264043211

1972112431625692.89068753891392901.29310344831088.12E+0613297191576998543211

197392641523573.28799654581399911.30092923521218.14E+0614870201677435243211

1974110701812683.27371273711308871.33027522941408.16E+0617155221567797643211

1975116732018713.45755161481237821.32578819731598.19E+0619407241468086243211

1976119882161733.60527193861184791.33445945951798.22E+0621771261458373443211

1977113572249693.96055296291103831.50498640072008.25E+0624237291458357443211

1978117272389714.07435831841055831.57345971562238.28E+0626945321358420443211

1979119732503724.18107408341019801.57016683022428.29E+0629178351248336542211

1980119092929724.91896884711055871.64928909952938.31E+0635259391349040743111

1981114832791694.86109901591040851.63461538463228.32E+0638702441148795942111

1982120622973724.929530757811131011.81491464513468.33E+0641562481048658742111

1983115603088695.342560553611601262.17241379313798.33E+0645493521048748642111

1984115023895696.772735176513973304.72440944884138.34E+0649538561288846142211

1985111523375676.052725968414002904.14285714294548.35E+0654371601079061942211

1986112113537676.309874230712362854.61165048544948.37E+0659020631079368342211

1987111063868666.965604177911452885.03056768565238.40E+0662269661189434742211

1988111974232667.559167634211012905.2679382385578.44E+0666027691189569142211

1989109484684648.5568140311073145.67299006326038.49E+0671000741289594542211

1990106145123629.6532881111583425.90673575136898.56E+0680500821279817142211

1991105415189619.845365714811553215.55844155847958.62E+06922558911610365842212

19921096657976310.572679190211843586.04729729738428.67E+06971399112710674642212

1993872352295011.9889946119114558610.23580786038688.72E+069955795131110479743212

1994871061915014.2158438576113066711.80530973459078.78E+0610329598151210540343212

1995812360944615.004308752910974959.02461257989238.83E+0610451810015910451843212

1996827863544715.35153418710965119.32481751829268.84E+0610471610015910471643212

1997599963123421.0435072512112760710.77196095839308.85E+06105092101211110405143212

1998573857705120.111537120992471015.3679653689635.66E+06170084101201516840043312

1000000Tobacco tax revenues as

ExcisesTax RevenuesTob.ExciseRevenues% of excises% of tax revenues

19721449000000058640000000177312.23602484473.0235334243

19731662000000061180000000167110.05415162452.7312847336

19741819000000068740000000195810.76415612972.8484143148

19752127000000081750000000215810.1457451812.6397553517

19762333000000010808000000023009.85855122162.1280532939

19772842000000012380000000023978.43420126671.936187399

19783210000000013443000000025357.89719626171.8857397902

19793683000000014308000000026467.18436057561.8493150685

19804160000000015963000000030867.41826923081.9332205726

19814325000000018449000000029446.80693641621.5957504472

19824757000000020320000000031436.60710531851.5467519685

19835083000000022835000000032866.46468620891.4390190497

19845573000000026296000000043287.76601471381.6458777

19855434000000029565000000037626.92307692311.2724505327

19865639000000031778000000039256.96045398121.2351312229

19875507000000037547000000042777.76647902671.1391056542

19885953000000041353000000046507.81118763651.1244649723

19896997000000046122000000051437.35029298271.1150860761

19906812000000052206000000056368.27363476221.0795693982

19916496000000051647000000056918.76077586211.1019033051

1992..511630000000636101.2432812775

1993443050000000618001.3948764248

1994446970000000727901.6285209298

1995555630000000702601.2645105556

1996620680000000732801.1806405877

1997642220000000752101.1710940176

1998..717900

1999

2000

Sweden

00

00

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Excise incidence

Tax incidence

Percent

Tobacco Excise and Tax Incidence in European Union in 1999

Norway

00

00

00

00

Boys

Girls

% change

% Change in Smoking Prevalence Among School Children

Finland

000

000

000

000

000

000

000

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Page &P

cigarettes

Pipe&roll tobacco

Moist&Snuff

Grams per person 15+

Moist&Snuff per person 15+

Per Capita Consumption of Tobacco Products in Sweden, 1970-1998

Sheet4

0

0

0

0

0

0

0

% share of HH Expenditures on Tobacco in 1996

% share

% Share of HH Expenditures on Tobacco in Sweden 1996

Sheet5

000

000

000

000

1981

1989

1998

% of daily smokers

Smoking Habits of School Children in Sweden 1981-1998

Sheet6

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&A

Page &P

cigarette/pack

Real tax cigarettes

pack/capita

real tax/pack

Cigarette Consumption and Tax Rate in Sweden 1970-1998, CPI, 1995=100

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&A

Page &P

TaxesMillion SKE

cigarette/pack

Million SKE

pack/capita

Cigarette Tax Revenue and Consumption

00

00

00

00

00

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00

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Page &P

TaxesMillion SKE

Taxes per pack

Million SKE (local currency)

Tax/pack SKE (local currency)

Trend in Cigarette Tax Revenues and Tax Rates in Sweden 1970-1998

00

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% of excises

% of tax revenues

% share in excise revenues

% share in total revenues

% Share of Tobacco Tax Revenues in Excise and Total Revenues in Sweden 1972-1991

Daily smokers among 13-15 year olds (%) 1975-1995

BoysGirls

CigarettePipe roll tobaccoTaxes collected MilNOKpopulationCigarette TaxesReal taxesCigarette/packpipe roll tobaccoExcise RevenuesTax Revenues19751517MenWomen

million piecestonnescigarettesall tobaccothousand 15+per packCPIper pack15+15+ /20gramMen198013121980199819801998

197018314042291519.11985121116-2435313731

197117524004293820.2Women199091025-3442384134

197218624333296521.753309998083362000076819958935-4442353638

197318424375299123.356940001283855199846445-5444373033

197417354493301625.557459998724394799923255-6450272128

197517554580304228.568649999365017600000065-7440271122

197617204397306531.1913799987259093999616

197719574401309033.91061600051267725000704

197818514188311636.71101100032074500997120

197920424335314138.41268099993683519995904

198022324427316642.615998000128105672998912

198119954373319348.519207000064126298996736

198217504066322354.020879998976136585003008

198317684154325258.524668999680147613007872

198419504062328062.228522999808164652007424

198523033999330965.735053998080189502996480

198626273770333570.435825999872202078994432

198727403551336376.637041999872208807002112

198828493494339581.732373999616212172996608

198929353425341985.435306999808216664997888

CigarettePipe roll tobaccoTaxes collected MilNOKpopulationCigarette TaxesReal taxes15+15+ /20gramTobacco taxes

million piecestonnesCigarette tax revenuesall tobaccothousand 15+Tax per packCPIReal tax/packCigarette/packpipe roll tobacco/20 grams per 15+Excise RevenuesTax Revenues%excise% tax revenues

19902948348323363650343215.888.917.842.9550.74381679984642331929968649.56298508411.5652271076

19913016349126554199344417.692.019.143.7950.684150000025624749100236810.11807222671.6966273359

19922682316727454380346020.594.121.738.7645.77451299983362485710028809.70529616991.7620719832

19932820336529214710347420.796.321.540.5948.434508599910425432699699210.44670206631.8519465317

19942588304830114915348923.397.623.837.0943.68491979980802751859916809.99024389571.7860647521

19952653294432145247350424.2100.024.237.8642.015125899878430135500800010.23625143771.7411358234

19962720299233915526352924.9101.324.638.5442.395505599897633199800320010.03705336891.6644678422

19972771278538146113354527.5103.926.539.0839.28

19982529242338686290356330.6106.228.835.4934.00

00

00

00

00

00

00

00

00

00

Cigarette/pack

pipe roll tobacco/20 grams per 15+

Per person 15+

Cigarette and Pipe & Roll Tobacco Consumption Per Person 15+ Norway, 1990-1998

00

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Page &P

Real tax/pack

Cigarette/pack

Real tax/pack

Cigarette/pack 15+

Cigarette Consumption and Real Tax/pack Norway, 1990-1998

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%excise

% tax revenues

% share in excise revenues

% share in tax revenues

% Share of Tobacco Tax Revenues in Excise and Total Tax Revenues, Norway, 1990-1996

00

00

00

00

00

00

Men 1980

Men 1998

% of daily smokers

Smoking Habits of the Male Adults by Age, Norway1980-1998

00

00

00

00

00

00

Women 1980

Women 1998

% of daily smokers

Smoking Habits of the Female Adults by Age, Norway 1980-1998

00

00

00

00

00

Boys

Girls

% of daily smokers

Daily Smokers Among 13-15 year olds Norway, 1975-1995

00

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Page &P

cigarette tax revenue

per pack

Million NOK (local currency)

Nominal tax/pack (local currency)

Cigarette Tax Revenues and Tax Rate/Pack, Norway, 1990-1998

365042.9487179487

419943.7862950058

438038.7572254335

471040.5872193437

491537.0879908283

524737.8567351598

552638.5378294134

611339.0832157969

629035.4897558237

&A

Page &P

all tobacco

Cigarette/pack

Million local currency

Pack/capita 15+

Cigarette Consumption and Tax Revenues in Norway, 1990-1998

Cigarette taxCigarettes per

per packpack/capitaTobacco Tax Revenues as

Cigarettes (mil.pieces)population 15+(thous)Cigarette Tax Revenuetotal tax revenueCigarette tax rate/packcigarette per pack/capitaExcise RevenuesTax Revenues% of excises% of tax revenuesCPIReal Tax/pack

198071193809115012013.2393.45109720002564800099942410.952.5046.796.91

198166493839122712863.6986.60125400002565691600076810.262.2652.407.04

198269263872140914774.0789.44146700001286314600038410.072.3457.427.09

198371403904157316404.4191.4416410999808703570001929.992.3362.227.08

198475183931172817994.6095.62150630000648012800000011.942.2566.626.90

198568293951165117234.8486.42162549995529073200332810.601.9070.536.86

198672263966185019245.1291.101741000089610089299968011.051.9172.577.06

198777063980208421635.4196.811654500044810298999603213.072.1075.537.16

198874483990227223546.1093.331959599923212303500083212.011.9179.387.69

198977264066259526846.7295.012128200089613974999859212.611.9284.657.94

199071604023261027037.2988.992262099968014586799718411.951.8589.818.12

199169714049279829068.0386.082214700032013936500736013.122.0993.518.58

199269004075301931638.7584.662205199974414009599590414.342.2695.949.12

199358244097284230329.7671.082322000076813556500070413.062.2497.969.96

199455534117276529499.9667.442418299904014911999180812.191.9899.0210.06

1995519241362848305110.9762.772517099929615188800307212.122.01100.0010.97

1996453741542669293811.7754.612750200012816356099686410.681.80100.6211.69

1997472841752868314212.1356.62101.8211.92

1998481341972982329612.3957.34103.2412.00

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Cigarette Tax Revenue

Cigarette tax rate/pack

Million FIN (local currency)

Tax/pack FIN (local currency)

Nominal Cigarette Tax Revenue and Tax Rate/pack, Finland, 1980-1998

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cigarette per pack/capita

Real Tax/pack

pack/per 15+

real tax rate/pack

Cigarette Consumption and Tax RateFinland, 1980-1996 CPI, 1995=100

10.94604422152.5020312377

10.25518320372.2594700658

10.0681662382.3390238353

9.99329729562.3309691936

11.94317196012.2451577476

10.59981573351.8989991809

11.05111947721.9069707572

13.07343572942.1002039842

12.01265611481.9132766969

12.61159612351.9205724702

11.94907403841.8530452547

13.12141580352.0851719202

14.34337038242.2577376174

13.05770843982.2365654736

12.19451729341.97760204

12.12109207162.0087169087

10.68285937871.7962717618

&A

Page &P

% of excises

% of tax revenues

% of excise

% of tax revenues

% Share of Tobacco Taxes in Excise and Tax Revenues, Finland, 1980-1996

Health AND Economics Key Stakeholders in Policy DialogueMinistries Health: Health care costsAgriculture: tobacco farmers and their livelihoodTrade: Tobacco export earningsLabor: jobs related to tobacco Finance and Customs: Tax revenues (profit, excise, income, investment, trade) and smugglingCentral, provincial/regional & local govtsTobacco industry

Today: Health AND EconomicsMost frequently raised issues in policy dialogueSupply side issues Farmers and their livelihoodsSmuggling Crop substitutionTrade issues (WTO, import duties etc.)

Health and economicsfor Successful Tobacco ControlPartnership is the KEYJoin comparative advantages for effective policy dialogue

Address concerns of key decision makers Policy relevant research, andDisseminate research evidence

Changing Cigarette Consumption

Chart2

1688099167378916089171567395

689769688880678537680441

911221930606940206940632

1991070199638019885661990359

1996

1997

1998

1999

Million pieces

Global Cigarette Consumption by Country Income Groups

Sheet2

World Cigarette Consumption2000 Population (000s)

30-NOV-1999 11:02

(Million Pieces)50000

Domestic Consumption19961997199819991999 per capita/piecesHIUMILMILI

HIAustralia28584279992787427100AUSTRALIA192211410

HIAustria12936132051550315600AUSTRIA8094192716880996897699112211991070

HIBelgium-Luxembourg15572122161230012300BELGIUM10672115316737896888809306061996380

HIBrunei800800800800BRUNEI328243916089176785379402061988566

HICanada48562469944879648796CANADA30911157915673956804419406321990359

HICyprus1450150015501550CYPRUS7672021packs

HIDenmark9472907485098700DENMARK53331631HIUMILMILI

HIFinland5059522352385300FINLAND5182102384404950000344884500004556105000099553500000

HIFrance86163829838383683000FRANCE59320139983689450000344440000004653030000099819000000

HIGermany127003137643137500137000GERMANY82001167180445850000339268500004701030000099428300000

HIHong Kong5076502755405900HONG KONG705683678369750000340220500004703160000099517950000

HIIceland600600600600ICELAND2802143billion packs1000000000

HIIreland6350635063506350IRELAND37501693HIUMILMILI

HIIsrael8200825083508350ISRAEL62161343843446100

HIItaly86960932079353692900ITALY575321615843447100

HIJapan336545319615257600257600JAPAN126722203380344799

HIKorea; Republic of103001102756102000102000KOREA, REP. OF472232160783447100

HIKuwait1000100010001000KUWAIT1983504

HIMacau8800880088008800MACAO48018333

HINetherlands15425166703012430124NETHERLANDS158771897

HINetherlands Antilles1700170017001700NETHERLANDS ANTILLES2177834

HINew Zealand6245624562256225NEW ZEALAND38531616

HINorway2720277125752715NORWAY4469608

HIPortugal16150164751647516475PORTUGAL100111646

HIReunion300300300300REUNION715420

HISingapore3389346733223480SINGAPORE32781062

HISpain74582808758992090000SPAIN394502281

HISweden8278599957006300SWEDEN8864711

HISwitzerland15452145091435014350SWITZERLAND71332012

HITaiwan37632400124010440080TAIWAN, CHINA220501818

HIUnited Arab Emirates6500650065006500UNITED ARAB EMIRATES29052238

HIUnited Kingdom89288880208294079500UNITED KINGDOM591761343

HIUnited States518305507004483000446000UNITED STATES OF AMERICA2754691619

156739592653885

LIAfghanistan1500150015001500AFGHANISTAN265503

LIArmenia; Republic of5600570058005800ARMENIA38281515

LIAzerbaijan; Republic of6100620061506150AZERBAIJAN8048764

LIBangladesh15400154001540015400BANGLADESH129752119

LIBenin500500500500BENIN628480

LIBosnia-Hercegovina9600960096008600BOSNIA AND HERZEGOVINA39232192

LIBurundi700700700700BURUNDI6807103

LICambodia4300430043004300CAMBODIA12021358

LICameroon5250525052505250CAMEROON15084348

LIChad55555555CHAD76937

LIChina; Peoples Republic of1659477166604816550901655950CHINA (EXCLUDING TAIWAN)12603761314

LICongo (Brazzaville)10701070600600CONGO, REP.2937204

LICote d''Ivoire4850485048504850COTE D'IVOIRE14919325

LIEthiopia2700270027002700ETHIOPIA6429842

LIGhana2250225022502250GHANA19450116

LIGuinea1051058585GUINEA741511

LIGuyana650650650650GUYANA863753

LIHaiti920920920920HAITI7960116

LIHonduras2011201120112011HONDURAS6492310

LIIndia100786976809682095975INDIA101592494

LIKenya7000700070007000KENYA30625229

LIKyrgyzstan; Republic of4000405041004100KYRGYZ REPUBLIC4790856

LILaos1300130013001300LAO PEOPLE'S DEM. REP.5217249

LILiberia225225225225LIBERIA313072

LIMadagascar2500250025002500MADAGASCAR15523161

LIMalawi12001100950930MALAWI1104084

LIMoldova; Republic of4800480047004700MOLDOVA42641102

LIMozambique1200120012001200MOZAMBIQUE1758168

LINepal1500150015001500NEPAL2392063

LINicaragua2400240024002400NICARAGUA5044476

LINiger800800800800NIGER1085074

LINigeria18700187001870018700NIGERIA126910147

LIPakistan45603469655170254500PAKISTAN138081395

LISenegal3900390039003900SENEGAL9530409

LISierra Leone1038103810381038SIERRA LEONE5031206

LISri Lanka5150515051505150SRI LANKA19190268

LISudan1250135014501450SUDAN2967749

LITajikistan; Republic of7400750074007400TAJIKISTAN63351168

LITanzania; United Republic of3750375037503750TANZANIA33696111

LITogo1000100010001000TOGO4670214

LIUganda2300230023002300UGANDA22063104

LIVietnam32000320003200032000VIET NAM78524408

LIYemen4700480048004800YEMEN, REP. OF17506274

LIZambia1600160016001600ZAMBIA10090159

LIZimbabwe2150218320902090ZIMBABWE12112173

1980579308763832

LMIAlbania3050320032503250ALBANIA3410953

LMIAlgeria20700210002150021500ALGERIA31167690

LMIBelarus15000155001600016000BELARUS101791572

LMIBelize18018018080BELIZE255314

LMIBolivia1300130013001300BOLIVIA8329156

LMIBotswana900900900900BOTSWANA1603561

LMIBulgaria19103186001800019000BULGARIA81752324

LMIColombia19800198001980019800COLOMBIA4230023

LMICosta Rica2025202520252025COSTA RICA365128

LMICuba15900159001590015900CUBA1119671

LMIDominican Republic4098388440894089DOMINICAN REP.855824

LMIEcuador4600460046004600ECUADOR1264418

LMIEgypt44250462004660046600EGYPT, ARAB REP. OF6343737

LMIEl Salvador1620162016201620EL SALVADOR632113

LMIEstonia2200220022002200ESTONIA143577

LMIFiji700700700700FIJI81043

LMIGeorgia; Republic of8600870088008800GEORGIA545981

LMIGuatemala2144217021752175GUATEMALA1137110

LMIIran24000241002420024200IRAN, ISLAMIC REP. OF6401619

LMIIraq13700142001420014200IRAQ2326531

LMIJamaica & Dep1240124012401240JAMAICA262024

LMIJordan3850395040004000JORDAN482641

LMIKazakhstan; Republic of15650160001700017000KAZAKHSTAN1528356

LMIKorea; Democratic Peoples Rep15500155001550015500KOREA, DEM. PEOPLE'S REP. OF2362133

LMILatvia3900400040004000LATVIA241183

LMILebanon5600565056505650LEBANON432865

LMILithuania5200525053005300LITHUANIA369372

LMIMacedonia (Skopje)4600460047004700MACEDONIA, FYR2031116

LMIMorocco15700158001590015900MOROCCO2872728

LMIPanama900915915915PANAMA285116

LMIPapua New Guinea55555555PAPUA NEW GUINEA48071

LMIParaguay1900195019501950PARAGUAY549618

LMIPeru4210421042104210PERU256678

LMIPhilippines77779692017500071620PHILIPPINES7831346

LMIRomania32500315003300040000ROMANIA2241389

LMIRussian Federation207000230000231500232000RUSSIAN FEDERATION14611779

LMISolomon Islands25252525SOLOMON ISLANDS4423

LMISurinam400400400400SURINAME41548

LMISyria10000101001020010200SYRIAN ARAB REP.1602132

LMIThailand49155491344170034290THAILAND6208428

LMITunisia11100111001120011200TUNISIA957758

LMITurkey98509100030109300111500TURKEY6537085

LMITurkmenistan5900600061006100TURKMENISTAN491362

LMIUkraine85000860008700087000UKRAINE4954988

LMIUruguay3938393839383938URUGUAY333659

LMIUzbekistan; Republic of17782179881598416600UZBEKISTAN2491033

LMIVenezuela7658699141004100VENEZUELA241708

LMIYugoslavia (>05/92)22300223002230022300YUGOSLAVIA, FED. REP.10616105

94063296218849

UMIArgentina41300412004170042500ARGENTINA3702057

UMIBarbados230230230235BARBADOS26844

UMIBrazil11900011030097000100000BRAZIL17026629

UMIChile12675139901414012545CHILE1521041

UMICroatia10491889695019501CROATIA4469106

UMICzech Republic22700239502000019000CZECH REPUBLIC1026993

UMIGreece30000299003000030150GREECE10557143

UMIHungary21200209002370023900HUNGARY10028119

UMIIndonesia192688202379205459207685INDONESIA21042249

UMILibya5700570057005700LIBYA554051

UMIMalaysia19933202291930018500MALAYSIA2321040

UMIMalta & Gozo1350137514001400MALTA381184

UMIMauritius1500150015001500MAURITIUS117964

UMIMexico46758469904718047230MEXICO9903024

UMIPoland91780916639305093000POLAND38734120

UMISaudi Arabia20000200002000020000SAUDI ARABIA2213645

UMISeychelles15151515SEYCHELLES819

UMISlovakia11250119001240012400SLOVAK REPUBLIC5402115

UMISlovenia3700370037003700SLOVENIA198093

UMISouth Africa; Republic of36024325883108230000SOUTH AFRICA4280135

UMITrinidad and Tobago1320132013201320TRINIDAD AND TOBAGO130151

68028171028448

9418019430729382992563932

2287826230403422961535544129

45543974586698457073611066688

79963718043480801543520064195

Sheet1

World Cigarette Consumption2000 Population (000s)

30-NOV-1999 11:02

(Million Pieces)50000

Domestic Consumption1996199719981999HIUMILMILI

199616880996897699112211991070

HIAustralia28584279992787427100AFGHANISTAN26550199716737896888809306061996380

HIAustria12936132051550315600ANGOLA12717199816089176785379402061988566

HIBelgium-Luxembourg15572122161230012300ALBANIA3410199915673956804419406321990359

HIBrunei800800800800NETHERLANDS ANTILLES217packs

HICanada48562469944879648796UNITED ARAB EMIRATES2905HIUMILMILI

HICyprus1450150015501550ARGENTINA3702084404950000344884500004556105000099553500000

HIDenmark9472907485098700ARMENIA382883689450000344440000004653030000099819000000

HIFinland5059522352385300ANTIGUA AND BARBUDA6880445850000339268500004701030000099428300000

HIFrance86163829838383683000AUSTRALIA1922178369750000340220500004703160000099517950000

HIGermany127003137643137500137000AUSTRIA8094billion packs1000000000

HIHong Kong5076502755405900AZERBAIJAN8048HIUMILMILI

HIIceland600600600600BURUNDI6807843446100

HIIreland6350635063506350BELGIUM10235843447100

HIIsrael8200825083508350BENIN628480344799

HIItaly86960932079353692900BURKINA FASO11274783447100

HIJapan336545319615257600257600BANGLADESH129752

HIKorea; Republic of103001102756102000102000BULGARIA8175

HIKuwait1000100010001000BAHRAIN683

HIMacau8800880088008800BAHAMAS, THE302

HINetherlands15425166703012430124BOSNIA AND HERZEGOVINA3923

HINetherlands Antilles1700170017001700BELARUS10179

HINew Zealand6245624562256225BELIZE255

HINorway2720277125752715BOLIVIA8329

HIPortugal16150164751647516475BRAZIL170266

HIReunion300300300300BARBADOS268

HISingapore3389346733223480BRUNEI328

HISpain74582808758992090000BHUTAN805

HISweden8278599957006300BOTSWANA1603

HISwitzerland15452145091435014350CENTRAL AFRICAN REP.3597

HITaiwan37632400124010440080CANADA30911

HIUnited Arab Emirates6500650065006500SWITZERLAND7133

HIUnited Kingdom89288880208294079500CHANNEL ISLANDS149

HIUnited States518305507004483000446000CHILE15210

1688099167378916089171567395CHINA (EXCLUDING TAIWAN)1260376

COTE D'IVOIRE14919

CAMEROON15084

LIAfghanistan1500150015001500CONGO, REP.2937

LIAngola2900290029002900COLOMBIA42300

LIArmenia; Republic of5600570058005800COMOROS558

LIAzerbaijan; Republic of6100620061506150CAPE VERDE442

LIBangladesh15400154001540015400COSTA RICA3651

LIBenin500500500500CUBA11196

LIBosnia-Hercegovina9600960096008600CYPRUS767

LIBurma1550155015501550CZECH REPUBLIC10269

LIBurundi700700700700GERMANY82001

LICambodia4300430043004300DJIBOUTI660

LICameroon5250525052505250DOMINICA73

LIChad55555555DENMARK5333

LIChina; Peoples Republic of1659477166604816550901655950DOMINICAN REP.8558

LICongo (Brazzaville)10701070600600ALGERIA31167

LICote d''Ivoire4850485048504850ECUADOR12644

LIEthiopia2700270027002700EGYPT, ARAB REP. OF63437

LIGhana2250225022502250ERITREA4097

LIGuinea1051058585SPAIN39450

LIGuyana650650650650ESTONIA1435

LIHaiti920920920920ETHIOPIA64298

LIHonduras2011201120112011FINLAND5182

LIIndia100786976809682095975FIJI810

LIKenya7000700070007000FRANCE59320

LIKyrgyzstan; Republic of4000405041004100MICRONESIA, FEDERATED STATES OF118

LILaos1300130013001300GABON1237

LILiberia225225225225UNITED KINGDOM59176

LIMadagascar2500250025002500GEORGIA5459

LIMalawi12001100950930GHANA19450

LIMoldova; Republic of4800480047004700GUINEA7415

LIMozambique1200120012001200GUADELOUPE440

LINepal1500150015001500GAMBIA, THE1286

LINicaragua2400240024002400GUINEA-BISSAU1207

LINiger800800800800EQUATORIAL GUINEA454

LINigeria18700187001870018700GREECE10557

LIPakistan45603469655170254500GRENADA98

LIRwanda30303030GUATEMALA11371

LISenegal3900390039003900GUAM154

LISierra Leone1038103810381038GUYANA863

LISri Lanka5150515051505150HONG KONG7056

LISudan1250135014501450HONDURAS6492

LITajikistan; Republic of7400750074007400CROATIA4469

LITanzania; United Republic of3750375037503750HAITI7960

LITogo1000100010001000HUNGARY10028

LIUganda2300230023002300INDONESIA210422

LIVietnam32000320003200032000INDIA1015924

LIYemen4700480048004800IRELAND3750

LIZaire5300530053005300IRAN, ISLAMIC REP. OF64016

LIZambia1600160016001600IRAQ23265

LIZimbabwe2150218320902090ICELAND280

1991070199638019885661990359ISRAEL6216

ITALY57532

JAMAICA2620

LMIAlbania3050320032503250JORDAN4826

LMIAlgeria20700210002150021500JAPAN126722

LMIBelarus15000155001600016000KAZAKHSTAN15283

LMIBelize18018018080KENYA30625

LMIBolivia1300130013001300KYRGYZ REPUBLIC4790

LMIBotswana900900900900CAMBODIA12021

LMIBulgaria19103186001800019000KIRIBATI92

LMIColombia19800198001980019800ST. KITTS AND NEVIS41

LMICosta Rica2025202520252025KOREA, REP. OF47223

LMICuba15900159001590015900KUWAIT1983

LMIDominican Republic4098388440894089LAO PEOPLE'S DEM. REP.5217

LMIEcuador4600460046004600LEBANON4328

LMIEgypt44250462004660046600LIBERIA3130

LMIEl Salvador1620162016201620LIBYA5540

LMIEstonia2200220022002200ST. LUCIA155

LMIFiji700700700700SRI LANKA19190

LMIGeorgia; Republic of8600870088008800LESOTHO2154

LMIGuatemala2144217021752175LITHUANIA3693

LMIIran24000241002420024200LUXEMBOURG437

LMIIraq13700142001420014200LATVIA2411

LMIJamaica & Dep1240124012401240MACAO480

LMIJordan3850395040004000MOROCCO28727

LMIKazakhstan; Republic of15650160001700017000MOLDOVA4264

LMIKorea; Democratic Peoples Rep15500155001550015500MADAGASCAR15523

LMILatvia3900400040004000MALDIVES276

LMILebanon5600565056505650MEXICO99030

LMILithuania5200525053005300MACEDONIA, FYR2031

LMIMacedonia (Skopje)4600460047004700MALI11236

LMIMorocco15700158001590015900MALTA381

LMIPanama900915915915MYANMAR45611

LMIPapua New Guinea55555555MONGOLIA2660

LMIParaguay1900195019501950MOZAMBIQUE17581

LMIPeru4210421042104210MAURITANIA2670

LMIPhilippines77779692017500071620MARTINIQUE402

LMIRomania32500315003300040000MAURITIUS1179

LMIRussian Federation207000230000231500232000MALAWI11040

LMISolomon Islands25252525MALAYSIA23210

LMISurinam400400400400NAMIBIA1741

LMISyria10000101001020010200NEW CALEDONIA218

LMIThailand49155491344170034290NIGER10850

LMITunisia11100111001120011200NIGERIA126910

LMITurkey98509100030109300111500NICARAGUA5044

LMITurkmenistan5900600061006100NETHERLANDS15877

LMIUkraine85000860008700087000NORWAY4469

LMIUruguay3938393839383938NEPAL23920

LMIUzbekistan; Republic of17782179881598416600NEW ZEALAND3853

LMIVenezuela7658699141004100OMAN2395

LMIYugoslavia (>05/92)22300223002230022300OTHER EUROPE302

911221930606940206940632OTHER WEST AFRICA9

OTHER LATIN AMERICA AND CARIBBEAN358

OTHER NORTHERN AMERICA128

UMIArgentina41300412004170042500OTHER NORTH AFRICA245

UMIBarbados230230230235OTHER MICRONESIA166

UMIBrazil11900011030097000100000OTHER POLYNESIA114

UMIChile12675139901414012545MAYOTTE135

UMICroatia10491889695019501PAKISTAN138081

UMICzech Republic22700239502000019000PANAMA2851

UMIGreece30000299003000030150PERU25667

UMIHungary21200209002370023900PHILIPPINES78313

UMIIndonesia192688202379205459207685PAPUA NEW GUINEA4807

UMILibya5700570057005700POLAND38734

UMIMalaysia19933202291930018500PUERTO RICO3920

UMIMalta & Gozo1350137514001400KOREA, DEM. PEOPLE'S REP. OF23621

UMIMauritius1500150015001500PORTUGAL10011

UMIMexico46758469904718047230PARAGUAY5496

UMIPoland91780916639305093000FRENCH POLYNESIA234

UMISaudi Arabia20000200002000020000QATAR766

UMISeychelles15151515REUNION715

UMISlovakia11250119001240012400ROMANIA22413

UMISlovenia3700370037003700RUSSIAN FEDERATION146117

UMISouth Africa; Republic of36024325883108230000RWANDA8506

UMITrinidad and Tobago1320132013201320SAUDI ARABIA22136

UMIWestern Samoa155155160160SUDAN29677

689769688880678537680441SENEGAL9530

SINGAPORE3278

SOLOMON ISLANDS442

SIERRA LEONE5031

EL SALVADOR6321

SOMALIA9713

SAO TOME AND PRINCIPE148

SURINAME415

SLOVAK REPUBLIC5402

SLOVENIA1980

SWEDEN8864

SWAZILAND1043

SEYCHELLES81

SYRIAN ARAB REP.16021

CHAD7693

TOGO4670

THAILAND62084

TAJIKISTAN6335

TURKMENISTAN4913

TONGA101

TRINIDAD AND TOBAGO1301

TUNISIA9577

TURKEY65370

TAIWAN, CHINA22050

TANZANIA33696

UGANDA22063

UKRAINE49549

URUGUAY3336

UNITED STATES OF AMERICA275469

UZBEKISTAN24910

ST. VINCENT AND THE GRENADINES115

VENEZUELA24170

VIRGIN ISLANDS (U.S.)121

VIET NAM78524

VANUATU195

WEST BANK AND GAZA2945

SAMOA171

YEMEN, REP. OF17506

YUGOSLAVIA, FED. REP.10616

SOUTH AFRICA42801

CONGO, DEM. REP.51390

ZAMBIA10090

ZIMBABWE12112

Sheet1

1996

1997

1998

1999

Million pieces

Global Cigarette Consumption by Country Income Groups

96-99cig_con

World Cigarette Consumption

30-NOV-1999 11:02

(Million Pieces)

19961997199819991996-1999

Domestic Consumption

LIAfghanistan15001500150015000

LMIAlbania30503200325032500.0655737705

LMIAlgeria207002100021500215000.038647343

LIAngola29002900290029000

UMIArgentina413004120041700425000.0290556901

LIArmenia; Republic of56005700580058000.0357142857

HIAustralia28584279992787427100-0.0519171565

HIAustria129361320515503156000.2059369202

LIAzerbaijan; Republic of61006200615061500.0081967213

LIBangladesh154001540015400154000

UMIBarbados2302302302350.0217391304

LMIBelarus150001550016000160000.0666666667

HIBelgium-Luxembourg15572122161230012300-0.2101207295

LMIBelize18018018080-0.5555555556

LIBenin5005005005000

LMIBolivia13001300130013000

LIBosnia-Hercegovina9600960096008600-0.1041666667

LMIBotswana9009009009000

UMIBrazil11900011030097000100000-0.1596638655

HIBrunei8008008008000

LMIBulgaria19103186001800019000-0.0053918233

LIBurma15501550155015500

LIBurundi7007007007000

LICambodia43004300430043000

LICameroon52505250525052500

HICanada485624699448796487960.0048185824

LIChad555555550

UMIChile12675139901414012545-0.0102564103

LIChina; Peoples Republic of1659477166604816550901655950-0.0021253684

LMIColombia198001980019800198000

LICongo (Brazzaville)10701070600600-0.4392523364

LMICosta Rica20252025202520250

LICote d''Ivoire48504850485048500

UMICroatia10491889695019501-0.0943665999

LMICuba159001590015900159000

HICyprus14501500155015500.0689655172

UMICzech Republic22700239502000019000-0.1629955947

HIDenmark9472907485098700-0.0815033784

LMIDominican Republic4098388440894089-0.0021961933

LMIEcuador46004600460046000

LMIEgypt442504620046600466000.0531073446

LMIEl Salvador16201620162016200

LMIEstonia22002200220022000

LIEthiopia27002700270027000

LMIFiji7007007007000

HIFinland50595223523853000.0476378731

HIFrance86163829838383683000-0.0367094925

LMIGeorgia; Republic of86008700880088000.023255814

HIGermany1270031376431375001370000.078714676

LIGhana22502250225022500

UMIGreece300002990030000301500.005

LMIGuatemala21442170217521750.0144589552

LIGuinea1051058585-0.1904761905

LIGuyana6506506506500

LIHaiti9209209209200

LIHonduras20112011201120110

HIHong Kong50765027554059000.1623325453

UMIHungary212002090023700239000.1273584906

HIIceland6006006006000

LIIndia100786976809682095975-0.0477348044

UMIIndonesia1926882023792054592076850.0778304824

LMIIran240002410024200242000.0083333333

LMIIraq137001420014200142000.0364963504

HIIreland63506350635063500

HIIsrael82008250835083500.0182926829

HIItaly869609320793536929000.0683072677

LMIJamaica & Dep12401240124012400

HIJapan336545319615257600257600-0.2345748711

LMIJordan38503950400040000.038961039

LMIKazakhstan; Republic of156501600017000170000.0862619808

LIKenya70007000700070000

LMIKorea; Democratic Peoples Rep155001550015500155000

HIKorea; Republic of103001102756102000102000-0.0097183522

HIKuwait10001000100010000

LIKyrgyzstan; Republic of40004050410041000.025

LILaos13001300130013000

LMILatvia39004000400040000.0256410256

LMILebanon56005650565056500.0089285714

LILiberia2252252252250

UMILibya57005700570057000

LMILithuania52005250530053000.0192307692

HIMacau88008800880088000

LMIMacedonia (Skopje)46004600470047000.0217391304

LIMadagascar25002500250025000

LIMalawi12001100950930-0.225

UMIMalaysia19933202291930018500-0.0718908343

UMIMalta & Gozo13501375140014000.037037037

UMIMauritius15001500150015000

UMIMexico467584699047180472300.0100945293

LIMoldova; Republic of4800480047004700-0.0208333333

LMIMorocco157001580015900159000.0127388535

LIMozambique12001200120012000

LINepal15001500150015000

HINetherlands154251667030124301240.9529335494

HINetherlands Antilles17001700170017000

HINew Zealand6245624562256225-0.003202562

LINicaragua24002400240024000

LINiger8008008008000

LINigeria187001870018700187000

HINorway2720277125752715-0.0018382353

LIPakistan456034696551702545000.1950968138

LMIPanama9009159159150.0166666667

LMIPapua New Guinea555555550

LMIParaguay19001950195019500.0263157895

LMIPeru42104210421042100

LMIPhilippines77779692017500071620-0.0791858985

UMIPoland917809166393050930000.0132926564

HIPortugal161501647516475164750.020123839

HIReunion3003003003000

LMIRomania325003150033000400000.2307692308

LMIRussian Federation2070002300002315002320000.1207729469

LIRwanda303030300

UMISaudi Arabia200002000020000200000

LISenegal39003900390039000

UMISeychelles151515150

LISierra Leone10381038103810380

HISingapore33893467332234800.0268515786

UMISlovakia112501190012400124000.1022222222

UMISlovenia37003700370037000

LMISolomon Islands252525250

UMISouth Africa; Republic of36024325883108230000-0.1672218521

HISpain745828087589920900000.2067254834

LISri Lanka51505150515051500

LISudan12501350145014500.16

LMISurinam4004004004000

HISweden8278599957006300-0.2389466055

HISwitzerland15452145091435014350-0.0713176288

LMISyria100001010010200102000.02

HITaiwan376324001240104400800.0650510204

LITajikistan; Republic of74007500740074000

LITanzania; United Republic of37503750375037500

LMIThailand49155491344170034290-0.3024107415

LITogo10001000100010000

UMITrinidad and Tobago13201320132013200

LMITunisia111001110011200112000.009009009

LMITurkey985091000301093001115000.1318762753

LMITurkmenistan59006000610061000.0338983051

LIUganda23002300230023000

LMIUkraine850008600087000870000.0235294118

HIUnited Arab Emirates65006500650065000

HIUnited Kingdom89288880208294079500-0.1096227937

HIUnited States518305507004483000446000-0.1395028024

LMIUruguay39383938393839380

LMIUzbekistan; Republic of17782179881598416600-0.066471713

LMIVenezuela7658699141004100-0.4646121703

LIVietnam320003200032000320000

UMIWestern Samoa1551551601600.0322580645

LIYemen47004800480048000.0212765957

LMIYugoslavia (>05/92)223002230022300223000

LIZaire53005300530053000

LIZambia16001600160016000

LIZimbabwe2150218320902090-0.0279069767

52801595178827

4.01%0.37%

207847Africa204803

0.03936377670.0395462138

LAC794001

0.1533167646

0.0000007486

&L&D&C&T&R&F

Conclusion1. Change in tobacco demand is slow. rising incomes population growth nicotine addiction consumer choice advertising and promotion all increase or maintain tobacco use. The global tobacco market will not wither away. 2. Economies change constantly. People made vulnerable may need help to adjust as demand switches to other goods & services.

Vera has described the harm to health and life caused by tobacco use. My reviews what we know about effective ways to reduce this harm. Of course and especially for many people here today, tobacco is more than a health issue, and we will spend most of these two days talking about the broader set of issues, especially around jobs and incomes. So my talk will also try to relate tobacco control efforts to the broader set of issues on which our meeting focuses.Discussions about tobacco control seem to me to have moved through three phases.At first, research focused on the health risks associated with tobacco, and the links between tobacco use, disease and mortality. Thousands and thousands of studies added stronger and stronger evidence. Commitment and attempts to reduce this harm increased. It became important to know how best to prevent harm to health; what policies and interventions are most effective in reducing tobacco use.And I will summarize briefly that evidence in the next few slides.Then the policy debate shifted to what I call the yes, but phase. Governments (and others) worried that tobacco control interventions might harm the economy. I will briefly comment on that debate.

But I hope this conference marks clearly that we have moved from framing the discussion as Health OR economics, to Health AND economics. Both matter greatly. To eliminate the but from Yes but, and to have constructive debate and sound policy decisions, we need facts and evidence, and high quality research, carried out by researchers with open minds and high standards.I think it marks enormous progress in the discussion on tobacco control, that we are are here together today different agencies and individuals, who recognize that health, jobs, farmers, incomes, revenues, and excellent research are all important.

There is clear evidence from many countries about the set of tobacco control measures that are effective (and highly cost-effective) in reducing the demand for tobacco products. Higher taxes on cigarettes and other tobacco products are probably the single most effective measure, especially to encourage young people and those with limited incomes to reduce their use of tobacco products. Non-price measures, especiallyLarge warning labels on cigarette boxes that use direct and strong language (such as "Smoking kills" or "Smoking causes heart disease.")Restrictions on smoking in public and work placesBetter consumer information: research findings, counter-advertisingComprehensive bans on advertising and promotionHelp for smokers who wish to quit, including increased access to Nicotine Replacement (NRT) and other cessation therapies.

Tax increases that raise cigarette prices are the single most effective way to reduce consumption. When used together with other interventions, the impact is likely to be even stronger. Every country for which trend data exist (and these data exist for large numbers of countries now) shows that at higher prices, less tobacco products are bought, and if real prices fall, people smoke more.An example: In South Africa, the Apartheid regime didnt care much about public health and had close links with the cigarette industry, and left tax rates low. High inflation during the 1970s and 1980s eroded the real tax and price level for cigarettes. And consumption rose steadily. Im pleased to say that the situation has changed dramatically in recent years, since the new Government has raised tobacco taxes sharply, and also introduced several other measures to reinforce their effect. And they received strong public support for these new policies. 1961 1991 real price of cigarettes fell by almost half and consumption by adults rose steadily from 50 to more than 80 packs per person per year. After 1991, when the real price per pack about doubled, consumption has fallen at an average annual rate of nearly 6%.

Key benefit: protect non-smokers. Very well established scientific data on the extent of damage from inhaling second hand smoke, and how long smoke remains in a room, even from a single cigarette. To make these work, need a degree of social consensus. Once there good information on dangers of passive smoking, public support for these restrictions became very strong in the US and other many other countries. Support was readily gained even among smokers for smoking bans in enclosed spaces (airplanes, buses, cinemas etc.) even in countries where smoking rates remain high and other measures difficult to implement.The Surgeon General's Report of 1986, The Health Consequences of Involuntary Smoking: smoking is restricted or banned in 35 to 40 percent of private sector businesses and in an increasing number of Federal, State and local government offices....Actions to restrict or ban smoking at the workplace are supported by a large majority of both smokers and nonsmokers." In Europe, 10% of all cigarettes are smoked at work. So workplace bans can have a significant impact. A 1992 Philip Morris memo (re US): "Total prohibition of smoking in the workplace strongly affects industry volume. Smokers facing these restrictions consume 11-15% less than average and quit at a rate that is 84% higher than average. (nearly double the quit rate very significant). Very little reduction among workers who can smoke in designated areas, strong reductions among workers whose workplaces are smoke free. Good experience with how to approach a ban. Cost-saving to employers: absenteeism, productivity (small effect), health care costs, insurance, ventilation, cleaning & maintenance, fires and accidents.Do smoking bans hurt business? Not in CA or Mass. Glantz and Smith, 1997 American Journal of Public Health (pp. 1687-93) and an earlier 1994 study: no reduction in revenues of smoke-free restaurants and bars. Most exposure of children and other non-smokers to second-hand smoke is in their homes some countries have begun to advise parents to smoke outside only. Protect your children is an acceptable message, but dont have info on impact.

Evidence shows that many smokers want to quit smoking and have tried at least once. 2% of US smokers quit each year. And in the mature smoking countries, something like half of all ever smokers have quit. It is important to help people who want to quit: (1) its very hard to do (2) crucial for any significant short/medium term impact on tobacco-related disease burden.Most quits are unaided, but there are ways to help improve the success rate of quit attempts eg - advice from health care providers (Strong evidence that advice from health professionals to patients to quit can make a substantial difference. Clear need in many countries to reduce smoking among health professionals themselves - social support from friends and family, quit lines(cost effective). - Nicotine replacement therapy NRT can double the success rate of quit attempts, and reduce individuals withdrawal costs. Yet in many countries, NRTs are difficult to obtain. (unlike cigarettes!)

NRT patches, gum, nasal spray, inhalors. Safe, highly regulated.Anti-depressant drugs (eg bupropion) Its not possible or sensible to try and reduce tobacco use through reducing tobacco production. Government actions such as prohibition, youth access restrictions, trade restrictions wont work.

Control of smuggling is the only exception and key supply-side measure which works. Luk Joosens will address this issue tomorrow, so I wont say more.

Although crop substitution is not recommended as a way to reduce demand for tobacco, it may be a good strategy to achieve other goals, such as diversification, or maintaining farm income levels if the price of tobacco falls, for example. In China, Prof Teh-Wei Hu has seen interesting efforts to grow sunflower seeds instead of tobacco, and I know that in India RITC has supported interesting efforts to help farmers move into other crops.As the voices and the evidence urging governments to adopt tobacco control policies became stronger, the discussion shifted, to what I call the yes, but phase. There is no doubt that tobacco use causes diseases and death, that could and should - be prevented. BUT tobacco also makes a large contribution to the economy, providing tax revenues, employment, and export earnings in some countries. Producers and their shareholders like the profits, and many employees depend on tobacco for their income and livelihoods. Tobacco is often a much more profitable cash crop for farmers than other crops that might grow in the same soil.Tobacco tax revenue are more than 10% of all central government tax revenues in Turkey and China.Tobacco provides a high % of all forex earnings in Malawi, and Zimbabwe which are in a class of their own in the extent of their economic dependence on tobacco.There are many workers directly or indirectly involved in tobacco products, including farmers, tobacco processing and manufacturing employees, retailers, advertisers, shop owners, etc. More and more countries are privatizing their cigarette manufacturing industries. Even where privatization is not taking place, international tobacco industrys investments in developing countries are significant.

This yes but debate has led many governments to hesitate to act decisively to reduce smoking and use of other tobacco products, because of fears that tobacco control interventions might have harmful economic consequences. For example, some policymakers fear that reduced sales of cigarettes would mean the permanent loss of thousands of jobs; that higher tobacco taxes would result in lower government revenues; and that higher prices would encourage massive levels of cigarette smuggling.

Because we know that both health AND economics matter greatly, we want to be sure that policy decision are not based on fear but on facts, to get the best possible outcomes. And when we asked a group of about 30 experts from various disciplines to carefully review and weigh the evidence, facts and figures, looking especially carefully at the economics issues, the conclusion that emerged was that governments must indeed often make tough choices, but its a distortion to frame tobacco control as a choice between health OR economics. These are serious concerns, and deserve full and careful consideration, During the rest of these two days, we will be looking at several of these issues in depth. So for now, just a few comments/important facts to keep in mind.Smuggling Luks the expertJob losses some, but expenditure switching creates other jobs. Net effect depends. Impact on vulnerable poor people- smokers face higher prices if taxes rise, but those who quit/cut back benefit in 2 ways health, and can use the money for other things.Very low-wage workers with few alternative jobs to turn to, may face layoffs. Likely to be both losers and winners. Other jobs for some.

Tobacco control and government tax revenues are highly compatible at least for quite a long time. Eventually, perhaps, that may change, but for at least the medium term, higher tobacco tax rates will generate HIGHER government tobacco tax revenues, because they reduce consumption but by less than the amount of the tax increase. So higher taxes are paid on a somewhat smaller total number of cigarettes, but government revenues and health outcomes are BOTH better off.This graph uses SA again to show this. (1960 to 1997)The line that is mostly below (in red) is the real cigarette tax rate in South Africa, and the black line is the total real revenue in constant 1990 local currency. It shows clearly that higher tax RATES give higher TOTAL REVENUES (in the early years and the last few years shown). When real tax rates were eroded by inflation, total revenues declined with them. And when the democratically elected govt began to raise tax rates, total revenues increased, and have continued to do so in the recent years not included on this graph.Even in countries that have very high taxes, very high cigarette prices, and long and rather successful complementary efforts to reduce tobacco use, you still see revenues continuing to increase as tax rates rise (Norway shown here, but the same is true in Sweden, and other countries) We want to make gains in both health and economics. To move policy discussion forward, and to be able to act decisively and well, it necessary to:Identify key stakeholders and the issues that concern themIdentify each countrys unique characteristics, taking account ofExisting tobacco legislationPolitical will among key and other decision makersStatus of tobacco industry in the countryPeoples knowledge and behavior with respect to tobacco productsAddress concerns and worries of stakeholders related to measures to reduce tobacco use.In China, weve had extremely interesting and constructive discussions with all stakeholders. As we mentioned, supply side measures are not effective tools in order to reduce demand for tobacco products But as every student learns in their first economics lecture, both supply and demand always matter. The supply side issues that we are here to discuss are key issues in policy discussion about tobacco.

Trade is not on our conference agenda, but its worth mentioning - eg in China, entry into WTO could have significant consequences for the domestic cigarette industry. Tobacco control policy will face obstacles if approached as if only health outcomes matter. I dont want to underplay the health issues there are too many millions of lives at stake. But I think even the most ardent public health advocates now understand that tobacco control is a multi-sector and complex issue, and that to make real progress in saving lives and making lives healthier and better, we need to work together, bringing out different specialized skills and concerns together.

We know that both health AND economics matter greatly. And in order to have a constructive policy discussion, and come to sound decisions, we need high quality research, carried out by researchers with open minds and high standards of honesty, research that looks carefully at facts and evidence concerning health and economic issues. I think it marks enormous progress in the discussion on tobacco control, that we are are here together today different agencies and individuals, who recognize that health, jobs, farmers, incomes, revenues, and excellent research are all important.

It is excellent to see the, FAO, ILO, World Bank, WHO and independent researchers from many different agencies and organizations sitting together to share and discuss research and concerns,

This graph shows just how small the falls in global cigarette (and hence tobacco) consumption have been despite all the tobacco control efforts and successes in recent years.

Strong pressures to increase consumption falls in global consumption (if achieved) likely to be gradual, long termEconomies are changing constantly, and some people lose, others gain all the time. We cant and dont want to hold economic activity static and unchanged. We DO want to help people whose jobs and incomes are at risk to adjust.When consumption of tobacco products falls in a country, the money does not disappear from the economy. People buy other goods and services instead. So there will be compensating increases in demand in many other sectors, that will generate new profits, new revenues, new jobs. In fact, in countries that import a high proportion of cigarettes or tobacco, there may be net gains in jobs perhaps quite substantial gains if people reduce their purchases of tobacco products and buy goods and services with a lower import content, and produced in more labor intensive ways.