Which are the most effective and cost-effective interventions for tobacco control?

Summary

The issue

Tobacco use is a leading cause of preventable premature death in the world today, claiming 1.6 million lives per year in the European Region, with 2 million projected by 2020. Although tobacco deaths are on the rise globally, in some places control policies have managed to reduce smoking. Millions of people in the European Region could be spared disease and early death if effective policies were put in place. The main approaches to tobacco control are:

• price increases through higher taxes;
• advertising and promotional bans;
• smoking restrictions;
• consumer education campaigns;
• smoking cessation therapies.

Findings

Several reviews have assessed the literature on the effectiveness of these measures, which varies within and across categories according to their settings and target populations. Nevertheless, different measures likely have synergistic effects, and the consensus is that a comprehensive approach is the most effective means of reducing tobacco consumption.

Price increases on tobacco products are one of the most effective means of reducing cigarette smoking. Studies show that a price increase of 10% results in a 2.5% – 5% smoking reduction in the short run and possibly up to 10% in the long run, if prices are increased to keep pace with inflation. Young people may reduce their smoking at two to three times the rate of older people. This level of response could result in 500 000 to 2 million fewer deaths from smoking in high-income countries, and in 600 000 to 1.8 million fewer deaths in eastern Europe. Some countries have raised taxes to 70%–80% of the price of a pack of cigarettes, resulting in significant reductions in smoking, although smaller tax raises have also been successful.

The most common concerns about tobacco price increases are that government revenues may fall and jobs may be lost due to reduced tobacco consumption, that smuggling may increase dramatically, and that an increase in price disproportionately burdens lower-income smokers. These consequences are either false or overestimated. The economic and health benefits from tobacco price increases appear to outweigh any disadvantages.

Policy considerations

The principle recommendation for policy-makers is that tobacco control programmes should be comprehensive to maximize smoking reductions, and should include:

• permanent price increases, scaled to inflation;
• comprehensive bans on advertising and promotion of tobacco products;
• strong restrictions on smoking in workplaces and public spaces;
• education and counter-advertising campaigns;
• improved product warning labels;
• increased access to cessation therapies.