Strategies for effective tobacco control in countries with world's largest tobacco users: what more is needed?

Abstract

As per the World Health Organization (WHO), non-communicable diseases (NCDs) caused 16 million premature deaths in 2012, with more than 80% of these being reported in low- and middleincome countries. Tobacco is among one of the major risk factors responsible for causing the global epidemic of NCDs. As a part of its Global Action Plan for control of these diseases, WHO called for 30% reduction in tobacco usage globally by 2025. According to the 'WHO Report on the global tobacco epidemic 2015', increasing tobacco taxes can prove to be an extremely effective and low-cost strategy for tobacco control worldwide. A few studies have also supported this view.1,2 Asia, comprising mainly of low- and middle-income-group countries, is home to the countries with the most tobacco smokers in the world, with China and India holding to the first and second positions, respectively, worldwide. The report on 'The Economics of Tobacco and Tobacco Taxation in India' pointed out that Indian smokers constitute 10% (120 million) of the world's tobacco smokers and it classes second position in tobacco smoking in the world after China, which is the largest tobacco producer and has the largest population of tobacco smokers (300 million) in the world.Complying with the WHO Framework Convention on Tobacco Control (FCTC), Indian Government took a brave step by imposing a steep hike of 11%-72% in excise duty on different tobacco products in 2014. Additionally, a total ban on public smoking and tobacco advertising and promotion have also been ensured by the Indian Government under the National Tobacco Control Programme (NTCP). In China, as a part of its tobacco control policy, an amendment on advertisement law was adopted from April 2015, which placed a ban on tobacco advertisements in mass media and public places. Initially, the Chinese Government desisted from hiking the tobacco taxes fearing that this would lead to an unfair burden on poor people; however, since May 2015 consumption tax on wholesale price of cigarettes has been raised from 5% to 11%.3 Verguet et al.4 and Zheng and Huang5 in their studies observed that increasing tobacco taxes in China is actually a pro-poor policy and can help in reducing the global burden of tobacco considerably. Unlike India, China is yet to adopt a national smoke-free law; however, very recently in June 2015, a sub-national tobacco control regulation has been adopted in Beijing in compliance with the WHO FCTC. Under this law, all public places including hospitals and educational institutes are required to be 100% smoke-free legally and failure to do so will call for imposing heavy fines.3Nevertheless, China needs to expand the Beijing law to the entire nation, formulate the National Tobacco Control Regulation and increase the tax hikes further like India for effective tobacco control. A research model in China recommends that increasing taxes on cigarettes such that they account for 75% of retail prices up from 40% of the share of price in 2010 would forefend almost 3.5 million deaths due to cigarette smoking. Although India is a step ahead of China in ensuring tobacco control, there are a number of concerns in the current policy of tobacco control which need to be addressed. The new tax policy has successfully removed disparity based on filter but not for different cigarette lengths. There is a difference in taxes on machine versus hand-rolled bidis. Taxes on bidis are very low (9%), although they account for almost 85% of total tobacco smoked in India, and small bidi manufacturers are exempted from paying taxes. …