Abstract
Previous systematic reviews of population-level tobacco control interventions and their effects on smoking inequality by socioeconomic factors concluded that tobacco taxation reduce smoking inequality by income (although this is not consistent for other socioeconomic factors, such as education). Inconsistent results have been reported for socioeconomic differences, especially for other tobacco control measures, such as smoke-free policies and anti-tobacco media campaigns. To understand smoking inequality itself and to develop strategies to reduce smoking inequality, knowledge of the underlying principles or mechanisms of the inequality over a long time-course may be important. For example, the inverse equity hypothesis recognizes that inequality may evolve in stages. New population-based interventions are initially primarily accessed by the affluent and well-educated, so there is an initial increase in socioeconomic inequality (early stage). These inequalities narrow when the deprived population can access the intervention after the affluent have gained maximum benefit (late stage). Following this hypothesis, all tobacco control measures may have the potential to reduce smoking inequality, if they continue for a long term, covering and reaching all socioeconomic subgroups. Re-evaluation of the impact of the interventions on smoking inequality using a long time-course perspective may lead to a favorable next step in equity effectiveness. Tackling socioeconomic inequality in smoking may be a key public health target for the reduction of inequality in health.
Highlights
It is a paradox that, while certain health programs can improve the average value of overall population health, they can increase health inequality by socioeconomic status
Previous systematic reviews and other empirical studies have consistently confirmed that tobacco price increase reduces smoking inequality by income
Based on the strategy of proportionate universalism, this reduction may be achieved if the measures continue long-term expansion to the best practical level (ie, covering and reaching all socioeconomic subgroups)
Summary
It is a paradox that, while certain health programs can improve the average value of overall population health, they can increase health inequality by socioeconomic status. Strategies are needed to ensure that an improvement in total health and a reduction in inequality are achieved concurrently. Regarding this issue, we have drawn attention to the impact of tobacco control measures on socioeconomic inequality in smoking. Most tobacco control measures, such as tobacco taxation, smoke-free legislation, and anti-tobacco media campaigns, have proved effective in the reduction of smoking prevalence.[1] there is little evidence about the impact of these measures on smoking inequality.[2,3,4] the objective of this article is to provide deep insights into the impact on smoking inequality as an aspect of the effect of tobacco control measures. The scope of this article includes the necessity of these measures, underlying mechanisms, evaluation models, and future implications
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