The impact of tobacco use on morbidity and mortality worldwide is exceedingly large. Tobacco use is expected to cause 8 million deaths per year by 2030, amounting to 1 billion deaths by the end of the century; the large majority of these deaths is projected to occur in lower and middle income countries (LMICs); (Mathers & Loncar, 2006). This impact, however, is preventable. The principal strategy for containing the global tobacco epidemic was formalized in 2003, when the World Health Organization’s Framework Convention for Tobacco Control (WHO FCTC) spelled out the common elements for tobacco control. The WHO FCTC, which has been ratified by 177 parties, underscores the importance of economic arguments in tobacco control (World Health Organization, 2003). In recognizing the influence of tobacco prices on tobacco use and its consequences, WHO has identified tobacco taxation as one of the very cost-effective interventions against noncommunicable diseases (World Health Organization, 2013). To help countries scale up implementation of cost-effective measures to reduce demand for tobacco, WHO introduced the MPOWER policy tool package in 2008, listing tobacco taxation as one of its six core measures. WHO further recommends that tobacco excise taxes reach and exceed 70% of the retail price for tobacco products (World Health Organization, 2010). The presumption is that if tobacco excise taxes—taxes that are applied exclusively to tobacco products—increased the price of tobacco relative to other products, tobacco products would become relatively less appealing and their consumption would decrease. The market response to price changes is summarized by the concept of price elasticity—the rate with which consumption declines in response to a percent price increase.
Although there is long-standing literature on the economics of tobacco use in the United States and other high-income countries, such evidence on LMICs has historically been difficult to obtain. However, policy makers engaging in tobacco policy in LMICs need evidence that is tailored to their country or region. In light of this need, the Bloomberg Initiative to Reduce Tobacco Use has afforded a timely impetus for evidence generation with the rollout of the Global Adult Tobacco Survey (GATS). Data for many LMICs have become increasingly available with the continuation of GATS, as well as from the Global Youth Tobacco Survey (GYTS), other country-based surveys, and repeated installments of the WHO Report on the Global Tobacco Epidemic. These recent data present new opportunities for filling the gaps in economic research on LMICs and aiding the transition from research to policy to action in these countries.
WHO has formulated a number of tobacco research priorities as part of a research agenda on noncommunicable diseases (World Health Organization, 2011). These focus specifically on the need for research on the impact of tax and price policies, including LMICs-specific price elasticity estimates and the impact of tobacco tax structure; research to optimize cessation interventions; research to assess the economic impact of tobacco use and control; and research on the inter-relationships between tobacco use and poverty, among others. The papers in this supplement address some of these research priorities by using recent data from multiple low- and middle-income countries. In the first paper, Chaloupka et al. use GATS data to examine the role of tax structure on a major determinant of cigarette consumption, the price variability across cigarette brands, and identify the type of tax structure that is most likely to help reduce tobacco use in in LMICs. The next several papers provide new evidence on the price elasticity of tobacco use in LMICs using data on adults from GATS and other similar surveys and on youth from GYTS. Kostova et al. use a cross-section of 13 LMICs to evaluate the magnitude of the negative relationship between prices and adult cigarette demand and the corresponding price elasticity, also shedding light on the role of socioeconomic status on smoking in LMICs. Nikaj and Chaloupka provide new estimates of the price elasticity of demand for cigarettes among youth using a set of 38 LMICs, while Joseph and Chaloupka focus specifically on youths in India and evaluate the price elasticity of their demand for cigarettes, bidis, and gutka; Sweiss and Chaloupka discuss results from independently collected data used to estimate the adult price elasticity of cigarette demand in Jordan. Quitting behavior among GATS adults is examined in Ross et al. and Shang et al.; Ross et al. quantify the impact of changes in tax policy on smoking cessation rates in Poland, Russia, and Ukraine, while Shang et al. describe the characteristics of quitters in relation to a number of policy-relevant factors including prices. Finally, Garces et al. provide an overview of the need for tobacco-specific fiscal action in Latin America, and Blecher et al. offer an assessment of the market for tobacco products in the African nation of Madagascar. The papers in this supplement add new evidence to the growing literature on economic aspects of tobacco control in LMICs, helping to fill critical research gaps.
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