Tobacco tax increases reduce infant mortality

Raising taxes on tobacco products could significantly reduce neonatal and infant mortality worldwide, according to a study published in the British Medical Journal. The authors emphasize that implementing tax policies in low- and middle-income countries should be a priority, as these regions are characterized by high accessibility to tobacco products and higher neonatal and infant mortality.

The study's authors looked at data from 159 countries, considering two parameters: tobacco tax levels between 2008 and 2018, and neonatal and infant mortality figures between 2009 and 2019, i.e., mortality occurring within the first 28 days after birth, or in the first year of life. The results were adjusted for hidden variables, such as the level of health spending per capita, the percentage of the rural population in the country, the level of access to drinking water, the percentage of female school enrollment, etc.[1].

Taxation: a minimum level recommended by the WHO

Scientific literature identifies regular and significant tax increases as the most effective and cost-effective tool for reducing tobacco consumption. For this reason, the World Health Organization (WHO) urges countries to implement a disincentive tax policy on tobacco products. In particular, the WHO recommends a minimum tax rate, where 75% of the price of a pack of tobacco should be made up of taxes. A report published in 2019 showed that only 14% of the world's population lives in a country where this measure is effectively implemented.

Very unequal situations in the world

Between 2008 and 2018, the average neonatal mortality rate was 14.4 per 1,000 births, while the average infant mortality rate was 24.9. However, these figures reveal significant disparities: in high-income countries, these rates were 3.7 and 5.6 per 1,000 births, respectively, compared to 19 and 33.2 in middle- and low-income countries. Meanwhile, the average tax on tobacco products between 2008 and 2018 corresponded to an average of 49.1% of the price of a pack of tobacco, well below WHO recommendations. Here again, there is a significant disparity between countries. In high-income countries, the average price of a pack of tobacco is made up of 63.8% in taxes, while this proportion falls to 42.7% for middle- and low-income countries. In total, only 11.2% of them have reached the recommended tax level, compared to more than 40% for high-income countries.

Tax increases are an effective tool to reduce infant mortality

The study shows that cigarette tax levels were inversely associated with neonatal and infant mortality. Specifically, the results highlight that after adjustment, a 10-point increase in retail price taxation results in a 2.6% decrease in neonatal mortality and a 1.9% decrease in infant mortality. Thus, in 2018, such an increase globally could have prevented nearly 78,000 neonatal deaths and more than 64,000 infant deaths. According to the researchers, if all countries aligned their tobacco tax policies with WHO recommendations, more than 400,000 neonatal and infant deaths could have been prevented in 2018.

FT

[1] Radó MK, Laverty AA, Hone T, Chang K, Jawad M, Millett C, et al. (2022) Cigarette taxation and neonatal and infant mortality: A longitudinal analysis of 159 countries. PLOS Global Public Health 2(3): e0000042. https://doi.org/10.1371/journal.pgph.0000042