A study confirms that high tobacco taxation is accompanied by a decrease in the burden of non-communicable diseases.

An international study covering 193 countries between 2008 and 2023 establishes a link between increased cigarette taxes and a reduction in deaths and disability-adjusted life years (DALYs) related to non-communicable diseases (NCDs). The effects appear more pronounced in upper-middle-income and high-income countries.[1], While specific taxes (set per unit of product) appear more effective than taxes proportional to the value of cigarettes, the authors call for both raising tobacco taxes and improving their structure, particularly in low-income countries, to strengthen the prevention of cardiovascular diseases, cancers, and digestive diseases.

A global study

Researchers analyzed national data from the WHO, the Global Burden of Disease study, and the World Bank. They used fixed-effects panel regression models with a two-year lag to account for the delayed effects of tax policies. The main variable was the share of total tax in the average retail price of a pack of 20 cigarettes. The authors also examined specific taxes levied by quantity, ad valorem taxes calculated as a percentage of the product's value, and other taxes, including import duties and VAT.

The sample includes 26 low-income countries, 52 lower-middle-income countries, 53 upper-middle-income countries, and 62 high-income countries. In 2022, only 41 countries, or 22.28 %, met the WHO-recommended threshold of 75 % for total taxation.

The effects of taxation vary depending on the country, the population, and the type of non-communicable disease.

Globally, a one percentage point increase in the total tax is associated with a decrease of 16.43 DALYs and 0.63 NCD deaths per 100,000 population. The association is significant in upper-middle-income and high-income countries, but not in low-income countries. According to the authors' models, if the 143 countries whose total tax was below 75 % in 2022 had reached this threshold, approximately 990,880 NCD deaths could have been avoided in 2025. The researchers emphasize, however, that this is an estimate based on an observational study, not proof of causality. Low-income countries remain particularly affected: their NCD burden in 2020 was still nearly 1.44 times higher in DALYs and 1.81 times higher in mortality than that of high-income countries. The authors specifically mention the slow growth of specific taxes and the possibility for consumers to switch to cheaper brands.

The effect of taxation is more pronounced among people aged 55 and over, with an estimated decrease of 71.82 DALYs per 100,000 inhabitants for each additional percentage point of total tax. Associations are also stronger among men, in whom smoking prevalence is generally higher. By disease type, the most significant reduction is seen in cardiovascular diseases, followed by digestive diseases and cancers. No significant association was observed for mental or neurological disorders.

The role of the tax structure

Specific taxes appear to produce the most significant health effects. A one percentage point increase in this type of tax is associated with a decrease of 7.16 DALYs and 0.33 deaths per 100,000 inhabitants. According to the authors, these taxes raise prices across all brands more and reduce the price gap between premium and low-priced products, thus limiting substitution with cheaper cigarettes. Ad valorem taxes are also associated with a decrease in the burden of NCDs, but to a more limited extent and primarily in high-income countries.

Researchers recommend a more effective and better integrated tobacco tax system

The results support the idea that increasing the cigarette tax is a key lever for preventing non-communicable diseases (NCDs). According to the study, raising the total tax to 75% of the retail price in the 143 countries that were below this level in 2022 could prevent approximately 990,880 NCD-related deaths in 2025. This measure also has budgetary benefits: the additional revenue generated by the tax can bolster healthcare systems. The authors present it as one of the most cost-effective interventions for reducing tobacco consumption and the burden of NCDs.

Beyond the overall level of taxation, the composition of the tax appears crucial, according to them. The results suggest favoring specific taxes, set per unit of product, as these raise prices more uniformly across all brands and reduce the likelihood of smokers switching to cheaper cigarettes. This recommendation is particularly aimed at low-income countries, where specific taxes remain low and where the use of ad valorem taxes can give manufacturers more leeway to adjust their prices. The authors therefore recommend avoiding excessive reliance on ad valorem taxes, while adapting the tax structure to the administrative capacities and characteristics of each market.

The benefits of taxation also vary across population groups. They are more pronounced among men and people aged 55 and over, which encourages maintaining smoking cessation services and pharmacological support for high-risk smokers. For younger people, for whom the observed effect is more limited, the authors suggest supplementing taxation with actions aimed at changing social norms surrounding smoking, particularly through the use of role models and prevention campaigns.

Furthermore, the study highlights the uneven implementation of tobacco control measures, particularly regarding the effective enforcement of taxes. By 2024, 40 countries had not implemented any of the measures in the WHO's MPOWER framework, leaving nearly two billion people exposed to the harmful effects of tobacco. The authors identify tobacco industry interference as one of the main obstacles to the implementation of the WHO Framework Convention on Tobacco Control (FCTC). They therefore call for coordination among various government agencies (health, finance, customs, and fraud prevention) to limit strategies aimed at circumventing price increases.

Finally, cardiovascular diseases, digestive diseases, and cancers are those for which the association with a higher tax is most pronounced. The authors believe that strengthening tobacco taxation must therefore be part of a strategy to prevent these diseases, which will continue to weigh heavily on global health. They emphasize, however, that NCDs result from multiple factors, including diet, alcohol consumption, physical activity, and environmental conditions. Tobacco taxation should therefore be accompanied by actions addressing social determinants, risky behaviors, and strengthening health systems.

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[1]Peng W., Lin S., Liu X., Zhang H., Lu J., Association between cigarette tax and the global burden of non-communicable diseases: a longitudinal ecological study in 193 countries, BMJ Global Health, published October 9, 2026, accessed October 29, 2026

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