MPOWER approach to tobacco control
LAST month, it was reported that the Health Ministry planned to increase tobacco tax, which would lead to a price hike for cigarettes (from RM17 to RM21.50 per pack). Nevertheless, the move was halted when the Government announced less than two weeks later that there was no immediate plan to increase tobacco tax.
One reason given for this about-turn was the concern that smokers would switch to cheaper illegal cigarettes, which pose greater risks to health. Another was that there is no tight correlation between smoking cessation and cigarette price hike in Malaysia. In fact, data from the Health Ministry’s reports during the period 2011 to 2015 were used to show that the number of smokers increased from 4.75 million to five million when there was a 30% cigarette price increase during the same period.
Despite this, a substantial body of research published by international peer-reviewed journals and professional organisations prove that tax increase is one of the crucial components in the holistic approach to reduce demand for tobacco.
It is not difficult to locate these reports on Google Scholar, for instance:
> Based on data accumulated over many decades in many regions around the world, the US National Cancer Institute (NCI) and World Health Organization (WHO) reported that significant increase in tobacco taxes reduced smoking habit, leading some current users to quit smoking and prevent potential smokers from trying cigarettes (The Economics of Tobacco and Tobacco Control, 2016).
> US researchers found that the tax hike by 61.66 cent imposed in April 2009 had caused the number of student smokers to decrease by approximately 220,000 to 287,000 (National Bureau of Economic Research Working Paper, April 2012).
> Increases in the US federal cigarette taxes from eight cents to US$1.01 per pack had resulted in decrease in cigarette sales from 24 million in 1970 to 13 million in 2015 (The Tax Burden on Tobacco, 2015).
> Cigarette price hike in California brought about a successful smoking cessation by 25% from 1980 to 1990 (Tobacco Control, 2007).
> Research conducted in Australia indicated that 60% of smokers would seriously consider quitting smoking when the price of a pack of 25 cigarettes increases to at least AU$20 (BMC Public Health, July 2013).
Based on these data, we have strong grounds to refute the myth that cigarette price hike does nothing to deter smokers. One of the key points that can be drawn from these studies is that effects of cigarette price hike ought to be viewed in the long term, not short-term observation (as in the data recorded in Malaysia during the period 2011 to 2015, which is only four years).
The so-called “lack of correlation” between smoker number and cigarette price would also need to be interpreted carefully, as there are many confounding factors affecting the number of smokers. These include age group of smokers, education programmes, enforcement of laws and regulations, enforcement against smuggling, availability or prevalence of illicit cigarettes in the local market, support for quitting tobacco use, and etc.
Furthermore, older adults are more likely to be unsuccessful in quitting smoking, possibly due to strong addiction. It is, however, important to nip the evil in the bud to curb addiction to smoking.
In order to reduce global tobacco use and promote a tobacco-free lifestyle, the WHO proposed the MPOWER policy package that requires governments to monitor tobacco use (M), protect people from tobacco smoke (P), offer help to quit tobacco use (O), warn about the dangers of tobacco (W), enforce bans on tobacco advertising and promotion (E), and raise taxes on tobacco products (R).
These strategies were proposed in conjunction with the WHO Framework Convention on Tobacco Control (WHO FCTC), which has 168 signatories including Malaysia.
Under the R strategy, interventions to be implemented include “Increase tax rates for tobacco products and ensure that they are adjusted periodically to keep pace with inflation and rise faster than consumer purchasing power” and “Strengthen tax administration to reduce the illicit trade in tobacco products”.
The WHO report also recommends that price hike alone is not the answer to fighting the tobacco epidemic. It takes a country to achieve an environment that favours tobacco-free living nationwide. A comprehensive and holistic approach will need to be executed effectively and good cooperation between government departments and ministries will be needed to ensure effective solution of the problems.
Smoking kills, and the health effects of cigarette smoking, including early death and disability, have been well documented in past studies. The holistic and comprehensive anti-smoking measurements have also been outlined and proposed by the WHO. It is now up to the Government to fulfil the promise made in the WHO FCTC.