Prabhat Jha

The economics of global tobacco control

Few people now dispute that smoking is damaging human health on a global scale.1 However, many governments have avoided taking action to control smoking—such as higher taxes—because of concerns that their interventions might have harmful economic consequences, such as permanent job losses. In 1997 the World Bank, in partnership with the World Health Organization, began a global study on the economics of tobacco control. A team of over 40 economists, epidemiologists, and tobacco control experts critically examined the current state of knowledge about tobacco control. The aim was to provide a sound and comprehensive evidence base for the design of effective tobacco control policies in any country, with an emphasis on the needs of the low income and middle income countries, where most smokers live. A synopsis of this work, including interim results, was published in 1999.2 Final results, including 19 chapters and a statistical appendix, are now available.3 This article presents the key findings from this study. #### Summary points Tax increases are the single most effective intervention to reduce demand for tobacco (tax increases that raise the real price of cigarettes by 10% would reduce smoking by about 4% in high income countries and by about 8% in low income or middle income countries) Tax comprises about two thirds of retail price of cigarettes in most high income countries but is less than half of the total price on average in lower income countries Improvements in the quality and extent of information, comprehensive bans on tobacco advertising and promotion, prominent warning labels, restrictions on smoking in public places, and increased access to nicotine replacement treatments are effective in reducing smoking Reducing the supply of tobacco is not effective in reducing tobacco consumption Comprehensive tobacco control policies are unlikely to harm economies Each chapter of the study relied on …

Chapter 8. Improving the Health of Populations: Lessons of Experience

In the past 50 years, the world has experienced enormous and unprecedented gains in the health of human populations. Progress has been especially apparent in developing countries. Average life expectancy has risen by more than 60 percent, from 40 years in 1950 to 65 years today. In 1950, roughly 28 percent of children died before their fifth birthday, but by 1990, this number had fallen to 10 percent. Furthermore, many of the world’s most deadly and debilitating diseases, including leprosy, measles, poliomyelitis (polio), and many childhood illnesses, have been effectively contained in most areas and virtually eliminated in others. Smallpox, a highly contagious and deadly disease that affected more than 50 million people a year prior to 1950, has been completely eradicated. Researchers have identified economic growth, rising incomes, and better living conditions brought about by rapid social and political transformations in many societies as major contributors to these impressive health gains. However, in recent years, the role of scientific and technological progress has emerged as a crucial, but little understood, factor underlying these gains. As Davis (1956, 306–7) observes,“It seems clear that the great reduction of mortality in underdeveloped areas since 1940 has been brought about mainly by the discovery of new methods of disease treatment applicable at reasonable cost [and] by the diffusion of these new methods.” New research has sought to validate, and indeed quantify, this basic intuition. For example, Jamison, Lau, and Wang (2005) show that technological progress (which is broadly defined as the generation or adoption of new technologies), together with education, has been a far more important contributor to declining infant mortality rates in developing countries than income growth. Furthermore, improvements in health brought about by investments in technological progress generate an important and positive feedback loop favoring economic growth and development in these countries. An important question that follows is what can be done to further consolidate these gains and ensure that the fruits of scientific and technology progress are placed in the hands of the people in developing countries who stand to benefit most? Because the work of the Disease Control Priorities Project (DCPP) focuses primarily on identifying the most costeffective interventions for diseases and conditions affecting the health of populations in developing countries, this work provides the starting point for analysis. The goal is to isolate the critical factors—in particular those “actionable” through specific public policies—that have contributed to the effective deployment and scaling up of proven cost-effective technologies and services in low-income settings. To address this question, the DCPP joined forces with the What Works Working Group of the Global Health Policy Research Network, an initiative led by the Center for Global Development in Washington, D.C., and funded by the Bill & Melinda Gates Foundation. DCPP authors were asked to identify outstanding examples of successful implementation of programs and projects geared toward the deployment of proven cost-effective interventions in their respective fields of international health and to speculate on what kinds of programmatic aspects and broader public policy decisions might have contributed to their success. From an initial set of nominations, the What Works Working Group selected a subset of cases that conformed to strict Chapter 8 Improving the Health of Populations: Lessons of Experience