The distributional effects of tobacco tax increases across regions in Mexico: an extended cost-effectiveness analysis

BACKGROUND

Several studies have shown the beneficial effects of tobacco fiscal policy, but distributional effects have been less examined, especially at the subnational level. The objective of this study is to analyse the distributional effects of a one-peso tobacco tax increase (roughly equivalent to tripling the current excise tax) on health, poverty, and financial outcomes at the subnational level in Mexico.

METHODS

We employ an extended cost-effectiveness analysis that estimates life-years gained, smoking attributable deaths averted, treatment costs averted, number of persons avoiding poverty and catastrophic health expenditures, and additional tax revenues by income group across five regions.

RESULTS

With the one-peso tax increase (or 44% price increase), about 1.5 million smokers would quit smoking across the five regions, resulting in nearly 630 thousand premature deaths averted and 12.6 million life years gained. The bottom income quintile would gain three times more life years gains than the top quintile (ratio 3:1), and the largest gain for the most deprived would occur in the South (ratio 19:1), the region with the highest poverty incidence. Costs averted and additional tax revenues would reach 44.6 and 16.2 billion pesos, respectively. Moreover, 251 thousand individuals would avoid falling into poverty, including 53.2 in the lowest income quintile, and 563.9 thousand would avoid catastrophic health expenditures. Overall, the bottom income group would obtain 26% of the life years gained and 24% of the cost averted, while only paying 3% of the additional tax revenue.

CONCLUSIONS

The most significant gains from a substantial cigarette price increase would be for the poorest 20%, especially in the South, the most impoverished region of Mexico. Therefore, tobacco taxes are an opportunity for governments to advance in equity and towards the achievement of sustainable development goals on non-communicable diseases.

'You cannot touch taxes easily': making the case for tobacco taxation in India

India represents over 1.3 billion people with >100 million adult smokers. The catastrophic health costs of smoking are staggering; and estimates show that even modest increases in taxes on cigarettes and bidis would both raise substantial revenues for the government and save ∼69 million years of healthy life over the next four decades. Karnataka represents a good example of tobacco control efforts and their impact. This case study examines the factors that have contributed to tobacco control policy in Karnataka based on 23 semi-structured interviews with key informants engaged in tobacco policymaking and decision-making, tobacco control/taxation research and advocacy. Their narratives indicate that: (i) Domestic taxation policy is complicated by the complex tax structure and centralized control over taxation with the introduction of Goods and Services Tax; (ii) Implementation of legal frameworks is a challenge, due to conflicts with powerful industry and farmer lobbies. A vigorous civil society backed by the Courts is necessary to garner political support; (iii) Action on taxation is hampered by weak leadership and mixed messaging; and (iv) There is a need for innovative policy solutions to promote both demand- and supply-side measures for tobacco control. Tobacco control advocates need to recognize the political economy of tobacco control and generate strong, reliable and scientifically sound evidence to support their arguments. Working for incremental 'wins' in terms of more stringent application of existing legal frameworks can make a substantial difference even in contexts where enhancing tobacco taxes is a challenge. Promoting multisectoral action is critical, at both policy and the ground levels, by expanding ownership and responsibility for tobacco control to sectors beyond health. Finally, the health sector needs to recommit to its role as a champion for tobacco control. Failure to do so would amount to a failure on multiple fronts-public health, economic, fiscal and ethical.

The impact of tobacco tax reforms on poverty in Mexico

This paper investigates the impact of increasing the tobacco taxes on the poverty rate in Mexico. Unlike most LMIC countries, the prevalence of smoking in Mexico is higher among the well-off than among the poor. Yet, tobacco tax rates in Mexico are lower than those in most LMIC countries. There is room, thus, to implement tax reforms and compensating policies to mitigate their impact on the poor. Our analysis is based on the stochastic dominance approach. More precisely, several tax reforms are analyzed through the so-called Consumption Dominance curves. In addition, the reforms are assumed to be revenue neutral and to give rise to compensating subsidies on specific goods. Our results show that if the Mexican government were to implement a WHO-type reform, poverty among households with at least one smoking member would increase by 2.6 % points. Yet, the deleterious effects are entirely mitigated by price subsidies on staple foods.

SUPPLEMENTARY INFORMATION

The online version of this article (10.1007/s43546-021-00141-x) contains supplementary material, which is available to authorized users.

The health, financial and distributional consequences of increases in the tobacco excise tax among smokers in Lebanon

Tobacco use is a significant risk factor for the leading causes of death worldwide, including cancer, heart disease and stroke. Most of these deaths occur in low- and middle-income countries, where tobacco-related deaths are also rising rapidly. Taxation is one of the most effective tobacco control measures, yet evidence on the distributional impact of tobacco taxation in low- and middle-income countries remains scant. This paper considers the financial and health effects, by socio-economic class, of increasing tobacco taxes in Lebanon, a middle-income country.

An Almost Ideal Demand System is used to estimate price elasticities of demand for tobacco products. Extended cost-effectiveness analysis (ECEA) methods are applied to quantify, across quintiles of socio-economic status, the health benefits gained, the additional tax revenues raised, and the net financial consequences for households from a 50% increase in the price of tobacco through excise taxes. We find that demand for tobacco is price inelastic with elasticities ranging from −0.32 for the poorest quintile to −0.22 for the richest quintile. The increase in tobacco tax is estimated to result in 65,000 (95% CI: 37,000–93,000) premature deaths averted, 25% of them in the poorest quintile, $300M ($256–340M) of additional tax revenues, 12% borne by the poorest quintile, $23M ($13–33M) of out-of-pocket spending on healthcare averted, 36% of which accrue to the poorest quintile, 9% to the richest. These savings would be associated with 23,000 (13,000–33,000) poverty cases averted (63% in the poorest quintile). Increasing tobacco taxes would lead to large financial and health benefits, and would be pro-poor in health gains, savings on healthcare, and poverty reduction.

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Health benefits from higher tobacco taxes would be progressive in Lebanon.

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Health benefits also result in health expenditures averted which are pro-poor.

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Tax revenue raised from higher tobacco taxes is borne mostly by richer quintiles.