By Anjola Raji, Adeola Habeeb and Solomon Adoga
Tobacco use constitutes the world’s leading cause of preventable death, according to the World Health Organization.
Increasingly, the burden of tobacco use is greatest in low- and middle‐income countries that have been targeted by the tobacco industry with its deadly products and deceptive marketing practices resulting in a global tobacco epidemic of preventable death, disease and economic harm to countries and families.
The effects of tobacco smoke are not confined solely to smokers, non-smokers too suffer from it through second hand intake thereby increasing the risk of death from many diseases, including heart disease, cancer, stroke, and respiratory diseases.
According to the World Health Organization (WHO), tobacco use caused over 7.1 million deaths—5.1 million in men, 2 million in women, worldwide. No fewer than 6.3 million the deaths were attributable to cigarette smoking, followed by secondhand smoke with 884,000 deaths.
Exposure to secondhand smoke is associated with numerous adverse health effects as the low- and middle-income countries including Nigeria are said to bear nearly 80% of the global burden.
Giving the monumental economic loss to tobacco use, the Global Adults Tobacco Survey (GATS), the first official data documenting the prevalence and pattern of adult tobacco use in Nigeria indicates that Nigerians spend an average of N7.45 billion on tobacco monthly, and N89.5 billion yearly.
An effort to provide an internationally coordinated response to combating the epidemic led to the adoption of WHO Framework Convention on Tobacco Control (FCTC) in 2005. The treaty upon its adoption was immediately signed onto by almost 80% of member countries and calls for governments to address tobacco use through specific steps including the adopting tax and price measures to reduce tobacco consumption; prohibiting tobacco advertisement, promotion and sponsorship; creating smoke-free work and public spaces; putting prominent health warnings on tobacco packages; and combating illicit trade in tobacco products.
In line with this, Nigeria passed into law in 2015 the National Tobacco Control Act in domestication of the FCTC.
It is worthy of a note that Article 6 of the FCTC specifically adopts the price and tax measure as a tool for reducing tobacco use as the guidelines focus mainly on tobacco excise taxes since they are the primary tool for raising the price of tobacco products relative to the prices of other goods or services.
The guidelines for the implementation of Article 6 are intended to assist parties in meeting their objectives and obligations under the Article.
While the determination of tobacco taxation policies is a sovereign right of the parties, effective tobacco taxes are important to reduce tobacco consumption and prevalence. Indeed, raising taxes on tobacco and thereby increasing its price is one of the most effective ways to reduce tobacco use.
Tobacco taxes are generally considered to be economically efficient as they apply to a product with inelastic demand and LMIC population are more responsive to tax and price increases therefore consumption and prevalence are reduced in these groups.
The Civil Society Legislative Advocacy Centre (CISLAC) with support from Tax Justice Network Africa (TJNA) under the aegis of a project titled ‘’Supporting Effective Tobacco Control through Progressive Tax System in Nigeria’’ has been engaging relevant stakeholders especially members of the Tax Justice Governance Platform across the geo-political zones of the country with a view to building a critical bloc of informed tobacco tax advocates to champion a national campaign for the adoption of price and tax measures as the most effective tool for tobacco control.
Speaking at various regional trainings held on the implementation of tobacco, Program Manager, Democratic Governance, CISLAC, Okeke Anya drew evidence from countries implementing strong price and tax measure to combat tobacco to show that raising taxes to increase tobacco product prices is the most cost-effective means to reduce tobacco use and prevent initiation among the youth.
For instance, the State of New York has led the United States in showing that periodically raising a state’s cigarette excise tax can significantly decrease consumption by adults and youth. In the ten years between 2000 and 2010, New York increased its cigarette excise tax three times, from $0.56 per pack in 2000, to $2.75 in 2010.
In the late 1990’s, data indicated that New York’s adult smoking rate closely mirrored the national rate. Over the next decade, as New York repeatedly increased the rate of its cigarette tax, the state’s adult smoking rate fell well below the national average. Also, greater reductions have been experienced in youth smoking as New York currently has the highest cigarette excise tax in United States, at $4.35 per pack while also dedicating revenue from cigarette excise tax to investments in the state’s health care programs.
Some of the sessions at the trainings were dedicated to discuss the recently reviewed excise rates on tobacco and alcoholic beverages which imposes N1.00 tax rate per stick and N20.00 per 20 sticks in the first year of the tax regime and expected to rise to N2.90 per stick and N58 per pack over the three year regime.
While the increase have been described as progress in the right direction, it is noted to be abysmally minimal to yield the desired objective of reduction in consumption as the tobacco industry can conveniently bear the burden of the tax without pushing it to the consumer.
African countries falling mostly within the medium and low income bracket must recognise that tobacco taxation is mainly a public health initiative. Even as studies have proven that tobacco taxation can raise revenue for governments which can be further channeled into other health care initiatives, the major goal is to reduce affordability for especially the low income households and thereby contributing to reduced health risks.
Low-income smokers have also shown to be more responsive to tobacco tax increases than higher-income smokers and are more likely to quit or cut back to avoid the higher cigarette prices. Those who stop smoking in response to cigarette tax increases experience better health and reduced health costs.
Smoking tobacco causes exposure to a lethal mixture of more than 7000 toxic chemicals, including at least 70 known carcinogens that can damage nearly every organ system in the human body.
Health care costs associated with tobacco related illnesses are extremely high. Tobacco use also causes huge economic losses from direct and indirect medical costs. In the United States, annual tobacco‐related health care costs amount to 96 billion USD; in Germany, 7 billion USD. It is estimated that Nigeria losses $800 million annually due to stroke, heart disease and diabetes and this was projected to an accumulated loss of $7.6 billion in 2015. Nigerians spend an average of N7.45 billion on tobacco monthly, and N89.5 billion yearly.
More importantly, 139 million premature deaths can be averted if Africa including Nigeria act now and adopt a stronger regulation with a view to implementing proven methods to reduce tobacco use.
In contrast, the tobacco industry makes huge profits unchecked without taking responsibility for the harm they do to public health. Evidence has shown that for every $1 gain from tobacco business about $3 is expended on healthcare cost.
A 2011 study by the University of Michigan found that without more action by African nations to discourage smoking, the percentage of smokers will rise from an average 16% to 22% and possibly as high as 27% by 2030.The same study estimates that if strong tobacco control policies are put in place, including a 100% tax increase, smoking prevalence will decrease to 11% by 2030.
Tobacco use also causes huge economic losses from direct and indirect medical costs. It is estimated that Nigeria losses $800 million annually due to stroke, heart disease and diabetes and this was projected to an accumulated loss of $7.6 billion in 2015. Nigerians spend an average of N7.45 billion on tobacco monthly, and N89.5 billion yearly. 139 million.
The burden of tobacco falls disproportionately on the poor, and is a source of both health and economic disparities. The poor spend a larger share of their income on tobacco products, crowding out spending on necessities such as food, education, health and shelter. In the World, Tobacco use costs an estimated $500 billion each year in health care expenditures, productivity losses, fire damage and other costs. And which will hit 1 trillion very soon.
Nigeria Global Adult Tobacco Survey in 2012, reports that in Nigeria, over 20 billion sticks of cigarettes are consumed annually, and 5.6% adults (4.5 million) currently use tobacco products while 82% are exposed to second-hand smoke when visiting bars/nightclubs and 29.3% (6.4 million) when visiting restaurants.
To date, Nigeria has passed only two legislations aimed at controlling tobacco consumption in the country. These are the 1990 Tobacco (Smoking) Control Decree and the 2015 National Tobacco Control Act.
The Nigeria Tobacco Control Bill, signed into Law on May 26, 2015, contains some important provisions in line with WHO FCTC Article 6.
There are overwhelming evidences to support employing effective price and tax measures towards ensuring effective Tobacco Control across the world.
Nigeria in June 2018 increased taxes on tobacco (cigarettes. Prior to this time, taxes were only on Ad Volarem of 20% without taxation on specifics. Effective from 4th June 2018, in addition to the 20% Ad Volarem, other staggered specific taxes for tobacco and tobacco products are ₦20 for a pack of 20 sticks in 2018, ₦40 for a pack of 20 sticks in 2019, and ₦58 for a pack of 20 sticks in 2010.
Increasing the retail price of tobacco products through higher taxes is the single most effective way to decrease consumption and encourage tobacco users to quit. It is evident that when tobacco prices increase: fewer people use tobacco, people who continue to use tobacco, consume less, people who have quit are less likely to start again, and the young are less likely to start using tobacco.