Smoking is the largest single cause of death and disease in the European Union (EU). Effective and equitable control of tobacco in the EU by the use of fiscal policies is both significant for addressing the tobacco disease burden and highly complex.
PPACTE aimed to develop evidence-based policy recommendations to improve market regulation of tobacco products, for more effective, equitable control of tobacco in Europe.
The PPACTE consortium undertook several studies to inform the design of tobacco tax policy in the EU. PPACTE convened an international working group to review and critically appraise the international literature on the effectiveness of tobacco tax and price policies for tobacco control.
PPACTE built on existing evidence by: surveying over 18,000 citizens in 18 European countries on their attitudes towards and responses to tobacco tax and price policies; analysing time series from 11 EU Member States to estimate the impact of price, income and tobacco control policies on the demand for tobacco products; developing dynamic simulation models to assess independently for each of 15 European countries the present impact of their tobacco tax policies and other tobacco control policies on smoking prevalence and smoking-attributable deaths and to make predictions for the future; examining industry influence on and responses to tobacco taxation in selected countries through interviewing key informants, analysing tobacco industry documents and analysing data on of the British cigarette market; and integrating research findings to distil policy recommendations.
There is substantial evidence that tobacco taxation improves public health through preventing initiation among never smokers, promoting cessation among current smokers and reducing consumption among continuing smokers. This is substantiated by robust econometric analysis of time series data from 11 European countries, which confirm convincingly that price is a major determinant of cigarette demand. A 10% increase in cigarette price reduces demand for cigarettes by 3-4%, while a 10% increase in income increases demand by 3-4%; thus, tobacco tax increases must increase price above inflation and income growth to achieve tobacco control aims.
SimSmoke simulation modelling indicates that increasing taxes has immediate effects on smoking prevalence and smoking-attributable mortality, with the effects growing over time. The PPACTE survey indicated that the majority of smokers would attempt to quit in response to a substantial increase in price. Furthermore, survey responses demonstrated strong public support for tax increases, particularly where at least some of the tax is earmarked for smoking cessation support and prevention.
Future EU tobacco tax Directives must address the following: the availability of cheap and ultra low price cigarettes; the relatively low taxes on alternative products such as fine cut tobacco used for hand-rolled cigarettes; illicit trade or smuggling; and the pernicious interference and influence of tobacco companies on the development of tobacco tax policy.
In this regard, the PPACTE Consortium formulated 15 recommendations for tobacco fiscal policy and supportive legislation, which if implemented have the potential to reduce tobacco use, tobacco-attributable mortality and health inequalities in the EU.
The PPACTE Consortium has also delivered tools to support advocacy for policy implementation in EU MS including: 15 country-specific simulation models and users’ manuals enabling advocates to demonstrate the potential impact of stronger policy, documentation exposing industry arguments and strategies to undermine and influence tobacco control policy, and a handbook to support researchers in conducting econometric analysis of demand in their own country.
Please click on image to enlarge and see details