Tobacco taxation advocacy

What the evidence says

The effect of the tax is well established. The International Agency for Research on Cancer, part of WHO, convened 25 experts from twelve countries to review the evidence for a 2011 handbook. They found sufficient evidence that higher tobacco taxes and prices reduce overall consumption and the share of people who use tobacco, prevent young people from starting, push current users to quit and lead those who keep using to use less. WHO calls tobacco taxes the single most effective and cost-effective measure for reducing tobacco use.

WHO says tobacco kills more than 7 million people a year, including more than 1.6 million non-smokers exposed to others’ smoke. It recommends that taxes make up at least 75 percent of the retail price, but only 41 countries, covering 12 percent of the world’s population, have reached that level.

Advocacy is harder to evaluate. The Philippines’ 2012 Sin Tax Reform, which simplified and sharply raised tobacco and alcohol taxes, is a well-documented case. In the first year, excise collections from both rose more than 86 percent, to about $2.44 billion, and the health department’s budget nearly doubled. A World Bank account credits a broad coalition: the finance and health departments, the president, legislators, development partners, and civil society groups including medical professionals and tobacco control advocates. It concludes that no single actor could have brought about the reform alone. When a law has many authors, the share of credit owed to any one advocacy group can’t be measured the way a trial measures a treatment.

The grade is moderate. Strong evidence shows the tax works, and Charitology found no rigorous test of how much advocacy causes taxes to rise. It has not found a reliable per-dollar estimate of advocacy’s outcomes either, so this entry has no Impact Calculator figure.

Where it sits on the depth scale

This is structure (depth 3). A tax changes the price of a harmful product for a whole country, so fewer people start and more stop, without anyone being treated one by one. It needs upkeep. The Philippines’ finance secretary warned that the law’s 4 percent yearly increases might not keep pace with rising incomes, which could make cigarettes more affordable over time.

Open questions

• How should a funder credit advocacy for a law with many authors? See the counterfactual problem and measuring the source.
• Health effects lag. The World Bank report notes that smoking prevalence is subject to both an effect lag and a measurement lag, so the full impact shows up only in later years.
• How should it be weighed against direct programs? See systemic change or proven programs.