17.6 Optimal investment in tobacco control

Following large-scale settlements of legal actions between US tobacco companies and state attorneys-general, the US Centers for Disease Control issued a series of guidelines for US states to aid budget allocation in tobacco control.1 Best Practices for Comprehensive Tobacco Control Programs included recommended spending levels for each US state taking into account the costs of administering each component of a comprehensive tobacco control program, and the costs of delivery determined by the numbers of people in each target group in that jurisdiction. Annual costs to implement all the recommendations ranged from $5 to $20 per capita. The Centers for Disease Control updated the guidelines in 2007.2 Recommended annual spending has increased to $15 to $20 per capita, depending on the state's population, demography and smoking prevalence.

In 2003, after release of the first Best Practices report, the Australian National Expert Advisory Committee on Tobacco (NEACT) undertook a project to adapt and tailor the methods used in the US report. It then issued recommendations for annual expenditure on tobacco control for Australia and each Australian state.

A detailed breakdown of the resources required for effective tobacco control with recommended national expenditure for programs, enforcement of policies and research was provided in the resource documents supporting the Australian National Tobacco Strategy—see Guide to planning and investing in tobacco control.3 The amounts recommended for each component of a comprehensive tobacco control program are summarised in Table 17.6.1.

Table 17.6.1
Recommended expenditure levels for each component of tobacco control in Australia

 

Range of spending required, A$, 2004

 

Lower

Mid-range

Upper

1.1 Enforcement of promotional bans

480 000

480 000

605 000

1.2 Enforcement of point-of sale and sales-to-minors restrictions

5 944 669

13 421 672

20 898 675

1.4 Statewide programs to enforce and promote smokefree environments

2 196 934

6 923 136

11 649 338

1.3 Affordability
1.5 Consumer information
1.6 Regulation to reduce tobacco-related harm
(assume all tackled at federal level)

950 000

1 075 000

1 200 000

2. Statewide campaigns to promote Quit and Smokefree messages

31 754 568

60 684 135

89 613 703

3.1 Quitline and other cessation programs

11 762 324

23 524 648

35 286 972

3.2 Subsidy and scheduling of pharmaceuticals
(assume all tackled at federal level)

400 000

525 000

650 000

3.3 Programs to engage health professionals

4 560 000

5 380 000

6 200 000

4. Promoting protective attitudes in children

4 467 446

5 206 808

5 946 169

5. Addressing social determinants

1 808 684

2 308 027

2 807 369

6. Extra resources to tailor initiatives for high-need groups

3 919 000

4 827 500

5 736 000

Total

68 243 625

124 355 925

180 593 225

7. Research, evaluation, monitoring and surveillance

5 662 181

7 882 796

11 954 661

Statewide tobacco control program infrastructure

5 900 000

6 525 000

7 150 000

Total

79 805 806

138 763 721

199 697 886

Total per capita (rounded up)

$4.00

$6.90

$10.00

Source: National Expert Advisory Committee on Tobacco, Guide to Planning and Investment in Tobacco Control, 2004,3 Section 2.1

Table 17.6.2 summarises the total recommended expenditure on tobacco control for each state and territory and for Australia, contrasted with actual expenditure in 2007–08.4 Expenditure between $4 and $10 per capita was the recommended level based on the NEACT analysis. The actual expenditure averaged $2.23 per capita in 2007–08. Total expenditure was $47.3 million. Spending in New South Wales and Western Australia was just below the lower recommended level, but in other states expenditures were considerably less than even the lower recommendation. Expenditure in 2007–08 would have been substantially lower than the level currently recommended in the revised Best Practices report.

Table 17.6.2
Recommended annual expenditure (total expenditure by state/territory government plus Australian government plus NGOs) per capita, for each jurisdiction

 

Range of spending required, per capita, A$, 2004

Actual expenditure, per capita, A$, 2007–08

 

Lower

Mid-range

Upper

 

New South Wales

2.90

5.70

8.50

2.76

Victoria

3.00

5.80

8.60

1.03

Queensland

3.20

6.10

9.00

1.49

Western Australia

3.80

6.80

9.80

3.60

South Australia

4.20

7.20

10.30

3.63

Tasmania

7.40

10.90

14.80

2.18

Australian Capital Territory

9.70

13.40

17.70

1.34

Northern Territory

14.60

19.20

24.80

6.31

Additional national initiatives

0.40

0.50

0.60

 

Total per capita for all jurisdictions and nationally (rounded)

$4.00

$6.90

$10.00

 

Average (weighted by the annual mean resident population
share of each jurisdiction)

     

$2.23

Source: National Expert Advisory Committee on Tobacco, Guide to Planning and Investment in Tobacco Control, 2004,3 Section 2.1

Australian Institute of Health and Welfare. Public health expenditure in Australia, 2007-08. Health and Welfare Expenditure Series no. 38, Cat. no. HWE 47. Canberra: Australian Institute of Health and Welfare, 2009,4 Table 10.2

Tobacco control in Australia has been under-funded by international and Australian private and public sector standards.5 Economic analysis also suggests that overall expenditure is much too low given the very high potential rates of return.6,7 Even in Western Australia, which has always had one of the highest per capita rates of spending on tobacco control of any jurisdiction in Australia, Collins and Lapsley concluded that a ten-fold expenditure increase from 2003 levels could be justified if a minimum social return of 10% was required for public expenditures.

In 2009, the National Preventative Health Taskforce called for implementation of more comprehensive and intensive tobacco control interventions in Australia in order to reduce the prevalence of smoking to less than 10% by 2020.8 The measures proposed included: increases in excise and customs duty on tobacco products, increased spending on anti-smoking marketing campaigns, modernisation of legislation to eliminate remaining forms of tobacco promotion and strengthened services and treatments for smokers wishing to quit. In April 2010,9 the then Prime Minister Kevin Rudd announced that the government would increase tobacco excise by 25%, and legislate to ensure that cigarettes will be sold in plain paper packaging and boost investment in anti-smoking advertising. In its May 2010 response to the National Preventative Health Taskforce report10 the government indicated that it would spend an additional $85 million over four years on anti-smoking social marketing campaigns and initiatives to reduce smoking among disadvantaged communities.10 The increase in tobacco control funding announced averages $21.25 million per year. (Adding this to existing funding of $47.3 million gives an estimated expenditure of approximately $3.23 per capita.)

Recent news and research

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References

1. Centers for Disease Control and Prevention. Best practices for comprehensive tobacco control programs. Atlanta Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1999. Available from: http://www.cdc.gov/tobacco/tobacco_control_programs/stateandcommunity/best_practices/

2. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2007. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2007. Available from: http://www.cdc.gov/tobacco/tobacco_control_programs/stateandcommunity/best_practices/

3. Ministerial Council on Drug Strategy. Australian National Tobacco Strategy 2004-2009: Guide to planning and investing in Tobacco Control. 2005, Last modified Last Modified Date [viewed January 2007]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/E955EA2B5D178432CA256FD30017A522/$File/tobacco_planning.pdf

4. Australian Institute of Health and Welfare. Public health expenditure in Australia, 2007-08. Health and Welfare Expenditure Series no. 38, Cat. no. HWE 47. Canberra: Australian Institute of Health and Welfare, 2009. Available from: http://www.aihw.gov.au/publications/index.cfm/title/10952

5. VicHealth Centre for Tobacco Control. Tobacco Control: A Blue Chip Investment in Public Health. Melbourne: The Cancer Council Victoria, 2003. Available from: http://vctc.org.au/browse.asp?ContainerID=bluechip

6. Collins D and Lapsley H. Counting the costs of tobacco and the benefits of reducing smoking prevalence in Victoria. Victorian Department of Human Services, 2006. Available from: http://www.health.vic.gov.au/tobaccoreforms/social.htm

7. Collins D and Lapsley H. Counting the costs of tobacco and the benefits of reducing smoking prevalence in Western Australia. Monograph Series, No 4. Perth: The Cancer Council Western Australia, 2004.

8. National Preventative Health Taskforce. Australia: the healthiest country by 2020. National preventative health strategy - the roadmap for action. 20 June 2009. Canberra: Commonwealth of Australia, 2009. Available from: http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/CCD7323311E358BECA2575FD000859E1/$File/nphs-roadmap.pdf

9. Rudd K, Swan W and Roxon N. Prime Minister, Treasurer, Minister for Health. Anti-Smoking Action. In Office of the Prime Minister, Editor. Canberra, 2010. Available from: http://www.alp.org.au/federal-government/news/anti-smoking-action/

10. Australian Government. Taking Preventative Action: Government's response to Australia: the healthiest country by 2020. 2010. Available from: http://yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/report-preventativehealthcare

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