17.7 How much should be invested in tobacco control?
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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.113 Best Practices for Comprehensive Tobacco Control Programs included recommended spending levels for each US state based on the cost 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.
In 2003 the Australian National Expert Advisory Committee on Tobacco 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 is provided in the resource documents supporting the Australian National Tobacco Strategy—see Guide to planning and investing in tobacco control.114 The amounts recommended for each component of a comprehensive tobacco control program are summarised in Table 17.14.
Table 17.14
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 |
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 |
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 |
$10.00 |
Source: National Expert Advisory Committee on Tobacco, Guide to Planning and Investment in Tobacco Control, 2004,114 Section 2.1
Table 17.15 sets out total recommended expenditure on tobacco control for each state and territory.
Table 17.15
Recommended annual expenditure (total expenditure by state/territory government plus Australian government plus NGOs) per capita, for each jurisdiction
|
Range of spending required, per capita, A$, 2004 |
|||
|
Lower |
Mid-range |
Upper |
|
|
New South Wales |
2.90 |
5.70 |
8.50 |
|
Victoria |
3.00 |
5.80 |
8.60 |
|
Queensland |
3.20 |
6.10 |
9.00 |
|
Western Australia |
3.80 |
6.80 |
9.80 |
|
South Australia |
4.20 |
7.20 |
10.30 |
|
Tasmania |
7.40 |
10.90 |
14.80 |
|
Australian Capital Territory |
9.70 |
13.40 |
17.70 |
|
Northern Territory |
14.60 |
19.20 |
24.80 |
|
Additional national initiatives |
0.40 |
0.50 |
0.60 |
|
Total per capita for all jurisdictions and nationally (rounded) |
$4.00 |
$6.90 |
$10.00 |
Total recommended expenditure on tobacco control for Australia is between $4.00 to $10.00 per capita, with recommended per capita levels per state ranging from about $3 to $8.50 per capita for the larger states and between $15 and $25 for smaller less urbanised jurisdictions.
In contrast to these recommended levels of expenditure, Table 17.16 sets out recent actual expenditure on tobacco control by both government and non-government bodies in each Australian jurisdiction in 2004–05.
Table 17.16
Total anti-smoking expenditure, all Australian states and territories and Commonwealth, 2004–05, ($ current)
|
$ |
$ Per capita |
|
|
New South Wales |
5,200,000 |
0.88 |
|
Victoria |
6,937,000 |
1.51 |
|
Queensland |
3,500,000 |
1.01 |
|
Western Australia |
8,400,000 |
4.36 |
|
South Australia |
4,300,000 |
2.91 |
|
Tasmania |
550,000 |
1.25 |
|
Australian Capital Territory |
500,000 |
1.65 |
|
Northern Territory |
500,000 |
2.61 |
|
Commonwealth expenditure |
2,200,000 |
0.11 |
|
Australia Total |
32,087,000 |
1.60 |
Sources: Health Expenditure Australia 2004–05, AIHW115, Cancer Institute NSW, Quit Victoria, Department of Health WA, Queensland Health, Drug & Alcohol Services SA, Department of Health
and Human Services Tas, ACT
Government, ABS Australian
Demographic Statistics116
Total national investment on tobacco control in 2004–05 was $32.1 million or approximately $1.60 per capita. Only in Western Australia did spending levels approach the minimum recommended by the National Expert Advisory Committee on Tobacco.
Based on analysis of spending by other commercial advertisers, federal government advertising campaigns and spending on tobacco control in other English-speaking countries, tobacco control expenditure in Australia could be considered grossly under-funded by international and Australian private and public sector standards.17
Economic analysis of spending on tobacco control in Australia also suggests that overall expenditure is much lower than it ought to be given the very high potential rates of return.23, 24 Even in WA, which has always had one of the highest per capita rates of spending on tobacco control of any jurisdiction in Australia, economists Collins and Lapsley concluded that expenditure at about 10 times the level of spending in 2003 could be justified on the basis on a minimum required social return of 10%.
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