13.11 Are tobacco taxes regressive?

Last updated: September 2019  

Suggested citation: Scollo, M, & Greenhalgh, EM. 13.11 Are tobacco taxes regressive? In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2019. Available from:  https://www.tobaccoinaustralia.org.au/chapter-13-taxation/13-11-are-tobacco-taxes-regressive


Despite robust evidence that tobacco tax increases are the single most effective and cost-effective policy to reduce tobacco use, 1 such increases are sometimes described as being ‘regressive’, in that poorer groups in the community are likely to pay a greater percentage of their income on tobacco taxes compared to more affluent groups. Since it is precisely the poorer, less educated and younger population sub-groups that provide a large proportion of the tobacco industry’s customers, it could equally be argued that the tobacco market itself is regressive.

Tobacco use is more prevalent 2 and quit rates 3 are lower and duration of smoking longer 4, 5 among low compared with high socio-economic groups 6 (see Chapter 9, sections 9.1 and 9.2). There is no doubt that this creates a large financial burden in many low-income households 3, 7, 8 (see Chapter 2, Section 2.4 and Chapter 9, Section 9.5) and in particular in many Aboriginal communities. 9, 10  Despite these factors, increases in tobacco taxes have been justified on the following grounds.

  • Smoking, within the limits of addiction, is discretionary. Tobacco is used by only one-sixth of the adult population (including one-fifth of low-income adults—see Section 1.7) and cannot be considered a majority behavior: cigarettes are not a ‘staple item’. The tax can be avoided by remaining a non-smoker, or giving up smoking, and those who quit smoking realise substantial financial savings immediately. Even the most addicted smokers unable or unwilling to quit are generally able to reduce consumption to at least some extent.
  • Due to their higher smoking rates, a disproportionate amount of ill-health and premature death due to smoking-caused illness is experienced by lower socio-economic groups (see Chapter 9, Section 9.3). These groups stand to gain most in health terms from tax increases that provide an additional incentive to quit.
  • Raising tobacco taxes is beneficial in revenue terms for government and revenue from increases can help to cover the cost of comprehensive smoking-control programs including campaigns, services and treatments to assist smokers or the cost of other programs that benefit low-income groups.
  • Taxation increases have been considered an appropriate tool for prevention by all major health organisations, 11, 12 and community support for such taxes has increased over the years in Australia, particularly if the taxes are used to promote health education (see Section 13.12).

It is clear that increases in tobacco taxes are most felt among poorer sub-groups: 13 that is what makes them an effective preventive tool. The key issues in determining whether tobacco taxes are regressive are: first, the extent to which people in various socio-economic groups actually do quit in response to price increases; and second, what the consequences are for those low socio-economic smokers who do not quit.

13.11.1 Findings from early overseas studies

Early research suggests that people on lower incomes tend to be more price sensitive than higher income groups. 14, 15 Analysis of British data from the 1980s, for instance, has shown that men and women in lower socio-economic groups are more likely to reduce their cigarette consumption because of price increases than in response to health publicity about tobacco. 14, 16 Considered from this angle, tobacco taxes can be described as progressive in their deterrent effects on uptake or influence on quitting. The US Centers for Disease Control analysis of data from the US National Health Interview Survey indicated that (while smoking intensity was less responsive) smoking prevalence among people below the median income level was more price responsive than among people above the median income level. 17 Analysis of some later US data challenged this view, finding that low-income smokers in the US in the late 1990s were less likely than middle or high-income smokers to quit following price increases, and that among remaining smokers, consumption was likely to fall equally among all income groups. 13, 18 As time has gone on, evidence has strengthened that low-income smokers are more price sensitive. 19-22 One study notably detected an increase in cessation in response to large price rises among older, less educated adults on low incomes. 23

13.11.2 Conclusions of major reviews

Several major reviews, summarised below, have examined whether tax increases are effective (or more effective) in reducing smoking among disadvantaged groups. Together, they provide strong evidence that increased tobacco price via tax is the intervention with the greatest potential to reduce socioeconomic inequalities in smoking.

  1. Thomas S, Fayter D, Misso K, Ogilvie D, Petticrew M, Sowden A , et al. Population tobacco control interventions and their effects on social inequalities in smoking: systematic review . Tobacco Control 2008;17(4):230–7 19
  2. Bader P, Boisclair D and Ferrence R. Effects of tobacco taxation and pricing on smoking behavior in high risk populations: a knowledge synthesis . International Journal of Environmental Research and Public Health 2011;8:4118–39 24
  3. The International Agency for Research on Cancer. Effectiveness of tax and price policies for tobacco control. Handbooks of cancer prevention, tobacco control. Vol. 14. Lyon, France: IARC, 2011 25 summarised in Chaloupka FJ, Straif K and Leon ME. Effectiveness of tax and price policies in tobacco control . Tobacco Control 2011;20(3):235–8. 22
  4. Hill S, Amos A, Clifford D, and Platt S. Impact of tobacco control interventions on socioeconomic inequalities in smoking: Review of the evidence. 2014; 23(e2):e89-e97. 26
  5. World Health Organization. WHO report on the global tobacco epidemic: Raising taxes on tobacco. Geneva: WHO, 2015. 1
  6. US National Cancer Institute and World Health Organization, Monograph 21: The economics of tobacco and tobacco control, 2016; 27 and National Cancer Institute, Monograph 22: A socioecological approach to addressing tobacco-related health disparities, 2017. 28

13.11.2.1 Thomas et al 2008

In their review of the effects of six different population interventions on social inequalities in smoking, Thomas and colleagues 19 used a ‘harvest plot’ methodology to show the strength of evidence for the hypothesis of negative gradient (greater effect on the more disadvantaged) and the competing hypothesis of a positive gradient (greater effect on the more advantaged). Twenty-eight studies concerning price increase were assessed. Each study was represented by a mark in each row for which that study had reported relevant results. Studies with hard behavioural outcome measures are indicated with full-tone (black) bars, and studies with intermediate outcome measures with half-tone (grey) bars. The suitability of study design is indicated by the height of the bar, where the highest bars represent the most suitable study designs (categories A and B) and the lowest bars represent the least suitable (category D). Each bar is annotated with the number of other methodological criteria (maximum six) met by that study.

 

Figure 13.11.1
Extract from Thomas et al 2008 harvest plot of studies examining relative effectiveness of cigarette price increases among
disadvantaged groups

Source: Thomas et al 2008 19

The authors concluded that price increases was the only one of the six population strategies studied for which there was strong evidence of a negative gradient for income, occupation, employment, education or ethnicity. The evidence was strongest for income and occupation, with some indication that the gradient may have been positive for education.

13.11.2.2 Bader et al 2011

Several years after the publication of the Thomas review, Canadian researchers Bader and colleagues undertook a further synthesis of the results of studies that examined the effects of price increases among low-income or low-education populations. The majority of studies (rated strong or moderate) reported significant smoking participation and consumption effects. Twenty-four studies (22 published, two unpublished) met selection criteria. Nineteen published and two unpublished studies were rated as strong or moderate. Studies were conducted in Canada, the US, the UK, other European countries, New Zealand, China/Russia and Mexico. Twelve studies found that persons of low socio-economic status (SES) were more responsive to price than the general population 4, 13, 14, 16, 19, 29-34  Five indicated that low SES groups had the same responsiveness to price as the general population, that is, increased price appears to benefit all socio-economic groups equally in terms of reducing smoking participation and consumption 18, 35-38

13.11.2.3 IARC review 2010

The International Agency for Research on Cancer convened an expert scientific panel that in 2010 undertook a major review of international evidence of the effectiveness of tax policies in reducing smoking. 25 It commented that while some studies found no differences between SES groups, the majority were consistent with economic theory in finding greater price sensitivity among low-income populations. The panel noted that some of the inconsistent findings might be attributable to differential access over time to cheap tobacco products. 21 The panel concluded that there was ‘strong’ evidence at least in high-income countries of stronger responsiveness to price among lower-income populations. 21, 22

13.11.2.4  Hill et al. 2014

Building on the Thomas et al. review, in 2014 an updated review and synthesis of the evidence on the equity impact of tobacco control interventions by socioeconomic status was published in Tobacco Control. The researchers concluded that, in line with the Thomas et al. review, there is strong evidence that increases in tobacco price have a clear pro-equity effect on the socioeconomic gradient in smoking. While this strategy is supported by a robust body of research, evidence on the SES impact of other policies—such as smoking bans, advertising bans, warning labels, cessation support, and media campaigns—is scarcer and/or mixed. Increased tobacco price (via tax) is the only intervention to have a clear pro-equity effect. 26

13.11.2.5  World Health Organization 2015

In its 2015 report on the global tobacco epidemic, the World health Organization focused on the role of tobacco taxes in reducing tobacco use. It concluded that lowest-income populations are more responsive to price increases than higher-income users, and that most of the health and economic benefits from reductions in tobacco use accrue to the most disadvantaged populations, whose tobacco use declines more when taxes increase. The report also cites the guiding principles underlying Article 6 of the WHO FCTC (Price and tax measures to reduce the demand for tobacco—see Chapter 19), which state that tobacco taxes are economically efficient and reduce health inequalities. Raising prices on tobacco products demonstrably reduces demand among those of lower socioeconomic status. 1

13.11.1.6  National Cancer Institute Monographs, 2016 and 2017

In 2016, the National Cancer Institute in collaboration with the World Health Organization published a monograph examining the research and evidence base surrounding the economics of tobacco and tobacco control. It concludes that lower income populations often respond more to tobacco tax and price increases than higher income populations; therefore, significant tobacco tax and price increases can help reduce the health disparities resulting from tobacco use. 27

In 2017, the National Cancer Institute published another monograph, this time a comprehensive review of the factors that influence and contribute to tobacco-related health disparities. Its section on tobacco tax policies and price similarly concludes that there is a very strong body of evidence demonstrating that significant increases in tobacco taxes are the most consistently effective policy tool to reduce tobacco use. Youth, young people, and low-socioeconomic populations are especially sensitive to significant tax and price increases, highlighting the potential for tobacco taxes to contribute to reducing tobacco-related health disparities. 28

13.11.3 Findings of research in Australia

After several years of no change, smoking rates fell significantly among Australians in the most disadvantaged social group between 2007 39 and 2010 40 following the first real increase in excise and customs duty in Australia in 10 years. Disparities in smoking prevalence between the most and least disadvantaged Australians also narrowed between 2013 and 2016, 5 following the introduction of annual 12.5% increases in excise and customs duty commencing in December 2013. A number of Australian studies suggest that tax increases over time in Australia have indeed had greater effects among those on low incomes. 41-43

A study published in 2003 41 examined changes in the prevalence of smoking over the period of the National Tobacco Campaign (May 1997 to November 2000). During the first stage of the campaign (which comprised a number of TV and other advertisements graphically explaining the health effects of smoking) the prevalence of smoking declined more sharply among white collar than blue collar groups. During the second stage of the campaign (when advertising continued at a somewhat lower rate but the prices of large packs increased sharply due to the reforms introduced between November 1999 and June 2000—see Section 13.2), smoking declined much more sharply among blue collar smokers—refer Table 13.11.1

Table 13.11.1
Summary of changes in smoking prevalence over the period of the Australian National Tobacco Campaign in adults 18–40 years (manufactured and RYO cigarettes)

 

Benchmark

Follow-up 2

Follow-up 4

% change

% change

 

May 1997 (%)

Nov 1998 (%)

Nov 2000 (%)

May 97 to Nov 1998

Nov 98 to Nov 2000

Enumerated sample
(total)

29.5
(n=6536)

27.9
(n=10306)

26.7
(n=11923)

–5.42

–4.30

Blue collar

33.4

32.6

30.6

–2.4

–6.1

White collar

25.1

23.0

23.2

–7.6

0.9

Informant sample
(total)

30.8
(n=2969)

28.6
(n=4562)

27.1
(n=5112)

–7.1

–5.2

Blue collar

34.1

33.1

32.1

–2.9

–3.0

White collar

25.6

22.6

22.0

–11.7

–2

Source: Scollo et al 2003 41

Note: From National Tobacco Campaign evaluation respondent surveys

A study using Australian population survey data collected monthly from January 1991 to December 2006 assessed the impact of the price of cigarettes on smoking prevalence across three income groups. It found strong evidence that as real price increased, prevalence decreased, and that the association was stronger in lower-income groups. One Australian dollar increase in price was associated with a decline of 2.6%, 0.3% and 0.2% in the prevalence of smoking among low, medium and high-income groups, respectively. The authors concluded that increasing the price of cigarettes not only is an effective tobacco-control strategy to lower smoking prevalence in the general population, but also may provide a means of reducing social disparities in smoking. 42

A more recent study in New South Wales examined the impact of the April 2010 increase in customs and excise duty among various income groups. Responses to the price increase included smoking-related changes (trying to quit, cut down) and product-related changes (changing to lower priced brands, started using loose tobacco, bought in bulk). Recent quitters were asked how much the increasing price of cigarettes influenced them to quit. Overall, 47.5% of smokers made smoking-related changes and 11.4% made product-related changes without making smoking-related changes. Results showed that low or moderate income smokers (vs. high income) were more likely to make smoking-related changes compared to no changes. 43 Victorian research examining smoking prevalence between 1998 and 2012 similarly suggests that an accelerated decrease in prevalence among low SES people may be attributable to increases to tobacco taxation (as well as increased funding for social marketing campaigns). 44

A recent examination of Australia’s tax increases concluded that while the increases will likely reduce inequalities in smoking rates, potential unintended consequences—impacts on individual and family income; illicit trade; social stigma; and opportunities for lobbying by the tobacco industry—should be acknowledged and mitigated as much as possible. The authors suggest that researchers and policy makers could:

  1. Understand potential harms of tax increases and examine the impacts from an equity perspective or from the perspective of low-income smokers
  2. Allocate some of the revenue raised for measures supporting the most disadvantaged communities
  3. Work collaboratively with disadvantaged communities when it comes to tobacco taxes
  4. Carefully monitor tobacco industry activities and arguments as well as illicit trade 45

 

13.11.4 What about highly disadvantaged groups suffering entrenched disadvantage?

There is little research about the effects of tax increases among those with mental disorders, the homeless and so on. One study 46 found that a 10% increase in cigarette prices was associated with 18.2% less smoking participation among individuals with alcohol, drug, or mental disorders, except those with alcohol dependence. They conclude that increasing cigarette taxes could be effective in reducing smoking among individuals with alcohol, drug, or mental disorders.

Research on the effects of the 25% tobacco tax excise rise in 2010 on remote Indigenous communities in Australia found that there was strong overall support among Indigenous Australians for price increases as a means of reducing smoking. Participants also suggested that tax increases needed to be supported by other tobacco control activities and greater local cessation support. While findings regarding effects of the tax on consumption were inconclusive, participants did report adopting price minimising strategies, such as increased demand to share cigarettes. 47


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References

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