2. Curbing the Epidemic: Governments and the Economics of Tobacco Control: Global, Regional and Hungarian Evidence By Annette Dixon Sector Director World Bank Tobacco Dissemination Meeting, Budapest, Hungary 2001

3. Why is Tobacco Control a Priority? ! 1.1 billion smokers worldwide, 800 million smokers in developing countries. ! By 2030, tobacco is expected to be the single biggest cause of death worldwide, accounting for about 10 million deaths per year ! Burden is shifting towards developing world ! Globally, 80,000 to 100,000 youths start smoking every day ! Smokers do not know the risks ! Tobacco is addictive and difficult to quit

4. 1.1 Billion Smokers Worldwide (1990-1995 estimate, million) Males FemalesTotal Developed 200100 300 Developing 700100 800 World 900 200 1.1 Bil.

5. Burden of Tobacco Deaths Shifting World: Annual Tobacco deaths (in millions) 20002030 Developed 2 ~3 Developing ~2 ~7 World Total 4 ~10 u 1 in 2 of long-term smokers killed by their addiction u 1/2 of deaths in middle age (35-69)

6. Tobacco attributed deaths have risen sharply and consistently for four decades in Hungary

7. Tobacco is responsible for high mortality in Hungary

8. Regional Share of Cigarette Consumption in ECA 1999

9. Smoking Prevalence in ECA

10. Why should governments intervene? To correct market failures Smokers do not know their risks Deter children from smoking Provide adults the needed information to make an informed choice Addiction Most start young, and discount the risk but regret later on Negative Externalities Costs imposed on others Costs of environmental tobacco smoke Health costs

11. Deter Children from Smoking: Evidence from ECA countries

12. Deter Children from Smoking in Hungary, 1995-1996 Source: Population based anti smoking campaign: Pecs, Hungary by Laszlo Tistyan, and Zsuzsanna Fuzesi, 1996

13. Addiction Starts Young Source: Population based anti smoking campaign: Pecs, Hungary by Laszlo Tistyan, and Zsuzsanna Fuzesi, 1996

14. Opinion about Smoking and Health in Hungary 1996

15. Tobacco attributed costs in Hungary, 1995 Mortality In 1995, 26,000 male and 8,000 females deaths attributed to smoking Economic Burden HUF 37-68 billion per year from direct costs and lost income from tobacco (8-15% of public expenditures through the National Health Insurance Fund) HUF 337-378 billion per year from economic cost of lost income due to premature mortality Source: Barta J. Economic consequences of smoking in Hungary, GKI Economic Research Co. 1996

16. Which interventions are effective? Measures to reduce demand Higher cigarette taxes Non-price measures: Increase consumer information: dissemination of research findings, warning labels, counter-advertising Comprehensive ban on advertising and promotion Restriction on smoking in public and work places Cessation help (NRT)

17. Cessation Treatments Cessation support from health professionals is key NRTs double the effectiveness of cessation efforts Quit lines, community support, etc., work Governments may increase accessibility and affordability of NRTs by: u OTC sales, allowing advertising, licensing u Conducting more studies on cost-effectiveness (especially in low/middle income countries) u Considering NRT subsidies for poorest smokers

18. Health Professionals and Smoking

19. Key recommendations Governments: adopt multi-pronged strategy, tailored to each country u Higher cigarette taxes 2/3 to 4/5 of retail price u consumer information, research, advertising and promotion bans, warning labels and restrictions on public smoking u widen access to NRT and other cessation therapies