提高香烟价格有望为人们多争取4.5亿年寿命

世界卫生组织（WHO）的数据显示，目前烟草每年会“杀死”700多万人，已成为全球公众健康的最大威胁。而《英国医学杂志》（BMJ）上周三刊登的研究报告认为，最佳干预途径或许源于经济领域。

该报告指出，把世界上13个中等收入国家的香烟税提高一倍有可能为人们挽回几乎4.5亿年寿命，还将节省1570亿美元的医疗成本——这是通过促使吸烟者戒烟，进而提高公共健康水平。

首先，研究人员用现有的价格弹性数据来估算提高香烟税会对包括中国、印度、墨西哥和巴西在内的13个国家的4.9亿男性烟民产生什么样的影响。他们发现，如果香烟价格上升50%，香烟消费量就会减少20%，从而推动数百万人戒烟。数据显示，收入最低的烟民在香烟涨价时戒烟的可能性特别高。

该研究报告的作者之一、多伦多大学达拉拉娜公共卫生学院流行病学教授普拉伯特·杰哈解释说，由于吸烟者往往集中在收入较低的群体中，上述理论戒烟人数可能会让此类人群的公共健康受益良多。他指出：“长期来看，高收入人群中戒烟者的比例远高于低收入人群。因此，长期吸烟产生的不良后果”，如心脏病和癌症，“在许多国家都集中在低收入人群中。”

总之，杰哈和同事们估算，因香烟价格上涨而戒烟有可能为这13个国家的居民多争取4.49亿年寿命，而且在理论上，最大的受益群体是较年轻、收入较低的吸烟者。按这样的戒烟规模计算，为医治肺病、癌症、心脏病和中风等与吸烟有关的疾病而产生的医疗费用也有望节省1570亿美元。此外，在未实现全民医保的国家，1550万人有可能避免“巨额医疗支出”，880万人及其家庭有可能免于陷入吸烟造成的极度贫困。

杰哈说：“染上烟瘾的男性是家里的经济支柱，家人在其患病时需要花了一大笔钱来救治，但通常都救不了。”这种情况在中低收入国家很常见。“家庭支离破碎，人也死了。男性的烟瘾是导致家庭贫困的重要因素。”

如果把推演范围扩大到本次研究覆盖的13个国家以外，杰哈估算这有可能让2000万人避免极度贫困命运。这表明烟草税实际上对低收入人群的益处更大，尽管有些经济学说的观点与此相反。该报告指出，作为香烟税带来的额外红利，上述13个国家的GDP有可能增长0.1%-1.1%。

杰哈指出：“税收真的是实现扶贫目标的利器。贫困人口对价格更敏感[而且更有可能在香烟涨价后戒烟]，说到底，收入最高的人群多交的税是收入最低群体的两倍。”

虽然此项研究的结论完全基于理论模型，但它们已经足够有吸引力——杰哈和同事们已经开始和加拿大国际发展研究中心（International Development Research Centre）以及世界银行探讨可能的实施策略。

不过，对于税收是解决所有公共健康问题的万能钥匙的看法，杰哈持谨慎态度。他认为，对含糖饮料和酒精饮料征收重税是人们经常提出的两项建议，它们有可能带来益处，但二者的情况互不相同。比如说，香烟的独特性在于市场上没有多少替代品，而另一方面，对碳酸饮料征税则可能只会促使消费者饮用加了糖的果汁或其他产品。

杰哈表示：“想用税收措施来限制不健康消费是个好主意，但烟草[税]的基础是几十年的仔细研究以及对有效措施的理解。而张嘴就说‘噢，我们只需要把针对这种产品的办法用到另一种产品上’，那可要小心了。”（BT365的网址是多少）

译者：Charlie

审校：夏林

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Tobacco currently kills more than 7 million people each year, making it one of the world’s most significant threats to public health, according to the World Health Organization. But the best intervention, according to a study published last?Wednesday in the BMJ, may be rooted in economics.

Doubling cigarette taxes in 13 middle-income countries across the globe could save almost 450 million years of life and $157 billion in averted medical costs — all by prompting smokers to lay off the habit, and reaping the public health gains that follow, the study says.

To start, the researchers used existing price elasticity data to estimate how raising cigarette taxes could influence the habits of the 490 million male smokers living in the 13 countries included in the study, such as China, India, Mexico, and Brazil. They determined that a 50% price increase would correspond to a 20% downturn in smoking, encouraging millions of men to quit. Those in the lowest economic brackets would be especially likely to quit in the face of price increases, the data says.

Since smokers tend to be concentrated in lower-income demographics, all that theoretical smoking cessation would come with major public health benefits for these populations, explains study co-author Prabhat Jha, a professor of epidemiology at the University of Toronto Dalla Lana School of Public Health. “Over time, the rich have quit in much greater numbers, in proportion, than the poor,” Jha explains, “so the persistent smoking burdens” — such as heart disease and cancer — “are concentrated on the poor in many countries.”

All in all, Jha and his colleagues found that smoking cessation caused by higher prices would save an estimated 449 million years of life across the 13 countries, with the most significant benefits theoretically seen among younger, poorer smokers. Smoking cessation on that scale could also save $157 billion in medical costs associated with smoking-related conditions including lung diseases, cancer, heart disease and stroke. In addition, 15.5 million men in countries without universal health care could be saved from “catastrophic health expenditures,” and 8.8 million individuals — and their families — could be spared from resulting extreme poverty.

“The male is addicted to smoking, he’s the breadwinner of the family, he gets a disease and the family spends a fortune to keep him alive, and usually fails,” Jha says, illustrating a common situation in low- and middle-income countries. “The family’s broke and he’s dead. The male addiction is having enormous consequences on household poverty.”

If you extrapolate beyond the 13 countries included in the study, Jha estimates something like 20 million people could avoid extreme poverty — suggesting that tobacco taxation actually disproportionately benefits low-income people, despite some economic arguments to the contrary. As an added bonus of cigarette taxes, the report says, the 13 countries included in the analysis would see their gross domestic products increase by between 0.1% and 1.1%.

“Tax is a really powerful instrument for addressing income poverty goals,” Jha says. “Because the poor are more price responsive [and are more likely to quit when prices go up], the richest income group ends up paying twice as much of the extra tax as the lowest income group.”

While the study’s findings are all based on theoretical models, they’re compelling enough that Jha and his colleagues are working with Canada’s International Development Research Centre and the World Bank to discuss possible implementation strategies.

That said, Jha cautions against thinking of taxation as a one-size-fits-all solution to public health problems. Heavily taxing sugary beverages or alcohol — two commonly suggested strategies — could come with benefits, Jha says, but each case is different. Cigarettes are unique, for example, in that there aren’t many alternatives on the market; taxing soda, on the other hand, could just push consumers to drink sweetened juices or other products.

“Thinking about taxation approaches to curb unhealthy consumption is a good idea, but tobacco [taxation] builds upon decades of careful research and understanding of what works,” Jha says. “You should be careful to just say, ‘Oh, we’re just going to take from one product and do it to another.'”