Tobacco and Public Health - TCSC Indonesia

AMANDA AMOS AND JUDITH MACKAY 337
populations, which characteristically experience high levels of disadvantage and deprivation
(Greaves 1996; Carrao et al. 2000). In these countries, therefore, smoking is both
a direct and indirect cause of inequality in women’s health and their wider social and
economic well being. Directly, it impacts on women’s health and consequently their
economic productivity and prosperity. Indirectly, expenditure on tobacco means less
resources are available for other essential household requirements.
Purchasing cigarettes
The economic impact of purchasing cigarettes can have a considerable effect on personal
and family income. This may be more serious for women, given their initial lower
earning power. In particular, it will hit poor women the hardest irrespective of whether
cigarettes are purchased by men and/or women in a family. Women who smoke a pack
of 20 cigarettes daily in Hong Kong spend approximately US$ 1500 per annum on the
habit. In China, research carried out in the outskirts of Shanghai showed that farmers
spend more on cigarettes and wine than on grains, pork, and fruits. Another study on
2716 households in Minhang district showed that smokers spent an average of 60% of
their personal income and 17% of household income on cigarettes (Gong et al. 1995).
In Bangladesh smoking is twice as high among the poor as the wealthy (Efroymson
et al. 2001). Average male smokers spend more than twice as much on cigarettes as per
capita expenditure on clothing, housing, health, and education combined. An estimated
10.5 million Bangladeshis who are currently malnourished could have an adequate
diet if money spent on tobacco was spent on food instead. In Vietnam, a survey
showed that the average smoker spends as much on cigarettes in one month as spent on
health care in one year, or which could have bought 169 kg of rice, more than enough
to feed one person for one year (Thuy 1998). The impact on diet is not only restricted
to developing countries. In the UK, for example, family diet has been shown to be
adversely affected among smokers on low income (Jarvis 1997) (Box 19.1).
Health costs
By 2025 the transmission of the tobacco epidemic from rich to poor countries will be
well advanced, with 85% of the world’s smokers living in developing countries (Lopez A.,
personal communication 1997). Health care facilities will be hopelessly inadequate to
cope with this epidemic, especially among women. Also, as smokers (in addition to
earlier death) have significantly higher rates of illness, they incur higher health care
costs and also loss of income. This will impact particularly on women as they usually
have to care for family smokers when they are ill. Structural adjustment and the global
financial crisis have severely increased health costs for women and children.
Tobacco taxation
Despite the addictive components of tobacco, there is strong evidence that smokers’
demand for tobacco is strongly affected by price. Higher taxes reduce cigarette