Can taxes on stimulants be good for our health? Yes, but there is one condition

Cigarettes are currently one of the most popular stimulants in the world. It is used by over a billion people in the world. While it is easy to say to the smoker “quit”, it is much more difficult to actually get out of the addiction. Statistics show that the vast majority of attempts to quit addiction are unsuccessful. How can I help these failing smokers?

1. Smoking is responsible for approx. 8 million deaths annually in the world, and in Poland for approx. 80 thousand. deaths
2. In Poland, unlike in many countries, there has been no significant improvement in the fight against this addiction in the last decade. The percentage of smokers in Poland remains at the level of over 20%.
3. Revenues from excise duty and VAT from the sale of cigarettes in our country amount to approximately PLN 30 billion annually, while the health and social costs of smoking exceed PLN 40 billion.
4. According to prof. Andrzej Fala, creating economic barriers can be an effective method of fighting addiction
5. More information can be found on the Onet homepage

Can nicotine products other than a cigarette be a temporary stop on the smoker’s path to abstinence? And, from a public health point of view, could different levels of taxation on such products benefit the healthcare system? Scientists and doctors discussed it during the Panhellenic Congress of Public Health 2022, during the session “New look at public health”.

A problem that does not expire

According to statistics, on average, 4 out of 100 smokers manage to say goodbye to this addiction without the professional support of a doctor. On the other hand, the chances of quitting increase by several dozen percent when the smoker decides to undergo treatment and when he takes nicotine preparations or nicotine substitutes, such as bupropion or varenicline, which has recently been recommended by the World Health Organization (WHO).

For decades, cigarette smoking has been identified as one of the most important risk factors for public health. It is estimated that the deadly addiction is responsible for approx. 8 million deaths annually in the world, and in Poland for approx. 80 thousand. deaths. The vast majority of these are premature deaths that we could avoid. Smoking significantly increases the risk of, for example, cardiovascular diseases (including heart attacks and strokes), respiratory diseases (including COPD), neoplastic diseases (including lung, nose, throat, bladder cancer, etc.) and many others, the occurrence of which is conditioned by inhaling toxins and compounds carcinogenic tobacco smoke resulting from smoking.

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The situation is dramatic, especially in our country. According to the “Map of Health Needs” of the Ministry of Health, smoking is currently a key health risk factor in Poland. We have been successful in the fight against cigarettes. In the last 30 years (1990-2019), the negative impact of cigarette smoking on the so-called The DALY index, i.e. the statistical length of life lived without damage to health, has been significantly reduced in our country: by over 24,03 percent. Unfortunately, these successes are a distant past. In the last 10 years, we have come to a standstill in the fight against cigarettes. There is no improvement in trends, and the impact of smoking on the DALY index in our country decreased to just … 1,22% during this period. The fight against smoking on the Vistula has slowed down. In the group of women, the situation is even getting worse. Cigarettes have already become one of the 1 key risk factors for Polish women, of whom over 5 million smoke cigarettes. Instead of falling, the DALY index in this group has increased by almost 3% in the last 10 years.

However, the topic of the “silent epidemic”, as the WHO defines cigarette smoking, is often marginalized. This is disastrous for public health. You have to remember that cigarettes kill not only smokers but also bystanders. It is estimated that in Poland up to 14 million people are passive smokers (i.e. non-smokers, but exposed to the poison of cigarette smoke).

The need to modernize the existing anti-cigarette policy solutions, verify the activity of individual countries in the context of their initiatives, as well as the advantages and disadvantages of the so-called harm reduction programs, considered as bridging solutions to achieving abstinence from smoking, were discussed by doctors and experts at the Panhellenic Congress of Public Health 2022.

You can find the rest of the text under the video.

Small steps instead of big leaps

What exactly is harm reduction policy? In short: it is a “lesser evil” strategy. Smokers who are unable or unwilling to quit smoking are advised to switch to other nicotine products that are tar-free, such as nicotine sachets, tobacco warmers or standardized e-cigarettes.

Collectively, they are known as the smokeless forms of nicotine ingestion. They eliminate the basic problem and the main risk factor associated with cigarettes: smoke and carcinogenic (carcinogenic) and toxic substances generated during the combustion of tobacco. This does not mean, however, that they are indifferent to health. It only means that their impact on health and the effects associated with their use, instead of smoking, may be much less harmful to the health of the smoker, but also the entire population – and thus less burdensome for the health care system.

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Considered less harmful, alternative products allow people addicted to nicotine to meet the narcotic (nicotine) and behavioral need resulting from this addiction. They can also, to some extent, reduce the health risks associated with smoking. As emphasized by part of the international medical community, the inclusion of such forms of further nicotine delivery in patients addicted to cigarettes may be an intermediate form, a bridge between quitting smoking and reducing its health effects. This is a practical approach that may lead the patient to quit the addiction, due to the lower addictive potential of the products mentioned, which is becoming more and more visible in scientific research. The reason is simple – cigarette smoke, which is not found in such products, contains compounds that can further aggravate nicotine addiction. Among the countries that apply the reduction of harm caused by smoking in practice, there are, among others, The United States, Great Britain, Sweden, New Zealand and Japan.

Whether such a strategy can lead us to a world where no one smokes anymore was discussed by the participants of the session “A new gaze of public health”. Among the speakers were prof. Dimitri Richter from Greece, prof. Karl Fagerström from Sweden and prof. Andrzej Fal from Poland.

Not everyone becomes a “quitter”

Prof. Dimitri Richter in his lecture “Directions of Public Health Regulation” pointed out that the approach to new nicotine products at the social level differs between countries.

And so, the American Food and Drug Administration (FDA) in July 2017 drew attention to the need to limit the concentration of nicotine in cigarettes, while emphasizing the role of alternative, tested technologies that deliver nicotine as such. The goal of a comprehensive nicotine addiction reduction plan is to wean smokers from the most harmful tobacco products (i.e., in this case, from cigarettes and other smoking tobacco products) and to break the habit or direct them towards less harmful, alternative forms of nicotine delivery, such as Risk Modified Products (MRTP), for which the FDA ranks one of the tobacco heaters. The turning point was the FDA’s decision to allow one such device, the IQOS tobacco heater, to be sold in 2020 as a modified health risk (MRTP) tobacco product.

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According to prof. Richter, such a pragmatic approach to fighting the addiction as in the USA works also in the case of other countries, an example of which is New Zealand, consistently implementing the smoke-free society plan: «The Smokefree Aotearoa 2025 Action Plan». The New Zealand Ministry of Health is running educational campaigns targeting smokers, explaining the differences in the different forms of nicotine consumption and encouraging smokers to choose smokeless nicotine products that it officially deems less harmful. It also applies less restrictive legal and fiscal regulations to them.

Harm reduction in its health policy is also carried out by the United Kingdom. For several years, the British PHE (Public Health England) has published reports in which it lists e-cigarettes and tobacco heaters as much less harmful than cigarettes and useful in situations where the patient cannot or does not want to quit the addiction. Anyway, as British statistics show, the more there are “Vapers” (users of e-cigarettes), including traditional smokers. The same principle applies to users of heaters.

In his speech, prof. Dimitri Richter referred to the words of prof. Michael Russell.

“Smokers smoke for nicotine, but they die from cigarette smoke and tar,” he said. In his opinion, it seems appropriate to inform smoking patients that they have alternatives to cigarettes. He stressed, however, that “the role of a doctor is always to encourage the patient to quit smoking, but when the patient returns to smoking, it may be worth offering him some other nicotine product that will harm him less than a cigarette”.

Swedish experiment?

Lecture “Another perspective for Public Health” presented by prof. Karl Fagerström, a key figure in the medical world in the area of ​​nicotine treatment, related to the “Swedish experiment” that proved to be a great success.

Even in the 80s, the percentage of smokers in Sweden reached 34%. Today it is about 5 percent. It became possible thanks to snus, i.e. oral tobacco. It is a snuff-like substance based on tobacco that is ingested by placing it under the lower or upper lip. Thanks to this, nicotine addicts can still take this alkaloid, but without the negative consequences associated with the absorption of cigarette smoke, which includes over 7 thousand. chemicals, at least 69 of which are carcinogenic.

During the lecture, prof. Fagerström referred to statistics showing how the replacement of cigarettes with snus and nicotine pouches since the late 70s translated into the number of deaths. Today, Sweden boasts the lowest death rate among men from lung cancer in Europe. The same is true for the number of deaths in this group from smoking-related cardiovascular disease. Apparently, the phenomenon is observed in Norway or Japan, although here it is due to devices for heating tobacco, or in Great Britain, mainly due to e-cigarettes.

– People do not want to give up stimulants, so we have to offer them less harmful products, alternative tobacco products to cigarettes. They are extremely necessary to be able to minimize the health damage caused by addiction, and thus – to reduce the costs it generates for public health – argued prof. Fagerström.

Give smokers a second chance

The last speaker was prof. Andrzej Fal. Already at the beginning of his lecture “Can Taxes Work for Public Health?” He noted that risk factors – including smoking, obesity, air pollution and low physical activity – today account for approx. 95 percent. premature deaths. Hence, they represent the greatest public health challenge requiring effective interventions.

During the presentation, prof. Fal referred to Polish statistics showing that despite a significant drop in the percentage of smokers in the last few decades, we have unfortunately not seen a clear improvement in recent years. The percentage of smokers in Poland remains at the level of over 20%. Equally worrying is the increase in the percentage of female smokers.

The president of the Polish Society of Public Health noted that the total state budget revenues from excise duty and VAT in the sale of cigarettes amount to approximately PLN 30 billion per year. At the same time, the health and social costs of smoking, including treatment, pensions for addicts and absenteeism, exceed … PLN 40 billion per year. This only shows that it is in the interest of everyone, including politicians, to reduce the number of smokers.

According to prof. The wave of creating economic barriers to addiction is an effective strategy and should apply especially to cigarettes, which today remain the main gateway to addiction in our country. On the other hand, tax regulations should be more lenient, e.g. with regard to certified and tested smokeless products with nicotine.

The already available scientific research may help in assessing the degree of harmfulness of some of these products, which justifies the application of a different fiscal policy to them, as emphasized by prof. Halyard. In his opinion, such products can dramatically reduce the health effects of smoking and make the social costs of smoking for the health care system much lower. Such products, as noted by the Polish expert, contain much less harmful compounds (they do not have, for example, tar bodies), so they can be a small but important step for the patient on the way to complete abstinence.

The harm reduction strategy, as experts have noted, not only does not conflict with the so-called an endgame strategy, i.e. an approach aimed at the complete elimination of the cigarette drug from society. On the contrary, it can lead to it even faster. The condition, however, is the ability to differentiate tax products.

Read also:

1. How to quit smoking Step by step plan
2. Smoking during pregnancy – the effects of how to quit?
3. Electronic Cigarettes – What’s inside e-cigarettes?