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Bangladesh Health Cost Full Report 2020

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Bangladesh Health Cost Full Report 2020 The Economic Cost of Tobacco Use in Bangladesh: A Health Cost Approach Bangladesh Cancer Society (Dhaka, Bangladesh) University of Dhaka, Department of Economics (Dhaka, Bangladesh) Programme for Research, Advocacy and Capacity Building on Tobacco Taxation (PROACTT), a collaboration between the Cancer Research United Kingdom and the American Cancer Society, USA EXECUTIVE SUMMARY TOBACCO USE IS THE SINGLE MOST PREVENTABLE CAUSE OF Tobacco control has been an explicit government priority, but DEATH GLOBALLY. IT IS ONE OF THE GREATEST RISK FACTORS adoption and application of a fully functional and effective measure FOR NONCOMMUNICABLE DISEASES INCLUDING CANCERS, have been constrained by the powerful lobby of the financially CARDIOVASCULAR AND RESPIRATORY DISEASES. GLOBALLY strong tobacco companies. The estimates of the economic burden SMOKING, CHEWING TOBACCO AND EXPOSURE TO SECONDHAND of tobacco use in this study provide the basis for a comprehensive SMOKE TOGETHER WERE RESPONSIBLE FOR THE LOSS OF MORE assessment of the social and economic impact of tobacco use in THAN 8 MILLION LIVES AND 213 MILLION DISABILITY-ADJUSTED Bangladesh and compelling evidence to support a strong public LIFE YEARS (DALYS) IN 2017. BETWEEN 2007 AND 2017, THE health policy intervention. This would also help raise people’s NUMBER OF TOBACCO-ATTRIBUTABLE DEATHS INCREASED awareness about the hard reality tobacco users face and build public BY 0.8 MILLION AND DALYS INCREASED BY 13 MILLION. IN THE opinion in support of tobacco control nationwide. 20TH CENTURY, TOBACCO IS KNOWN TO HAVE KILLED ABOUT 100 MILLION PEOPLE, AND IT IS PROJECTED TO KILL 1 BILLION This study estimated that tobacco use caused nearly 126,000 deaths PEOPLE IN THE 21ST CENTURY. THERE IS URGENT NEED TO accounting for 13.5 percent of deaths from any cause in Bangladesh REVERSE THIS TREND BEFORE MORE LIVES AND HEALTHY LIFE in 2018. In addition, the study revealed that approximately 1.5 million YEARS ARE LOST. adults were suffering from diseases attributable to tobacco use and nearly 61,000 children were suffering from diseases due to exposure The global economic cost of diseases attributable to smoking, to secondhand smoke. Tobacco-induced deaths and diseases alone including health expenditures and productivity losses, was estimated cost the economy of Bangladesh around BDT 305.6 billion ($3.61 at $1,436 billion in 2012, roughly equivalent to 1.8 percent of the billion) a year, which was equivalent to 1.4 percent of its national GDP world’s annual Gross Domestic Product. Globally there are 1.1 billion in the year 2017-18. tobacco smokers aged 15 years or older, around 80 percent of whom live in low- and middle-income countries (LMICs). As a result, the The total economic contribution of the tobacco sector (in terms enormous global health and economic burden of tobacco use will of household final consumption expenditure, private and public be increasingly borne by these LMICs. The present study finds that domestic investment and net export) to the GDP in Bangladesh was Bangladesh, a lower-middle income country, incurs substantial and estimated at BDT 229.1 in 2016-17 fiscal year in 2018 prices. This is increasing tobacco-attributable economic costs consistent with the BDT 76.5 billion short of the estimated total cost of tobacco, BDT global evidence. 305.6 billion. Tobacco thus appears to be causing net loss to the economy of Bangladesh. According to the Global Adult Tobacco Survey (GATS), the prevalence of tobacco use (including smoking and smokeless tobacco) among These findings establish that tobacco use imposes a significant adults 15 and older decreased from 43.3 percent in 2009 to 35.3 financial burden on tobacco users, their families, and on the nation. percent in 2017 overall. In males, there was a reduction from 58.0 The breakdown of the total cost estimate of BDT 305.6 billion shows to 46.0 percent; among females, a drop from 28.7 to 25.2 percent. that the direct healthcare costs attributable to tobacco use amounted The youth (13-15) prevalence of tobacco use was 6.9 percent overall to BDT 83.9 billion annually, 76 percent of which was paid by tobacco (9.2 percent among boys; 2.8 percent among girls) in 2013. That users’ households. The remaining 24 percent was financed through represented no significant change in the prevalence overall and public health sector budget representing nearly 9 percent of total among boys, and a decrease among girls from 5.1 percent since 2007. government health expenditure in fiscal year 2018-19. The indirect cost given by the annual productivity loss, due to morbidity and Despite some positive changes in tobacco use prevalence among premature mortality from tobacco-related diseases, was estimated to adult men and women and girls in the recent past, tobacco use be BDT 221.7 billion. remains one of the major risk factors for noncommunicable diseases in Bangladesh, one that can be modified to prevent a substantial Generally, studies that measure the economic cost of tobacco use number of deaths and disabilities. apply diverse methods, and the estimates are not readily comparable across populations, time and studies. The present study shows that The primary objective of the present study was to estimate the direct the annual estimate of total economic cost of tobacco in Bangladesh and indirect health costs attributable to tobacco use and harm more than doubled since 2004. By maintaining the cost-of-illness from exposure to secondhand smoke. It also aimed at providing approach followed in the 2004 WHO study in Bangladesh, this study a comparison between the current estimates and those obtained provided a consistent evidence base for comparison of the economic from a 2004 WHO study on the impact of tobacco related illnesses costs of tobacco over time, measurement of progress in curbing the in Bangladesh. The ultimate objective was to compare the costs of tobacco epidemic and timely intervention to accelerate the progress tobacco use with tobacco’s so-called economic benefit, with a view in tobacco control. to shaping national tobacco control policy. 1 Though this study is comprehensive insofar as including direct can reduce tobacco consumption faster among the poor, who are medical costs and indirect productivity costs, it still misses a usually more price sensitive. The effect of tax and price increases in significant number of additional costs, and therefore remains an reducing tobacco consumption can be stronger, if tax policy can be underestimate of the total costs of the tobacco burden. We recognize aligned and combined with other measures. that this study has not accounted for the substantial costs of the environmental and health damages from tobacco cultivation, loss of Estimates of the tobacco-attributable health care costs and food security caused by the use of scarce land resources for tobacco productivity loss at the population level help to understand the growing, smoking-related fire hazards, environmental pollution economic impact of tobacco use and provide the evidence base for from littering of cigarette butts, and so on. Had these costs been policymakers to implement comprehensive tobacco control policies estimated, the net loss from tobacco would have been even larger. to curb the epidemic. The progress in tobacco control policies in These costs can be measured in future research endeavors. Perhaps Bangladesh since the ratification of the WHO Framework Convention more importantly from a human perspective, we will never be able on Tobacco Control (WHO FCTC) in 2004, followed by the passage to gauge the pain and suffering of tobacco victims and their families. of the Tobacco Control Act in 2005 and the amendment to the Tobacco Control Act in 2013, has been limited. Despite the reduction Moreover, the spending on tobacco and on health care attributable of tobacco use, Bangladesh will not meet the target of a Tobacco- to tobacco diverts resources away from necessities. The crowding- Free Bangladesh by 2040 envisioned by the prime minister. It will out effect of tobacco consumption can lead to displacement of take much stronger tobacco control measures fortified with “best basic needs among lower-income households and contribute to practices” and stricter compliance with the guidelines of the articles impoverishment and overall economic and health inequity. under the WHO FCTC, especially targeted at youth, who constitute the generation of potential future smokers. The need to reverse the adverse socioeconomic, environmental and health consequences of tobacco use on individuals and on society is THE GOALS OF TOBACCO CONTROL ARE INTERTWINED WITH urgent. The vision of Tobacco-Free Bangladesh by 2040 underscores THE UNITED NATIONS 2030 SUSTAINABLE DEVELOPMENT this need. The path to a tobacco-free state is, however, arduous and GOALS TO ERADICATE EXTREME INCOME POVERTY, REDUCE can be reached only with aggressive and effective tobacco control DEATHS FROM NONCOMMUNICABLE DISEASES BY ONE- measures that: THIRD, AND ACHIEVE UNIVERSAL HEALTH COVERAGE TO HELP PROTECT AGAINST IMPOVERISHMENT CAUSED BY ILLNESSES. • Raise tobacco taxes and prices ELIMINATION OF TOBACCO USE CAN PREVENT THE DEATHS AND • Monitor tobacco use and prevention policies DISEASES ATTRIBUTABLE TO TOBACCO USE AND SECONDHAND • Protect people from tobacco smoke with smoke-free laws SMOKE EXPOSURE ALTOGETHER, THEREBY CONTRIBUTING • Offer help for tobacco use cessation SIGNIFICANTLY TO THE SUSTAINABLE DEVELOPMENT GOALS IN • Warn about the dangers with graphic warning labels on tobacco BANGLADESH BY 2030. packages • Enforce bans on tobacco advertising, promotion and sponsorship • Tax tobacco farming land as industrial land to discourage tobacco cultivation • Provide incentive to tobacco farmers to shift to alternative and more viable livelihoods • Enforce ban of tobacco sales to minors. At present, 35.3 percent of Bangladeshis 15 and older (an estimated 37.7 million adults) smoke and/or use smokeless tobacco. If we start the clock now, 1.8 million tobacco users will have to quit tobacco use every year to make the country tobacco-free by 2040.
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