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The Bill China Cannot Afford HEALTH, ECONOMIC and SOCIAL COSTS of CHINA’S TOBACCO EPIDEMIC

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The Bill China Cannot Afford HEALTH, ECONOMIC and SOCIAL COSTS of CHINA’S TOBACCO EPIDEMIC The Bill China Cannot Afford HEALTH, ECONOMIC AND SOCIAL COSTS OF CHINA’S TOBACCO EPIDEMIC The Bill China Cannot Afford HEALTH, ECONOMIC AND SOCIAL COSTS OF CHINA’S TOBACCO EPIDEMIC Acknowledgements This report was written by Angela Pratt (World Health Organization–WHO) and Andrea Pastorelli (United Nations Development Programme–UNDP), with the support of Trinette Lee. The modelling included in this report commissioned by WHO and UNDP was conducted by Yang Lian (Chengdu University of Traditional Chinese Medicine) and her colleagues Tehwei Hu, Zhongzheng Mao and Qun Sun; Stéphane Verguet (Harvard University) and his colleagues Cindy L. Gauvreau, Prabhat Jha, Lingrui Liu, Sujata Mishra, Gillian Tarr, Yue Xiao, Qiu Yingpeng and Kun Zhao; and Christopher Millett (Imperial College London) and his colleagues Sanjay Basu and Anthony Laverty. We are also grateful to the following colleagues who reviewed the report and provided valuable feedback: Tom Carroll, Quan Gan, Mark Goodchild, Luminita Hayes, Teh-Wei Hu, Judith Mackay, Susan Mercado, Jeremias Paul Jr., Vinayak Prasad, Nadia Rasheed, Bernhard Schwartländer, Roy Small, Ferdinand Strobel, Steve Tamplin, Kazuyuki Uji, Douglas Webb, Xi Yin and Rose Zheng. Funding for this report was provided by WHO, with the support of Bloomberg Philanthropies and UNDP. © World Health Organization 2017 ISBN 978 92 9061 790 7 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC- SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules). Suggested citation. The bill China cannot afford: health, economic and social costs of China’s tobacco epidemic. Manila, Philippines: World Health Organization Regional Office for the Western Pacific; 2017. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. 1. Smoking cessation. 2. Tobacco use disorder – economics, prevention and control. I. World Health Organization Regional Office for the Western Pacific. II. United Nations Development Programme. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, Fax. No. (632) 521-1036, email: [email protected] Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. For inquiries and request for WHO Western Pacific Regional Publications, please contact the Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, Fax. No. (632) 521-1036, email: [email protected] CONTENTS Foreword ii Executive summary iv 1. Introduction 1 2. Economic and social costs of tobacco use in China 10 3. Economic and social benefits of tobacco control 16 4. The policy path to reducing tobacco use in China 24 5. Conclusions and recommendations 29 References 32 Annexes 35 A. Summary of Economic costs attributable to smoking in China 2014 35 B. Summary of Equity and poverty alleviation benefits of tobacco tax and smoke-free workplaces in China: a modelling study 39 C. Summary of The policy path to reducing tobacco use 42 THE BILL CHINA CANNOT AFFORD FOREWORD Tobacco use kills approximately 6 million people globally every year and is a significant threat to health and development. It is one of the main risk factors driving the growing epidemic of noncommunicable diseases (NCDs). Heart disease, cancer, diabetes, lung diseases and other NCDs are now the world’s biggest killers – responsible for over 60% of all deaths and over 80% of deaths in China. Over three quarters of NCD deaths occur in low- and middle-income countries, as do 82% of premature NCD deaths. Tobacco use hurts families, impoverishes communities, exacerbates inequalities, and damages economies and societies. We will have difficulty reaching the Sustainable Development Goals (SDGs) vision of a more equitable, healthy and sustainable world without seriously tackling the global tobacco threat. China is the epicentre of this epidemic, and thus lies at the heart of global efforts to stop it. China is the world’s largest producer and consumer of tobacco. A staggering 44% of the world’s cigarettes are smoked in China. One million people die of tobacco-related diseases in China every year, many of them in the prime of their productive years. The purchase of cigarettes imposes a financial burden on low-income smokers and their families, but the illness, disability and death caused by tobacco use extracts an even greater cost – with such high rates of smoking among Chinese men, tobacco use is killing or disabling the main wage earner in many Chinese families (especially families on low incomes) and plunging those already on the margins into poverty. If nothing is done to slow these trends, smoking-related diseases are on track to claim more than 200 million lives in China this century. This will decrease economic productivity and push tens of millions of people into poverty. It will also place increasing demands on the Chinese social welfare and health systems, as well as the private sector, and will further entrench already growing inequalities. The health and broader (social, economic, environmental) costs of tobacco use add up to a bill that China cannot afford. Yet, all of this is preventable. This report shows that through implementation of a comprehensive package of strong tobacco control policies, China could avert many millions of preventable deaths, as well as mitigate the impact tobacco use is having on China’s society and economy. Increasing the retail price of cigarettes by 50%, for example, would save 20 million lives over 50 years and prevent 8 million people from being plunged into poverty. A well-enforced national policy to make all offices smoke free would avert at least 6 million deaths and avoid 2 million people becoming impoverished. A comprehensive national smoke-free law, including all public places, would deliver even greater health and equity gains. Strong tobacco control policies are therefore not only pro-health – and thus consistent with the Healthy China vision of the Government are also pro-poor and positive for the economy. Tobacco control will deliver a sustainable return on investment in the form of a healthier, more equitable and productive country. ii HEALTH, ECONOMIC AND SOCIAL COSTS OF CHINA’S TOBACCO EPIDEMIC In the adopting of the SDGs, the international community recognized that tobacco control is a priority issue, for health and for development more broadly. The SDGs commit governments to implement the WHO Framework Convention on Tobacco Control (WHO FCTC), which China ratified in 2005. Scaled-up implementation of the WHO FCTC be constitute a huge step towards delivering on the vision articulated in the 2030 Agenda for Sustainable Development – of a world transformed,
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