Tobacco tax could ‘untax’ our health

AFTER the deputy health minister announced his ministry's plans to increase tobacco tax, several statements mentioned that smokers will turn to illicit cigarettes, and that these cigarettes are more harmful than the legal ones.

Cigarettes, whether legal or illicit, are harmful and addictive. There is no safe level of smoking. They are linked to 16 types of cancer, 25 life threatening diseases, and result in 20,000 deaths of Malaysians each year.

Increasing tobacco tax, implemented alongside other tobacco control programmes, including education, is one of the most effective tobacco control measures. Increased cigarette prices encourage smokers to either quit or smoke less, and discourage non-smokers to start. A US study found that an increased cost of smoking, just by US$2.25 (RM10) a day, led 40% of tobacco users to stop.

In addition, tobacco taxes benefit the poor more than they do the wealthy. As the poor are more affected by changes in price, this group, which is also the most vulnerable to rising healthcare costs, gains more health benefits.

Those opposing the tax increase say it will exacerbate tobacco smuggling in Malaysia. This claim, despite being touted worldwide when any country implements an increase, is not substantiated. WHO has not found a direct link between tobacco tax and illicit trade. Singapore, Australia and Hong Kong have much higher tobacco taxes than Malaysia, but also much lower illicit trade.

While price increases may incentivise smuggling, many other factors, such as enforcement, have a bigger influence. These include the ease of operating in the country, how high the gains and risks are, the likelihood of getting caught and punished, how sophisticated the crime network is, tobacco industry participation, and the country's tax system.

Other countries such as the UK, US, Italy, Spain, and Turkey, have also succeeded in implementing tax increases without adding to illicit trade.

Italy and Spain scaled up its joint customs activity and intelligence gathering, increased their penalties for smugglers, and introduced anti-smuggling legislations. The UK cut its illicit cigarette market by half after introducing the "Tackling tobacco smuggling" strategy in year 2000.

This shows that tobacco control is not just a health problem, and should not be left to only one ministry, or tackled from the health angle alone. The WHO Framework Convention on Tobacco Control, of which we are a signatory, calls for the help of all ministries.

Increasing tobacco tax is not the sole solution to curb smoking. It is most effective when complemented with other tobacco control initiatives, one of which is reducing access: people may be more tempted to smoke if they can buy cigarettes – easily – from anywhere, including in coffee shops (even though cigarettes are not a food item).

Retailers must be licenced, as they are in many other countries where smoking is steadily declining. This includes Australia, Brunei, Singapore and Thailand.

Make no mistake: tax increases are meant to make cigarettes unaffordable gradually. But instead of treating them as enemies to our wallets, we should focus on the long-term benefits, including health. Also, assuming that masses will just turn to illicit cigarettes is almost an insult to Malaysian smokers, as it implies that they are incapable or reluctant to quit.

More than 60% of smokers in Malaysia do want to stop. We fully support the Health Ministry's proposal to increase tobacco tax and cigarette prices, and urge them to implement licensing.

Dr Saunthari Somasundaram
Medical Director and President
The National Cancer Society of Malaysia