Higher cigarette taxes could prevent 182,000 child deaths, globally

Child death rates could be reduced by higher cigarette taxes – as regions with the lowest tobacco tax also have the worst child health issues

Tobacco use has direct and indirect effects on children’s health – but can often cause life lasting birth defects on children. Researchers found that increases in all types of taxation were associated with benefits for child survival.

Often with mothers who smoke during pregnancy, their babies can have premature births as well as exposure to second-hand smoke, often causing lung conditions like asthma.

If every country’s cigarette tax met the World Health Organization’s recommendations – a minimum 75% tax share of the retail price of tobacco – around 182,000 newborn deaths could have been averted in 2018.

Co-lead author of the study Dr Anthony Laverty, from Imperial’s School of Public Health, said: “Taxation can increase the retail cost of a packet of cigarettes, which might mean that people choose to quit smoking as the habit becomes more expensive.”

Overall, increased cigarette taxes could have averted around 231,000 deaths of children aged under a year old in 2018 (including roughly 182,000 newborns). Almost all of these averted deaths would be in low- and middle-income countries (LMICs).

Health effects like frequent and severe asthma attacks and respiratory infections can occur to children exposed to smoking

According to research led by Imperial College London and Erasmus MC and published in PLOS Global Public Health, the WHO recommends that tax represents more than 75% of the retail price of tobacco products – however in 2018 only 14% of the world’s population lived in countries which had achieved this.

Analysing the link between cigarette taxes and neonatal and infant mortality in 159 LMICs and high-income countries (HICs), this study used every country’s mortality and tobacco tax data from 2008-2018.

The researchers also analysed the results based on the type of taxes used such as specific cigarette taxes, value added taxes and import duties. However, the study does not look at overall prices of cigarettes, which may overlook how tobacco companies often offset these taxes by lowering the cost of their products.

The researchers accounted for other related variables including gross domestic product, fertility rate, education, and access to drinking water.

Dr Laverty, touching on the link between children and smoking, said: “Tobacco use has significant and varied ill-effects on children’s health. When babies are exposed to smoking while in the womb or exposed to second-hand smoke in the home after birth, this can increase the risk of health problems early on, like premature birth and asthma.

“Equally, tobacco can cause significant health problems for parents who smoke, affecting their ability to earn a living and their family’s wealth, which can indirectly affect a child’s health.

“Strong global tobacco control is vital to counter all of these causes, and to reduce the hundreds of thousands of needless child deaths we estimate are associated with smoking.”

Increasing tobacco taxes in LMICs is vital, as more children die from these issues in these countries

The research found that worldwide, between 2008-2018, the average neonatal and infant mortality rates overall were estimated to be 14.4 and 24.9 deaths per 1,000 live births, respectively.

With rates evidently higher in LMICs than HICs – with 33 children aged under one (including 19 newborns) in every 1,000 dying each year in LMICs, compared to 6 under-ones (including 4 newborns) in every 1,000 in HICs – the average tax on cigarettes was lower in LMICs than in HICs between 2008-2018 (43% and 64% taxes, respectively) also.

As well as this, fewer LMICs achieved the 75% tax level recommended by WHO in 2018 – which is 11% of LMICs vs 42% of HICs.

The researchers estimate that a 10% increase in tobacco taxation – such as increasing the overall retail price of cigarettes by 10% – could be linked to a 2.6% reduction in newborn deaths globally, and a 1.9% reduction in deaths of children aged under a year old.

Ideally this could prevent around 78,000 deaths of children under one, including 64,000 newborn deaths, worldwide in 2018.

Senior study author, Dr Filippos Filippidis, also from Imperial’s School of Public Health, added: “Raising tobacco taxes has been shown to be the most effective measure to reduce smoking, but most research is only in adults or high-income countries.

“Past studies from high-income countries have found that increasing tobacco taxes reduces preterm birth rates, asthma exacerbations and child deaths, but until now it was not clear if these findings can be applied to low- and middle-income countries where there is lower awareness of tobacco-related harm, and the influence of the tobacco industry is stronger and might suppress the positive effects of raising taxes.”

Dr Marta Rado from the Erasmus MC Rotterdam who co-led the study, said: “Ensuring that children grow up in a smoke-free environment should be a global health and human rights priority.”

The researchers note that their study only included data on cigarette taxes and not on other forms of tobacco. They also relied on tax data from the best-selling cigarette brands from each country.