A 10-year study of median cigarette prices and infant mortality conducted by researchers at the Imperial College London and some other European institutes shows that an increase of €1 (US $1.18) per pack in the median cigarette price was associated with a decline of 0.23 deaths per 1000 live births in the same year.
While the study published in JAMA Pediatrics tracked 53 704 641 live births in 23 European nations during the 2004-2014 study period, the findings are particularly significant for India which has the largest number of under five child deaths in the world. An analysis of the Global Burden of Disease study published recently in The Lancet revealed that in 2016, 0.9 million children aged under 5 years died in India – the highest in the world, more than some of the poorest countries in the world.
India has also, for some months now been going through a phase of self doubt in its tobacco control measures with organisations affiliated to the Rashtriya Swayam Sewak Sangh (RSS) accusing foreign donors of trifling with the interests of poor tobacco farmers of India. There has been a crackdown on the Public Health Foundation of India and several other organisation partnering the government on tobacco control for alleged violations of the Foreign Contributions (Regulation) Act (FCRA). Significantly, while the new GST regime puts tobacco in the highest tax bracket of 28%, the taxes on all tobacco products except bidis have since actually gone marginally down.
“…an increase of €1 per pack in the median cigarette price was associated with 0.23 fewer deaths per 1000 live births (95% CI, –0.37 to –0.09) in the same year and an additional 0.16 fewer deaths per 1000 live births in the following year (95% CI, –0.30 to –0.03). An increase of 10% in the price differential between median and minimum cigarette price was associated with 0.07 more deaths per 1000 live births (95% CI, 0.01-0.13) the following year, while the association was nonsignificant in the same year (β, –0.04; 95% CI, –0.08 to 0.01),”the study found.
Apart from Imperial College, Researchers from Erasmus University Medical Centre–Sophia Children’s Hospital, Rotterdam and Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh participated in the study. While the health benefits of higher tobacco taxation have been elucidated in multiple studies across the world, this is the first quantitative correlation between tobacco pricing and infant mortality across such a large number of countries. There were however previous studies in USA, UK and Canada linking higher tobacco prices with reduced child deaths.
The JAMA study concluded: “Higher cigarette prices were associated with reduced infant mortality, while increased cigarette price differentials were associated with higher infant mortality in the European Union. Combined with other evidence, this research suggests that legislators should implement tobacco tax and price control measures that eliminate budget cigarettes.”
The tobacco tax structure in India is such that apart from GST there is a cess on all products except bidis. All taken together it comes to about 50-55% which is not low but still not upto the levels recommended by WHO.
“WHO recommends a 70-75% tax on tobacco the retail price. In India it is in the 50-55% range, so there is a very large room for improvement. Post GST taxes on cigarettes and smokeless tobacco have actually gone down; by about 1-2% for cigarettes and by 4-5% for smokeless products. It has though gone up marginally for bidis, by about 1-2%,”says a researcher who works on tobacco economics.
A study of the economics of tobacco and tobacco taxation in India done by researchers including those from PHFI, University of Illinois at Chicago and Centre for Global Health Research, St. Michael’s Hospital, University of Toronto, estimated that over 120 million Indians smoke, and 10% of the world’s tobacco smokers live in India. India has the second largest group of smokers in the world after China. Almost a third of Indians—57% of all men and 11% of all women—consume some form of tobacco and many use more than one type of tobacco products. Bidis are the most popular tobacco product used in India. Bidis account for nearly 85% of total smoked tobacco in India.
A top notch health tourism destination, complicated surgeries and “star” doctors many of whom are the pioneers in their respective fields – India’s private healthcare system enjoys a glorious international reputation. It is in short a stark contrast to the state of the public health sector. A 2007 paper published in the Economic and Political Weekly notes, “…high absenteeism, low quality in clinical care, low satisfaction levels with care (clinical and with regards to courtesy and amenities) and rampant corruption plague the [public health] system.” It is something that the private sector never fails to remind us about in times such as now when its business model is facing countless questions after Fortis Gurugram billed the family of 7-year-old Aadya Singh – who eventually died of dengue – Rs 15 lakh plus for a fortnight’s stay in the hospital.
The Union ministry of health has notified amendments to the Food Safety & Standards (Contaminants, Toxins & Residues) Regulations, 2011 on 7th November, 2017. The notification contains maximum permissible limits of various antibiotics in meat and meat products including chicken.