The New Straits Times, April 9, 1998
Q: I am very concerned about the Government's efforts to increase tobacco output through further research and development, as reported in the New Straits Times on March 23. Among the suggestions being considered is the opening of more tobacco farms, the introduction of integrated farming in small farms and the reduction of tobacco production costs. Can you elaborate on the disadvantages of such a move?
A: As pointed out correctly, the suggestions by the National Tobacco Board were largely to reduce the cost of tobacco production so that local tobacco can be as competitive as that imported from the Asean region. These moves, if implemented, would increase the availability of tobacco products in Malaysia and ultimately, result in a higher incidence of smoking-related diseases.
It would affect our mortality rate and result in higher healthcare costs, due to these diseases.
A counter-argument towards such a move would be to analyse the cost benefit study, as was done by the World Bank during the 9th World Conference on Tobacco and Health in 1994. In an address to the delegates, a senior World Bank economist stated that "controlling the consumption of tobacco is not only good for people's health but also an important policy for their countries' economic prospects."
Based on his estimation of the producer and consumer benefits from tobacco consumption in the United States and comparing them to the economic costs, he assessed that a tonne of tobacco consumed causes an average of 0.65 deaths, with an average lag of 25 to 30 years. From this, he calculated the number of premature deaths and new cases of the top four diseases caused by tobacco - cancer, cardiovascular diseases, cerebrovascular diseases and chronic obstructive pulmonary diseases - over a 30-year period for 1,000 tonnes of added tobacco consumption to be 990 premature deaths and 650 new cases.
As a result, the direct medical costs for treating these diseases were US$5.6 million in 1990, or about RM22 million today. Meanwhile, the indirect costs according to the estimated value of life lost were US$11 million for premature death, and US$13.2 million for premature mortality.
Using the approach on the economic models of the estimated demand and supply responses of the market for tobacco, the benefits of consumption to producers and consumers (at 1990 prices) for 1,000 added tones of tobacco consumption was US$2.6 million.
Thus, summing up benefits and cost, he derived a global net loss of US$27 million for 1,000 tonnes of tobacco. Based on the global trend, he estimated there were seven million tonnes of tobacco produced in the world in 1990, which would give a rough estimate of an annual global loss of US$200 billion, of which about a third occurs in the low-income countries.
Based on these figures, the World Bank has come out with the following policies:
- In the health sector, World Bank activities discourage the use of tobacco products.
- There are no direct loans, investment or guarantees for tobacco production, processing or marketing, except in the context of the few countries heavily dependent on tobacco as a source of income and foreign exchange. In those countries, the World Bank seeks to help them diversify away from tobacco.
- As much as practicable, the World Bank does not lend indirectly for tobacco production.
- Raw and manufactured tobacco, tobacco-processing machinery and equipment, and related services cannot be included under imports financed under loans.
- Tobacco and tobacco-related producer or consumer imports may be exempt from borrowers' agreements with the Bank to liberalise trade and reduce tariff levels.
A study by a medical journal published last year highlighted the health costs of exposing infants and children to environmental tobacco smoke. It is already well established that exposure to tobacco smoke increases the risk of respiratory illness among children.
To estimate the amount spent on children's healthcare for respiratory illness attributable to exposure to environmental tobacco smoke, the authors examined data from the US concerning smoking, healthcare usage, health expenses for respiratory healthcare and socio-demographic features of the families of 2,624 children under the age of five in 1987.
Based on the results, the authors noted, among others, that exposure to tobacco smoke causes more respiratory illness, and that the expenses incurred are higher than that for non-exposed children with the same illness. In addition, tobacco smoke increases both the period prevalence and the severity of the childhood respiratory conditions.
Further calculations on healthcare costs showed that maternal smoking was estimated to increase direct healthcare costs per child to US$120 a year for children under five, and US$174 a year for children under two. Based on these figures, the US national-level expenditures for respiratory illness due to maternal smoking were estimated to be US$460 million for children under two, US$201 million for children between three and five, or US$661 million for children under six, about 19 per cent of total expenditures for childhood respiratory conditions.
To conclude, it is hoped that this information can help our society and the Government recognise the consequences of the decision to support the tobacco industry.
Contributed by the National Poison Centre (http://www.prn.usm.my).
