 8. Future Smoking Cost Trends in Developing Countries While tobacco consumption in developed countries declines, it continues to increase in developing countries. This will lead to very substantial future increases in the social costs of smoking, and particularly in the public expenditure costs. Effective tobacco control policies should be implemented as early as possible in order to minimise future smoking costs. The future prospects for the impact of smoking on developing countries are discussed by Mackay and Crofton (1996). "With the decrease in smoking prevalence in developed countries, the multinational tobacco countries are now moving massive resources to boosting sales in developing countries. In some developing countries, indigenous tobacco production and consumption present major problems. Many people and governments in these countries are not yet fully aware of the risks and lack the resources to counter ruthless marketing by the industry. If not prevented, there will be an appaling future increase in tobacco-related disease, disability and death." This increase will inevitably lead to a similar increase in the social costs of smoking. Although many developing nations face a lack of basic epidemiological information on the impact of smoking, it is clear that smoking patterns are very different in developing and developed countries (specific information on prevalence in the Pacific Islands is presented in Section 10 below). In general, more men (50-60%) smoke in developing countries but fewer women (2-10%). On average, in developed countries approximately 25-30% of both men and women are smokers (Mackay and Crofton, 1996). The United Nations Food and Agricultural Organisation (FAO) has estimated that, between the years 1984 and 2000, tobacco consumption in developed countries will decrease by 11% while in developing nations it will increase by 10%. As a result, the developing nations' share of global tobacco consumption will steadily increase. Mackay and Crofton predict that the number of smokers in developing nations will increase for the following reasons: A likely increase in smoking among women as a result of intensive tobacco marketing and of a decrease in the social taboo of smoking for women; Ignorance of the health risks of smoking; Lack of funding for tobacco control measures and the difficulty of implementing these particularly in rural areas; and Energetic marketing by tobacco companies. Not all of these factors apply to all developing nations but most factors apply to most nations.Increases in smoking prevalence and tobacco consumption do not lead immediately to higher levels of social costs. In general the morbidity and mortality effects are only felt after prolonged periods of smoking. Thus, many developing nations face the prospect of high future social costs, the full impact of which is not currently appreciated. As developing nations experience economic growth and achieve higher per capita incomes, the quality of public health services will inevitably improve. The result is that a higher proportion of the health costs of smoking will be borne by the public sector. Public expenditures attributable to smoking are likely to rise at a rate even higher than the rate of increase of social smoking costs overall. One implication of these long lead times, however, is that cessation of smoking can, over a period of time, reverse some of the health impacts of prior smoking. If developing nations fail to implement effective measures to reduce smoking prevalence, they face heavy future costs attributable to the smoking epidemic. If effective measures are introduced, future smoking costs can be substantially reduced (although not totally eliminated). It is never too late to implement tobacco control measures. The earlier tobacco control measures are introduced the greater will be the reduction in the proportion of future smoking-related morbidity and mortality and concomitant costs. |