In 2009 California took in $839 million in taxes from the sale of cigarettes. And with its—and many other states'—budget in dire straights, it is hard to turn down any extra income.
But that's just what the state has been doing, with overall cigarette sales dropping year after year thanks to anti-smoking efforts. And these tobacco control programs aren't free either—adding up to some $100 million per year for California alone.
So why take such a hit, with the state more than $374 billion in the hole? The payoff in medical savings more than makes up for money lost—and fast, according to a new essay published online Wednesday in The Lancet.
Tobacco use, as we well know, can lead to long, slow and expensive chronic conditions, such as cancer, cardiovascular disease and respiratory problems. So getting people to stop smoking now had been expected to pay off in avoided medical costs down the road. Such long-term benefits, though, can be a tough sell in the world of short-term, election-cycle politics.
The payoffs of getting people to kick their cigarette habit are actually quite immediate, argue the essay's authors, Stanton Glantz and Mariaelena Gonzalez, both of the Center for Tobacco Control Research and Education at University of California, San Francisco. In the past decade evidence has been mounting to show that "benefits of reducing smoking accrue quickly; a reduction in tobacco use rapidly decreases [non-communicable diseases] and health-care costs within one year," they wrote.
As soon as a person stops smoking, his or her risk of a heart attack drops, and it continues to fall for five years, when it reaches levels close to those of people who have not smoked. With the number of smokers in that state having declined some 50 percent since 1985, that is presumably a lot of heart attacks—and related medical bills—avoided. But just how much?
Here's how the numbers break down: In the first 15 years of the California tobacco control program, the state spent $1.4 billion on the initiative, during which time it also lost some $3.1 billion on tax revenue from all of the billions of packs its residents were no longer buying. Could all of that lost money possibly be made up in avoided health care expenses? Yes, more than 19 times over. With the reduction in smokers over that same 15-year period, some $86 billion in direct medical costs were avoided, Glantz and Gonzalez noted. And that does not include the extra money flowing into the economy generated by increased productivity—thanks to more, and higher quality, days of work—of the non-smokers. A similar story has played out in Arizona, where like tobacco control measures were introduced.
After last week's U.N. General Assembly's special session on non-communicable diseases, to which tobacco use is a major contributor worldwide, the organization recommended that "member states implement six tobacco control policies based on the [World Health Organization's Framework Convention on Tobacco Control] (strong clean indoor air laws, increased price, banning of advertising and promotion, education and prevention, cessation services, and monitoring or tobacco use and prevention policies)," Glantz and Gonzalez wrote. "However, as of 2009, less than 10 percent of the world's population was covered" by these guidelines.
Despite the challenge of putting these recommendations into practice—and the continued opposition of the tobacco industry—the researchers noted, there is good reason to forge ahead, even from a purely economic standpoint. Policy makers and the public "can be confident that there is good evidence showing that effective programs not only reduce tobacco use and the attendant [non-communicable diseases] in the short term, but [also] make an important contribution to curbing health care costs and improving standards of living and human capital levels immediately, with increasing benefits over time."