# A Tobacco Tax to Save Lives



## Alex (26/8/15)

nytimes.com
*A Tobacco Tax to Save Lives*
Joe Nocera

A smokeless tobacco product called snus, which a user puts between his gums and his upper lip, has a long history in Sweden. At the start of the last century, it was the most common way Swedes ingested nicotine. By the early 1950s, however, sales of snus had been overtaken by cigarettes, a trend that continued for two decades.

But in time, snus made a comeback, while cigarette use steadily declined. As of 2012, only 13 percent of adult Swedes smoked, less than half the European Union rate. Meanwhile, 19 to 21 percent of Swedish males use snus, which is now more prevalent than cigarettes. (Swedish women, for some reason, stuck with smokes.)

The result? Even though tobacco use in Sweden is comparable to its use in the rest of Europe, Sweden’s preference for snus means that it “has Europe’s lowest tobacco-attributable mortality among men,” according to a paper in the latest issue of The New England Journal of Medicine. Indeed, a 2012 study by the World Health Organization found that tobacco caused 152 deaths per 100,000 men in Sweden, versus 467 deaths per 100,000 men in Europe.

It’s hard to know exactly what caused snus to regain its popularity. There was no explicit government policy promoting it. David Sweanor, one of the authors of the paper, told me that Sweden’s predominant tobacco company took it upon itself to market snus once the dangers of cigarettes had become irrefutable. (That company, Swedish Match, sells mainly snus today.) But another likely reason was a huge price differential between cigarettes and snus; at one point a pack of the former was taxed so heavily that it cost twice as much as a can of snus.

Sweanor, a tobacco policy expert at the University of Ottawa, and his co-authors, Kenneth Warner, a University of Michigan economist specializing in public health, and Frank J. Chaloupka, an economist focused on public health at the University of Illinois at Chicago, would label snus a “harm reduction” product. Although it contains tobacco and allows users to get their fix of addictive nicotine, snus poses far less risk than cigarettes, as the statistics amply show.

All three men are big believers in the virtue of harm reduction policies to reduce the illness and death caused by cigarettes. Thus the point of their paper: The tax policies that worked in Sweden — raise taxes on the killer product while lowering them on the harm reduction product — should be applied today to electronic cigarettes and other noncombustible nicotine delivery systems.

Regular readers will not be surprised to learn that I think this is a terrific idea. Because it contains tobacco, snus has traces of nitrosamines, a cancer-causing agent found in tobacco. Electronic cigarettes, by contrast, contain no tobacco at all. Instead, they vaporize nicotine, which gets to the user’s brain far quicker than, say, a nicotine patch, thus more closely replicating the nicotine hit delivered by a cigarette.

As Warner pointed out to me, nobody can say for sure how much safer e-cigarettes are because the products haven’t been around long enough for long-term studies. But it is plain as day that they are far less risky than cigarettes. Countries use tax policy all the time to affect behavior. Using tax policy to move people from cigarettes to e-cigarettes would, to be blunt, save lives. The e-cigarette has the potential to be the greatest tobacco cessation device ever invented.

Yet, as the authors note, because most of the tobacco-control community believes that “all tobacco products are seriously deleterious to health, conventional wisdom … has long been that all products should be taxed similarly.” Indeed, the World Health Organization has described “comparable” taxation on all tobacco products as a “best practice for tobacco taxation.”

As irrational as this is, it is easy to understand where it stems from. Health claims about e-cigarettes remind anti-tobacco activists of the days when Big Tobacco marketed low-tar cigarettes as a “healthier” smoking choice. E-cigarettes come in many flavors, which could appeal to kids. Their marketing aims to make e-cigarettes look cool — just like Big Tobacco once did. Despite a complete lack of proof, the tobacco-control community fears that young people who use e-cigarettes will eventually gravitate to combustible cigarettes.

Which is all the more reason the authors’ tax idea deserves consideration: It puts the emphasis on moving _smokers_ to e-cigarettes, which is where it should be. “Studies have … shown that changes in the relative price of tobacco products lead some tobacco users to switch to less expensive products,” the authors write. A big tax differential is a way to take advantage of the lower risk of e-cigarettes without ever having to acknowledge it.

Not that I expect rationality to take hold any time soon. After all, you know how the European Union reacted to the Swedish snus experience, don’t you?

It banned snus.

source: http://www.nytimes.com/2015/08/18/opinion/joe-nocera-seeing-good-in-a-tobacco-product.html

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