Cigarette affordability in the Eastern Mediterranean Region

Abstract

Arab Emirates and Yemen), with a population of nearly 679 million people (3). The prevalence of use of smoking tobacco products (including but not limited to cigarettes and water pipes) by males aged 15 years or older is decreasing in all WHO regions apart from the EMR, where it continues to increase (4). In EMR countries, approximately 14% of the population aged 15 years or more are current cigarette smokers, with prevalence noticeably higher among males (25%) when compared to females (2%) (5). The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and its implementation guidelines provide an evidence-based framework for governmental action to reduce tobacco use (6). Article 6 of the WHO FCTC outlines the "Price and tax measures to reduce the demand for tobacco" (6). Effective tobacco tax policies can significantly improve health and economic outcomes for individuals, households, and the country, especially in low-income settings (5,7-9). Evidence shows that raising tax on tobacco increases the real price of tobacco and reduces tobacco consumption (6). Approximately half of the impact of a price increase is on the prevalence of use and half is on the intensity of consumption among users (6). Therefore, taxation must increase prices more than any growth in average income occurring at the same time in order to prevent tobacco becoming more affordable (6). Research has suggested that tobacco affordability benchmarks may be more effective than tax incidence benchmarks, since tax incidence benchmarks do not respond to changes in average income (10). Rising incomes may undermine pre-existing high levels of taxation unless tobacco taxes are raised in response to changes in income. This argument is particularly pertinent in the case of lower middle-income countries experiencing rapid economic growth (10). Previous research has shown that globally the most sold brand of cigarettes in countries are becoming less affordable in upper middle and high-income countries and more affordable in low and lower middle-income countries (5,11,12).

Implementation of tobacco control measures in the Gulf Cooperation Council countries, 2008–2020

“…The results of this study showed that the evolution of implementing tobacco taxes is slow in GCC countries [ 28 ]. Similarly, previous studies indicated that the average price of tobacco products in the Eastern Mediterranean region, including the GCC region, is lower than other regions like Africa, America, South-East Asia, Europe, and Western Pacific [ 40 , 41 ]. As of 2018, the most sold cigarette brand prices in GCC countries ranged from $2.75/pack in Qatar to $7.33/pack in Saudi Arabia [ 42 ].…”

Where to next for countries with high tobacco taxes? The potential for greater control of tobacco pricing through licensing regulation

“…9 Simple tax structure and frequent above-inflation increases in specific excise taxes are crucial tobacco control measures for any jurisdiction and need to be pursued without delay. [42][43][44] Price caps are not a panacea that all countries could readily adopt, but their potential for significant impact suggests they could be an option for countries that already have high tobacco taxes and which are looking to do more. For such countries, price regulation through licensing offers the possibility of radically and sustainably increasing the effectiveness of tax policy while also raising additional tax revenue for governments by reducing industry profitability.…”

“…The 2019 WHO report on the global tobacco epidemic reported that only 14% of the world’s population live in countries with sufficiently high tobacco taxes 9. Simple tax structure and frequent above-inflation increases in specific excise taxes are crucial tobacco control measures for any jurisdiction and need to be pursued without delay 42–44. Price caps are not a panacea that all countries could readily adopt, but their potential for significant impact suggests they could be an option for countries that already have high tobacco taxes and which are looking to do more.…”

Factors associated with baseline smoking self-efficacy among male Qatari residents enrolled in a quit smoking study

“…Cigarette smoking remains the leading cause of many preventable diseases, with the number of smoking-attributable deaths expected to rise to 10 million per year by the year 2030 [ 1 ]. Smoking prevalence in the Eastern Mediterranean Region countries continues to be high unlike the decline observed in the rest of the world [ 2 , 3 ]. Qatar is one of the countries in the region with high smoking rates, currently at 25.2% smoking prevalence among adults.…”