Russia’s controversial involvement in the Ukrainian crisis in the last months has been labeled by many commentators as an attempt to take the attention of the Russian public away from the mounting internal problems of the country. One of the most serious of these problems has been since the last few decades the catastrophic health situation of the Russian population. Part 1 of out report, prepared by a group of Public Health scholars at the London School of Hygiene and Tropical Medicine, analysed the health burden resulting from tobacco consumption in the Russian Federation – see https://crossingthebaltic.com/2014/04/13/smoking-in-russia-rationale-for-action/.
Part 2 suggests actions that need to be taken by the Russian federal government in order to address this problem.
Anna Barr, Tamara Davies, Teresa Hall, Emilia Holland, Nazla Rafeeg, Silvia Segovia Chacon, Emilie Taymor, Mateusz Zatonski
Key message of report:
- More effective legislation and tobacco control measures can help reduce Russia’s mortality burden. Options include higher taxes on tobacco products, enforcement of new smoke-free legislation, and the introduction of graphic warning labels on tobacco products sold on the Russian market.
- Increase of tobacco prices
A rise of tobacco prices is key to curbing tobacco use in Russia. This can be achieved by increasing tariffs on raw tobacco imported into the country by cigarette manufacturers, as well as increasing tariffs on any product containing tobacco sold or brought into Russia.
Currently tobacco companies take advantage of low import duties for raw tobacco which allow cigarette manufacturers to keep cigarette prices down. Over the last decade income and real wages have increased by 12% to 16% annually while real prices for cigarettes have fallen over 40%, making tobacco products increasingly affordable.
Studies by the World Bank and the WHO show that the most powerful and cost-effective intervention to curb tobacco consumption is through the use of taxes to raise the price of tobacco related goods on the individual consumer. This inverse relationship between cigarette price and consumption is seen to be stronger in Eastern Europe than Western Europe, where tobacco taxes have already been raised substantially higher. This makes the policy of increased taxation particularly suitable for Russia.
Although in 2011 cigarette taxes were raised to 50% of retail price in the Russian Federation, this is still far below other European countries. It would therefore be beneficial to follow the recommendations of the International Union Against Tuberculosis and Lung Disease and raise the tobacco tax to 70%.
In proposing raising tobacco taxes we recognise their regressive nature. However, because tobacco price elasticity is higher for people with lower incomes, the tobacco products tax will deter young smokers and people with lower income most effectively from smoking. This will contribute significantly to reducing smoking prevalence among the Russian population as a whole.
In order to help address the negative implications of a regressive tax – in that it is more harmful to lower income individuals and could therefore potentially increase inequalities if tobacco consumers continue to consume higher priced tobacco products and cut other spending – we propose that the money from the additional tax revenue goes towards tobacco cessation education programs targeted at young and lower income individuals. The tax money can subsidize education programmes in schools about the negative effects of cigarette smoking and smoking cessation programmes in local community centres in low-income neighbourhoods.
- Enforcement of new smoke-free policies
As part of Russia’s adoption of the FCTC guidelines, a governmental action plan has been established to implement a comprehensive public smoking ban by 2015. On 1 June 2013, 100% smoke-free policies were implemented in private offices, educational, cultural, medical and sport facilities, government buildings, elevators and stairwells of apartment buildings, public transport, airports, and all public playgrounds and beaches. On 15 November 2013 fines were introduced for those who did not comply, ranging from 500 to 3,000 rubles (US$15-US$90). From 1 June 2014, a complete smoking bans will be extended to venues of hospitality including restaurants, bars, clubs, cafes, hotels, shopping areas. It is crucial that these new legislation be enforced and policed effectively.
If implemented and enforced correctly these policies can change social norms and views about the dangers of second hand smoke, and smoking in general. This new understanding may translate into alterations to smoking behaviours particularly in the smoker’s own personal spaces such as their home and car. The projected effect of these policies is a reduction in the prevalence of male and female smoking by 9% relative to the scenario in 2015 if no smoke-free laws were implemented, and by 12% by 2055. These predictions do not include the additional deaths prevented due to reductions in second hand smoke exposure.
Experiences in other countries have found smoking bans in public places as cost-effective interventions to reduce both active and passive smoking. They affect a high proportion of the population, including vulnerable populations such as women and children. They are particularly effective when implemented with the support of the public. According to reports, prior to the implementation of smoking bans, the majority of respondents supported bans in work places, educational and health care facilities. Support was not as high for a ban in restaurants (59.1%) or bars (48.9%), however the numbers in favour were higher than in some countries where these laws had already been implemented successfully. Public health advertising campaigns which reinforce the messages of the dangers of second hand smoke have appeared to coincide with the implementation of the smoking ban, and should be continued.
Russia is taking important steps towards creating healthy, smoke-free environments and reducing the exposure of non-smokers to harmful second hand smoke. It is crucial that these laws are enforced proactively and consistently across the country to achieve high compliance. Continuous evaluation of compliance by the Ministry of Health through self-reporting, direct observation and government enforcement and compliance records is essential. Civil anti-smoking groups are needed to apply pressure to those local governments or enforcement groups which turn a blind eye to establishments and institutions that do not comply. Additionally local governments should incorporate lessons learnt through the establishment of Sochi, the 2014 host of the Winter Olympics, as a smoke-free city, into its enforcement and compliance mechanisms.
- Introduction of large, bold and graphic warning labels
Another key measure to reduce tobacco-attributable mortality in Russia is to upgrade the current governmental policy on warning labels to include large, bold and graphic labels concerning the negative health effects of smoking on all cigarette packets. This measure should be adopted immediately with all new packets and with a policy-adoption phase of one year for existing packets. Such labels will encourage smoking cessation, as well as combat smoking initiation.
The efficacy of graphic pictorial warning labels in promoting the adverse health effects of smoking has been demonstrated in studies from Canada, Mexico, and Spain. This research has highlighted the need to accompany black and white labels with graphic pictures in order to generate sufficient negative emotional activation to discourage from smoking.
The adoption of a large, bold and graphic warning label protocol has been estimated to reduce the prevalence and initiation of smoking by 4% and promote a 10% increase in cessation rate. This protocol would more than halve the projected initiation and prevalence smoking rates, and double the projected cessation rate of that of the current governmental policy in which warning labels are required to cover 1/3 of the front of packet.
A 10% increase in cessation rate would ease the burden of the large number of existing smokers. The benefit of promoting health knowledge through pictures at the point of sale may access the subset of the population who are less likely to receive health information through traditional media sources (rural, homeless, illiterate). The consequent reduction in tobacco-related disease will reduce the burden on the health services in the country, improve the quality of life of Russians, and improve the productivity of the working age population.
National funding to support local monitoring of the policy will be crucial in its successful enforcement. Similarly important will be the determination to face legal action against the policy from the tobacco industry, and an ability to evince policy from similar best practice precedents from around the world. Finally, a certain level of government subsidy might be needed to encourage shopkeepers to support the new measure, as their revenue might temporarily decrease until they transition to new products.
Some suggested reading (for full bibliography contact us directly):
See part 1 of report: https://crossingthebaltic.com/2014/04/13/smoking-in-russia-rationale-for-action/