Sin Tax and the Tuberculosis Epidemic

On the 102nd anniversary of the Philippine Tuberculosis Society, Inc. (PTSI), we have chosen as theme, controlling TB by curbing tobacco usage. This theme is most appropriate in light of the recent initiative of both the Executive and the Philippine Congress to pass the sin tax reform.

In a country where cigarettes are among the cheapest in the world, it is no surprise that the number of non-communicable diseases (NCDs) has alarmingly risen.

Let’s talk statistics here.

According to a 2007 World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (The Union), about 1.3 billion people worldwide are tobacco users. Nine hundred million of them are from developing countries, including the Philippines.

The 2009 Philippine Global Adult Tobacco Survey cites a staggering 17.3 million smokers. That’s 28.3% of our population roughly three years ago and chances are, the numbers have already climbed since then.

Today, tobacco is the leading preventable cause of death and accounts for the deaths of one in ten adults around the world. The worldwide death toll is at 4.9 million a year and can escalate to 8 million by 2030. In the Philippines, smoking kills an estimated 35,000 people a year.

Smoking, whether firsthand or secondhand, is one of the leading risk factors of major NCDs, including cancer, heart disease, and respiratory disease. It is also the biggest risk factor for chronic obstructive pulmonary disease (COPD) and lung cancer.

Now, recent studies and reviews of past studies have evidence strongly linking smoking and tuberculosis – a communicable disease that has been a persistent health problem all over the world.

Worldwide, 9.4 million were diagnosed with tuberculosis in 2005 – a number that has continuously escalated over the years. Asia bears the greatest burden with 55% of the 9.4 million. In the Philippines, the Department of Health (DOH) statistics recorded about 114,360 cases and 25,860 deaths.

The studies revealed a strong correlation between the TB and smoking epidemics, whether active or passive smoking, and the specific type of TB outcome.

Compared to non-smokers, current and former smokers are at a greater risk of TB infection. More distressingly, the odds are greater the longer an individual has been smoking or the higher the cigarette consumption.

The same holds true for tuberculosis disease. If infected, active smoking heightens the risk of disease. Moreover, smoking may even worsen the disease’s severity.

Studies also showed a positive association between exposure to secondhand smoke and TB disease, particularly with children. The risk factor escalates even further if we take into consideration close contact and cigarette consumption. Regular exposure substantially increases one’s risk, even without direct contact with TB patients. Tobacco use also augments the risk of death in a TB patient. Nearly 61% of TB deaths are attributed to smoking and one out of five deaths could have been avoided if the patient had not been a smoker. All of these effects are independent of factors such as alcohol use and socio-economic status.

Over the years, we have seen tuberculosis wreak havoc on hundreds of patients and their families. Even worse, treatment of the disease often leaves them in financial disarray when they could have spent their hard-earned money on more essential needs.

The facts are all there: smoking greatly contributes to the risk of both communicable and non-communicable diseases. It is time we put a stop to the diseases that continuously ravage our country.

Contrary to what a few legislators say, education by itself is not enough to address the problem. Many of us, especially the young and the poor, are aware of the dangers of smoking yet they continue to smoke.

The current sin tax law is weak, and has not curbed the increasing number of smokers. In fact it has only served to protect an industry that kills millions. Heavy tax rates for tobacco products, as the Abaya sin tax bill proposes, are the most effective solution. The Aquino tax reform contains the essential features of a high unitary tax, indexation of tax rates to inflation or nominal gross domestic product (GDP), and removal of the price classification freeze. All these are vital to its central goal: health.

Political commitment is essential and if our legislators are truly“for the people” as they claim to be, then they ought to pass the sin tax reform bill soon.
Zeneida Quezon-Avanceña is the president of the Philippine Tuberculosis Society, Inc.
Camilo Roa, MD is the vice-president of the Philippine Tuberculosis Society, Inc. and the Secretary-General of The Union.

 

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