Economics of tobacco control - Maldives

Abstract

Country situation The Maldives, an archipelago of about 1190 islands, lies in the middle of the Indian Ocean. The population was 269 010 in 2000. Per capita GDP was estimated at US$ 1279 in 1998, twice as high as the regional average, and has grown at an average of 9% for the past 25 years. The Maldives’ social welfare indicators are good compared to most countries with comparable income levels. Adult literacy rate is close to 100%. Infant mortality had fallen to 35 per 1000 by 1995, and the crude death rate to 0.5%. Life expectancy at birth was 72 years in 1998. Cardiovascular and respiratory diseases and cancers are the 3 leading cause of death; they are all linked to tobacco use. Curative and preventive health services are organized into a four-tier system comprising central, regional, atoll and island levels. Services are provided through both public ad private sectors. Tobacco imports and tobacco control Most tobacco products are imported, import volumes are increasing. Cigarettes account for 97% of all tobacco products by quantity. There is very little local tobacco production—just small amounts of bidi and tobacco for hukkah—in the Maldives. Tobacco smuggling is believed to be negligible. There are no specialist tobacco importers or retail outlets in the country. Thus no jobs would be lost if tobacco sales were to fall. Maldivian tobacco control goes back to a 1942 law which banned tobacco product imports for some years. A 1947 bill that was enforced for a period banned smoking by all students and Maldivians under the age of 17, and prohibited smoking in public. In 1984, advertising was banned in government media, and in 1994 a total ban on all forms of tobacco advertisement and promotion was imposed. Smoking was banned in all health care facilities in 1993, and in all government buildings and educational institutions in 1994. Islands declaring themselves tobacco-free may qualify for trophies and cash prizes. In 2000, a large-scale school anti-tobacco programme was initiated by the education sector for the whole country. One tobacco-free island, Madifushi, runs a quit-smoking programme that provides accommodation and food for people who come to the island to quit smoking. This island received a WHO tobacco-free award in 2000. Prevalence and consumption A survey conducted in 1997 showed that 57% of males and 29% of females consumed some form of tobacco, and that smoking prevalence stood at 41%. Prevalence is higher in the outlying islands. Per capita consumption is highest in the 15 – 49 age groups, an d averages 14 cigarettes a day for men and 10 a day for women.

xiv Prices, taxes and government revenue Prices of cigarettes were relatively stable (in nominal and real terms) from 1997 to 2000. In 2000, prices rose steeply but then fell to 40% above the earlier price. Until May 2000, duty on all imported tobacco products was 50% of CIF value. In 2000 the levy for cigarettes only was changed to 30 laari per cigarette (100 laari = 1 rufiyaa) to reduce cigarette price differentials and eliminate trade in cheap cigarettes. The overall effect was positive for revenue and public health: imports dropped and import duty revenues rose by over 50%. Tobacco duty revenues have fallen as a share of all import revenues from around 4% to below 2%. Policy recommendations There should be an annual increase in tobacco prices. The World Health Organization recommends an annual 5% increase in the real price of tobacco products. Tax increases should apply to all tobacco products. The Maldives should consider introducing an ad valorem excise tax to sustain increased tobacco prices. Tobacco control measures should be consolidated and a comprehensive tobacco control law formulated as a foundation for ratification of the Framework Convention on Tobacco Control. The National Tobacco Control Committee needs to be revamped to play a more active role in tobacco control. Surveillance and enforcement need to be enhanced. An assessment of smoking prevalence in the Maldives should be done every five years, as part of the existing regular household surveys. The government should implement a smoking cessation programme. Information, education and communication programmes need further innovation and strengthening. The government should also improve routinely gathered data such as the cancer registry and lifestyle-related disease statistics so that the smoking-attributed burden of disease can be better understood. The government should also consider revising death certificates to include smoking status in order to enhance future research.