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Genuine Progress Index for Atlantic Canada Indice de progrès véritable - Atlantique The Cost of Tobacco in Nova Scotia: An Update Tobacco Control Summit, Halifax, NS 20 October , 200 6. The larger context – GPI : - PowerPoint PPT Presentation
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Genuine Progress Index for Atlantic CanadaIndice de progrès véritable - Atlantique
The Cost of Tobacco in Nova Scotia: An Update
Tobacco Control Summit, Halifax, NS
20 October, 2006
The larger context – GPI: 1)Tobacco, sickness as costs vs. $300m/yr
on tobacco + $168m sickness = make GDP grow
2)GPI Question: Creating a healthier NS? – 2000-06 – Are we getting healthier, making genuine progress?
To answer this question, what does the evidence
show:1. Then and now: Smoking since 2000 GPI report
2. Then and now: SAM & Costs - Why the Lag?
3. What has made the most difference?
4. Where to from here? – Effects of tobacco control investment on SAM and costs
5. Lessons for health promotion
1) Then… and Now… Smoking Prevalence, 15+,
2000
10
15
20
25
30
35
CAN NL PE NS NB QC ON MB SK AB BC
%
2000: Smoking kills 1650/year = 21% of all deaths
in NS
• NS - highest rate of deaths from cancer and respiratory disease in Canada
• 2nd highest circulatory deaths, diabetes
• Highest use of disability days
• Highest smoking rate in Canada (30%) – 25% higher than Can., 50% above BC
Then: Smoking Prevalence, Age 15+, 2000
24
2826
30
27 28
23
2628
23
20
10
15
20
25
30
35
CAN NL PE NS NB QC ON MB SK AB BC
%
Now: Smoking Prevalence, Age 15+, 2005
1921 20 21 22 22
16
22 22 21
15
10
15
20
25
30
35
CAN NL PE NS NB QC ON MB SK AB BC
%
Nova Scotia: Smoking Prevalence, Age 15+, 1999-
2005
15
17
19
21
23
25
27
29
31
1999 2000 2001 2002 2003 2004 2005
%
Cigarette Sales in NS, 1991-2005 (down 35% since ’96)
(consumption/risk)
800
9001,000
1,1001,200
1,300
1,4001,500
1,600 millions
Smoking rates Canada and NS, Age 15- 24
15
20
25
30
35
1999 2000 2001 2002 2003 2004 2005
%
CANADA NS
% Decline in Smoking: Can and NS, Ages 15-24 and 25+
(1999 to 2005)
05
1015202530354045
CAN NL PE NS NB QC ON MB SK AB BC
%
15-24 25+
2) 2000 – Costs of Smoking
• Chronic diseases cost NS $3 billion/yr (direct + indirect) = 13% GDP – huge burden
• Good news: 40% chronic disease; 50% premature death; $500 m./yr health care costs avoidable = small # risk factors -> OHP
• Tobacco – single largest preventable cause of death and sickness = $168m. in health care costs + $300m. In indirect costs +ETS costs
2006 Costs of Tobacco (preliminary estimates)
• 1,730 deaths (up from 1,650); $220 million health care costs + $550 million indirect costs (up since 2000 despite decline in prevalence)
• = Due to ‘backlog’ of older ex-smokers (former high smoking rates) + female lag
• Health Canada: Despite declining prevalence, SAM = 38,357 (1989), 45,000 (’96), 47,581 (’98)
• US: Lung cancer peaked early 90s despite drop in cig consumption: 3800 (1965) – 2800 (1993)
But benefits will accrue: Time lag (ACS study of 1
million)• 2-4 years: lung cancer death risk down - ex-
light smoker = 2/3; ex-heavy smoker = 13%; 5 years: ex-light smoker risk = non-smoker; ex-heavy smoker down 50%
• CHD death risk: ex-light smokers = down 50% in 5 years; 100% in 10 years; Ex-heavy smokers much longer = down 1/3 after 7 years; down 2/3 after 10+ years
• COPD – much longer, no return to normal
Lung Cancer Risk
0
0.2
0.4
0.6
0.8
1
1.2
1 2 3 4 5 6 7 8 9 10 11 12 13
Years since Quitting
Exce
ss L
ung
Canc
er
Ris
kLess than 20 cigarettes a day 20+ cigarettes a day
Chronic Heart Disease Risk
0
0.2
0.4
0.6
0.8
1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Years since Quitting
Exce
ss R
isk
of C
HD
Less than 20 cigarettes a day 20+ cigarettes a day
47,121
25,842
77,697
45,118
79,300
132,280
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
Costs Savings Costs Savings Costs Savings
$
Lifetime smoker costs and cessation benefits,
NS
LIGHT MODERATE
HEAVY
3) Key changes since 2000
• BMJ + World Bank: Cigarette taxes = “single most effective intervention” to reduce tob. demand
• 10% increase in price -> 4% drop consumption -> 7% drop among youth, pregnant women
• NS price more than doubled since 2000; Consumption dropped by more than 30%
• NS tax: $9.64/carton = 2000 -> $31.04 (2004); Prov tax revenue more than doubled = $76m in 1999-2000 to $162m in 2003-04
-0.83
-0.52
-0.37
-0.2
-0.1
-0.9-0.8-0.7-0.6-0.5-0.4-0.3-0.2-0.1
015-17 18-20 21-23 24-26 27-29
Age
Pric
e El
astic
ityPrice Elasticity by age
38.97 38.79
54.92
49.47
59.59
53.66
32.58
37.2
47.46
53.3
253035404550556065
Pri
ce p
er C
arto
n ($
)Cigarette Prices – US &
Canada, 2000
63.58
78.8884.89
38.7938.9732.58
37.20
53.30
80.3471.67
25
35
45
55
65
75
85
95
Quebec N.B. N.S. P.E.I. Nfld.
Pri
ce p
er C
arto
n (
$)
2000.00 2006.00
Cigarette Prices, Selected Provinces
25
35
45
55
65
75
85
95
BC AB SK MB ON QC NB NS PE NL
Pri
ce p
er C
arto
n ($
)
1997 2006
Cigarette Prices
0%
20%
40%
60%
80%
100%
120%
140%
BC AB SK MB ON QC NB NS PE NLPer
cen
tage
cha
nge
, pri
ce fo
r ca
rton
of c
igar
ette
s% Change in Cigarette
Prices, 1997-2006
Other actions since 2000
• Smoke-free act - associated with 14% drop in prevalence; 25% drop in consumption
• Comprehensive tobacco control strategy - up 4x: $500,000 (2001-02) ->$1,960,000 (2003-04) + coordinated: OHP – DHPP
• Education: Package warnings; display bans; media campaign; school-based programs + Youth access denial + workplace programs
• Quit aids: Counselling/help line/support groups
4) Where to from here? Complacency or build on
success? • NS smoking rate = 21%; BC = 15%; Calif = 14%
• California Proposition 99 (1988); raised prices by 25c/pack; earmarked 25% of new revenue for tobacco control program
• Results: 50% drop in consumption = 50% faster than rest of US; 25% drop in prevalence; decline in lung and bronchus cancer = 3x US average; est. 33,000 fewer deaths from heart disease
Economics of tobacco control: All studies show
high ROI• Cal. saves $3 for every $1 on tobacco control
• Mass saves $2 in health care costs alone for every $1 spent on tobacco control
• School-based prevention = 15:1; physician advice = 12:1; prenatal counselling = 10:1; media advertising = 7:1; counsel/NRT = 3-4:1 (doubles quit rates)
• $1 per capita increase in education spending ->20% prevalence decline (BMJ)
Is NS tobacco control adequate?
• NS still 1 billion cigs/yr = 1 pack for every Nova Scotian – can reduce by 1/3 to Calif. rates
• NS collects $162m in tobacco tax revenues; spends 1.2% of that on tobacco control = $2pp
• CDC int’l best practices = $8-$23Cdn pp small states (<3m) = $7.5 m - $21.5 m in NS
• At min. CDC level, OMA estimates $90m Ontario program will reduce prevalence 15%, save $1.3b in health care, and add $2.4b sales and inc. tax (prod. incr), + $7.5b tobacco taxes
Estimated benefits of best practice strategy
• OMA = $3 saved in avoided health care costs for every $1 invested + $6 in sales, income tax (not count tob. tax revenue)
• If prevalence drops 20% then = 12:1 + Would save 116 NS lives/yr by year 5; 300+ lives/yr by year 10; 500+ lives/yr by year 15 + 26,000 avoided hosp. Days
• To justify $7.5m NS investment, using only health care savings as benefit, program need only induce 5% Nova Scotians to quit
+ Benefits to employers
• Empirical research using 10 objective measures of productivity shows ex- smokers = 5% more productive than current smokers
• Conference Board of Canada = Smoker costs employer $2,280/year more than non-smoker =$250m/yr in NS (smoke breaks, absenteeism)
• Extrapolating from OMA Ontario results - productivity gains from $7.5m NS program -> add $177m in higher income and sales taxes over program duration
10% fall in prevalence
15% fall in prevalence
20% fall in prevalence
Livessaved
Avoided hosp. days
Livessave
d
Avoided hosp. days
Livessaved
Avoided hosp. days
Year 5 56 3005 87 4,507 116 6,010
Year 10 154 8,035 232 10,539 309 16,069
Year 15 251 13,103 377 19.655 502 26,206
OMA: “The province is not forced to choose between social spending and responsible fiscal
management – it can accomplish both goals through one policy.”
5) Applying the lessons to other health promotion
strategies• Build on, expand success – comprehensive
program works; values change. E.g. CDC found cig sales drop 2+x as much in states with comprehensive programs cf US av.
• -> Comprehensive health promotion program = no smoking, healthy eating, healthy weights, physical activity
• + attention to social determinants. E.g. CDC found 10% price increase = low-income smokers 4x more likely quit cf higher-income (E.g. St Henri, Montreal)
Can: Smoking Down, O’wt+Obese Up BMI>25: Can = 48.9%, NS =
56.5%
0
510
1520
25
3035
40
1985 1990 1995 1997 1999 2001 2003 2005
smok
ing
prev
alen
ce (
%)
0
10
20
30
40
50
60
obes
ity
prev
alen
ce (
%)
smoking obesity
NS - Smoking Down, Obesity Up BMI>30: NS = 20.7%, Can
= 15.5%
15
1719
2123
25
2729
31
1999 2001 2003 2005
smok
ing
prev
alen
ce (%
)
15
1617
1819
20
2122
23
obes
ity
prev
alen
ce (%
)
smoking obesity
Costs of other risk factors
• RAND Health study found obesity costs for first time have passed smoking costs in US
• NS: Obesity and physical inactivity kill more than 1,000 Nova Scotians/ yr; diabetes up; cost NS health care system $150m+/yr + cost economy $250m+/yr productivity loss
• E.g. GPI estimate that 10% drop in physical inactivity would save 50 lives/year, $7.5m in avoided health care costs + $17.2m in economic productivity gains
As with comprehensive tobacco control program:
• DHPP school healthy eating program very positive. Now supplement with:- price measures (Brownell),- labelling (Finland), - education (Singapore – reduced youth
obesity by up to 50%), - regulatory mechanisms- media campaign, - physician advice, counselling etc.
Comprehensive tobacco control and health
promotion strategy will create a healthier Nova
Scotia for our children –
Genuine Progress Index for Atlantic CanadaIndice de progrès véritable - Atlantique
www.gpiatlantic.org