ABSTRACT
Background: Higher taxes are the single most effective way to encourage tobacco users to quit tobacco use and prevent youth from initiation. Objectives: The present study aims to estimate the effect of raising the tax on smoked tobacco products on its consumption and smoking‑attributable deaths in India. Materials and Methods: A mathematical model was developed which used the projected population of India, taxation rates on smoked tobacco products, smoking prevalence, and price elasticity of demand of cigarette and bidi from 2017 to 2025. Four scenarios of tax increment (0%, 25%, 50%, and 100%) on smoked tobacco products were created which were modeled to calculate smoking prevalence and smoking‑attributable deaths due to respiratory diseases, heart diseases, stroke tuberculosis, and cancer in country till 2025. Results: A relative decrease of 6.2% in the prevalence of smoking was observed between the existing tax rates and its increment to 100% over the last increment of 6%. Similarly, smoking‑attributable deaths (SAD) decreased by 6.04% on increasing the tax rates to 100% of the existing taxation rates. There has been a steady increase in SAD in scenario 1 which decreases effectively in scenario 4, which in turn leads to the saving of around 33,000 lives due to tobacco‑related diseases by 2025. Conclusion: The consumption of cigarettes and bidis can be reduced by raising the price of these products. The model will help policymakers in deciding to fix the tax and ultimately the price of cigarettes and bidi to reduce its consumption and smoking‑attributable mortality.
ABSTRACT
Background & objectives: Numerous studies have highlighted the regressive and immiserating impact of out-of-pocket (OOP) health spending in India. However, most of these studies have explored this issue at the national or up to the State level, with an associated risk of overlooking intra-State diversities in the health system and health-seeking behaviour and their implication on the financial burden of healthcare. This study was aimed to address this issue by analyzing district level diversities in inequity, financial burden and impoverishing impact of OOP health spending. Methods: A household survey of 62,335 individuals from 12,134 households, covering eight districts across three States, namely Gujarat, Haryana and Rajasthan was conducted during 2014-2015. Other than general household characteristics, the survey collected information on household OOP [sum total of expenditure on doctor consultation, drugs, diagnostic tests etc. on inpatient depatment (IPD), outpatient depatment (OPD) or chronic ailments] and household monthly consumption expenditure [sum total of monthly expenditure on food, clothing, education, healthcare (OOP) and others]. Gini index of consumption expenditure, concentration index and Kakwani index (KI) of progressivity of OOP, catastrophic burden (at 20% threshold) and poverty impact (using district-level poverty thresholds) were computed, for these eight districts using the survey data. The concentration curve (of OOP expenditure) and Lorenz curve (of consumption expenditure) for the eight districts were also drawn. Results: The distribution of OOP was found to be regressive in all the districts, with significant inter-district variations in equity parameters within a State (KI ranges from ?0.062 to ?0.353). Chhota Udepur, the only tribal district within the sample was found to have the most regressive distribution (KI of ?0.353) of OOP. Furthermore, the economic burden of OOP was more pronounced among the rural sample (CB of 19.2% and IM of 8.9%) compared to the urban sample (CB of 9.4% and IM of 3.7%). Interpretation & conclusions: The results indicate that greater decentralized planning taking into account district-level health financing patterns could be an effective way to tackle inequity and financial vulnerability emerging out of OOP expenses on healthcare.
ABSTRACT
Despite the high prevalence of Smokeless Tobacco (SLT) in India, cost-effective interventions to curb smokeless tobacco use are very low. Taxation is considered as one of the most cost-effective intervention to curb overall tobacco use but taxation on SLT product is very complex and is on ad-valorem basis. Further, Goods and Service Tax has increased the price from 0.8/gram to 1.06/gram, but still the impact of increasing the tax needs to be explored so that harmony between excise revenue generated from these products and decrease in demand of these products can be maintained. Therefore, we carried out a literature review, which involved literature search, data extraction, and synthesis. The evidence suggests that the price elasticity of SLT products has gone closer to the inelastic nature with the passing time suggesting the increasing affordability of these products. The macroeconomic impact of the disease burden resulting from these SLT products is far greater than excise revenue generated by these products. More research is required in this field with updated data. The agricultural aspect of SLT products also need to be explored to determine cost-effective alternative crops for tobacco farming. Also, as the use of SLT is culturally accepted in India, appropriate public awareness program and cost-effective interventions are required to curb SLT use along with increased tax and cessation services.
ABSTRACT
Anthropometric data of 2466 children in Haryana revealed low sensitivity (6.9%) and positive predictive value (14.3%) of Mid-upper Arm Circumference (MUAC) at 115 mm cut-off for identifying Severe acute malnutrition (SAM). This raises concerns regarding the reliability of MUAC as a screening tool to identify SAM at the community-level.