Simon Chapman, professor of public health at the University of Sydney, has provided a robust critique of Jennifer Doggett’s recent critique of increased tobacco taxes:

Erstwhile Croakey correspondent Jennifer Doggett has written a piece for ABC-Online challenging the wisdom of  increasing tobacco tax, arguing that it would be regressive and harm the poor (it will “mean they cut back on other essentials, such as food, heating and housing costs.)

I suppose the corollary of this argument is that all caring people should support the lowering of tobacco tax to make it easier for those who smoke most (the poor) to keep on smoking and thus widen even further the smoking caused disease gap between rich and poor. What a perverse way of “helping” the poor while feeling good about social justice.

The poor, along with the young, are the most responsive to tobacco price rises. The heavy smoking Kerry Packer wouldn’t have cared less if he paid $13 a pack or $30, but budget conscious people do.

The responsiveness takes the form of quitting (the poor are quitting at broadly the same rate as the more well off, but from a much higher “ever smoking” prevalence) but also from reducing the amount smoked each day. Between 1980 and  2004, average daily consumption in Australia reduced from 20 (males) and 18 (females) cigarettes a  day to 14 – a 30% decline.

Along the way Jennifer trots out the myth that will not die that “seventy to 80 per cent of people with serious mental illnesses smoke and for people with schizophrenia the smoking rate is 90 per cent”.

A recent metanalysis of all studies of smoking & schizophrenia showed the average smoking prevalence was 62% (range 14-80%) with none topping 90%. (see Chapman S, Ragg M, McGeechan K. Citation bias in the reporting of the prevalence of smoking in people with schizophrenia. Aust NZ J Psychiatry 2009;43:277-82.)

While those with mental illness are under-studied, some evidence suggests that their cessation rates mirror those of the wider community. Yes, they smoke more, but their rate of decline (from a higher starting point) is not dissimilar to everyone else’s.

The only thing one needs to know about why tobacco tax is a the most effective way of bringing smoking down is to look at the tobacco industry’s reaction. Each year, you can set your watch by the predictability of their lobbying.

As Philip Morris put it with such candour as far back as 1983 in an internal memo “the most certain way to reduce consumption is through price”.

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