Over the past 10 years Russia has made great progress in increasing the life expectancy of its people. Back in the mid-2000s, we documented the dramatic decrease in life expectancy in the post-Soviet period in the report “Dying Too Young,” due especially to high mortality among working-age men. Behavioral risk factors, such high rates of cigarette smoking and alcohol abuse, economic and social dislocation, a shift in the predominant diseases and the deterioration of the health care system, including access to it, all contributed to premature death and a dramatic shrinking of the Russian population that hadn’t been seen since World War II.
At the time, cigarette smoking was singled out as one of the most preventable causes of disease and death in Russia, as it’s associated with higher rates of cardiovascular diseases, many cancers and chronic lung diseases. Survey data in the report showed that smoking prevalence among men stood at 61 percent in 2004, and 15 percent among women.
|Image courtesy Patricio Marquez|
The good news is this has changed dramatically over the past decade. At the Second All-Russia Forum on Public Health, held in Moscow on October 17 to 18, 2018, we presented findings of recent assessments from the World Bank Group (WBG) showing that life expectancy in the country for men increased to 65.4 years in 2016, up from 58 years in 2003. Among women it reached 76.2 years in 2016, up from 72 years in 2003. A big factor for this change has been the effective measures adopted to control the consumption of tobacco and alcohol over this period.
While this is cause for celebration, the Russian government recently set ambitious demographic goals to increase the life expectancy of the population to 80 years by 2030. To achieve this, further efforts will be needed to reduce the persistently high rates of smoking in the country. Russia is the third largest cigarette-consuming nation (after China and Indonesia) and has the highest per capita cigarette consumption rate in the world. Currently 50 percent of adult men are smokers, far above the global average of 30 percent for men. For women, the situation is not much better: 14.5 percent of adult women in Russia smoke--twice as high as the world average.
As we stressed during the Forum last month, global evidence shows that raising tobacco taxes and prices are the single most effective measure for reducing tobacco use and therefore should be a key component of any Russian strategy to achieve the 2030 demographic target. Russia has been working on this. The government adopted a law on tobacco control in 2013 and has raised tobacco excise taxes regularly since 2010,annually increasing the average excise tax burden by at least 30 percent since then.Because of tax and price increases, along with other tobacco control interventions, tobacco sales fell by almost 30 percent over this decade. Not surprisingly, the number of smokers also decreased, by 21 percent between 2009 and 2016.
However, findings of the first WBG assessment we presented at the Forum clearly indicate that tobacco taxes will only continue to reduce tobacco consumption if they increase the price of and reduce the affordability of cigarettes, which can be done by adjusting tax increases for inflation and any rise in per capita incomes. We found that between 2002 and 2008, there was a 22 percent increase in cigarette affordability in Russia, and cigarette consumption increased by 17 percent. By contrast, between 2008 and 2017 there was a 62 percent decrease in cigarette affordability, which was accompanied by a cigarette consumption drop of 34 percent. This is an area Russia can really focus on in its tobacco control efforts, as the country has the most affordable cigarettes among the main tobacco-using countries despite its striking progress in reducing the affordability of cigarettes.
Our other presented findings showed that under different tobacco tax increase scenarios, not only would cigarette consumption decrease, but excise tax revenue would continue to increase. We also showed that the aggregate effect of an increase in tobacco taxes in Russia would be positive and progressive, especially for the poorest groups as they tend to be more likely to decrease cigarette use in the face of higher prices.
Finally, since Russia is part of the Eurasian Economic Union, it’s imperative that a strict minimum excise rate (tax floor) on cigarettes be set for all member countries at a level higher than currently proposed, which is only €30–35 (US$34-40) per 1,000 cigarettes by 2020. The European Union, in contrast, has a mandatory level of €90 (US$103) per 1,000 cigarettes for its member countries.
Russia has made much progress on tobacco control, and the related decrease in cigarette consumption and increase in life expectancy. However, to further improve health conditions and achieve the life expectancy target by 2030, big tax increases, with regular hikes to keep cigarette prices from climbing more steeply than inflation and per capita income growth, should be a priority policy measure in Russia’s overall tobacco control efforts. An added bonus: these taxes can also help increase tax revenue for the country and expand fiscal space for priority investments and programs, including health.
Back from the Cold: Russia Confronts Tobacco
World Bank Group Global Tobacco Control Program