Cancer, smoking and taxes

Some 300,000 Filipinos die due to non-communicable diseases (NCDs) each year, comprising about 60 percent of the total annual death toll in the country.

Indeed, while the death toll from infectious diseases like tuberculosis and malaria has been falling, there has been a corresponding “surge” in deaths and disabilities due to NCDs, said Dr. Anthony Leachon, a consultant of the Department of Health.

“People are dying quietly due to NCDs,” remarked Leachon. While these diseases—heart ailments and strokes, diabetes, cancer, and chronic lung illness—are most often described as “lifestyle” diseases ascribed to lack of exercise, a diet rich in fats and sugar, and bad habits like smoking, the reality is “NCD death rates are highest among poor countries in Asia,” he said.

Leachon was joined by other health experts and speakers on related matters at the recent “Cancer Stakeholders Consultative Meeting” called to forge an “Action Plan for Cancer Prevention and Control.”

Dr. Cecille Llave, lead convenor in the country for “Moving as One,” which seeks to gather the various sectors involved in the battle against cancer, said that based on the World Cancer Day Declaration, worldwide efforts today were intended to “reduce the burden of cancer and improve the quality of life of patients with cancer, with a view to reducing cancer deaths by at least 15 percent.”

But while the focus was on cancer, the issues raised in the course of the discussions shed light on the related health, social, financial and even political implications of diseases that are today felling a growing number of individuals.

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Grouped under the classification of non-communicable diseases—because they are not traceable to infections or contact with infected individuals—NCDs are “a major global threat to economic development” and have a major impact on the ability of developing countries to meet the Millennium Development Goals, said Dr. John Go of the local World Health Organization office.

Go cited four “major risk factors” that make an individual susceptible to NCDs: lifestyle, lack of exercise, indulging in liquor, and, most importantly, use of tobacco.

And governments and societies would do well to adopt policies and practices that make good economic sense while reducing vulnerability to NCDs, he said. Among them: decrease tobacco use (by, among other measures, taxing tobacco products to levels that would take these out of the economic reach of the poor and vulnerable, like the young); restrict access to alcohol; ban advertising of alcohol and tobacco products; reduce salt intake; and engage in “massive health campaigns” to get people to exercise more, eat a balanced diet, and avoid tobacco and liquor.

Leachon spoke at length on the pending “sin tax” bill that would rationalize the current tax system levied on tobacco and liquor products. “We need 200 votes in the House” to have the contentious bill passed, he observed, remarking that, with the support of the cigarette and alcohol lobby, the number of legislators softening their support for the “sin tax” had been growing. This is tragic because the “sin tax,” while presented as essentially a revenue measure (it is being heard by the House committee on ways and means), is really aimed at “reducing the number of smokers among the young and the poor,” two sectors of society most vulnerable to NCDs, Leachon said.

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Recently, the House committee on ways and means approved HB 5727 which in essence seeks to restructure the excise tax system on tobacco and alcohol products.

When he spoke before the Cancer Stakeholders meeting, Leachon appeared basically supportive of the Abaya bill, even if this had already been amended with suggestions from the Department of Finance.

However, HealthJustice, a nongovernment organization working on smoking reduction and tobacco control, says there are still many gaps in the legislation, calling to question the impact the proposed measure would have on reducing the number of smokers and drinkers among Filipinos.

HealthJustice sat down with some journalists recently and invited former Health Secretary Alberto “Quasi” Romualdez to shed light on the implications of a proposed “sin tax” bill that may be able to raise revenue for the government, but have little impact on the numbers of Filipinos getting sick and dying each year due to NCDs.

“In the first place, this measure was conceived basically to increase government revenues, only secondly to address the growing health problems brought on by tobacco and alcohol,” said Romualdez.

And in the second place, the bill contains so many loopholes that it may have little, if any, impact on cigarette and alcohol consumption in the long run.

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A briefing document provided by HealthJustice points to the need to align legislation not just with economic needs and ends but also with long-term health goals. In the case of the “sin taxes,” this means measuring the long-term impact on tobacco use reduction, including youth uptake (the number of young people starting the habit), against the short-term gains in revenue.

“The substantial increase in taxes from the current law’s first and second tier tax rates…to meet the third tier tax rate then an increase from P12 to P22 in the first two years would have tremendous impact on lives saved, but this effect will wane in succeeding years,” says the document. “Smokers and the youth will be desensitized with the stable tax/price that will have only marginal increases until 2025. After the first few years of the increase, tobacco consumption will begin to rise again but excise taxes will be untouchable for another 10 years or until 2025.”

Are we just fooling ourselves again?