GAZETTE – May 2025
Lower-income people in Argentina smoke more, die more, get sick more, and see their economy affected more than higher-income people., according to a study that estimated for the first time the health and economic burden of smoking by socioeconomic level. The study, conducted by the Institute for Clinical and Healthcare Effectiveness (IECS), an institution affiliated with the Faculty of Medicine of the University of Buenos Aires (UBA), was released as part of World No Tobacco Day and funded by the Cancer Research Institute of the United Kingdom. See infographic of this work here.
The research also projected that full implementation of the tobacco control measures promoted by the World Health Organization (WHO) could prevent deaths and diseases and save costs for the health system and society in general. The greatest benefits would be reaped by people of low socioeconomic status. Furthermore, these measures provide financial protection for society, preventing a significant number of people from falling into poverty or facing catastrophic health expenses. These measures include: Tax increases, plain packaging, smoke-free environments, and a ban on tobacco advertising, promotion, and sponsorship.
“It can be concluded that Smoking deepens existing economic disparities and, on the other hand, that Measures to control it would generate a redistributive effect towards greater equity", said the principal researcher of this work, Natalia Espínola, Master in Economics, Coordinator of Health Economics in the Department of Health Technology Assessment and Economic Evaluations of the IECS.
HEALTH AND ECONOMIC DISPARITY
For the study, Espínola and his colleagues developed a mathematical model This allows estimating the probability of people becoming ill or dying from each of the main health conditions associated with smoking, adapted for each socioeconomic level. To establish the socioeconomic stratum, the population was divided into five equal parts, or "quintiles," according to their family income. The first quintile was made up of the 20% with the lowest incomes, and the fifth quintile was made up of the 20% with the highest incomes. The analysis confirms that Cigarettes are bad for everyone equally, but they have different impacts depending on the socioeconomic level of the person who smokes them.
In Argentina, it is estimated that 26% of low-income people smoke, compared to 21% of high-income people. This translates into the fact that, among the lowest-income people, Tobacco causes 7% more deaths (11.855 vs. 11.085) and 15% more cases of disease (109.838 vs. 95.405) that those with higher incomes.
Inequality is also evident in the financial burden of smoking on households. The annual out-of-pocket health expenditure associated with smoking is $370.906 Argentine pesos for low-income households and $394.112 Argentine pesos for high-income households. However, the burden generated by this Spending represents more than a quarter (26,3%) of the income of low-income households, while it only represents 3,5% of the income of high-income households.If we add to this the cost in lost work productivity and time spent informally caring for a sick family member, the gap widens: it represents almost 68% of the income of low-income households compared to only 8,4% in wealthier households.
“Tobacco not only makes people sick and kills, but it also makes them poor. People with lower incomes not only get sicker from smoking but also have more barriers to accessing health care, and the disease It most critically affects the sustainability of households themselves", summarized a co-author, Dr. Federico Augustovski, Master of Science in Epidemiology, Director of the Department of Health Technology Assessment and Health Economics at IECS, Adjunct Professor of Public Health at the Faculty of Medicine of the University of Buenos Aires (UBA), and Principal Investigator at CONICET (Argentina).
"Tobacco can have a devastating impact on household finances. In many cases, the costs associated with smoking and the treatment of associated diseases exceed the financial capacity of families, leading them to debt or even poverty. added another co-author, Agustín Casarini, health economist and researcher at IECS.
EFFECT OF CONTROL MEASURES
In a second stage of the analysis, the research team explored the differential effect of fully implementing the strategies recommended by the WHO—tax increases, neutral labeling, bans on advertising, promotion and sponsorship, and smoke-free environments—and found that The benefits would be greater in lower socioeconomic groups.
For example, increasing the price of cigarettes by 50% through taxes and implementing neutral labeling would prevent approximately twice as many deaths and illnesses in this stratum compared to those estimated in higher-income groups. Both measures, taken separately, would also result in savings in out-of-pocket expenses relative to income being 14 times greater in the less-advantaged socioeconomic groups.
Tobacco control measures also have a strong financial protection aspect for households. The implementation of tax increases, neutral labeling, advertising bans and smoke-free environments would prevent 144.398, 60.847, 32.717 and 56.523 cases of catastrophic health spending* and would prevent 14.335, 4.695, 3.807 and 6.879 people from falling into poverty due to out-of-pocket expenses associated with tobacco-related illnesses, respectively.
"If WHO tobacco control measures were fully implemented, the entire population would benefit, but those with lower incomes would benefit most, reducing social gaps.", said Espínola, who is also a professor of the Master's degree in Clinical Effectiveness taught at the School of Public Health at the University of Buenos Aires (UBA).
*Catastrophic spending is spending on medical care that exceeds a critical threshold of family income (usually 10% to 40%), jeopardizing the family's ability to cover other basic needs.
ABOUT IECS:
The IECS is an independent academic institution dedicated to research, education and technical cooperation in health. Founded in 2002, it is an institution affiliated with the Faculty of Medicine of the University of Buenos Aires (UBA) that is home to a CONICET executing unit, a WHO Collaborating center and a Cochrane Center.
The mission of the IECS is “to contribute to improving global health, generating and promoting the application of the best scientific evidence.”
In 2018, the IECS was honored by the WHO for its work against the tobacco pandemic in Latin America. See here
See institutional video here Visit institutional website at: www.iecs.org.ar
IECS PRESS CONTACT: Lic. Mariana Comolli, mcomolli@iecs.org.ar