Cigarettes, the increase in prices and its health benefits
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From an economic point of view, it is a “mini-tax”. Evidently essential, however, to allow the Meloni government to keep some of the promises made to Italians: from Quota 103 for pensions to the flat tax, up to measures for the family. From 1 January, according to what is reported in the draft of the budget, the excise duty on cigarettes will rise again. From the first estimates, with the beginning of the new year the cost of a pack of twenty cigarettes will increase on average between 20 and 50 cents.
Heavy smokers could thus find themselves spending between 7 and 15 euros more a month: with a benefit for the state coffers estimated at around one hundred million a year. However, the repercussions could not only be of an economic nature. It may take some time, but such a measure could also lead to health benefits.
Cigarettes: from January an increase of up to 20 euros per month for those who consume one pack a day
In fact, it has been known for some time that the increase in taxation leads to a reduction in cigarette consumption. With a consequent impact on people’s health, since smoking is the cause of over ninety thousand deaths a year in Italy. For this reason, the provision included in the financial maneuver has become an opportunity for discussion also within the scientific community.
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“I don’t think the measure was born out of a health need, but an economic one – he comments George Sesti, professor at the University of Rome La Sapienza and president of the Italian Society of Internal Medicine -. A measure of this type is welcome, even if the fight against cigarette smoking requires long-term investments. The benefits would be even more significant if part of the funds that the State will secure thanks to this increase in excise duty were destined to strengthen the anti-smoking centres, which require more human resources to ensure the success of a process of cessation. Or to the activity of general practitioners, who are the first to make the population aware of the damage that cigarette smoke can cause”. An activity that is almost always sacrificed today, due to the growing shortage of white coats and time smaller that each of them has to devote to the individual patient.
Potential benefits for heart health (and allergies) too
In the last twenty years, several steps forward have been made in the fight against smoking. “This is demonstrated by the progressive decline in smokers recorded in the adult population from the 80s to today – he reasons Cyrus Indolfi, at the head of the hemodynamic cardiology unit of the Mater Domini university hospital in Catanzaro and president of the Italian Society of Cardiology -. But there is still a long way to go, as demonstrated by the growing data among women. Cigarette smoking remains the leading preventable risk factor for premature death from noncommunicable diseases and the cause of cardiovascular incidence and mortality. Which is why, regardless of the reasons behind it, any move capable of determining a decline in smokers is welcomed by the scientific community”.
Opinion he finds in agreement Mario DiGioacchino, number one of the Italian Society of Allergy, Asthma and Clinical Immunology. “All inflammatory diseases worsen with cigarette smoke. This, by damaging the mucous membrane of the airways, can make even those who have not suffered from it up to that moment more sensitive to developing an allergy. The increase in the cost of products of tobacco could have an impact above all on the youngest, who are also almost all of those who develop an allergic disease”.
Positive feedback also from the world of oncology
Next to the cardiovascular one, the main risk represented by cigarette smoke is the oncological one. Over one hundred thousand new cases of cancer and over forty thousand registered each year in our country represent the epilogue of years of smoking. “Eight out of ten lung cancer diagnoses could be avoided if cigarettes weren’t part of our society,” he says. Saverio Cinieri, president of the Italian Association of Medical Oncology -. But in reality, the habit of smoking is the cause of almost all oncological diseases not strictly linked to a genetic mutation. If this measure serves to reduce the number of smokers or in any case of cigarettes smoked, over time it could contribute to a reduction in new cancer diagnoses”. An aspect to reflect on, especially at a time when oncology is in trouble, due to the impact of the pandemic on the health system.
Hence also the relaunch of the Umberto Veronesi Foundation, after the proposal made in Parliament in 2021: to bring the price of a pack of cigarettes to 10 euros to support primary prevention and smoking cessation programs, reimburse anti-smoking therapies (currently paid of patients), fund secondary prevention programs for early detection of smoking-related diseases and independent research.
“Any intervention that mitigates the impact of tobacco products on society is welcome – he adds Elizabeth Iannelli, general secretary of the Italian Federation of Volunteer Associations in Oncology (FAVO) -. Risk awareness is not yet adequate. Many people know that cigarettes cause lung cancer, but they don’t imagine that smoking can also cause other forms of cancer: such as kidney or pancreatic cancer, to name just two examples”.
If the price of cigarettes increases, children will also benefit
What might be the consequences of the increase in the price of cigarettes in Italy can be deduced from an analysis published in the journal of the Italian Association of Epidemiology in 2020.
In our country, the average price of a pack of cigarettes is around five euros. With an extra euro of expenditure, on the basis of the projections formulated in the work, a reduction in exposure and consumption would be determined of close to seven per cent. Lowering these data in the national context, the drop in smokers could amount to around four percent: affecting approximately 250 thousand people. An aspect that is significant for some. For others, too shy.
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What is certain is that children could also benefit from it. According to a study published in “Plos Global Public Health”, a ten percent increase in taxation can lead to a drop in mortality among both children and newborns (between 1.6 and 2.3 percent). This starts from the poorest areas, which are the ones most exposed to damage from (including passive) smoking. Hence the liking of Anna Maria Staiano, president of the Italian Society of Pediatrics. Albeit partial: “We share the measure, which can be a deterrent for many kids who always start smoking earlier. But we ask that the proceeds be allocated to initiatives to prevent and protect the health of children and adolescents”.
Experts: “Also beware of electronic cigarettes and heated tobacco”
The increase in excise duty decided by the government foresees that the cost of cigars, shredded tobacco (the loose form for preparing your own cigarettes), heated tobacco and electronic cigarette liquids (a ten milliliter bottle with nicotine it could cost 1.5 euros more). Measures that could serve “to prevent the number of consumers of these products from continuing to grow: especially among the very young, who should instead keep away from any form of smoking – says Sesti, who directs the internal medicine complex operating unit at the “Sant’Andrea hospital in Rome – The impact on the risk of developing an addiction is similar. As are the recrudescences that are recorded in the forms of asthma, bronchitis and chronic obstructive pulmonary disease”.
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Reflections shared by Fabio Midulla, president of the Italian Society of Childhood Respiratory Diseases. “For adolescents, electronic cigarettes are too often the gateway to traditional cigarettes. The greater revenue deriving from this measure should be used for initiatives aimed at protecting the health of the little ones”.
If there seems to be damage on the oncological front, but of a lesser extent than that caused by traditional cigarettes, cardiologists and allergists are also expressing concern. “The long-term cardiovascular effects of e-cigarettes and heated tobacco remain largely unknown,” summarizes Indolfi. “Allergies manifest themselves above all at a young age: this is why it is necessary to carefully study the impact of these new devices on health”, is Di Gioacchino’s final thought.
Twitter @fabioditodaro
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