Impact of Policy

Impact of Existing and Future Tobacco Control Policies

Raising excise taxes is the most cost-effective measure to reduce tobacco consumption.

Other measures include advertising bans, plain packaging, and smoke-free public places.

A 10% increase in the price of tobacco is expected to decrease consumption by 6% to 8% in South Africa.

In 2019, 65% of the world’s population was covered by at least one tobacco control measure, compared to only 15% in 2007.

This page considers the various types of tobacco control measures used by governments around the world and presents estimates of their effectiveness in reducing tobacco use. It examines how increasing excise taxes influences tobacco consumption, shows that tobacco costs the South African economy more than it contributes, and presents examples of how illicit trade and tobacco industry interference counter the gains made by tobacco control measures in reducing tobacco consumption.

A one page fact sheet with the key information from this page is available here.

To learn more about the data and methods used in this page, click here.

Breaking News

On 1 June 2023, the South African Treasury will introduce an excise tax on e-cigarettes. This tax will be implemented at a rate of R2.90 per millilitre, irrespective of nicotine content of e-cigarettes.

Despite substantial opposition from the vaping and tobacco industry, the government will implement this excise tax, at a rate which is one of the highest in the world. With the positive developments on the taxation of e-cigarettes, there is renewed hope that there will be progress on the Control of Tobacco Products and Electronic Delivery Systems Bill during 2023. Read more about policy related to e-cigarettes here.

Excise taxes are the most cost-effective measure to reduce tobacco use.

Excise Taxes Defined

Excise Taxes Defined

Excise taxes are levied on producers or suppliers and can be applied as a percentage of the total cost of a package (ad valorem tax), a fixed amount per quantity (specific excise tax), or a combination of the two. Producers typically pass the tobacco excise tax on to their consumers by raising prices, which, in turn, lowers demand. Note that if the excise tax rate does not adjust with inflation, the value of the tax declines in real terms, which could lead to an increase in tobacco consumption. Therefore, it is important to increase the excise tax rate on a regular basis – just to keep up with inflation.

Excise Taxes in South Africa

Excise Taxes in South Africa

South Africa’s excise tax is levied as a specific tax. For the 2021/2022 financial year, the excise tax was R18.78 per box of 20 cigarettes.

The excise tax burden (i.e. excise tax as a percentage of the retail price) is targeted at 40%. The total tax burden is expressed as a percentage of the retail price of the most popular brand.

While 40% is higher than some other developing countries, it is below the 70% level recommended by the WHO.

Excise Taxes

and Tobacco Consumption

In all countries, as tobacco prices increase, tobacco consumption falls.

This is true both for intensity of use (quantity of tobacco consumed per day) and for overall prevalence (number of people that use tobacco).

This effect is driven by fewer people initiating smoking and higher numbers of people quitting. The rate that consumption falls as price increases varies by country. On average, poorer countries see a larger drop in consumption for a given price increase (i.e. greater price sensitivity).In developing countries, a 10% increase in price is expected to decrease consumption by 4% to 8%.

In a sample of 24 African countries, a 10% increase in tobacco excise tax was shown to decrease the prevalence of smoking by between 2.6% and 3.6%.

In South Africa, a 10% price increase is expected to decrease consumption by 6% to 8%.

Consumer behaviour varies by brand. IA 10% increase in price reduces cigarette consumption by 4.3% for the economy brands and 6.9% for the mid-price brands.

Beyond the effect on cigarette consumption and prevalence, tobacco excise taxes have been shown to boost economic growth both in the short and long terms, especially through its effect on population health.

South Africa should increase excise taxes further to increase cigarette prices and thereby reduce consumption and increase government revenue. South Africa has lower average cigarette prices than many neighbouring countries. For example, cigarette prices are 65% higher in Botswana, 37% higher in Lesotho, and 4% higher in Namibia.

Excise Rate per Cigarette Pack

Retail Price per Cigarette Pack

Legend:

Total cost per cigarette pack (20) in 2016 Rands.

Excise tax per cigarette pack (20) in 2016 Rands.

Source: REEP & AMPS data. TCDI analysis

Official cigarette consumption

Cigarette consumption accounting for consumption from illicit cigarettes

Note: Between 1961 and 2001, the dark red line represents both the official and total consumption of cigarettes, as data to differentiate between official and total consumption only exist after 2002.

Legend:

Annual total cigarette consumption (millions of packs).

Annual official cigarette consumption after 2002 (millions of packs).

Source: REEP & AMPS data. TCDI analysis

The above charts plot changes in cigarette excise taxes, prices, and consumption between 1961 and 2018. The data shows the following trends:

Chart 1 shows that as the excise tax rate increased from the early 1990s to 2004, prices rose. Over the same time, consumption decreased (Chart 2).

Despite a continued increase in both tax rate and price between 2004 and 2009 (Chart 1), total consumption and official consumption remained roughly constant (Chart 2), primarily because South Africa experienced rapid economic growth during that time and the resulting increase in average incomes balanced out the effect of rising prices.

From 2010 onward, both the tax rate and the price of cigarettes essentially remained constant (Chart 1). However, it is at this point that we see a growing divergence between total consumption and official consumption (Chart 2). On average, from 2010 to 2018, official consumption fell while total consumption remained essentially constant.

The divergence between official and total consumption is explained by the expansion of the illicit trade in cigarettes in the 2010s, especially from 2015 onwards, largely due to weakening enforcement capacities at the South African Revenue Service (SARS).

Read more here on how the charts were calculated.

The Tobacco Excise Tax Simulation Model (TETSiM) is a simulation tool that quantifies the likely impact of a change in the excise tax on cigarette consumption, government excise revenue, and cigarette prices.

The South African TETSiM presented below was developed by the Research Unit on the Economics of Excisable Products at the University of Cape Town. It takes into account the characteristics of the South African tobacco market, for instance that South Africa has a uniform specific excise tax structure (i.e. the excise tax is the same for all cigarettes, irrespective of price, brand, or other product features). The model has 100 separate simulations from a 1% increase to a 100% increase in a tax amount. Read more about how the model works here.

The charts below display three estimated outcomes for each percentage increase in excise tax:

Consumption of cigarettes by consumers,

Excise tax revenue for the government, and

Cigarette retail price.

Exact cigarette prices after excise tax changes are difficult to predict. The charts therefore display a range of estimates, which range from a conservative to an extreme scenario.

In the conservative scenario, it is assumed that the tobacco industry will increase the cigarette retail price by less than the tax increase

In the extreme scenario, it is assumed that the tobacco industry will increase the cigarette retail price by more than the tax increase

The TETSiM visualisation below shows the simulated decrease in cigarette consumption for various excise tax increases. The higher the excise tax, the fewer cigarettes will be consumed.

Simulated cigarette consumption after tax change

View consumption by:

Number of cigarette packages

Consumption change (%)

Source: Research Unit on the Economics of Excisable Products (REEP), University of Cape Town

The TETSiM visualisation below shows the simulated increase in the excise revenue that government collects at various excise tax increases. The higher the excise tax on cigarettes, the greater the government revenue collected.

Simulated excise revenue after tax change

Source: Research Unit on the Economics of Excisable Products (REEP), University of Cape Town

The higher the tax per pack (and hence the retail price), the more cigarette consumption decreases, and the more revenue the government collects.

The TETSiM visualisation below shows the simulated change in the level and composition of the retail price for the most popular cigarette brand at various excise tax increases. It is assumed that a “perfect shift” (meaning the tobacco industry increases the retail price by exactly the same increase as the increase in excise tax). The higher the excise tax, the higher the price of cigarettes.

Simulated cigarette price breakdown after tax change

Perfectshift scenario

Net of Tax

Excise Tax

VAT Amount

Source: Research Unit on the Economics of Excisable Products (REEP), University of Cape Town

How does the model work?

The model uses what is known in economics as the “price elasticity of demand” to estimate how a change in the excise tax rate or structure (and ultimately, a change in the retail price of cigarettes) will affect the consumption of cigarettes. These changes will in turn cause a change in government revenue, tobacco industry revenue, etc. The model also uses the concept of “cross-price elasticity of demand” to estimate how an increase in the price of one brand of cigarettes will impact the consumption of a cheaper brand of cigarettes. Read more about the TETSiM methodology and assumptions.

Click on the images below to read more about the impact each measure has had on smoking prevalence in various countries around the world.

Packaging and Warnings

Packaging and warnings

Plain packaging (or standardised packaging) of tobacco is a policy that removes the promotional, marketing, and advertising features on packs of tobacco but leaves the text health warnings and tax stamps required by the government. Graphic health warnings go a step further and include pictorial evidence of the harmful health effects that tobacco can have, such as throat cancer, heart disease, and blindness.

By 2018, 78 countries (representing almost half of the world’s population) were implementing packaging legislation in line with best practices, including printing warnings in the local language that covered at least half of the pack on both the front and back with images and text.

South Africa is currently behind the curve in terms of cigarette packaging legislation, with the law requiring only 15% of the front and 25% of the back of the pack to display a warning, and no graphic health warnings are required.

Evidence from multiple countries indicates that graphic health warnings are more likely to be noticed and are more effective in communicating the health risks of tobacco use than text warnings alone.

They are also more likely to encourage smokers to quit and motivate ex-smokers to continue to abstain.

For example, in a survey in 2008 in the EU, respondents from all countries indicated that pictorial warnings were more effective than text-only warnings.

Surveys carried out in a diverse range of countries – Brazil, Canada, Singapore and Thailand – found similar results on the effects of pictorial warnings:

• A majority of respondents in each country reported increased awareness of the health effects.

• Between 28% and 67% of respondents across countries reported that the warnings increased their motivation to quit or to reduce their consumption.

• 27% of respondents in Canada and 14% of respondents in Thailand changed their smoking behaviour to reduce the harm to those around them.

The introduction of pictorial warnings has also been found to increase the usage of cessation hotlines. In Brazil, in the six months following the implementation of graphic health warnings and of information on toll-free quitlines on tobacco packaging, calls to these numbers increased by 800%.

In Australia, pictorial warnings on cigarette packages, information about a smoking cessation hotline, and targeted television commercials were introduced in 2006. The policy reduced smoking rates among adults aged 15-50 by around 4% within the first year of the policy. The effect was found to be permanent.

Ban on Tobacco Advertising, Promotion and Sponsorship

Globally, setting regulations around tobacco advertising, promotion, and sponsorship (TAPS) is a public health priority and is detailed extensively in Article 13

of the WHO Framework convention on tobacco control (FCTC).

South Africa is a signatory of the FCTC and has strict domestic TAPS regulations through the Tobacco Products Control Amendment Act of 1993.

The Act prohibits direct and indirect advertising and promotion of tobacco products on TV, radio, newspapers, pamphlets, and the internet.

Evidence on the link between TAPS and smoking is contested. While public health advocates argue that advertising increases consumption and that it therefore should be banned, the tobacco industry has drawn on findings that fail to find such a relationship and argue that advertising only affects the market share of each brand rather than the total market for cigarettes.

A review study that considered all research on this policy concluded that tobacco advertising increases the consumption of tobacco and that a TAPS ban can be effective at lowering consumption – but only if it is comprehensive.

Partial bans are ineffective as they typically result in advertising being redirected from one type to another without reducing the total level of advertising.

However, the ever-evolving and relatively unregulated nature of digital media (including the internet, social media, and smartphone apps) has allowed the tobacco industry to potentially engage users with questionable TAPS tactics (examples detailed below). Updated TAPS regulations for digital media are needed – this is particularly urgent since adolescents are exposed to substances (including tobacco) more via digital media compared to traditional media.

Whilst there is limited South African- or African-specific research on this, there is no reason to think these global trends would not be applicable in South Africa.

Examples of TAPS in digital media include:

“Pro-tobacco” websites and branded websites:

A study examining 12 global tobacco brand websites (for cigarettes, cigars/cigarillos, smokeless tobacco, and e-cigarettes) found just under half (42%) of the websites did not require online registration before entering.

E-cigarette websites were more likely to use click-through age verification (a less stringent means of checking users’ age) than the other tobacco types.

This highlights the importance of enforcing registration and stringent age verification for such websites that advertise tobacco products.

A nationally representative study in the USA found that of 13,651 youth (between 12–17 years old), only 2.3% had ever visited a tobacco company website.

However, those who had were three times more likely to have used cigarettes and e-cigarettes in the past month, compared to youth who had not visited a tobacco website. After visiting tobacco company websites, youth who had previously never used tobacco were 2.4 times more likely to be susceptible to smoking cigarettes and 2.9 times to e-cigarettes.

Smartphone applications (apps):

Whilst there is limited research from South Africa or Africa on tobacco apps, in Korea in 2017, the Google Play store had a total of 392 pro-smoking apps with content on cigarettes, e-cigarettes, nicotine, cigars, and hookahs.

This included information on how to make tobacco, places where smoking is permitted, and games to simulate smoking behaviour.

An example of such an app is Vaffle, freely available on the Google Play app store and, according to Vaffle, available in 178 countries with an estimated 1,500,000 users.

Vaffle contains a “Vape Tool” for how to set up your vape, chat rooms to connect with other users, product reviews, and vape tricks.

Despite Apple banning all 181 vaping apps in 2019 from their App Store, Google has yet to follow suit.

Influencers:

In South Africa, the tobacco industry is prohibited from advertising or promoting products. However, there are documented incidents of the tobacco industry “collaborating” with social media influencers – people who have large followings and engagements of digital users. This creates a legal conundrum.

For example, in 2019, Philip Morris South Africa sent Metro FM talk show host Pearl Modiadie on an all-expenses paid trip to Italy.

In exchange, Modiadie published approximately 20 Instagram stories discussing the advantages of Phillip Morris products. These posts reached her 2+ million followers.

In the same year, a leaked contract revealed that tobacco companies paid influencers to do their “market research” in South Africa.

This involved influencers attending social events with various boxes of British American Tobacco (BAT) brands to chat with other party-goers about their assigned brand. The choice to hire influencers rather than anonymous, trained field researchers to conduct this research has been questioned, as these influencers are now associated with the brand and pro-tobacco consumption in general.

YouTube:

YouTube has 122 million active global users daily

and was cited by young people in the USA as their favourite website in 2015.

Concerningly, research has highlighted a variety of pro-tobacco messages across the platform.

For example, a content analysis of 46 YouTube videos of e-cigarettes and vapes found that only four videos (9%) required age verification and six (15%) featured health warnings.

In 43 (93%) of the videos, e-cigarettes were depicted as positive; the other three (7%) were neutral.

Tobacco-Free Public Places

In South Africa, smoking is prohibited in many public spaces (as regulated through the Tobacco Products Control Amendment Act of 1999 which amended the Tobacco Products Control Act 83 of 1993). Although anti-tobacco advocates called for a comprehensive ban on smoking in hospitality establishments in the late 1990s, the National Department of Health faced pressure from the tobacco industry and the Federated Hospitality Association of South Africa and therefore agreed to dedicated smoking areas of up to 25% of the restaurants’ floor space.

In the Control of Tobacco Products and Electronic Delivery Systems Bill (2018), it is proposed that public spaces should be tobacco-free, which would mean that, by law, all indoor workplaces and public places are 100% smoke-free. These places include restaurants, cafes, bars, and casinos. Tobacco-free public spaces have the dual benefits of a) protecting non-smokers from the harms of second-hand smoke and b) contributing to reducing smoking prevalence. It makes it clear that non-smoking is the norm and that the health of the non-smoking public is protected.

Three years after a smoking ban in workplaces, restaurants, and bars was implemented in the USA, hospital admissions for adults aged 65 and older dropped by 20%–21% for acute myocardial infarctions (heart attacks) and 11%–15% for chronic obstructive pulmonary disease.

This shows strong evidence of the health benefits of enforcing tobacco-free areas. Furthermore, the more locations in which the ban was enforced and the longer the ban had been in place, the greater the impact.

Other studies have shown that tobacco-free workplaces lower smoking prevalence. A study using data from Europe, USA, and Canada showed that employees who worked in places that maintained or implemented smoke-free policies were almost twice as likely to stop smoking as employees who worked in places that allowed smoking everywhere.

In South Africa, a 2004/2005 study looked at the effect of the Tobacco Products Control Amendment Act of 1999 and concluded that restaurant revenues were either unaffected or slightly positively affected by the policy.

More recently, in 2016, a survey of 2,000 nationally distributed restaurants in South Africa found that two-thirds of the sample supported a move to make restaurants 100% smoke-free. Of the restaurants surveyed, 44% had outside smoking sections, 11% had inside smoking sections, 1% allowed smoking anywhere (which is illegal), and the remaining 44% were 100% smoke-free. Of the restaurants with smoking sections, just one-third said these areas were busier than the non-smoking areas.

A common argument made by the tobacco industry is that smoke-free policies negatively impact the hospitality industry. However, a review of 97 studies in developed countries found that the only ones that reported a negative effect were those funded by the tobacco industry. Those not funded by the tobacco industry found that smoke-free laws had either no impact or a positive impact on sales or employment.

R42 Billion

In South Africa, the economic cost of smoking was estimated at R42 billion in 2016.

This includes total healthcare costs (R14 billion), the cost of productivity loss (R369 million), and the cost of premature death (R28.5 billion).

Conversely, over the 2016/2017 period, the tobacco industry generated just R12 billion in excise taxes, which is about 1% of total government revenue. This means that the economy loses R3.43 for every R1 raised from tobacco tax revenue.

The economic cost of tobacco (R42 billion in 2016) could:

Build approximately 250,000 Reconstruction and Development Programme (RDP) houses.

Pay approximately 215,000 high school teachers for a year.

Provide approximately 8.8 million children with the Child Support Grant for a year.

To see how the infographics were calculated, go to the Policies section of Data and Methods here.

Impact of Mechanisation

on Job Losses

Tobacco job losses are affected more by mechanisation than tobacco control measures

Flawed tobacco industry-funded research claims that tobacco policies that cause a decline in tobacco consumption lead to job losses and reduce economic growth. It overestimates the number of jobs in tobacco by conflating part-time and seasonal work with full-time employment. It also ignores that most tobacco farms grow multiple crops.

More importantly, these studies ignore that a decline in tobacco expenditure is usually associated with increased spending on other goods and services in the economy, leading to growth in those sectors. Thus job losses in the tobacco industry do not necessarily lead to a decrease in employment overall, as jobs are created in other sectors. Rather, most studies have found that there is a net increase in employment after tobacco expenditure decreases.

In the South African context, one study found that eliminating the domestic tobacco industry would result in a net gain in jobs (0.4% increase) if consumer spending switched from tobacco to other goods and services (eg.clothing, transport, communication, education, and recreational goods).

The net effect on employment may be negative in the small number of countries that are heavily dependent on tobacco (South Africa is not one of these countries). Even in those cases, the effect would be gradual, allowing government time to allocate resources to assist in livelihood transition.

For example, when taxes on tobacco increased in the Philippines in 2012, 15% of the newly generated revenue was directed to assisting tobacco farmers and workers to find alternative forms of work.

Where there have been large job losses in the tobacco sector, the losses are largely due to advances in farming techniques and manufacturing processes. Increased mechanisation has resulted in a decrease in the use of human labour. Increased mechanisation decreased the use of human labour. The privatisation of the tobacco industry (in many countries, but not in South Africa) has also led to a decline in jobs as companies cut costs in order to remain competitive.

In 2020, as part of South Africa’s COVID-19 lockdown, the South African government imposed a ban on the sale of all tobacco products. While the ban was initially intended to last for three weeks, it was ultimately in place for 20 weeks (from March to August). South Africa was one of only three countries to ban the sale of tobacco during the pandemic, and its ban was the longest: Botswana banned tobacco sales for 12 weeks and India for six weeks.

While not necessarily nationally representative, various studies assessed the impact of the sales ban:

Cessation

Cessation

• Between 7.9% and 15.3% of pre-lockdown smokers quit during the lockdown.

• Between a quarter and half of lockdown quitters had relapsed after the ban, thus the overall quit rate (related to the ban) was between 4% and 12%.

Illicit Trade of Cigarettes

Illicit Trade of Cigarettes

• Despite the ban on sales, 93% of continuing smokers (aged 18 and over) purchased cigarettes during the ban.

• Both multinational cigarette brands and local/regional brands were sold during the ban. Smokers shifted away from the previously dominant multinational brands, such as Peter Stuyvesant, and rather favoured local brands, which were cheaper and more readily available.

• For many smokers, the ban may have normalised cheaper brands, which were more likely to be illicit, thus making smoking more affordable and accessible. This may have contributed to the increase in prevalence and illicit trade, observed in recent studies.

Cigarette Prices

Cigarette Prices

• The average price of cigarettes increased by 240% in June 2020, compared to before the ban.

• In the month after the ban, cigarette prices dropped back to slightly above pre-ban levels (3.6% higher). Many smokers continued to buy the cheaper local brands to which they became accustomed during the ban, despite the availability of multinational cigarettes.

E-Cigarettes Industry Tactics

E-Cigarettes Industry Tactics

• The e-cigarette industry used a variety of tactics to evade the restrictions on the sale of “tobacco, tobacco products, e-cigarettes and related products”. These included promoting CBD as a substitute product, allowing the sale of restricted items if purchased with CBD, and deeming ingredients for e-liquid and other e-cigarette paraphernalia as “essential items”.

Government Revenue

Government Revenue

• The National Treasury collected R7.5 billion from excise taxes from cigarettes in the 2020/2021 financial year.

• This is R6.9 billion less than what they had budgeted for that year.

• They therefore collected 48% less excise revenue than planned.

Smoking cessation can be encouraged with many different measures. Effective methods include nicotine replacement therapy, Champix, Zyban, training, counselling, quit-and-win schemes, and cognitive behavioural therapy.

Combining measures improves their efficacy, with, for example, quit rates quadrupling when behavioural therapy is coupled with nicotine replacement therapy.

In 2010, signatories of the WHO FCTC

(which South Africa signed in 2003) adopted guidelines which encourage parties to implement tobacco cessation promotion activities,

such as healthcare professionals screening for tobacco use, providing advice, and offering cessation treatments at clinics (all of which are shown to significantly increase the likelihood of smoking cessation).

Although South Africa has made efforts to incorporate tobacco dependence treatment into the healthcare system,

only 29.3% of smokers received cessation advice from a healthcare professional in 2012.

Further, there was no evidence of an increase in the proportion of smokers receiving cessation advice between 2007 and 2017.65 There was, however, an association between receiving cessation advice and making a quit attempt in all survey years, which highlights the importance of scaling up cessation advice in South Africa.

Evidence-based nicotine-dependence treatment is not included in South Africa’s Essential Drug list and must be paid out-of-pocket, a challenge for many South Africans.

Including these treatments on the South African Essential Drugs list and adding coverage for smoking cessation treatment within the incoming National Health Insurance may increase access and utilisation of evidence-based cessation aids among smokers in South Africa.

The tobacco industry is known for using a range of tactics to prevent or reduce government regulation of tobacco products and usage. Public relations campaigns, funding politicians, paying for research, and using front groups are some of the ways in which the industry tries to further their own interests.

Illicit Trade

The tobacco industry has used the presence of illicit trade to argue for lower taxation and to draw attention and efforts away from implementing new tobacco control policies.

Tobacco Industry Influence

The tobacco industry is known to use political contributions, front groups, lobbying and biased research findings to influence governments that are pursuing increased regulation of the industry.

Increasing numbers of countries are implementing tobacco control policies, ranging from graphic warnings and advertising bans to increases in excise taxes and the introduction of smoke-free laws.

Policies and programs designed to reduce the demand for tobacco are cost-effective. These include significant tobacco tax and price increases, comprehensive bans on tobacco marketing, graphic health warnings, smoke-free public places, and the provision of wide-scale tobacco cessation programs. Of these interventions, significant tobacco taxes and price increases are the most cost-effective.

Control of the illicit trade in tobacco is a key supply-side policy to reduce the prevalence of smoking and its health and economic consequences. Other supply-side interventions, like restrictions on production, are generally not perceived as particularly successful or impactful. However, where there is a decrease in tobacco production, farmers should be helped to find other livelihoods.

The tobacco industry uses a wide range of tactics to oppose any policies that might reduce sales. These include strategies such as political lobbying, financing research, attempting to influence regulation and policy, and using corporate social responsibility initiatives as part of their public relations campaigns.

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Tobacco Tax

Policies

Impact of Tax Changes

on Prevalence, Revenue, and Price

Non-Tax

Policies

Packaging and warnings

Ban on Tobacco Advertising, Promotion and Sponsorship

Tobacco-Free Public Places

The Economics

of Tobacco

Tobacco Sales Ban

During the COVID-19 Pandemic

Cessation

Support

Tobacco Industry

Tactics

Lessons Learned

from the Global Tobacco Control Movement

References