The association between economic recession and public support for increased tobacco taxation in 27 European countries

Introduction

Most European countries have signed the Framework Convention on Tobacco Control (FCTC), but wide variations exist in the level of commitment of national governments to implement and enforce tobacco control policies [1]. High tobacco taxes encourage current tobacco users to quit, prevent the uptake of tobacco use among price sensitive populations (e.g. youths) and reduce the overall consumption of tobacco products [2]. During the recent recession, economic factors, including taxation, may have had differential effects in health-related behaviours such as diet, alcohol and tobacco consumption among certain population groups [3,4]. Despite the harmonisation of cigarette tax in countries of the European Union (EU), cigarette prices and excise tax burden still vary within the EU [5].

Public support is crucial in implementing and enforcing robust tobacco control policies. However, little information is available regarding the trends in public support for tobacco control measures in the EU, especially in light of the economic constraints among EU nations. To address this gap, we analysed two waves of the Eurobarometer survey (2009 and 2012) to associate temporal changes in support for increased tobacco taxation in 27 EU countries, with changes in national gross domestic products (GDP) during the same timeframe in Europe.

Methods

Results

The proportion of respondents aged ≥15 years in the EU who were in favour of increased taxes on tobacco products declined significantly between 2009 and 2012 (56.1% to 53.2%; p<0.001). In individual countries, support ranged from 47.7% (France) to 69.7% (Finland) in 2009 and from 38.4% (Greece) to 71.3% (Finland) in 2012. Between 2009 and 2012 the proportion of respondents who supported tax increases on tobacco products changed significantly in nine out of the 27 member countries of the EU (Greece, Spain, Sweden, Czech Republic, Estonia, Latvia, Lithuania, United Kingdom and Germany). Among these, an increase in support for increased taxation was observed only in Sweden and Estonia, while the largest decrease was observed in Greece (52.0% to 38.4%) (supplementary material Table 1).

Between 2009 and 2012, seven countries in the EU experienced an overall decrease in the GDP per capita (supplementary material Table 2). The correlation coefficient between the change (%) in GDP per capita and the change (%) in the proportion of the population who supported tax increases in tobacco products was 0.31 (95% CI: −0.08 to 0.62). Notably, Latvia and Lithuania were the only two countries that had a significant decrease in population support for tax increases and a big increase in the GDP per capita within the same time period (Figure 1). After excluding these two countries from the analysis, the correlation coefficient increased to 0.64 (95% CI: 0.33–0.83).

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Figure 1.

Association between the change in GDP against change in the proportion of the population who were in favour of increasing taxes in tobacco products in 27 countries of the EU during 2009–2012).

The univariate linear regression analysis indicated that for a 10% increase in GDP per capita, population support for increased taxation on tobacco products increased by 3.1% (95%CI: −0.8% to 7.0%). After adjusting for baseline GDP per capita (2009), a 10% increase in GDP per capita was associated with 4.5% increase in support of tax increases (95% CI: 0.7–8.4%). On the contrary, adjusting for prevalence of any tobacco product use or average price of 20 cigarettes did not significantly change the estimate of the univariate analysis. When Latvia and Lithuania were excluded, the estimated increase of support for tax increases, adjusting for baseline GDP per capita, was 7.0% (95% CI: 3.4–10.7%) for a 10% increase in GDP per capita. Furthermore, by additionally excluding the case of Greece, which was severely impacted by the financial crisis, within the regression analysis, the estimated increase of support for tax increases, adjusting for baseline GDP per capita, was 4.9% (95%CI: 0.7–9.1%) for a 10% increase in GDP per capita.

Discussion

During 2009–2012, a decline in support for increased taxes on tobacco products was observed in the EU, mostly in countries where GDP per capita fell during the study period. Overall, the change in the level of population support of tax increases was associated with changes in GDP per capita. Latvia and Lithuania were clear outliers, but the fact that, during the study period, these two countries were recovering from a steep decline in GDP [6] might partly explain the different trends.

Tax increases in tobacco products are expected to reduce consumption, the burden of tobacco-related disease and increase tax revenues, even in countries in recession, where smoking prevalence is likely to decline [3,8]. Wide public support might be able to counteract the efforts of the tobacco industry to lobby against tax increases and motivate elected officials to legislate effective tobacco control policies, especially in countries experiencing economic problems. Even though non-smokers are more likely to support tax increases [9,10], adjusting for the national prevalence of tobacco use did not alter the final results. Population support towards tobacco taxation may also be affected by earmarking towards favourable causes, even in dire economic circumstances [9].

Despite the large sample size, and survey methodology, this study has some limitations. Current tobacco use was self-reported. However studies have shown that self-reported cigarette use has high agreement with biochemical assessments [11]. Also, data on the effects of the economic crisis on individuals were not collected and thus associations between the change in income and support for tax increases could be made only at a country level. Therefore, the results should be interpreted cautiously. Finally, while the relatively short period may not be sufficiently long to assess long-term behavioural changes in the population, our outcome was limited to attitudinal changes (i.e. support for policy).

In conclusion, during 2009–2012, population support for increased taxes on tobacco products declined, especially in countries where GDP per capita fell. These findings indicate a potential association between economic recession and support for tobacco product taxation, a key tobacco prevention modality. Thus, additional efforts to increase support for tobacco taxation might be needed during recession.