Smoking stubbornly remains a leading cause of disease, disability and death in Canada, even as prevalence rates have fallen significantly over the last 50 years. So what new smoking cessation initiative can save lives and billions of dollars in health-care costs?
A highly compelling analysis by a uOttawa Faculty of Medicine health economist explores the long-term impacts of one bold smoking restriction proposal: a lifetime ban on tobacco products to individuals born after a specific date.
This "smoke-free generation" concept is aimed at forging a generation of individuals who would never be able to legally purchase tobacco or nicotine vaping products. It proposes that preventing young people from taking up smoking is key since roughly 80 percent of people take up smoking by age 18, and nearly all smokers start by age 26. It's a policy measure that was seriously debated in New Zealand and has been recommended by smoking cessation experts in Canada .
Dr. Doug Coyle suggests that if the Canadian government were to implement a "smoke-free generation" policy there would be massive health benefits. His study estimates that the policy would result in $2.3 billion less in health care costs and lead to 476,814 more quality-adjusted life years for Canadians over a 50-year timespan.
The analysis assumed a perpetual ban on cigarette sales to anyone born after 2009 if imposed on Jan. 1, 2025.
The research forecasting the long-term impacts of a SFG policy was featured today in the January edition of Health Promotion and Chronic Disease Prevention in Canada , a publication of the Public Health Agency of Canada.
One of the peer-reviewed journal's reviewers described Dr. Coyle's analysis as a "very important piece of work which could influence policy."
An expert at researching health economics and applying analyses to health policy, Dr. Coyle says the study's "biggest finding is that introducing a SFG policy would lead to substantive health gains with significant health care cost savings."
"Current legislation is ineffective as most long-term smokers initiate smoking prior to the legal age for smoking. Thus, a SFG policy avoids the vast health losses occurring due to uptake of smoking earlier than legally allowed," he says.
The published analysis took an existing model relating to smoking cessation and augmented it to assess the impacts of an SFG policy on quality-adjusted life years (QALYs), life expectancy, health care costs, smoking-related taxes, and Canadian tobacco industry gross domestic product. The policy's overall impact for the entire Canadian population was assessed for time periods up to 90 years.
While the study found that there would be significant health care cost saving and more quality-adjusted life years for Canadians, it also found the policy would also result in $7.4 billion less in smoking-related taxes and a $3.1 billion reduction in tobacco industry GDP. However, the study suggests that the combined value of health benefits gained and health care costs averted would surpass the hit of lower tax revenues and reduced GDP.
"Although health care cost savings are lower than the combination of lost tax revenues and the decline in the GDP from the Canadian tobacco industry, the value of the health benefits realized outweigh the negative offsets," the study concludes.
Dr. Coyle says that since taxes on tobacco smoking are regressive and impact poorer populations more proportionally than wealthier ones, the government could replace the lost tax with a "more progressive tax substitute" that "would be more fair and equitable."
Dr. Coyle's decades of work have influenced the practice and methods of health economics and directly influenced policy in Canada and the UK. He's a Professor Emeritus of the uOttawa Faculty of Medicine's School of Epidemiology and Public Health (SEPH). He served as SEPH's interim director from 2016-18 and was previously director of the graduate program in epidemiology.
