WHO FCTC Indicator Compendium · This WHO FCTC Indicator Compendium was developed in response to the mandate given to the Convention Secretariat, in cooperation with competent authorities

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WHO FCTC

Indicator Compendium

(1st edition)

October 2013

2

Introduction

This WHO FCTC Indicator Compendium was developed in response to the mandate given to the

Convention Secretariat, in cooperation with competent authorities within WHO, by the Conference of

the Parties at its fifth session.1 As envisaged in the decision, the Compendium is expected “to further

facilitate standardization of indicators and their use by Parties, including relevant definitions and sources

of information”.

The Compendium is expected to facilitate data collection and epidemiological surveillance of tobacco

consumption and related social, economic and health indicators within countries, as well as to assist

Parties in exchanging information on these indicators at both regional and global levels, in line with

Parties’ obligations under Articles 20.3 and 20.4 of the Convention.

The routine and periodical monitoring by Parties of the standardized indicators proposed in this

Indicator Compendium is strongly encouraged. Parties may consider incorporating the collection of data

in line with the proposed indicators into national data collection initiatives, including those performed

by non-health agencies and national statistical offices. This would greatly facilitate preparation of

implementation reports to the Conference of the Parties, allow trend analysis to be undertaken, enable

monitoring of the impact of implementation of the Convention nationally, and facilitate cross-country

comparison of data. Once Parties report to the Conference of the Parties using the indicators, the

Convention Secretariat analyses the reports and elaborates, on a biennial basis, global progress reports

on the implementation of the Convention, providing both regional and international comparisons.

The WHO FCTC Indicator Compendium includes quantitative indicators used in section 2 of the reporting

instrument (Tobacco consumption and related health, social and economic indicators), which, in most

cases, have not been defined in the treaty or implementation guidelines. These indicators are listed on

page 4. For each indicator, the following information is given: indicator name; data type representation;

rationale; definition; preferred data sources; other possible data sources; method of measurement;

disaggregation; expected frequency of data collection; comments; and useful links and sources.

The indicators were developed by using the World Health Statistics Indicator Compendium under the

WHO Indicator and Measurement Registry as a template. Sources consulted during the development of

the Compendium include several WHO departments. For non-health-related indicators, other sources

were checked and input received from the following: the World Bank, the International Monetary Fund

and the American Cancer Society (on taxation and price-related indicators); the United Nations

Conference on Trade and Development (on trade in tobacco products); the World Customs Organization

and Mr LukJoossens of the European Association of Cancer Leagues (on illicit trade in tobacco products);

the International Labour Organization (on employment in tobacco growing); and the Food and

Agriculture Organization of the United Nations (on tobacco leaf production).

This is the first edition of this Compendium prepared by the Convention Secretariat at the request of the

Conference of the Parties to be used by the Parties in the 2014 reporting cycle. Any feedback, comments

1 Decision FCTC/COP5(11).

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and suggestions will be appreciated both before and at the sixth session of the Conference of the Parties,

and they will be taken into account for any further work on the Compendium.

Questions or suggestions concerning the content of the Compendium can be addressed to the

Convention Secretariat at: [email protected].

mailto:[email protected]

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GLOSSARY OF ABBREVIATIONS

CIF = cost, insurance and freight

DALY = disability adjusted life year

DHS = Demographic and Health Survey

ESPAD = European School Survey Project on Alcohol and Other Drugs

FTE = full-time job equivalents

GATS = Global Adult Tobacco Survey

GDP = gross domestic product

GSHS = Global School-based Student Health Survey

GST = goods and services tax

GYTS = Global Youth Tobacco Survey

HBSC = health behaviour of school-aged children

ITC = International Tobacco Control Policy Evaluation Project

PAF = population attributable fraction

RR = relative risk

SAGE = WHO Study on Global Ageing and Adult Health

TAE = tobacco-attributable health-care expenditures

TAF = tobacco-attributable fraction

TAI = tobacco-attributable indirect morbidity costs

TAMC = tobacco-attributable indirect mortality costs

VAT = value added tax

WHO = World Health Organization

WHO STEPS = WHO STEPwise Approach to Surveillance

YPLL = years of potential life lost

YRBSS = Youth Risk Behaviour Surveillance System

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List of indicators included in the Compendium2

1. Prevalence of tobacco smoking in the adult population……………………………………………… 7

1.1 Current smokers……………………………………………………………………………………………………………. 8

1.2 Daily smokers………………………………………………………………………………………………………………… 11

1.3 Occasional smokers………………………………………………………………………………………………………..13

1.4 Former smokers…………………………………………………………………………………………………………….. 18

1.5 Never smokers………………………………………………………………………………………………………………. 21

1.6 Average number of the most-consumed smoking tobacco product used per day

among daily smokers…………………………………………………………………………………………………….. 24

2. Prevalence of smokeless tobacco use in the adult population…………………………………….. 27

2.1 Current smokeless tobacco users………………………………………………………………………………….. 28

2.2 Daily smokeless tobacco users………………………………………………………………………………………. 31

2.3 Occasional smokeless tobacco users……………………………………………………………………………… 34

2.4 Former smokeless tobacco users…………………………………………………………………………………… 37

2.5 Never users of smokeless tobacco…………………………………………………………………………………. 40

2.6 Average number of the most-consumed smokeless tobacco product used per day

among daily users……………………………………………………………………………………………………….… 43

3. Prevalence of tobacco use by youth…………………………………………………………………………… 46

3.1 Current youth smokers………………………………………………………………………………………………..… 47

3.2 Current youth smokeless tobacco users………………………………………………………………………… 50

4. Exposure to tobacco smoke in the adult population…………………………………………………… 53

4.1 Percentage of adults exposed to tobacco smoke at home…………………………………………..… 54

4.2 Percentage of adults exposed to tobacco smoke in the workplace………………………………… 57

4.3 Percentage of adults exposed to tobacco smoke in public transport…………………………….. 60

5. Exposure to tobacco smoke in youth………………………………………………………………………….. 63

5.1 Percentage of youth exposed to tobacco smoke at home…………………………………………….. 64

5.2 Percentage of youth exposed to tobacco smoke in public places or public transport……. 67

6. Tobacco-related mortality…………………………………………………………………………………………. 70

6.1 Estimated total number of deaths attributable to tobacco use……………………………………... 71

2 Indicators included in this Compendium are the quantitative indicators used in section 2 of the reporting

instrument (Tobacco consumption and related health, social and economic indicators) of the WHO FCTC. The indicators are presented in the order in which they appear in the reporting instrument.

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7. Tobacco-related costs………………………………………………………………………………………………… 74

7.1 Overall cost of tobacco use imposed on society……………………………………………………..…….. 75

7.2 Direct (health-care related) costs of tobacco use………………………………………………………..… 79

7.3 Indirect costs of tobacco use…………………………………………………………………………………..…….. 83

8. Supply of tobacco and tobacco products……………………………………………………………………. 87

8.1 Total volume of duty-free sales of tobacco products……………………………………………….……. 88

8.2 Volume of domestic production of tobacco and tobacco products………………………….……. 90

8.3 Volume of exports of tobacco and tobacco products……………………………………………….……. 93

8.4 Volume of imports of tobacco and tobacco products……………………………………………….…… 96

9. Seizures of tobacco products…………………………………………………………………………………..…. 99

9.1 Quantity of seized illicit tobacco products………………………………………………………………..…… 100

9.2 Percentage of smuggled tobacco products on the national tobacco market……………..……103

10. Tobacco growing…………………………………………………………………………………………………..…… 106

10.1 Number of workers involved in tobacco growing…………………………………………….……………. 107

10.2 Share of the value of tobacco leaf production in the national gross domestic product…. 110

11. Taxation of tobacco products…………………………………………………………………………………..… 112

11.1 Proportion of the retail price of the most widely sold brand of tobacco product

consisting of taxes…………………………………………………………………………………………………….…… 113

11.2 Specific excise tax…………………………………………………………………………………………………….……. 116

11.3 Ad valorem excise tax…………………………………………………………………………………………….……… 119

11.4 Import duty……………………………………………………………………………………………………….…..……… 122

11.5 VAT/GST/sales tax……………………………………………………………………………………………….………… 124

11.6 Earmarking of any percentage of taxation income for funding tobacco control……..……… 126

12. Price of tobacco products……………………………………………………………………………………..……. 128

12.1 Most widely sold brand of smoking or smokeless tobacco product………………………..……… 129

12.2 Retail price of a pack of the most widely sold brand of tobacco product……………….……… 131

Appendix 1. Smoking-related causes of death…………………………………………………………………………………… 133

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1. PREVALENCE OF TOBACCO SMOKING IN THE ADULT POPULATION

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1.1 Current smokers INDICATOR NAME

Current smokers

DATA TYPE REPRESENTATION

Percent

RATIONALE

The prevalence of current smoking of any tobacco product among adults is an important indicator to use

when calculating the health and economic burden of tobacco use imposed on society, and is also

important for informing policy-making and substantiating the need for action.

Routine and regular monitoring of this indicator is necessary to enable accurate monitoring and

evaluation of the impact of implementation of the WHO FCTC over time.

DEFINITION

A current smoker is someone who either smokes every day (daily smoker) or who currently smokes but

not every day (occasional or non-daily smoker).

At a population level, the prevalence of current smokers for a country is calculated as (the number of

respondents in a survey who indicated smoking every day + the number of respondents who indicated

smoking occasionally) divided by the total number of respondents to the survey.

"Tobacco smoking" includes the consumption of cigarettes, bidis, cigars, cheroots, pipes, shisha (water

pipes), fine-cut smoking articles (roll-your-own), krekets, and any other form of smoked tobacco.

PREFERRED DATA SOURCES

National household surveys using standard methods across time, so that changes over time can be

measured. Examples of such surveys include:

- tobacco-specific surveys such as the Global Adult Tobacco Survey (GATS), and the International

Tobacco Control Policy Evaluation Project (ITC Project);

- multi-risk-factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to

Surveillance (WHO STEPS);

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- other health surveys such as the WHO Study on Global Ageing and Adult Health (SAGE), Demographic

and Health Surveys (DHS), Eurobarometer and the European Health Interview Survey.

OTHER POSSIBLE DATA SOURCES

These include: national censuses, national health surveys, and other national household surveys that

may be about other topics such as household expenditure. Such surveys may be conducted by the

country’s national statistical offices, or any other relevant agency, or by national or international

research groups (and include academic research or studies carried out by nongovernmental

organizations). If no recent national data are available, country estimates may be found in the WHO

Global Health Observatory Data Repository.

METHOD OF MEASUREMENT

( )

( )

( )

( )

DISAGGREGATION

Disaggregation should be made by gender and age.

In the case of gender: data should be separated for males and females, and combined (total) prevalence

should also be provided.

In the case of age: taking into account the age range selected for the relevant survey, data on smoking

prevalence should be broken down by age groups (preferably by 10-year category, e.g. 25−34, 35−44).

EXPECTED FREQUENCY OF DATA COLLECTION

Regular collection of data on the prevalence of current smokers contributes to effective monitoring and

evaluation of the impact of tobacco control policies. WHO recommends that such surveys be conducted

regularly (at least once every five years), and such repetition would also contribute to the creation of

tobacco-related national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart

from the repeatability and frequency of the survey, other criteria that characterize a good national

surveillance system include: comparability; validity and reliability; mechanisms to translate findings into

action; and sustainability (of financial and human resources). Article 20.2 of the Convention calls upon

Parties to "establish, as appropriate, programmes for national, regional and global surveillance of the

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magnitude, patterns, determinants and consequences of tobacco consumption and exposure to tobacco

smoke", expecting data to be collected with some regularity.

COMMENTS

If national data are not available at the time of preparation of the implementation report, subnational

data may be reported. In these cases, please provide information about the study (e.g. year, source,

name of the region concerned and referred adult population group).

USEFUL LINKS AND SOURCES

Global:

- DHS: http://www.measuredhs.com/What-We-Do/

- GATS: http://www.who.int/tobacco/surveillance/survey/gats/en/index.html

- Global InfoBase: https://apps.who.int/infobase/

- Tobacco Questions for Surveys: http://www.who.int/tobacco/surveillance/tqs/en/index.html

- WHO Global Health Observatory: http://apps.who.int/gho/data/view.main

- WHO Indicator Code Book Tobacco Control: http://apps.who.int/gho/data/node.main.1257?lang=en

- WHO STEPS: http://www.who.int/chp/steps/en/

Regional:

- Eurobarometer: http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm

- Eurostat (health status):

http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/data

base

- European Health Interview Survey 2008:

http://epp.eurostat.ec.europa.eu/cache/ITY_SDDS/en/hlth_ehis_esms.htm

Other sources:

- ITC Project: http://www.itcproject.org/

http://www.measuredhs.com/What-We-Do/

http://www.who.int/tobacco/surveillance/survey/gats/en/index.html

https://apps.who.int/infobase/

http://www.who.int/tobacco/surveillance/tqs/en/index.html

http://apps.who.int/gho/data/view.main

http://apps.who.int/gho/data/node.main.1257?lang=en

http://www.who.int/chp/steps/en/

http://ec.europa.eu/health/tobacco/eurobarometers/index_en.htm

http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/database



http://www.itcproject.org/

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1.2 Daily smokers INDICATOR NAME Daily smokers DATA TYPE REPRESENTATION

Percent

RATIONALE

The prevalence of daily smoking of any tobacco product among adults is an important indicator to use

when calculating the health and economic burden of tobacco on society, and is also important for

informing policy-making and substantiating the need for action.



DEFINITION

A daily smoker is someone who smokes any tobacco product at least once a day (people who smoke

every day apart from days of religious fasting are still classified as daily smokers).

The crude rate, expressed as a percentage of the total adult population, refers to the number of adults

who smoke any tobacco product daily per 100 of the adult population of the country, resulting from the

latest adult national tobacco use survey (or any other survey which asks tobacco use questions). The age

range to which the prevalence data for the entire adult population refer should be, for example, 15

years and over, 18 years and over, 18–64 years, or similar, as determined in the survey’s methodology.

When this crude prevalence rate is multiplied by the country’s adult population, the result is the number

of adults who are daily smokers of any tobacco product in the country.

The definition of "daily smoker" varies between surveys, but often means someone who smokes any

tobacco product at least once a day during a defined period leading up to the survey date.



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- multi-risk factor surveys on noncommunicable diseases such as the WHO STEPwise Approach to


- other health surveys like the WHO Study on Global Ageing and Adult Health (SAGE), Demographic




may be about other topics such as household expenditure. Such surveys may be conducted by countries’

national statistical offices or any other relevant agency, or by national or international research groups

(and include academic research or studies implemented by nongovernmental organizations). If no

recent national data are available, country estimates may be found in the WHO Global Health

Observatory Data Repository.


( )

( )

The prevalence of daily tobacco smokers should be less than or equal to the prevalence of current

tobacco smokers.

DISAGGREGATION


In the case of gender, data should be separated for males and females, and the combined (total)

prevalence should also be provided.

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In the case of age, taking into account the age range selected to be applied for the relevant survey, data

on smoking prevalence should be broken down by age groups (preferably by 10-year category, e.g.

25−34, 35−44)


Regular collection of data on the prevalence of daily smokers contributes to effective monitoring and









smoke”, expecting data to be collected with some regularity.

COMMENTS





Global:






- WHO Indicator Code Book Tobacco Control:



Regional:




base















14

Other sources:



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1.3 Occasional smokers

INDICATOR NAME

Occasional smokers


Percent

RATIONALE

The prevalence of occasional smoking of any tobacco product among adults is an important indicator to

use when calculating the health and economic burden of tobacco on society, and is also important for




DEFINITION

An occasional smoker is someone who smokes, but not every day. Occasional smokers include: reducers

(people who used to smoke daily but now do not smoke every day); continuing occasionals (people who

have never smoked daily, but who have smoked 100 or more cigarettes – or the equivalent amount of

tobacco – in their lifetime and now smoke occasionally); and experimenters (people who have smoked

less than 100 cigarettes or the equivalent amount of tobacco in their lifetime and now smoke

occasionally).


who are occasional or non-daily smokers of any tobacco product per 100 of the adult population of the

country, resulting from the latest adult tobacco use survey (or survey which asks tobacco use questions).

The age range to which the prevalence data for the entire adult population refer should be, for example,

15 years and over, 18 years and over, 18–64 years, or similar, as determined in the survey’s

methodology.


of adults who are occasional or non-daily smokers of any tobacco product in the country.

An “occasional smoker” is someone who smokes any tobacco product non-daily during a defined period

leading up to the survey date.


pipes) fine-cut smoking articles (roll-your-own), krekets, and any other form of smoked tobacco.

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These include: national censuses, national health surveys; and other national household surveys that


country’s national statistical office or any other relevant agency, or by national or international research

groups (and include academic research or studies implemented by nongovernmental organizations). If

no recent national data are available, country estimates may be found in the WHO Global Health



( )

( )

In the numerator, occasional smokers include those respondents who are currently less than daily

smokers of any tobacco product, including formerly daily and never daily smokers of any tobacco

product in the adult population.

DISAGGREGATION


In the case of gender, data should be separated for males and females, and combined (total) prevalence


In the case of age, taking into account the age range selected for the relevant survey, data on smoking

prevalence should be broken down by age group (preferably by 10-year category, e.g. 25−34, 35−44).

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Regular collection of data on the prevalence of occasional smokers contributes to effective monitoring

and evaluation of the impact of tobacco control policies. WHO recommends that such surveys be

conducted regularly (at least once every five years), and such repetition would also contribute to the

creation of tobacco-related national surveillance systems as envisaged in Article 20.3(a) of the

Convention. Apart from the repeatability and frequency of the survey, other criteria that characterize a

good national surveillance system include: comparability; validity and reliability; mechanisms to

translate findings into action; and sustainability (of financial and human resources). Article 20.2 of the

Convention calls upon Parties to “establish, as appropriate, programmes for national, regional and

global surveillance of the magnitude, patterns, determinants and consequences of tobacco consumption

and exposure to tobacco smoke”, expecting data to be collected with some regularity.

COMMENTS





Global:








Regional:



http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/dat

abase



Other sources:














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1.4 Former smokers

INDICATOR NAME

Former smokers


Percent

RATIONALE

The prevalence of former smoking of any tobacco product among adults is an important indicator of

cessation of tobacco use, and provides a baseline for evaluating the effectiveness of tobacco control

programmes over time.

DEFINITION

The definition of “former smokers” is: adults who were ever smokers of any tobacco product, and

currently do not smoke any tobacco product during a defined period leading up to the survey date.

Rare instances of smoking or experimental smoking can be discounted, and the individuals concerned

taken as having smoked "not at all”. Accordingly, a “former smoker” or “ex-smoker” may be defined as

“a person who has smoked at least 100 cigarettes or equivalent tobacco in his or her lifetime, but does

not smoke at all now”.


who are former smokers of any tobacco product per 100 of the adult population of the country,

resulting from the latest adult tobacco use survey (or survey which asks tobacco use questions). The age




of adults who are former smokers of any tobacco product in the country.





measured. Examples of such surveys, which may have been implemented by the Parties, include:



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may be about other topics such as household expenditure. Such surveys may be conducted either by the

countries’ national statistical office, or any other relevant agency, or by national or international

research groups (including academic research or studies implemented by nongovernmental




( )

In the numerator the number of former smokers includes respondents who were ever daily or non-daily

smokers of any tobacco product, and who currently do not smoke any tobacco product in the surveyed

adult population.

DISAGGREGATION




In the case of age, taking into account the age range selected for the relevant survey, data on smoking

prevalence should be broken down by age group (preferably by 10-year category, e.g. 25−34, 35−44).


Regular collection of data on the prevalence of former smokers contributes to effective monitoring and





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smoke”.

COMMENTS





Global:





Regional:




base



Other sources:











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1.5 Never smokers

INDICATOR NAME

Never smokers


Percent

RATIONALE

The prevalence of never smokers of any tobacco product among adults is an important indicator of non-

initiation of tobacco use, and provides a baseline for evaluating the effectiveness of tobacco control

programmes over time.

DEFINITION

The definition of “never smoker” is someone who has never smoked any tobacco product in their lives.

Rare instances of smoking or experimental smoking can be discounted, and the individuals concerned

taken as having smoked "not at all”. Accordingly, a “never smoker” or “non-smoker” may be defined as

“a person who does not smoke now and has smoked fewer than 100 cigarettes or the equivalent

tobacco in his or her lifetime”.


who have never smoked any tobacco product in their life per 100 of the adult population of the country,





of adults who are never smokers of any tobacco product in the country.




National household surveys using standard methods across time, to ensure capacity to measure changes

in levels over time. Examples of such surveys, which may have been implemented by the Parties, include:



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may be about other topics such as household expenditure survey. Such surveys may be conducted

either by the country’s national statistical office, or any other relevant agency, or by international





( )

DISAGGREGATION




In the case of age: taking into account the age range selected to be applied for the relevant survey, data

on smoking prevalence should be broken down by age group (preferably by 10-year category, e.g. 25−34,

35−44).


Regular collection of data on the prevalence of never smokers contributes to effective monitoring and

evaluation of the impact of tobacco control policies. WHO recommends such surveys be conducted






Parties to “establish, as appropriate, programmes for national, regional and global surveillance of the

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smoke” expecting data to be collected with some regularity.

COMMENTS





Global:


- GATS:

- http://www.who.int/tobacco/surveillance/survey/gats/en/index.html



Regional:




base



Other sources:











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1.6 Average number of the most-consumed smoking tobacco product used per day among daily

smokers

INDICATOR NAME

Average number of the most-consumed smoking tobacco product used per day among daily smokers


Count

RATIONALE

This information can be used to assess the most-consumed smoking tobacco product, as well as to

indirectly calculate sales of the most-consumed smoking tobacco product, individual average and

country per capita consumption of the most-consumed smoking tobacco product. (This information will

pertain to consumption by daily smokers only; contribution of occasional smokers to the overall per

capita consumption will need to be assessed separately.)

DEFINITION

Number of the most widely consumed smoking tobacco product used per day on average among daily

smokers during a defined period leading up to the survey date among daily smokers of that product.

This may differ for each country based on the type of smoked tobacco product most widely consumed.















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research groups (and include academic research or studies implemented by nongovernmental




(%)

DISAGGREGATION




In the case of age: taking into account the age range selected for the relevant survey, data on smoking

prevalence should be broken down by age groups (preferably by 10-year category, e.g. 25−34, 35−44).


Regular collection of data on the average number of the most-consumed tobacco product contributes to

effective monitoring and evaluation of the impact of tobacco control policies. WHO recommends that

such surveys be conducted regularly (at least once every five years), and such repetition would also

contribute to the creation WHO also recommends that such surveys be conducted regularly of tobacco-

related national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart from the

repeatability and frequency of the survey, other criteria that characterize a good national surveillance

system include: comparability; validity and reliability; mechanisms to translate findings into action; and

sustainability (of financial and human resources). If data used for the calculations are collected regularly

(e.g. are available for each calendar year), such calculations can be repeated on an annual basis. Article

20.2 of the Convention calls upon Parties to "establish, as appropriate, programmes for national,

regional and global surveillance of the magnitude, patterns, determinants and consequences of tobacco

consumption and exposure to tobacco smoke”, expecting data be collected with some regularity.

COMMENTS




26


Global:



- Global Infobase: https://apps.who.int/infobase/



Regional:


Other sources:









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2. PREVALENCE OF SMOKELESS TOBACCO USE IN THE ADULT POPULATION

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2.1 Current smokeless tobacco users

INDICATOR NAME

Current smokeless tobacco users


Percent

RATIONALE

The prevalence of current use of any smokeless tobacco product among adults is an important indicator

to use when calculating the health and economic burden of tobacco on society, and is also important for




DEFINITION

The definition of "current smokeless tobacco user" varies between surveys, but often means someone

who uses any smokeless tobacco product at least once during a defined period leading up to the survey

date.


who are current users of any smokeless tobacco product per 100 of the adult population of the country,





of adults who are current users of any smokeless tobacco product in the country.

"Smokeless tobacco" includes moist snuff, plug, creamy snuff, dissolvables, dry snuff, gul, loose leaf, red

tooth powder, snus, chimo, gutkha, khaini, gudakhu, zarda, quiwam, dohra, tuibur, nasway,

naas/naswar, shammah, betel quid, toombak, pan (betel quid), iq’mik, mishri, tapkeer, tombol and any

other tobacco product that is sniffed, held in the mouth, or chewed.






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country’s national statistical office, or any other relevant agency, or by national or international research





( )

( )

( )

DISAGGREGATION




In the case of age, taking into account the age range selected for the relevant survey, data on smokeless

tobacco use prevalence should be broken down by age group (preferably by 10-year category, e.g.

25−34, 35−44)


Regular collection of data on the prevalence of current users of any smokeless tobacco product

contributes to effective monitoring and evaluation of the impact of tobacco control policies. WHO

recommends that such surveys be conducted regularly (at least once every five years), and such

repetition would also contribute to the creation of tobacco-related national surveillance systems as

envisaged in Article 20.3(a) of the Convention. Apart from the repeatability and frequency of the survey,

other criteria that characterize a good national surveillance system include: comparability; validity and

reliability; mechanisms to translate findings into action; and sustainability (of financial and human

30

resources). Article 20.2 of the Convention calls upon Parties to "establish, as appropriate, programmes

for national, regional and global surveillance of the magnitude, patterns, determinants and

consequences of tobacco consumption and exposure to tobacco smoke” , expecting data be collected

with some regularity.

COMMENTS


data maybe reported. In these cases, please provide information about the study (e.g. year, source,



Global:




- WHO Global Health Observatory: http://apps.who.int/gho/data/node.main.1257?lang=en

- WHO Indicator Code Book Tobacco Control

http://apps.who.int/gho/indicatorregistry/App_Main/view_indicator.aspx?iid=364


Regional:


Other sources:










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2.2 Daily smokeless tobacco users

INDICATOR NAME

Daily smokeless tobacco users


Percent

RATIONALE

The prevalence of daily use of any smokeless tobacco product among adults is an important indicator to

use when calculating the health and economic burden of tobacco on society, and is also important for

informing policy-making and substantiating the need for action. Routine and regular monitoring of this

indicator is necessary to enable accurate monitoring and evaluation of the impact of implementation of

the WHO FCTC over time.

DEFINITION

The definition of "daily user" varies between surveys, but often means someone who currently uses any

smokeless tobacco product at least once a day during a defined period leading up to the survey date.


who are daily users of any smokeless tobacco product per 100 of the adult population of the country,





of adults who are daily users of any smokeless tobacco product in the country.










32








countries’ national statistical offices or any other relevant agency, or by national or international





( )

( )

DISAGGREGATION




In the case of age, taking into account the age range selected to be applied for the relevant survey data

on smokeless tobacco use prevalence should be broken down by age group (preferably by 10-year

category, e.g. 25−34, 35−44).


Regular collection of data on the prevalence of daily users of any smokeless tobacco product contributes

to effective monitoring and evaluation of the impact of tobacco control policies. WHO recommends that

such surveys be conducted regularly (at least once every five years) and such repetition would also

contribute to the creation of tobacco-related national surveillance systems as envisaged in Article 20.3(a)

of the Convention. Apart from the repeatability and frequency of the survey, other criteria that

characterize a good national surveillance system include: comparability; validity and reliability;

mechanisms to translate findings into action; and sustainability (of financial and human resources).

33

Article 20.2 of the Convention calls upon Parties to “establish, as appropriate, programmes for national,



COMMENTS





Global:





Regional:


Other sources:








34

2.3 Occasional smokeless tobacco users

INDICATOR NAME

Occasional smokeless tobacco users


Percent

RATIONALE

The prevalence of occasional or non-daily use of smokeless tobacco among adults is an important

measure of the health and economic burden of tobacco. Routine and regular monitoring of this indicator

is necessary to enable accurate monitoring and evaluation of the impact of implementation of the WHO

FCTC over time.

Crude prevalence rates can be used to assess the actual use of smokeless tobacco in a country and to

generate an estimate of the number of users for the relevant indicator (e.g. occasional users) in the

population.

DEFINITION

An “occasional smokeless tobacco user" is someone who uses any smokeless tobacco product non-daily

during a defined period leading up to the survey date.


who are occasional or non-daily users of any smokeless tobacco product per 100 of the adult population

of the country, resulting from the latest adult tobacco use survey (or survey which asks tobacco use

questions). The age range to which the prevalence data for the entire adult population refer should be,

for example, 15 years and over, 18 years and over, 18–64 years, or similar, as determined in the survey’s

methodology.


of adults who are occasional or non-daily users of any smokeless tobacco product in the country.








35










country’s national statistical office or any other relevant agency, or by national or international research





( )

( )

In the numerator the number of occasional smokeless tobacco users includes formerly daily and never

daily users of any smokeless tobacco product in the adult population.

DISAGGREGATION




In the case of age: taking into account the age range selected for the relevant survey, data on smokeless


25−34, 35−44)

36


Regular collection of data on the prevalence of occasional smokeless tobacco users contributes to

effective monitoring and evaluation of the impact of tobacco control policies. WHO recommends that






Article 20.2 of the Convention calls upon Parties to “establish, as appropriate, programmes for national,



COMMENTS





Global:





Regional:


Other sources:








37

2.4 Former smokeless tobacco users

INDICATOR NAME

Former smokeless tobacco users


Percent

RATIONALE

The prevalence of former smokeless tobacco users among adults is an important measure of cessation

of smokeless tobacco use, and routine and regular monitoring of this indicator is necessary to enable

accurate monitoring and evaluation of the impact of implementation of the WHO FCTC over time.

DEFINITION

“Former smokeless tobacco users" are people who have ever used any smokeless tobacco product, and

who currently does not use any smokeless tobacco product during a defined period leading up to the

survey date.

Rare instances of smokeless tobacco use or experimental use of such products can be discounted, and

the individuals concerned taken as having used smokeless tobacco products ”not at all”. Accordingly, a

“former user” or “ex-user” may be defined as “a person who has consumed the tobacco equivalent of

fewer than 100 cigarettes or in his or her lifetime, and does not use smokeless tobacco at all now”.


who are former users of any smokeless tobacco product per 100 of the adult population of the country,





of adults who are former users of any smokeless tobacco product in the country.








38















( )

In the numerator the number of former smokeless tobacco users includes respondents who are ever

daily and non-daily users of any smokeless tobacco product, and who currently do not use any

smokeless tobacco product.

DISAGGREGATION




In the case of age, taking into account the age range selected for the relevant survey, data on smokeless


25−34, 35−44).

39


Regular collection of data on the prevalence of former users of any smokeless tobacco product









consequences of tobacco consumption and exposure to tobacco smoke”, expecting data be collected


Once Parties reported on such surveys to the Conference of the Parties as part of their regular

implementation reports, the Secretariat analyses them by preparing regional and global comparisons.

COMMENTS





Global:





Regional:


Other sources:








40

2.5 Never users of smokeless tobacco

INDICATOR NAME

Never users of smokeless tobacco


Percent

RATIONALE

The prevalence of never users of smokeless tobacco products among adults is an important measure of

non-initiation of smokeless tobacco use, and provides a baseline for evaluating the effectiveness of

tobacco control programmes over time.



DEFINITION

“Never smokeless tobacco users" includes people who have never used any smokeless tobacco product

in their lives.

Rare instances of smokeless tobacco use or experimental use of such products can be discounted, and

the individuals concerned taken as having used smokeless tobacco products “not at all”. Accordingly, a

“never user of smokeless tobacco” or “non-user of smokeless tobacco” may be defined as “a person

who does not use smokeless tobacco now and has consumed the tobacco equivalent of fewer than 100

cigarettes or in his or her lifetime”.


who have never used any smokeless tobacco product in their life per 100 of the adult population of the

country, resulting from the latest adult tobacco use survey (or survey which asks tobacco use questions).

The age range to which the prevalence data for the entire adult population refer should be, for example,

15 years and over, 18 years and over, 18–64 years, or similar, as determined in the survey’s

methodology.


of adults who have never used any smokeless tobacco product in the country.





41


















( )

DISAGGREGATION




In the case of age: taking into account the age range selected for the relevant survey, data on smokeless


25−34, 35−44).

42


Regular collection of data on the prevalence of never users of smokeless tobacco products contributes

to effective monitoring and evaluation of the impact of tobacco control policies. WHO recommends that






Article 20.2 of the Convention calls upon Parties to "establish, as appropriate, programmes for national,


consumption and exposure to tobacco smoke”, expecting data to be collected with some regularity.

COMMENTS





Global:





Regional:


Other sources:








43

2.6 Average number of the most-consumed smokeless tobacco product used per day among daily

users

INDICATOR NAME

Average number of the most-consumed smokeless tobacco product used per day among daily users


Count

RATIONALE

This information can be used to assess the quantity of the most-consumed smokeless tobacco product,

as well as to indirectly calculate sales of the most-consumed smokeless tobacco product, individual

average and country per capita consumption of the most-consumed smokeless tobacco product.(This

information will pertain to consumption by daily smokeless tobacco users only; contribution of

occasional smokeless tobacco users to the overall per capita consumption will need to be assessed

separately.)

DEFINITION

The “average number of the most-consumed smokeless tobacco product used per day among daily

users” means the number of the most widely consumed smokeless tobacco product used per day on

average during a defined period leading up to the survey date.














44




countries’ national statistical office, or any other relevant agency, or national or international research





DISAGGREGATION




In the case of age, taking into account the age range selected for the relevant survey, data on average

number of smokeless tobacco product used per day should be broken down by age group (preferably by

10-year category, e.g. 25−34, 35−44).


Regular collection of data on the average number of the most consumed smokeless tobacco product







resources). Article 20.2 of the Convention calls upon Parties to “establish, as appropriate, programmes


45

consequences of tobacco consumption and exposure to tobacco smoke”, expecting data be collected


Once Parties reported on such surveys to the Conference of the Parties as part of their regular

implementation reports, the Secretariat analyses them by preparing regional and international

comparisons.

COMMENTS





Global:





Regional:


Other sources:








46

3. PREVALENCE OF TOBACCO USE BY YOUTH

47

3.1 Current youth smokers

INDICATOR NAME

Current youth smokers


Percent

RATIONALE

Risky behaviour which starts in childhood often continues into adulthood. Tobacco is an addictive

substance and smoking often starts in adolescence, before the development of risk perception. By the

time the risk to health is recognized, addicted individuals find it difficult to stop tobacco use.

Prevalence rates from youth surveys can be used to gauge the future prospects for smoking tobacco use

in a country.

DEFINITION

The youth prevalence rate, expressed as a percentage of the total youth population, refers to the

number of current smokers of any tobacco product per 100 of the youth population in the country,

resulting from the latest youth tobacco use survey (or survey which asks tobacco use questions).

When this prevalence rate is multiplied by the country's youth population, the result is an estimate of

the number of current smokers of any tobacco product in the country. The age range to which the

prevalence data for the youth refer could be, for example, 12 to 17 years; less than 18 years of age; or as

determined in the survey’s methodology. The upper age limit of “youth” may also be defined by age of

maturity as per individual countries’ laws legislative framework.

The definition of "current smoker" varies between surveys, but often means someone who smokes any

tobacco product either daily or occasionally at least once during a defined period leading up to the

survey date.




National surveys implemented as part of international data collection initiatives, such as:

- Tobacco-specific surveys: Global Youth Tobacco Survey (GYTS);

- Non-tobacco-specific surveys: Global School-based Student Health Survey (GSHS), European School

Survey Project on Alcohol and Other Drugs (ESPAD), Health Behaviour of School-aged Children (HBSC),

Youth Risk Behaviour Surveillance System (YRBSS).

48


These include: national specific population surveys conducted by the country’s national surveillance

system, national statistical office, or any other relevant agency, or by research groups (and include

academic research or studies implemented by nongovernmental organizations).

If no national data are available, country estimates may be found in the WHO Global Health Observatory

Data Repository.


( )

( )

( )

DISAGGREGATION

Wherever possible, prevalence data should be separated for boys and girls, and combined (total)



Regular collection of data on the prevalence of current smokers of any tobacco product among youth

contributes to effective monitoring and evaluation of the impact of tobacco control policies. WHO also








consequences of tobacco consumption and exposure to tobacco smoke", expecting data to be collected


COMMENTS


data may be reported. In these cases, Parties are required to provide information about the study (e.g.

year, source, name of the region concerned).

49


Global:

- GSHS: http://www.who.int/chp/gshs

- GYTS: http://www.who.int/tobacco/surveillance/gyts/en/index.html




- YRBSS:http://www.cdc.gov/HealthyYouth/yrbs/index.htm

Regional:

- ESPAD: http://www.espad.org

- HSBC: http://www.hbsc.org

http://www.who.int/chp/gshs

http://www.who.int/tobacco/surveillance/gyts/en/index.html



http://www.cdc.gov/HealthyYouth/yrbs/index.htm

http://www.espad.org/

http://www.hbsc.org/

50

3.2 Current youth smokeless tobacco users

INDICATOR NAME

Current youth smokeless tobacco users


Percent

RATIONALE

Risky behaviour which starts in childhood often Tobacco is an addictive substance and smokeless

tobacco use often starts in adolescence, before the development of risk perception. By the time the risk

to health is recognized, addicted individuals find it difficult to stop smokeless tobacco use.

Prevalence rates from youth surveys can be used to gauge the future prospects for smokeless tobacco

use in a country.

DEFINITION

The definition of "current smokeless tobacco user" varies between surveys, but often means someone

who uses any smokeless tobacco product at least once during a defined period leading up to the survey

date.

The youth prevalence rate, expressed as a percentage of the total youth population, refers to the

number of current users of any smokeless tobacco product per 100 of the youth population in the

country, resulting from the latest youth tobacco use survey (or survey which asks tobacco use questions).

When this prevalence rate is multiplied by the country's youth population, the result is an estimate of

the number of current users of any smokeless tobacco product in the country.

The age range to which the prevalence data for the youth refer could be, for example, 12 to 17 years;

less than 18 years of age; or as determined in the survey’s methodology. The upper age limit of “youth”

may also be defined by age of maturity as per individual countries’ laws legislative framework.





51




- Non-tobacco-specific surveys: the Global School-based Student Health Survey (GSHS), the European

School Survey Project on Alcohol and Other Drugs (ESPAD), the Health Behaviour of School-aged

Children (HBSC), and the Youth Risk Behaviour Surveillance System (YRBSS).


These include: national specific population surveys conducted by the country’s national surveillance

system, national statistical office, or by any other relevant agency or research groups (and include

academic research or studies implemented by nongovernmental organizations). If no national data are

available, country estimates may be found in the WHO Global Health Observatory Data Repository.


( )

( )

( )

DISAGGREGATION

Wherever possible, prevalence data should be separated for boys and girls, and combined (total)



Regular collection of data on the prevalence of current youth users of smokeless tobacco products








52


consequences of tobacco consumption and exposure to tobacco smoke", expecting data be collected


COMMENTS

If national data are not available at the time of preparation of the report, subnational data may be

reported. In these cases, please provide information about the study (e.g. year, source, name of the

region concerned and referred adult population group).


Global:


- GYTS: http://www.who.int/tobacco/surveillance/gyts/en/index.html




- YRBSS: http://www.cdc.gov/HealthyYouth/yrbs/index.htm





http://www.cdc.gov/HealthyYouth/yrbs/index.htm

53

4. EXPOSURE TO TOBACCO SMOKE IN THE ADULT POPULATION

54

4.1 Percentage of adults exposed to tobacco smoke3 at home

INDICATOR NAME

Percentage of adults exposed to tobacco smoke at home


Percent

RATIONALE

The adult exposure rate indicates how widespread exposure to second-hand smoke is in a country and

can be used to estimate the number of adults exposed to second-hand smoke at home) in the

population. It can also be used to estimate the health impacts attributable to this exposure.

Some of the health conditions caused by second-hand smoke in adults include heart disease and lung

cancer. People who already have heart disease are at especially high risk of suffering adverse effects

from breathing second-hand smoke and should take special precautions to avoid even brief exposure.

DEFINITION

The rate of adult exposure at home, expressed as a percentage of the total adult population, refers to

the number of adults who were exposed to tobacco smoke in their homes per 100 of the adult

population. Multiplying this rate by the adult population results in the number of adults exposed to

second-hand smoke at home. The age range to which the prevalence data for the entire adult

population refer should be, for example, 15 years and over, 18 years and over, 18–64 years, or similar,

as determined in the survey’s methodology.

"Exposure at home" is defined as respondents reporting another person smoking in respondent’s home

at least once during a defined period leading up to the survey date.

Second-hand tobacco smoke can be defined as “the smoke emitted from the burning end of a cigarette

or from other tobacco products usually in combination with the smoke exhaled by the smoker”

(guidelines for implementation of Article 8 of the Convention).



3 Several alternative terms are commonly used to describe the type of smoke addressed by Article 8 of the WHO

Framework Convention. These include “second-hand smoke”, “environmental tobacco smoke”, and “other people’s smoke”. Terms such as “passive smoking” and “involuntary exposure to tobacco smoke” should be avoided, as experience in France and elsewhere suggests that the tobacco industry may use these terms to support a position that “voluntary” exposure is acceptable. “Second-hand tobacco smoke”, sometimes abbreviated as “SHS”, and “environmental tobacco smoke”, sometimes abbreviated “ETS”, are the preferable terms; this Compendium uses the term “second-hand tobacco smoke”.

55

- Tobacco-specific surveys: the Global Adult Tobacco Survey (GATS) and the International Tobacco

Control Policy Evaluation Project (ITC Project).

- Non-tobacco-specific surveys: the WHO STEPwise Approach to Surveillance (STEPS), the WHO Study

on Global Ageing and Adult Health (SAGE), Demographic and Health Surveys (DHS), Eurobarometer

and the European Health Interview Survey.


These include: national health surveys, national household surveys, and national specific population

surveys. Such surveys may be conducted by the country’s national surveillance system, or national

statistical office, or by any other relevant agency or research groups (and include academic research or

studies carried out by nongovernmental organizations).


( )

DISAGGREGATION

Wherever possible, disaggregation should be made by gender and age.




on second-hand smoke exposure at home should be broken down by age groups (preferably by 10-year

category, e.g. 25−34, 35−44).


Regular collection of data on the prevalence of adults exposed to tobacco smoke in their homes

contributes to effective monitoring and evaluation of the impact of tobacco control policies. WHO also

recommends that such surveys be conducted regularly (at least once every five years) so that their

repetition contributes to the creation of tobacco-related national surveillance systems as envisaged in

Article 20.3(a) of the Convention. Apart from the repeatability and frequency of the survey, other

56

criteria that characterize a good national surveillance system include: comparability; validity and




consequences of tobacco consumption and exposure to tobacco smoke" , expecting data be collected


COMMENTS





Global:





Regional:


Other sources:








57

4.2 Percentage of adults exposed to tobacco smoke in the workplace

INDICATOR NAME

Percentage of adults exposed to tobacco smoke in the workplace


Percent

RATIONALE


can be used to estimate the number of adults exposed to second-hand smoke in their work places in the





DEFINITION

The adult second-hand smoke exposure rate at work, expressed as a percentage of the total adult

population, refers to the number of adults who were exposed to tobacco smoke in their workplaces per

100 of the adult population. Multiplying this rate by the adult population results in the number of adults

exposed to second-hand smoke in the workplace. The age range to which the prevalence data for the

entire adult population refer should be, for example, 15 years and over, 18 years and over, 18–64 years,

or similar, as determined in the survey’s methodology.

"Exposure in the workplace" is defined as other people smoking in the workplace in the presence of the

respondent at least once during a defined period leading up to the survey date.

In line with the recommendation of the guidelines for implementation of Article 8 of the Convention, a

“workplace” should be defined broadly as “any place used by people during their employment or work”.

This should include not only work done for compensation, but also voluntary work, if it is of the type for

which compensation is normally paid. In addition, “workplaces” include not only those places at which

work is performed, but also all attached or associated places commonly used by the workers in the

course of their employment, including, for example, corridors, lifts, stairwells, lobbies, joint facilities,

cafeterias, toilets, lounges, lunchrooms and also outbuildings such as sheds and huts. Vehicles used in

the course of work are workplaces and should be specifically identified as such.





58








studies implemented by nongovernmental organizations).


( )

DISAGGREGATION





on SHS exposure at work should be broken down by age group (preferably by 10-year category, e.g.

25−34, 35−44)


Regular collection of data on the prevalence of adults exposed to tobacco smoke in the workplace

contributes to effective tobacco control policies. WHO also recommends that such surveys be conducted

regularly (at least once every five years) so that their repetition contributes to the creation of tobacco-




sustainability (of financial and human resources). Article 20.2 of the Convention calls upon Parties to

"establish, as appropriate, programmes for national, regional and global surveillance of the magnitude,

patterns, determinants and consequences of tobacco consumption and exposure to tobacco smoke",

expecting data be collected with some regularity.

59

COMMENTS





Global:





Regional:


Other sources:








60

4.3 Percentage of adults exposed to tobacco smoke in public transport

INDICATOR NAME

Percentage of adults exposed to tobacco smoke in public transport


Percent

RATIONALE


can be used to estimate the number of adults exposed to second-hand smoke in public transport in the





DEFINITION

The adult exposure rate, expressed as a percentage of the total adult population, refers to the number

of adults who were exposed to tobacco smoke in public transport per 100 of the adult population.

Multiplying this rate by the adult population results in the number of adults exposed to second-hand

smoke in public transport. The age range to which the prevalence data for the entire adult population

refer should be, for example, 15 years and over, 18 years and over, 18–64 years, or similar, as

determined in the survey’s methodology.

"Exposure in public transport" is defined as other people smoking in the presence of the respondent in

public transport at least once during a defined period leading up to the survey date.

In line with the recommendation of the guidelines for implementation of Article 8 of the Convention,

“public transport” should be defined as any vehicle used for the carriage of members of the public,

usually for reward or commercial gain. This includes taxis.








61





studies implemented by nongovernmental organizations).


( )

DISAGGREGATION





on SHS exposure in Public transport should be broken down by age group (preferably by 10-year

category, e.g. 25−34, 35−44)


Regular collection of data on the prevalence of adults exposed to tobacco smoke in public transport










COMMENTS




62


Global:





Regional:


Other sources:








63

5. EXPOSURE TO TOBACCO SMOKE IN YOUTH

64

5.1 Percentage of youth exposed to tobacco smoke at home

INDICATOR NAME

Percentage of youth exposed to tobacco smoke at home


Percent

RATIONALE

Children are at particular risk from adults’ smoking. Adverse health effects include pneumonia and

bronchitis, coughing and wheezing, worsening of asthma, middle ear disease, and possibly neuro-

behavioural impairment and cardiovascular disease in adulthood. In addition, many studies show that

parental smoking is associated with higher youth smoking.

The youth exposure rates reflect the exposure to second-hand smoke among youth in a country and can

be used to estimate of the number of youth exposed in the population.

DEFINITION

The youth second-hand smoke exposure rate, expressed as a percentage of the total youth population,

refers to the number of youth exposed to second-hand smoke at home per 100 of the youth population

in the country, resulting from the latest youth tobacco use survey (or survey which asks tobacco use

questions). When this rate is multiplied by the country's youth population, the result is an estimate of

the number of youth currently exposed to second-hand smoke at home in the country.




"Exposure at home" is defined as other people smoking in the presence of the respondent in the

respondent’s home at least once during a defined period leading up to the survey date.



- Tobacco-specific surveys: Global Youth Tobacco Survey (GYTS).


Survey Project on Alcohol and Other Drugs (ESPAD), Health Behaviour of School-aged Children (HBSC).

65


These include national specific population surveys. Such surveys may be conducted by the country’s

national surveillance system, or national statistical office, or by any other relevant agency or research

groups (and include academic research or studies implemented by nongovernmental organizations).

Youth exposure rates for selected countries can be found in the WHO Global Health Observatory Data

Repository.


( )

( )

DISAGGREGATION

Wherever possible, data should be separated for boys and girls, and combined (total) prevalence should

be provided.


Regular collection of data on the prevalence of youth exposed to tobacco smoke at home contributes to

effective tobacco control policies. WHO also recommends that such surveys be conducted regularly (at

least once every five years) so that their repetition contributes to the creation of tobacco-related

national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart from the







COMMENTS




66


Global:

- Global Youth Tobacco Survey: http://www.who.int/tobacco/surveillance/gyts/en/index.html


- WHO Global Health Observatory Data Repository:





67

5.2 Percentage of youth exposed to tobacco smoke in public places or public transport

INDICATOR NAME

Percentage of youth exposed to tobacco smoke in public places


Percent

RATIONALE

Children are at particular risk from adults’ smoking. Adverse health effects include pneumonia and

bronchitis, coughing and wheezing, worsening of asthma, middle ear disease, and possibly neuro-

behavioural impairment and cardiovascular disease in adulthood. In addition, many studies show that

parental smoking is associated with higher youth smoking.

The youth exposure rates reflect the exposure to second-hand smoke among youth in a country and can

be used to estimate the number of youth exposed to tobacco smoke in public places in the population.

DEFINITION

The youth exposure rate, expressed as a percentage of the total youth population, refers to the number

of youth exposed to other people’s tobacco smoke in public places per 100 of the youth population in

the country, resulting from the latest youth tobacco use survey (or survey which asks tobacco use

questions). When this rate is multiplied by the country's youth population, the result is an estimate of

the number of youth currently exposed to smoke in public places in the country.




"Exposure in public places" is defined as youth reporting other people smoking in public places at least

once in the presence of the respondent during a defined period leading up to the survey date.

While the precise definition of “public places” will vary between jurisdictions, it is important for the

legislation in force to define this term as broadly as possible. The definition used should cover all places

accessible to the general public or places for collective use, regardless of ownership or right to access.

(in line with the guidelines for implementation of Article 8 of the Convention)




68


Survey Project on Alcohol and Other Drugs (ESPAD), Health Behaviour of School-aged Children (HBSC).


These include national specific population surveys. Such surveys may be conducted by the country’s

national surveillance system, or national statistical office, or by any other relevant agency or research

groups (including academic research or studies implemented by nongovernmental organizations). Data

on youth exposure to tobacco smoke outside home for selected countries can be found in the WHO



( )

( )

DISAGGREGATION

Wherever possible, disaggregation should be made by gender, data should be separated for boys, girls,

and combined (total) prevalence should also be provided.


Regular collection of data on the prevalence of youth exposed to tobacco smoke in public places








patterns, determinants and consequences of tobacco consumption and exposure to tobacco smoke”,


COMMENTS




69


Global:

- Global Youth Tobacco Survey: http://www.who.int/tobacco/surveillance/gyts/en/index.html


- WHO Global Health Observatory Data Repository:





70

6. TOBACCO-RELATED MORTALITY

71

6.1 Estimated total number of deaths attributable to tobacco use

INDICATOR NAME

Estimated total number of deaths attributable to tobacco use


Count

RATIONALE

Almost 6 million people die from tobacco use each year, both from direct tobacco use and from

exposure to second-hand smoke. By 2020, this number will increase to 7.5 million, accounting for 10% of

all deaths. Smoking is estimated to cause about 71% of lung cancer, 42% of chronic respiratory disease

and nearly 10% of cardiovascular disease. (Global status report on noncommunicable diseases 2010)

DEFINITION

Proportion of adult (age 30 years and above) deaths attributable to tobacco use by major communicable

and noncommunicable causes.

A list of the main smoking-related causes of death (which can be taken into account when calculating

the estimated total number of deaths attributable to tobacco use) is provided is provided for reference

in Appendix 1.


Estimates produced by various research groups, using information from sources such as: national civil

registration with complete coverage and medical certification of cause of death; household surveys;

population census; sample or sentinel registration systems; national cancer registries; and special

studies.


If no national data are available, country estimates may be found at the WHO Global Health Observatory

Data Repository.


The contribution of a risk factor (e.g. tobacco) to a disease or a death is quantified using the Population

Attributable Fraction (PAF). PAF is the proportional reduction in population disease or mortality that

would occur if exposure to a risk factor were reduced to an alternative ideal exposure scenario (e.g. no

tobacco use). To enable the calculation of mortality attributable to tobacco use using PAF method, three

pieces of information are needed:

- the prevalence of tobacco use;

72

- the risk of death related to specific causes among tobacco users compared with the risk of death of

these same causes among non-users; and

- vital statistics information on the number of deaths in a population by cause of death, age at death and

gender of the deceased.

The population attributable fraction (PAF) formula is made up of two factors: (i) the prevalence (P) of

tobacco use in the population in question; and (ii) the relative risk (RR) of developing a disease among

those who smoke tobacco or consume smokeless tobacco compared with those who do not smoke

tobacco.

PAF = P(RR-1)/[P(RR-1)+1]

The PAF can range from zero to one. It can only take the value zero when either the relative risk is

exactly equal to 1 or prevalence of tobacco use is zero (i.e. nobody uses tobacco). Otherwise, the higher

the prevalence (P) the higher the PAF as long as RR is not equal to 1; and conversely, the higher the

measure of relative risk (RR), the higher the PAF as long as prevalence of tobacco use is not zero.

Multiplying the number of cause specific deaths by the PAF results in the number of deaths attributable

to tobacco use.

If relative risk is not available from local sources, the estimated relative risk (RR) of mortality for current

and former cigarette smokers compared to never smokers can be obtained from the following source:

WHO economics of tobacco toolkit: assessment of the economic costs of smoking (available at

http://whqlibdoc.who.int/publications/2011/9789241501576_eng.pdf).

DISAGGREGATION

Wherever possible, disaggregation should be made by gender and age and cause of death.




on tobacco-attributable mortality should be broken down by age group (preferably by 10-year category,

e.g. 25−34, 35−44)

In the case of cause of death, if available, provide data by each separate tobacco-related cause of death

provided in Annex 1.


Regular collection of data on the overall tobacco-attributable mortality contributes to effective

monitoring and evaluation of the impact tobacco control policies. WHO also recommends that such

surveys be conducted regularly so that their repetition contributes to the creation of tobacco-related

national surveillance systems as envisaged in Article 20.3(a) of the Convention. Apart from the

http://whqlibdoc.who.int/publications/2011/9789241501576_eng.pdf

73







COMMENTS

None


Global:

- CANCERmondial: http://www-dep.iarc.fr/

- WHO Global Health Observatory (Mortality and global health

estimates):http://www.who.int/gho/mortality_burden_disease/en/

- WHO global report: mortality attributable to tobacco (WHO, 2012)

http://www.who.int/tobacco/publications/surveillance/rep_mortality_attibutable/en/

Other sources:

- Bulletin of the World Health Organization: Counting the dead and what they died from: an

assessment of the global status of cause of death data (Mathers CD et al. Bulletin of the World Health

Organization, 2005, 83:171–177)

http://www.who.int/bulletin/volumes/83/3/mathers0305abstract/en/

http://www-dep.iarc.fr/

http://www.who.int/gho/mortality_burden_disease/en/

http://www.who.int/tobacco/publications/surveillance/rep_mortality_attibutable/en/

http://www.who.int/bulletin/volumes/83/3/mathers0305abstract/en/

74

7. TOBACCO-RELATED COSTS

75

7.1 Overall cost of tobacco use imposed on society

INDICATOR NAME

Overall cost of tobacco use imposed on society


Local currency unit

RATIONALE

Tobacco use creates a significant economic burden on society. Higher direct health costs associated with

tobacco-related disease, and higher indirect costs associated with premature loss of life, disability due

to tobacco-related disease and productivity losses create significant negative externalities of tobacco

use.

Measuring the cost of tobacco use translates the adverse health effects of tobacco use into monetary

terms. Information on the overall cost of tobacco use imposed on society is useful for a number of

purposes:

• to measure the impact of tobacco use on health-care delivery and financing, and the productivity of

the population;

• to inform the adoption of economic interventions, such as increases in taxes applied to tobacco

products and financial incentives for not using such products;

• to determine damages in court cases/litigation related to tobacco use;

• to advocate for and to guide the development of public health policies with respect to tobacco control;

• to inform decision-makers at both national and subnational levels;

• to provide an economic framework for tobacco control programme evaluation.

DEFINITION

The term ”costs of tobacco use” is defined as the difference between overall (health-care and other)

costs that actually occur due to tobacco use, and the costs that would have occurred had there been no

tobacco use. That is, the cost of tobacco use is based on an excess cost approach. Tobacco use includes

the use of smoking tobacco products, smokeless tobacco products, and other tobacco products.

Based on the conventional cost of illness approach, the economic costs of tobacco use distinguish

between direct and indirect costs.

Direct costs consist of goods or services which involve a monetary exchange in the market place.

76

Indirect costs represent losses for which no money changes hands, but nonetheless involve a loss of

resources. Indirect costs include the value of time lost from activities due to illness and disability, and

the value of lives lost prematurely from tobacco-related illnesses.


Cost calculations are usually carried out by research that has been given the task of translating the

health effects of tobacco use into monetary terms. Such groups may have been constituted by health,

finance and other relevant departments of government or other relevant -agencies and institutions

affiliated to the government.

Such cost calculations can be based on information available on the public domain, i.e. government

statistics. These sources can include, but may not be limited to, public expenditure reports, statistical

yearbooks and other periodicals, budgetary documents, national account reports, statistical data on

official web sites, and data provided by government ministries and offices.


Reports of studies and analyses undertaken by research groups not affiliated to any government

department or agency. Other such sources may include academic studies and reports, or research done

by nongovernmental organizations not affiliated with the tobacco industry and any other public and

private agency. It should be ensured that, in the context of Article 5.3 of the Convention, such research

is protected from the commercial and other vested interests of the tobacco industry, including

resources provided for such research by the tobacco industry or by organizations and individuals that

work to further the interests of the tobacco industry.


Different research groups may apply various formulae for the calculation of costs attributable to tobacco

use. First and foremost, the decision needs to be taken as to which (or all) of the diseases attributable to

tobacco use and/or exposure to tobacco smoke will be included in the calculations. The most

comprehensive studies include diseases occurring in both children and adults, and are related to either

tobacco use or exposure to tobacco smoke. Once the nature of diseases to be included in the calculation

has been decided upon, the tobacco-attributable fraction (TAF) will need to be calculated.

Tobacco-attributable fraction

The TAF is the proportion of health services utilization, health-care costs, deaths, or other health

outcome measures that can be attributed to tobacco use. This fraction is also known as the population

attributable risk (PAR).

Once the TAF is determined, it can be multiplied by the corresponding total measure of interest to

derive the tobacco-attributable measure. For example, the product of the TAF and total number of

inpatient days in a country is the tobacco-attributable inpatient days; the product of the TAF and total

national outpatient cost is the tobacco-attributable outpatient cost. Similarly, the product of the TAF for

77

lung cancer deaths and the total number of lung cancer deaths gives the number of tobacco-attributable

lung cancer deaths.

To calculate the TAF using the epidemiological approach,4 two fundamental data elements need to be

estimated first: (1) tobacco use prevalence, and (2) relative risk.

(1) Pe = Ne / (total population) x 100%

(2) RRie = [Incident cases for disease i or incident i among tobacco users/Ne] / [Incident cases for disease

i or incident i among non-tobacco users/Nn]

(3) TAFi = [Pe * (RRie – 1)/Pe * (RRie – 1) + 1] x 100%

= [(Pn + Pe * RRie) – 1]/(Pn + Pe * RRie)]x 100%

where the subscript i = a particular tobacco-related disease i (e.g.lung cancer)

Pe = percentage of ever tobacco users (current plus former users)

Pn = percentage of never tobacco users which equals (1 – Pe)

Ne = number of ever tobacco users (current plus former users)

Nn = number of never tobacco users

The total economic cost of tobacco use is the sum of the estimated tobacco-attributable health-care

expenditures, tobacco-attributable indirect morbidity cost, and tobacco-attributable mortality cost

across all tobacco-attributable diseases. For cross-country comparison, the total cost of tobacco use is

often expressed as a percentage of the gross domestic product (GDP). Although this proportion provides

convenient comparison for the relative scale of tobacco-attributable burden on society across countries,

it does not measure the impact of tobacco use on economic growth.

For more technical information, please refer to the useful links and information below.

DISAGGREGATION

As a minimum, calculations need to be made separately for direct and indirect costs. If resources are

available, disaggregated figures may also be provided by tobacco product (e.g. smoking, smokeless and

other tobacco products); gender; and for children and adults. As a minimum, such calculation needs to

be conducted for the adults where most of the costs related to tobacco use occur.

4WHO’sEconomics of tobacco toolkitalso describes the econometric approach to estimate the smoking-attributable

fraction. However, the econometric approach is not as straightforward as the epidemiological approach and is also very data intensive. For example, data from a household health and demographic survey may not be readily available in most countries. In practice, researchers mostly rely on the epidemiological approach when estimating the tobacco-attributable fraction, which is why the epidemiological approach is presented in this Compendium. For more information and the description of other approaches please refer to the toolkit.

78


To better contribute to the substantiation of tobacco control policies, the overall cost of tobacco use

imposed on society need to be recalculated regularly. If data used for the calculations are collected

regularly (e.g. are available for each calendar year), such calculations can be repeated on an annual basis.

Article 20.3(a) of the Convention calls upon Parties to "establish progressively a national system for the

epidemiological surveillance of tobacco consumption and related social, economic and health indicators".

COMMENTS

It is useful to present the estimated total economic cost of tobacco use in the following ways:

• by the component of the economic costs (e.g. health-care costs, mortality cost, etc.);

• by type of tobacco use-related diseases (e.g. heart diseases, cancer, etc.);

• by demographic subgroups (e.g. gender);

• in terms of cost per person or per tobacco user;

• in terms of cost per pack of cigarettes sold or per unit of other tobacco product sold.

USEFUL INFORMATION AND LINKS

Global:

- OECD (data on health expenditure): http://www.oecd-ilibrary.org/social-issues-migration-

health/health-key-tables-from-oecd_20758480

- United Nations Statistical Division, UNdata (government expenditure allocated to health):

http://data.un.org/Data.aspx?q=health+expenditure&d=SOWC&f=inID%3a85

- The World Bank (health expenditure as % of GDP):

http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

- World Health Organization, economics of tobacco toolkit: assessment of the economic costs of

smoking. http://apps.who.int/iris/bitstream/10665/44596/1/9789241501576_eng.pdf

- WHO Global Health Observatory Data Repository (health financing):


Regional:

- Eurostat (health care expenditure):


base

http://www.oecd-ilibrary.org/social-issues-migration-health/health-key-tables-from-oecd_20758480




http://apps.who.int/iris/bitstream/10665/44596/1/9789241501576_eng.pdf

http://apps.who.int/nha/database/DataExplorerRegime.aspand%20http:/apps.who.int/gho/data/node.main.75?lang=en



79

7.2 Direct (health-care related) costs of tobacco use

INDICATOR NAME

Direct costs of tobacco use


Local currency unit

RATIONALE




use.

The direct cost of tobacco-related illnesses is determined by both the number of persons being treated

and the cost of treatment. The number of patients depends on a country’s population and stage in the

tobacco epidemic, whereas cost of treatment depends on the country’s health system. Estimates may

also vary depending on the research method used. Tobacco-related health-care costs have only been

calculated in a few countries, primarily due to limited or poor-quality data, dearth of research funding,

and absence of research capacity. As health systems of low- and middle-income countries develop along

with their economies, the medical costs of tobacco-related diseases will continue to grow along with the

need to evaluate these costs.

DEFINITION

“Direct costs” represent the monetary value of goods and services consumed as a result of tobacco use

and tobacco-related illness, and for which a payment is made. Some direct costs result from the use of

health-care services, while other are related to non-health-care costs. Direct costs include payments

made out-of-pocket on health-care benefits, disability, and workers' compensation. (Note that there are

two approaches which can be used to estimate the direct costs of tobacco use – annual cost approach

and lifetime cost approach.)

Direct costs include the following types of costs:

Health-care costs include hospitalizations, physician services, nursing home care, home health-care,

medications, and services of other health-care providers in the treatment of tobacco-related diseases. It

also includes the costs of transportation to health-care providers, and care giving by non-health-care

providers, such as family members, to tobacco users who are ill. Costs for herbal treatments,

complementary and alternative medicine, and traditional healers might also be included. Other related

costs include medical supplies and equipment.

80

Non-health-care costs of tobacco use, include property losses from fires caused by smoking, cleaning of

clothes and air to remove smoke and odours, business expenses to hire and train replacements for

tobacco users who are ill, and insurance premiums for fire and accident insurance.


Cost calculations are usually carried out by research that have been given the task of translating the


finance and other relevant departments of government or other relevant agencies and institutions

affiliated to the government.

Such cost calculations can be based on information available on the public domain, i.e. government

statistics. These sources may include public expenditure reports (e.g. those concerning health care

funding, health insurance companies’ reports), statistical yearbooks and other periodicals, budgetary

documents, national account reports, statistical data available on official web sites, and other data

provided by government departments or agencies.


Reports of studies and analyses implemented by various other research groups, not affiliated to any

government department or agency. Other such sources may include academic studies and reports, or

research done by nongovernmental organizations not affiliated with the tobacco industry and any other

public and private agency or organization. It should be ensured that, in the context of Article 5.3 of the

Convention, such research is protected from commercial and other vested interests of the tobacco

industry, including resources provided for such research by the tobacco industry or by organizations and

individuals that work to further the interests of the tobacco industry.

METHOD OF MEASURMENT

The direct costs of tobacco use, also called tobacco-attributable health-care expenditures (TAE), are

those health-care expenditures resulting from the treatment of tobacco-related diseases. The key step

in estimating the costs of tobacco use is to determine the TAF. Once the TAF is determined, the product

of the TAF and the total national health-care expenditures gives the TAE.

Estimating the TAE consists of four steps:

1. Determine the tobacco-related diseases, the types of health-care services to be included, and the

appropriate classification of population subgroups.

2. Estimate the TAF of health-care expenditures using the epidemiological approach.

3. Estimate total national health-care expenditures (THE) by population groups.

4. Estimate the TAE as the product of the TAF and the THE according to Equation below.

81

The formula to calculate the tobacco-attributable health-care expenditures for treating disease i using

health-care service type k among population subgroup j (TAEikj) is specified as:

TAEikj = TAFikj x THEikj

where TAFikj = tobacco-attributable fraction for treating disease i using health-care service type k

among population subgroup j

THEikj = total national annual expenditures in the country for treating disease i using health-care service

type k among population subgroup j

If the TAF estimates are not available by type of health-care services, the above formula is approximated

to be:

TAEikj = TAFij x THEikj

where TAFij = tobacco-attributable fraction for disease i among population subgroup j

The value of the total national health-care expenditures can be estimated from the total health

expenditure as a % of GDP.


DISAGGREGATION

As a minimum, such calculation needs to be conducted for the adults, where most of the costs related to

tobacco use occur. Taking into account local needs and availability of resources, disaggregated figures

can also be provided by tobacco products (e.g. smoking, smokeless, or other tobacco products); types of

health-care services (e.g. inpatient/outpatient); gender (e.g. data separated for males and females and

total); and age (e.g. children and adults).


To better contribute to the substantiation of tobacco control policies, the direct cost of tobacco use





COMMENTS

It is useful to present the estimated total smoking-attributable health-care cost in the following ways:

• by type of health-care services (e.g. inpatient hospitalizations, outpatient visits and etc.)

• by type of smoking-related diseases

• by demographic subgroups

82

• in terms of costs per person or per smoker

• in terms of cost per pack of cigarettes sold

For cross-country comparison, the total smoking-attributable health-care cost is commonly expressed as

the percentage of the national total health-care expenditures or the national gross domestic product.

The estimated costs related to tobacco use vary considerably depending on the premises used and the

items included in the cost analysis. Therefore, careful consideration should be given when providing

cross-country comparisons of the cost estimates. [JAPAN]


Global:











Regional:



base









83

7.3 Indirect costs of tobacco use

INDICATOR NAME

Indirect costs of tobacco use


Local currency unit

RATIONALE




use.

Indirect costs of tobacco use are expenses not immediately related to treatment of disease. These non-

medical expenditures include lost wages, lost workdays, costs related to using replacement workers,

overtime premiums, productivity losses related to unscheduled absences, and productivity losses of

workers on the job.

DEFINITION

Indirect costs include the following:

Morbidity costs are an indirect cost representing the value of lost productivity by persons who are ill or

disabled as a result of a tobacco-related disease. An ill person may be unable to work at their usual job

or perform their usual housekeeping and childcare activities. Morbidity costs are estimated by

determining what a person would have been able to earn performing paid labour, and also by

estimating an imputed value for lost household production services.

Mortality costs: tobacco users have an increased probability of dying from a number of diseases that

have been causally linked to tobacco use. The value of the lives lost is known as the mortality cost. One

measure of the value of life is based on assigning a monetary value to a life. This can be done using the

human capital approach, which values life according to what an individual produces, or the willingness-

to-pay approach, which values life according to what someone would pay to avoid illness or death.

Another measure of the value of lives lost prematurely is the number of years of potential life lost (YPLL).

YPLL denotes the number of years an individual would have lived had they not died of a tobacco-

attributable disease. The YPLL is determined by the number of years of life expectancy remaining at the

age of death.

Disability adjusted life years (DALYs) incorporate both the impact of tobacco-related illness on disability

and premature death, i.e. the qualitative and quantitative aspects of illness, by combining them into one

measure. The DALY was first conceptualized by Murray and Lopez in work carried out with WHO and the

84

World Bank (Murray and Lopez, 1996)5. Years of life lost due to living with a disability is the product of

number of incident cases of disease, duration of each case, and a disability weight which reflects the

degree of disability. Disability weights to be used with years lived with a specific illness have been

developed, and years of life lost from premature death are determined by comparing age at death with

the greatest life expectancy – that of Japanese women. The mortality component of the DALYs is similar

to the YPLLs. Disability weights for specific illnesses are found in the Global Burden of Disease Study

(Murray and Lopez, 1997).6


Calculation of these costs is usually carried out by research groups given the task of translating the


finance and other relevant departments of government, as well as by other relevant agencies and

institutions affiliated to the government.

Such cost calculations can be based on information available on the public domain, for example from

various government statistics. These sources can include, but may not be limited to, public expenditure

reports (e.g. those concerning health care funding, health insurance companies’ reports), statistical

yearbooks and other periodicals, budgetary documents, national account reports, statistical data

available on official web sites, and other data provided by government departments or agencies.


Reports of studies and analyses carried out by other research groups not affiliated to any government

department or agency. Other such sources may include academic studies and reports, or research done

by nongovernmental organizations not affiliated with the tobacco industry and any other public and

private agency or organization. It should be ensured that, in the context of Article 5.3 of the Convention,

such research is protected from commercial and other vested interests of the tobacco industry,

including resources provided for such research by the tobacco industry or by organizations and

individuals that work to further the interests of the tobacco industry.

METHOD OF MEASURMENT

The indirect morbidity costs of tobacco use, also called tobacco-attributable indirect morbidity costs

(TAI), are the economic value of lost productivity by persons who are sick or disabled due to tobacco-

related diseases. The lost productivity is measured by work-loss days and/or disability days.

In the epidemiological approach, the TAF is calculated for each tobacco-related disease of interest;

similarly, the TAI need to be estimated for each particular tobacco-related disease.

5. Murray CJL, Lopez AD, eds. The Global Burden of Disease: a comprehensive assessment of mortality and disability

from diseases, injuries and risk factors in 1990 and projected to 2020. Harvard, MA, Harvard School of Public Health, 1996. 6Murray CJL, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease

Study. Lancet, 1997, 349:1436–1442

85

Estimating the TAI comprises five steps:

1. Determine the tobacco-related diseases, the type of health-care services to be included, and the

appropriate classification of population subgroups.

2. Estimate the TAF of work-loss days and non-health-care costs using the epidemiological approach.

3. Estimate total national work-loss days (TWLD) and total national non-health-care costs (TNHC) by

population groups.

4. Estimate the mean daily earnings or salary.

5. Estimate the TAI by adding the product of the TAF, TWLD, and mean daily earnings to the product of

the TAF and the TNHC for each type of health-care services.

The indirect mortality costs of tobacco use, also called tobacco-attributable indirect mortality costs

(TAMC), are defined as the value of lives lost due to tobacco-caused premature death. Another way to

measure the value of lives is in terms of the number of years of potential life lost (YPLL), which indicates

how many more years an individual would have lived had they not died prematurely from a tobacco-

related disease. The YPLL is determined by the number of years of life expectancy remaining at the age

of death.

Estimating the TAMC and TAYPLL involves six steps:

1. Determine the tobacco-related diseases, and the appropriate classification of population subgroups.

2. Estimate the TAF of mortality.

3. Estimate the total number of deaths in the country for the disease of interest (TDEATH).

4. Estimate the present value of lifetime earnings (PVLE).

5. Determine the years of remaining life expectancy (YLIFE).

6. Estimate the TAMC as the product of the TAF, TDEATH, and PVLE. Similarly, estimate TAYPLL as the

product of TAF, TDEATH, and YLIFE.

DISAGGREGATION

As a minimum, such calculations need to be conducted for the adults, the group in which most of the

costs related to tobacco use occur. Taking into account local needs and availability of resources,

disaggregated figures can also be provided by tobacco products (e.g. smoking, smokeless, or other

tobacco products); types of health-care services (e.g.. inpatient/outpatient); gender (e.g.. data

separated for males and females and total); and age (e.g.. children and adults).

86


To better contribute to the substantiation of tobacco control policies, the indirect cost of tobacco use





COMMENTS

None


Global:











Regional:



base









87

8. SUPPLY OF TOBACCO AND TOBACCO PRODUCTS

88

8.1 Total volume of duty-free sales of tobacco products

INDICATOR NAME

Total volume of duty-free sales of tobacco products


Volume expressed in unit (e.g. pieces, millions of pieces, tonnes, thousands of packages)

RATIONALE

Tax avoidance by consumers involves legal activities such as purchases for personal consumption from a

lower-tax jurisdictions or duty-free shops. The extent of duty-free shopping and/or other tax avoidance

activities by individuals can be significant in some countries. This defeats the health purpose of taxation

and harms public health by encouraging personal consumption. Prohibiting or restricting duty-free sales

of tobacco products reduces opportunities for tax avoidance, and a number of Parties to the Convention

have already taken such measures.

In addition, there is some evidence that the availability of duty-free sales of tobacco products has

facilitated illicit trade in tobacco products in many countries.

DEFINITION

Duty-free tobacco products (cigarettes, smoking, smokeless and other tobacco products) are defined as

merchandise on which duty is not charged because it is sold only to departing passengers in an airport's

or port's departure lounge (which are bonded areas) upon presentation of valid travel documents (such

as a passport and travel ticket).

These tobacco products are treated for customs purposes as goods for duty-free shops and tax should

not be paid.


Government departments, national statistical offices or agencies, or any other organization affiliated to

the government, which is responsible for collecting data on licit supply of tobacco products.


Any other relevant agency or research group, including academic research or studies implemented by

nongovernmental organizations.


Duty-free sales can be reported by product and unit (e.g. pieces, millions of pieces, tonnes, thousands of

packages). In some cases, duty-free sales information is provided in value. The value of duty-free sales of

89

tobacco products is equal to the price per unit of tobacco product multiplied by the number of quantity

of units of tobacco products.

DISAGGREGATION

Data can be disaggregated by category of tobacco product - cigarettes, smoking tobacco products,

smokeless tobacco products and/or other tobacco products, as appropriate.


Such information is usually available with the relevant government department, national statistical

offices or agency, or any other organization affiliated to the government that is responsible for

collecting data on licit supply of tobacco products in the country.

COMMENTS

Article 6.2(b) of the Convention not only requires Parties to prohibit or restrict sales to international

travellers of tax- and duty-free tobacco products, but also importations of tax- and duty-free tobacco

products by returning travellers.


- Expert review on a possible ban on duty-free sales of tobacco products (document FCTC/COP/INB-

IT/3/INF.DOC./3, available at http://apps.who.int/gb/fctc/PDF/it3/FCTC_COP_INB_IT3_ID3-en.pdf)

http://apps.who.int/gb/fctc/PDF/it3/FCTC_COP_INB_IT3_ID3-en.pdf

90

8.2 Total volume of domestic production of tobacco and tobacco products

INDICATOR NAME

Total volume of domestic production of tobacco and tobacco products


Volume expressed in dry weight (e.g. kilograms, tonnes) in the case of unmanufactured tobacco

(tobacco leaf) and unit (e.g. pieces, millions of pieces, tonnes, thousands of packages) in the case of

manufactured tobacco products.

RATIONALE

Tobacco is produced and manufactured in many countries worldwide, including developing countries.

Tobacco is a cash crop that active industry intervention has made attractive to farmers. It is the largest

non-food crop by monetary value in the world. Nevertheless, many countries, including the world’s

largest producers, are taking steps to find alternatives to tobacco growing.

Unmanufactured tobacco is mostly used in the production of tobacco products. Cigarette production

has, until recently, been located largely in developed countries for various reasons. First, consumption

was concentrated in developed countries. Second, cigarette production is a capital intensive

manufacturing activity and requires specialized technology, supply of materials and considerable

research and development that were typically not available in developing countries.

The market for unmanufactured tobacco and tobacco products does not resemble a free market and

governmental interventions influence both the production and trade of tobacco in most countries.

Monitoring domestic production of tobacco and tobacco products facilitates the development of

sectoral policies, including transition to viable alternatives to tobacco growing, and an effective

administration of excise, respectively.

DEFINITION

Domestic tobacco and tobacco products include all tobacco grown or manufactured within a particular

territory rather than imported from outside that territory.


Government departments (e.g. trade, industry, finance), national statistical offices or agencies, or any

other organization affiliated to the government that is responsible for collecting data on licit supply of

unmanufactured tobacco and tobacco products.


Any other relevant agency or research group, including academic research or studies implemented by


91


Domestic production of unmanufactured tobacco can be reported in dry weight (e.g. kilograms, tonnes).

Domestic production of manufactured tobacco can be reported by product and unit (e.g. pieces, millions

of pieces, tonnes, thousands of packages).

Licit supply is calculated, as appropriate, using the following formula: domestic production + (imports −

exports), where:

Domestic production = total licit supply - imports + exports

DISAGGREGATION

Data can be disaggregated by unmanufactured tobacco (tobacco leaf) and category of manufactured

tobacco product – e.g. cigarettes, smoking tobacco products, smokeless tobacco products and/ or other

tobacco products.



offices or agencies, or any other organization affiliated to the government that is responsible for

collecting data on licit supply of tobacco products in the country at any time.

COMMENTS

In some cases, information on domestic production is available in the form of the value of tobacco leaf

or manufactured tobacco product.


Information on the domestic production of tobacco and tobacco products are available on the following

sites:

- Food and Agriculture Organization of the United Nations:

http://faostat3.fao.org/home/index.html#DOWNLOAD (commodity code 2671)

- United Nations Commodity Trade Statistics Database (UN Comtrade): http://comtrade.un.org/db/

- United Nations Conference on Trade and Development (UNCTAD):

http://unctadstat.unctad.org/ReportFolders/reportFolders.aspx

- United Nations Statistical Division (UNSD-UN data): http://data.un.org/Default.aspx and

http://data.un.org/Data.aspx?q=TOBACCO&d=ICS&f=cmID%3a25090-0

- UNSD Industrial Commodity Production Statistics Dataset

http://unstats.un.org/unsd/industry/ics_intro.asp

http://faostat3.fao.org/home/index.html#DOWNLOAD

http://comtrade.un.org/db/

http://unctadstat.unctad.org/ReportFolders/reportFolders.aspx-

http://data.un.org/Default.aspx

http://data.un.org/Data.aspx?q=TOBACCO&d=ICS&f=cmID%3a25090-0

http://unstats.un.org/unsd/industry/ics_intro.asp

92

- World Integrated Trade Solution (WITS)7: http://wits.worldbank.org/wits/

7 The World Integrated Trade Solution (WITS) is software developed by the World Bank, in collaboration with the

United Nations Conference on Trade and Development (UNCTAD), International Trade Center (ITC), United Nations Statistical Division (UNSD) and the World Trade Organization (WTO). WITS gives users access to major international merchandise trade, tariffs and non-tariff data compilations such as: the UN COMTRADE database maintained by the UNSD (containing merchandise trade exports and imports by detailed commodity and partner country); the TRAINS maintained by UNCTAD (imports, tariffs, para-tariffs and non-tariff measures at national tariff level); the IDB and CTS databases maintained by WTO (MFN applied, preferential & bound tariffs at national tariff level); the GPTAD database maintained by the World Bank and the Center for International Business, Tuck School of Business at Dartmouth College. WITS is free, but access to databases themselves may require payment of a fee or be limited, depending on the status of the user.

http://wits.worldbank.org/wits/

93

8.3 Volume of exports of tobacco and tobacco products

INDICATOR NAME

Volume of exports of tobacco and tobacco products


Volume expressed in dry weight (e.g. kilograms, tonnes) in the case of unmanufactured tobacco

(tobacco leaf) and unit (e.g. pieces, millions of pieces, tonnes, thousands of packages) in the case of

manufactured tobacco products.

RATIONALE

There are several basic reasons why international trade in tobacco and tobacco products has arisen,

including the following:

(1) a country’s inability to domestically produce tobacco and tobacco products in sufficient quantity to

satisfy domestic demand for these products;

(2) a country’s inability to domestically produce tobacco and tobacco products of sufficiently high quality

to satisfy domestic demand;

(3) differences in prices among countries for different types and qualities of tobacco and tobacco

products; and

(4) the importing of unmanufactured tobacco for use in production of tobacco products for export.

The recent liberalization of tobacco-related trade through bilateral, regional, and international trade

agreements has significantly reduced tariff and nontariff trade barriers. The elimination or reduction of

these barriers has almost certainly increased competition in tobacco-product markets leading to

reductions in the relative prices of these products and increases in their advertising and promotion.

Cross-country price comparisons of tobacco of the same type indicate that prices have been altered

significantly by trade restrictions and domestic tobacco policy in major producing and consuming

counties. Liberalization of tobacco-related trade has contributed to global increases in cigarette smoking

and other tobacco use, particularly in low- and middle-income countries.

DEFINITION

Tobacco and tobacco product exports are all tobacco which are subtracted from the stock of material

resources of the country by leaving its economic territory. In many cases, a country's economic territory

largely coincides with its customs territory, which is the territory in which the customs law of a country

applies in full. Unmanufactured tobacco and tobacco products simply being transported through a

country (in transit) or temporarily admitted or withdrawn (except for goods for inward or outward

processing) do not subtract from the stock of material resources of the country and are not included in

the definition.

94


Government departments (e.g. trade, industry, and finance), national statistical offices or agencies, or

any other organization affiliated to the government that is responsible for collecting data on licit supply

of unmanufactured tobacco and tobacco products.


Any other relevant agency or research groups, including academic research or studies implemented by


If such data are not available or not easily accessible within the country, the sources mentioned at the

end of this section provide information on exports/imports of unmanufactured tobacco and tobacco

products.


Exports can be reported in dry weight (e.g. kilograms, tonnes) in the case of unmanufactured tobacco,

and by product and unit (e.g. pieces, millions of pieces, tonnes, thousands of packages) in the case of

manufactured tobacco.

Licit supply is calculated, as appropriate, from the following formula: domestic production + (imports –

exports), where:

Exports = domestic production + imports – total licit supply

DISAGGREGATION


tobacco product – e.g. cigarettes, smoking tobacco products, smokeless tobacco products and/or other

tobacco products.




collecting data on licit supply of unmanufactured tobacco and tobacco products in the country.

COMMENTS

In some cases, information on exports is available in form of the value of the exported quantity of

product.


Information on tobacco exports/imports are available on the following sites:

95




- United Nations Statistical Division, UNdata (tobacco exports/imports):

http://data.un.org/Data.aspx?q=TOBACCO&d=ComTrade&f=_l1Code%3a25




96

8.4 Volume of imports of tobacco and tobacco products

INDICATOR NAME

Volume of imports of tobacco and tobacco products


Volume expressed in dry weight (e.g. kilograms, tonnes) in the case of unmanufactured tobacco and in

unit (e.g. pieces, millions of pieces, tonnes, thousands of packages) in the case of manufactured tobacco

products.

RATIONALE

There are several basic reasons why international trade in unmanufactured tobacco and tobacco

products has arisen, including the following:

(1) a country’s inability to domestically produce tobacco and tobacco products in sufficient quantity to

satisfy domestic demand for these products;

(2) a country’s inability to domestically produce tobacco and tobacco products of sufficiently high quality

to satisfy domestic demand;

(3) differences in prices among countries for different types and qualities of tobacco and tobacco

products; and

(4) the importing of unmanufactured tobacco for use in production of tobacco products for export.

The recent liberalization of tobacco-related trade through bilateral, regional, and international trade

agreements has significantly reduced tariff and nontariff trade barriers. The elimination or reduction of

these barriers has almost certainly increased competition in tobacco-product markets leading to

reductions in the relative prices of these products and increases in their advertising and promotion.

Cross-country price comparisons of tobacco of the same type indicate that prices have been altered

significantly by trade restrictions and domestic tobacco policy in major producing and consuming

counties. Liberalization of tobacco-related trade has contributed to global increases in cigarette smoking

and other tobacco use, particularly in low- and middle-income countries.

In addition, many countries are net importers of tobacco leaf and tobacco products, and lose millions of

dollars each year in foreign exchange as a result.

DEFINITION

Tobacco and tobacco product imports are all products which add to the stock of material resources of

the country by entering its economic territory. In many cases, a country's economic territory largely

coincides with its customs territory, which is the territory in which the customs law of a country applies

in full. Unmanufactured tobacco and tobacco products simply being transported through a country (in

97

transit) or temporarily admitted or withdrawn (except for goods for inward or outward processing) do

not add to the stock of material resources of the country and are not included in the definition.


Government departments (e.g. trade, industry, and finance), national statistical offices or agencies, or

any other organization affiliated to the government that is responsible for collecting data on licit supply

of unmanufactured tobacco and tobacco products.




If such data are not available or not easily accessible within the country, the sources mentioned at the

end of this section provide information on exports/imports of unmanufactured tobacco and tobacco

products.


Imports can be reported in dry weight (e.g. kilograms, tonnes) in the case of unmanufactured tobacco,

and by product and unit (e.g. pieces, millions of pieces, tonnes, thousands of packages) in the case of

manufactured tobacco.

Licit supply is calculated, as appropriate, from the following formula: domestic production + (imports −

exports), where:

Imports = total licit supply – (domestic production - exports)

DISAGGREGATION


tobacco product – e.g. cigarettes, smoking tobacco products, smokeless tobacco products and/or other

tobacco products.




collecting data on licit supply of tobacco products in the country at any time.

COMMENTS

In some cases, information on imports is available in form of the value of the imported quantity of

product.

98


Information on tobacco exports/imports are available on the following sites:




- United Nations Statistical Division, UNdata:





99

9. SEIZURES OF TOBACCO PRODUCTS

100

9.1 Quantity of seized illicit tobacco products

INDICATOR NAME

Quantity of seized illicit tobacco products


Count

RATIONALE

Tobacco products are particularly attractive to smugglers because tax represents a high proportion of

their price, and evading tax by diverting tobacco products into the illicit market (where sales are largely

tax free) generates a considerable profit margin for the smugglers. The availability of cheap tobacco

products increases consumption and thus tobacco-related deaths in the future. Eliminating or reducing

the illicit trade in tobacco products will reduce consumption (by reinforcing and facilitating the impact of

taxation and price increases), save lives, and increase tax revenue to governments.

The quantity of seized illicit tobacco products gives an indication of the size of the illicit trade problem; it

is also important to analyse the seized tobacco products, disaggregating by brand and origin, to better

understand details and monitor trends.

Evidence that higher-income countries, where tobacco products are more expensive, have lower levels

of illicit trade than lower-income countries, is contrary to the claim of the tobacco industry that the

overall level of illicit trade is dependent (solely) on the price of tobacco products.

DEFINITION

Seizure of illicit tobacco products is the action of confiscating such products by warrant of legal right.

“Illicit trade” is defined in Article 1 of the WHO FCTC as any practice or conduct prohibited by law and

which relates to production, shipment, receipt, possession, distribution, sale or purchase including any

practice or conduct intended to facilitate such activity.


National customs offices, government departments, national statistical offices or agencies, or any other

organization affiliated to the government that is responsible for collecting data on illicit supply of

tobacco products.

Such data may be available on the Internet in the public domain, or on websites maintained by national

customs offices.

Collection and analysis of data should be protected from any interference by the tobacco industry.

101




Information on seizures can be available in publications of the World Customs Organization.


Seizures can be reported by product and unit (e.g. millions of pieces, thousands of packages). Following

conventional standards, one cigarette or stick weighs one gram, considering all the packaging, and 1

kilogram therefore represents 1000 sticks.

DISAGGREGATION

Data can be disaggregated by category of tobacco product (e.g. cigarettes, smoking tobacco products,

smokeless tobacco products and/or other tobacco products), as appropriate.


Such information is usually available with the relevant national customs offices, government

departments, national statistical offices or agencies, or any other organization affiliated to the

government that is responsible for collecting data on illicit supply of tobacco products in the country at

any time.

COMMENTS

The tobacco industry may present its own data or estimates concerning any indicator on illicit trade in

tobacco products. It is important to note that such information needs to be viewed with caution,

because the aim of the tobacco industry is to promote its interests and agenda, and there is a

fundamental and irreconcilable conflict between the tobacco industry’s interests and public health

policy interests. The industry promotes such information with a view to interfering with the

development of public health policies with respect to tobacco control. The guidelines for

implementation of Article 5.3 of the Convention require Parties not to accept support or endorse any

offer of assistance or any proposed tobacco control legislation or policy drafted by or in collaboration

with the tobacco industry.


Global:

- OLAF: http://ec.europa.eu/anti_fraud/index_en.htm

http://ec.europa.eu/atwork/synthesis/amp/doc/olaf_mp_en.pdf

- World Customs Organization: http://www.wcoomd.org/

http://ec.europa.eu/anti_fraud/index_en.htm%20http:/ec.europa.eu/atwork/synthesis/amp/doc/olaf_mp_en.pdf

http://ec.europa.eu/anti_fraud/index_en.htm%20http:/ec.europa.eu/atwork/synthesis/amp/doc/olaf_mp_en.pdf

http://www.wcoomd.org/

102

(Customs and Tobacco Report of the World Customs Organization are available for the years 2008,

2009, 2010 and 2011.) http://www.wcoomd.org/en/topics/enforcement-and-compliance/activities-

and-programmes/ef_tobaccoandcigarettesmuggling.aspx

Other sources:

- Joossens L. Illicit tobacco trade in Europe: issues and solutions.

In:http://www.ppacte.eu/index.php?option=com_docman&task=doc_download&gid=187&Itemid=2

9.

- Joossens L, et al. How eliminating the global illicit cigarette trade would increase tax revenue and

save lives. Paris, International Union Against Tuberculosis and Lung Disease, 2009.

http://www.worldlungfoundation.org/ht/display/ContentDetails/i/6589/pid/6512

http://www.wcoomd.org/en/topics/enforcement-and-compliance/activities-and-programmes/ef_tobaccoandcigarettesmuggling.aspx

http://www.wcoomd.org/en/topics/enforcement-and-compliance/activities-and-programmes/ef_tobaccoandcigarettesmuggling.aspx

http://www.worldlungfoundation.org/ht/display/ContentDetails/i/6589/pid/6512

103

9.2 Percentage of illicit tobacco products on the national tobacco market

INDICATOR NAME

Percentage of illicit tobacco products on the national tobacco market


Percent

RATIONALE

Tobacco products are particularly attractive to smugglers because tax represents a high proportion of

their price, and evading tax by diverting tobacco products into the illicit market (where sales are largely

tax free) generates a considerable profit margin for the smugglers. The availability of cheap tobacco

products increases consumption and thus tobacco-related deaths in the future. Eliminating or reducing

the illicit trade in tobacco products will reduce consumption (by reinforcing and facilitating the impact of

taxation and price increases), save lives, and increase tax revenue to governments.

DEFINITION

This indicator refers to the proportion of the national tobacco market represented by illicit tobacco

products.

Since there is no direct measure of the percentage of illicit tobacco products on the national tobacco

market, the value of this indicator is based on estimates.

Estimates of illicit trade do not always refer to illicit trade in the same way. Sometimes they refer to tax

evasion or to large-scale smuggling, sometimes to smuggling, sometimes to illicit trade (smuggling and

domestic illicit manufacturing combined). An additional problem is that the estimates of illicit cigarette

trade are expressed in different ways, sometimes as a percentage of cigarette sales based on tax records,

sometimes as a percentage of cigarette consumption or sometimes as a percentage of the cigarette

market. However, there is no standard way to define cigarette consumption or cigarette market and the

terms have been used to refer to different data sets, including tax recorded sales, tax recorded sales

plus illegal sales, tax recorded sales and legal cross-border sales in neighbouring countries, tax recorded

sales, illegal sales and legal cross border shopping sales.

The "national market" refers to sales of tobacco products in a country. The legal market refers to legal

sales. The illegal market refers to illegal (or illicit) sales. The total market refers to legal and illegal sales

in a country.

Sales data are based on sales to those who live in a country and to those who visit the country (tourist

shopping).

104

Consumption data are based on survey data among the population and reflect the use of all legal and

illegal tobacco products by those who live in the country, but not by non-residents passing through the

country.

Total consumption data for a country include: the legal sales in the country + the illegal sales to its

inhabitants + the legal sales to its inhabitants visiting other countries or duty-free shops (in amounts

allowable under customs regulations), minus legal sales to non-residents passing through the country.


National customs office, government departments, national statistical offices or agency, or any other

organization affiliated to the government that is responsible for collecting data on illicit supply of

tobacco products.


Research undertaken by any other relevant agency or research group, including academic research or

studies implemented by nongovernmental organizations.

A World Bank guide to understanding and measuring illicit trade in tobacco products within national

markets suggests that a range of different approaches are needed to obtain estimates. These

approaches include interviews with customs officials or law enforcement personnel, surveys of smokers

about their sources and buying habits, measures of tobacco trade figures, comparisons of tobacco sales

with tobacco consumption and empirical modelling of tobacco sales and consumption.


The difference between tax paid sales and individually reported consumption should reflect the extent

of overall tax avoidance and evasion – if there are no reporting biases in measures of tax paid sales and

measures of average consumption and prevalence obtained from representative population surveys.

Measuring illicit tobacco trade is methodologically challenging for many reasons. First, smuggling is an

illegal activity, and illegal traders are unlikely to record their activity. Similarly, for security reasons, data

on illicit trade are usually difficult to collect, as law enforcement agencies often prefer not to publicize

the scope of the activity. In addition, the data source may bias the estimate.

DISAGGREGATION

Data can be disaggregated by category of tobacco product (e.g. cigarettes, smoking tobacco products,

smokeless tobacco products and/or other tobacco products), as appropriate.


Such information is usually available with the relevant national customs offices, government

departments, national statistical offices or agencies, or any other organization affiliated to the

105

government that is responsible for collecting data on illicit supply of tobacco products in the country at

any time or estimates can be provided by any such agency upon request.

If estimates are not available at any time, as a minimum the relevant agencies should provide such

information regularly, in relation to the Party’s obligation under the Convention (Article 15.5 and Article

21.1).

COMMENTS

The tobacco industry may present its own data or estimates concerning any indicator on illicit trade in

tobacco products. It is important to note that such information needs to be viewed with caution,

because the aim of the tobacco industry is to promote its interests and agenda, and there is a

fundamental and irreconcilable conflict between the tobacco industry’s interests and public health

policy interests. The industry promotes such information with a view to interfering with the

development of public health policies with respect to tobacco control The guidelines for implementation

of Article 5.3 of the Convention require Parties not to accept, support or endorse any offer of assistance

or any proposed tobacco control legislation or policy drafted by or in collaboration with the tobacco

industry.


Global:

- OLAF: http://ec.europa.eu/anti_fraud/index_en.htm

- World Customs Organization:

http://www.wcoomd.org/andhttp://www.wcoomd.org/en/topics/enforcement-and-

compliance/activities-and-programmes/ef_tobaccoandcigarettesmuggling.aspx

Other sources:

- Joossens L. Illicit tobacco trade in Europe: issues and solutions. In:

http://www.ppacte.eu/index.php?option=com_docman&task=doc_download&gid=187&Itemid=29

- Measuring Tax Gaps (estimating the illicit tobacco market): http://www.hmrc.gov.uk/statistics/tax-

gaps/mtg-2009.pdf

- Merriman D. Tool 7. Smuggling: Understand, measure and combat tobacco smuggling. In: Yurekli A,

De Beyer J, eds. World Bank economics of tobacco toolkit. Washington, DC, World Bank, 2003.

http://siteresources.worldbank.org/INTPH/Resources/7Smuggling.pdf

http://ec.europa.eu/anti_fraud/index_en.htm

http://www.wcoomd.org/

http://www.ppacte.eu/index.php?option=com_docman&task=doc_download&gid=187&Itemid=29

http://www.hmrc.gov.uk/statistics/tax-gaps/mtg-2009.pdf

http://www.hmrc.gov.uk/statistics/tax-gaps/mtg-2009.pdf

http://siteresources.worldbank.org/INTPH/Resources/7Smuggling.pdf

106

10. TOBACCO GROWING

107

10.1 Number of workers involved in tobacco growing

INDICATOR NAME

Number of workers involved in tobacco growing


Count/Percent/Full time job equivalents (FTE)

RATIONALE

Article 17 of the Convention concerns the provision of support for economically viable alternatives to

tobacco growing, while under Article 18 Parties agree to have due regard to the protection of health of

persons working in tobacco cultivation (and manufacture).

Tobacco farmers are engaged in the preparation of farms, nursery establishment, planting, farm/crop

management, harvesting, curing, sorting and leaf grading, and transportation from their homes to leaf

buying centres.

The agricultural sector is composed of tobacco farmers and contractual or non-contractual workers

employed by the farmers. The exact number of tobacco farmers is difficult to estimate due to a lack of

reliable statistics for the tobacco sector. There is also controversy over how the workforce should be

counted. The tobacco industry favours “head counts”. Another method uses the concept of “annual

working units”. Applying the latter method produces a lower number than the former, because the

number of theoretically fully employed persons is much lower than that produced by the head count

method. Both concepts have their rationale.

Nearly 1.2 million workers operate in the organized tobacco manufacturing industry worldwide for the

processing of tobacco leaves and manufacturing of cigarettes. An additional 4 million people work in the

unorganized sector, for example bidi rolling in India. Jobs in the tobacco industry have been declining in

recent decades owing to the mechanization of cigarette production plants, in which technology

supplants factory workers, and changes in tobacco demand, rather than as a result of national and

international tobacco control policies targeting consumption.8

DEFINITION

Direct tobacco-growing employment is defined as paid employment directly related to the production,

distribution, and retailing of tobacco leaf.

In general, tobacco farming includes all aspects of tobacco-related work on the farm, from initial land

preparation to the delivery of cured tobacco at the place where the leaf buyer takes physical charge of it.

Tobacco leaf marketing and processing consists of all activities after tobacco departs the farm but prior

to the ageing process. Major activities include leaf auctioning and warehousing (a central place for leaf 8Document FCTC/COP/5/10 (available at http://apps.who.int/gb/fctc/PDF/cop5/FCTC_COP5_10-en.pdf).

108

trade and temporary leaf storage), and leaf processing (the name given to a series of treatments to

separate the midrib or stems of each leaf from the lamina, thresh the tobacco, and dry it with uniform

moisture content for storage and ageing).


National agricultural statistics of individual countries, national accounts, national labour force surveys,

establishment censuses, establishment surveys, administrative records and official estimates.

According to the International Labour Organization, national/central statistical offices are usually the

point of call when collecting such information on countries.





Information on the number of jobs related to tobacco farming is normally not available directly from

government statistical resources. Thus, this information may be derived or estimated using other

relevant resources and by following one or both of two methods. The procedure involved in the two

methods is similar: first estimate the total hours of labour used, and then convert this number into a

full-time employee base. The difference between the two methods lies in the way in which the number

of hours of labour used is estimated. In the first method, the number of hours is calculated as the

product of the amount of tobacco produced and hours of labour required per production unit. In the

second method, the total number of hours of labour is the product of acres of tobacco planted and

hours of labour required per acre.

In many countries, information on the number of tobacco farms is available in governmental agricultural

statistics. However, the number of tobacco farmers is not equal to the number of jobs related to

tobacco farming for several reasons: there may be more than one person working on a tobacco farm;

although tobacco may be the major source of income, it is very likely that tobacco farmers also grow

other crops or engage in other economic activities; and the number of tobacco farms may not include

those where the amount of tobacco harvested falls below a certain crop percentage or threshold,

depending on how a tobacco farm is defined in the statistical data

DISAGGREGATION

If possible, the data should be broken down into full-time, part-time and seasonal workers, and by

gender.

109


Such information is usually available in the national agricultural statistics, or by organizations affiliated

to the government that are responsible for collecting data on the agricultural sector or workforce; or

estimates can be provided by such an agency upon request.


information regularly, in relation to the Party’s reporting obligations under the Convention (Article 21),

to the agency responsible for the preparation and submission of implementation reports.

COMMENTS

None


Global:

- The World Bank (employment in agriculture): http://data.worldbank.org/indicator/SL.AGR.EMPL.ZS

http://data.worldbank.org/indicator/SL.AGR.EMPL.ZS

110

10.2 Share of the value of tobacco leaf production in the national gross domestic product

INDICATOR NAME

Share of the value of tobacco leaf production in the national gross domestic product


Percent

RATIONALE

This indicator promotes a better understanding of the economic importance and contribution of

tobacco leaf production to the national gross domestic product.

DEFINITION

The proportion of the national gross domestic product represented by tobacco leaf-growing or

production.

Gross domestic product at purchaser's prices is the sum of gross value added by all resident producers in

the economy plus any product taxes and minus any subsidies not included in the value of the products.


National agricultural statistics of individual countries, national accounts, national labour force surveys,

establishment censuses, establishment surveys, administrative records and official estimates.


These include any other relevant agency or research groups, including academic research or studies

implemented by nongovernmental organizations.

The Food and Agriculture Organization’s statistical database contains information on the share of the

value of tobacco leaf production in the national gross domestic product.


Value of tobacco leaf production expressed as a percentage of the national gross domestic product.

Dollar figures for gross domestic product need to be calculated from domestic currencies using single

year official exchange rates.

DISAGGREGATION

Not applicable


111

Such information is usually available in national agricultural statistics, or through other organizations

affiliated to the government that are responsible for collecting data on the agricultural sector or

workforce, at any time or estimates can be provided by any such agency upon request.


information regularly, in relation to the Party’s reporting obligations under the Convention (Article 21),

to the agency responsible for the preparation and submission of implementation reports.

COMMENTS

None


Global:

- Food and Agriculture Organization of the United Nations:

http://faostat3.fao.org/home/index.html#SEARCH_DATA (enter the word “tobacco”; information will

be found on tobacco (products nes) or tobacco (unmanufactured))

- The World Bank (net output of the agriculture sector, % of GDP):

http://data.worldbank.org/indicator/NV.AGR.TOTL.ZS(GDP values can be found at:

http://data.worldbank.org/indicator/NY.GDP.MKTP.CD/countries)

- UN National Accounts: http://unstats.un.org/unsd/nationalaccount/madt.asp

http://faostat3.fao.org/home/index.html#SEARCH_DATA

http://data.worldbank.org/indicator/NV.AGR.TOTL.ZS

http://data.worldbank.org/indicator/NY.GDP.MKTP.CD/countries

http://unstats.un.org/unsd/nationalaccount/madt.asp

112

11. TAXATION OF TOBACCO PRODUCTS

113

11.1 Proportion of the retail price of the most widely sold brand of tobacco product consisting of taxes

INDICATOR NAME

Proportion of the retail price of the most widely sold brand of tobacco product consisting of taxes


Percent

RATIONALE

Tax and price policies are widely recognized to be one of the most effective means of influencing the

demand for and thus the consumption of tobacco products. Consequently, implementation of Article 6

of the WHO FCTC is an essential element of tobacco control policies and thereby efforts to improve

public health.

Taxes are a very effective tool for policy-makers to influence the price of tobacco products. In most

cases, higher taxes on tobacco products lead to higher prices which, in turn, lead to lower consumption

and prevalence and result in a reduction of mortality and morbidity and thus in the improved health of

the population.

Parties have the sovereign right to determine and establish their taxation policies, including the level of

tax rates to apply. There is no single optimal level of tobacco taxes that applies to all countries because

of differences in tax systems, in geographical and economic circumstances, and in national public health

and fiscal objectives. In setting tobacco tax levels, consideration could be given to final retail prices

rather than individual tax rates. In this regard, the WHO technical manual on tobacco tax administration

recommends that tobacco excise taxes account for at least 70% of the retail prices of tobacco products.

This indicator takes into account the exact contribution of all taxes in the price of the most popular price

category of tobacco product and therefore represents a good comparable measure of the magnitude of

tobacco taxes by also indicating the likelihood that such rates are of a level that may contribute to the

health objectives aimed at reducing tobacco consumption. The use of this indicator can provide for

cross-country comparisons between overall tax rates.

DEFINITION

This indicator refers to the proportion (in percentage terms) of the retail price of a unit pack and/or

package of tobacco product, of the most popular price category that consists of taxes, including the sum

of all taxes levied on tobacco products, such as excise tax, import taxes, value added tax and sales taxes

(VAT/GST), if applicable.


Finance or other relevant government departments that are in the possession of the latest available

information concerning all types of taxes applied to the most widely sold brand of tobacco product in

114

the country. Information on this indicator is usually made available by these relevant departments at

regular intervals.

Calculation of this indicator can also be done on an ad-hoc basis, using normative documents containing

the latest tax rates (e.g. budget laws, relevant regulations) as well as other sources (e.g. statistical or

trade reports or any other relevant documents).


If such data are not available in the country, estimates produced WHO may be used. WHO’s country

reports contain comparable estimates for more than 180 countries concerning the total taxes as

percentage of retail price of 20 cigarettes of the most sold brand in the country. Such estimates are

available at: http://www.who.int/tobacco/surveillance/policy/country_profile/.


Information provided on tax policy can be used to calculate the share of tobacco taxes in the retail price

of the most widely sold brand of tobacco product in the country.

Total tax share includes specific excise tax, ad valorem excise tax, VAT, import duty (if the most popular

brand in the country is imported), and others (if applicable).

Only the price of the most popular brand of tobacco products is considered in the calculation of tax as a

share of retail price. In the case of countries in which different levels of taxes are applied, only the rate

that applies to the most-sold brand should be used in the calculation.


DISAGGREGATION

Data on taxation can be provided by category of tobacco product, e.g. smoking, smokeless or other

tobacco products.


Since all information for the calculation of this indicator is available in a country at any time, the

calculation can be repeated on a regular basis, thus contributing to the Party’s compliance with the

requirements of Article 20.3(a) of the Convention.

Information on the trend over time can contribute to assessment of how price and tax measures to

reduce the demand for tobacco are being used in the country and could serve the purposes of cross-

country comparisons.

COMMENTS

None

http://www.who.int/tobacco/surveillance/policy/country_profile/

115


Global:

- WHO: http://www.who.int/tobacco/economics/prices/en/


- WHO technical manual on tobacco tax administration. Geneva, World Health Organization, 2010.

http://www.who.int/tobacco/publications/economics/tax_administration/

- Technical note III: Tobacco taxes in WHO Member States. In: WHO report on the global tobacco

epidemic, 2011.Geneva, World Health Organization, 2011.

http://www.who.int/tobacco/global_report/2011/en_tfi_global_report_2011_techincal_note_iii.pdf

Regional: - European Union Taxation and Customs Commission

http://ec.europa.eu/taxation_customs/taxation/gen_info/index_en.htm and

http://ec.europa.eu/taxation_customs/taxation/excise_duties/tobacco_products/rates/index_en.ht

m

http://www.who.int/tobacco/economics/prices/en/




http://ec.europa.eu/taxation_customs/taxation/gen_info/index_en.htm

http://ec.europa.eu/taxation_customs/taxation/excise_duties/tobacco_products/rates/index_en.htm


116

11.2 Specific excise tax

INDICATOR NAME

Specific excise tax


Amount

RATIONALE

This indicator provides information that can be used to assess the affordability9 of tobacco products. It

also needs to be taken into account when calculating the share of taxes in the price of a pack and/or

package of tobacco product.

Excise taxes are imposed on selected nonessential or luxury goods, such as tobacco products, alcoholic

beverages and energy products. In the case of tobacco products, they are the primary tool for increasing

the price of tobacco products relative to the prices of other goods or services.

An excise tax is a tax levied on the sale or production for sale of a specific product within a country but

normally not on products produced in a country for sale abroad (exported).

DEFINITION

A specific excise tax is a tax levied on quantity of a tobacco product (e.g. piece, pack, carton, weight). In

general, the tax is collected from the manufacturer/wholesaler or at the point of entry into the country

by the importer, in addition to import duties. These taxes come in the form of an amount per pack, per

1000 sticks or per kilogram. Example: US$ 1.50 per pack of 20 cigarettes.

The most common base for a specific excise is a pack of 20 cigarettes or a tax per 1000 cigarettes, but

there are exceptions such as a carton of 5 packs of 25 cigarettes (e.g. Canada), a cigarette stick not

exceeding in weight 0.8 grams of actual tobacco content or kilogram of loose pouch for roll-your-own

tobacco (e.g. Australia), a metre (e.g. Nepal), the weight (e.g. New Zealand), or the weighted average

price10 (e.g. European Union).


Finance or other relevant departments of the government or normative documents containing the latest

tax rates (e.g. budget laws, relevant regulations) as well as other sources (e.g. statistical or trade reports

or any other relevant documents).

9Price relative to per capita income.

10 The weighted average price is the average consumer price of a tobacco product based on the prices of individual

brands and weighted by sales of each brand.

117


If such data are not available in the country or they cannot be obtained, estimates produced by the

tobacco economics team of WHO are also available at:

http://www.who.int/tobacco/surveillance/policy/country_profile/.


For specific excise tax, the tax base is the quantity of the tobacco product (e.g. piece, pack, carton,

weight). For example, if a tax is US$ 5 per 100 cigarettes, the amount of tax is US$ 5 and the base of the

tax is 100 cigarettes.


DISAGGREGATION


tobacco products.


Such information is usually available with the relevant government agency (most often ministry of

finance) in the country at any time.

COMMENTS

Specific taxes can either be uniform or tiered. Uniform specific taxes create a price floor (minimum

price). Furthermore, uniform specific taxes tend to lead to relatively higher prices, even on low-priced

brands. Uniform specific taxes compared to ad valorem taxes may reduce incentives for consumers to

switch to lower-priced brands because they generate smaller price differences between lower- and

higher-priced brands.

Mixed (or hybrid) excise tax structures apply both specific and ad valorem excise taxes and seek to

combine the advantages of pure specific and pure ad valorem taxes. Mixed systems usually combine a

uniform specific tax (which has relatively more impact on less expensive brands) and an ad valorem tax

(which has a greater absolute impact on more expensive brands). In a mixed system, the emphasis

placed on either the ad valorem or the specific element depends on national circumstances and the

policy objectives being pursued.


Global:

- WHO: http://www.who.int/tobacco/economics/prices/en/





http://www.who.int/tobacco/economics/prices/en/



118




Regional: - European Union Taxation and Customs Commission



m





119

11.3 Ad valorem excise tax

INDICATOR NAME

Ad valorem excise tax


Percent

RATIONALE

This indicator provides information that can be used to assess the affordability of tobacco products. It

also needs to be taken into account when calculating the share of taxes in the price of a pack and/or

package of tobacco product.

Excise taxes are imposed on selected nonessential or luxury goods, such as tobacco products, alcoholic

beverages and energy products. In the case of tobacco products, they are the primary tool for increasing

the price of tobacco products relative to the prices of other goods or services.

An excise tax is a tax levied on the sale or production for sale of a specific product within a country but

normally not on products produced in a country for sale abroad (exported).

DEFINITION

Ad valorem taxes are expressed as a percentage of a certain base value, which can be the retail selling

price (containing all applicable taxes), the manufacturer’s (or ex-factory) price, or the cost insurance

freight (CIF) price. Example: 30% of the retail selling price.

In general, the tax is collected from the manufacturer/wholesaler or at the point of entry into the

country by the importer, in addition to import duties. These taxes are in the form of a percentage of the

value of a transaction between two independent entities at some point of the production/distribution

chain; ad valorem taxes are generally applied to the value of the transactions between the manufacturer

and the retailer/wholesaler.






If such data are not available in the country or they cannot be obtained, estimates produced by the

tobacco economics team of WHO are also available at:

http://www.who.int/tobacco/surveillance/policy/country_profile/.


120


The calculation of the ad valorem tax as a proportion of the retail price will depend on the stage and the

base on when the tax is imposed. Comparing reported ad valorem tax rates without taking into account

the stage at which the tax is applied could lead to biased results. All tax rates should be recalculated to

the same base: the tax inclusive retail sales price. If the tax is expressed as a percentage (e.g. ad valorem

tax), the base of the tax is the actual value of the good that is taxed; for example, 30% of the retail

selling price.


DISAGGREGATION


tobacco products.




COMMENTS

Compared to a uniform specific tax, an ad valorem tax leads to larger differences in price between lower

and higher-priced brands and increases incentives for consumers to switch to cheaper brands. Used

alone, ad valorem taxes can lead to more price competition, and consequently to a lower average price.

Mixed (or hybrid) excise tax structures apply both specific and ad valorem excise taxes and they seek to

combine the advantages of pure specific and pure ad valorem taxes. Mixed systems usually combine a

uniform specific tax (which has relatively more impact on less expensive brands) and an ad valorem tax

(which has a greater absolute impact on more expensive brands). In a mixed system, the emphasis

placed on either the ad valorem or the specific element depends on national circumstances and the

policy objectives being pursued.


Global:


epidemic, 2011.Geneva, World Health Organization,

2011.http://www.who.int/tobacco/global_report/2011/en_tfi_global_report_2011_techincal_note_i

ii.pdf



- WHO Global Health Observatory:






121

Regional:

- European Union Taxation and Customs Commission

http://ec.europa.eu/taxation_customs/taxation/gen_info/index_en.htmand


m




122

11.4 Import duty

INDICATOR NAME

Import duty


Percent

RATIONALE

Taxes on international trade and transactions are taxes that become payable when goods cross the

national or customs frontiers of the economic territory, or when transactions in services exchange

between residents and non-residents. These taxes are classified into various subcategories according to

the nature of the exchange and whether the exchange is related to imports or exports.

This item covers revenue from all levies and duties payable on goods of a particular kind when they

enter the country from abroad. It includes duties levied under the customs tariff schedule and its

annexes, including surtaxes that are based on the tariff schedule, consular fees, tonnage charges,

statistical taxes, fiscal duties, and surtaxes not based on the customs tariff schedule. This category

covers taxes that fall on imports only.

In the past, many countries levied a tariff on imported tobacco products. In recent years, given bilateral,

regional and global trade agreements, import duty rates have been reduced dramatically in many

countries. Import duties discriminate against imported products and free trade agreements usually

require participating countries to gradually phase them out. As import duties are phased out, the

government loses the revenues they generated. Replacing import duties with excise taxes or increasing

excise taxes can compensate for these revenue losses.

DEFINITION

An import duty is a tax on a selected good imported into a country to be consumed in that country (i.e.

the goods are not in transit to another country). In general, the import duties are collected from the

importer at the point of entry into the country. These taxes can be either amount-specific or ad valorem.


Customs, finance or other relevant departments of the government or normative documents containing

the latest tax rates (e.g. budget laws, relevant regulations) as well as other sources (e.g. statistical or

trade reports or any other relevant documents).


If such data are not available in the country or they cannot be obtained, estimates produced by WHO

are also available at: http://www.who.int/tobacco/surveillance/policy/country_profile/.


123


Amount-specific import duties are applied in the same fashion as amount-specific excise taxes. Ad

valorem import duties are generally applied to the cost, insurance, freight (CIF) value (i.e. the value of

the unloaded consignment that includes the cost of the product itself, insurance and transport and

unloading). Example: 50% import duty levied on CIF.

For more technical information, please refer to the links and resources given below.

DISAGGREGATION


tobacco products.




COMMENTS

None


Global:



- International Customs Tariff Bureau (BITD): http://www.bitd.org/

- International Trade Centre (ITC)(import tariffs are available per country upon registration on the site):

http://www.intracen.org/

- WTO World Tariff Profiles 2012:

http://www.wto.org/english/res_e/publications_e/world_tariff_profiles12_e.htm

- World Integrated Trade Solution (WITS):http://wits.worldbank.org/wits/


http://www.bitd.org/

http://www.intracen.org/

http://www.wto.org/english/res_e/publications_e/world_tariff_profiles12_e.htm

http://wits.worldbank.org/wits/

124

11.5 VAT/GST/sales tax

INDICATOR NAME

VAT/GST/sales tax


Percent

RATIONALE

The value added tax (VAT), goods and services tax (GST) and other sales taxes are general taxes applied

on goods and services, and have great practical appeal for revenue generation. Although they are also

applied to tobacco products and have a significant impact on the retail prices of tobacco products, they

do not generally affect the prices of tobacco products relative to the prices of other goods and services

and, consequently, have less impact on public health.

DEFINITION

VAT or GST is a tax imposed on a wide variety of products, based on the value added at each stage of

production or distribution. Sales taxes are also taxes imposed on a wide variety of products, typically

based on the retail price.

VAT is a “multi-stage” tax described as a deductible tax, because producers are not usually required to

pay the government the full amount of the tax they invoice to their customers, as they are permitted to

deduct the amount of tax they have been invoiced on their own purchases of goods or services intended

for intermediate consumption or fixed capital formation.









VAT or similar taxes are calculated on the price of the good or service, including any other tax on the

product. VAT may also be payable on imports of goods or services in addition to any import duties or

other taxes on the imports. Most countries that impose VAT do so on a base that already includes any

excise tax and customs duty. Example: VAT representing 10% of the retail price.


125


DISAGGREGATION


tobacco products.




COMMENTS

None


Global:








Regional:

- European Union Taxation and Customs Commission



m







126

11.6 Earmarking of any percentage of taxation income for tobacco control

INDICATOR NAME

Earmarking of any percentage of taxation income for tobacco control


Percent

RATIONALE

According to Article 6.2 of the WHO FCTC, Parties retain their sovereign right to determine and establish

their taxation policies, including decisions on how the revenue stemming from tobacco taxation is used.

The guidelines for implementation of Articles 8, 9 and 10, 12, and 14 of the Convention note that

tobacco excise taxes provide a potential source of financing for tobacco control.

While bearing in mind Article 26.2 of the Convention, and in accordance with national law, some Parties

dedicate tobacco tax revenues to tobacco control programmes, while others do not. Parties’ reports

indicate that some of them add a given percentage or an amount to the excise tax in order to collect

revenues for special purposes, including health, while others earmark a given share of collected tobacco

taxes.

DEFINITION

Earmarking of any percentage of taxation income for tobacco control indicates whether or not the

country has dedicated taxes from any fiscal interventions to influence behaviour change through

funding awareness raising, health promotion and disease prevention programmes, cessation services,

economically viable alternative activities to tobacco growing and financing appropriate structures for

tobacco control.


Finance or other relevant departments of the government should have the latest information

concerning all taxes applied on tobacco products. There may be specific normative documents referring

to this type of additional tax on tobacco products, for example, national tobacco control legislation.





127


The earmarked percentage is given in the normative document (e.g. national tobacco control legislation)

mandating its introduction.

DISAGGREGATION

Information on earmarking may be provided, if applicable, by category of tobacco product, e.g. smoking,

smokeless or other tobacco products.


Information on earmarking is usually available with the relevant government agency (most often

ministry of finance) in the country at any time. In addition, information on the spending of the total

earmarked amount may be available in statistical yearbooks, budgetary documents, national account

reports, data available with government ministries and agencies that are concerned with its spending,

etc.

COMMENTS

The reporting instrument of the WHO FCTC contains a question aimed at collecting information on this

indicator (“Do you earmark any percentage of your taxation income for funding any national plan or

strategy on tobacco control in your jurisdiction?”) Parties may also provide details on how they apply

this approach. Fourteen Parties provided information on earmarking in their 2012 implementation

reports.


Global:



- The WHO Global Health Observatory includes a similar indicator named “Earmarking of taxes from

fiscal interventions to influence behaviour change used to fund health promotion programmes or a

health promotion foundation”. Available at



128

12. PRICE OF TOBACCO PRODUCTS

129

12.1 Most widely sold brand of smoking or smokeless tobacco product

INDICATOR NAME

Most widely sold brand of smoking or smokeless tobacco product


Categorical

RATIONALE

Identification of the most widely sold brand of smoking or smokeless tobacco product can be used to

assess the affordability of smoking and smokeless tobacco products, as well as to calculate the share of

taxes in the price of the most widely sold brand of smoking and smokeless tobacco product.

DEFINITION

The most sold brand of smoking and smokeless tobacco product nationally determined by national

market share information.


Finance, trade, economy or other relevant departments of the government usually have this information

along with any other national market share information. Such information may also be collected by

national statistical offices.


Statistical yearbooks and other periodicals, budgetary documents, national account reports, data

provided by government ministries and offices, nongovernmental organization reports, academic

studies and reports, etc.


The most widely sold brand of smoking and smokeless tobacco product is determined based on national

market share information. Where this is not available, in-country tobacco focal points are asked to

determine the most popular brand by consulting vendors, preferably in the capital city, in a retail outlet

widely used by the local population.

DISAGGREGATION

Information on the most widely sold brand may be provided, if applicable, by category of tobacco

product, e.g. smoking, smokeless or other tobacco products.

130


The relevant government department or the agency which follows trends in national market share,

including national statistical offices, when relevant, usually have this information available at any time.

COMMENTS

When reporting on the prices of the most widely sold brand of smoking and smokeless tobacco products

Parties should provide price information for a brand (e.g. Marlboro), not a product group (e.g. cigarettes,

snus).


Global:







131

12.2 Retail price of a pack of the most widely sold brand of tobacco product

INDICATOR NAME

Retail price of a pack of the most widely sold brand of tobacco product


Standard local currency unit

RATIONALE

This information can be used to assess the affordability of tobacco products, as well as to calculate the

share of taxes in the price of the most popular price category of tobacco product.

Monitoring the trends in tobacco prices will help in assessing the impact of tobacco tax increases (if

these have been reflected in the prices of products by the tobacco companies or not) and could help in

projecting the possible health impact of tobacco tax increases.

DEFINITION

Retail price (inclusive of all taxes and in local currency where possible) is the price of the product

purchased at a convenience store or supermarket in the capital city. Popularity is determined based on

national market share information or by consulting with vendors in at least three stores.

With reference to the word “retail”, retail trade is a form of trade in which goods are mainly purchased

and resold to the consumer or end-user, generally in small quantities and in the state in which they were

purchased (or following minor transformations).


Finance, trade, economy or other relevant departments of the government usually have this information

along with any other national market share information. Such information may also be collected by the

national statistical offices.


Statistical yearbooks and other periodicals, budgetary documents, national account reports, data

provided by government ministries and offices, nongovernmental organization reports, academic

studies and reports, and any other agency or organization, etc.


The price of the most widely sold tobacco product for a unit retail pack, in local currency unit, in the

latest available year, preferably in the capital city, from a retail outlet widely used by the local

population. Where this information is not collected regularly, the relevant tobacco focal points are

132

required to determine the retail price of a pack of the most popular brand of tobacco product by

consulting vendors, preferably in the capital city, in a retail outlet widely used by the local population.

When information on the retail price is collected, attention should be given to the number of units (e.g.

pieces) or amount (e.g. weight in grams) per package. For cigarettes, if Parties have 20-piece cigarette

packs on the market, they should determine the price of this retail pack. (Small packets, tins, sachets,

metal or glass containers of various sizes, toothpaste-like tubes and candy-like wrapped cylinders are

examples of packages in which smokeless tobacco products can be sold. In these cases, the unit can be

the weight of the packaged product.)

DISAGGREGATION


tobacco products.

If applicable, data should be provided separately for domestic and imported brands.


The relevant government department or the agency which follows trends in national market share,

including national statistical offices, when relevant usually have this information available at any time.

COMMENTS

For standard local currency unit, please refer to the International Organization for Standardization ISO

4217 Codes for the representation of currencies and funds.

The price of the most widely sold brand of tobacco product can be converted from local currency to

Purchasing Power Parity (PPP) adjusted dollars or international dollars to account for differences in

purchasing power across countries, using the conversion rate published by the International Monetary

Fund.


Global:

- Standard local currency units: http://www.iso.org/iso/home/standards/currency_codes.htm

- WHO Global health Observatory:




http://www.iso.org/iso/home/standards/currency_codes.htm



133

Appendix 1. Smoking-related causes of death11

Disease categories ICD-9 Codes ICD-10 Codes

Malignant neoplasms:

Lip, oral cavity, pharynx 140-141, 143-149 C00-C14

Oesophagus 150 C15

Stomach (gastric) 151 C16

Pancreas 157 C25

Larynx 161 C32

Trachea, lung, bronchus 162 C33-C34

Cervix, uteri 180 C53

Kidney and renal pelvis 189 C64-C65

Urinary bladder 188 C67

Acute myeloid leukaemia 205 C92.0

Cardiovascular diseases:

Ischaemic heart disease 410-414,429.2 I20-I25

Cerebrovascular disease (stroke) 430-438 I60-I69

Atherosclerosis 440 I70

Aortic aneurysm 441 I71

Peripheral vascular disease 443.1-443.9 I73

Arterial embolism and thrombosis 444 I74

Respiratory diseases:

Chronic bronchitis, emphysema 491-492 J41-J43

Chronic airways obstruction 496 J44

11

Published in: WHO Economics of tobacco toolkit: assessment of the economic costs of smoking, Geneva, World Health Organization, 2011 (available at: http://whqlibdoc.who.int/publications/2011/9789241501576_eng.pdf).

http://whqlibdoc.who.int/publications/2011/9789241501576_eng.pdf

134

Reproductive effects:

Low birth weight 765 P07

Respiratory distress syndrome -

Newborn

769 P22

Other respiratory conditions -Newborn 770 P23-P28

Sudden Infant Death Syndrome 798 R95

Documents

WHO FCTC Indicator Compendium · This WHO FCTC Indicator Compendium was developed in response to the mandate given to the Convention Secretariat, in cooperation with competent authorities