A higher tax on cigarettes in low and middle-income countries can help to reduce child mortality, especially amongst the poorest children, a new study led by researchers at Karolinska Institutet and published in The Lancet Public Health suggests.

The World Health Organisation (WHO) recommends a tax of at least 75 percent on the retail price of cigarettes, but most countries impose a much lower tax than that.

“If all 94 countries included in the study had raised their cigarette tax to the level recommended by the WHO, the lives of over 280,000 children could potentially have been saved in a single year,” says Márta Radó, principal investigator at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet in Sweden. “Not only that, it would narrow the socioeconomic gap in child mortality rates in line with the UN’s sustainable development goals.”

The study examined the link between cigarette taxes and under-five mortality among different income groups in 94 low and middle-income countries.

Socioeconomic differences

The study is based on publicly accessible data from the WHO, the World Bank and the UN Inter-agency Group for Child Mortality Estimation (UN IGME) covering the years between 2008 and 2020. The researchers analysed the links between child mortality and different types of cigarette tax, such as specific excise duty (a fixed tax per packet regardless of sale price), ad valorem duty (a percentage of the product’s value), import duties and VAT.

Their calculations suggest that higher cigarette taxes can improve childhood survival among all socioeconomic groups, while reducing differences in survival between the richest and poorest groups. Excise duties had the most salient effect.

“Smoking related morbidity and mortality among children is disproportionately high in low and middle-income counties,” says lead author Olivia Bannon, researcher at Karolinska Institutet and Linköping University in Sweden. “An increase in cigarette tax is a vital policy measure that can improve the health of children worldwide, especially in the most vulnerable groups.”

Overcoming the obstacles

 “We know that the tobacco industry has a number of well-established tactics to undermine, disrupt and delay the implementation of effective tobacco control measures globally, including increasing taxation. Our study provides compelling evidence for governments to overcome tobacco industry interference and  other obstacles to implement higher taxes on tobacco in LMICs.” Says Dr Rado.

The study was conducted in close collaboration with Jasper Been, paediatrician and researcher at Erasmus MC (the Netherlands) and researchers at McGill University (Canada) and Imperial College London (the UK). It was financed by Forte (the Swedish Research Council for Health, Working Life and Welfare), Riksbankens Jubileumsfond and the EU Horizon 2020 Programme. There are no reported conflicts of interest.

Publication: “Cigarette taxation and socioeconomic inequalities in under-five mortality across 94 low- and middle-income countries”, Olivia S. Bannon, Jasper V. Been, Sam Harper, Anthony A. Laverty, Christopher Millett, Frank J. van Lenthe, Filippos T. Filippidis, Márta K. Radó, The Lancet Public Health, online 29 April 2025. 

Journal

The Lancet Public Health

DOI

10.1016/S2468-2667(25)00065-9

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