Masud, Haleema (2021) Reducing the affordability of tobacco products in Pakistan : a political economy analysis. PhD thesis, University of Warwick.

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Abstract

Background

Tobacco taxation is one of the most effective yet underused intervention to control tobacco use globally. Several LMICs including Pakistan have failed over the years to implement effective taxation measures for tobacco products to control its use and reduce harms. One of the reasons for this underutilisation is the poorly understood political economy of tobacco taxation in the LMICs context. This thesis aims to present a political economy analysis for introducing tobacco taxation and pricing policy (TTPP) reforms in Pakistan to achieve public health objectives.

Methods

A mixed-methods approach was used as follows: 1) a qualitative documents analysis of the regulatory framework for tobacco taxation, 2) econometric analysis to estimate the price elasticity and building econometric simulation models to predict fiscal and public health outcomes, 3) qualitative study based on in-depth interviews with key stakeholders in TTPP arena, and 4) a mixed methods analytical integration to ascertain policy, practice and research implications.

Results

Study component 1 highlighted that Pakistan does not have a clear strategy on using tobacco taxation as a public health tool in the country. Existing TTPP face dual issues of flawed structure and poor administration translating into highly affordable tobacco products and low revenues. Study component 2 found negative price elasticity estimates for Pakistani adults (n=7831), indicating an increase in the price will decrease consumption. It was found that an increase in the price of low-priced cigarettes would have a greater impact on smoking prevalence and daily consumption by smokers. Study component 3 predicted positive fiscal and public health outcomes for a 10% annual increase in taxation even in expanding illicit market activity. Study component 4 identified the position-power dynamics of key stakeholders and revealed the key facilitators and challenges for introducing TTPP reforms in the country. Mixed methods analytical integration found the best-fit taxation policy considering the political economy scenario in the country will be a long-term commitment to slowly and regularly increase excise duty on tobacco products along with control of illicit market activity.

Conclusions

The findings provide a detailed understanding of the political economy of tobacco taxation in Pakistan, which can be used for designing future policies.

Item Type:	Thesis (PhD)
Subjects:	H Social Sciences > HV Social pathology. Social and public welfare R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine
Library of Congress Subject Headings (LCSH):	Tobacco -- Pakistan, Smoking cessation -- Pakistan, Smoking -- Health aspects -- Pakistan, Public health -- Pakistan, Tobacco -- Taxation -- Pakistan, Tobacco products -- Pakistan, Tobacco industry -- Pakistan
Official Date:	August 2021
Dates:	Date Event August 2021 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Oyebode, Oyinlola ; Sekalala, Sharifah ; Gill, Paramjit
Sponsors:	Punjab Education Endowment Fund
Extent:	281 leaves : illustrations, charts, map
Language:	eng

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