Here are some quick things and not a full response:
That’s what you would think but I was actually reading today (link) that it has gotten more costly which has changed the calculus for some insurance companies and made them willing to divest from tobacco. Here is the trend: lung cancer used to be a quick death, but medical advances in palliative care now give patients the opportunity to live much longer whilst regularly undergoing intensive medical procedures (e.g radiation treatment)
So I think it’s an okay question on if black market effects have a significant enough effect that it should be modeled into the CEA. However, this is a different question than if there is reason to believe that black market effects would knock the intervention’s cost-effectiveness down a whole tier, which I believe the answer is no. The experts have been clear that no black-market effects come close to offsetting the benefits of reduced consumption from taxation. Also, taxes/price are not the primary determinant of black market (Savedoff citing others, 2015).
We could imagine a situation where the effects of the black market would not conform to those studies e.g. 300% price hike in a state with no import controls. However, I don’t think an EA tobacco taxation, or any other serious tobacco control org, would put itself in that position.
I think the concerns about black market effects are gonna be consequential, not in the worthiness of the intervention, but in which state to pursue. For example, we know that two variables that affect the prevalence of black market is the price differential between bordering states and how effective a state’s import controls.
If I had more time, I’d write about the value of getting these laws on the books in countries in SSA that are weaker states (but will hopefully develop state capacity over time) whilst tobacco companies aren’t as focused there and before these get a new generation hooked like they have in other emerging markets e.g. SE Asia
So if I understand you right, disentangle tobacco deaths from things that can be double counted like a smoker that died from COVID, which might get marked in both camps?
Yah I hear you on this. The GWWC number is exciting, but the intervention should be proven on a DALY standard, which I think it has notwithstanding someone finding a big hole in it.
I am not sure what you mean by this one. If you mean concern about it being a regressive tax, then I’d agree (more so than the black market concern) that this should be in a CEA. However, I again don’t expect it to drastically change the cost-effectiveness. Poorer people are more price sensitive and disproportionately reap more benefits from reduced consumption due to taxation than wealthier classes. I think the Liu 2006 study observes what is intuitive to us all—tobacco consumption increases poverty across a society.
If you are talking about the economy in general, then you’d need to elaborate more. Aside from tobacco being a substantial strain on the economy, the taxes on it generate great revenue for poorer governments.
Case study: Columbia tripled their tobacco tax from 2016 to 2018 and over that time consumption of tobacco fell by a third and their national health service doubled its funding with that tax.
I realize these thoughts were not as quick as I planned. But I hope that’s useful for a first pass. Thanks for bringing those points up
Great response J.T. This was me saying “I want these things thought about in a CEA that I suspect might not have been.” I actually think this is quite promising.
For 2, I don’t think this is something to just dismiss without calculations
For 3, yes. If someone died of coronary heart disease, there was a decent chance that they would get it without smoking. Or they had lung cancer and diabetes, there needs to be some factor you attribute to each, not just “they died of lung cancer from smoking” which is what happens in these organizations.
For 5, I’m concerned generally that LMIC have corrupt governments who, when they get more money, is actually net negative. I’m concerned about this as well in developed countries if they use it to start wars, etc. as well.
On the whole, I think this is still likely to come out as a strong intervention. I’m still more skeptical of policy changes and I think we likely over-estimate their odds of success but this still seems well worth trying.
Here are some quick things and not a full response:
That’s what you would think but I was actually reading today (link) that it has gotten more costly which has changed the calculus for some insurance companies and made them willing to divest from tobacco. Here is the trend: lung cancer used to be a quick death, but medical advances in palliative care now give patients the opportunity to live much longer whilst regularly undergoing intensive medical procedures (e.g radiation treatment)
So I think it’s an okay question on if black market effects have a significant enough effect that it should be modeled into the CEA. However, this is a different question than if there is reason to believe that black market effects would knock the intervention’s cost-effectiveness down a whole tier, which I believe the answer is no. The experts have been clear that no black-market effects come close to offsetting the benefits of reduced consumption from taxation. Also, taxes/price are not the primary determinant of black market (Savedoff citing others, 2015).
We could imagine a situation where the effects of the black market would not conform to those studies e.g. 300% price hike in a state with no import controls. However, I don’t think an EA tobacco taxation, or any other serious tobacco control org, would put itself in that position.
I think the concerns about black market effects are gonna be consequential, not in the worthiness of the intervention, but in which state to pursue. For example, we know that two variables that affect the prevalence of black market is the price differential between bordering states and how effective a state’s import controls.
If I had more time, I’d write about the value of getting these laws on the books in countries in SSA that are weaker states (but will hopefully develop state capacity over time) whilst tobacco companies aren’t as focused there and before these get a new generation hooked like they have in other emerging markets e.g. SE Asia
So if I understand you right, disentangle tobacco deaths from things that can be double counted like a smoker that died from COVID, which might get marked in both camps?
Yah I hear you on this. The GWWC number is exciting, but the intervention should be proven on a DALY standard, which I think it has notwithstanding someone finding a big hole in it.
I am not sure what you mean by this one. If you mean concern about it being a regressive tax, then I’d agree (more so than the black market concern) that this should be in a CEA. However, I again don’t expect it to drastically change the cost-effectiveness. Poorer people are more price sensitive and disproportionately reap more benefits from reduced consumption due to taxation than wealthier classes. I think the Liu 2006 study observes what is intuitive to us all—tobacco consumption increases poverty across a society.
If you are talking about the economy in general, then you’d need to elaborate more. Aside from tobacco being a substantial strain on the economy, the taxes on it generate great revenue for poorer governments.
Case study: Columbia tripled their tobacco tax from 2016 to 2018 and over that time consumption of tobacco fell by a third and their national health service doubled its funding with that tax.
I realize these thoughts were not as quick as I planned. But I hope that’s useful for a first pass. Thanks for bringing those points up
Great response J.T. This was me saying “I want these things thought about in a CEA that I suspect might not have been.” I actually think this is quite promising.
For 1, divestment in this case means nothing IMO. Divestment is mainly a signalling thing. It doesn’t really do anything to reduce stock price for example. https://forum.effectivealtruism.org/topics/divestment
For 2, I don’t think this is something to just dismiss without calculations
For 3, yes. If someone died of coronary heart disease, there was a decent chance that they would get it without smoking. Or they had lung cancer and diabetes, there needs to be some factor you attribute to each, not just “they died of lung cancer from smoking” which is what happens in these organizations.
For 5, I’m concerned generally that LMIC have corrupt governments who, when they get more money, is actually net negative. I’m concerned about this as well in developed countries if they use it to start wars, etc. as well.
On the whole, I think this is still likely to come out as a strong intervention. I’m still more skeptical of policy changes and I think we likely over-estimate their odds of success but this still seems well worth trying.