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The Potential Use of Tobacco Taxes Revenue for TB Control in Indonesia: A Briefing Paper.

Authors:
  • Yayasan Masyarakat Peduli Anak Indonesia

Abstract and Figures

Smoking is a major issue in Indonesia and has a significant impact on health. It is a major contributor to tuberculosis, resulting in morbidity and mortality and placing a huge economic burden on patients, families and society in general. Taxes on the production and sale of tobacco products are in place but could do more to discourage smoking. These taxes could also contribute significantly to the costs of TB control but this is limited by the restrictive policy on the use of the revenue from tobacco production taxes and by a lack of understanding of the possibilities of using the revenue from cigarette taxes. Recommendations from this study of the use of these taxes in four provinces include reviewing the policy for the use of the tobacco production tax and educating health planners, managers and administrators on the options and rules for using the taxes for Tb control.
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The Potential Use of Tobacco Tax Revenue for
TB Control in Indonesia: A Briefing Paper
By Julie Rostina and David Collins of MSH
December, 2014
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This report was made possible through the support for the TB CARE I provided by the U.S. Agency for
International Development (USAID), under the terms of cooperative agreement number AID-OAA-A-
10-00020.
Abstract
Smoking is a major issue in Indonesia and has a significant impact on health. It is a major contributor
to tuberculosis, resulting in morbidity and mortality and placing a huge economic burden on
patients, families and society in general. Taxes on the production and sale of tobacco products are in
place but could do more to discourage smoking. These taxes could also contribute significantly to the
costs of TB control but this is limited by the restrictive policy on the use of the revenue from tobacco
production taxes and by a lack of understanding of the possibilities of using the revenue from
cigarette taxes. Recommendations from this study of the use of these taxes in four provinces
include reviewing the policy for the use of the tobacco production tax and educating health
planners, managers and administrators on the options and rules for using the taxes for Tb control.
Recommended Citation
This report may be reproduced if credit is given to TB CARE I. Please use the following citation:
Rostina, J. and Collins, D. December, 2014. The Potential Use of Tobacco Taxes Revenue for TB
Control in Indonesia: A Briefing Paper. TB CARE I Management Sciences for Health. Submitted to
USAID by the TB CARE I Project: Management Sciences for Health. Information shown in the body of
the report and annexes may not be quoted or reproduced separate from the rest of the document
without the written permission of Management Sciences for Health.
Key Words
Tuberculosis, financing, exit strategy, sustainability, budget, tobacco, tax.
Disclaimer
The authors’ views expressed in this publication do not necessarily reflect the views of the United
States Agency for International Development or the United States Government.
Cover page photo
Men smoke cigarettes at a railway station in Jakarta, Indonesia. (Photo: Reuters)
Management Sciences for Health
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Page 3
Background
In Indonesia, there are 200,000 deaths related to tobacco consumption each year and over
61 million tobacco users. Smoking prevalence has increased significantly from 27 % in 1995
to 34.7 in 2010 (Ahsan et al, 2013). Over on-third (36%) of Indonesians use tobacco in
smoking and/or smokeless form. Sixty seven % of males smoke and while the female rate is
much lower low (4.5%), it is expected to rise. Among youths aged 13-15, an estimated 20%
smoke cigarettes (SEARO WHO, 2013). People who do not smoke, predominantly women
and children are affected by second-hand smoke.
There is strong evidence that smokers (both current and former) have higher risks of
developing tuberculosis, of developing more severe forms of tuberculosis, and of dying from
tuberculosis (Hassmiller KM, 2006).
It is also worth noting that tuberculosis has a major impact on morbidity and mortality and
is a major economic burden to patients, their families, and society in general. A 2013 study
showed that the number of new active TB cases in Indonesia would result in about 1.9
million years of life lost and about 1.5 million years of productive life lost. The resulting
economic burden to society would be roughly US$ 2.1 billion.1 2
Tobacco Tax Regulations
Taxation of tobacco products is one of the most common sources of government revenue
around the world. Three primary purposes for imposing tobacco taxes are raising revenue,
correcting externalities, and discouraging the use of tobacco products (Gruber J, Sen A, et al
2003).
Tobacco production in Indonesia has been taxed for a number of years and Law 39/2007 of
2007 stipulated that the 2% of its national revenues from these tobacco taxes should be
used to control, supervise and mitigate the negative impact caused by tobacco products.3
Article 66A the law states that the funds can only be used for:
1. Funding for increasing quality of raw materials
2. Development of tobacco industry
3. Establishing social environment
1 Collins, D., F. Hafidz and C. Suraratdecha. December, 2013. The Economic Burden of Tuberculosis in
Indonesia. TB CARE I - Management Sciences for Health.
2 Note that this is the economic burden that will be borne over a number of years related to the number of
new infections in 2011.
3 Most recently under Tobacco Excise Law Number 39 of 2007 (39/2007), as an amendment of Law No. 11 year
1995.
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4. Socialization of excise taxes, and
5. Combating illegal goods which should be subject to excise.
Under the aspect of social environment it is possible to use funding for certain health
issues4, specifically to:
Establish non-smoking areas and provide options for smoking in public areas, and
Improve community health status by providing health care facilities for patients
suffering from the effects of cigarettes (Kemenkes, 2012)
A limitation of the use of these funds5, however, is that they are only provided to excise-
producing provinces and/or tobacco-producing provinces (SEARO WHO, 2012) (Sulistyowati,
2012) (Kemenkes RI, 2012).
Cigarette Tax Fund
A second tax on tobacco is known as the cigarette tax which was established in 2009.
Since the decentralization era, the implementation of local autonomy has required local
government to have greater financial independence through local owned revenue
(PAD/Pendapatan Asli Daerah), based on the assumption that greater domestic revenue will
result in better quality public services. The sources of PAD that were deemed to be most
reliable are local taxes and local charges. In 2009, Central Government and parliament
established Law 28 concerning regulations on local taxes and charges. These include an
additional tax, called a cigarette tax of 10% (Srikandi et al, 2014), that was made effective
from 1 January 2014.
Article 31 of Law 28/2009, stated that the at least 50% of the revenue from the cigarette tax
at both for province and district/city levels should be allocated to public health services and
law enforcement (Srikandi et al, 2014).
The implementation of the cigarette tax demonstrated great commitment by the
government to address needs to reduce tobacco use and control the impact of tobacco and
also to use local taxing power to increase public services, specifically for health. It
recognized that implementing cigarette taxes as local taxes could bring broad benefits for
health services.
4 Minister of Finance Regulation Number. 20/PMK.7/2009 article No. 1
5 Known as the Profit Sharing Fund from Tobacco Excise Duties (Dana Bagi Hasil Cukai Hasil
Tembakau/DBHCHT)
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The purposes of the cigarette tax are shown in Figure 1.
Figure 1.
TB Financing needs
The Government of Indonesia has committed to ensuring the sustainability of AIDS, TB and
Malaria (ATM) programs by gradually replacing donor funding with domestic funding
(Collins et al, 2013). The financing needs for TB control are significant and will increase as
the program expands in its goal to end TB by 2035.
Current total funding obtained from government and international donors is insufficient to
cover the costs and donor funding is expected to reduce over the next few years. The
government has, therefore, developed an exit strategy which aims to eliminate dependency
on these grants and which focuses on increasing government budget allocations, generating
revenue from insurance and corporate social responsibility financing, and improving the
cost-effectiveness and efficiency of services (Collins and Parihatin, 2011).
The expansion and maintenance of TB control will require significant additional funding.
While some of this will come from the national government and some from health
Cigarette
Tax Fund
Health care and
Law
Enforcement
Public health efforts (Upaya Kesehatan
Masyarakat/UKM)
A. Control of Consumption and Products other
tobacco
B. Law enforcement policies of Non-Smoking Area/
Kawasan Tanpa Rokok
C. Public health efforts
1. Efforts to reduce non-communicable disease
risk factors and injury
2. Efforts to reduce risk factors of infectious
diseases
3. Efforts health peningkatak mothers, children
and the elderly
Other fields Individual Health Services (UKP)
A. Improved infrastructure health, both primary
and faskes faskes advanced
B. Increasing quality of human resources efforts
individual health
Sources: (Setiaji and Mulyana, 2014)
Page 6
insurance there will be a need for additional funding, especially at provincial and local
government levels. However, commitments at these levels to fund TB control program
remain low. Tobacco and cigarette taxes can potentially play an important role in financing
TB control.
In 2014, MSH initiated a study of the use of tobacco tax revenues to identify how the
tobacco taxes and cigarette have been used, and the potential for using them to help
finance TB control services and any challenges with that. The study was conducted in four
provinces - West Java, Central Java, West Nusa Tenggara and Bali.
Revenue from tobacco taxes (DBHCHT)
In 2011, the Ministry of Finance started to distribute the tobacco tax revenue to the
provinces according to Law 39/2007. Overall from 2011 to 2014 the trend of revenue
improved at the national level and in the 4 study provinces (Table 1).
Table 1.
Allocation of Revenue Sharing Fund of Tobacco Excise (DBHCHT) for 2011-2014 Fiscal Years
(Indonesia Rupees)
Year
2011
1
2012
2
2013
3
2014
4
National 1,373,443,893,666 1,686,993,369,623 2,092,351,910,357 2,213,999,999,987
West Java 108,511,444,547 160,551,014,173 201,302,529,415 226,832,530,881
Central Java 329,385,940,362 426,566,946,953 545,556,711,908 481,509,388,275
Jawa Timur
708,331,484,547 817,646,710,511 1,144,687,961,676 1,144,687,961,676
Bali 2,573,157,820 10,781,443,442 12,421,737,216 11,133,826,586
West Nusa
Tenggara
150,608,767,584 187,230,526,704 209,557,143,592 227,419,501,397
Sources:
1 Peraturan Menteri Keuangan Republik Indonesia Nomor 195/PMK.07/2012 Tentang Alokasi Definitif Dana Bagi Hasil Cukai Hasil
Tembakau Tahun Anggaran 2011
2 Peraturan Menteri Keuangan Republik Indonesia Nomor 197/PMK.07/2012 Tentang Alokasi Definitif Dana Bagi Hasil Cukai Hasil
Tembakau Tahun Anggaran 2012
3 Peraturan Menteri Keuangan Republik Indonesia Nomor 181/PMK.07/2013 Tentang Alokasi Definitif Dana Bagi Hasil Cukai Hasil
Tembakau Tahun Anggaran 2013
4 Peraturan Menter! Keuangan Republik Indonesia Nomor 216 /PMK.07 /2014 Tentang Perubahan Atas Peraturan Menteri Keuangan
Nomor 106/PMK.07 /2014 Tentang Perkiraan Alokasi Dana Bagi Hasil Cukai Hasil Tembakau Tahun Anggaran 2014
Page 7
The Use of tobacco taxes (DBHCHT)
In term of financing for health, the Ministry of Health through Health Promotion Center
published the protocol of utilization of DBHCHT fund for health care (Kemenkes, 2012). This
is expected to serve as a guide for local governments on how to use the DBHCHT funds in
the health sector.
The analysis showed that the use of the tobacco taxes for health was quite varied. Mostly
the health funds were used for health infrastructure; lung and heart health, and health
prevention and promotion to increase awareness of tobacco impact and Tuberculosis/AIDS
prevention. In some cases they were used to establish non-smoking areas (Kawasan Tanpa
Rokok/KTR), for example in West Nusa Tenggara they were explicitly used to prevent
smoking in public areas. In some cases they were used to procure equipment for diseases
caused by smoking, but not specifically for TB.
The planning and budgeting of the funds is done through the government planning and
development agency (BAPPEDA). It starts at the provincial letter with a request letter and,
once approved, it is allocated to the district/city through a structural unit within the
Province. The attention paid to the use of these funds is generally very low. The budgeted
funds are sometimes underspent. Local government officers in Bali and West Java explained
that this is due to limited human resources and the concerns around using the funds where
the policy is perceived to contradict with other policies. In addition, the use of the funds
requires more management and complex reporting and some officials find it easier and
safer not to use the funds to reduce workload and avoid issues.
The budget allocations for the tobacco taxes are shown in Table 2 for the four study
provinces. Of the total allocation of IDR 426 billion in Central Java in 2012, IDR 200 million
was allocated for the TB Program for increasing Laboratory Staff Safety for TB services. In
the same year West Java was allocated IDR 160 billion, from which funds were allocated to
TB control for Tobacco Impact Control at the Provincial Health Office and at 3 hospitals (Al
Ihsan Hospital, the Lung Hospital and the Psychiatric Hospital.
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Table 2.
Definitive Allocation of DBHCHT in Year Budget 2011 and 2012 (IDR)
No Province 2011 2012
1 West Java 94,791,583,714 160,551,014,173
2
Central Java
288,124,894,231
426,656,946,953
Bali
7,494,103,508
10,781,443,442
West Nusa Tenggara
131,590,571,590
187,230,516,704
Source: Regulation of Ministry of Finance No. 197/PMK.07/2012 about definitive allocation if DBHCHT in 2012
It was also noted that budgeted amounts were sometimes underspent as shown for West
Java. 6 As shown in Table 3 almost all of the allocations were underspent in the three years
2011-2013, in some cases significantly.
6 Of the four provinces only West Java was able to provide full data on the provincial budgets for 2011-2014.
Page 9
Table 3.
Allocation of DBHCHT in Year Budget 2011-2014 by Budget and Realization in West Java Province (IDR)
Year
2011
1
2012
2
2013
3
2014
4
Note: till quarter 3
Institution Budget Realization Budget Realization Budget Realization Budget Realization
PHO
3,480,000,000
3,035,395,000
178,762,000
178,762,000
2,293,430,000
322,626,000
Lung Sidawangi
Hospital
(Provincial
Hospital)
12,226,061,119 10,472,812,500 14,553,433,000 13,099,643,000 2,381,781,00 1,624,769,880 950,000,000 384,700,000
Al Ihsan
Hospital
5,000,000,000 4,754,000,000 5,000,000,000 4,797,649,000 17,890,451,064 15,528,530,400 19,250,000,000 88,520,000
Psychiatric
Hospital
850,000,000 850,000,000 1,300,000,000 97,675,000,000
Source:
1 Peraturan Daerah Provinsi Jawa Barat tahun 2011 tanggal Agustus 2012
2 Peraturan Daerah Provinsi Jawa Barat No 5. tahun 2012 tanggal 30 Agustus 2013
3 Peraturan Daerah Provinsi Jawa Barat No.13 tahun 2013 tanggal 28 Agustus 2043
4 APBD Provinsi Jawa Barat 2014
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When health staff were interviewed, some of them stated that they had concerns about
using the DBHCTH funds in case they were criticised for breaking the rules. Staff expressed
concerns about not following the specific criteria of the DBHCTH, which does not prioritize
health issues. This is because the KPK (Corruption Eradication Commission) is very strict and
they do not want to risk punishment. Furthermore both local and centre government also
strive to get a Wajar Tanpa Pengecualian/WTP (unqualified opinion) for financing
performance as acknowledgement from Ministry of Finance toward clean government.
As a result staff were not sure if they could use funds to help finance the TB control
program. For example, Tabanan District preferred to use the funds to finance activities such
as socialization and dissemination of smoking impact and building a clinic to promote
smoking cessation (where only one of the sessions is about TB) instead of spending funs on
TB control.
Cigarette tax revenue
The estimated total revenue from cigarette tax in 2014 would be IDR 9.64 Trillion of which
half of the district/city revenue will be allocated to health services (Setiaji and Mulyana,
2014; and Ahsan, 2014). A breakdown of estimated total cigarette tax revenue and
allocation to health for the provinces is shown in Table 4, which shows that the amounts
allocated to health should be quite significant, especially in the three Java provinces. These
figures were estimated by the Lembaga Demografi Faculty of Economic with Health
Promotion Center (MoH) for 2014 based on the 2010 population and assuming 50%
allocation to health as prescribed under the law.
Table 4.
Revenue of Cigarette Tax and Budget Allocation for Health Services by Province in 2014 (IDR)
No.
Provinsi
Revenue from Cigarette
Tax by Province
Budget Allocation from
Cigarette Tax for Health
1
Nanggroe Aceh Darussalam
59,321,990,756
29,660,995,378
2
Sumatera Utara
171,690,288,822
85,845,144,411
3
Sumatera Barat
64,074,392,813
32,037,196,406
4
Riau
73,290,650,484
36,645,325,242
5
Jambi
40,838,094,234
20,419,047,117
6
Sumatera Selatan
98,457,247,138
49,228,623,569
7
Bengkulu
22,654,696,953
11,327,348,476
8
Lampung
100,436,784,406
50,218,392,203
9
Kepulauan Bangka Belitung
16,171,293,917
8,085,646,959
10
Kepulauan Riau
22,288,510,192
11,144,255,096
11
DKI Jakarta
126,776,355,462
63,388,177,731
12
Jawa Barat
568,839,974,478
284,419,987,239
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13
Jawa Tengah
428,141,501,169
214,070,750,584
14
D.I. Yogyakarta
45,647,933,202
22,823,966,601
xc15
Jawa Timur
495,512,513,597
247,756,256,798
16
Banten
140,736,698,474
70,368,349,237
17
Bali
51,452,948,655
25,726,474,327
18
Nusa Tenggara Barat
59,457,980,315
29,728,990,158
19
Nusa Tenggara Timur
61,870,502,522
30,935,251,261
20
Kalimantan Barat
58,087,956,579
29,043,978,289
21
Kalimantan Tengah
29,123,039,988
14,561,519,994
22
Kalimantan Selatan
47,944,999,810
23,972,499,905
23
Kalimantan Timur
46,946,293,019
23,473,146,510
24
Sulawesi Utara
29,960,502,961
14,980,251,480
25
Sulawesi Tengah
34,819,409,236
17,409,704,618
26
Sulawesi Selatan
106,207,395,889
53,103,697,944
27
Sulawesi Tenggara
29,492,862,833
14,746,431,416
28
Gorontalo
13,732,301,016
6,866,150,508
29
Sulawesi Barat
15,315,663,744
7,657,831,872
30
Maluku
20,248,389,145
10,124,194,573
31
Maluku Utara
13,691,219,873
6,845,609,936
32
Papua Barat
10,060,120,153
5,030,060,077
33
Papua
37,709,488,165
18,854,744,082
TOTAL
3,141,000,000,000
1,570,500,000,000
Source:
Srikandi, D and Ahsan, A. 2014. Penerimaan Dana Pajak Rokok Untuk Kesehatan Menurut Provinsi Di
Indonesia. Lembaga Demografi FEUI. 2014.
The use of cigarette taxes
The Ministry of Finance encourages and directs cigarette tax funds to be used to support
activities that are not funded from other sources (local health budget, DAK, Dekon Fund,
DBHCHT, Operational Assistance Health (BOK)) . The Cigarette Tax Fund should be additional
funding on top of existing resources and should not serve as a substitute for other funds
(Setiaji and Mulyana, 2014).
The government policies have been well developed and should be in line with systematized
socialization and followed up with monitoring and evaluation of both provinces and
district/cities as challenges remain in terms of implementation. However a major constraint
to the use of the funds is a lack of knowledge and information on the use of the tax revenue
for health. Based on Study of Demographic Institute, Faculty of Economics University of
Indonesia about Law No. 28 year 2009 in 2013 at 3 provinces, it found most of province
stakeholders were not aware of the existence of the law and the allocation of funds to
Page 12
public health program although it was put in place on the 1st January 2014 (Srikandi et al,
2014).
Conclusion and Recommendation for TB Control
The Government of Indonesia has passed tobacco and cigarette taxation policies which have
great potential to support the TB control program with revenue from the tobacco tax and
cigarette taxes.
However, there are some important challenges to using revenues to help fund the health
and TB programs:
Firstly, due to the restrictions and priorities set for the use of the tobacco tax
revenue there is presently very limited potential for using these funds for financing
health and TB control programmes.
Secondly, while there is much greater potential for using the cigarette tax revenue
and the amounts of available funding could be significant, the lack of understanding
and of the regulations have led to limitations in the use of funds.
In order to increase the amount of tobacco and cigarette tax financing for health and TB the
following actions would be required:
The tobacco tax regulations should be reviewed to see if the priorities can be
changed in favor of allocating increased funding to health and TB control. This would
require advocacy at the highest of levels.
Effort should be placed on raising the awareness and understanding of all those
involved in the planning and use of tobacco and cigarette tax revenue. The MOH
guidelines for the use of both types of tax revenue should be reviewed and improved
if necessary and then widely shared and explained.
Additional advocacy should be used to emphasize the importance of choosing TB
control as priority health interventions and the proposed interventions should be
subjected to cost-effectiveness analysis to ensure good use of the funds. Training of
staff and improvement in planning and reporting systems and monitoring and
evaluation systems will be important.
Additional analysis is required to analyze the relative contribution of the tobacco and
cigarette taxes compared to the other sources of revenue in the different provinces
and districts.
In looking it the alternative source of funding for TB control it will be important to
take into account that the needs may be greatest in the public health aspects of TB
control, such as case finding, especially if national social health insurance is sufficient
to cover diagnostic and treatment costs.
Page 13
Case studies should be developed of the use of tobacco and cigarette tax revenue for
TB control and the impact of these investments.
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Technical Report
Full-text available
This report describes recommended actions for the National Tuberculosis Control Program (NTP) to consider in developing its Exit Strategy implementation plan. It also describes a set of recommended technical assistance and training activities aimed at supporting the NTP in this process. These recommended actions and activities were based on document reviews and on discussions with NTP members, USAID and other partners. The recommended actions can be summarized as: increasing the domestic share of funding through improved advocacy and planning and budgeting; expanding income from social insurance and corporate social responsibility schemes; and ensuring that existing and additional services, including new diagnoses and treatments, are provided in the most cost-effective and efficient ways possible.
Technical Report
Full-text available
Understanding the economic burden to society from a disease like TB is important as it can be used as evidence when advocating for greater investment. This report describes the development of a tool to estimate the economic burden of TB in Indonesia and the results stemming from its use. The development and use of the tool was requested by the Director of the National TB Control Program to assist with advocacy for greater resources. In Indonesia in 2011 there were an estimated 441,940 new active TB cases of which 321,411 were treated for first-line TB and 4,267 new MDR-TB cases of which 286 started treatment. It is estimated that 286,560 of these cases would have been treated and cured, 59,662 would have self-cured and 95,718 would eventually die. Based on this 2011 cohort the total number of years of life lost would be about 1.9 million and the total number of years of productive life lost would be about 1.5 million. The total economic burden would be roughly US$ 2.1 billion1. Loss of productivity due to premature death would be by far the largest element, comprising 63% of the total cost. Loss of productivity due to disability, medical costs and direct non-medical costs incurred by patients and their households are likely to be 31%, 3.6% and 0.4% respectively of the total economic burden. Note that this is the economic burden that will be borne over a number of years related to the number of new infections in 2011. The model shows that increasing the number of cases treated has a major impact on the economic burden. If, for example in 2011, the 2016 treatment targets could have been met, the TB treatment rate would have been 92.7% instead of 72.7% and the MDR-TB treatment rate would have been 31.4% instead of 6.7%. The resulting economic burden would have been only US$ 1.3 billion instead of US$ 2.1 billion. An investment of an additional US$ 35 million in medical costs (US$ 0.14 per capita) would have resulted in an overall saving of US$ 800 million (US$ 3.36 per capita). The number of TB-related deaths would have been reduced by 37% - from 95,718 to 59,876. This shows clearly value of investing in scaling up TB services.
Article
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Associations between smoking and tuberculosis disease including death from tuberculosis have been reported, but there are few reports on the influence of smoking on the risk of developing Mycobacterium tuberculosis infection. The aim of this study was to determine the association between smoking and M tuberculosis infection. In a cross sectional population survey, data on smoking and tuberculin skin test (TST) results of 2401 adults aged > or =15 years were compared. A total of 1832 (76%) subjects had a positive TST (> or = 10 mm induration). Of 1309 current smokers or ex-smokers, 1070 (82%) had a positive TST. This was significantly higher than for never smokers (unadjusted OR 1.99, 95% confidence interval (CI) 1.62 to 2.45). A positive relationship with pack-years was observed, with those smoking more than 15 pack-years having the highest risk (adjusted OR 1.90, 95% CI 1.28 to 2.81). Smoking may increase the risk of M tuberculosis infection.
Article
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To review epidemiological evidence on the association between smoking and tuberculosis. Reviewed articles were identified by searching Pubmed for the terms "smoking" or "tobacco" and "tuberculosis". Additional articles were obtained from the bibliographies of identified papers. Thirty-four studies were reviewed: five investigate the association between smoking and mortality from tuberculosis, 13 investigate the association between smoking and development of tuberculosis, eight investigate the association between smoking and infection with Mycobacterium tuberculosis, and nine estimate the impact of smoking on characteristics of tuberculosis and disease outcomes. Taken together, evidence suggests that smoking (both current and former) is associated with: risk of being infected with Mycobacterium tuberculosis, risk of developing tuberculosis, development of more severe forms of tuberculosis, and risk of dying of tuberculosis. In many cases, there is a strong dose-response relationship -both in terms of quantity and duration of smoking. These relationships are not explained away by controlling for potentially confounding variables such as age, gender, alcohol consumption, and HIV status.
Article
A central parameter for evaluating tax policies is the price elasticity of demand for cigarettes. But in many countries this parameter is difficult to estimate reliably due to widespread smuggling, which significantly biases estimates using legal sales data. An excellent example is Canada, where widespread smuggling in the early 1990s, in response to large tax increases, biases upwards the response of legal cigarette sales to price. We surmount this problem through two approaches: excluding the provinces and years where smuggling was greatest; and using household level expenditure data on smoking. These two approaches yield a tightly estimated elasticity in the range of -0.45 to -0.47. We also show that the sensitivity of smoking to price is much larger among lower income Canadians. In the context of recent behavioral models of smoking, whereby higher taxes reduce unwanted smoking among price sensitive populations, this finding suggests that cigarette taxes may not be as regressive as previously suggested. Finally, we show that price increases on cigarettes do not increase, and may actually decrease, consumption of alcohol; as a result, smuggling of cigarettes may have raised consumption of alcohol as well.
Impact of Increasing TobaccoTax on Government Revenueand Tobacco Consumption. SEADI Discussion Paper No. 8 This paper was pursuant to a grant funded by the USAID Support for Economic Analysis Development in Indonesia project
  • A Ahsan
Ahsan A, et al. 2013. Impact of Increasing TobaccoTax on Government Revenueand Tobacco Consumption. SEADI Discussion Paper No. 8 This paper was pursuant to a grant funded by the USAID Support for Economic Analysis Development in Indonesia project
Pajak Rokok Daerah dan Pendanaan Kesehatan. Dipresentasikan dalam the1st Congress of Indonesian Health Economic Association in Bandung
  • D Srikandi
Srikandi D, et al. 2014. Pajak Rokok Daerah dan Pendanaan Kesehatan. Dipresentasikan dalam the1st Congress of Indonesian Health Economic Association in Bandung, West Java.
Regional Office for South-East Asia. 2012. Tobacco taxation and innovative health-care financing. New Delhi: WHO World Health Organization, Regional Office for South East Asia
World Health Organization, Regional Office for South-East Asia. 2012. Tobacco taxation and innovative health-care financing. New Delhi: WHO World Health Organization, Regional Office for South East Asia. Global Adult Tobacco Survey: Indonesia Report 2011).
Penggunaan Daba Hasil Cukai Hasil Tembakau dalam Bidang Kesehatan. Dipresentasikan di Hotel Puri Denpasar 22 Novemver
  • L Sulistyowati
Sulistyowati, L. 2012, Penggunaan Daba Hasil Cukai Hasil Tembakau dalam Bidang Kesehatan. Dipresentasikan di Hotel Puri Denpasar 22 Novemver 2012.
Undang-Undang Republik Indonesia Nomor 28 Tahun
  • Kemenkumham
Kemenkumham. 2009. Undang-Undang Republik Indonesia Nomor 28 Tahun 2009 Tentang Pajak Daerah Dan Retribusi Daerah