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WNTD 2017 – Tobacco Use: A Lost Opportunity

Economic and Health Policy Research, American Cancer Society

Quick facts


For the first decades of the tobacco epidemic, smoking was commonplace among the rich and influential. This slowly changed among the wealthy and educated, particularly as knowledge of the adverse health effects of tobacco use spread. Recent studies consistently show that tobacco use prevalence is now highest among the lower income groups of most countries. This is an especially troubling trend because tobacco use exacerbates the financial insecurity of these most-vulnerable families.

A monograph on the economics of tobacco and tobacco control recently published by the US National Cancer Institute and the World Health Organization examines the relationship between tobacco and poverty. The monograph notes that most poor families are unable to provide basic necessities such as food, clothing and housing due to their low income and lack of other non-monetary resources. However, some families have sufficient income and resources to provide these necessities, but are still impoverished because they spend too much of their income on things other than the necessities. Unfortunately, many smokers fall into this trap, and these families must forgo a sizable portion of their income to feed the debilitating habit of tobacco use. For example, smokers in the lowest-income tercile in the US spent 7.7% of their household income on tobacco products, compared to 1.4% for the highest-income tercile. Similarly, in the lower-middle-income country of Vietnam, these figures are 5.3% and 3.6% of household income for the lowest-quintile and the highest-quintile families respectively.

Vicious Cycle

In many ways, tobacco and poverty are part of the same vicious cycle. This cycle starts with social disadvantage—such as unemployment, isolation, and stress—which often leads to tobacco smoking. Households start allocating their budgets toward tobacco products, instead of toward food and other necessities such as health care, education, clothing and financial security. This situation is exacerbated when the households must spend money on treating illnesses caused by tobacco use. Further productivity and income losses from tobacco-related illnesses and deaths contribute to even more poverty. These circumstances lead to more social disadvantages and deprivation, and the cycle continues.


This post was drafted by Michal Stoklosa and Amitoch Kohli with contributions from John Daniel, Jeffrey Drope, and Nigar Nargis

ACS Staff

Economic and Health Policy Research, American Cancer Society

The Economic and Health Policy Research program seeks to address cancer worldwide by conducting research on the economic and policy aspects of risk factors to cancer, including in the areas of tobacco, nutrition, physical activity and harmful alcohol use. We also examine issues around the economics of health equity, including access to care.

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