With one fifth of the world population, China consumes a third of the world’s cigarettes and contributes to a third of lung cancer cases in the world (Stone & Zhou, 2016; Chen, 2015). Although the smoking rate of females is lower than the smoking rate of males in China, lung cancer rates are increasing in both genders (Stone & Zhou, 2016; Chen, 2015). The majority of smoking behaviors are related to tobacco assumption, which later leads to higher possibility of getting lung cancer. By this logic, tobacco smoking is a crucial contributor to lung cancer. If nothing has been done to prevent people from smoking, the number of deaths caused by tobacco in China per year will rise from near 1 million in 2010 to 3 million in 2050 (Chen, 2015).
In fact, China has its own tobacco control policies, but the lung cancer rates keep rising, due to a lack of consistent enforcement across the country (Stone & Zhou, 2016). Strict regulations on the tobacco industries are constantly hindered because tobacco industry is an influential department in Chinese governments (Stone & Zhou, 2016). Consequently, the tobacco industry in China consistently thrives at the cost of people’s health (Stone & Zhou, 2016).
According to the World Bank, imposing the excise tax on tobacco is one of the most effective strategies for tobacco control (Stone & Zhou, 2016). Lung cancer cases in China are still rising, tremendously harming the health of Chinese population. Therefore, in order to create more effective policies across China, it is essential to investigate how different levels of excise tax on tobacco reduce lung cancer rates in males and females. In this study, I aim to conduct a meta-analysis of the relationship between different levels of excise tax on tobacco and lung cancer rate in China.
With a goal of lung cancer rate reduction, it is important to learn about different risk factors of lung cancer among subgroups. There are two main risk factors for lung cancer: smoking and environmental tobacco smoke.
Among all the subgroups: rural men, urban men, rural women, and urban women, rural men have the highest rates of smoking and there is no significant difference between rural and urban women (Stone & Zhou, 2016). Noticeably, the smoking rate among young Chinese males saw its rise first in urban China, followed by a rise in rural areas (Chen, 2015). About two-thirds of young Chinese men now smoke cigarettes and a recent study shows that at least half of them will die because of their smoking behaviors if they don’t stop smoking (Chen, 2015).
Moreover, the incidence of lung cancer in women is likely associated with environmental tobacco smoke (Stone & Zhou, 2016). The tobacco smoke contains more than several hundred poisonous chemicals and 69 of those are known as carcinogen, damaging DNA and leading to the incidence of lung cancer (Sheng, 2018). Non Smokers are exposed under the risks of lung cancer not only from second-hand smoke, but also from third-hand smoke, namely tobacco smoke absorbed by dust, clothing, and furnishings (Ni & Xu, 2018). Heavy exposures of environmental tobacco smoke is the main factors of determining the lung cancer risk of environmental tobacco smoke (Ni & Xu, 2018). The incidence of lung cancer in nonsmoking population is still growing (Sheng, 2018).
Cessation is one of the keys that work effectively in reducing the lung cancer rates. People who have consumed cigarettes since young age but stop at 30, 40, 50 years-old are ale to live 10, 9, 6 years longer than those who keep smoking (Jha & Richard, 2014). In order to encourage people to stop smoking, the Chinese government plays an important role. One of the effective ways is to impose excise taxes on tobacco, since tobacco taxes and consumption have a strongly inverse relationship (Jha & Richard, 2014; Jha, 2009). In a 2012 survey in Jiangxi province, 63% of a group of 4025 participants, including 1088 smokers, consumed lower-price cigarettes ($0.28– $1.70). Among this group, the average price paid in a pack of cigarettes was $1.30, the estimated price that would cause a change to cheaper cigarettes was $2.10, and the estimated price that would cause cessation was $3.40. (Stone & Zhou, 2016). From this example, people tend to stop smoking, reducing lung cancer rate, when the cost of cigarettes becomes higher.
In low and middle income countries, tripling taxes on tobacco could swiftly increase cessation rates and hamper smoking initiation by at least doubling the average price of cigarettes, thus reducing consumption by about a third (Jha & Richard, 2014; Jha, 2009). As a middle-income country, it is possible that China can also benefit from such a policy change. It is clear that increasing the price of tobacco with excise tax on tobacco will reduce tobacco consumption and decrease lung cancer rate. However, due to the differences of rural and urban China, particularly in regard to income gaps, imposing universal excise tax rate on tobacco may impact different areas in China differently. Therefore, further research needs to be conducted to explore locally based tobacco excise rate.