Cost of tobacco-related diseases, including passive smoking, in Hong Kong

There is steadily mounting evidence of the harm caused to health by active and passive tobacco smoking ^{1, 2} but policymakers can be reluctant to implement stricter legislation to protect non-smokers and restrict promotion of tobacco products. One way of enhancing appreciation of the magnitude of the problem is to transform the data on health effects of tobacco-induced disease into monetary values. This has been done to good effect in the United States where costs attributable to smoking were estimated to be over US$157 billion ³ with attributable direct health costs taking up 6-9% of the total national health care budget. ^{4, 5} Other countries have followed suit and calculated their own financial burdens resulting from tobacco use. ^{6- 9} However, it is difficult to extrapolate from developed to developing countries where the tobacco epidemic is usually at an earlier stage. Furthermore, none of the costings in developing countries and few of those in developed countries have included any costs for passive smoking. In Hong Kong, a special administrative region of China, the prevalence of regular smoking among men in 2000 was 22%, ¹⁰ much lower than that of mainland China where over 53% of males smoked in 1998. ¹¹ The current peak in the prevalence of cigarette smoking in China occurred about 40 years later than in the United States but post dates that in Hong Kong by about 20 years. Although the effect of smoking is probably not yet fully expressed in terms of health impact in either Hong Kong or mainland China, the future burden of health costs in the mainland can be predicted from Hong Kong's experience.

A previous attempt to cost the health effects of smoking in Hong Kong ¹² used overseas risk data because at that time there were no locally generated data. Since then local data on the risks of active and passive smoking have been published ^{13- 20} which allow us to estimate the monetary value of tobacco-related disease. The main objectives of this costing were to raise awareness among local and regional decision-makers of the true costs of tobacco to both smokers and non-smokers and to promote tobacco control legislation. This paper describes the costing and its findings.

METHODS

We limited the costing to health-related impacts...