The Impact of the Anti-Smoking Policy in Hungary

József BODROGI, Tamás JOÓ
th December 2018

1. Introduction
a) Social burden of smoking (Hungarian study)
b) Smoking attitudes

2. Tobacco-control
a) Measures
b) Results

3. Conclusions/Lessons learnt


1. Introduction
a) Social burden of smoking


• Smoking and its side effects cost the world’s economies > $1 trillion
• Annual global revenue from tobacco taxes: $269 billion
• In Hungary and all other countries

"the health status of the Hungarian population is
among the poorest in OECD…”
OECD Economic Surveys Hungary, 2012

• IHD mortality varies across OECD (CEE vs. Japan, France, Korea)
• 84% higher for men than women; 8-10x difference; 1990

• Cerebrovascular disease was the underlying cause for about 7% of all deaths
• CVD mortality also varies across OECD (SLK, HUN - 3x > - SUI, CAN, FRA),; highest
• The high prevalence of risk factors common to both diseases

• Average rate of mortality: 200 / 100 000
• Lowest: Mexico, Turkey, Finland – with rates less than 180 / 100 000
• Highest: Hungary – with rates nearly 300 / 100 000

• Highest mortality in Hungary (around 90 / 100 000)
• 3x higher among men than among women in the EU

• Smoking is one the most important health risks in Hungary
• Half a million patients (in Hungarian hospitals)

• 16% of all mortalities (20 470 people) were the result of smoking-related diseases
• The lives of male and female smokers were shortened by 16+ and 19+ years
In 2010:

• State revenue from smoking was over US$ 1.73 billion
• Direct and indirect tobacco-related costs were, however, over US$ 2.12 billion,
corresponding to a net loss of US$ 385 million



1. Introduction
b) Smoking attitudes

• European Commission: Eurobarometer – tobacco related
• Prevalence of tobacco use
• Exposure to tobacco smoke
• Motivations for smoking
• Measures to reduce
• 28 Member States of the EU
• March 2017
• 27,901 respondents

• The overall proportion of smokers in the EU has been stable
since 2014 (26%)
• 20% are former smokers
• Over half (54%) have never smoked
• An increase in consumption in the age group 15-24 is observed
since 2014 (from 24% to 29%)

Over 90% of smokers consume tobacco daily, with the majority choosing boxed
• Boxed cigarettes (79%) remain the most popular choice of tobacco among smokers
• Hand-rolled cigarettes (29%) are used by a significant share of smokers (unchanged
since 2014)
Introduction/Smoking attitudes
• They are particularly popular
in Hungary (49%),
• but used by only a small
minority in Sweden (3%) and
Romania (5%)

2. Tobacco control
a) Measures

Protect non-smokers / total ban @ indoor places

Over 1.3 billion people, or 18% of the world's population, are protected
by comprehensive national smoke-free laws

Smoke-free laws protect the health of non-smokers, are popular, do not
harm business and encourage smokers to quit

Hungary already had relevant legislation in place, namely, Act XLII on the
protection of non-smokers of 1999

The important amendment came into effect on 1 January 2012 with a
three-month grace period (total indoor ban of smoking)

Protect non-smokers / total ban @ indoor places

• Main goal: A total ban on smoking (in all indoor places):
• in public-education institutions;
• in child-care, child-welfare institutions;
• in hospitality venues, health-care providers;
• on public transport;
• in enclosed workplace areas;
• in enclosed areas of public institutions and within 5 meters of their external
• in public playgrounds and within 5 meters of their external borderlines;
• in areas of railway stations that are open to the public;
• at bus, tramway and trolley-bus stops and waiting areas, and within 5 meters of their
external borderlines

Most important pillar…

5 other important tobacco-control measures (after 2012)
1. Media campaigns
2. A significant increase in tobacco products taxes
3. The requirement for pictorial warning labels on tobacco product packs
4. A drastic decrease in the number of stores selling tobacco products;
5. Improved cessation services

Media campaigns
• The media campaigns also represented an important tool for gaining
public support
• Well-known people likely to influence the target groups

“Sugar, rum and tobacco are commodities which are no where necessaries of life,
which are become objects of almost universal consumption, and which are
therefore extremely proper subjects of taxation.”

• Tobacco taxes are the most cost-effective way to reduce tobacco use
• 10% -> 4-5%
• US: Hamilton (1794)
• Taxes from smoking are realized via two channels in Europe
• Excise tax
• VAT: 27% (highest rate in the EU)
• Average 70-80% of the retail price

• Many publications have been made in the international literature
(consumption and taxes)
• Total cigarette sales and prices in the USA 1970-2000 (Frank Chaloupka):

• All tobacco products produced from September 2012
• From 2013 only TP with PWL could be sold

Reducing the sale of tobacco to youth
• In 2012, the Parliament adopted the act (“Tobacco Shop Law”):
• reducing smoking prevalence among young people
• And retail of tobacco products
• Tobacco may only be sold in STS (customers must be above 18 years of age)
• Over 40 000 outlets -> 6 519 supervised tobacco stores
• Are eligible to sell tobacco products
• It has become more difficult for young to purchase TP
• National youth tobacco survey
• 2012: 45% of young people bought cigarettes in shops
• 2013: 20%

2. Tobacco control
b) Results

Rumours VS reality
• 3 arguments: employment, black market, state revenue
• Philippines
• “There is nothing new under the sun”
• In reality…

World No Tobacco Day 2013 Award
in recognition of his government's non-smoking initiatives

Indoor air quality and exposure to SHS
Measurements of indoor air quality in hospitality venues across various
districts of Budapest

Public attitudes and support
• In 2013, the majority of non-smokers and a high rate of smokers
were in agreement with the smoking ban:
• Pubs: 45% of S – 72% of NS
• Discos: 53% of S – 78% of NS
• Workplaces: 70% of S – 86% of NS

Prevalence/tobacco consumption
• These anti-smoking measures:
• prevalence of smoking (2009: 38% vs. 2017: 27%)
• and tobacco consumption (2012: 19,5bn vs. 2016: 15,3bn pieces)

Fine cut tobacco
• Market transformation
• The market share of the cigarettes decreased
• Escape route for smokers
• Tax advantage – price advantage


3. Conclusions/Lessons learnt

• Combining the smoking ban and other effective tobacco-control measures:
• media campaigns,
• taxation,
• pictorial warning labels,
• restriction of the number of shops selling tobacco products,
• smoking-cessation services
• maximized the success of the ban and led to a significant decrease in the:
• Prevalence of smoking
• Tobacco consumption

Increasing tax revenues
Decreasing black market
Decreasing prevalence of smoking and tobacco consumption
Improving indoor air quality
Reducing second-hand smoke exposure

These positive outcomes comprise an important
message for other countries planning a smoking ban
and any other useful measures similar to that
implemented in Hungary!