This also results in a disproportionate burden of
disease and deaths across the groups. The
inequality in smoking implies wide disparities in
the health status of different socioeconomic groups
in many countries.
In many ways tobacco perpetuates the vicious cycle
of poverty that many smokers are in. Nicotine
addiction drives smokers to spend a large proportion
of their
income on tobacco, diverting limited
family resources from spending on basic necessities
such as food, health care, shelter, and education.
Tobacco also exacerbates poverty among families of
tobacco users, who are at risk of falling seriously ill
from tobacco-related diseases and dying
prematurely, thereby imposing heavy health care
costs on families and depriving them of
much-needed household income.
Globally, about 226 million adult tobacco users live in poverty. Smoking prevalence was strongly linked to the level of education and socio economic status. In most countries, smoking and other forms of tobacco use are much higher among the poor.
Education level of adult smokers in ASEAN
*Figure refers to post-secondary school.
**The percentage of primary and less than primary.
Expenditures of poorest households on tobacco and basic needs (USD)
Among poor families in urban slum areas of Indonesia, households where the father was a smoker are at greater risk of household food insecurity. Paternal smoking diverts household money from food to tobacco (22% of weekly per capita household expenditures) and exacerbates child malnutrition.
Annual tobacco expenditures = Lost opportunities
Cambodia
Annual expenditure of USD 235,062,723 spent on tobacco in 2021. Of these, USD 203,476,326 on manufactured cigarettes, and hand-rolled cigarettes (USD 5,051,519).
94,025
Motorbikes Honda
Dream 125cc (2021)
47,012
wooden houses
in rural areas
211,391
tons of
high quality rice
Indonesia
Annual expenditure on cigarettes by smokers among the poorest group in 2013.
14 times
the average expenditure
on meat
6 times
the average expenditure
on milk and eggs
2 times
the average expenditure
on fish and vegetables
7 times
the average expenditure
on education
11 times
the average expenditure
on health
Philippines
Annual expenditure of current smokers on cigarettes is USD 299.56 (PHP 15,286.8) per smoker in 2021.
Rice
(PHP 43/kg)
355.5 kg/year
Fish
(PHP 150/kg)
102 kg/year
Green Leafy
(PHP 100/kg)
1,528.68 kg/year
Egg
(PHP 6.30 per piece)
2,426 pieces of eggs
11 times
the average expenditure
on health
Thailand
Annual expenditure on tobacco is estimated to be USD 20.87 Billion (THB 65.76 Billion) in 2017.
0.69 times
household expenditure
on education
(THB 95.3 Billion)
2.6 times
expenditure on Bangkok Mass
Transit System (BTS) Sky train
(THB 25,000 Million)
Vietnam
Average annual expenditure on cigarettes is USD 150.6 (VND 3,476,400) per smoker in 2020.
1.15 times
the average expenditure
on health per person
1.4 times
the average expenditure
on school fee per
person
In low-income countries, sometimes more than 10% of household income is spent on tobacco products – meaning less money for food, education and healthcare.
Price per pack of most popular cigarette brands relative to quantity of rice (kg) and eggs in ASEAN
| Country | Most Popular Cigarette Brand | Price | Quantity of | ||
|---|---|---|---|---|---|
| Brand name | Local currency | USD | Rice (kg) | Eggs (pieces) | |
| Brunei | Djarum Super* | BND 4.10 | 5.11 | 5.8 | 35 |
| Cambodia | Luxury | KHR 2,000 | 0.50 | 0.7 | 4 |
| Indonesia | A Mild (16 sticks) | IDR 29,000 | 1.93 | 2.6 | 15 |
| Lao PDR | Adeng | LAK 9,000 | 0.43 | 0.5 | 5 |
| Malaysia | Dunhill | MYR 17.70 | 3.75 | 6.8 | 43 |
| Myanmar | Lucky Strike | MMK 2,200 | 0.65 | 0.8 | 7 |
| Philippines | Marlboro | PHP 175 | 3.12 | 4.4 | 28 |
| Singapore | Marlboro | SGD 15.50 | 11.49 | 5.87 | 45 |
| Thailand | SMS | THB 66 | 1.82 | 3.67 | 15 |
| Vietnam | Thang Long | VND 13,500 | 0.54 | 1.1 | 5 |
* Djarum Super was the most popular brand sold prior to May 2014. There are no licensed tobacco importers and retailers in Brunei since May 2014. Hence, there are no cigarettes being sold legally in the country at present.
Tobacco farming: Cycle of poverty
Poverty is widespread among tobacco farmers in Indonesia. 72.2% of tobacco farmers are poor compared to 11.1% of the general population in the country.
- Most tobacco-farming households are on social assistance in some form, including nearly three-fourths who use “rice for the poor” programmes.
- Food insecurity is common among tobacco-farming households—more than 60% of households reported insufficient food for the household at some point in the year.
- Tobacco farmers have a high risk of green tobacco sickness (GTS).
Tobacco cultivation is not profitable for most farmers.
- Considering only direct costs (i.e. not household labor), most tobacco-farming households are spending more on tobacco cultivation than the revenue they generate from it.
- Input costs for growing tobacco are typically very high in Indonesia compared to most other crops.
- Many tobacco farmers report having limited capital—53% of tobacco farmers reported the need for loans to cultivate tobacco.
On average, former tobacco farmers were doing better (average total incomes - USD 3,797.68) than current tobacco farmers (household’s total income - USD 2,921.19).
Lao PDR: Tobacco tax revenue losses
The Lao government continues to lose revenues due to its unfair Investment License Agreement (ILA) with the tobacco industry. Signed in 2001, the ILA capped ad valorem tobacco tax rates at 15% to 30% of production cost until 2026 (25-year tax break) when the country's tobacco tax rate by law is 72% of wholesale price (effective December 2023). If the ILA is not terminated, the Lao government will continue to suffer more revenue losses till 2026.
Tobacco tax revenues and revenue losses in Lao PDR (2002 – 2022)
The Lao government lost an estimated USD 142.9 million (LAK 1,429 billion) in revenue between 2002 and 2019.
*General tax refers to the overall tobacco tax revenue that the Lao Government is supposed to collect (but failed to do so), while the excise tax collected refers to the actual tobacco tax revenue that the Lao Government is able to collect.
Tobacco tax revenues and revenue losses in Lao PDR (2002 – 2022)
The Lao government lost an estimated USD 20.33 million (LAK 180.21 billion) between 2014 and 2019 from uncollected revenue (2% of profit tax and LAK 200/pack surcharge taxes from domestic tobacco companies such as Lao Tobacco Ltd) for the Tobacco Control Fund (TCF). This is a significant revenue collection loss to support tobacco control programs and strengthen public health in the country.
Annual deaths attributed to major tobacco-related diseases* in ASEAN
- < 1,000
- 1,001 - 50,000
- 50,001 - 100,000
- > 100,001
| COUNTRY | Annual deaths attributed |
|---|---|
| Philippines | 88,200 |
| Myanmar | 56,800 |
| Indonesia | 269,000 |
| Malaysia | 24,100 |
| Cambodia | 15,000 |
| Thailand | 86,364 |
| Lao PDR | 6,700 |
| Vietnam | 100,000 |
| Singapore | 1,950 |
| Brunei | 206 |
* Institute for Health Metrics and Evaluation tobacco metrics team has used a new Burden of Proof approach to estimate the relative risk curves for smoking on related health outcomes and calculated the risk-outcome score (ROS) for each smoking-outcome pair. Based on the ROS, each smoking-outcome pair is rated from 1 to 5 stars, with 5 stars indicating the strongest evidence on the effects of smoking on the health outcome. The BOP approach is a major methodological update for Global Burden of Disease (GBD) 2021. This new approach incorporates both within and between study heterogeneity, which distinguishes it from other traditional meta-analytical approaches.
More than half a million people die from tobacco-related diseases annually in ASEAN. On average smokers lose 15 years of their life. Millions of people stop smoking by dying.
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