A Conversation with Prof. Teh-wei Hu

Dr. Teh-wei Hu is a Professor Emeritus of Health Economics and served as Associate Dean and Department Chair in the School of Public Health at the University of California, Berkeley. Currently he serves as the Director for International Tobacco Control Policy Research and Evaluation at the Public Health Institute. He has been appointed by the U.S. Government as a member of the Interagency Committee on Smoking and Health. Professor Hu’s areas of expertise are the application of econometrics to health care services research. He is the author of more than 200 publications. He contributed chapters in major WHO and World Bank tobacco control publications. During the past 20 years, he has been conducting research in economics of tobacco control in the US, China, Southeast Asia, and Estonia. He is the editor of Tobacco Control Policy Analysis in China: Economics and Health (2008). He co-authored a report on Tobacco Taxation and Its Potential Impact in China (Hu, Mao, Shi, and Chen, 2008) funded by the Bloomberg Philanthropies and the Gates Foundation. He has served as a consultant to the World Bank, the World Health Organization, and a senior policy advisor to the Ministry of Health, China.

胡德伟教授简介:胡德伟博士曾任美国加州大学伯克利分校公共卫生学院副院长和系主任,现为该校卫生经济学荣休教授。他同时还担任美国宾夕法尼亚大学经济学教授,美国联邦政府跨部委控烟委员会委员,世界银行及世界卫生组织顾问,中国卫生部高级政策顾问,南开大学富布赖特客座教授,以及中国香港地区和台湾地区政府顾问。在过去的四十年中,胡德伟教授一直从事卫生经济学的教学和研究工作。他的主要研究领域为应用计量经济学,卫生保健服务和烟草控制。迄今为止,胡德伟教授正式发表的论文已达200余篇。

1.     Cigarette Use and Its Consequences in China

中国吸烟现状及其影响

Xin: I read your 2011 article in Tobacco Control on smoking and related economic costs in China. It provided an update using data from year 2008 and a comparison with data from 2000. I am wondering if you have any comments on cigarette use and its consequences in China.

徐昕:我有幸拜读了您2011年发表在烟草研究杂志上有关中国吸烟现状及其经济成本的论文。在这篇文章中,您用2008年的数据更新了对中国吸烟状况及其经济成本的分析,并与2000年的相关数据做了比较。我想知道,您对中国吸烟现状及其影响有什么看法。

Prof. Hu: The article was a collaborated work with Prof. MAO Zheng-Zhong at Sichuan University with several important findings. First, smoking prevalence in China has not been declining in recent years. Moreover, the smoking prevalence among youth and women living in urban areas has gone up. The most important finding in the article is the 300% increase in total economic costs of smoking in China between 2000 and 2008, from 6.2 billion to 28.9 billion U.S. dollars. However, I think this is still an underestimate of the situation, as we only considered three major smoking related diseases, i.e., lung cancer, cardiovascular diseases and chronic obstructive pulmonary diseases. Medical costs related to other smoking related diseases were not included. As a result, these findings imply that if no significant smoking control interventions took place in China in the near future, the economic burden of smoking would escalate even faster than before. There are at least two reasons: (1) the health care cost in China is increasing much faster than the national average consumer price index, and (2) with the rapid economic development in China, the associated indirect costs and the productivity loss could be much higher. That is why we are very concerned about not only the negative health impact, but also the economic impact of smoking on Chinese society.

胡德伟教授:发表在烟草研究杂志上的那篇文章是与四川大学毛正中教授的合作研究。在文中,我们有几个重要的发现。首先,近年来中国的吸烟率没有下降。此外,在城市地区的青少年和女性中,吸烟率有所上升。本文最重要的结论是,在2000至2008年间,在中国与吸烟相关的经济成本增加了3倍,从2000年的62亿美元增长到2008年的289亿美元。不过,我认为2008年的经济成本仍然是被低估的,因为在分析中,我们只考虑了与吸烟有直接关系的三大疾病,肺癌,心血管疾病和慢性阻塞性呼吸系统疾病,而其它与吸烟有关疾病的医疗费用并没有包括在我们估算的经济成本中。所以,这些研究结果意味着,在不久的将来,如果没有明显有效的控烟政策,中国与吸烟相关的经济负担会进一步增长。其增长速度甚至可能比以前更快。导致这种可能性的至少有以下两个原因:(1)在中国保健成本正在上升。其增长速度远远高于全国居民消费品价格指数上涨的平均水平。(2)随着中国经济的快速发展,与吸烟相关的间接成本以及劳动生产率丧失的成本可能会高得多。这就是为什么我们不仅非常关注吸烟对健康的负面影响,也非常关注吸烟对中国社会的负面经济影响。

2.     Tobacco Control in China: Success and Challenges

中国烟草控制中的成就与挑战

Xin: In your opinion, what are the successes and challenges regarding tobacco controls in China?

徐昕:在您看来,中国烟草管控中取得了哪些的成就,又有哪些挑战呢?

Prof. Hu: On the positive side, our research findings, as part of the evidence based policy interventions, have been communicated to and beyond the Ministry of Health. Other key policy makers in China, including the State Council, the Ministry of Finance, the State Bureau of Taxation, National Development and Reform Commission, and even the Premier’s Office are well aware of two things: (1) the consequences and economic costs of smoking in China and (2) excise tax is an effective way to control cigarette use. So the information has been successfully disseminated to top officials. That being said, we have not seen much of actions so far. The cigarette retail price has remained the same between 2009 and 2011. According to a collaborative survey with the Chinese Center for Diseases Control and Prevention in which retail prices were collected from 6 cities, the cigarette retail price did not change even after the tax adjustment in 2009. The tax adjustment only affected the producer’s price and the wholesale price, but not the retail price. This is because of the monopoly power of the manufactures. These companies are part of the government and they make substantial profits from cigarettes. Consequently, even with tobacco excise tax, they could afford to reallocate between the profit and the tax within the Chinese government after the adjustment to maintain their market share.

胡德伟教授:从积极的一面来说,我们的研究成果,作为以实践证据为基础的控烟政策的一部分,已经上报到中国卫生部及其领导部门。其他重要的政策制定部门,包括国务院,财政部,国家税务总局,国家发展和改革委员会,甚至总理办公室都清楚地知道两个事实,(1)在中国吸烟的后果及其经济成本,(2)烟草消费税是一种行之有效的控烟手段。所以,相关信息已成功传递到政府的高级官员。虽然如此,到目前为止,我们还没有看到很多与控烟相关的实际行动。在2009至2011年间,香烟的零售价格一直保持不变。在一个与中国疾病预防控制中心合作开展的社会调查中,我们从6个城市收集香烟零售价格。香烟的零售价格甚至在2009年税收调整后都保持不变。税收调整只影响了香烟的出厂价和批发价,而不是零售价。这是因为卷烟厂拥有市场垄断力。他们是政府的一部分,而且他们从香烟的销售中获取了可观的利润。因此,即使在税收调整后,他们仍然能够在中国政府部门之间调整利润和税收的比例以维持其市场份额。

Xin: Chinese government announced the indoor smoke-free regulations on May 1st, 2011. Do we have any anecdotal evidence on the effectiveness of the policy?

徐昕:在2011年5月1日,中国政府宣布“室内公共场所”禁烟令正式生效。有没有任何证据展示这个政策的有效性呢?

Prof. Hu: Well, it was good that the government have made further clarifications on the Smoke-Free Public Regulation announced earlier in May, 2011. However, it still lacks concrete implementation strategies, such as how to measure the exposures, who is going to monitor and what is the penalty. Remember, it is not a law. They are regulations in many different cities. From the newspapers and monitoring reports I have seen, there may be some partial success in some cities, such as Haerbin, Guangzhou, and Shanghai. Presumably, these cities developed implementation strategies. However, there is still a lack of systematic evaluation of the impact of this indoor smoking regulation. Also, the Ministry of Health is the only government authority who announced the regulation. Unfortunately, no other organizations or government authorities have made strong advocacy for this regulation.

胡德伟教授:嗯,政府已经对2011年5月1日生效的“室内公共场所”禁烟令做出了进一步的解释。这是个很好的现象。然而,这个条例仍然缺乏具体的实施细则,比如,如何衡量二手烟的危害,谁负责监测,以及违规后的处罚是什么。请记住,禁烟令是不是法律,而是许多城市的条例。根据我所看到的报纸和监测报告,在一些城市,如哈尔滨,广州和上海,有一些部分成功的案例。我推测,这些城市制定了相应的实施细则。不过,目前对“室内公共场所”禁烟令的效果仍然缺乏系统评估。此外,卫生部是唯一公布禁烟令的政府部门。遗憾的是,没有任何其他组织或政府部门加入对禁烟令的宣传。

3.     Public Policy and Research Priorities in Tobacco Control

烟草控制中公共政策和研究的重点

Xin: As a senior policy advisor to the Ministry of Health of China, in your opinion, what are public policy priorities and research priorities on tobacco control in China?

徐昕:作为中国卫生部的高级顾问,在您看来,在中国烟草控制中,哪些是现阶段公共政策和研究的重点?

Prof. Hu: From the existing literature and my own professional background, in terms of public policy, I believe the Chinese government should raise tobacco tax, especially the excise tax, the tax based on the quantity of cigarettes purchased. This is an effective policy, allowing the government not only to collect the revenue, but also narrow down the price range of cigarettes.

胡德伟教授:从现有的文献和我本人的专业背景来看,在公共政策方面,我相信中国政府应提高烟草消费税,尤其是从量的消费税。这样税基是购买香烟的数量。无论是从政府税收的角度而言,还是从缩小香烟差价的角度而言,从量的消费税都是非常有效的。

Prof. Hu: In terms of research priorities, the following areas might have more importance. First, research has only been done at national level so far, such as economic cost studies, and simulation studies evaluating the impact of excise tax on tobacco industry and tobacco farming. I think the next step is to perform studies for a few major tobacco-producing provinces, e.g. Yunnan, Guizhou, or Hunan provinces. These provinces are very much against tobacco control. Regional analyses need to be done to address the concerns among the top local officials. Second, the central government is concerned about the impact of raising taxes on the low-income population. This is another area that needs more research. Is this really the case? If so, how large the impact would be? What would be the impact of switching brands among the low-income population with rising taxes? We really need to help the government understand the answers to these questions. And finally, studies on the options, as well as impacts of separating the national tobacco companies from the government ownership. This may not entirely be an economic research, maybe can be referred as political economy, but this is a major hurdle in tobacco control in China. It suggests that Chinese cigarette companies are not operating in a market economy. It is a very important topic, as this type of structure is not only a barrier to the effectiveness of tax increases, but also an obstacle to the implementation of other provisions in the Framework Convention on Tobacco Control, such as health warning labels, or smoke-free public places.

胡德伟教授:从研究角度来说,以下几个领域可能会是重点。首先,当前研究主要局限在国家这一级的层面上,比如对吸烟经济成本的估算,以及我们开展的提高烟草消费税对不同行业及烟草种植业所产生影响的模拟研究。我觉得下一步就是对几个主要的烟草生产省份开展有针对性地研究,例如云南,贵州,以及湖南。这些省份是比较反对控烟的。下一步的区域性分析需要切实有效的解决当地政府所关注的问题。其次,中央政府也关注提高烟草消费税对低收入人群产生的影响。这是另一个需要更多研究投入的领域。这种担心真的会发生吗?如果是这样,税收调整会对低收入人群产生多大影响呢?税收调整后,主动降低香烟消费的品牌档次又会对低收入人群产生什么样的影响呢?我们切实需要(通过研究)帮助政府了解这些问题的答案。最后一项研究是考虑,将国家烟草公司从政府所有权中剥离的政策选项及其影响。这可能不是一个纯经济学问题,也许更接近政治经济学研究,但是这是一个中国烟草控制中的主要问题。这意味着中国卷烟企业并没有在市场经济模式中运作。这是一个非常重要的课题,因为这种行业结构不仅是阻碍了烟草消费税的有效性,而且也阻碍了烟草控制框架公约中其他规定的应用,例如香烟的警示标签,或者是无烟公共场所的设立。

4.     The Role of Government in Tobacco Control

政府在烟草控制中的作用

Xin:  The last research priority you mentioned related to the role of government in tobacco control, is that the case?

徐昕:您提到的最后一个研究重点与政府在烟草控制中的作用是息息相关的,是这样吗?

Prof. Hu: Right, the separation between national tobacco companies and government definitely relates to the role of government in tobacco control. In fact, we can learn from the international experience, like Turkey, Thailand, South Korean, and even Japan. They all took actions to separate the national ownership from tobacco companies. Also, in national tobacco research conferences or meetings in China, only researchers have been attending and talking to each other. Top government officials have not been involved in these meetings. They did not come even if they were invited. The Chinese government has a top-down system. The system can be very efficient if the government has the will, just like we observed in the severe acute respiratory syndrome epidemic. So I think that top government officials beyond ministers need to be involved in the action. That would be another role of government in tobacco control.

胡德伟教授:是这样的,将国家烟草公司从政府中剥离必然涉及到政府在烟草控制方面的作用。事实上,在这方面我们可以借鉴国际经验,如土耳其,泰国,韩国,甚至日本。他们都采取实际行动将曾经的国有烟草公司私有化。此外,目前只有研究人员出席中国国家级的烟草研究会议并相互交流。政府高层官员没有参与到这些会议中去。即使获得会议邀请,他们也通常缺席。中国政府有一个自上而下的系统。如果政府有相关的意愿,该系统可以非常有效的运作,就如同我们在非典疫情中看到的那样。因此,我认为我们需要比部长更高层级的政府官员参与到行动中来。这是政府在烟草控制方面能够起到的另一个重要作用。

5.     The Impact of China Health Care System Reform on Tobacco Control

中国卫生体制改革对烟草控制的影响

Xin: Another topic in China now is the health care system reform. Do you anticipate any impact of China’s health care reform on tobacco control?

徐昕:现在中国面临的另一项课题是卫生保健系统的改革。您认为中国医疗体制改革会对烟草控制产生影响吗?

Prof. Hu: I would think so. We know that the medical costs in China and the government share in health care expenditures are much greater than before. Back to the first point we talked about, the medical costs associated with smoking have substantially contributed to this increase in medical care costs. If we could not curb the smoking prevalence, it would incur additional medical costs and government investment in health care in the future, particular on the costly chronic, non-communicable diseases. In that sense, the Health Care reform and tobacco control should work together to reduce health care expenditure and to improve health. On the other hand, under the reform, we also talk about more effective health care delivery system and health care balancing. In the Health Care reform, we need to give incentives to providers, say hospitals and physicians, and consumers, the patients. This way both sides would integrate the tobacco control issue into their agenda. It would make the Health Care reform more effective and cost-effective.

胡德伟教授:实际上,我觉得会的。我们知道,现在中国医疗支出以及政府在医疗保健支出中所占的比重比以前更大。参考我们讨论的第一问题,与吸烟有关的医疗费用在总医疗保健支出的增长中占据了相当的份额。如果我们不能有效控制吸烟率,吸烟将导致额外的医疗指出并造成政府在未来医疗保健投入中的额外开支,特别是在昂贵的非传染性的慢性疾病方面。在这个意义上说,医疗体制改革和烟草控制应共同努力,以减少医疗开支,改善人民健康。另一方面,在医疗体制改革中,我们也在探讨建立更有效的卫生保健服务体系和保健的收支平衡问题。因此,在医疗体制改革中,我们需要向供方(例如,医院和医生)和需方(病人)在烟草控制问题上都提供激励机制。这样双方都会把烟草控制问题整合到他们的日程行动中去。这会使医疗体制改革更有效和更符合成本效益。

By Xin Xu, PhD, University of Illinois at Chicago

徐昕,博士,伊利诺大学,芝加哥

 Dr. Teh-wei HU

Dr. Teh-wei HU