THE GROWING awareness of middle income and rich families on the illnesses caused by cigarette smoking and the increasing availability of multiple alternatives to cigarettes have caused declines in cigarette usage among these classes but became more pervasive among the poorer households.
With the barrage of negative propaganda against cigarette smoking– which once used to be tied to social status or those with power, style and urban glamor– more and more of those that can readily afford them kicked the habit.
But for the poor, cigarette smoking was one palliative to a hungry stomach, which could not be quelled by high-cost of food for their families. The exposure to cigarette smoking has even attracted younger members of the poor household that now, instead of buying food for their stomachs they buy cigarettes (which has become even costlier with all the taxes slapped on them) ultimately leading to higher public health expenditure.
An analysis of World Health Organization data done by UP Professor Dr. Rogelio Alicor Panao, also Inquirer data scientist, said daily exposure to smoking at home remains significantly higher among poorer households than wealthier families.
Panao said 39 percent of the poorest households reported daily exposure to smoking at home in both 2017 and 2022. By contrast, among the richest households, the figure ranges from about 22 percent in 2017 to 19 percent in 2022.
The gap suggests that poorer Filipino families are roughly twice as likely as richer households to live with daily smoking exposure, which reflects earlier findings linking tobacco use to poverty and inequality in developing countries, the Philippines included.
A 2008 WHO report titled “Tobacco and Poverty in the Philippines” said tobacco consumption is higher among the poorest households and that tobacco spending diverts resources that could otherwise go to food, education, shelter and health care.
Tobacco is inextricably linked with poverty. “For the poor, money spent on tobacco is money that could be spent on basic necessities such as food, shelter, education and health care,” the WHO reported.
Burden For The Poor
Panao said smoking exposure cannot be treated as “a neutral habit” because it is closely tied to long-term health risks such as heart disease, stroke and respiratory illnesses.
When smoking is concentrated among poorer households, the burden of these diseases also becomes concentrated among those who are already more vulnerable in terms of income, access to care, and overall health,” Panao reported to Inquirer.
The WHO report documented the scale of that burden in the Philippines, estimating that smoking-related diseases accounted for thousands of deaths and billions of pesos in economic losses.
Smoking-attributable deaths from four major diseases, including cardiovascular and respiratory illnesses, comprised “a little over 8 percent of mortality from all causes,” the WHO noted.
The report estimated total costs of illness from smoking-related diseases at as much as $6.05 billion in 2003 using one methodology and the more conservative estimate is at $2.86 billion.
For poorer households, the impact extends beyond medical costs.
Panao said tobacco spending takes up a meaningful share of limited household budgets in poorer families, reducing resources available for food, education and other essential needs.
“At the same time, smoking-related illness increases medical expenses and can reduce a household’s ability to earn income, deepening financial strain over time,” he added.
The WHO study found that poor and poorest households in the Philippines spent more on tobacco than on clothing, education or health care. It also noted that reallocating tobacco expenses to food could significantly improve nutrition among poor families.
“Should 61.1 percent (percentage of expenses on food) of tobacco expenditure be reallocated to rice, a person from a poor household would, on the average, have an additional 466 calories daily from rice alone,” the WHO report stated.
“The average monthly tobacco expenditure of the poor, when reallocated to food, can add around 750 calories daily from different kinds of food items,” it added.
Smoking Still Prevalent
The latest Global Adult Tobacco Survey conducted by the Philippine Statistics Authority and the Department of Health showed tobacco use remains widespread in the country, the Inquirer noted.
In 2021, 19.5 percent of Filipino adults, equivalent to around 15.1 million people, were current tobacco users. Among men, the smoking rate reached 34.7 percent, compared with 4.2 percent among women.
The survey also found that 21.8 percent of adults were exposed to tobacco smoke inside their homes. Filipino smokers spent an average of P1,273.90 a month on manufactured cigarettes in 2021.
The survey showed that cigarette prices influence smoking behavior. About 68 percent of current smokers who tried to quit in the previous 12 months said high cigarette prices pushed them to attempt quitting.
WHO researchers have noted that raising tobacco taxes could reduce cigarette consumption while increasing government revenues, which did not stop tobacco use but only made consumers divert to cheaper available cigarettes.
The WHO report said simulations showed tax increases could yield revenue gains of 17 percent to 85 percent while lowering cigarette consumption.
Panao said the persistence of smoking among poorer households is tied to broader social and economic conditions.
Smoking Is Quick Relief
“Smoking is more common in poorer communities where stress levels are higher, daily life is more insecure, and cigarettes are often used as a form of quick relief,” he said.
“It is also easier to maintain the habit where smoking is common in homes and neighborhoods and where access to sustained quitting support is limited.”
The WHO report described tobacco and poverty as a “vicious cycle” in which tobacco use both contributes to and deepens economic hardship.
“As the data suggest, smoking is not merely a matter of personal choice or cultural habit,” Panao said. “It both follows and deepens inequality over time.”