Vicious Cycle of Tobacco Use and Health and Economic Disparities

Low socio-economic status, defined as possession of limited household income and resources, are associated with higher tobacco use at the population level. Tobacco use aggravates economic inequality between the households with one or more members who use tobacco and the households with no member using tobacco by crowding out household financial resources of the former and reducing their net wealth through several pathways (Figure 2.8.1).

First, the money spent on tobacco product purchases could have been otherwise available for household savings or spending on necessities like food, education, health, or housing (Figure 2.8.2). Individuals who smoke in the lowest income groups spend a much higher percentage of their household income on tobacco compared with high-income groups.¹ The adverse consequences of smoking on the economic well-being of families with children contribute to intergenerational economic inequality by affecting children’s health outcomes and overall well-being.^2,3

Second, out-of-pocket health expenditures attributable to tobacco-induced diseases divert household financial resources away. Third, household income and wealth are lowered by loss of workdays or employment due to tobacco-induced morbidity and premature mortality of household earning members. On average, people who smoke tend to have lower wages than people who do not smoke.^4,5,6 Additionally, families incur loss of home productivity for caregiving by household members to those suffering from tobacco-related illnesses.

It is important to break the vicious cycle of tobacco use and health and economic disparities with a comprehensive tobacco control scheme targeted to reduce tobacco use among people with limited income and resources and mitigate the adverse health and income distributional consequences of tobacco.