Discussion

The trend of tobacco consumption increased in Saudi Arabia from 2001 to 2010, except from 2007 to 2008. This trend, which is supported by other published data,7 ,18 reflects the need for more political commitments and additional measures to decrease tobacco consumption. The decrease in imported tobacco from 2007 to 2008 might be due to variation in the stock volume caused by agents or by the economic recession and subsequent economic revival.

The economic burden generated in our study would be even larger if we used a rate of 1.3 (instead of 0.65) premature deaths per ton of tobacco consumed, which has been suggested by other studies.19 More importantly, the economic loss for one premature death and the direct and indirect costs of morbidity were calculated for the whole world, while Saudi Arabia is a high-income and rapidly developing country.20 This means that the net loss of 47.6 million US dollars for every thousand tons of tobacco consumed that was calculated in the Barnum study is an under estimation for Saudi Arabia. Also, according to the Barnum study,15 the benefits, (in terms of added value for consumers and producers) were subtracted from the total loss for each thousand tons consumed. Knowing that there is no tobacco agriculture or industry, this means that the benefit is much smaller.

Knowing that Saudi Arabia is a net importer of tobacco,7 the potential exists that modest short-term economic gains will accompany the transition of the Saudi society to one with decreased tobacco consumption. Reduced spending on tobacco imports will permit more domestic spending, and therefore more employment may be generated within the country.

However, measures to decrease importation and consumption cannot be successful without combating tobacco smuggling.21 It is estimated that 11.6% of all internationally traded cigarettes are smuggled,22 causing losses to government revenue worldwide. Smuggling reduces the overall price, increases demand and undermines national tobacco tax policies and, as a result, harms health by increasing tobacco use.

Governments have the potential to use tobacco taxes to manage consumption, raise revenues and promote public health. Raising tobacco taxes so that they account for at least 70% of retail prices would lead to significant price increases, induce many current users to quit and deter numerous youths from smoking.23

As a country without no cigarette production or excise tax, Saudi Arabia levies higher import duties on cigarettes for revenue purposes. As it does not manufacture cigarettes, there is no real effect on the economy. The Gulf Council Countries, including Saudi Arabia, impose a 100% duty based on importers’ declared cost, insurance and freight value, though the average price per pack of cigarettes in US$ is lower than the average global price.24

We acknowledge the methodological limitations of our study in using the Barnum concept and in using global parameters in a high-income country such as Saudi Arabia, where the economic costs of consumption are higher. In addition, applying global parameters does not take into consideration the time lag between the consumption and the effect of tobacco in different countries. The recent increase in tobacco consumption in developing countries will cause an increase in future illnesses.15 Regardless, our estimation of the economic loss is valuable in the absence of any economic study in Saudi Arabia to evaluate the burden of tobacco use. It motivates decision makers to implement effective policies to offset the harmful effects of future tobacco use.

In conclusion, tobacco consumption in Saudi Arabia results in a high economic loss. A more comprehensive study on the economic costs of tobacco consumption in Saudi Arabia is needed. Anti-tobacco policies, including anti-smoking campaigns and excise taxes, are recommended in Saudi Arabia.