Revisiting the association between worldwide implementation of the MPOWER package and smoking prevalence, 2008-2017.

BACKGROUND: We revisited the association between progress in MPOWER implementation from 2008 to 2016 and smoking prevalence from 2009 to 2017 and offered an in-depth understanding of differential outcomes for various country groups. METHODS: We used data from six rounds of the WHO Reports on the Global Tobacco Epidemic and calculated a composite MPOWER Score for each country in each period. We categorised the countries in four initial conditions based on their tobacco control preparedness measured by MPOWER score in 2008 and smoking burden measured by age-adjusted adult daily smoking prevalence in 2006: (1) High MPOWER - high prevalence (HM-HP). (2) High MPOWER - low prevalence (HM-LP). (3) Low MPOWER - high prevalence (LM-HP). (4) Low MPOWER - low prevalence (LM-LP). We estimated the association of age-adjusted adult daily smoking prevalence with MPOWER Score and cigarette tax rates using two-way fixed-effects panel regression models including both year and country fixed effects. RESULTS: A unit increase of the MPOWER Score was associated with 0.39 and 0.50 percentage points decrease in adult daily smoking prevalence for HM-HP and HM-LP countries, respectively. When tax rate was controlled for separately from MPOWE, an increase in tax rate showed a negative association with daily smoking prevalence for HM-HP and LM-LP countries, while the MPOWE Score showed a negative association for all initial condition country groups except for LM-LP countries. CONCLUSION: A decade after the introduction of the WHO MPOWER package, we observed that the countries with higher initial tobacco control preparedness and higher smoking burden were able to reduce the adult daily smoking prevalence significantly.

The crowding out effect of out-of-pocket medication expenses of two major non-communicable diseases in Pakistan.

BACKGROUND: Elevated blood pressure (i.e. hypertension) and diabetes (BPD) are the two major noncommunicable diseases that expose households to high out-of-pocket treatment costs in low- and middle-income countries. Medication is the biggest share of BPD treatment expenses, and households with someone suffering from BPD may need to adjust consumption of other commodities to pay for essential BPD medicines. We assess how BPD medication expenditures are associated with crowding out of other household commodities in Pakistan. METHODS: We analyze self-reported household consumption data from the nationally representative Pakistan Household Income and Expenditure Survey 2015-16. We estimate conditional Engel curves under the Quadratic Almost Ideal Demand System framework to examine the differences in average consumption shares between BPD medication-consuming and not-consuming households. RESULTS: We find that BPD medication expenditures are associated with crowding out of food and crowding in of other medical expenditures for all households, but the magnitudes of crowding out and crowding in are larger for the poorer households. BPD medication spending is also associated with crowding out of education and personal care for middle-class and wealthier households. CONCLUSIONS: Our results indicate that allocations for essential commodities, like food and education, are lower for BPD medication-consuming households and inform policies for preventive health promotions and affordable treatment for hypertension and diabetes.

Consumption displacement in households with noncommunicable diseases in Bangladesh.

The economic burden of noncommunicable diseases (NCDs), including treatment costs and income and productivity losses, is a growing concern in developing countries, where NCD medical expenditure may offset consumption of other essential commodities. This study examines the role of NCDs in household resource allocation in Bangladesh. We use the Bangladesh Household Income and Expenditure Survey (HIES) 2010 to obtain expenditure data on 11 household expenditure categories and 12 food expenditure sub-categories for 12,240 households. Household NCD status was determined through self-report of at least one of the six major NCDs within the household-heart disease, hypertension, diabetes, kidney diseases, asthma, and cancer. We estimated unadjusted and regression-adjusted differences in household expenditure shares between NCD and non-NCD households. We further investigated how consumption of different food sub-categories is related to NCD status, distinguishing between household economic levels. The medical expenditure share was estimated to be 59% higher for NCD households than non-NCD households, and NCD households had lower expenditure shares on food, clothing, hygiene, and energy. Regression results indicated that presence of NCDs was associated with lower relative expenditure on clothing and housing in all economic subgroups, and with lower expenditure on food among marginally poor households. Having an NCD was significantly associated with higher household spending on tobacco and higher-calorie foods such as sugar, beverages, meat, dairy, and fruit, and with lower spending on fish, vegetables, and legumes. The findings indicate a link between NCDs and the possibility of adverse economic effects on the household by highlighting the potential displacement effect on household consumption that might occur through higher medical expenditure and lower spending on essentials. The findings might also point to a need for raising awareness about the link between NCDs and diet in Bangladesh.