T 2361*
CONM)ENIMAT. Jjj%1rrj, JITTI31.1SHED
SPVIOKiNG AND HEALTH
A study of the effects of a
reduction in cigarette smoking on
mortality and morbidity rates, on health
care and social security expenditure
and on productive potential
DEPARTMENT OF HEALTH AND SOCIAL SECURITY
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A. EFFECTS OF A REDUCTION IN CIGARETTE SMOKING ON
MORTALITY AND MORBIDITY RATES AND ON HEALTH
CARE AND SOCIAL SECURITY EXPENDITURE
1. Research studies into the health effects of
smoking have almost
entirely been concerned with the association
between smoking and
mortality. The principal studies have been made in
Great Britain, the
United States and Canada; the findings froin them
are much in line and
all show a significantly higher rate of mortality
among cigarette smokers
compared WiLh non-smokers. The most important
study in this country
is that made by Doll and Hill begun in 1951 into
the smoking habits and
death rates of British doctors.
2. All the major studies show that cigarvite
smoking is associated
with increased mortality from a range of medical
conditions and that the
three main conditions are lung cancer, bionchitis
and coronary heart
disease which together account for aboijt
four-fifths of the excess
mortality of smokers compared with non smokers.
3. In order to calculate the number of deaths in
any period which are
caused by cigarette smoking the extent to which
the total deaths from
the main smoking related conditions arc
attributable to the habit must
be known. Thc research sli.dies referred to above
provide the ddta from
which such attrIIAL) lability factors have been
derived. These do not
enable precise figures 10 IX UICUlated und this
paper draws attention
to factors that it has not been possible to take
into account. Nevertheless
the figures in the following paragraphs give a
broad indication of the
health consequences of cigarette smoking and the
benefits that would
follow a substantial reduction in cigarette
consumption.
4. The Report of the Royal College of Physicians
"Smoking and
Health Now" presents figures on the extent to
which deaths among
persons aged 35 to 64 from cancer of the lung,
bronchitis and coronary
heart disease are caused by cigarette smoking. No
specific figures are
given for older persons although it was recognised
that the number of
deaths certified as due to the main smoking
related diseases is much
greater than at younger ages and that many
thousands of old people
who are cigarette smokers die a year or two
earlier than they would
have done had they not smoked.
5. The atuibutability factors used in the present
calculations are
shown in Table 1 and were agreed between
representatives of the
Department of Health and Social Security, the
Office of Population
Censuses and Surveys (Medical Statistics Division)
and the Government
Actuary's Department. Those up to the age of 64
are the same as given
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in "Sniokiiiq ajid licalth Now". The
tepiewijiitivos (if flic Departments
thought it icasonable EU it-NUTIC a rut-oil
lioi,it at the ago of 75 despite
the sudden tiansition fru.n the agc group 65 to 74
to that of 75 and
over: the main reason for this was flif!
difficulty iii quantifying the
number of desth~ attributable to smok"fig aincing
such ciderly pcrsons.
TAB LE 1. RE RCENTAGF 017 DEATI IS F ROM CE RTAI N
CAUSES
Al TR I BU TAB I. L TO CIG A R LTTL SMOK I NG
Age a r fYejth
Cause of death ' 35 to 64 65 to 74 75 and over
per ccn
ICD 162.1, 163.0 Cancer of Iting
M.Ae~ . . . . . 90 90 No
Fert.1,s . . . . 40 40 Nil
ICI) 491, 492 dro-ha,,
Males 75 75 Nil
F-A,, GO 60 N.1
IC D 410. 414 Coronary licart disr?a%e
Males . . . . 25 10 Nil
Fen,,,!,-. . . . . 20 10 Nil
CICO -ri bers t.,ikcn from the liatn nat ional
Clissi licat i nn of Di-iscs. lit h Rt~vision).
6. It should he noted that only the thiec main
smoking refatcd
conditions are included in Table 1. The othcr
conditions are excluded
because of the difficultv (it quantifying the
extent to which they cause
excess deaths among cigaiette smokers. Their
exclusion and the ignoring
of any deaths among persons aged 75 and over means
that the number
of cleaths when calculated cin the basis of Tal)lp
I is understated.
7. The importance of the assumptions of
attributability is shown by
the following illustration. The number of deatlis
due to cigarette
smoking in 1968 in England and Wales among persons
aged under 75
calculated oii the factors in Table I was 45.5
thousand. If the factors at
age 65 to 74 are extended to the age of 75 and
over the number of
deathswould be 63.5 thousand. I f only the factors
for cancer of the lung
are extended the number of deaths would be 49.2
thousand. Studies on
the economic effects of smoking have been made in
Canada and
attributability factors were used to estimate the
number of deaths
caused in that country by smoking. The application
of the Canadian
factors to data for England and Wales for 1968
gives 46.8 thousand
deaths under age 75 compared with 45,5 thousand
based on the factors
in Table 1.
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8. Ajiz)tlii!r factor has beeii igriored in the
present calculation
is any effects on licalth of tile introcILIC00.1
and growing use since tile
Doll iind Hill taudy COFT11iienced uf cigarcittes
with a lower tardelivery.
It is icasniiable to jssun,~ that lowei- tar
cigarettes havu some further
effect in reducing the mcidence of lung cincer but
it is not knoWr. What
alluwaricc should be made for thm. However, the
calculations in
paragraph 10 below are based on known deaths and
will thus have
implicitly taken some account of the effect of the
use of lower tar
cigarwes and filters over tile pas, 10 to 20
years.
9. Tho ibove relates to mortality. As for
morbidity there is a paucity
of research data on its association with smoking
and attributability
factoi s catmot be calculated in the same way as
for mortality. It seems
reasonable to assume that the same facturs would
apply for morbidity
as for neurtality, that is the factors in Table 1.
10. BaTd on the factois in Table 1 (which do riot
take account of
ber of deaths
deaths among those aged 75 and over) thi!
estimatcd num
which will occur in 1971 iii Great Britain clue to
cicarette smoking is
52,000. This is one eviny 10 Minutes (if the night
and day. Figures for
1968 show that among PL'i-sons under oic age of 75
about one in seven
of all deaths and one in five of all inale deaths
were clue to cigarette
smoking. Amonq men a9t-d 355 to 44 onu in cight of
all deaths were due
to cigarette sino king, amung those agcd 45 to 64
one quarter, and those
65 to 74 one fifth.
11. ThL magnitude (if the health hazards of
smoking can be underlined
by a comparison of the number of dcatlis rlue to
cigarette smoking and
those frorn various other conditions which give
rise to public concern.
in 1968 some seven ttines as many people died
bccause of cigarette
smoking than were killed in all motor accidents
(although it has to be
noted that the latter iricfijdcd a higher
proportion of younger persons
than tht: former and also persons of 75 and over).
For every five deaths
among persons aged under 75 caused by cigarette
smoking there were
seven from all forms of cancer other than those
due to smoking. Again,
cleathsdue to smoking were almost twice the number
from all respiratory
conditions other than those caused by smoking.
12. A further hazard of cigarette sinuking is that
expectant mothers
who smoke regularly hive smaller babies than do
those who do not
smoke and in consequence there is d higher rate of
mortality of the
infant at birth and in early life. It has been
estimated from survey
research data that in 1971 some 1,500perinatal
deaths will occur because
of smoking.
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Current health care costs due to smokiog
13. Thu only health ::~rvice costs vhicli havc
bc,.n brought dircc:ty
into tli,! c..1culation ~,r- thuse of tho hospital
and gunerAl practitioner
and gencral services. Obviously all servicF.'s
will be
affi-cied in some cleyrre i-nd allowanct,. has
been madr, indirt~ctly for this
as descril)(A in paragraph 16.
14. The number of hu.-pital beds occupiud by
p;,ti,--nrs with the three
main smoking coriffiEiuns listed in Table I were
derivcd from the
Hospital In-patient Enquiryind the finctors in the
same tabl,: enabled the
number occupied on account of cigarCLt(! smoking
to be calculated.
These werc reckoned iss acute becl: and their cost
was, tzkcn as the
equiva!cnt proportion of the total cost of beds in
acute hospitals. On
that hasis the estimated cost in 1970-71 was E25
million.
15. There are but few data on the use of the
general pravitioner
services to assist in the stimation of the
proportion of the total cost of
that service and the associated pharniaccurical
seivice which is inclin-A
in the treatment of ccridi(ions inducod by
smoking. What data are
available are derived from surveys, and [lit,
validity of these in reflecting
the number of consuliai;ons due to pioticular
conditions is open to
question especially in the case of those
conditioiis which in the early
stages gave rise To non tpucific symptoms.
16. Thme sets of sur~(:y findings hrive been uscd
in arriving at
estimated cusis. The first is that trom a SUrvey
over the period May
1955 to April 1956 covering 1CG qcneizil practices
in England and
Walus; the second frnoi 1 SUrvey of 36 practices
in Exeter from 1
November, 1966, to 31 Ociober, 1E)67; and the thud
from a short-term
survey of one group practice in Stistol and
another in Smathwick in
early 197 1. The three surveys produced different
results and the figure
of El I million for 1970-71 Which is tdken as the
rost of the general
praciitiatier and pharnincrtitical services ilue
to smoking is hased on the
findings from the largest ind widest spread survey
(inade 15 years ago)
which revualed The larclast proportion of
consultatio,is due to illness
associated with smoking. This figure is subject to
wide error but any
overstatements will be ulf~iet by those health
care costs, for example on
home nursing, which have not been UrUL19:IL into
the calculation.
17. The total annual current health care costs
incurred by the hospital,
family doctor and general pharmaccutical services
in the treatment of
smoking-induced disease is thus E36 million.
Changes in mortality and health care costs due to
reductions of 20 per
cent and 40 per cent in cigarette smoking
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Time hig in changes in
ti:rrt~.-,fify.7i;,I!ii,jrhidity
18. Ali ass-.imption ill the prrs,ilt -:crcise i5
that the rtductions. in
cigarettr -.n)ukinj uf :10 licir cent ;;r., 1 10
per cnrit viill occur ovu: a fivf-.-
ye:!r peri0d 311d tIl,1t Owicifter thu proprirtion
(if cigaretle --ifl0crs
aniuiiq ih-.- pepWalitnt full fiu fui thcr. Co
flic batis of the -j~ilabl(!
rc!~iml-Lll filZdir1g% C11 IIW t;!!IC las a fall
ill cip-ette irnoliing orld
a fall ill 1?1()rf;jiily (lot: to smokinj, a li;.i
been asrumcd th.~, whztever
reductwo in sivokicit-i ;,: .1fected ;- c:lurtiun
of similar proportion Ill
moruJity attribijt~il-!,- rt) t-moKm-.j ~:nd in
corrcspuiiding morbidity will
occui 10 years later. Tln.-s, for thu f)!irpclsLs
u' this study, if it fall in
smoking is achievcd i- f*,,,-- year-. th.-!
~-5,uinptinn is that Lhe fill! health
consequences will OLCur 15 yeats df!-:i the start
of the fall in sinoking.
Redixtiolt in the nurnbi-i )f dewhs cdused by
c,-'g.7rerfc smokifig
19. On the basis of the factor, in Ti;ble 1 the
estimated number of
deaths "it Great Britiln c.!used hy sninking, with
no teduction 3iid %vilh
20 per cent and 40 pt;r cz-ot rcdtjf:tiL'11'; ill
5M0ki!ltj achit:ved evenly over
the five years coil'! t luncmg April 10!2, are
shown in Table 2. These
figures take accuunt of the prujoct.--d Lhang~s
ill population structure
and the (loneral iniprnvcwL.,nt in mortality over
thu period to 2001; the
effect of these c,-.:i most cirarly b:! nc--r. in
the number of deaths
estiniatcri to occur Vjjjj rio reduction ill
smoking - a fall from 52,000
in 1971 to 46,000 in 200 1.
TABLE 2. ESTIMATEr) NUMBER OF DEAT14S IN GnFAT
BRITAIN
CAUSED BY CIG,,riC-:TTE SMOKING
(In '000s)
fleduc..;~In in the number
If no fall If 1.01 in smoking of of Livarlis if
47/1 in sinakin2
;n smoking 20 per cAw 40 per cen r 20 per cer. r
40 per cent
1971 . . . 52 52 52 - -
1981 . . . 52 44 36 a 16
1991 . . . 48 38 28 10 20
2001 . . 46 37 28 9 18
20. Table 2 shows that in 1981 8,000 less people
will die from smoking
causes if smoking is reduced by 20 per ccnt
compared with the number
who would die were there no reduction, while with
a 40 per cent
reduction the saving in such deaths would be
doubled. The savings
would increase to about 10,000 and 20,000 a year,
respectively, after 15
year,~, although these numbers would fall slightly
by the and of the
century.
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21. It inust be cmph-isiscd that tho of deadis
refetted to ill
parag-;)h *?0 rel~:tt- uilly Ili clcalh~ "1011i
C.;US--2S ill ''d
VL,ar!;. It Ill.-- :1010ber Of dl,~015 fl0lit
Other th"ll,
inloarcNAJ 01C F.X.::J
fewer, viz. 7,OUO, 5,0,11 2,000, hi Ili:: th,r.L-
C. I-
yea% (,,. a it-ductio'l ,~ 20 per Mllt .1lid
dULlbl1: ill,:- I'll J
rcrit,ctam r~f 40 pe, ce--" '.The tutal nt!mber of
pi.;-,,ons sjvud !roni dying
oval 11,1! IU yt.-ors 1912 z-i [~-;H loecnw~,- tif
a 20pei C~-llt CUL ill Srl,0.1119
would h, Z,,000; (,Y(!r thu 20 to 1991 it woidd bo
90,000; and
tiver th., :;'U yvars to ',!1)01 it -.vuij'tl I:r
1:;0,C00. Of the latzcr, cjbc%!~
50.OCO i,-.-oold die bck-.,! *.:-- -.g- at 50.
Coire,,pond.ticl figurcs fur d 40
per cm i i. cu I ill e 050,000, 1 Lu.000,
260.0-CiO and 100.000.
Chi jef. ill licalth corr co. :,-
22. In --stitniting ih,: -fler:s of 1`V-fL1C.1Ul1S
ill 5MV1. OU On health ..i!rf,-
costs ill 1918 1, 199 1 3-,.[ 200 1, arrow, - I
tas to Ili., U.- (::i u! I he
murb.ifity rt::ulwiU h ir,q. :wd , -f iny in
the size and make up -mrilis (it jod agi-I ui the
consctjij,~nOal to the mort,ility from smoking. A
reduction ir.
morWiLy clue to smci!~iiiq incans in 11100il-o a
l,)01,IljQl1ejT!e!)* of (fi-ath,
sortit: p,.ul)l,, %r.,I-,o are ~---vcd from dy;nil
'.Lim sinckii:q conditio;I:
in, Sly, 1.'12 will (lie i., 'j-,jt ycz!, c),, I-,
2001 knd i:;decd later) the Sawily it, cf-.ith-,
attribul.il,lo to
cxccud thi: increase in the number nw, It,
the proit:rted population be I;iry-.!r than if
tl,,:rc il~.d Ueeri no
reduction ill smoking.
23. The lower morbidity resulting Irwo the fall in
~inol,~ing will tr!nc
towards a saving ill livaWi care costs hut the
larger r3opulation will le!-
towards art increase.
24. Thr assumption lias,ilready bcert made that,
ill relation to sinuling,
morbidity wil! change in Ehe %arric way as
mortality. A further ISSUmplion
is that heilth care costswill change in tliv saina
way as moi bidity. Chanqcs
in mortality are thus laken as an index of changes
it) henlih cire costs.
This rricans that if the jitimher of dc.-ths
caused by a lower level oi
smoking in a pariticular year Was O11P-ILlltIl
less thaii the number which
would occur with no irdk-ciion in smoking then
attributablf'. health care
costs would fall by'unr-tPrith.
25. Health care costs in 1970-71 due to i~inoking
were C36 million (see
paragraph 17). The number of deiths caused by
cigarette smoking
estimated to occur in 1981, 1991 arid 2001 with 20
per cent and 40
per cent reductions in smoking are given in Table
2. The reductions in
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Walth care cc.:,Is dtic to lU(IW,.,:d mLihi-!1tN-
arr. given lit the sucond
c"ItIll- 3 (fivio...4).
26. of the G(-::,!ni-W Ac I D.-p.a [,~ ::,~t
-JIU.V 1113L
0117 '2X1,rj lit):%, ';.;!-'IS ill 19U1 L-11(f
:'~Xl .-~-!.k! from
IN, dut: !(., a C?i .... ... .. hz!va a niuch
I lw~j- J vId,-rly 1), . on: It.,, Ilv! 1911
1:~,puliiwjn. The
u-:1.. "f Ulf- .~i;Laqt-d c.-.1-uIvred
pro ima po!.- ht:.. ! of pvj,t,I::t:-1-,!, v,ff:
~iti uroad
lo, Im.1 L!:;,-, plup,~f tior of Ili,-, 1y. The
cxlra co.-u; aac given
Ili 0.- thiii! ut T.shY 3. *1 lit- wor6i i.oluimi
0 dw t-,hi, shuws thu.
r.,-.l chanc" 1:1 1.. .7 AU
TAHLFF 3. CITL CTS (M Iff-'Al TH CAM: CUST`. Of-
IIEOUCTIM'~ OF
20 IM: U't-'l At.111.) 4U Ill R CI:I.JT 11 J
i:IG.-%RE ME Si,W')W!G
l" Alet cl-gm
'&h." th", m m in costs
"'O'bidi'l, palwkaw,,
IE "'illa-1 (E .611i".') IE rnifl.o")
20 jit:f cent -ftirti- it winkinq
1981 . . . . . G 2 4 Im,
1991 . . . . . 10 6 4less
2 C0 T 10 12 2 more
4 U pt:t cen: t,!ducitt- on sniuktotj
1981 . . . . . 11 4 7less
1991 17 16 1Ics.
2 co 1 17 22 5mo re
Effects in hunnan terms
27. What a reduction ill ill-health and premature
death V;OLIILJ inean in
terins of rcduC2d stiffi-rinU IfILI distresn
rantiot lie cfuantih-~d ind must
largely be a inatt,,r only for ifnaginaticiii and
individUJI. judgement. But
in factual tenits if smokitig werr! redUCed by 40
per cent there would
20 years IatLr lie more than 100,00U fewer vvidows
anti widowers (many
would have dependent children) and nrarly 2.000
tuvier people in
hospital. Ili descriptive trims, carcinoma of the
bronchus can cause pain
that may nut respond even to the must powerful
pain relieving drugs
and coronary heart disease too can cause intense
pain. Also distressing
is the limitation of activity and the anticipation
of furtliv attacks or of
sudden death. Death from chronic bronchitis is
very long drawn out and
the lung damage may make almost any activity
impossible without
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si-vcre I I dessness tin ti I fim." y, eve: -.
when cnrT-.p:c1vIy bodriddcn, the
padem li~-, to rtrut;qle fui cveiy Urcatli.
Curremt sikn:ns ;O)scricc n.-:il se. -.,,-ity dtn~
to ~m,,kinq
28. W~,.n the !.:c,.-:lr-~ in '1*7.hle I are
app:ied ic; sic!--ri~--ss
for the 2 %Ivy 11,359 "t ;-;estimated that
26 m;::',: LIJYs ab,:-.nt:L: ca:i-,I I)!.
c;q,iruttv ritiuking. For Lhe
pt1lI1OL--S of this CL!ICL;!..!!-Df1 ..:[ spelk.
of s:(:I%nt!= -r-Ofied as chrrinic
bronch;zi:. tunether vAll; all !,--cl!s cei filied
as bionchitis (Linqualifind)
laszinq 30 or more days were includet! .:s chronic
brGochitis, that is, as a
inain smukiriq refaLcd coriditiLli. Any hortc.,
spElls were not included.
29. On thul).risiscifthe-ratcso' payin,:n, in
1070-71 he cosruf sicPjjc~s
bcf,.r!lit loid ful these 2C days % s C30 iml!imi.
A fut th;:t dzbit il
tile su:il of ra milliull iexclu'~'inq SI. V) ior
lljiollol i;15utlr..C,-, contri
bution-, nut paid. The stifil u.' UIUC ;V.0 i1Cl:,
is th-zis [28 million. In
additic.-i to thecost of ib%cnc.. fr,,ni work
attrihutcd to sll',A'Jng
thure is riv? cost 0l widovvs pr:lsioiis pairi to
v.,idows of Elio,.-. who li;.ve
I , and it is likely that this constitutes an
dic-1 as a iesult of snio' itiq
aMULIM similar to cost of sickness . Off,vt aljmt
them covs,
howevcr, is the amount of re-irement pension that
riould have bccn
paid hzd bicisewhohave died Liver the I;i,;t',O Ur
w yearsclue to sincking
sur.-ivtd ti.) enjoy a period of retirem, iii. It
is not p-mble to estimate
with any raliahility the cost L;,' reciranwnt
jocrisions 10 those who have
already died, but it is likcly that it vv~,uld
cxcc!!d the combined cossr of
sickness absence from work and the benefits paid
to widows of smokers.
Changes in social security payments clue to
reductions of 20 per cent
and 40 per cent in smoking
30. The reductions in smoking will rusult in less
sickness absence and
hence [,?ss sickness benefit paid and niure
national insurance cuntri-
butiuns rLcuived. The net reSUlt Of th.-sc factors
is shown in Table 4.
The extra population will result in enlarged
paynu~nts for sickncss
benefits and retirement pensions but iriort:
national insurance contri-
butions received and smaller payments for widows
pensions. The third
column of Table 4 shows the net result of theseand
the fourth column
the overall changes in expenditure.
(-,4
CD
CD
011
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TAnLE 4. EFFECT ON SOCIALS L Ck I P I TY or M'ij I
I17T I ONSOF
20 Pr I I C!'NT AND 10 VE'l I Cr NI 1 1 N CI
GAIAFTTE SMOKING
Not i.-, M!t h, ToWne!
exticr.-litoirt., d- ,!.je rl:j;;.r!? if,
to reducti-7 in fu i,,c, C;, , ;,I /my'news
sid"".5s
W
20 1.- i,, ,-k-o
108 1 6IL:,- 2 mme 4less
1991 10 Ic! I Imo, U Imore
20 U I I I 1 21 mn,,! 10 more
40 pv, cew "-d-6n., '. "."king
1981 17 3 more 9less
1991 16 kn!. 23 mor. 5mow
2001 18 42 mrre 24 more
Conibined effec! on IIL,Ilth :xid -.oc:.!f ity
c:r)s'.s
3 1. Paraqmph F showt, th.:t C-;)~, !1;,::: Im
hcalth carc rluc :o srnn~;rg
is currunt ly wdhon a ye:,,; i" 29 it is said diaL
sociJ
wcurity payi::~~nzs cminut v;iiii any b Ut 010'
the
pnymcnt~- 11.:It aw not minee of proti:thly uxucd
the
cx1ra pjymew~ thzt w(: nvde.
32. The uffects uf 20 per cent and 40 p, r crilt
mduction; i n cigaiette
sinuking oii -AM,JI IIE!Ath c--rt; ,.-.c! - .
socj FcCUri*,y Cosis are shown in
Table 5 (belr,-.-.,).
TA13LE 5. NET EFF ECT ON HCALTH CARE AND
SOCIAL SEI-'.~R!l Y COSTS
Social security Net chaMes
klea-'rh carp covs Pay-ws in costs
(Tahle 3) (T.Ule 4)
"'.11-0.) IE milli,,W (E millio")
20 fler cent reciticti,.,it in smoking
1981 4 less 4 less 8 1 ess
1991 4 less I more 3 less
2001 2 mo,c 10 no,c 12 more
40 per cent rLnJuclion in smoking
1981 7 less 9 less 16 less
1991 1 IV's 5 more 4 more
2001 5 more 24 more 29 more
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P! rs oF i, !,,.,Luc'rio;., IN i', d~ S%`-K ION
1'1:0i,'UCTIVE :AL
Th.:
Of -XV
m flw pcpula;ior, of
ci 60 y,-;-r Uld ,.~)tfld
,f 10
As
Witit .20p, -,1 -:ducl, .q 7.()f!,) 0.0:t
to,,- i 2 1. U' UU 0.01.1
With 40 1,-:: -r ,,g 1.98 ; 16~00:1 0.06
11-13, 47.000 0.11)
Al-,.~: ali the lo IN! I fjr;;P v4ou;~; 5%!
rniilcs
45 to U4 :;:: arCUp, -112 '.(, CUP intyla
I;L: rrc;:t! th.i, pi, -'la 011 !1 1~ OCL.ount.
Rcdoctium,, fri-I -s. ;.,
36). P;., ~11~;'-. :.", :',at zi i-t.1 of 26 ...
illio, days. 1~,st ;n
Ilw 1,2 ~wie i,; 1C, .~ -s , r,!,.It of sickness
which
auribut..!,' - to 1,; :,. aii i.,,, of Antur
p,vcisuly I pe,
hc!ad of vvoilonu 1 lopt d..: i, "Idde up days
1,17r mail ~mcl ',~ Lf-y
per wom.:,t. On zhe b,:.,.*, of an effecf;-.-P 220
dijits per hvd pur ycar ac
work th;s rvpcc!,cnts an of 0.43 per curit of the
iol"If of
working 0~;ys.
37. It h,-,. Wun asstnw!d Lli3t the 20 ji--! cuot
and 40 rier cefir redut-1 - ions
in sm-)I-ir:g would havc 70 I)C.- =11t ,f their
eftCCt it) n!ducing sic' ixss
absefi-c by 108 1 and M 13121- (--,,nt by 19D ;.
On zhis Liasis:
20 1),.- 3.6 of in '93 1.
5.2 iij.11ir- rfiVs uf -iickoc;s iii 199 1.
40 lie, c,:,,: rxlucii- -Wd 7.3 dfi- 1,.Vs of
m!:-ss in 1981.
10.4 rUy~ of sickness in 199 1.
38. If these amounts arc applied to the tutil
number of working days
as indicated above a proportionate incr ease in
GDP is achieved as follows:
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BATCo document for Province of British Columbia 29
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Per cc,, r
20 per ct:nt fedLICtIUn 1981 0.062
1991 0.09
40 per cent red-icti,-, 19.11 0.127
1991 0.181
39. The (wo set.- of cstimates togethei yive the
following increase in
piod,xtive potential:
Popul.,oc-n Sick -s To rof
Wort absenc effrt aflec:
20 re. cL:,,i ,d~cvo,- 1-:1 0.03 O-QG 0.1
V191 0.08 0.09 0.2
40 ;JCr LWr reduction 1~,ll 0.00 0.13 0.2
1991 0. IU 0.18 0.4
Appiicd to the INO OUP uf E42,000 million, 0.1 per
cent aincunts to
C42 m0liun.
40. Assuming no further n!duczion in cigarpite
smoking. the whole uf
thu "sickness absence CffCLi- would havc been
reaped bv 1991. Them
would be sorne small furti.er population effect
af-Lrr 1091 u:kin-, the
additional productive poteritial up to perhaps 1/4
per cent on the 20 per
cent reduction and Y: per ent on the 40 per cent
reduction by the year
2006.
41. As alrerdy pointf-d ow, the assumed reductions
in smoking would
reduce some health C21m and social secui ity
costs, but others, vould be
increased because the incrt,sed population would
require more services
and benefits, particularly iii old age. Th~- small
net gain dUring the first
15 to 20 year-, would, ho-.-.aver, allow an
increase in resuurces to be
devoted to improving the !iLalth Sefvice or to
increasing GDP in other
forms. Thc~ substantial increase in the tutal of
pensions payments woUld
represent in real resource terms a charge upon the
higher level of GDP
that may be attained.
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BATCo document for Province of BritiSh Columbia 29
October 1999