Cost-Benefit-Analysis of No-smoking Policy Instruments---Case Study of Beijing

DAI Yixin[1] XUE Lan[1] HU Yinglian[2]

[1] School of Public Policy & Management, Tsinghua University[2] Department of Social & Cultural Studies, Chinese Academy of G

overnance (CAG)

WHO WHO Framework Convention on Tobacco Framework Convention on Tobacco Control (FCTC) Control (FCTC) 8.2

• This is the responsibility clearly given by the WHO Framework Convention on Tobacco Control (FCTC) to all parties which should actively take measures and reinforce effective legislation, administrative regulations within jurisdiction of courts, so as to prevent from exposure to second-hand smoke at indoor working places, public vehicles and indoor public places, as well as other pubic places at a appropriate time.

Tobacco Control Work by Chinese Government

• On Nov.10, 2003, Chinese government signed the Convention officially

• On August 28, 2005, The Convention was adopted by Standing Committee of the 10th National People's Congress

• In recent years, under joint endeavor by different regions, relevant departments and the whole society, China strengthen its effort in tobacco control increasingly. Tobacco control theories, legislation, and policy systems have been established and improved persistently, hence guarantee a stable tobacco control status and a favorable turn.

Non-smoking Practice at Public Places in Beijing

• On Dec.21, 1995, the Provision on No-smoking at Public Places in Beijing (here-in-after referred as Provision) was adopted by standing committee of the 10th People’s Congress of Beijing Municipality

• On March 24, 2008, Special Provision on No-smoking Scale of Public Places in Beijing Municipality was adopted by the 2nd meeting of standing committee by Beijing Municipal Government (here-in-after referred as Special Provision)

I. Key Topic

• How to assess effectiveness of no-smoking policy implementation at public places in Beijing?

II. Theory Framework

• （ 1 ） Effectiveness assessment of provision implementation

• （ 2 ） Efficiency assessment of provision implementation

• （ 3 ） Application range assessment of provision implementation

Table 1 Assessment Indexes System of No-smoking Efficiency at Public Places

Primary Index Secondary Index Tertiary Index

Cost

Direct cost of obliged institutions

Daily management fee

facilities reform and maintenance fee

Advocacy cost

reviewer allowances

Direct cost of regulated implementing

institutions

allocated funds

self-funded funds

Indirect cost

tobacco sales revenue loss brought by smoking ban

tariff loss brought by smoking ban

Profit loss of commercial places brought by smoking ban

BenefitsHealth benefit

medical benefits

life benefits

Safety benefit Reducing loss of fire due to reduce of smoking

III. Study Method • Sampling Areas

– 2 urban districts, 2 suburban districts and 1 outer suburban district• Sampling Targets

– （ 1 ） Public places related to tobacco control work – （ 2 ） Legislation executive body– （ 3 ） defined obliger by regulation

• Subjects– Provision and Special Provision

• Methods– Cost-Benefit Analysis combined with multi-social scientific study methods including stati

stic analysis, expert opinion analysis • First-hand data

– Questionnaire, including Questionnaire to obliged no-smoke institutions (n=1244), Questionnaire to the public (n=102), Questionnaire to provision applicable instructions (n=21)

• Second-hand data– Literatures home and abroad, literature of law and regulations, Beijing Social & Economi

c Statistics Yearbook (2005~2008)

Figure 1 Diagram of Distribution Proportion of Sampled Institution

IV. Assessment Findings

• 4.1 Efficiency Assessment• 4.2 Effectiveness Assessment• 4.3 Scope Assessment

4.1 Efficiency Assessment

• Significant achievements of tobacco control – Smoking prevalence among population aged 15 and above decreased

to 26.9% of 2004 from 34.5% of 1997. – The no-smoke prevalence at healthcare institutions, kindergartens,

middle and primary schools, store, financial places, and post office reached 90% and above in 2008.

• Difficulties in tobacco control work– More than 50% restaurants and internet bars didn’t set up distinct

smoking area or have no idea of whether they set up smoking area or not.

– Only 33% obliged institutions set up obvious signs for No-smoking– Only 23.4% institutions realized complete quarantine between

smoking area and no-smoking area– In house no smoking difficulties usually concentrated at elevator room

and rest rooms.

4.1 Efficiency Assessment (continued)

• Advocacy format adopted by obliged institutions -Compared efficiency of different advocacy formats,

mass media campaigns, including no-smoking advertisement, no-smoking bulletin board, dissemination of no-smoking brochures, are of highest efficiency, while internal meeting and website propaganda of related information achieved little effects.

• Inspective behaviors of executive body -restaurant is the most important and difficult places

for tobacco control, in particular to restaurants of grade C and D.

Figure 2 Relationship between Expenditure and Effect of Different Advocacy Formats

Table 2 Top 5 Categories of Highest Random Inspection Frequency at Primary Level

Public PlacesRandom

InspectionFrequencies

RankingOf

Frequencies

Amount of Inspectors

Ranking Of

Inspectors

Restaurants of grade C and

D5.56 1 17.56 2

Nursery/kindergarte

n4.25 2 8.11 15

Hotel 4.05 3 9.28 12

Restaurants of grade A and

B3.83 4 12.39 5

Guesthouse 3.64 5 11.75 6

Table 3 Top 5 Institutions with Most Law Enforcement Inspectors at Primary Level

Public Places Random

InspectionFrequencies

Ranking of

Frequencies

Amount of

Inspectors

Ranking Of

Inspectors

Classroom of commercial

training1.5 18 18.2 1

Restaurants of grade C and

D5.56 1 17.56 2

Concert Hall 0.86 26 13.2 3

Teaching Area in Campus 1.3 20 12.5 4

Restaurants of grade A and

B3.83 4 12.39 5

4.2 Effectiveness Assessment• Though assessment of cost of fulfilling obligations by obliged i

nstitutions, we found – （ 1 ） Viewing in aspect of mean cost of all kinds of obliged institutio

ns, the absolute value was not high. Calculated according to total sample amount, annual expenditure of each institutions was less than 10, 000 Yuan.

– （ 2 ） Viewing in aspect of expenditure structure, designating inspector and redecorating places accounted for the most proportion of no-smoking cost, in particular to employing part-time inspectors.

– （ 3 ） Viewing in aspect of no-smoking expenditure of different institutions, administrative cost of complete no-smoking institutions was obviously higher than that of other institutions, while the in house no-smoking institutions of the least.

Table 4 No-smoking Cost Calculation Form of Different Obliged Institutions

Cost & Institution Category

Gross Daily

Administrative Cost

(Yuan)

Designating Inspector and Executing Function Cost Redecor

ation and

Maintenance Cost

(Yuan)

In House Advocacy

& Education

Cost (Yuan)

Total Mean Cost

(Yuan)

Proportion

Relationship

Full-time Inspector (Yuan)

Part-time Inspector

(Yuan)

Completely No-smoking Institutions

1921.61 4896.57 8979.19 7064.98 837.91 23700.26 21

Partially No-smoking

Institutions1181.4 2954.84 2287.14 947.98 759.62 8130.98 7

In house 1644.87 731.39 2294 2310.19 344.68 7325.13 6

No-smoking Institutions 150 5 810 114.29 75 1154.29 1

Table 5 No-smoking Cost Calculation Form of Different Obliged Institutions

Code of Institutions Gross Daily

Administrative Cost (Yuan)

Designating Inspector and Executing Function Cost Redecoration and

Maintenance Cost (Yuan)

In House Advocacy & Education Cost

(Yuan)

Total Mean Cost (Yuan)Full-time

Inspector (Yuan)

Part-time Inspector

(Yuan)

Medical Institutions of Grade A 1010.00 125.57 2342.17 719.05 1932.00 6128.79

Nursery and Kindergarten of Grade B 604.12 0.00 1518.75 400.59 401.54 2924.99

Middle and Primary School of Grade C 1406.30 141.38 965.52 2170.6 848.89 5532.77

D Higher Education Colleges and other educational and training

institutions3500.00 0.00 0.00 2000.00 200.00 5700.00

E Recreation Places 663.64 0.00 162.58 932.27 703.06 2461.55

F Shops, Financial and Postal Offices 1499.10 1550.68 3582.12 876.69 743.08 7720.38

G Public Transportation Vehicles 480.00 1287.50 125.00 1460.00 220.00 3572.50

H Historic Preservations Open to Society 850.00 0.00 576.00 3100.00 300.00 4826.00

I Fitness Gyms 0.00 782.61 864.70 657.86 583.33 3264.69

J Restaurants and Internet Bars 671.22 366.76 187.70 863.19 637.20 2726.06

K Entertainment and Amusement Places 366.67 533.33 640.00 1175.00 280.00 2995.00

L Commercial Places providing accommodation services 2322.20 714.20 1401.97 1100.00 1026.63 6564.99

M Public Institutions 1644.87 88.36 384.90 771.73 344.68 3234.54

Cost of No-smoking Executing Body

• Major funds and expenditure is supervised by Municipal Health Promotion Committees. There was distinct deficits in funds and expenditure of county level and below.

• The total cost of executing body is far below than obliged institutions’ obliged cost.

Indirect Cost of Execution of Regulations

• Tobacco sales revenue loss brought by smoking ban

• Taxation loss brought by smoking ban• Profit loss of commercial places brought by

smoking ban

Heath Benefits

• Health benefits for smokers and passive smokers (namely, people who exposed to second-hand smoke) – Lung cancer – Cardiac diseases – Respiratory diseases

Table 6 Social Health Benefits (Yuan) Brought by Smoking Ban

Disease Category

Lung Cancer Cardiac Disease Respiratory Disease

Reduced deaths

362~410 911~931 441~490

Mean medical cost

40,000~100,000 40,000~100,000 40000~100000

Reduced medical expenditure

14,472,317~41,044,087

36,420,213~93,139,319

17,650,199~49,014,819

Per capita death loss

337,283~337,283 337,283~337,283 337,283~337,283

Reduced death loss

122,031,751~138,434,834

307,098,197~314,143,327

148,827,912~165,318,779

Total health benefits

136,504,068~179,478,921

343,518,409~07,282,645

166,478,110~14,333,598

Economic Effectiveness Manifested by Execution of Provision

• According on calculation by cost-benefit analysis, although Beijing Municipality expanded scope and input for execution of Provision, the derived benefits were higher than cost. The social net benefits was between 46,960,213 Yuan and162,776,294 Yuan in 2008.

Cost of Obliged

Institutions (Yuan)

Cost of Executing

Body (Yuan)

Indirect Cost (Yuan)

Total Cost (Yuan)

599,551,324 6,576,110 0 606,127,434~644,905,960

Health Benefits (Yuan)

Safety Benefits (Yuan)

Total Revenue (Yuan)

646,500,587~801,095,164 10950 646,511,537~801,

106,144

4.3 Scope Assessment

• Studies show that majority of Beijing citizens possess similar expectations defined by Convention– Over 50% general publics consent with contents defined

by Provision, involving complete no-smoking at public places, in particular to public transportation vehicles, taxies, internet bars, and inside institutions.

– Over 80% above mentioned general publics are more willing to go to public places after the scope of no-smoking been enlarged to overall no-smoking. Those who is more willing to go to entertainment places were less, of 62%.

V. Main Conclusion and Policy Suggestions

• Straighten out relationships between rights and obligations of each parties

• Adjust and arrange scope and schedule of no-smoking at public places, according to assignment of rights and obligations

• Develop tools for enforcement, and improve efficiency so as to achieve the goal

Requirements for Enforcement Differ upon Different Place Categories

Figure 3 Analysis and Thoughts about Supervision Model of Enforcement

Suggestions • Re-clarification of rights and obligations: explicitly inform no-smoking obligations to obliged

institutions and clarify legal responsibility its borne, in accordance with different categories of public places .

• Supervise formulation of corresponding internal no-smoking management plan by obliged institutions within jurisdictional area, and inspect the implementation of no-smoking responsibility have been applied to specific staff .

• Adjust no-smoking schedule according to public places of different categories: allow for certain smoking rate to public places which aim at satisfying personal demands in short-term. As for these places, internal no-smoking regime should explicitly set up plan for smoking area and smoking room, and methods for examination and maintenance.

• Adjust enforcement ways flexibly : law enforcement agencies at primary level, such as District Office, should examine implementation work of plan by obliged institutions within jurisdictional area.

• Further develop rating work of no-smoking at public places, connect no-smoking work of each institutions and public places together with sanitation inspection, and update ranks periodically according to no-smoking works of obliged institutions. At the same time, advocate no-smoking ranking of each institution to the public, so as to improve public awareness of meaning of different ranking level. Places which done bad no-smoking work shall be categorized into lower sanitation grade, and shall be upgraded when its no-smoking work return to normal.

• Commend public places which is to satisfy individual demands for their excellent work of implementing no-smoking obligations, in particular to restaurants, and establish their public image. On the other hand, launch report system, so as to carry out supervision by peer competitor and consumers.

Thank you