After a dip in number of smokers, another increase looms

A few months ago, a 49-year-old office worker was referred to our clinic by his family physician for chest and back pains and shortness of breath. This was accompanied by a dry, hacking cough. He also complained of left shoulder pains, radiating to the inner side of the left arm and hand.

His neck appeared swollen, with engorged neck veins on the left side. His face was puffy. His physician thought he might be suffering from heart failure, and referred him to us.

He was a heavy smoker until he started feeling really bad from the symptoms. He had been consuming more than a pack a day for the last 30 years. He estimated he must have lost more than 20 pounds in the last three months since his symptoms started.

Although his heart was stressed—more than 100 beats per minute—its sounds were good and there was no strong indication that he was suffering from heart failure.

In the chest Xray, his left upper lung field was all white, with the upper lung borders already indistinguishable because of a big tumor.

Further work-ups, including bronchoscopy (insertion of a tube through the airways) with a biopsy, confirmed an advanced stage of lung cancer.

The lung specialist we referred him to presented the limited options he had for his late-stage cancer. He opted to forego all potent cancer therapies and just have palliative treatment.

Leading cause of death

Lung cancer remains one of the leading causes of cancer deaths in the Philippines, killing nearly 10,000 yearly. Smoking is the No. 1 risk factor identified in patients with lung cancer.

If we include those dying from other smoking-related illnesses such as chronic obstructive lung disease, heart attack, stroke and severe asthma, the number of deaths that could be attributed to smoking could be staggering.

Before the passage of the Sin Tax Law, there was an estimated 17 million active smokers in the country. If we include the number of passive or second-hand smokers (spouses, children, regular companions of smokers) who face equal risks of cigarette smoking, the figures will easily double.

In 2012, the Sin Tax Law was finally signed by then President Benigno Aquino III, which increased taxes on tobacco and alcohol. More than simply being a measure to raise more revenues, it lowered the number of smokers dramatically on its first year—from 17 million in 2012 to 14 million in 2013.

This would translate to tens of thousands with less lung cancer, chronic obstructive lung disease and other smoking-related illnesses.

The health advocate group of Dr. Tony Leachon and Dr. Tony Dans from the University of the Philippines estimates that around 70,000 deaths have been prevented from 2013 to 2015 with the noted decline in the number of smokers.

More than P300 billion additional revenues have been collected in four years, which went to fund better healthcare service delivery by the Department of Health, with an almost 100-percent coverage by PhilHealth, particularly for the lowest two quintiles of society. Part of it also went to the tobacco farmers.

Operational funds of big government hospitals like the Philippine General Hospital have been significantly increased, and indigent patients are grateful for the free laboratory examinations and medicines, including blood transfusions, that they’re now getting.


However, the effectiveness of the Sin Tax Law as a health measure appeared to be short-lived. Since 2015, the decline in the number of smokers has reached a plateau.

Smokers have probably found other things to give up just so they could maintain their vice.

Citing estimates based on the National Nutrition and Health Survey, Dr. Leachon and Dr. Dans warn that “there will be about 200,000 new smokers in 2018 and every year thereafter.”

Monitoring of actual sales of cigarettes confirms this alarming trend. Following the sharp decline in sales in 2013 and 2014, sales started to pick up again in 2015. It seems cigarette manufacturers are singing, “Happy days are here again!”

There is a pending bill authored by Senator Manny Pacquiao (Senate Bill No. 1599, or An Act Raising the Excise Tax on Tobacco Products and Amending for the Purpose Pertinent Sections of the National Internal Revenue Code, as Amended) which proposes higher excise tax rates for alcohol and tobacco products.

It also signals the move toward a unitary rate system and indexes the tax rate to inflation by increasing it gradually to 4 percent annually.

Although the revenue-generating objective is undeniable, it being a health measure and a deterrent to potential smokers
—and a good reason for current smokers to kick the habit—is the more important goal.

It will be another fierce battle to get the amended law passed, and Dr. Dans is asking everyone’s help. If senators see civil society supporting the bill, they may submit to the wish of the people, despite the strong lobby of cigarette manufacturers and other tobacco stakeholders.

Dr. Dans and his group have designed a “health warrior frame” which supporters can use for their Facebook profile photo. One can join the Health Warriors advocacy in three simple steps:

1) Go to your profile picrure and click “Edit.”

2) Search for and use the “I’m a Health Warrior” frame.

3) Click “use,” and you already are a health warrior.

The original Sin Tax bill languished in Congress for more than a decade before it saw the light of day. It was the tenacity and perseverance of various health advocates that put the pressure on legislators to finally pass it.

When it’s an advocacy that can save tens of thousands of lives and improve healthcare delivery for Filipinos, it’s much sweeter the second time around.