Annals of Health Law
STRATEGY AGAINST SMOKING
it might force people of low socioeconomic status to comply, as they cannot
afford to forgo the additional income. While the mechanism shall, and
can, 148 be structured in a way to avoid coercion and discrimination as far as
possible, the intended modification of behavior requires a justification.
The main reason for the state trying to incentivize people to help
themselves is the responsibility for the welfare of its citizens. Evidently,
smoking poses a significant threat to smokers’ health, which they seem
incapable of guarding themselves against under the current tobacco control
strategies as shown by the percentage of failed cessation attempts149 and the
initiation rates among youths. People of low socioeconomic status and
especially adolescents, who are even more vulnerable, are in particular need
of protection and are affected disproportionately. 150 Hence, it can very well
be considered the state’s obligation to take further action to protect its
citizens. The state also seems in the best position to administer an
incentivizing mechanism in an impartial, transparent, and non-coercive or
discriminating way. Another important aspect is the fact that the intensity of
the paternalistic interference with people’s private way of life is very low,
given that one can simply decide not to participate in the incentivizing
mechanism and then will not be affected at all.
One might question whether the state’s intervention is desirable from an
economical perspective. It is evident that smoking causes considerable
intangible costs, namely the pain and suffering of smokers, secondhand
smokers, and their affiliates, thereby creating a strong moral and ethical
responsibility to intervene. However, these intangible costs play no role in
an economic assessment of whether smoking is disadvantageous. From a
purely economic point of view, a model that provides economic incentives
for non-smoking is favorable only if it leads to a more efficient allocation of
resources compared to the existing system. This depends on whether the
above-mentioned151 tobacco-related expenditures outweigh the program’s
benefits. Instead of dealing with this highly controversial question152 that –
due to its complexity and considerable dependency on estimates – seems
virtually impossible to assess, this article looks at the government’s
smoking-related health expenditures as “direct” costs of smoking and
presume that tobacco control strategies are economically desirable.
One has to consider that in the long run a respective investment would
help to overcome tobacco use and thereby not only decrease but almost
See supra Part III.
See supra Part II. B.
See supra Introduction.
See supra Part I. A.