# Impact of waterpipe tobacco taxation on consumption, government revenue and premature deaths averted in Jordan, Lebanon and Palestine: a simulation study

## TL;DR

This study shows that increasing taxes on waterpipe tobacco in Jordan, Lebanon, and Palestine can reduce smoking, boost government revenue, and prevent many premature deaths.

## Contribution

The study provides new simulation-based evidence on the impact of waterpipe tobacco taxation in three Eastern Mediterranean countries.

## Key findings

- Waterpipe smoking decreased by 32.4% in Jordan, 71.0% in Lebanon, and 16.3% in Palestine after tax increases.
- Government revenue increased by $126.3 million in Jordan, $53.8 million in Lebanon, and $162.4 million in Palestine.
- Approximately 162,000 to 1,000,000 premature deaths were averted annually across the three countries.

## Abstract

Despite the high prevalence of waterpipe tobacco smoking in the Eastern Mediterranean region, evidence supporting its fiscal measures is limited. We modelled the impact of waterpipe tobacco-specific excise taxes on consumption, government revenue and premature deaths averted in Jordan, Lebanon and Palestine.

We developed a simulation model using country-specific and market share-specific price, consumption and price elasticity data from WHO, UN Comtrade and nationally representative surveys. We modelled increases to specific excise taxes to meet a 35.9% tax burden on 20 g of waterpipe tobacco in Lebanon and Jordan, in line with the global average, and to double government revenues from excise duties in Palestine, which has surpassed this average.

Specific excise tax was raised by $1.14 ($0.18–$1.32) in Jordan, $2.41 ($0.03–$2.44) in Lebanon (alongside removal of ad valorem taxes) and $2.39 ($1.72–$4.11) in Palestine per 20 g of waterpipe tobacco. Government revenue increased by $126.3 million in Jordan, $53.8 million in Lebanon and $162.4 million in Palestine while waterpipes smoked decreased by 32.4% in Jordan, 71.0% in Lebanon and 16.3% in Palestine. The corresponding numbers of premature deaths averted annually were approximately 162 000; 1 000 000; and 52 000.

Increases in waterpipe tobacco-specific excise taxes substantially reduce smoking and increase government revenue and averted premature deaths in Jordan, Lebanon and Palestine. This has positive implications for both public health and financing and should be considered a policy priority.