REEP appoints Dr Estelle Dauchy as a Principal Research Officer
Dr Estelle Dauchy joined REEP on 1 March 2024 as a Principal Research Officer (the research equivalent of a full professor). Estelle brings a lot of experience to the unit. Prior to joining REEP, Estelle worked for the Campaign for Tobacco-free Kids for nine years. She has lived and worked in many countries, including the United States, Russia, China, and France.
We asked her some questions:
Estelle, please tell us about how you became involved in tobacco control research and policy.
In the first few years after I obtained my PhD in economics, specializing in public finance /public economics, 17 years ago, I worked on questions related to international, corporate, and individual taxation. As an applied economist, I have always been fascinated by how we can respond to a range of economic or policy questions with the use of wisely designed, well-targeted databases. I worked for a few years in the private sector helping large multinationals prepare and respond to global or local tax-policy reforms. During this time, I was amazed at how large taxpayers (e.g., large multinationals) were able to anticipate fiscal policy and tax reforms well ahead of everyone else and develop their own research agenda to support or lobby for their own fiscal policy proposals, or amendments to exiting tax laws. I realized that companies that can afford it have the power to influence, interpret and apply the tax code in the way that is most profitable, without breaking the law, sometimes defeating the intent of a policy. The biggest determinants of companies’ ability to anticipate, respond to, or influence tax policy rely on the way the tax code is written, the strength of the tax administration, or the ability for tax officers to enforce tax policy, more than on economic principles.
When I returned to academia in 2010, in China and Russia, I taught economics courses and worked on various research projects on international (legal) tax minimization, and other topics of international tax policy. For various reasons, including family and my desire to apply economics to a good cause and gain better access to government agencies, I decided about eight years ago to apply my skills to the non-profit sector and support fiscal policies that can improve the welfare of populations, especially in low- and middle-income countries (LIMCs). Looking at various options, and aware that a large part of the world relies on indirect taxes, much more than on direct taxes, to secure government revenue, I moved my attention to health taxes. There is a great rationale for government to impose these taxes because, on the one hand, they are a sustainable source of revenue (at least in the medium term and until people stop using addictive substances entirely) and, on the other hand, society largely supports them, because harmful substances represent a huge cost to the economy and the planet. Looking at various options, it became clear to me that tobacco was by far the leading cause of deaths due to non-communicable diseases (NCDs) or complications related to tobacco use. As a public finance economist, it was easy and natural for me to apply my research skills to direct taxation (e.g., excise taxes, sales taxes, consumption, or production taxes) that can help reduce the use of this harmful substance and its derivative products, especially in countries that suffer the most from tobacco-related NCDs.
What advice would you want to give to graduate students who are interested in public health, and specifically tobacco control?
Applying your graduate and post-graduate years to studying and researching in the field of health economics (and especially health taxes, including tobacco taxes) is a choice you will not regret. The field of tobacco economics (and the economics of other products that are harmful to health) is broad and keeps expanding with the emergence of new and innovative vaping and tobacco products like e-cigarettes (e.g., JUUL), heated tobacco products (e.g., IQOS) or nicotine pouches (e.g., Zyn). Adolescents and young adults are increasingly targeted by the tobacco industry and are much more likely to start smoking when tobacco is promoted, easily accessible, and affordable. While there has been tremendous progress in limiting the promotion and availability of cigarettes, new-generation tobacco products have become very popular among youth. However, there is almost no research that evaluates the impacts of these products on health and other aspects of demand and supply. In fact, the existing research shows that they might be a pathway for users to start smoking at an even younger age than if these products were not available. The populations that are subject to aggressive tobacco marketing are also the most vulnerable, in low- and middle-income countries, which already suffer from high levels of poverty and inequality. As a student, if you want to contribute to making this world healthier and wealthier, studying and practicing research in public health and/or health policy would be a good choice. The battle is far from over, unfortunately, as the business of selling products that are addictive (be it tobacco, sugar, drugs, or alcohol) and imposing a death sentence on people that use them is a very lucrative industry that will not disappear anytime soon.
What do you see as the biggest challenges facing tobacco control in the next five to ten years?
Despite the continued decline of tobacco use in most countries, both in the absolute number of persons and in prevalence, the journey is far from over, as tobacco remains the leading cause of NCDs by far. As of today, there are still 1.24 billion adult tobacco users in the world, causing over 8.7 million deaths annually (including from environmental damages due to tobacco) leading to massive economic cost to societies. It is estimated that the economic cost of tobacco use represents at least US$1.85 trillion, that is at least 1.8% of global GDP, and this only includes the total direct healthcare cost to smokers and the cost of lost productivity and morbidity (smokers are less healthy, and more likely to be absent or less effective at work). In comparison countries invest only $1 billion in tobacco control activities globally, representing only a tiny portion of what they collect in tobacco excise tax revenue (estimated at US$ 250 billion each year). Moreover, even though 80% of all tobacco-induced deaths are in LMICs, 95% of the investment in tobacco control is in HICs.
In addition, while the world is making progress in discouraging the use of conventional tobacco (combustible cigarettes), the tobacco industry has already moved to the next level, promoting and constantly developing emerging “non-combustible” vapor products (e.g., e-cigarettes, heated tobacco) that are currently mostly unregulated and uncovered by tobacco-control activities.
Clearly, to this day, the WHO’s MPOWER measure that has had the poorest performance globally is the “R” (raising taxes, reducing affordability). Though the way the WHO evaluates the tax performance “R” is a bit outdated, it still provides a valuable tool for comparing countries over years. It ranks countries on the basis of their total tax-to-price ratio for a pack of most-sold brands (MSB) cigarettes. This ratio is called the “total tax burden”. In 2022, only 41 out of 195 countries covered by the WHO had the highest level of performance (75% or more), and tobacco taxation has been the slowest measure to progress since 2007, with only an additional 5% of the global population covered. The poor performance of the tax measure contrasts with the high performance of other measures. For instance, 103 countries were covered by the highest policy on warning labels, with an additional 52% of the world population covered since 2007.
Next year it will be 20 years after the WHO FCTC came into effect. In your mind, what have been the biggest successes of the FCTC?
The World Health Assembly adopted the WHO FCTC in 2003, which entered into force in 2005. It has been adopted by 183 countries. There is no treaty or public health program that has saved more lives than the FCTC. The foundation and the biggest success of the FCTC is the MPOWER package, adopted in 2008. MPOWER has proven to be an important guide for member states because it is a set of clear, enforceable, and evidence-based policy measures to reduce tobacco use.
Though MPOWER includes a set of six cost-effective and high-impact measures that contribute to reducing tobacco demand, there has been a large variation in their performance and their adoption across countries over the past 15 years. These measures include monitoring tobacco use and prevention (M), protecting people from tobacco smoke (P), offering help for users to quit (O), warning about the dangers of smoking (W), enforcing bans on advertising and promotion (E), and raising taxes on tobacco (R). Countries are evaluated by the WHO biannually on their performance for each measure, with grades ranking from 0 (lowest) to 5 (highest). Today, 5.6 billion persons (7 out of 10 persons) are protected by at least one of these measures, which is more than five times what it was 15 years ago. More than half of all countries covered by the WHO (representing 40% of the world’s population) have implemented at least one of these measures to the highest level of achievement.
Which of your research projects did you enjoy the most, and why?
It is so hard to nail down one project. If I must choose, it would be the work we did in partnership with the Kiev School of Economics in Ukraine in 2021 (just before Covid and the war). At the time the tobacco industry was lobbying hard to support its own tobacco-tax system reform proposal while pushing back another proposal on the taxation of emerging tobacco products (HTPs), backed by tobacco-control advocates. The tobacco industry developed its own model and collected its own data to defend its tax plan. To counter this, we built a multi-year tax simulation model to simulate the impact of the current tax system on health and revenue outcomes over the duration of the current tax plan (7 years) and compared it with our own simulations of the tobacco-industry tax proposal. We wrote reports to the Ministries of Finance and Health, detailing the impacts of both tax plans. Our reports provided strong evidence that the government’s tax plan that was being considered would be most beneficial to the welfare of the country and generate the maximum amount of tax revenue (in present value). We also built a simulation model to defend the tax proposal on heated tobacco products. Our modeling efforts and reports were very well received by members of Parliament in Ukraine. The result of this work was not only that the current 7-year tax plan was saved, but also that the bill, that proposed a new tax on HTPs at the same rates as cigarettes, was adopted. Ukraine was the first country in Europe to tax HTPs at the same level (and using the same tax system) as cigarettes.
What will you be working on at REEP?
This is a tough question because we, researchers, are constantly learning and our research evolves with ongoing needs or opportunities. What is certain is that in the next few years a large part of my work will still be related to tobacco economics, as there is still so much work to be done, and many countries need support. This said, at REEP we are also aware that countries in the region need support to better design other health taxes, including those on alcohol and sugar-sweetened beverages.
Capacity development is key to the development of research-based evidence on tobacco taxation. Countries that lack capacity the most are more likely to be LMICs. Though tobacco-use prevalence is small in Africa compared to the rest of the world, the rapid economic and population growth, coupled with the development of new tobacco products, places the region at risk. Having followed the epidemic in other regions, I hope that that experience will enable me to apply my knowledge and research to development capacity in Africa. As I indicated earlier, tax policy is the measure that has not been implemented as well as it could have been, in most countries. This is in large part due to poor design of tobacco-tax policies and weak administrative capacity. With other economists at REEP, a large part of my work will support better designed and more sustainable tobacco tax policies.
In addition, in recent years I have particularly specialized in emerging nicotine and tobacco products (e-cigarettes, heated tobacco, etc.) and the risk they represent for future generations. Though these products still represent a tiny share of the tobacco market, their growth rate is alarming. Developing the research that can help design tax policies for these products will also be a significant part of my work.
Can you share a bit about yourself outside of work? What hobbies or interests do you have?
I am addicted to swimming and running, which I have done daily since my graduate school years (at least 20 years). A daily contact with water is almost vital for me, and I need a pool wherever I travel. A related passion is scuba diving. I obtained my first diving license prior to the Covid pandemic and additional licenses since then. I have dived at least 50 times to this day (I know this number may seem small for advanced divers, including me J), and on three continents (not yet in Africa). To me the deep sea is magical; there is no better way to escape our daily lives.
I am also passionate about traveling. Thanks to my career I have been able to visit and work in many countries on all continents (except Antarctica). I love discovering new cultures, and meeting new people.
I am also very attracted to Christian Science, a religion that teaches how to heal metaphysically through prayer. I have taken a class in Christian Science and have practiced it almost all my life to heal myself and pray for others and the world.