菸品貿易自由化與菸害防制政策對吸菸率及菸品消費量的影響

Abstract

有鑑於貿易與健康間衝擊之爭議不斷發生，而針對貿易與健康此類跨領域議題之相關研究至今仍少見，本研究以公共衛生的觀點切入，並提供量性與質性結果作為佐證，以補足目前學界針對貿易與健康議題研究之不足之處。 透過檢視貿易與健康關係的歷史演進、貿易自由化影響健康之機制，以及菸品貿易與全球菸害防制體系之相關文獻收集與探討，深知全球貿易自由化的範圍持續擴大，對於健康的影響已是不可抹滅的事實，除了正面影響以外，貿易自由化對於健康的負面影響不亞於正面影響，且是導致非傳染性疾病發生率上升的主要原因之一。有鑑於此，本研究欲探討：(1)全球菸品貿易自由化之趨勢及其與吸菸率間的關係、(2)全球菸害防制政策（如FCTC）對於貿易協定內容及落實的影響及其對於菸品貿易的影響，以及(3)菸商干擾對於全球各國FCTC落實程度間的關聯性。 本研究主要有三點重要發現：第一，全球菸品貿易自由化透過菸品關稅持續降低以及簽訂貿易協定的數量之上升逐步擴大中，其中，隨著關稅逐年降低，大部分國家的吸菸率亦呈現下降趨勢，僅有中低收入國家的男性及女性吸菸率及低收入國家的男性吸菸率呈現上升的趨勢。第二，FCTC的落實或許是阻擋吸菸率上升的原因之一；隨著時間，有越來越多貿易協定納入FCTC相關內容，且將FCTC納入貿易協定內容中的締約國間的菸品貿易進出口量較未納入FCTC的締約國間的菸品貿易進出口量要來得少，但目前僅限於歐盟所簽訂的貿易協定之結果。第三，菸商干擾仍被視為是促進菸品貿易自由化的背後推手，儘管本研究未能呈現菸商干擾與FCTC落實程度間的關聯性，可能原因有二：第一，是因為目前採用的2020年的FCTC落實程度為單年的資料，較難以看出長期變化的趨勢、第二，由於FCTC的落實已改變全球菸草控制政策環境，現今受到關注的菸草議題並未在FCTC落實程度的項目中。 最後，有鑑於目前國內外貿易與健康相關研究仍為數不多，且此類議題的量性研究也仍在初期發展中，建議未來仍需有更多研究投入此領域，可更進一步結合貿易與健康間的資料進行分析，或有助於減緩貿易與健康間衝突，並促進兩者間的一致性。

In light of the ongoing controversies surrounding the impact between trade and health, and considering the limited research on interdisciplinary issues such as trade and health, this study adopts a public health perspective. It provides both quantitative and qualitative results as evidence to address the current shortcomings in academic research on trade and health issues.

By examining the historical evolution of the relationship between trade and health, the mechanisms through which trade liberalization affects health, and reviewing relevant literature on tobacco trade and the global tobacco control system, it is evident that the expanding scope of global trade liberalization has undeniable implications for health. Beyond positive effects, the negative impact of trade liberalization on health is substantial and contributes significantly to the rise in non-communicable diseases. In light of this, the study aims to explore: (1) the trends in global tobacco trade liberalization and its relationship with smoking rates, (2) the impact of global tobacco control policies (such as FCTC) on the content and implementation of trade agreements and their influence on tobacco trade, and (3) the correlation between tobacco industry interference and the level of FCTC implementation across different countries.

The study reveals three key findings: First, global tobacco trade liberalization is gradually expanding, with decreasing tobacco tariffs and an increasing number of signed trade agreements. As tariffs decrease, smoking rates in most countries also decline, except for an upward trend in smoking rates among males and females in low-middle-income countries and males in low-income countries. Second, the implementation of FCTC may be a contributing factor in preventing the rise in smoking rates. Over time, more trade agreements incorporate FCTC-related content, and the volume of tobacco trade between FCTC-contracting countries is lower than that between non-FCTC-contracting countries, although this is currently limited to trade agreements signed by the European Union. Third, tobacco industry interference is still considered a driving force behind tobacco trade liberalization. While this study does not establish a clear correlation between tobacco industry interference and the level of FCTC implementation, potential reasons include the use of 2020 data for FCTC implementation, which may not capture long-term trends, and the fact that FCTC implementation has already changed the global tobacco control policy environment, with current tobacco issues not covered in the FCTC implementation indicators.

In conclusion, given the limited number of domestic and international studies on trade and health, especially in the quantitative research domain, it is recommended that future research invest more in this field. Further integration of data on trade and health for analysis could contribute to mitigating conflicts between trade and health and promoting greater consistency between the two.