The Equity Benchmark: How Should We Measure Whether Nicotine Policy Is Fair?
Most nicotine policies are evaluated by their effect on population averages—smoking prevalence, quit rates. But policies can reduce average prevalence while widening disparities. An equity benchmark would evaluate policies by their effect on the most disadvantaged.
A cigarette tax that reduces smoking prevalence by 2% looks like a policy success. But if the tax reduces smoking by 4% among the affluent and 0% among the poor—because the poor are more addicted, have less access to cessation support, and can't afford the alternatives—the tax has increased the socioeconomic disparity in smoking even as it reduced the population average. **The equity benchmark evaluates nicotine policy not by its effect on the average but by its effect on the most disadvantaged. A policy that reduces inequality is better than a policy that reduces prevalence—because health equity, not just population health, is the goal.**
**Applying the equity benchmark would change which policies are prioritized.** Flavor bans: evaluated by their effect on low-income smokers who depend on flavored products to stay off cigarettes, not just by their effect on youth initiation. Tax increases: evaluated by their effect on the poor smokers who pay the tax, not just by the aggregate reduction in consumption. Cessation support: directed at the populations with the highest smoking rates and the least access to care. **The equity benchmark is a tool for ensuring that nicotine policy serves the people it has left behind—not just the people who are easiest to reach.**
