Born out of crisis and largely overshadowed by its revenue-raising potential for the schools, the proposed $2-per-pack cigarette tax would be among the biggest boons to the health of Philadelphians in decades.
Years of research show that a price increase of this magnitude would translate to about a 13 percent reduction in adult smoking rates, probably more for youths. Those who continue to smoke would do so less. Hospitalizations would decline, as would health costs, much of which is paid by the public because so many city residents are uninsured or have government coverage.
"It would probably be the single most important thing to promote the health of the public in the city's history, other than clean water," said David B. Nash, dean of the Jefferson School of Population Health.
The tax passed the Senate Finance Committee in Harrisburg on Tuesday and will likely come up for debate in Appropriations this week. It faces a harder time in the House, with some Republicans balking at a move that could be seen as violating pledges not to raise taxes.
Mayor Nutter proposed the tax, projected to raise $89 million in its first year, as part of a package to close the city School District's $304 million deficit.
A $2-per-pack excise tax on Jan. 1 would catapult the city into 10th place in rankings of combined state and local taxes, according to the Campaign for Tobacco-Free Kids.
The rankings count all of New York state ($4.35 per pack state tax, compared with Pennsylvania's $1.60 and New Jersey's $2.70) as one jurisdiction; New York City adds an additional $1.50, making it the highest combination in the United States.
Still, cigarette taxes here are low compared with many other developed countries.
"I just came back from New Zealand, and their taxes are about $10 a pack," said Stanton Glantz, a professor of medicine at the University of California, San Francisco.
"There is very consistent evidence from all over the world that when you raise cigarette prices 10 percent, consumption drops 4 percent," said Glantz, who has led scores of studies into the effects of tobacco and how to reduce them. (The city proposal would raise the $6 average price 34 percent.)
Many researchers believe that increases have up to twice the impact on people under 18, who have less money, although Glantz would say only that the effect was similar.
In an analysis last year of 45 studies that looked at what follows smoking declines, he and Crystal E. Tan found that hospitalizations from heart attacks fell 17 percent, with greater drops for stroke, asthma, and other conditions in the years after comprehensive smoke-free laws.
Glantz said smoking reductions from price rises would be similar, with hospital admissions "dropping immediately."
Philadelphia's adult smoking rate has fallen since 2008, but rises in prior years mean it was no lower in 2012 than the 23 percent to 26 percent range of a decade ago, several points above the national average.
Efforts aimed at youth smoking - greater enforcement of laws against underage sales, and smoking bans at pools, playgrounds, and rec centers - have met with more long-term success: 9.6 percent of high school students said they had smoked in the last 30 days in 2011, down from 15.8 percent in 2001. That is below the national average, as in most big cities, partly since African Americans smoke less than whites in high school, but often more as adults.
The city Health Department estimates that 2,100 residents die of tobacco-related causes a year, 16 percent of all deaths, and an additional 40,000 have illnesses linked to smoking, like asthma, heart disease, and various cancers. It says a $2 tax, with continued tobacco control, would lead about 40,000 adult smokers and 1,000 to 2,000 youths to quit.
"It also does a great job of preventing people from starting in the first place," said Giridhar Mallya, the Health Department's director of policy.
Doris Leisch, 56, who was smoking outside her Center City office Tuesday, said she never would have started at age 12 if the tax had been anything like that.
But the lawyer from East Falls, who has tried to quit "many, many, many times," said she was "ambivalent" about a $2 tax, because on the one hand "people shouldn't smoke," while on the other, "it's an easy target."
David Sutton, a spokesman for Altria Group Inc., agreed. He also said revenue projections for cigarette taxes often were low because of rises in illegal sales and buying elsewhere.
With a $2 tax, he said, an adult smoker "could save $1,059 a year by going to Delaware or elsewhere in Pennsylvania."
Health Commissioner Donald F. Schwarz said the city's projected revenue "includes both reduction in smoking and some avoidance of the tax."
Nutter's original proposal would have diverted $2 million a year for smoking cessation, but Council opted to send all money to the schools.
That change worries Nash, the dean at Jefferson, who said research showed that smoking-cessation lines could be overwhelmed after price increases, as smokers try to quit and go through withdrawal. The city, through the state, provides free telephone coaching and nicotine-replacement therapy via 1-800-QUIT-NOW.
More than 400 localities impose their own taxes.
Highest combined state, local taxes*
1. New York City ($1.50)
+ N.Y. state ($4.35) . . . $5.85
2. Chicago ($0.68) + Cook County
($3) + Ill. ($1.98) . . . $5.66
3. Evanston, Ill. ($0.50)** . . . $5.48
4. Cicero, Ill. ($0.16)** . . . $5.14
5. Rosemont, Ill. ($0.05)** . . . $5.03
6. Rest of Cook County ($3)
+ Ill. ($1.98) . . . $4.98
7. Rest of New York state ($4.35) . . . $4.35
8. Bethel, Ala. ($2.21) + Ala. ($2) . . . $4.21
9. Anchorage ($2.206) + Ala. ($2) . . . $4.206
10. Philadelphia ($2 proposed)
+ Pa. ($1.60) . . . $3.60
State taxes in the region
There currently are no local taxes in the area.
New Jersey ($2.70) . . . $2.70
Pennsylvania ($1.60) . . . $1.60
Delaware ($1.60) . . . $1.60
* Excise taxes; excludes state and local sales taxes, which are typically low. (Pennsylvania's 6 percent sales tax and Philadelphia's 2 percent add about 44 cents combined per pack of cigarettes..)
** Plus Cook County ($3) and Ill. ($1.98).
SOURCE: Campaign for Tobacco-Free Kids