Tobacco in the developing world

The World Health Organization (WHO) estimates that approximately 5 million people die each year worldwide from tobacco-related illnesses. If current trends continue, this figure will rise to about 10 million per year by 2025. [1]

Prevalence and consumption

Tobacco consumption has fallen over the past 20 years in most high-income countries such as Britain, Canada, the United States, Australia and most northern European countries.  Demand is projected to continue to fall, dropping to 2.05 million tonnes in 2010. This is 10 percent lower than the 1998 figure. By contrast, tobacco consumption rates in the developing countries are expected to increase to 5.09 million tonnes - a 1.7 percent growth rate between 1998 and 2010. About 80 percent of this increase in demand is expected to be in the Far East, particularly China. [2]

Worldwide, approximately 1.3 billion people smoke cigarettes or other tobacco products: almost one billion men and 250 million women. [3]

Globally, tobacco use is significantly higher amongst men (47%) than it is amongst women (12%). [4]  In most developing nations this is partly due to cultural traditions, although the situation is changing and more women are taking up smoking in response to the marketing tactics of the tobacco industry. [5]  In developed countries 35% of men and 22% of women smoke, while in developing countries 50% of men and 9% of women are smokers. [6]  Women in developing countries are clearly a key potential market for the tobacco industry. Recent increases in female smoking prevalence have been reported from Cambodia, Malaysia and Bangladesh. [4]

The spread of smoking to the developing world

The large multinational tobacco companies based in Britain and the USA are largely responsible for the spread of the smoking habit to developing countries.

The entry of a multi-national tobacco company into a new market is typically accompanied by sophisticated and effective advertising and promotional activities, often leading national tobacco companies to step up their marketing activities in response.  As a result, overall expenditure on advertising increases with a corresponding rise in tobacco consumption and huge impact on human health. 

In July 2004, British American Tobacco (BAT) announced plans to manufacture cigarettes in China, although this is subject to confirmation by the Chinese authorities.  If it goes ahead,  the deal with local partner, China Eastern Investments, will involve building an £800million factory with a capacity of 100bn a year. [7]

Figures for 1998 reveal that 4% of Chinese women smoke, up from 3% in 1991. [8], [9]  For BAT, persuading more Chinese women to smoke is a huge marketing opportunity. Even as long ago as 1915 BAT had business interests in China and was instrumental in encouraging the Chinese people to smoke. Within 30 years, China's annual consumption of cigarettes rose from a negligible number to 100 billion [9] and by 1994 it stood at 1,646 billion.

Following World War II, the USA began exporting tobacco under the "Food for Peace" programme.  In the first 25 years of the programme, the US exported almost $1 billion worth of tobacco. This project exposed developing countries to Western-style cigarettes. By the late 1960s, the leading US and UK companies were selling to dozens of countries. [10]

During the 1980s, international sales rose dramatically.  In 1994, 220 billion US-manufactured cigarettes were shipped abroad, a 55% increase since 1989.  In the year 2000 the US exported 148,261 million cigarettes. [11]

Asian countries in particular have been the target of US tobacco companies. During the 1980s, the US Government threatened trade sanctions against Japan, Taiwan, South Korea and Thailand unless they opened up their markets to American cigarettes.

All four countries gave in to US pressure but Thailand later won the right to ban cigarette advertising under a ruling by the General Agreement on Tariffs and Trade (GATT) which ruled that countries could give "priority to human health over trade liberalisation".

Since the lifting of import restrictions, the Asian countries have witnessed a dramatic increase in smoking: South Korea’s cigarette consumption rose from 68,000 tonnes in 1980-82 to 101,000 tonnes in 1999, whilst consumption in Thailand over the same period grew from 31,000 tonnes to 40,000 tonnes. [12]

Economic impact

Although tobacco is grown in more than 100 countries, just five countries –  China, USA,  India, Brazil and Turkey – account for almost two-thirds of global production.  Only two countries – Malawi and Zimbabwe – are significantly dependent on export earnings from tobacco. [13] 

In 2002, Japan Tobacco, Philip Morris/Altria and BAT, the world’s three largest tobacco multinationals, had combined tobacco revenues of more than US$ 121 billion. This sum was greater than the total combined GDP of 27 developing countries. [14]

Faced with the offer of jobs, revenue, exports and foreign exchange, governments of developing countries find it difficult to resist especially when "aid" is also offered.  Although the initial cost of seed, tools, curing barns, etc. is high, the multinational tobacco companies make loans to small farmers for fertiliser and insecticides, thus trapping them into a cycle of debt.  

It has also been claimed that several large tobacco companies collude and exercise overweening influence on tobacco growers. They decide prices amongst themselves and severely punish growers who decide to sell their crop elsewhere. Growers are effectively squeezed, with many farmers driven deeper in debt to the tobacco companies. [15]     

In the past, tobacco has been supported as a cash crop by the FAO (United Nations Food and Agriculture Organization), the World Bank and other governmental agencies. However, in 1992 the World Bank stopped giving loans for growing tobacco. [16] A cost-benefit analysis of tobacco growing for developing countries has shown that the short-term gains are likely to be offset by long-term costs. [17]

Multinational tobacco companies often seek to strengthen their presence in developing countries by engaging in their economies and communities.  Seemingly philanthropic acts of building schools and hospitals have allowed the tobacco companies to buy into health and education sectors of society.

Poorer developing nations are less likely to resist such financial aid and look favourably on the tobacco industry.

Health effects

In industrialised countries, smoking has been identified as the most important preventable cause of disease and premature death. Cigarettes kill half of all lifetime users and tobacco kills more than AIDS, legal drugs, illegal drugs, road accidents, murder and suicide combined.

By 2030, a projected 7 million people in developing countries will be killed every year by tobacco. [18]  China alone (with 20% of the world’s population) suffers almost a million deaths a year from tobacco, a figure that is likely to at least double by 2025. [19] 

A study in Bangladesh has shown that tobacco consumption has a direct impact on the health of poor households, with poorer people spending less on food, resulting in malnutrition.  The study found that the typical poor smoker could add over 500 calories to the diet of one or two children with his or her daily tobacco expenditure.  Applied to the whole country, an estimated 10.5 million people currently malnourished could have an adequate diet if money spent on food were spent on food instead. [20]

A packet of Marlboro cigarettes or equivalent brand, will buy a dozen eggs in Panama, a kilogram of fish in Ghana or six kilograms of rice in Bangladesh. [21] 

The effects of tobacco use may be worsened by the incidence of infectious disease and environmental hazards in the developing world that may cause increases in certain cancers.  Occupational hazards such as organic dusts, uranium or asbestos can act as synergistic carcinogens in workers. [22]

Environmental impact

Almost three-quarters of the world's tobacco is grown in developing countries. Serious environmental costs are associated with tobacco production, especially deforestation, erosion and desertification.  There is also an increased risk of fires resulting from cigarette smoking in countries where dwellings are often constructed of highly flammable materials. 

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Tobacco Control

As the tobacco industry is able to wield so much power over the governments of the poorer countries, regulations to control smoking tend to be weak.

Advertising restrictions are few, or negligible, and tar levels of cigarettes sold in developing countries tend to be significantly higher than in brands sold in the USA or Europe.

Advertising tends to reflect the aspirations of the poor to emulate the West. For example in Africa, brand names include “Diplomat” (Ghana), “High Society” (Nigeria), "Sportsman" & “Champion” (both Kenya). [23]

More than 40 developing countries do not require health warnings to appear on cigarette packs, and of those that do, 73% require weakly worded warnings, often in English rather than in local languages.  [24]

There are some commendable exceptions:  South Africa, Thailand and Singapore all have comprehensive tobacco control laws including bans on tobacco advertising and sponsorship, smoke-free public places, large clear health warnings, and health education campaigns.    

Framework convention on tobacco control

Created under the auspices of the WHO, The Framework Convention on Tobacco Control (FCTC) is the first-ever global health treaty. It provides the basic tools for countries to enact comprehensive tobacco control legislation and take on the powerful tobacco industry.

For example, the treaty commits nations to ban all tobacco advertising, promotion and sponsorship (with an exception for nations with constitutional constraints) and to require large warning labels covering at least 30 percent of the display areas of the cigarette pack.

As soon as 40 countries ratify the Convention, it becomes law for those countries and thereafter for other countries that ratify it.By early August 2004, 168 WHO member countries had signed the FCTC and 24 had ratified it, [25]

References

[1] Tobacco Free Initiative (TFI), World Health Organization, 2004.

[2] Projections of Tobacco Production, Consumption and Trade to the Year 2010.  Food & Agriculture Organization of the United Nations, 2003, pg 2

[3] Tobacco Control Country Profiles. Second Edition, 2003, pg 7

[4] Tobacco Control Country Profiles. Second Edition, 2003, pg 10 

[5] Women and Tobacco. World Health Organization, 1992. pg 63-66

[6]  Mackay J and Eriksen M. The Tobacco Atlas.  World Health Organization 2002  

[7] Urquhart, L & McGregor, R. BAT goes in search of the Chinese Holy Grail. Financial Times,  17 July, 2004

[8] Tobacco Control Country Profiles. Second Edition, 2003, pg 116

[9] Mackay, J. Tobacco: the third world war. Thorax 1991; 46: pg153-156.

[10] A deadly business. Multinational Monitor July/August 1987.

[11] Tobacco Control Country Profiles. Second Edition, 2003, pg 418.

[12] Projections of Tobacco Production, Consumption and Trade to the Year 2010.  Food & Agriculture Organization of the United Nations, 2003, pg 76

[13] Global Tobacco Market.  Tobacco Journal International (poster) 2003

[14] Tobacco and poverty: A vicious circle. World Health Organization, 2004 pg6.

[15] Tobacco and Poverty: A vicious circle. World Health Organization, 2004 pg4.

[16] Investing in Health. World Development Report 1993, World Bank 1993.

[17] Barnum, H. Priorities for controlling the global economic impact of tobacco. Proceedings of the All Africa Conference on Tobacco or Health, 14-17 November 1993.

[18] Mackay J and Eriksen M. The Tobacco Atlas.  World Health Organization 2002

[19] Peto, R and Lopez, A. The future worldwide health effects of current smoking patterns.  To appear in: Global Health in the 21st Century. In press.

[20] Efroymson, D. et al. Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor in Bangladesh.

[21]    Mackay, J, Eriksen, M, The Tobacco Atlas, World Health Organization, 2002, pg 43.

[22]  Barry, M.  New England Journal of Medicine 1991; 324: 917-920.

[23] Maxwell Report. Tobacco Reporter, September 1997 & October 1997.

[24] Tobacco Warning Labels & Packaging Fact sheet. 11th  World Conference on Tobacco OR Health, 2000 

[25]  Updated status of the WHO Framework Convention on Tobacco Control, June 29, 2004.