March 2001 Insights Health Issue #1
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Controlling the global tobacco epidemic
Towards a transnational response
Recent trends in the globalisation of the tobacco
industry are reflected in the shifting of the burden of tobacco-related
disease and deaths towards developing countries. Tobacco companies have
proved sufficiently powerful to thwart comprehensive control programmes
in all but a handful of countries. What new strategies are needed to
control the epidemic in developing regions?
One billion people smoke worldwide and around 3.5
million die from tobacco-related illnesses annually. By 2030, this
figure will rise to ten million, with 70 percent of deaths in lower and
middle income countries (LMICs). Four companies now control 75 percent
of global cigarette sales, as sophisticated strategies for supply,
production and sales have produced increasingly popular global brands.
The onward march of Marlboro man epitomises this
globalisation, exploiting the opportunities presented by trade
liberalisation, regional organisations and the communications
revolution. Control efforts are undermined by the industry's success in
developing favourable relationships with many governments, the magnitude
of their foreign direct investments and the scale of advertising,
marketing and sponsorship campaigns. In addition, large-scale cigarette
smuggling, which comprises one-third of total exports, depletes tax
revenues and further jeopardises public health.
A unique response by the World Health Organisation (WHO)
reflects the scale of the challenge. WHO is negotiating its first public
health treaty: the Framework Convention on Tobacco Control. To be
effective, this potentially powerful instrument must be backed up by
strengthened national policies set within the context of globalisation
and based on an appreciation of transnational tobacco industry
strategies. In support of this process, an international team based at
the London School of Hygiene and Tropical Medicine carried out pilot
studies in Thailand and Zimbabwe. These aimed to initiate the
development of guidelines for tobacco policy research in LMICs, where
resources and expertise are frequently lacking.
The political sensitivities surrounding tobacco control
reflect the complex array of powerful vested interests involved. The
case studies showed that political mapping and stakeholder analysis can
make a valuable contribution to understanding the opportunities and
constraints for national control policies in an era of globalisation
(Figure 1).
For example, they found that the 1992 Global Agreement
on Tariffs and Trade (GATT) ruling that opened Thailand's previously
closed cigarette market had contradictory results:
-
Thailand is a key market for tobacco companies
seeking expansion in Asia.
-
The US Trade Representative secured access to the
Thai market through GATT's insistence on equal treatment of domestic
and foreign cigarette manufacturers, and imports escalated rapidly.
-
The GATT ruling also upheld the right to protect
public health, giving a major impetus to health activists pressing
the Thai government for action.
-
Subsequent comprehensive control legislation has
stabilised smoking rates in Thailand.
Control policies of wealthier countries cannot simply be
transplanted to poorer nations. Knowledge of the complex policy
environments surrounding tobacco control in LMICs is limited and
effective policies will require:
-
detailed analysis of the particular political and
economic contexts
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multidisciplinary expertise from public health and
social science
-
links between researchers, policymakers and
activists
-
support for national research capacity through the
development of clear guidelines for tobacco policy analysis and
their application by national researchers.
Finally, the enforced opening of internal industry
documents provides an important new resource. Access to the depositories
in Minnesota, USA, and Guildford, UK, and via the internet offers a
unique opportunity to understand the global strategies of the tobacco
companies. Analysis of their contents has so far focused on the United
States. There is an urgent need to extend this attention to industry
activities within LMICs.
Jeff Collin
Centre on Globalisation
Environmental Change and Health
London School of Hygiene and Tropical Medicine
Keppel Street
London
WC1E 7HT
UK
T: +44 (0)20 7612 7884
F: +44 (0)20 7637 5391
jeff.collin@lshtm.ac.uk
See also
Case study report: Global analysis project on the political economy
of tobacco control in low- and middle-income countries, London
School of Hygiene and Tropical Medicine, edited by J. Vaughan, J. Collin
and K. Lee (2000)
Special theme: Tobacco, Bulletin of the World Health Organization
78, 7 (2000) http://www.who.int/bulletin/tableofcontents/2000/vol.78no.7.html
World Health Organization / Tobacco Free Initiative
Website: http://tobacco.who.int |
