Pushing tobacco control up the development agenda

Tobacco kills around 5 million people each year and remains the leading cause of preventable death worldwide.

Smoking causes approximately 25 diseases including numerous cancers. Yet despite the wealth of knowledge about its harmful effects, the public health community continues to struggle to control tobacco use.

Today, tobacco companies are earning record profits, largely by shifting their attention to 'emerging markets' such as China and Central Asia. By 2030, 70 percent of the 10 million tobacco-related deaths predicted will occur in developing countries. Tobacco control needs to be understood as a development issue, requiring policy action beyond the health sector. How can the development community help tackle what the World Health Organization calls the global tobacco pandemic?

Tobacco and exploitation

Internal tobacco industry documents reveal several ways that development is undermined by tobacco. Research shows a clear link between using tobacco and poverty, with the cost of consumption falling on poor people and countries. Research by the London School of Hygiene and Tropical Medicine (LSHTM) also shows that the production of tobacco contributes to poverty. Research in Uzbekistan, Kenya and Brazil found that companies pay unnecessarily low prices to contracted tobacco farmers. In many countries, farmers are also obliged to purchase seed and other inputs, including hazardous pesticides, from these companies.

This ability to exploit farmers comes from the increased concentration of ownership in the hands of a few transnational companies. This has undermined the capacity of small farmers to negotiate better working conditions and prices. This is evident in the takeover of numerous state-owned monopolies across Asia, Africa, Latin America and the former Soviet Union, facilitated by promises of foreign investment and job creation. However, World Bank research indicates that the tobacco industry inflicts a net cost on societies when all social and environmental factors are fully considered. This challenges the argument that tobacco makes good economic sense to developing economies.

The tobacco industry's portrayal of itself as a responsible investor in the developing world is further undermined by internal documents describing its complicity in cigarette smuggling. LSHTM research in Viet Nam describes how British American Tobacco (BAT) used the promise of import substitution and export growth to negotiate a joint venture. At the same time, documents describe how BAT supplied billions of cigarettes to transit agents for smuggling into Viet Nam, undermining the country's tax and health policies.

A development approach to tobacco control should address:

• measures to control the supply and demand of tobacco
• the full economic, social and environmental costs of tobacco
• strong measures to tackle smuggling including more effective systems for detection, tracking and punishment
• implementing the Framework Convention on Tobacco Control as a foundation for effective multi-sectoral and global collaboration.

Kelley Lee
Centre on Global Change and Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
kelley.lee@lshtm.ac.uk

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