It is estimated that tobacco will be the biggest cause of death worldwide by 2030. This represents a massive challenge to development in poorer regions, on a par with the HIV epidemic. However, unlike AIDS, the tobacco epidemic is caused not by an infectious agent, but by the product of powerful transnational companies, exploiting the opportunities presented by international free trade. The problem cuts across national borders, cultures, societies and socio-economic levels. There is therefore a pressing need for political measures to reduce tobacco consumption. Tobacco control is a global health priority - but what are the consequences for development of tobacco cultivation, consumption and its control? Crucially, how will the World Health Organisation's Framework Convention on Tobacco Control (FCTC) work for developing countries?

The WHO's 191 member states are currently developing the FCTC - a new legal instrument which addresses such diverse issues as tobacco promotion, agricultural diversification, smuggling, taxes and subsidies (1). The national and global thrusts of the FCTC are interdependent and all countries will need to develop their own tobacco control policies within the agreed framework. How can developing countries take advantage of the opportunities presented by the FCTC? What financial and technical assistance will they need to formulate tobacco control policies and who will provide this? Are the interests of developing countries fully represented in the FCTC negotiations?

This online forum hopes to initiate a focused and constructive public discussion on some of the priority issues. We invite you to share your ideas, knowledge and diverse perspectives. Participants will include international and national policy-makers, health professionals, tobacco control agencies, NGOs and researchers from diverse academic disciplines. A final report will summarise the discussion and identify important research questions on the impact of tobacco consumption and control on development. A draft of the final report will be presented to the participants at the next round of negotiations on the FCTC in November 2001.

Please read the guidelines for participation and the context document below, which provides a framework for the discussion over the coming weeks.

Context

Tobacco consumption in developing countries
Developing countries face particular challenges in controlling the tobacco epidemic. Fifty percent of men in lower income regions smoke. Tobacco use is traditionally low among women in these regions, but is rising steadily as tobacco companies vigorously target these heavily-populated potential markets (2). As a result, the burden of tobacco-related disease and deaths is shifting towards developing countries. Seventy percent of tobacco-related deaths in 2030 will be in poorer nations (3).

The costs of smoking
Smoking is most common among the poor in many countries. Tobacco is often a significant part of family expenditure: in China, smokers in 2,716 households in Minhang district spent 17 percent of household income on cigarettes (4). How does smoking affect the quantity and quality of a family's food intake? What is the impact on their children's education? Smoking has costs beyond personal healthcare expenditure, affecting both smokers and non-smokers and increasing the burden on poor states. Health and social services have limited resources in developing countries and the burden of tobacco-related illness and death often falls upon families and communities, increasing poverty. Moreover, intensive tobacco cultivation has implications for environmental health and negative environmental consequences, including contamination of water supplies by fertilisers and pesticides, depletion of soil nutrients and extensive deforestation.

The costs of tobacco control
These costs must be set against the potential economic benefits of the production and trade in tobacco products. However, research suggests that tobacco control measures do not necessarily have negative economic consequences, even for tobacco producing countries. Tobacco control policies can bring unprecedented health benefits without harming national economies (5). But will there be unforeseen costs to developing countries? Will major tobacco-exporting nations require extra assistance if demand is successfully curbed?

Tobacco control strategies
Each country will need to implement the various elements of tobacco control such as tobacco taxes, health education and restrictions on cigarette promotion. What are the relative merits and realities of strategies to reduce either supply of tobacco products or consumer demand in poorer regions? How can bureaucracies adapt to cope with the technicalities of collecting tobacco taxes? How can developing countries address tobacco smuggling?

Multi-sectoral response
Like the HIV epidemic, tobacco control policy requires a multi-sectoral response, involving ministries of health, foreign affairs, finance, environment, labour, justice, foreign trade, education and agriculture. What specific challenges will each face? What role can NGOs and researchers play in this process? Are there additional barriers facing tobacco control legislation and implementation at the local level?

Research for tobacco control
Successful tobacco control policies and programmes require a strong evidence base (6). Country-specific data is often lacking in poorer regions. What additional evidence do developing countries need to inform policy decisions? There are also international research issues. Common protocols on key issues would facilitate research locally and the pooling of data globally. But how can we engage developing country researchers on these issues? How can the international research community help to build capacity within developing countries to undertake this research? And how can we encourage researchers from the broader research community to address tobacco control as a development issue? Additional funding is being provided to support international tobacco research (7). The next priority will be to translate research into effective policy and implementation strategies. What steps need to be taken to ensure that research reaches policy-makers?

Discussion themes

Phase 1 (24/9 - 5/10): Is tobacco control a development issue? What are the costs and benefits of tobacco control for developing countries? What new perspectives can the development community bring to the tobacco control debate?

Phase 2 (8/10 - 19/10): What are the gaps in our knowledge on the development impact of smoking and tobacco control? What new country-specific data is needed and what are the international issues that should be addressed? What are the opportunities for cross-disciplinary research? How can we ensure that research reaches policy-makers?

Phase 3 (22/10 - 2/11): How will the FCTC affect developing countries? Should the FCTC incorporate a broader development perspective? How can development professionals contribute to the ongoing negotiations?

Background reading

1) 'The framework convention on tobacco control. A primer' WHO Tobacco Free Initiative (2000)
2) 'Smoking gun? Grim predictions for tobacco-related deaths in China' id21 Health (2001)
3) 'Controlling the global tobacco epidemic' id21 Insights Health 1 (2001)
4) 'Cigarette smoking in China. Prevalence, characteristics, and attitudes in Minhang District' by Y. Gong, JAMA 274 (1995)
5) 'Curbing the epidemic. Governments and the economics of tobacco control' The World Bank (1999)
6) 'Confronting the epidemic: a global agenda for tobacco control research' RITC/WHO (1999)
7) 'International tobacco and health research and capacity building program. Request for applications.' Fogarty International Center (2001)