Colleagues who have contributed so far presented a range of perspectives, including economic, agricultural and trade-related analyses of the impact of tobacco control on poverty, as well as practical proposals for action on tobacco. Here is a summary of the main points:

Tobacco and poverty

• One participant suggests that although expenditure on tobacco amongst the poorest households in developing countries is quite low, spending on smoking has a very high opportunity cost for these people. It contributes to malnutrition, while associated ill-health and premature death constitute one of the shocks that force households deeper into poverty.
• Other participants comment that while poorer households seem to have a higher prevalence of smoking than richer ones in developed countries, the same is not necessarily true in developing countries. Evidence from South Africa suggests that the reverse is true, although rapid economic development is likely to increase the number of people who can afford to smoke cigarettes. So rapid economic growth in developing countries could undermine tobacco control efforts.
• Further contributions suggest that there is a weakness in the data from developing countries because the use of traditional tobacco products (just as addictive as cigarettes) is not taken into account. So when poor people are not able to afford cigarettes, they may turn to traditional pipe-smoking or use snuff, which also have associated health problems.

Impact of tobacco control

• One contributor cites evidence from a number of studies that suggests that price increases reduce tobacco consumption. In South Africa, raising taxes on cigarettes has resulted in a 30 percent decrease in consumption in less than a decade. Although recognising the argument that the poor bear the greater burden of taxation vis-a-vis the rich, the contributor cites a counter argument that poorer people are more responsive to price changes, so taxation has been effective at reducing cigarette consumption amongst poorer people. However, another contributor argues that there is a need to monitor closely the effects of cigarette tax increases given that people may turn to cheaper tobacco products, undermining efforts to reduce the incidence of all tobacco-related diseases and their impacts on development.
• Possible impacts of tobacco control on tobacco producing countries are raised by research in Malawi. Reform has made agriculture the driver of the economy, which relies heavily on tobacco exports. Smallholder farmers produce much of the tobacco, selling it directly at auction and receiving payment in US dollars. An analysis of the dependency of the economy on tobacco reveals that it provides a livelihood to over 70 percent of the population. So any fall in demand could be potentially catastrophic for livelihoods in Malawi. The Ministry of Agriculture does have a plan to phase out tobacco from mainstream agricultural activities but this will require a commitment from the wider development community.
• It seems that more research is needed to help predict the potential impacts of tobacco control. One contributor suggests a need for more detailed information on how tobacco farmers, national government and multinational tobacco companies benefit from the industry and how corruption continues to pose a problem for tobacco control. Research is also vital to develop policy options that are appropriate to developing countries and to avoid mis-applying solutions that are tailored to developed countries.