1. Why we need to address tobacco control from a global perspective
Reducing tobacco use in the USA -- a country with only 4% of the world's smokers -- will not solve the global tobacco epidemic. As cigarette consumption in the US has fallen from 624 billion in 1982 to 472 billion in 1996, output has increased and US to bacco exports have risen from 85 to 250 billions over the same period. American (and British) tobacco companies are now flooding the globe with tobacco products.
US embassies and consulates around the world one-sidedly support tobacco, not health, interests. The situation is akin to the opium wars of 150 years ago, when British business and government colluded to sell another dangerous and addictive product to China. Quotes from lawyers for opium interests sound remarkably familiar to quotes from tobacco interests today: 'Smoking is perfectly innocuous. It is on a par with tea drinking. The alleged effects of opium have been vastly exaggerated. The use of opium is not a curse but a comfort to the hard-working Chinese.' The lawyer also attempted to 'expose the mischievous fallacies disseminated by the Society for the Suppression of the Opium Trade.'
Yet the USA could take a leading and exemplar role in reducing the epidemic, and export health expertise and experience. The tobacco epidemic is not being reduced. It is both increasing and it is being transferred from the rich to the poor countries.
The current 1.1 billion smokers in the world will increase to around 1.64 billion by 2025, partly because the world's population will have risen from the current 6 billion to 8.5 billion, people will live longer, and more women will be smoking.
On current smoking patterns, by 2025 the annual number of deaths will have risen from 3 million to 10 million, of which seven million will be in developing countries, which can ill afford this burden, either in health or economic terms.
The net economic costs of tobacco are profoundly negative -- costs of treatment, mortality and disability exceed estimates of the economic benefits to producers and consumers by at least 200 billion US dollars annually, with one third of this loss being incurred by developing countries.
Tobacco is a major threat to sustainable and equitable global development.
2. How the tobacco industry has impacted on the international community through politics, economics, and trade policy
Transnational tobacco company tactics include promotion, political and commercial pressures with the weakening of national monopolies.
a) Promotion and Sales
Developing countries are being bombarded with sophisticated, western tobacco marketing and promotion, including direct and indirect advertising, sponsorship, product placement in films, "Marlboro" and "Salem" clothing shops, travel agencies, funding of political events, and targeting of women, currently few of whom smoke in developing countries.
b) Political and Commercial Pressures
Orchestrated and sophisticated political and media lobbying by the transnational tobacco companies is now common throughout developing regions. The TTCs strenuously oppose attempts by developing countries to introduce their own national public health laws.
American tobacco companies have persuaded the US government to threaten unilateral retaliatory trade sanctions against countries (to date, Japan, the Republic of Korea, Taiwan, Thailand, China) unless they open up to the sales and promotion of US tobacco products, even in countries with established national laws forbidding tobacco advertising. Lobbying on behalf of tobacco by the US embassies continues.
b) Weakening of national monopolies
Opening up of markets, joint ventures, and a complex of licensing agreements have weakened national monopolies. The opening up of markets is not only leading to a sharp increase in market share of foreign cigarettes, but is also leading to market expansion, especially increased smoking among youth. One analysis showed that market share of US cigarettes in four countries affected by trade threats --
Japan, Taiwan, South Korea, and Thailand -- increased dramatically after the countries accepted US tobacco products. The study also found per capita cigarette consumption to be almost 10% higher than it would have been if markets had stayed shut to American cigarettes.
3. How local actions can have far-reaching effects
Many developing countries have little expertise in countering the transnational tobacco companies, or in dealing with the new, non-communicable disease epidemic. The USA has an opportunity to play a global role in the tobacco epidemic. Countries like Laos and Bangladesh have little hope of implementing comprehensive tobacco control policies if the USA does not grasp the political nettle of tobacco control.
Any settlement agreement whereby the US tobacco companies offer compensation only to people within the USA, ignoring smokers of US tobacco products elsewhere, would be ethically unacceptable to the rest of the world. Addressing global responsibility is complex, but it is an issue that must be addressed.
While it is the responsibility of each nation to implement their own tobacco control measures, governmental and non-governmental organisations in the USA have a very special responsibility:
The exemplar role -- showing that 'It can be done.' The message from the USA is that smoking rates can be reduced and that litigation can have a major impact.
Examples from Forum resolutions:
"...to move progressively towards the adoption of
comprehensive tobacco control policies..."
* It is particularly important that the USA bans all tobacco advertising, and raising the current very low price of cigarettes (tax is only 23% of cost).
The political role -- showing the importance of government involvement.
Examples from Forum resolutions:
Resolution B. Guidelines for international tobacco trade matters which ensure that human health is protected and that countries have the right to regulate the transnational tobacco companies.
Resolution E. Require the transnational tobacco companies to adhere to the same standards both domestically and internationally.
Resolution F. Campaign reform that limits political contributions by individual, agencies, companies, and organizations.
The supportive and sharing role -- supporting tobacco control measures in developing countries and sharing experience, expertise and funds. Examples from Forum resolutions:
- The San Francisco Tobacco Free Coalition will actively work with local, State, National, and International policy makers to adopt and promote this Global Tobacco Control Policy Framework;
Resolution C. Actively support international boycotts of products produced by the transnational tobacco companies or their subsidiaries.
Resolution D. Social justice criteria for Sister City relationships which includes adopting all or part of the Global Tobacco Control Policy Framework.
There are already many such examples of the sharing and supportive role, involving government and non-governmental organizations.
1. Temple DK, Chew LL, Wong W, Johnson N, Dikkers A, Pinon BV, Shimizu M. United States Equity Research: Tobacco. International Tobacco -- A Global Business for Global Brands. Salomon Brothers 1996 April:27, 12.
2. Samuel Couling. Encyclopaedia Sinica. Shanghai; Hong Kong-Singapore-Yokohama: Kelly and Walsh, Ltd., 1917. Reprinted Oxford, New York, Melbourne: Hong Kong Oxford University Press;1983:405-410.
3. United Nations. World Population Prospects 1990. Department of International Economic and Social Affairs. Population Studies No 120. United Nations, New York, 1991.
4. Chaloupka FJ, Laixuthai A. US trade policy and cigarette smoking in Asia. National Bureau of Economic Research, Working Paper 5,543. June 1996.
Dr. Judith M. Mackay is the Director at the Asian Consultancy on Tobacco Control, Hong Kong