As smoking becomes more and more socially unacceptable in the United States and in Europe, one of the world’s biggest killers - the tobacco industry, increasingly shifts its hunting grounds to Africa, Asia, and Eastern Europe.

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Some observations:

In Tashkent, the first person I met in the immigration line at the airport during the mid-90’s, was a tobacco farmer with RJ Reynolds. This gentleman had come to provide “technical assistance” to Uzbekistan.

In Almaty (Alma Alta) Kazakhstan, the Marlboro man is alive and well (at least back in the ‘90’s).

In Ukraine, where people struggle daily in an economic uncertainty, bill boards advertising cigarettes show young, care free Americans frolicking on street cars in San Francisco.

In Phnom Penh there are kiosks with nothing but cartoons of Marlboro cigarettes stacked two stories tall. The restaurants are so full of smoke that you almost need a machete to cut through the smoke to find a table. In Uganda, there is the “Sportsman” cigarette. If you are poor, have no pleasures in life, and will never be a well fed sports hero, you can at least smoke cigarettes.

As cities like New York in the USA and countries like Norway ban smoking in all public areas, and as taxes on cigarettes in industrialised countries increase, the tobacco industry has intensified assaults on the poor and the poorer countries in order to sustain and increase its corporate profit.

Micro economics

So now the Tobacco corporations prey not only on the less informed, but especially on the economically deprived in the poor countries. For if you have nothing, a nicotine high can at least provide a temporary illusion of well being.

The health effects of tobacco are quite well known, even in the non-industrialised countries. However, the micro economic impact of nicotine addiction on families remains one the silent side effects of tobacco.

I know first hand that the cost of those individual sticks and packs add up. My father was addicted to nicotine longer than most people live, 65 years. While he was still able to smoke, he was spending $200 per month on cigarettes and with a limited income from social security of only $900 per month, almost a quarter of his income.

While this example represents costs in the USA and the tobacco corporations sell cheap, and more addictive, varieties in developing countries, the cost of a cigarette to a rickshaw driver, turn boy, or street hawker is money lost for purchasing food or medical care. Sadly, most in developing countries will not live long enough for other reasons to begin experiencing the income loss due to the long term health effects like emphysema and lung cancer.

Economic extortion

Rather cynically, the tobacco corporations, like British American Tobacco (BAT), use economic gain to justify selling their addictive product, providing revenue for the government and income for farmers. Many years ago, I was talking to the Ministry of Health physician overseeing tobacco prevention in Uganda. In those days, smoking prevention came under the TB program. He looked at me in despair and said, “With the tobacco companies being one of the major sources of tax for the government, what can I do?” Even today, BAT is the second largest tax source for the government and tobacco exports are projected to reach $48 million this year. BAT even claims that tobacco benefits up to 65,000 farmers in Uganda, for a total projected to reach 50 billion shillings. Of course as one farmer in Arua, Uganda points out, it’s the middle man who really makes the money. (source: New Vision, Kampala).

This economic extortion and political control tactic is also well established in the United States. While the US government warnings on the serious health consequences of smoking have been communicated since the 1960’s, it is only more recently that lawsuits, tax increases and public awareness have begun to erode the tobacco industry’s firm grip on politicians (NY Times and New York City ban on smoking). And in the State of Virginia, the State with the lowest sales tax on cigarettes in the USA, and coincidentally headquarters for (add info on tobacco industry in Richmond, the State capital), the State government is fighting against those municipalities (e.g. Arlington, Virginia Beach) which are increasing their local sales tax on cigarettes to generate much needed revenue for depleted local government budgets.

Assault on Children

As the tobacco industry in America promotes a “good guy” image with marketing and in some instances programs aimed at preventing teenage smoking, their silent assault on the children of Africa, Asia, Latin America, and Eastern Europe intensifies, receiving little attention in the “developed” world. Laws can be established and enforced to help prevent children from smoking in the USA, but the poorer countries don’t even have the resources to enforce traffic violations. Any child can purchase a cigarette stick at any shabby local stand in Africa and most any poor country. (Ten years later, I learn that my son at age ten used to go with the local boys in Uganda to a little stand nearby to purchase and smoke cigarettes). So the promotion of early nicotine addiction becomes even more deadly as it is applied to countries without resources to combat this shameful tactic.

Who’s Developing Whom? (... and the positive)

Much can be learned from the Tobacco Industry’s behaviour and tactics in the so-called developed world; for their tactics are global: bribing politicians (In America, we call it “campaign contributions.”), childhood addiction, and supposed economic benefits for the farmer and the government. We need to follow and analyze the trends and events in both the “developed” and the “developing” world. Just as the tobacco industries exports their tactics, some governments in the poorer countries are attempting to employ the same responses as those in industrialised nations to fight these tactics and prevent the spread of the cigarette pandemic. In Uganda the High Court has ruled that “... smoking in public places is a violation of the non-smoker’s right to life.” In Bangladesh significant legal victories have been achieved against misleading promotional campaigns by the Imperial Tobacco Ltd. Health warning labels on cigarette packs now appear in most countries and many governments have issued statements, or warnings concerning the hazards of smoking.

Yet, more global support is needed to enforce and build on these gains being made by the individuals and small organizations in countries lacking the political support and financial resources to challenge the global giants. With BAT ranking second in revenue for the Ugandan government, who is going to take the political or financial risk to enforce this lone judge’s decision?

Efforts like Politics of Health can help promote awareness globally about these gains being made by the anti tobacco activists in countries where the tobacco in corporations are strongest, and thereby add external, global, more unified pressure on the tobacco corporations. It will also be great if we can find examples where farmers have changed from growing tobacco to some other non addictive crop. (Hopefully there are such examples.)

In summary, I would say that “Tobacco” presents a real challenge for us. It takes years to actually observe the health consequences, and the cynical can always say that people in the poorer countries won’t live long enough to experience smoking related diseases anyway. Sadly, there is much competition for an individual’s attention from more immediate and more visible issues like the HIV/AIDS pandemic, or going to war against Iraq for example. Consequently, it’s more difficult to sustain interest in tobacco related issues.

The financial control and resulting political control by the tobacco industry remains formidable. Nevertheless, even the tobacco executives no longer arrogantly ignore the health hazards of smoking. If we can join the gains achieved by the activists and public health officials in the so called developed” countries with the fledgling efforts of those in the so called “developing” countries, we should see more change, and more quickly.