The Growing Global Tobacco
Epidemic and the
International Response
Ross Hammond
Campaign for Tobacco-Free Kids
University of Washington
1. Tobacco & Globalization
2. Tobacco & Poverty
3. The Global Toll
4. The International Response
1. Tobacco & Globalization
 Free Trade
& Financial Liberalization have
greatly increased profit opportunities for Big
Tobacco
 Global Communications/Marketing has helped
them take advantage of these opportunities
 Coordinated Lobbying has ensured (so far)
that their profits are protected
“Tobacco exports should be
expanded aggressively, because
Americans are smoking less.”
-- U.S. Vice-President Dan Quayle, 1990
Global Expansion Fuelled By:
 opening
up of formerly closed
economies (FSU, E. Europe, China)
 pressure to liberalize investment
laws and privatize state-owned
industries
 pressure to embrace “free trade” (as
defined by the West) & expansion of
free trade areas in Asia & L.
America
Complete Transformation of
the Global Tobacco Industry in
the Last 25 years
 Privatization
of state-owned
tobacco monopolies
 Joint-venture agreements
 Consolidation/mergers
 Between 1991-2001, over 140
mergers and acquisitions
Global Expansion
 In
2002, Philip Morris, BAT and Japan
Tobacco operated in over 50 countries
each and had combined tobacco sales of
over $121 billion, a sum greater than the
combined GDPs of:
Albania, Bahrain, Belize, Bolivia, Botswana,
Cambodia, Cameroon, Estonia, Georgia, Ghana,
Honduras, Jamaica, Jordan, Macedonia, Malawi,
Malta, Moldova, Mongolia, Namibia, Nepal,
Paraguay, Senegal, Tajikistan, Togo, Uganda,
Zambia and Zimbabwe
Philip Morris Tobacco Revenue
& Select Country GDPs (2000)
Philip Morris
Czech Rep
Hungary
Sri Lanka
Costa Rica
Kenya
Senegal
0
10
20
30
US$ billions
40
50
60
Source: Philip Morris, World Bank
“We are still in the foothills
when it comes to exploring the
full opportunities of many of
our new markets.”
-- Geoffrey Bible, Philip Morris CEO, 1996
US Government Has
Promoted Tobacco Overseas
 1980s: Threat
of trade sanctions to pry open
Japan, Thailand, S. Korea & Thailand. In S.
Korea led to 10% increase in prevalence.
 1999: US-China treaty for PNTR included
provision requiring China to slash tariffs on
imported cigarettes
 2001: Pressure on S. Korea not to raise
tobacco tariffs
“Philip Morris strongly supports
NAFTA and also supports the
Uruguay Round process….We are
well positioned to take advantage of
the new opportunities that the
removal of trade barriers will offer
us. I see both the NAFTA and the
Uruguay Round as real “winners”
as far as Philip Morris is
concerned.”
-- Internal Philip Morris document, 1994
Global Communications &
Marketing
Traffic Lights in Bucharest, Romania
“This is a market with
tremendous potential. The rate of
population growth is 2.2. percent
each year, and 40 percent of the
population is under 18.”
-- Philip Morris Turkey, 1997
Thailand
“Give me an amerika”
Czech slang for a good cigarette
Global Lobbying Effort
In every region of the world:
http://www.library.ucsf.edu/tobacco/docsbiblio.
html
“Tobacco use is unlike other
threats to global health. Infectious
diseases do not employ
multinational public relations
firms. There are no front groups to
promote the spread of cholera.
Mosquitoes have no lobbyists.”
-- WHO Zeltner Report, 2000
“We must try to stop the development
towards a Third World commitment
against tobacco. We must try to get
all or at least a substantial part of
Third World countries committed to
our cause….We must try to mitigate
the impact to WHO by pushing them
into a more objective and neutral
position.”
-- BAT internal document, 1979
2. Tobacco & Poverty
How Tobacco Impoverishes
Individuals
 Money
spent on tobacco cannot be spent
on food, health care or education.
 In
Bangladesh, over 10.5 million
malnourished people could have an
adequate diet if money spent on tobacco
was instead spent on food.
Child Labor
 Use
of child labor in tobacco growing and
manufacturing widespread.
 These children miss out on educational
opportunities that could help lift them
out of poverty.
How Tobacco Impoverishes
Families
 Smokers
are at much higher risk of
falling ill and dying prematurely. If
the main breadwinner becomes ill
from tobacco, the family loses that
person’s income AND has to bear
the additional health care costs.
Tobacco Farming Can Lead to
Indebtedness & Ill Health
 Extremely
labor-intensive
 Requires expensive inputs
(fertilizers, pesticides, etc.)
 Pesticide and nicotine poisoning
common.
Tobacco Growing: Who
Profits?
 Limited
# of purchasers for tobacco.
Farmers dependent on the companies to
grade tobacco (and thus set price).
 A tobacco farmer in Brazil would need
to work for 6 years to earn what BAT's
Director earns in a single day. It would
take him 2,140 years to earn the
Director’s annual salary.
How Tobacco Impoverishes
Countries
 Environmental
Damage
 Increased Health Care Costs
 Lost productivity due to illness and
premature death
 Foreign exchange losses
Environmental Damage
 Wood
used to cure tobacco in many
countries. Each year an est. 494,000
acres of forest is cut down (equiv. to ¾
the size of Olympic Natl. Park)
 Tobacco
leeches nutrients from the soil,
requiring more fertilizer use. Runoff
from fields pollutes watersheds vital for
drinking water.
Environmental Damage Has
Economic Costs
 All
of this environmental damage
has an economic cost, though not
currently captured in official
statistics.
Increased Health Care Costs
 In
high income countries, annual tobaccoattributable health care costs est. at
between 6% and 15% of total health care
costs (very few estimates for low income
countries).
 In
China, direct and indirect tobaccoattributable health care costs est. at $6.5
billion per year in mid-’90s.
Lost Productivity
 If
current trends persist, about 500
million people alive today will
eventually be killed by tobacco, half
of them in productive middle age,
each losing 20 to 25 years of life.
Foreign Exchange Losses
 Most
countries import more tobacco
leaf, tobacco products and tobaccorelated machinery than they export.
 Most
tobacco profits repatriated to
the home countries of the
multinationals.
Tobacco’s Economic
Importance Exaggerated
 Despite
industry claims, few countries
benefit from tobacco. Only 5 derive more
than 5% of export earnings from tobacco
 Tobacco
represents small % of the labor
force. In Brazil (world’s largest tobacco
exporter), tobacco accounts for less than
2% of the ag. labor force.
3. The Global Toll
Global Causes of Death
5
4.5
Deaths in Millions
4
3.5
3
2.5
2
1.5
1
0.5
0
Tobacco
Lower
Respiratory
Infections*
Diarrheal
Diseases*
Perinatal
Conditions*
Tuberculosis
AIDS
* WHO World Health Report 2002
The Coming Epidemic
Rise in Smokers Worldwide
billions of smokers
2
1.5
1.64
1.1
1
0.5
0
2000
2025
Global Deaths
8
10
7
millions of deaths
Currently:
 4.9 million people die per
year
 13,400 people per day
 560 people every hour
By 2030:
 10 million people a year
will die from tobacco use
 70% of those deaths will
occur in developing
countries
6
5
4
4.9
3
2
1
0
2000
2030
Developed Countries
Developing Countries
4. The International Response

FCTC
 Civil Society
 Donor Community
Framework Convention on
Tobacco Control (FCTC)
 1st
international public health treaty
 Objective: to protect present and future
generations from the devastating health,
social, environmental and economic
consequences of tobacco consumption and
exposure to tobacco smoke ...
FCTC
 Preamble
 38 Articles
 168
Countries Have Signed
 146 Have Ratified (not the U.S.)
 Find
the full text at www.fctc.org
FCTC: Key Provisions `
Enact comprehensive bans on tobacco
advertising, promotion & sponsorship within
5 years of ratification (some exceptions)
Japan
Thailand
Pakistan
Place rotating health warnings on packs
that cover 30% or more of the package
and can include pictures or pictograms
Ban the use of misleading and
deceptive terms such as "light" and
"mild"
Protect citizens from exposure to
tobacco smoke in workplaces, public
transport and indoor public places
Other Key Provisions
 Encourage
tobacco tax increases
 Establish & finance ntl. coordinating body
 Include cessation services in ntl. health progs
 Prohibit free distribution of tobacco
 Promote NGO participation
 Prohibit sales to minors
 No reservations allowed
Framework Convention
Alliance (FCA)
Diverse alliance of over 250 NGOS
from more than 90 countries working
to support FCTC ratification and
implementation
WWW.FCTC.ORG
“The
participation of
civil society is
essential in
achieving the
objective of the
Convention and
its protocols.”
STAGED EVENTS DURING
FCTC MEETINGS
Issued Daily Report Card
Challenges for Civil Society

Keep momentum going and maintain sense
of urgency
 Hold governments accountable for FCTC
commitments
 Work on guidelines and protocols to FCTC
ENCOURAGE COUNTRYLEVEL ADVOCACY
CLOCK IS TICKING

February 27, 2008- 40 original ratifying
countries must have health warnings on
packages

February 27, 2010- 40 original ratifying
countries must have ad ban in place
MONITOR COUNTRY
COMPLIANCE
Global Voices for A
Smokefree World Campaign

Reach out to governments to secure support for
strong Article 8 guidelines.
 Meet with Health Ministers in target countries.

Conduct a media campaign around smokefree air
and the Article 8 guidelines.
www.globalsmokefreepartnership.org
Donor Community








Bloomberg
Open Society Institute (Soros)
NIH
American Cancer Society
IDRC/Research for Intn’l Tobacco Control
Cancer Research Campaign
Bilaterals (Sweden IDA, Canada IDA, etc.)
Others? (Gates Foundation)
Bloomberg Grantees

Campaign for Tobacco Free Kids
 CDC Foundation
 Framework Convention Alliance
 Johns Hopkins School of Public Health
 World Health Organization
 World Lung Foundation/IUATLD
Focus on fifteen countries with the
greatest number of tobacco users
China
India
Indonesia
Russia
Bangladesh
Brazil
Mexico
Turkey
Pakistan
Egypt
Ukraine
Philippines
Thailand
Vietnam
Poland
Campaign for Tobacco Free Kids’
Role in Bloomberg Initiative
To support advocacy efforts in the following ways:

Strategic Planning/Campaign Support

Research

Media/Communications

International Legal Consortium

Advocacy Grant Fund
MORE INFORMATION:
www.fctc.org
www.tobaccofreekids.org
Yach, Wipfli, Hammond & Glantz, “Globalization
and Tobacco” in Ichiro Kawachi & Sarah Wamala
eds., Globalization and Health, London: Oxford
University Press (2006).