• Tobacco transnationals
• Smoking creates more poverty
• Children and tobacco
• Tobacco farmers are poor
• Recommendations
• Conclusion

In 1971 the British Medical Journal in an editorial on the Second World Conference on Smoking and Health issued a warning which said, "There is a real danger of this deadly habit being exported to the younger countries of Africa and Asia, and the Western World has a responsibility to see that this is not done. We have already produced millions of slaves to cigarettes in our own land. To export this slavery to the developing countries would be very wrong."

Today after almost thirty years, it is clear that this slavery has indeed been tragically transported to developing countries where millions are now enslaved in its poverty, diseases and death. Of the 1.1 billion smokers in the world today the vast majority, that is 800 million, are in developing countries. The truth about tobacco is that countries where consumption is growing the fastest are also among the world's poorest.

The living standards of the developing countries of these 800 million smokers tell us that the effects of smoking will be far worst for them. Nearly three-fifths of the population lack access to sanitation, a third have no access to clean water, a quarter do not have adequate housing and a fifth have no access to modern health services of any kind.

850 million people are illiterate. Two billion children are anemic. About 17 million people in developing countries die each year from curable infectious and parasitic diseases such as diarrhea, measles, malaria and tuberculosis. Come 2025 a greater fate is awaiting the poor people from the developing world, where 7 million are projected to die from tobacco related diseases each year.

While per capita consumption of tobacco fell by about 10 percent between 1970-1990 in developed countries, it increased by about 64 percent in developing countries in the same period. Per capita consumption has more than doubled in Haiti, Indonesia, Nepal, Senegal and Syria while it has tripled in Cameroon and China.

China's increases in tobacco consumption has been most dramatic. It alone accounts for 300 million smokers, about the same number as in all the developed countries combined 61% of its men smoke. Tobacco may eventually kill about 50 million of all the children and youth alive today in China.

Most developing countries spend far more foreign exchange on tobacco imports then they gain from tobacco exports. Even for those countries that do export a significant amount of tobacco, most of the profits from the global tobacco trade go to the tobacco transnationals, rather than the treasuries of the developing country.

TOBACCO TRANSNATIONALS

Philip Morris, R.J. Reynolds and British American Tobacco, the world's largest multinational cigarette companies, now each own or lease plants in at 50 countries. In 1997, these three companies had the combined revenues of more than US$65 billion, a sum greater than the GDP of Costa Rica, Lithuania, Senegal, Sri Lanka, Uganda and Zimbabwe combined. 75 percent of BAT's sales comes from developing countries.

Tobacco transnationals have been notorious for using aggressive advertising and promotional tactics not allowed at home. Malaysia for example has come to be known as the world capital for indirect advertising used by the transnationals.

SMOKING CREATES MORE POVERTY

Effects of smoking are more devastating on developing countries. There are 1.3 billion people in developing countries living on less than $1 a day. But smoking makes them even poorer. Cigarettes can cost a smoker about 25 percent of his income. Smoking two packs a day can siphon off about 30 percent of a man's income in Malaysia. A poor man in China can spend up to 60 percent of his income on cigarettes. This takes away income badly needed for more basic needs for the family such as food, rentals, transport, education, etc. Should he become incapacitated he loses the ability to bring in the income. And should he die to a smoking related disease, his family loses their breadwinner altogether plus meet his medical bills.

The amount spent on tobacco in poor countries exceeds that spent on health care and education. Vietnam has a GNP per capita &290 and most of its people earn less than $1 a day. Its annual expenditure on cigarettes represented six times the amount spent on health care and twice the amount spent on education. Smoking costs governments money treating smoking related diseases which their limited health budgets cannot meet.

The burden on governments is great and the statistics speak for themselves; for example it costs Guatemala $800 million, Costa Rica $534 million and India $11 billion. WHO estimated, China gained $4.9B in cigarettes taxes, but lost $7.8B in productivity and health care cost in 1993.

CHILDREN AND TOBACCO

We know that 80 percent of those who start smoking do so before the age of 20. This is quite consistent right across the globe. However we must see the problem in a different context when considering children from poor countries who already have a disadvantaged start in life and will probably continue in this disadvantage well into adult life. Many of the children who start smoking or using tobacco in poor countries are already malnourished, underweight or wasting.

In Pakistan about 1,200 children take up smoking everyday. This must be seen in the light of the 51 percent of Pakistan's children who do not have enough to eat and are moderately to severely underweight. Less than half of the children make it past fifth grade. Its government spends 1 percent of its budget on health and 2 percent on education. It is these children that companies such as BAT hook into a lifetime of addiction and suffering through lies and deception.

In India 92 percent of its children are underweight and wasting. Yet each day 55,000 children in India start using tobacco and about 5 million children under the age of fifteen are addicted to tobacco.

Although cigarettes form about only 20 percent of India's market, the transnational cigarette companies are engaged in an aggressive campaign to capture and convert India's 250 million tobacco users, particularly the young. Tobacco use is growing at the rate of about 5-7 percent. India's health budget which is 1 percent of national budget is no match to handle the carnage of the tobacco related diseases upon its poor. Currently it is already claiming 630,000 lives a year.

Similarly in other poor countries such as Cambodia, Vietnam, Indonesia and Nepal, more than half of their children are underweight and wasting and many of these are entrapping themselves in tobacco addition early in life. It is also apparent that governments, health workers, social organisations and children organisation have not fully realised the wide impact of smoking on these children nor include tobacco control activities as an important aspect of health education and improving public health .

The problem is further complicated when poor children in many developing countries are directly involved in the tobacco business so that they and their families can eat for the day. They either sell cigarettes or involved in its cultivation.

In India for example children are employed for 45 cents a day to roll beedies (cheap handmade high-nicotine cigarettes wrapped in tobacco leaves) and now beedies are exported to the USA and are becoming a fad among the young rebellious Americans.

In the African continent, in Senegal another poor country with a GNP of $570 with a life expectancy of 51 years, in its capital of Dakar a survey found 71 percent of boys and 52 percent of girls between the ages of 10-12 smoke. The problem is worse among children not attending school where 87% were smokers.

TOBACCO FARMERS ARE POOR

Tobacco transnationals are turning to developing countries not only to expand their markets, but for a source of less expensive tobacco. One reason for low prices is much of the direct and indirect cost is absorbed by the farmers, their families and the environment in Southern countries.

Tobacco farmers in developing countries are poor and the cultivation is usually carried out a small scale less than 1 acre and on fertile land that can sustain food crops. Tobacco cultivation is not as lucrative as it is made out to be. The lion's share of profits goes to companies and not to producers.

Tobacco cultivation therefore usurps the place of food crops, and land under tobacco cultivation world wide could feed an estimated 10-20 million people. As a result the governments and people have to bear the burden of higher costs of imported food.

In Kenya, food production in tobacco growing districts has decreased as farmers have shifted from food crops to tobacco. The number of farmers contracted by BAT has increased by 67 percent between 1972 to 1991 and the land under tobacco grew rapidly.

However the net income from tobacco is less than what the farmers would earn from other food crops. BAT is the largest agro-based company in Kenya contracting some 17,500 farmers to cultivate tobacco over an estimated 15,000 ha of fertile agricultural land. But what they earn is not enough to buy sufficient food for the family. Tobacco cultivation is labour intensive and capital intensive. Tobacco requires 1,200 labour hours per acre compared to
beans which take only 120 labour hour per acre or maize which takes only 107 hours.

As a Kenyan farmer pointed out, "In the tobacco season we have a lot of work and we have little time to cook for our children. We buy our maize from the town." The Tobacco money has not alleviated poverty among Kenyan farmers where malnutrition among children is high. A survey by UNICEF in one tobacco growing district reports that 52 percent of he children in that district either suffer from chronic or acute malnutrition or are under-weight.

The situation is similar in Brazil. Today Brazil is the world's largest exporter of tobacco exporting more tobacco to the US than any other country. Brazilian tobacco is primarily used by Philip Morris and other transnationals since it is half the cost of American tobacco. But life for its tobacco farmers has been difficult, riddled with debt and ill health.

Governments of developing countries should also take responsibility for supporting and promoting tobacco cultivation, running state tobacco monopolies, allowing tobacco transnationals to flood the markets and not giving smoking the priority it deserves as it continues to ravage its people.

Who will produce tomorrow's American, British and Japanese cigarettes?

The Marlboro Man and Joe Camel are now riding cheaply out from factories in developing countries to meet international markets. Like many other multinationals, the tobacco transnational are not only good at securing markets among developing countries bit also shifting the production itself overseas. In Vietnam tobacco transnationals such as Philip Morris, R.J. Reynolds and BAT have all started production of their respective brands. In 1997 R.J. Reynold's local joint venture sold $1 million worth cigarettes to Canada and Germany.

Vietnam's poverty makes it a prime target for foreign tobacco companies looking for countries with cheap labour and available land to produce tobacco. Ironically local directors consider this an advantage and welcome the employment opportunities for their poor. We need to stop the relocation of an industry that produces a product that kills. Dimon Inc., one of the world's largest tobacco leaf dealers was the first foreign tobacco company to open on office in Vietnam. It now develops new crop varieties for what it hopes will be growing export market. The local manager is clear about why Vietnam was selected by this company: "Because of cheap labour, Vietnam can sell the majority of its tobacco for less than 43 per kilo... we will be extremely competitive. Tobacco is a fairly stable commodity. Come boom, come bust, there will always be smokers."

Liberalisation of trade is certainly not good news for the smoking epidemic in developing countries. In India previously foreign tobacco companies could only enter the country through joint ventures and had to export at least half of their production. The Indian government has relaxed this ruling and since August 1998 multinational corporations have 100 percent ownership of cigarettes manufacturing plants in the country.

Market predictions are that the transnational will initially operate through joint ventures and licensing arrangements with Indian companies but will eventually take over the market completely much as they have done in other countries. In a more recent example tobacco transnationals have sought to
condition China's entry into the WTO on the opening up of its market. In August 1997 China was to have reportedly cut its tariffs on tobacco imports "as part of its bid to join the WTO."

RECOMMENDATIONS:

Fighting tobacco requires resources that seem to be a never ending problem among Third World governments, NGOs, health workers and tobacco control advocates. In fact it appears that we should be fighting poverty first. The world has more than enough resource to accelerate progress in human development for all and to eradicate the worst forms of poverty.

It is estimated that the total additional yearly investment required to achieve universal access to basic social services would be roughly $40 billion or 1% of world income. That covers the bill for basic education, health, nutrition, reproductive health, family planning, safe water and sanitation.

Ample resources are available but perhaps not channeled for tobacco control and human development (Transparency - The World's Priorities? Annual Expenditure) Smoking and tobacco should be seen as a poverty issue in developing countries. The statistics illustrate that it is devastating for the economy of the country, its farmers, its smokers and on smokers.

The following are a few recommendations:

1. International Action When fighting tobacco the war must be fought both nationally and internationally. Internationally we must stop market expansion to developing countries; free trade arguments should not apply to tobacco. We must expose all double standards practiced both by transnationals as well as governments. Our colleagues in the US, UK and Japan have an extra responsibility of tackling their tobacco transnationals overseas.
2. Tobacco Control is Cost Effective Anti smoking campaigns are the next most cost-effective measures to improve health after childhood immunizations. An anti smoking campaign costs between US$20-40 per year of life gained, compared to $18,000 per year of life gained from lung cancer treatment. By spending less on treatment which many poor countries cannot afford anyway, and more on anti smoking efforts, many more years of life can be saved with the limited resources.
3. Increasing Tobacco Prices
   Raising tobacco prices is one of the simplest and most effective methods for significantly reducing tobacco use, especially among young people. Surveys do indicate that smokers in developing countries are much more sensitive to price changes than their counterparts in developed countries.
4. Setting Aside Tobacco Tax for Tobacco Control
   If health budgets of developing countries are averaging 1 percent of the national budget it is unrealistic to expect any resources from the government for comprehensive tobacco control programs. It would be more realistic to generate money from taxing tobacco more.
   Experience in many countries show that a tobacco tax works and it can significantly increase revenue to fund tobacco control programmers. In Australia his approach has been successfully used for health promotion and health sponsorship funds to replace tobacco industry support of sports and fund aggressive mass media, public education and smoking cessation programs.
5. Impose Equivalent Taxes on All Tobacco Products to Avoid Substitution
   Unless equivalent taxes are placed on all tobacco products, users may simply substitute one form of tobacco addiction for another. Cigarettes, beedies, cigars, pipe tobacco, oral tobacco should all be taxed at equivalent rates.
6. Community-Based Health Programs
   In communities where two thirds of the population does not read and write, it is crucial to devise simple, creative and low budget health programmes. Local government, health groups and other community organisations should all be involved in tobacco control programmes.
   There are simply not enough tobacco control advocates to handles the programmes alone. Health groups can play a key role in the development of comprehensive national tobacco control programmes.
7. Push for Bans on All Forms of Advertising (direct & indirect) and Promotions by Tobacco Companies.
   There must be comprehensive bans which covers all aspects of promotions and this must be legislated.
8. Phase Out Tobacco Cultivation and Stop Subsidies for Tobacco
   Subsidies for tobacco cultivation can no longer be justified and countries should take steps to move away from tobacco cultivation to viable alternate cash crops.

CONCLUSION

For us in the developing world we understand epidemics and outbreaks only too well. Malaysia has just overcome a Japanese Encephalitis (JE and Nipah virus) outbreak. During the past five months we mobilised the health sector and veterinary department to attend to the emergency, the army was brought in to cull about 1 million pigs, we raised millions to rescue pig farmers whose business was affected, we effectively used the mass media to educate the public. All in all about 100 people died in this outbreak and we brought it under control within months. I did not see my government making deals with the vector nor protecting the business that rears the vector. Till today fumigation and vaccination activities are still being carried out to ensure Malaysians are safe from the virus.

The smoking scourge is more serious epidemic for us in the developing world. It has claimed millions of lives over the years and caused untold misery and suffering among millions more, and robbed our governments of precious resources. This epidemic has now infected 800 million people in our part of world, of whom about half will die prematurely.

This epidemic has a vector in form of the tobacco industry which we must tackle in an adequate and comprehensive manner. It is our task to convince governments to put tobacco control as top priority, to illustrate that tobacco exacerbates poverty and is bad economics all round.