June 24, 2018
How Big Tobacco Hurts World Health

How Big Tobacco Hurts World Health

by John Swartzberg, M.D.

What does the tobacco industry do when its US and Western markets shrink? Create new markets, in the poorest of nations, in a most insidious way.

This year marks the 28th World Health Organization (WHO) World No Tobacco Day, and it's worth taking a few minutes to look at how Big Tobacco is intentionally undermining the health of the world's most vulnerable people.

China is an example. That nation went from being a hodge-podge producer of poor quality tobacco during its years of isolation and poverty to being the largest tobacco producer in the world today—with help of US advisors and tobacco companies. The industry is run by China's Tobacco Monopoly Administration and it brings in a whopping 7.6 percent of the central government's total revenue. Today that nation has a third of the world's smokers. Tobacco kills an estimated 1 million Chinese a year. But until recently the government had little incentive to try to curb smoking because it made so much money from tobacco.

As the health costs of smoking in China rose, my colleague at the UC Berkeley School of Public Health, professor emeritus Teh-wei Hu, was able to work with others to convince the government to put a small excise tax on each pack of cigarettes, plus increase the wholesale price by 6 percent. This raised the cost per pack about 10 percent. We hope this will begin a transition to stricter tobacco control that we've seen in other developed, wealthy nations. Governments tend to become more concerned about the health costs when their need for tobacco dollars diminishes.

But, of course, while China's economic strength was growing, Big Tobacco was already moving on to its next target: Sub-Saharan Africa. Countries such as Malawi, Mozambique, Tanzania, Zambia, and Zimbabwe have low smoking rates, which makes Africa an enticing new market for the tobacco industry. And, as of 2012, those countries were among the top 20 tobacco producers in the world. Professor Hu's research shows that between 2003 and 2012, the total area harvested for tobacco in African countries increased by 66 percent.

Poor countries view tobacco as an important source of revenue, and the tobacco industry says the cultivation relieves poverty. The reality? Tobacco cultivation enriches the governments far more than the small farmer. Hu's research shows that tobacco in Africa is typically grown on small farms, often worked by women and children. The farmers take loans from tobacco companies to buy seeds, fertilizers, and pesticides, then they sell the tobacco leaf back to the tobacco companies, often at a controlled price. After paying back their loans and factoring in the cost of labor, the farmers may make less than they would on food crops such as paprika, tomatoes, rice, or groundnuts, Hu says.

The governments of tobacco-growing African countries, however, make a fortune off of tobacco. Tobacco accounts for 60 percent of Malawi's annual earnings—13 percent of the country's GDP. So the governments have no financial incentive to discourage smoking. In fact they have every incentive to encourage it.

The cycle could be broken. WHO and large foundations could subsidize—at least temporarily—alternative food crops. The international community could help create stable markets for those crops. Yes, it would take creativity and effort. But the model is there for us to follow. Big Tobacco developed it: Sell the seeds and supervise cultivation, guarantee a market, enlist the government in managing the industry. That model is turning poor nations into major tobacco producers. Surely it could turn them into food producers as well.