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Environment

Tobacco and developing countries

January 14, 2020

Par: webstudio_editor

Dernière mise à jour: August 6, 2024

Temps de lecture: 22 minutes

Tabac et pays en développement

Tobacco in developing countries

The World Health Organization (WHO) estimates that approximately 1.1 billion people aged 15 and over use tobacco products, of whom 80% live in low- and middle-income countries. Tobacco cultivation and consumption have been concentrated in developing countries where the health, economic and environmental burden is greatest and is expected to further increase in the years to come.

  • In summary

  • Data show that the number of smokers in low- and middle-income countries has increased and will likely continue to increase without strong tobacco control measures.
  • The health burden of tobacco use is disproportionately high in developing countries. By 2030, it is estimated that tens of millions of people in developing countries will have died from tobacco use. The majority of child deaths due to second-hand smoke also occur in Africa and Southeast Asia.
  • Smoking in developing countries has been shown to reinforce poverty, as already impoverished smokers spend less on health care, children's education, food and clothing.
  • Almost all tobacco cultivation now takes place in low- and middle-income countries. This causes major environmental damage such as massive deforestation and air pollution. Poor industry safety practices leave tobacco farmers – many of whom are children – prone to developing serious occupational illnesses (See green tobacco disease + pesticide exposure…).
  • Transnational tobacco companies have been shown to target women and children in developing countries. They also undermine efforts to limit the harms of tobacco, particularly through proceedings brought against all governments around the world seeking to protect their populations.
  • Although some progress has been made in tobacco control in developing countries, low- and middle-income countries still lag significantly behind high-income countries.
There is no standard definition of “developing country” and classification varies from organization to organization. For example, the World Trade Organization requires its members to self-declare themselves as “developed” or “developing”, the United Nations system has no established convention for designating developed and developing countries, but in common practice, North America, Europe, Australia, New Zealand and Japan are generally considered “developed”. In 2016, the World Bank stopped distinguishing between “developed” and “developing” countries, but continues to classify countries by income level: low, lower middle, middle and upper. This latter classification is widely used in the public health literature and low- and middle-income countries are often referred to as “developing”. In general, these countries tend to have poorer economies, higher poverty and mortality rates and generally lower standards of living than high-income countries. [caption id="attachment_1176" align="alignnone" width="1024"]pays-en-developpement-tabac Advanced economies - Emerging and developing economies (not least advanced) - Emerging and developing economies (least developed) IMF and UN classifications[/caption] Tobacco use is the leading cause of preventable premature death worldwide. The tobacco epidemic is the greatest global public health threat the world has ever faced, killing more than 8 million people each year, with more than 7 million dying as a direct result of tobacco use. While demand for tobacco has declined over time in developed countries, tobacco cultivation and consumption are increasingly concentrated in the developing world. The tobacco epidemic is causing unprecedented environmental, health, and economic costs in the developing world -. Due to population growth, rising incomes, and inadequate tobacco control, the burden of tobacco use is expected to increase further. This is a price that developing countries cannot afford to pay.

  • Tobacco consumption by gender

Smoking rates among men remain higher than those among women in both developing and developed countries. However, an analysis of WHO data shows that for men, declines are projected for most countries in almost all regions except Africa. The prevalence of smoking among women is currently significantly lower in developing countries than in developed countries, around 3% compared to 17% according to one study. This lower prevalence represents a challenge for tobacco manufacturers who deploy aggressive marketing strategies aimed at them. As a result, the growing tobacco epidemic is increasingly recognized as a particular threat to the health of girls and women in low- and middle-income countries, and increases in female smoking in some developing countries have been reported.

  • Health effects

Tobacco use harms almost every organ in the body and is the leading cause of preventable death. In 2016, more than 8 million deaths were attributable to tobacco use worldwide. Millions of people suffer from lung cancer, tuberculosis, asthma and chronic respiratory diseases because of tobacco use. Tobacco use also aggravates certain diseases such as tuberculosis. It is estimated that tobacco use will kill around 40 million people in developed countries between 2005 and 2030. In developing countries, this number is more than three times higher, estimated at around 135 million. Although the prevalence of tobacco use is decreasing in some low- and middle-income countries, relatively high population growth in the developing world means that the number of smokers, and therefore the number of deaths and diseases attributable to tobacco use, will continue to increase. This public health epidemic will place a heavy burden on health systems and economies in developing countries as smokers begin to suffer from tobacco-related diseases. Because of a time lag between the onset of smoking and when people begin to experience the bulk of the health effects of smoking, the full extent of the health and economic burden is not yet fully apparent in these countries. Smoking also contributes to poor health because smokers in some of the poorest countries spend their income on tobacco at the expense of food and health care budgets. In many cases, tobacco expenditures are a direct cause of malnutrition. In Bangladesh, for example, it was found that poor smokers could have added more than 500 calories to the diet of one of their children on average if they had kept the share of their daily budget spent on tobacco in food. This would save 350 children's lives every day. In Indonesia, paternal smoking was associated in the study with an increased risk of severe underweight and severe stunting in rural children[1].

  • Tobacco, a vicious circle of poverty

Smoking has been shown to reinforce wealth inequality and poverty. One study found that the poorest households in Bangladesh were twice as likely to smoke as the richest households, and male smokers on average spent twice as much on cigarettes as the combined per capita expenditure on clothing, housing, health and education. In India, about 15 million people are pushed into poverty because of tobacco use. Households whose main income earners are daily tobacco users also spend less on children’s education. This reduces household purchasing power, contributing to intergenerational poverty. On a macroeconomic level it also impairs economic output at the national level. One study found that smoking reinforced a cycle of deprivation in Cambodia: tobacco spending crowds out education spending, and lower education is associated with higher levels of smoking, which in turn increases tobacco spending. Contrary to the tobacco industry's claims that tobacco farming brings positive economic benefits to developing countries, most of the profits go to large multinational corporations, while many tobacco farmers remain poor and indebted. Moreover, the tobacco industry's economic gains are more than offset by the considerable costs to the environment and public health. Contrary to the argument often put forward by the tobacco industry, WHO estimates that in almost all countries dependent on tobacco farming, there would be no net loss of jobs if tobacco consumption were reduced. Tobacco accounts for about 1% of global agricultural employment: in China, the world's largest tobacco producer, only 1% of agricultural output is for tobacco farming; in Brazil, another major producer, less than 2% of the total agricultural workforce produces tobacco. Old man are smoking tobacco in the countryside.

  • The tobacco industry

The tobacco industry has expanded significantly in low- and middle-income countries in recent decades, driven by the various opportunities that exist there. The global industry is dominated by four privately owned transnational tobacco companies – Philip Morris International (PMI), British American Tobacco (BAT), Japan Tobacco International and Imperial Tobacco. Because tobacco consumption is declining in most high-income countries, tobacco companies have exploited opportunities in Asia, Africa and the Middle East, where consumption has increased and tobacco control laws and policies were weak. Although the tobacco industry claims that it advertises only to influence smokers’ brand choices, evidence suggests that it pursues marketing tactics to encourage people to start smoking, particularly in developing countries. Given that smoking rates were historically low among women in low- and middle-income countries (see above), manufacturers targeted marketing to women by creating more “feminized” products, including cigarette packs that resembled lipstick or perfume, as well as ultra-thin “light” cigarettes. They also promoted cigarettes as a tool for women’s empowerment in order to normalize smoking among women in developing countries. In India, where smoking among women is often taboo, companies even offered to deliver them to homes. The tobacco industry has also been shown to target children. Sub-Saharan Africa’s rapidly growing youth population is a prime target for the tobacco industry. In many African countries, large numbers of children are offered free cigarettes by tobacco company representatives—for example, nearly a quarter of children in Guinea and Gambia reported that this had happened to them. WHO warns that the tobacco industry actively undermines efforts to implement tobacco control policies, for example by exaggerating the economic importance of the industry. In addition, it manipulates public opinion.[2] ; discredits scientific research; and intimidates governments with legal action. Manufacturers also use deals with governments to prevent policies that are unfavorable to them. For example, Philip Morris and BAT, the world’s two largest tobacco companies, struck a deal with Mexico’s health ministry: in exchange for funding health services for the uninsured, the government waived tax increases and graphic health warnings on cigarette packages. Tobacco companies have also sued many low- and middle-income countries for efforts to reduce tobacco use and associated harm. Examples include Sri Lanka over the increase in the size of health warnings; Kenya and Uganda; and South Africa and a number of South American countries. A recent report by the Tax Justice Network revealed a series of mechanisms used by British American Tobacco (BAT) to reduce taxes paid in low-income countries. While tobacco companies are among the most profitable corporations in the world and have long stressed that they make an economic contribution to countries through taxes collected on tobacco, the profits and corporate taxes they pay are small compared to the economic damage caused by smoking. The activities undertaken by companies as part of their “corporate social responsibility (CSR)” are normally aimed at achieving social and/or ethical goals such as improving living standards or the environment. However, WHO stresses that tobacco companies’ CSR initiatives are an image-building exercise and are intended to promote their companies while increasing their power vis-à-vis management.[3].

Tobacco control and the FCTC

The Framework Convention on Tobacco Control (FCTC) is the first international public health treaty negotiated through the WHO. This treaty was developed in response to the global tobacco epidemic. The treaty provides a comprehensive framework of obligations and evidence-based enforcement guidelines for countries to adopt comprehensive tobacco control legislation. The treaty also aims to help countries resist pressure from the tobacco industry. The FCTC currently has 181 Parties, covering 90% of the world's population. The integration of the FCTC into the 2015 Sustainable Development Goals (SDGs) reaffirmed the importance of tobacco control in achieving these Sustainable Development Goals. Significant progress has been made in tobacco control policies in low- and middle-income countries. Since 2014, low- and middle-income countries that previously had no comprehensive tobacco control policy have introduced one or more best practice measures with particularly strong effects. important cclat-convention-cadre-lutte-anti-tabac However, much remains to be done in tobacco control in developing countries, particularly in low-income countries. For example, while more than 70% in developed countries adequately monitor tobacco consumption, only one low-income country (Uganda) has an effective surveillance system. Additionally, approximately 30% of developing countries have no treatment for tobacco dependence, while all high-income countries have at least nicotine replacement therapy and/or cessation services. In more than 40% of low-income countries, there is no ban on tobacco advertising, promotion and sponsorship activities, compared to around 10% of high-income countries. Stronger and more comprehensive tobacco control policies are therefore essential to ensure that developing countries are not left behind in the global fight to reduce tobacco consumption.  

Sheet translated and adapted from Action for Smoking and Health UK

The ASH UK website: https://ash.org.uk/home/

logo-ash-uk ©Tobacco Free Generation
[1] Best CM, Sun K, De Pee S, Sari M, Bloem MW, Semba RD. Paternal smoking and increased risk of child malnutrition among families in rural Indonesia. Tobacco control. 2008 Feb 1;17(1):38-45 [2] WHO. Tobacco industry interference: A global brief. 2012 [3] WHO. Tobacco industry and corporate responsibility… an inherent contradiction. 2004   environnement-et-tabac-cnct-gst-reférence ©National Committee Against Smoking |

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