The Tobacco Epidemic in the XXIst

Century:Tobacco as a Development Issue

Linda Waverley, MSc, PhDResearch for International Tobacco Control (RITC), IDRC

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The Tobacco Epidemic in the XXIst Century:Tobacco as a Development Issue

Global Tobacco Use

Tobacco and Developing Countries

Tobacco and Development

Tobacco and Poverty

Tobacco Cultivation, Manufacturing and Marketing

Global Responses

Tobacco Control in the XXIst Century

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Global Tobacco Use

Approximately 1.3 billion people smoke cigarettes (1 in 5 of the world’s population; 1 in 3 of those over 15)

Global prevalence (2000) = 29%

(47% men: 10% women)

Tobacco Atlas (2nd Ed.) places women’s smoking at 11%; Men 35% in developed countries; 50% in developing countries

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Global Tobacco Use

GYTS shows many smokers in developing countries begin in their teens

Quitting rates low in low- and middle-income countries compared to developed countries

One in two long-term smokers will die from a tobacco related disease - many before 65

Tobacco expected to be the leading global cause of death before age 65 by 2020

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Global Tobacco Use Tobacco use sustained through addictive properties,

low prices, social norms, vigorous marketing by powerful multinational corporations

Perceived by many to contribute to social and psychological well-being

Tobacco epidemic exacerbated by complex factors with cross border effects, including trade liberalization, foreign direct investment, global marketing; transnational advertising, promotion and sponsorship; international movement of contraband and counterfeit cigarettes.

Tobacco advertising is ubiquitous and aggressive

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Advertising

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Advertising

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Tobacco and Developing Countries

70 % of tobacco grown in developing countries

70 % of tobacco consumed in developing countries

In 2000 half of 5 million tobacco-related deaths occurred in developing countries

By 2030 70 % of tobacco–related deaths will occur in developing countries

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Stages of the Tobacco Epidemic

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Tobacco Use and Non Communicable Diseases (NCDs) in Developing

Countries

Tobacco use linked causally to cancers, cardiovascular disease, respiratory diseases, tuberculosis, and diabetes

Population aging and changes in risk factors have accelerated the epidemic of NCDs in many developing countries

Burden of NCDs is increasing, accounting for nearly half of the global burden of disease (all ages)

Many developing countries now face a “double burden”

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Past and Future Annual Deaths due to Tobacco Use

0.3 0 0.31.3

0.2

1.52.12.1

4.2

3

7

10

01234567

89

10

1950 1975 2000 2025-2030

Developed

Developing

World

Source: Who (2002) The Tobacco Atlas, p.36.

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Tobacco and Development

More than a health issue: economic, agricultural, environmental, socio-cultural, trade and marketing

Tobacco linked to poverty (up to 10% of household expenditures in poorest families)

Women and youth at particularly high risk

Tobacco kills people in their productive middle years

High economic costs – estimated $2.2 B direct medical costs; $5.4 B lost productivity in Canada (1992 USD)

Tobacco and Poverty

“Each tobacco user represents one of more people – whether the smoker or his or her spouse or child – who is needlessly going hungry”

(Efroymson et al, Tobacco Control 2001

 

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Tobacco and Poverty

Tobacco linked to poverty as household income is spent on tobacco rather than food or basic need

India/Bangladesh/Egypt: 2% - 4.5% of household expenditures on tobacco products

Bulgaria 10.4% of total income on tobacco products

China 17% of household income on tobacco

Even small amounts represent very high opportunity costs

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Tobacco and Poverty

Evidence in some countries that tobacco use is growing fastest amongst the poorest groups:

Indonesia:1981 – lowest income groups spent 9% of

their total expenditure on tobacco1996 – lowest income groups spent 15%

of their total expenditure on tobacco

In Bangladesh- smoking twice as high in the lowest income group as in the highest

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Tobacco and Poverty

Smoking exacerbates poverty in other ways:Poor families are vulnerable to illness

particularly the loss of a breadwinner Paying for treatment further impoverishes

families

Study of 20,000 poor men and women in 23 countries found that sickness or injury in a family is by far the most frequent trigger into (worse) poverty

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Tobacco and Poverty

Urban and rural Bangladesh per capita spending on tobacco higher than on milk

Spending by average smoker on cigarettes would buy 3000 calories of rice

Often men control the income and have first access to food. Women and children are most likely to go hungry.

Vietnam – annual household expenditure on tobacco 1.7 times expenditure on education

Advertising and low taxes encourage purchase of tobacco

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Tobacco Cultivation

Given the growth in world population, the tobacco industry will not decline rapidly enough to cause workers to lose their jobs

Trans-national companies are increasingly replacing less efficient local operations. Manufacture of foreign cigarettes is highly mechanized

Most job losses result from increasing mechanization.

Farm families reap little profit from tobacco cultivation

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Tobacco Cultivation

Tobacco farmers in cycle of debt to repay farm input loans

Farm income vulnerable in case of bad crop year or low tobacco prices

Harm to farm families and the environment through heavy use of pesticides.

Labour intensive crop often involving women and children

Curing process harmful to health and involves extensive deforestation

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Tobacco Manufacturing and Marketing

Those working in tobacco factories or selling tobacco on the streets earn starvation wages.

Beedi workers in India among the most exploited in India

Young children often involved in the production of beedis

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Global Responses:WHO Commission on Macroeconomics and

Health (CMH)

CMH emphasized the interconnectedness of health and sustainable development

Where national disease burden is high, national wealth and productivity are likely to be low

Two way relationship between economic development and health:Poverty increases vulnerability to diseasePeople who are sick cannot work – affecting their

income

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Global Responses:WHO Commission on Macroeconomics and

Health (CMH)

CMH emphasized tobacco as a link between poverty and illness

CMH highlights tobacco consumption as one of the serious deleterious consequences of globalization

Significant changes can be achieved through modest investments in tax increases; ad bans; strong health warnings on cigarette packages; and use of primary health care services for advice and assistance to smokers

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Global Responses:Millennium Development Goals (MDGS)

Overlap between the MDGs and CMH:Both seek to reduce the impact of health-

related problems as an element of economic development

Both focus on alleviation of poverty as a key determinant of future economic development

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Global Responses:The Framework Convention on Tobacco

Control (FCTC)

First global treaty to focus on a health issue

Negotiated under the auspices of the WHO

Came into force in Feb. 2005 following ratification by 40 countries

Includes demand and supply reduction strategies

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Global Responses:The FCTC

Public health issues cannot be contained within national borders; require greater collaboration and coordination

FCTC responds to:The tobacco epidemic in developing countries;Globalization;Trade liberalization

Highlights the need for: Multi-sectoral action and Trans-national cooperation

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The FCTC:includes a variety of policy measures:

Advertising, promotion and sponsorship

Price and tax measures

Passive smoking and smoke-free environments

Packaging and labelling

Product regulation

Tobacco sales to and by young people

Treatment of tobacco dependence

Education, communication and public awareness

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Tobacco Control in the XXIst Century

While tobacco use contributes to the entrenchment of individuals and nations in poverty, economic growth in the world’s poorest nations is likely to fuel, if unchecked, an increase in tobacco use.

Tobacco use is not a personal choice, freely made. Tobacco control should be a part of initiatives designed to improve health and reduce poverty.

Lack of statistical information results in poor evidence for the individual and national health and economic impacts of tobacco use.

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Tobacco Control in the XXIst Century

Tobacco industry greatly overstates its contribution to national economies and understates the costs tobacco imposes.

Price and tax measures in coordination with measures to reduce smuggling will increase government revenues (and reduce poverty) and decrease tobacco use.

Action to reduce exposure to ETS will beneficial for health and the environment

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Tobacco Control in the XXIst Century

Controls on labelling and packaging, limits on advertising and sales to minors, education and public information will increase awareness of the dangers of smoking.

Support for alternative crops and the environment will limit the negative effects of tobacco cultivation and may alleviate poverty.

Research and sound evidence to convince policy-makers to support these measures

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Thank You

Linda Waverley

http://www.idrc.ca/ritc