The Tobacco Epidemic in the XXIst Century: Tobacco as a Development Issue Linda Waverley, MSc, PhD R

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The Tobacco Epidemic in the XXIstCenturyTobacc
o as a Development IssueLinda Waverley, MSc,
PhDResearch for International Tobacco Control
(RITC), IDRC
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The Tobacco Epidemic in the XXIst
CenturyTobacco 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 worlds population 1 in 3 of
  those over 15)
• Global prevalence (2000) 29
• (47 men 10 women)
• Tobacco Atlas (2nd Ed.) places womens 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 tobaccorelated 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
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)

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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 tobacco
• 1996 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 ResponsesWHO 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 disease
• People who are sick cannot work affecting their
  income

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Global ResponsesWHO 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 ResponsesMillennium 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 ResponsesThe 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 ResponsesThe 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 FCTCincludes 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 worlds 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 YouLinda Waverleyhttp//www.idrc.ca/ritc