The Growing Global Tobacco Epidemic and the

International Response

Ross HammondCampaign for Tobacco-Free Kids

University of Washington2 May 2007

1. Tobacco & Globalization1. Tobacco & Globalization2. Tobacco & Poverty2. Tobacco & Poverty3. The Global Toll3. The Global Toll4. The International Response4. The International Response

1. Tobacco & Globalization1. Tobacco & Globalization

Free Trade & Financial Liberalization have greatly increased profit opportunities for Big Tobacco

Global Communications/Marketing has helped them take advantage of these opportunities

Coordinated Lobbying has ensured (so far) that their profits are protected

“Tobacco exports should be expanded aggressively, because Americans are smoking less.”

-- U.S. Vice-President Dan Quayle, 1990

Global Expansion Fuelled By:Global Expansion Fuelled By:

opening up of formerly closed economies (FSU, E. Europe, China)

pressure to liberalize investment laws and privatize state-owned industries

pressure to embrace “free trade” (as defined by the West) & expansion of free trade areas in Asia & L. America

Complete Transformation of Complete Transformation of the Global Tobacco Industry in the Global Tobacco Industry in

the Last 25 yearsthe Last 25 yearsPrivatization of state-owned

tobacco monopoliesJoint-venture agreementsConsolidation/mergersBetween 1991-2001, over 140

mergers and acquisitions

Global ExpansionGlobal ExpansionIn 2002, Philip Morris, BAT and Japan

Tobacco operated in over 50 countries each and had combined tobacco sales of over $121 billion, a sum greater than the combined GDPs of: Albania, Bahrain, Belize, Bolivia, Botswana,

Cambodia, Cameroon, Estonia, Georgia, Ghana, Honduras, Jamaica, Jordan, Macedonia, Malawi, Malta, Moldova, Mongolia, Namibia, Nepal, Paraguay, Senegal, Tajikistan, Togo, Uganda, Zambia and Zimbabwe

0 10 20 30 40 50 60

Philip Morris

US$ billions

Czech Rep

Kenya

Senegal

Sri LankaCosta Rica

Hungary

Source: Philip Morris, World Bank

Philip Morris Tobacco RevenuePhilip Morris Tobacco Revenue& Select Country GDPs (2000)& Select Country GDPs (2000)

“We are still in the foothills when it comes to exploring the full opportunities of many of our new markets.”

-- Geoffrey Bible, Philip Morris CEO, 1996

US Government Has US Government Has Promoted Tobacco OverseasPromoted Tobacco Overseas

1980s: Threat of trade sanctions to pry open Japan, Thailand, S. Korea & Thailand. In S. Korea led to 10% increase in prevalence.

1999: US-China treaty for PNTR included provision requiring China to slash tariffs on imported cigarettes

2001: Pressure on S. Korea not to raise tobacco tariffs

“Philip Morris strongly supports NAFTA and also supports the Uruguay Round process….We are well positioned to take advantage of the new opportunities that the removal of trade barriers will offer us. I see both the NAFTA and the Uruguay Round as real “winners” as far as Philip Morris is concerned.”

-- Internal Philip Morris document, 1994

Global Communications & Global Communications & MarketingMarketing

Traffic Lights in Bucharest, Romania

“This is a market with tremendous potential. The rate of population growth is 2.2. percent each year, and 40 percent of the population is under 18.”

-- Philip Morris Turkey, 1997

Thailand

“Give me an amerika”Czech slang for a good cigarette

Global Lobbying EffortGlobal Lobbying Effort

In every region of the world:http://www.library.ucsf.edu/tobacco/docsbiblio.html

““Tobacco use is unlike other Tobacco use is unlike other threats to global health. Infectious threats to global health. Infectious diseases do not employ diseases do not employ multinational public relations multinational public relations firms. There are no front groups to firms. There are no front groups to promote the spread of cholera. promote the spread of cholera. Mosquitoes have no lobbyistsMosquitoes have no lobbyists.”.”

-- WHO Zeltner Report, 2000

“We must try to stop the development towards a Third World commitment against tobacco. We must try to get all or at least a substantial part of Third World countries committed to our cause….We must try to mitigate the impact to WHO by pushing them into a more objective and neutral position.”

-- BAT internal document, 1979

2. Tobacco & Poverty2. Tobacco & Poverty

How Tobacco Impoverishes How Tobacco Impoverishes IndividualsIndividuals

Money spent on tobacco cannot be spent on food, health care or education.

In Bangladesh, over 10.5 million malnourished people could have an adequate diet if money spent on tobacco was instead spent on food.

Child LaborChild Labor

Use of child labor in tobacco growing and manufacturing widespread.

These children miss out on educational opportunities that could help lift them out of poverty.

How Tobacco Impoverishes How Tobacco Impoverishes FamiliesFamilies

Smokers are at much higher risk of falling ill and dying prematurely. If the main breadwinner becomes ill from tobacco, the family loses that person’s income AND has to bear the additional health care costs.

Tobacco Farming Can Lead to Tobacco Farming Can Lead to Indebtedness & Ill HealthIndebtedness & Ill Health

Extremely labor-intensiveRequires expensive inputs

(fertilizers, pesticides, etc.)Pesticide and nicotine poisoning

common.

Tobacco Growing: Who Tobacco Growing: Who Profits?Profits?

Limited # of purchasers for tobacco. Farmers dependent on the companies to grade tobacco (and thus set price).

A tobacco farmer in Brazil would need to work for 6 years to earn what BAT's Director earns in a single day. It would take him 2,140 years to earn the Director’s annual salary.

How Tobacco Impoverishes How Tobacco Impoverishes CountriesCountries

Environmental DamageIncreased Health Care CostsLost productivity due to illness and

premature death Foreign exchange losses

Environmental DamageEnvironmental Damage

Wood used to cure tobacco in many countries. Each year an est. 494,000 acres of forest is cut down (equiv. to ¾ the size of Olympic Natl. Park)

Tobacco leeches nutrients from the soil, requiring more fertilizer use. Runoff from fields pollutes watersheds vital for drinking water.

Environmental Damage Has Environmental Damage Has Economic CostsEconomic Costs

All of this environmental damage has an economic cost, though not currently captured in official statistics.

Increased Health Care CostsIncreased Health Care CostsIn high income countries, annual tobacco-

attributable health care costs est. at between 6% and 15% of total health care costs (very few estimates for low income countries).

In China, direct and indirect tobacco-attributable health care costs est. at $6.5 billion per year in mid-’90s.

Lost ProductivityLost Productivity

If current trends persist, about 500 million people alive today will eventually be killed by tobacco, half of them in productive middle age, each losing 20 to 25 years of life.

Foreign Exchange LossesForeign Exchange Losses

Most countries import more tobacco leaf, tobacco products and tobacco-related machinery than they export.

Most tobacco profits repatriated to the home countries of the multinationals.

Tobacco’s Economic Tobacco’s Economic Importance ExaggeratedImportance Exaggerated

Despite industry claims, few countries benefit from tobacco. Only 5 derive more than 5% of export earnings from tobacco

Tobacco represents small % of the labor

force. In Brazil (world’s largest tobacco exporter), tobacco accounts for less than 2% of the ag. labor force.

3. The Global Toll3. The Global Toll

Global Causes of Death

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Deaths in Millions

Tobacco LowerRespiratory

Infections*

DiarrhealDiseases*

PerinatalConditions*

Tuberculosis AIDS

* WHO World Health Report 2002

The Coming Epidemic

1.1

1.64

0

0.5

1

1.5

2

billions of smokers

2000 2025

Rise in Smokers Worldwide

Currently: 4.9 million people die per

year 13,400 people per day 560 people every hour

By 2030: 10 million people a year

will die from tobacco use 70% of those deaths will

occur in developing countries

Global DeathsGlobal Deaths

4.9

10

0

1

2

3

4

5

6

7

8

2000 2030

millions of deaths

Developed CountriesDeveloping Countries

4. The International Response4. The International Response

FCTCCivil SocietyDonor Community

Framework Convention on Framework Convention on Tobacco Control (FCTC)Tobacco Control (FCTC)

1st international public health treatyObjective: to protect present and future

generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke ...

FCTCFCTCPreamble38 Articles168 Countries Have Signed146 Have Ratified (not the U.S.)

Find the full text at www.fctc.org

FCTC: Key ProvisionsFCTC: Key Provisions ` `

Enact comprehensive bans on tobacco Enact comprehensive bans on tobacco advertising, promotion & sponsorship within advertising, promotion & sponsorship within

5 years of ratification (some exceptions)5 years of ratification (some exceptions)

Pakistan

Japan

Thailand

Place rotating health warnings on packs Place rotating health warnings on packs that cover 30% or more of the package that cover 30% or more of the package and can include pictures or pictogramsand can include pictures or pictograms

Ban the use of misleading and Ban the use of misleading and deceptive terms such as "light" and deceptive terms such as "light" and

"mild""mild"

Protect citizens from exposure to Protect citizens from exposure to tobacco smoke in workplaces, public tobacco smoke in workplaces, public transport and indoor public placestransport and indoor public places

Other Key ProvisionsOther Key Provisions Encourage tobacco tax increases Establish & finance ntl. coordinating body Include cessation services in ntl. health progs Prohibit free distribution of tobacco Promote NGO participation Prohibit sales to minors No reservations allowed

Framework Convention Framework Convention Alliance (FCA)Alliance (FCA)

Diverse alliance of over 250 NGOS from more than 90 countries working to support FCTC ratification and implementation

WWW.FCTC.ORG

“The participation of civil society is

essential in achieving the

objective of the Convention and its protocols.”

STAGED EVENTS DURING STAGED EVENTS DURING FCTC MEETINGSFCTC MEETINGS

Issued Daily Report CardIssued Daily Report Card

Challenges for Civil SocietyChallenges for Civil Society

Keep momentum going and maintain sense of urgency

Hold governments accountable for FCTC commitments

Work on guidelines and protocols to FCTC

ENCOURAGE COUNTRY-ENCOURAGE COUNTRY-LEVEL ADVOCACYLEVEL ADVOCACY

CLOCK IS TICKINGCLOCK IS TICKING

February 27, 2008- 40 original ratifying countries must have health warnings on packages

February 27, 2010- 40 original ratifying countries must have ad ban in place

MONITOR COUNTRY MONITOR COUNTRY COMPLIANCECOMPLIANCE

Global Voices for A Global Voices for A Smokefree World Smokefree World Campaign Campaign

Reach out to governments to secure support for strong Article 8 guidelines.

Meet with Health Ministers in target countries. Conduct a media campaign around smokefree

air and the Article 8 guidelines.

www.globalsmokefreepartnership.org

Donor CommunityDonor Community

Bloomberg Open Society Institute (Soros) NIH American Cancer Society IDRC/Research for Intn’l Tobacco Control Cancer Research Campaign Bilaterals (Sweden IDA, Canada IDA, etc.) Others? (Gates Foundation)

Bloomberg GranteesBloomberg Grantees

Campaign for Tobacco Free KidsCDC FoundationFramework Convention AllianceJohns Hopkins School of Public HealthWorld Health OrganizationWorld Lung Foundation/IUATLD

Focus on fifteen cFocus on fifteen countriesountries with the with the greatest number of tobacco usersgreatest number of tobacco users

China

India

Indonesia

Russia

Bangladesh

BrazilMexicoTurkeyPakistanEgypt

UkrainePhilippinesThailandVietnamPoland

Campaign for Tobacco Free Kids’ Campaign for Tobacco Free Kids’ Role in Bloomberg InitiativeRole in Bloomberg Initiative

To support advocacy efforts in the following ways:

Strategic Planning/Campaign Support

Research

Media/Communications

International Legal Consortium

Advocacy Grant Fund

MORE INFORMATION:

www.fctc.org

www.tobaccofreekids.org

Yach, Wipfli, Hammond & Glantz, “Globalization and Tobacco” in Ichiro Kawachi & Sarah Wamala eds., Globalization and Health, London: Oxford University Press (2006).