The Tobacco Epidemic in the XXI st Century: Tobacco as a Development Issue Linda Waverley, MSc, PhD Research for International Tobacco Control (RITC), IDRC Insert your image here

2 The Tobacco Epidemic in the XXI st 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 XXI st Century

3 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 (2 nd Ed.) places women’s smoking at 11%; Men 35% in developed countries; 50% in developing countries

4 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

5 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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9 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 % of tobacco–related deaths will occur in developing countries

10 Stages of the Tobacco Epidemic

11 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”

12 Past and Future Annual Deaths due to Tobacco Use Source: Who (2002) The Tobacco Atlas, p.36.

13 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

15 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

16 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

17 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

18 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

19 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

20 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

21 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

22 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 disease  People who are sick cannot work – affecting their income

23 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

24 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

25 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 following ratification by 40 countries  Includes demand and supply reduction strategies

26 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

27 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

28 Tobacco Control in the XXI st 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.

29 Tobacco Control in the XXI st 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

30 Tobacco Control in the XXI st 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

31 Thank You Linda Waverley