Stymied by Less Smoking in Richer Countries, Big Tobacco Shifts Focus on Developing Countries

Anti-tobacco demonstrators in Brazil demand implementation of the national Tobacco Control Law. Credit: Aliança de Controle do Tabagismo

This was originally published by Global Health TV on March 2, 2015.

Between 1990 and 2009, cigarette consumption decreased by 26% in Western Europe, but in Africa and the Middle East, it increased 57%, according to the American Cancer Society (ACS). In response, many of these developing countries are stepping up their efforts to fight tobacco with new laws and restrictions. Big Tobacco is using its deep pockets to finance creative attempts to circumvent those laws.

The problem is so daunting that ACS named rising use of tobacco in developing countries as one of it “Three Top Cancer Challenges of the 21^st Century” earlier this month when it observed World Cancer Day. Comedian John Oliver covered the issue very well in this segment from his HBO show “Last Week Tonight.”

An estimated 8 million of the 14.1 million new cancer cases diagnosed in 2012 occurred in developing countries with 82% of the world’s population, according to Global Cancer Facts & Figures, 3^rd Edition. Smoking causes at least 12 types of cancer, according to the U.S. Surgeon General, and accounts for a fifth of all global cancer deaths. Tobacco use is the cause of nearly 6 million premature deaths annually, notes the report.

Not all cancers can be prevented, but all cancers caused by tobacco can. That is why the fight against tobacco consumption is so important.

The Framework Convention on Tobacco Control (FCTC) is the main global treaty on tobacco control, and 180 countries (out of 196) have ratified it (but not the U.S.). About 90% of the world’s population falls under the FCTC’s protections. Some of the main provisions of the FCTC are regulation of the contents, packaging and labeling of tobacco products, and comprehensive bans on tobacco advertising, promotion and sponsorship. The 27^th of February is the tenth anniversary of the FCTC.

Some of the tactics for fighting tobacco now being implemented, or considered, by developing countries include:

•           Marketing Bans: Despite the fact that many countries have imposed restrictions on tobacco advertising, the tobacco industry still spends almost $10 billion on marketing (2008). Complete bans on tobacco advertising, promotion and sponsorship decrease tobacco use, reports the World Health Organization, but only 24 countries have complete bans on such activities. “The traditional marketing of tobacco products is being more and more regulated,” says Michal Stoklosa, an economist at the American Cancer Society. “That is why tobacco companies are moving toward point-of-sale advertising as well as sponsorship and corporate social responsibility.” But only 67 countries have banned point-of-sale advertising, says Stoklosa. In 2013, the government of Kenya pledged to enforce legislation to ban advertising and promotion of tobacco products, and Stoklosa says Kenya has done an exceptional job of implementing the ban.
•          Warning labels: Health warnings on cigarette packaging are now required in most countries but the degree of the warnings vary by country. The FCTC requires that they cover at least 30%, and preferably 50%, of the visible area of the pack. Some countries require pictorial warnings but most do not. Sri Lanka’s Ministry of Health has just ordered tobacco manufacturers to place graphic warnings about the dangers of smoking on cigarette packs, and it must cover at least 60% of the visible area. And in April 2015, India will go further and require pictorial warnings to cover 85% of the package.
•         Plain cigarette packaging: Cigarette manufacturers have a knack for making their products look appealing. In response, some countries are considering laws that require plain cigarette packaging with limited colors and standardized fonts. A Cancer Research UK campaign for plain cigarette packaging made this video, which brilliantly captures what tobacco foes are up against. So far, only Australia has implemented these plain packs.

I have previously written about tobacco control efforts in Brazil, which were supported by ACS’s “Meet the Targets” program. In 2011, Brazilian President Dilma Roussef signed tough anti-tobacco measures into law. The law called for advertising restrictions, stronger warning labels, higher taxes and smoke-free places. However, it took another year and a half of intense efforts by a civil society coalition led by Aliança de Controle de Tabagismo (ACT) before government issued a decree in May 2014.

ACT told me that the law, which went into effect Dec. 3, 2014, got a huge amount of media coverage as part of an effort to educate people on the law and what it does. Last month, coalition members organized street events with volunteers wearing the campaign’s T-shirt and distributing information about the law, while artists painted the campaign logo on walls. An advertising campaign was launched in social media in December and on radio, newspapers, billboards, buses and elevators in 11 of the 26 states of Brazil.

Last year, when Philip Morris, the manufacturer of Marlboro, was running a major Marlboro campaign called “Be Malboro” in Brazil, ACT and the Campaign for Tobacco-Free Kids criticized the campaign for being a new “youth seduction for smoking,” demanding that it be discontinued in Brazil and asked the Roussef administration to fully implement and enforce the 2011 law. Philip Morris responded that the campaign was aimed “exclusively” for adult smokers.

These efforts are welcome but much more work needs to be done in order to make a dent in the 8 million deaths from tobacco that are expected by 2030.

The American Cancer Society will release the 5^th edition of the Tobacco Atlas on March 18, when you will find it at this website.