Many governments are trying to make it harder for the tobacco industry to do business in their countries.
Some are succeeding, but others are failing to combat the industry’s push worldwide. And if spending is an indicator of priorities, fighting tobacco use ranks very low on the global health agenda.
Among the victors thus far is the Australian government, which is waging war against big tobacco with plain packaging laws and graphic labels warning consumers of the dangers of smoking. Also, when it discovered that smoking accounted for much of the disparities in health outcomes between Indigenous Australians and the rest of the population, the government funded an initiative to lower smoking in this group.
The Australian government recently won lawsuits launched by two international tobacco companies in response to its new packaging guidelines, as mentioned in John Oliver’s Last Week Tonight episode in February (make sure to watch to end to see the T-shirts featuring the cartoon character Jeff the diseased lung that Oliver’s gang sent to Togo!):
Despite the fact that the world has known about the dangers of tobacco since the US Surgeon General’s report issued in 1964, Oliver notes that the tobacco industry is booming thanks to growing demand from developing countries. The screen grabs from IHME’s tobacco visualization tool, below, illustrate these trends. The number of cigarette smokers among males and females decreased in developed countries between 1980 and 2012, but it increased dramatically in males in developing countries during this period. Population growth is the main reason that the number of smokers is rising in developing countries.
Number of smokers in developed countries, males (green), and females (purple), 1980-2012
Note: To access the data visualization online, visit http://ihmeuw.org/31uu. Data are derived from the study Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980-2012, published in JAMA in 2014.
Number of smokers in developing countries, males (green), and females (purple), 1980-2012
Note: To access the data visualization online, visit http://ihmeuw.org/31ut. Data are derived from the study “Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980-2012,” published in JAMA in 2014.
Certain developing countries are taking steps to reduce tobacco use. Oliver profiles some of these efforts in the video. He recounts how Togo attempted to implement new packaging regulations for tobacco products similar to Australia’s, but they backed down when Phillip Morris International, whose profits are 20 times the size of Togo’s annual GDP, sent them a letter threatening litigation. The screen grab below shows how smoking has steadily increased among Togolese men since 1980.
Number of smokers in Togo, males (green), and females (purple), 1980-2012
Note: To access the data visualization online, visit http://ihmeuw.org/31ux. Data are derived from the study “Smoking Prevalence and Cigarette Consumption in 187 Countries, 1980-2012,” published in JAMA in 2014.
A recent blog post by David J. Olson on Global Health TV discussed efforts by Sri Lanka and India to get tobacco manufacturers to cover packages with graphic warnings. Indian smokers make up 11% of smokers worldwide, so reducing tobacco use in this country could have a sizeable impact on global disease trends down the road.
According to the Global Burden of Disease (GBD) 2010 study, an estimated 6.3 million people died as a result of smoking in 2010. A new study, published in the New England Journal of Medicine, indicates that smoking could be causing even more deaths than previously thought. Researchers uncovered associations between smoking and diseases including kidney failure, blockage of the blood vessels to the intestines (intestinal ischemia), and even infections.
Although the fight against tobacco is far from won, global health donors have invested relatively little money in this area. In 2011, tobacco funding amounted to just $67.76 million, compared to $7.7 and $6.1 billion invested in malaria and maternal, newborn, and child health, respectively.