Healthy Skepticism Library item: 12747

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Publication type: news

McKay B.
Where There's Smoke: Emerging World
The Wall Street Journal 2008 Feb 7
http://online.wsj.com/article/SB120235550960649857-email.html

Abstract:

WHO to Offer a Road Map To Combat Tobacco Use; Sales Up in Poorer Nations

Full text:

The World Health Organization is expected to release a report today that may offer an important new road map for combating tobacco use globally. Smoking is declining in the U.S., Canada and some other developed countries after decades of increasingly effective attacks on tobacco use. But in the developing world, public-health officials see a mushrooming scourge.

The WHO report comes amid aggressive efforts by multinational tobacco companies to push smoking in countries where there has been relatively little effort to discourage it. Moves like Altria Group Inc.‘s plan to spin off Philip Morris International into a separate company that will be less constrained by U.S. public opinion are raising the ante for global public-health officials, especially as the death toll from tobacco in developing nations grows.

In 2006, the Chinese consumed 1,490 cigarettes per capita

PMI and other international tobacco giants deny that they are targeting new smokers or seeking to expand in areas with minimal regulation. But they are moving to build sales in countries where populations are growing, more people are joining the middle class and smoking is viewed as a sign of upward mobility. At the same time, the companies are developing and promoting new products, such as shorter cigarettes, to attract new customers and to adapt to tobacco restrictions that are already in place.

About 5.4 million people in the world die prematurely from tobacco-related causes such as cancer annually, according to current WHO estimates. By 2030, the agency predicts that number will rise to some 8.3 million annual deaths. About 80% of those will come from low- and middle-income nations, which are least equipped to deal with the financial, health and social consequences of tobacco-related illness. More than half of the world’s smokers live in 15 such countries, including China, India, Indonesia, Russia and Bangladesh, according to public-health experts.

Margaret Chan, the director-general of the WHO, will unveil the report today in New York with the city’s mayor, Michael R. Bloomberg, whose Bloomberg Philanthropies helped the United Nations agency fund the report.

In August 2006, Mr. Bloomberg, a billionaire and former smoker, pledged $125 million to a global antismoking campaign that was to include pushes for smoking bans and higher taxes in other countries, smoking cessation programs, and systems to monitor global tobacco use and tobacco prevention efforts. Five organizations, including the WHO, are receiving the money.

The campaign follows Mr. Bloomberg’s highly publicized campaign in New York City against tobacco. It was launched in 2002 and has included bans on smoking in restaurants and workplaces, sharp tax increases on cigarettes, antitobacco advertising and other measures.

For its part, the WHO has a new antitobacco treaty that requires 152 participating countries to restrict tobacco advertising, impose smoking bans and tax increases on cigarettes, and toughen health warnings on cigarettes. The document even encourages countries to explore litigation against tobacco companies.

But the WHO faces huge challenges in combating tobacco use world-wide. Many countries that ratified the WHO treaty don’t have the money or resources to pursue the measures advocated in it. Tax increases and other antitobacco measures can be difficult to implement and enforce. Among the countries that haven’t ratified the treaty, meanwhile, is the U.S.

A PMI spokesman, Greg Prager, says the company, with about a 15% international market share, is competing for existing smokers rather than targeting new ones. “The goal for us is to appeal to adult smokers who’ve already made the decision to smoke, and get them to smoke our brands,” he says.

He also says that PMI supports regulation, in part because it helps even the playing field with local competitors that may market their products more aggressively. “Wherever we do business, we advocate for regulation,” including bans on outdoor and certain other forms of advertising, and taxation, he says. “Tough but fair regulation in every country is something that’s clearly in the interest of governments, the public-health community, and consumers, and also for us at PMI.”

Smoking is entrenched in many emerging economies. In Bulgaria, for example, 52% of health professionals — potential models of healthy living for patients — smoke, according to the Tobacco Atlas, which is published by the American Cancer Society.

Young people with rising incomes and women, whose smoking rates have historically been low, are particularly at risk, public-health experts say. They note that tobacco marketers are employing tactics similar to those used in the U.S. as far back as the 1920s, when, for instance, women marching for equality were urged to display cigarettes as “torches of freedom.”

“Everyone is afraid [smoking] is going to explode,” says Michael Eriksen, a former director of the Office on Smoking and Health at the Centers for Disease Control and Prevention who is now the director of Georgia State University’s Institute of Public Health in Atlanta. The belief is that “in Bangladesh, India and other developing countries, as people prosper economically and women get more rights, smoking is going to increase.”

A spokeswoman for London-based British American Tobacco says that “the accusation we’re moving into emerging markets to avoid regulation simply isn’t true.”

“As disposable income grows around the world, particularly in developing countries, more smokers are upgrading to premium brands rather than low-quality local alternatives,” she says, adding, “We still choose to place warnings on packs in all countries even if they are not required by law.”

China has more than a third of the world’s 1.3 billion smokers, according to research firm Euromonitor International. Per capita consumption of cigarettes there rose 11% from 2001 to 2006. State-run China National Tobacco Corp. holds the largest share of cigarette sales globally, and multinational firms want a bigger piece of the action. PMI aims to expand its sales there by producing Marlboro at state-owned factories.

Big markets for PMI include Russia and Eastern Europe, as well as Western Europe, while British American Tobacco counts South Africa, Malaysia and Russia among its biggest markets, as well as Canada and Germany. While the proportion of people who smoke may have reached a plateau or be declining globally, in some developing nations per capita consumption — the number of cigarettes the average person smokes — is growing.