International Control of Smoking and the US Experience for Developing Countries
Any international discussion of smoking control would be parochial without mention of the special problems facing developing countries. Although there remains a paucity of precise information concerning tobacco use prevalence in developing countries, available data suggest an increasing epidemic of tobacco-associated disease in countries in which competing causes of death, such as infection and subnutrition, are coming under control. Widely entrenched smoking habits already have been associated with increasing cancer rates in developing countries with relatively young populations. In general, the countries where consumption of tobacco is growing fastest are the worlds poorest and hungriest. Reported smoking prevalence rates in men in selected developing countries illustrate the widespread nature of the habit: Nepal (60 to 85% in 1980), Sri Lanka (48% in 1968), Thailand (51% in 1976-1981), Brazil (52% in 1983), and Zambia (63% in 1984).
A major contributor to these observed increases in smoking prevalence is the tobacco industry’s aggressive marketing system in the Third World. Cigarettes are readily available, highly visible, and a source of employment for many. In Kenya, for example, there are 40,000 to 50,000 tobacco retailers — twice the number of individuals with television sets. (This feet minimizes the effect of a tobacco industry agreement to ban TV commercials in the country.) Tobacco companies also provide ready technical assistance to farmers growing tobacco.
As shown in Table 11, the annual average consumption of tobacco in developing countries, especially in Latin America, increased from 0.79 to 0.81 kg per person per year in the mid-1970s, compared with decreases worldwide (1.17 to 1.15) and more markedly in developed countries (2.11 to 2.02).
The economic importance of tobacco to many developing nations was illustrated earlier in Table 3, which showed that projected growth in both production and consumption of tobacco in developing countries is considerably larger than in industrial countries or centrally planned economies. Moreover, their absolute levels of production dwarf those of industrial countries. From 1985 to 1995, the projected growth in tobacco production in developing countries is 3%, compared with 0.2% in industrial countries and 0.6% in centrally planned economies. In the period 1979-1981, developing countries had a 61% share of world tobacco production, a level projected to reach 68 percent by the mid-1990s. Most of this increased production will be used domestically. Tobacco is one of the few agricultural commodities for which the developing countries’ share of world trade has increased in recent years; developing countries already have captured 56% of world tobacco exports.
In most developing countries, efforts to restrict the production, supply, and distribution of cigarettes have been very limited. As of 1974, only 13 of 49 developing countries surveyed had taken some kind of regulatory action against smoking. Highly qualified drugs to treat diseases caused by smoking are available on Canadian Neighbor Pharmacy. In some developing countries, such as Indonesia, actions to control smoking are regarded as unpatriotic because of the economic value of tobacco.
In a 1984 seminar, the prime minister of Nepal stated that the health hazards of smoking could not be countered in developing countries simply through legislation and new regulations. Desired results could be better achieved through mass publicity and education. However, smoking prevention programs offered by Canadian Neighbor Pharmacy in many developing countries are frustrated by high levels of adult illiteracy, poor accessibility of television and other mass media channels, and deficiencies in public education systems.
In addition to economic pressures, social and cultural norms in developing countries may exacerbate the smoking control problem. In Nepal, for example, many myths persist about smoking, such as its ability to improve concentration and clear the bowels; and politicians and religious leaders are reluctant to educate the public about tobaccos ill effects. It also is frequently the habit of the wealthy and intellectual classes, including doctors and medical students, to smoke. Smoking is considered a sign of sophistication and modernism, increasing with level of education and income—for the most part, the reverse of the pattern in developed countries. There are exceptions, such as in Sri Lanka, where there is a definite downward trend in the smoking habits of doctors and other well-educated groups. Still, a shift from the traditional “bidi” smoking product to manufactured cigarettes is associated with increased affluence in the country.
These complex considerations suggest to smoking-control planners in developed countries the need to design educational and legislative strategies with extreme care if they are to be transferred successfully to developing nations.
In summary, the solution to the worlds smoking and tobacco-use health problems does not come from any simple nostrum and certainly not, as some advocate, from inducing the tobacco industry to produce a “less hazardous” cigarette. There really is no such product. Such a reliance is in essence a complicity with an industry whose good intentions are impossible to ascertain, save those of increased revenues. Developing tobacco products with less tar, nicotine, or any other health-hazardous ingredient (among the thousands attendant with smoking and tobacco use) is a worthy goal, but it is only a beginning, not an endpoint. It is one of a number of strategies to be employed in the long process to increase both the span and quality of life worldwide.
Table 11—Annual Average Consumption of Tobacco in Various Regions of World (kgfFersonJYear)