The Fight Against The Tobacco Epidemic Is At A Critical Stage
Strong tobacco control laws have led to reductions in smoking prevalence but much remains to be done. The Atlas' authors conclude that the battle against tobacco has reached a critical stage:
The tobacco industry is committing unprecedented resources to litigate, threaten, and interfere with efforts to introduce, implement, and enforce tobacco control. The increase in tobacco users in the world's most populous countries is outpacing the global impact of tobacco control. There are now over 1 billion smokers in the world. Over 300 million people use smokeless tobacco, and the use of other alternative tobacco products, like water pipes, is growing. Over 5.8 trillion cigarettes were smoked in 2014. Increased consumption in China (where average consumption is 22 cigarettes a day) offsets declines in other countries. 90% of the world's population live in countries that have ratified the Framework Convention on Tobacco Control (FCTC), but only 10% are covered by comprehensive tobacco advertising, promotion, and sponsorship (TAPS) bans and only 16% by comprehensive smoke-free laws. Progress made in de-normalizing smoking may be reversed by the increasing prevalence of e-cigarettes and other alternative tobacco products. Tobacco is killing more than half and as many as two-thirds of tobacco users.
Unprecedented Activity By The Tobacco Industry Is Preventing Progress
The Atlas reveals the extent of the tobacco industry's expanding and well-resourced array of tactics to preserve its profits, to hide the truth from the public and to influence or derail regulation. Among the top six transnational tobacco companies - accounting for 85% of all cigarettes smoked globally - profits have reached US$44.1 billion or around US$7,000 for every tobacco-related death, up from US$6,000 per death when the last edition of The Atlas was published in 2012. These industry tactics include:
Aggressively targeting developing economies in Asia, Africa, Latin America and the Middle East. Increasing prices above and beyond taxes in 146 countries between 2008 and 2012 so consumers blame governments for higher prices while tobacco companies profit. Funding and promoting misleading research regarding measures like plain packaging, display bans, pack size restrictions, smoke-free laws, and tobacco taxes. Running a two-year media and social media campaign valued at nearly AUS$3.5 million to try to prevent the adoption of plain packaging in Australia and having 450 people lobbying to prevent plain packaging in the UK (both BAT). Increased lobbying. Philip Morris International spent GB£5.25 million lobbying the EU in 2014. In 2012, the industry spent over US$26million on lobbying in the USA. Increasing its use of legal action or the threat of legal action, particularly citing international trade and investment agreements, to try to stop tobacco control including: Graphic warnings in the Philippines, Sri Lanka, Thailand, Uruguay, and the US Plain packaging in Australia; with threats against the UK and Ireland Pack-size restrictions in Peru A ban on additives and flavorings in Brazil The EU Tobacco Products Directive Retail display bans in Norway and Scotland Tobacco marketing bans in the Philippines and South Africa Smoke-free laws in Pakistan and the Philippines Bans on sales of tobacco products near educational establishments and the sale of gutkha and pan masala containing tobacco in India A health law in Indonesia.
Tobacco Industry Tactics Are Causing Economic, Social and Environmental Harm
Tobacco use costs the global economy over US$1 trillion according to The Atlas and may have an economic impact of as much as US$2.1 trillion according to other sources. Low- and middle-income countries (LMICs) represent over 80% of tobacco users and tobacco-related deaths, so an increasing proportion of this cost is born by people who can least afford it. Negative economic, social, and environmental consequences of tobacco include:
Development funding is going up in smoke. In 2012, LMICs received a total of US$133 billion in development aid, while spending more than double that amount, US$350 billion, on tobacco products. From 2000-2011, nearly a quarter of global growth in LMICs resulted from health improvements. The benefit was most marked in the Middle East and North Africa, where it contributed 35%, and Sub-Saharan Africa, where it contributed nearly 70%. Increasing tobacco-related ill health will be a drain on economic growth. All forms of tobacco use disproportionately burden the poorest and increase socioeconomic health inequalities. Female tobacco use - often linked by the tobacco industry to emancipation and sophistication - has increased rates of lung cancer so it now kills more women than breast cancer; worryingly, there are 24 countries where girls smoke more than boys compared to just two countries where more women smoke than men. Maternal tobacco use also causes health harms and increases the lifetime risk of health conditions to infants and children. Increased tobacco use in Africa in recent years means lung cancer is now the most common cause of premature death among men. In 12 of the 25 top tobacco leaf-producing countries, tobacco cultivation co-exists alongside undernourishment rates which exceed 10%. This is most acute in four African nations: Zambia (43%), Mozambique (37%), Tanzania (33%), and Zimbabwe (31%). Tobacco causes air, land, and water pollution. 200,000 hectares of forest are lost every year to tobacco cultivation and curing - contributing to climate change - and cigarette butts are the most commonly discarded piece of waste worldwide. 4.5 trillion butts, weighing 1.69 billion pounds, end up as toxic rubbish.
Creating A Future Of Missed Opportunities
Without change, governments around the world will miss targets to improve health and opportunities to reduce the harm of tobacco:
Tobacco will remain on track to kill 1 billion people this century. Governments will miss the Sustainable Development Goals target of reducing premature deaths from NCDs by one-third by 2030. Governments will miss the WHO Global NCD Action Plan target of a 30% reduction in tobacco use prevalence by 2025. Smoking has already prevented countries from meeting Millennium Development Goals related to mortality associated with tuberculosis (TB). It will be 2029 before any region (the Americas) meets its goal while smoking is still prevalent. In the Western Pacific and Africa, TB mortality goals will never be achieved while smoking is prevalent. Smokers with HIV will continue to lose more than twice as many years of life as non-smokers - 12.3 years compared with 5.1 years.
Bolder, Faster Action Is Needed
The Atlas authors conclude that bolder, faster action is needed to reduce tobacco use:
Governments should re-invest income from tobacco taxes. 0.69% of tobacco excise tax revenue is spent on tobacco control, and 96% of that in high-income countries. Donors' development assistance should more closely match tobacco-related harm. Only US$68 million was spent in 2011, but US$600 million per year would deliver four "best buy" tobacco control interventions to all LMICs; that is only 11 cents per person and just less than 0.17% of what citizens of LMICs spent on tobacco products in 2013. Governments should ignore tobacco industry threats and enact and enforce comprehensive tobacco control measures at the highest levels of best practice. Governments should implement comprehensive TAPS bans, with immediate effect. The Atlas reveals that one-third of youth experimentation with tobacco occurs as a result of exposure to tobacco advertising, promotion, and sponsorship, and 78% of youth worldwide report regular exposure to such tobacco marketing. All governments should legislate to introduce best practice large graphic pack warnings and are encouraged to follow Australia, Ireland and the UK in legislating for plain packaging. Greater use should be made of mass and social media to educate, inform, and encourage quitting. An ad campaign in Senegal increased calls to the national quitline by 600%, while a video in Thailand led to a 40% increase in calls to the national quitline and more than 5 million YouTube views within 10 days. Health experts, tobacco users, and governments cannot assume that e-cigarettes will help end the tobacco epidemic. Nearly half of US adult e-cigarette users are dual users, and youth uptake is of real concern from a health and "gateway" perspective. Tobacco control advocates should engage and collaborate with colleagues across social, developmental, economic and environmental disciplines to make a multi-faceted case for stronger tobacco control.
Quotes From Leadership
"Whether it's the link between tobacco and increasing rates of lung cancer among women or the ever-increasing number of health conditions and deaths related to tobacco use, the health and economic case for reducing tobacco use has never been clearer," said John R. Seffrin, PhD, chief executive officer, American Cancer Society. "We encourage public health advocates; colleagues across legal, environmental, and developmental specialisms; governments; economists; educators; and the media to use this vital tool to tell people the truth about how a cohesive, well-funded tobacco industry is systematically causing preventable deaths, destroying the environment, and crippling economies - all for its own profit. These truths will help us create support for the change so bitterly opposed by the tobacco industry."
"There is a perception that we know everything about tobacco and the harm it causes, but the truth is that every edition of The Tobacco Atlas reveals something new about the industry, its tactics and the real harm it causes," said Peter Baldini, Chief Executive Officer, World Lung Foundation. "Our challenge, as a global community interested in health and development, is to raise awareness, to bring new voices to the table, to encourage governments to implement comprehensive tobacco control measures as quickly as possible, and to help them stand firm against industry threats and interference. Our fervent hope is that the next Atlas will report the fruits of such a strategy."
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