Report: Big tobacco is targeting the world's most vulnerable to increase profits

Africa and the Middle East are at a tipping point for avoiding epidemic numbers of preventable morbidity and mortality

The sixth edition of The Tobacco Atlas and its companion website TobaccoAtlas.org finds the tobacco industry is increasingly targeting vulnerable populations in emerging markets, such as Africa, Asia, and the Middle East, where people are not protected by strong tobacco control regulations. The report was released at the 17th World Congress on Tobacco OR Health in Cape Town, South Africa.

The Atlas, which is co-authored by American Cancer Society (ACS) and Vital Strategies, graphically details the scale of the tobacco epidemic around the globe. It shows where progress has been made in tobacco control, and describes the latest products and tactics being deployed by the tobacco industry to grow its profits and delay or derail tobacco control efforts. In response to an evolving tobacco control landscape, the Sixth Edition includes new chapters on regulating novel products, partnerships, tobacco industry tactics and countering the industry.

In 2016 alone, tobacco use caused over 7.1 million deaths worldwide (5.1 million in men, 2.0 million in women). Most of these deaths were attributable to cigarette smoking, while 884,000 were related to secondhand smoke. The increase in tobacco-related disease and death has been outpaced by the increase in industry profits. The combined profits of the world's biggest tobacco companies exceeded US $62.27 billion in 2015, the last year on record for all the major companies. This is equivalent to US $9,730 for the death of each smoker, an increase of 39% since the last Atlas was published, when the figure stood at US$7,000.

"Every death from tobacco is preventable, and every government has the power reduce the human and economic toll of the tobacco epidemic," said Jeffrey Drope, PhD, co-editor and author of The Atlas and Vice President, Economic and Health Policy Research at the American Cancer Society. "It starts by resisting the influence of the industry and implementing proven tobacco control policies. The Atlas shows that progress is possible in every region of the world. African countries in particular are at a critical point - both because they are targets of the industry but also because many have opportunity to strengthen policies and act before smoking is at epidemic levels."

"Tobacco causes harm at every stage of its life cycle, from cultivation to disposal," said Dr. Neil Schluger, Vital Strategies' Senior Advisor for Science and co-editor and author of The Atlas. "It is linked to an ever-increasing list of diseases, burdens health systems, and exacerbates poverty, especially when a breadwinner falls ill and dies from tobacco use. At a conservative estimate, there are more than 7 million tobacco-related deaths and global economic costs of two trillion dollars (PPP) each year, not including costs such as those caused by second-hand smoke and the environmental and health damages of tobacco farming. The only way to avert this harm is for all governments to vigorously implement the Framework Convention on Tobacco Control and to enforce the proven strategies that reduce tobacco use."

Tobacco use and exposure to secondhand smoke costs the global economy more than two trillion dollars (PPP) every year - equivalent to almost 2% of the world's total economic output. More than 1.1 billion people are current smokers, while 360 million people use smokeless tobacco. Low and middle income countries represent over 80% of tobacco users and tobacco-related deaths, placing an increased share of tobacco-related costs on those who can least afford it. A growing proportion of that burden will fall on countries across Africa in the future, if governments do not implement tobacco control policies now to prevent it.

Africa is at a tipping point

The Sixth Edition of The Tobacco Atlas reveals that the tobacco industry deliberately targets countries that lack tobacco control laws and exploits governments, farmers and vulnerable populations across Africa. In Sub-Saharan Africa alone, consumption increased by 52% between 1980 and 2016 (from 164 billion to 250 billion sticks). This is being driven by population growth and aggressive tobacco marketing in countries like Lesotho, where prevalence is estimated to have increased from 15% in 2004 to 54% in 2015. Economic growth has increased consumers' ability to afford tobacco products and there is a lack of tobacco control interventions to deter tobacco use. Furthermore, in countries like Ethiopia, Nigeria, and Senegal, smoking is now more common among youth than adults - potentially increasing the future health and economic burden of tobacco in these countries.

Yet Africa has also seen real successes in tobacco control recently, according to The Tobacco Atlas. Ghana and Madagascar have introduced comprehensive bans on tobacco advertising, promotion and sponsorship. Burkina Faso, Djibouti, Kenya, and Madagascar have implemented graphic warnings on cigarettes, an important intervention in countries with multiple dialects and for citizens in those countries who have low levels of literacy. South Africa has implemented consecutive tobacco tax increases to deter consumption and Kenya has implemented a highly effective track-and-trace system to track and reduce illicit trade. These countries are setting an example to others across the world.

Other examples of effective tobacco control policies

In spite of the tobacco industry's efforts to impede progress, global cigarette consumption and tobacco use prevalence have declined recently thanks to an overall increase in the adoption of proven and innovative tobacco control measures. Tobacco taxes alone could deliver a 30% relative reduction in smoking prevalence by 2025. This would save 38 million lives and $16.9 trillion, just from former smokers becoming healthier.

In 2013, the Philippines implemented one of the largest tobacco tax increases in a low and middle income country, leading more than 1 million smokers to quit. Kenya implemented a successful track and trace system for tobacco products, which helped to stem the illicit market.

Turkey's comprehensive tobacco control strategy reduced smoking prevalence from 39.3% in 2000 to 25.9% in 2015.

Analysis by Australia's government found that plain packaging alone resulted in 108,228 fewer smokers between December 2012 and September 2015.

Brazil has banned all tobacco additives such as flavors used to attract children. WHO predicts that there will be 3 million fewer smokers in Brazil between 2015 and 2025.

"We are proud that our two organizations have worked together for almost two decades to engender a healthier world," said Dr Otis Brawley, Chief Medical Officer, American Cancer Society. "The data in The Tobacco Atlas depict a sobering look at the daunting magnitude of the epidemic, but also show considerable progress in places where governments take up solutions that are proven to work. For the first time, more than two billion people are protected by at least one WHO MPOWER measure, but very few countries have taken up every measure. The data are clear that measures like raising taxes and enacting 100% smoke-free air laws indisputably work, but too many governments have not yet committed to adopting them. Our life-saving opportunity lies in that gap."

"The ultimate path to improved tobacco control is political will," said José Luis Castro, President and CEO, Vital Strategies. "Strong tobacco control policies deliver a significant return on investment, and The Tobacco Atlas offers the best and most recent data on the tobacco epidemic as a resource for governments to pursue effective strategies. The answer does not lie with the industry: as The Atlas makes clear, there is a complete disconnect between the tobacco industry's claims about harm reduction and its actual work to grow tobacco use among vulnerable populations. Governments must be accountable to their citizens in reducing tobacco use and improving health. They must prepare to rebuff the tobacco industry's challenges to legislation, seek the appropriate assistance to build capacity, and be transparent about the industry's inevitable approaches. We urge governments, advocates, organizations and people who care about health, the environment and development to stand together to reduce this man-made epidemic in pursuit of a healthier planet."

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About the Authors

The authors of The Tobacco Atlas bring a deep knowledge of the tobacco epidemic and its solutions. The work of a team of global experts is led by two editor-authors. Jeffrey Drope, PhD, is Vice President, Economic and Health Policy Research at the American Cancer Society in Atlanta, Georgia and Professor in Residence of Global Public Health at Marquette University. His research focuses on the nexus of public health (including tobacco control, nutrition, physical activity, alcohol misuse and access to care) and economic policymaking, especially trade, investment and taxation. Neil W. Schluger, MD, is Senior Advisor for Science for Vital Strategies as well as Professor of Medicine, Epidemiology and Environmental Health Science and Chief of the Division of Pulmonary, Allergy and Critical Care Medicine at Columbia University Medical Center in New York City. He is also a founder and director of the East Africa Training Initiative, a Vital Strategies- sponsored project to train pulmonary physicians in Ethiopia. This program is the first of its kind in East Africa.

About the Sixth Edition

The Sixth Edition of The Tobacco Atlas is being launched on March 8, 2018, at the World Conference on Tobacco OR Health in Cape Town. The Atlas compiles, validates and interprets global- and country-level data from multiple sources to present the best and most recent evidence, and build a holistic and accurate picture of the tobacco industry's activities, tobacco use and tobacco control across the globe. In print and online at tobaccoatlas.org - where policy makers, public health practitioners, advocates and journalists may interact with the data - The Atlas graphically details the scale of the tobacco epidemic, progress that has been made in tobacco control, and the latest products and tactics being deployed by the tobacco industry to grow its profits and delay or derail tobacco control efforts. In addition to addressing major developments across all topic areas, new for the Sixth Edition are chapters on regulating novel products, partnerships, tobacco industry tactics and countering the industry. Tobaccoatlas.org features a more graphic-rich interface and new functionality to enable users to hone in on the data points contained within the graphics.