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Facing greater restriction in the USA and other industrialized countries, international tobacco companies are increasingly marketing their products in developing countries, particularly among women and adolescents.

As many developed countries around the world, including the UK, introduce tighter restrictions on tobacco sales, the billionaire and former Mayor of New York, Michael Bloomberg, has told the BBC of his determination to combat the spread of smoking in poorer countries. “We are in this to help countries that cannot defend themselves against an industry that is trying to kill one billion people this century. If that is not a noble cause I don’t know what it is,” said Bloomberg.

While smoking rates in some industrialized countries are decreasing at about 1% a year, those in developing countries are increasing at around 3% per year. It is estimated that, if current trends persist for the next 30 years, seven million people from developing countries will die every year from smoking-related diseases.

For the past several years, international corporations such as Philip Morris, RJ Reynolds, and British-American Tobacco have been expanding rapidly in Eastern Europe, Asia, Africa and Latin America.

Tobacco-provoked deaths can only add to the inequities in health of ethnic and minority populations. Jeanette Noltenius, an expert on tobacco and alcohol abuse issues, stated, “In the US, minorities such as Hispanics have been specifically targeted by the tobacco companies since the early 1960s, and have received a double dose of advertising (in Spanish and English).”

According to data from the Bureau of Census, US Department of Commerce, Latino smoking youth will triple in size in 2020 in the U.S., increasing from 9% of the national youth population to 19%.

Since the early 1980s, US trade officials, with help from the Office of the US Trade Representative (USTR), have led a sustained campaign to open markets in Japan, South Korea, Taiwan and Thailand among the Asian nations.

In Taiwan, US officials’ efforts to force Taiwan to open its markets to US tobacco products have resulted in increased smoking, particularly among women and children. Talking about US government support for American tobacco companies, a corporation executive remarked, ‘We expect such support. That’s why we vote them in.’

These actions have prompted the Asia-Pacific Association for the Control of Tobacco to protest strongly at what they consider an invasion of their countries by US companies targeting Asian women and children. The Association has complained about the strong-arm tactics used by US government officials in their countries. A report from the US General Accounting Office established that ‘US policy and programs for assisting the export of tobacco and tobacco products work at cross purposes to US health policy initiatives, both domestically and internationally’.

Several studies have shown that in the poorest households in developing countries 10 percent or more of the total household expenditure is on tobacco. As a result, there is less money to spend on some basic items such as food, education and health care needs, thus increasing malnutrition, illiteracy and premature death.

In China, tobacco companies have been moving steadily inland with intense promotional campaigns. It is estimated that of the world’s 1.71 billion smokers, more than 350 million are in China, where lung cancer has been increasing at a rate of 4.75% a year.

The Chinese government is facing the dilemma of promoting tobacco cessation policies while it is heavily dependent on earnings from the state-run monopoly tobacco company. However, researchers with the School of Public Health at the University of California state that raising the tobacco tax fifteen cents per cigarette pack could save more than 13 million lives and generate $9.5 billion in revenue for the Chinese government.

Lured by financial gains from growing tobacco, millions of hectares in China are presently under cultivation. Gains from the sale of tobacco, however, may be just short-term, since the costs of treating lung cancer and other related diseases amply exceed the tobacco profits. According to experts, those excess costs are $200 billion annually on a global scale, one-third of which is incurred by developing countries.

While anti-smoking efforts gather momentum in the USA, those efforts are far less effective in developing countries. Such countries’ policies will not be as effective unless transnational tobacco firms are made to limit their aggressive advertisements.

Countries in Asia and Latin America are conducting health-education campaigns and have passed legislation to control smoking. Up to now, several countries worldwide have enacted legislation to control tobacco consumption. Although in general this legislation has been passed at the national level, in the USA, Canada, and in several countries in Latin America and the Caribbean these laws are being enacted by state or local bodies.

Despite increasing condemnation by public health officials and the World Health Organization (WHO), international companies continue with their indiscriminate tobacco-promotional efforts in developing countries, at a high human cost. As things stand now, only a multidisciplinary strategy including education, taxation, legislation, and regulation of trade practices of transnational corporations will be able to control this pandemic.

Dr. Cesar Chelala is an international public health consultant and a winner of an Overseas Press Club of America award.