In tobacco smoke, there are at least 69 cancer-causing ingredients. Yet the top 6 tobacco companies earned a combined profit of $44.1 billion from selling these deadly products in 2013. A big part of the problem: marketing. In the United States alone, tobacco companies spend more than $900,000 an hour marketing their products. All of this smoking is also hurting the environment – nearly 1.7 billion pounds of cigarette butts end up as “toxic trash” each year.
These are just a few of the numerous facts about smoking and the tobacco industry that are laid out in the fifth edition of The Tobacco Atlas, produced by the World Lung Foundation and the American Cancer Society. The book and companion website outline in detail the challenges – to health, the economy, and the planet – of tobacco use worldwide. The Tobacco Atlas also offers solutions.
In this interview, The Tobacco Atlas author and editor Jeffrey Drope, Ph.D., of the American Cancer Society discusses how the global tobacco epidemic has changed over time and what is needed to put an end to it.
Q. This is the fifth edition of The Tobacco Atlas. The first edition came out in 2002. What have been some of the biggest changes in the global tobacco epidemic since that time?
DROPE: One of the largest positive changes is the coming into force of the WHO Framework Convention on Tobacco Control (usually just called the FCTC), an international public health treaty that directly addresses the tobacco epidemic. While it is voluntary and lacks true “enforcement,” (after all, there’s no “tobacco control police”), it is very impressive how many countries have ratified or acceded to it (180) and, more importantly, the positive steps that many governments are taking to adhere to the tobacco control best practices in the framework. On the negative side, the tobacco industry has recently developed a host of new products – including e-cigarettes – that they suggest are part of their harm reduction strategy. The scientific community is still evaluating these products, but what is clear is the tobacco industry has never considered good health when selling their products, and we must bear this in mind as we determine how to regulate these still-harmful products.
Q. Are there new challenges to the fight against tobacco that have arisen since the first edition of the Tobacco Atlas came out in 2002?
DROPE: One of the nastiest fronts in the fight against tobacco that has emerged is the tobacco industry’s effort to use the international economic system to undermine public health efforts. For example, using sympathetic governments, the industry is challenging – in the World Trade Organization dispute settlement body – Australia’s outstanding public health policy that places tobacco products in plain, standardized packaging with enormous graphic warning labels. Similarly, the industry has ramped up its efforts around the world to use domestic litigation to undermine governments’ tobacco control efforts. In the Philippines, the government is fighting multiple attacks by the industry in their domestic legal system to undermine their public health efforts. This is expensive and challenging for all governments, but especially those in low- and middle-income countries.
Q. The Tobacco Atlas describes just how costly the tobacco epidemic is – both to individuals and to society. What are some of the most striking figures that highlight the economic burden of tobacco use?
DROPE: The harm to the human body from tobacco use is staggering. It’s worth a look at the graphic in the Harms chapter in the Tobacco Atlas, which systematically identifies the areas of the body that tobacco negatively affects. And remarkably, we’re still finding out that there are other diseases that are linked to tobacco use. For example, recent research from the American Cancer Society suggests a significant connection between kidney failure and tobacco use, which was not known previously. Economically, the most recent estimates suggest that costs of tobacco globally are at least a trillion U.S. dollars annually and may be as high as 2 trillion. And these estimates don’t very effectively account for all of the vigorous economic activity that our societies are missing out on because we’re making and using tobacco products instead of more productive, healthier pursuits. Furthermore, research continues to demonstrate that we have underestimated the negative effects of tobacco on mortality and morbidity, which is another reason that these crude estimates are surely significantly higher. Imagine, if these resources were put toward healthy activities, how much better off we would be as a global society.
Q. Are there any countries that are doing everything right when it comes to tobacco control?
DROPE: No country is doing everything right, but there are some notable high performers. I just mentioned the Australian plain packaging policy for tobacco products, and now other countries, including Ireland, appear to be wisely following. In 2013, the Philippines boldly reformed its tobacco tax structure and rates, and it is already yielding positive effects -- there have been declines in consumption and increases in tax revenue that they’ve earmarked directly to health. Other countries are noticing their success, and the possibilities are very exciting.
Q. For low- and middle-income countries, what are the biggest barriers to implementing tobacco control interventions?
DROPE: One of the most daunting barriers is the fierce resistance from the tobacco industry. The industry bullies countries with very limited resources, like Togo and Namibia, not to enact forward-thinking tobacco control policies. Just to give you some sense of how ridiculously lopsided this fight is, the profits alone of Philip Morris International (around 8.5 billion USD) are roughly twice that of the entire economic activity of Togo (their 2013 gross domestic product was just a little over 4 billion USD). The other bleak challenge is a lack of political will – we see highly energized civil society organizations meet tepid enthusiasm from some governments to drive public health policy change. Despite the overwhelming evidence of the harms and the relatively straightforward policy solutions, we remain amazed at some governments’ utter disinterest in – and sometimes, complete disdain toward – change. All that said, we have seen some spectacular successes in low- and middle-income countries, and we should celebrate and encourage governments to emulate those.
Q. What finding was most surprising to you in putting together the Tobacco Atlas?
DROPE: One of the most disturbing negative findings was the fact that now more girls than boys use tobacco products in 24 countries, compared to only 2 countries where prevalence is higher for women. This suggests to me a massive and apparently successful effort by the tobacco industry to market specifically to young girls. As not only a breathing person, but also the father of two daughters, I object strenuously to these malevolent efforts. On the positive side, it turns out that the size of the average investment to tackle these challenges meaningfully is miniscule in the grand scheme of government budgets. For an average investment of only 11 cents per citizen annually, governments in low- and middle-income countries can implement the four cornerstone tobacco control policies: smoke-free public and work places; bans on tobacco advertising, promotion and sponsorship; warning labels on tobacco packaging; and increasing tobacco excise taxes. The health and economic dividends from such investments are enormous. For example, 69% of growth in Africa in recent years has been driven by improvements in health.
Q. What, for you, are the key takeaways from the Tobacco Atlas?
DROPE: The key takeaway is that although we have done a lot toward fighting this epidemic, we still have a long way to go. Overall consumption of cigarettes has only begun to level off globally in the last couple of years, but we’re still seeing an upsetting level of growth in Africa and the Middle East. Moreover, there are still more than a billion tobacco users worldwide. Much of the responsibility to take on the tobacco epidemic lies with governments – they are the entities that enact policy. That said, as citizens, and in our case here at the American Cancer Society, as a large non-governmental health organization, we have a moral imperative to try to help our governments to do the right thing. For our part, we will continue not only to monitor rigorously the harms caused by tobacco, but also to provide the evidentiary foundation for what constitutes best practices in policy and their successful implementation to help policymakers make the best decisions.
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