Economic & Health Policy Research Reports

In October 2019, researchers from the University of Zambia and the American Cancer Society released a second report on the economics of tobacco farming in Zambia that unequivocally demonstrates that growing tobacco continues consistently to be a difficult economic livelihood for thousands of smallholder (< 5 ha) farmers. The research is based on a household-level survey of a nationally-representative sample of current and former tobacco farmers. The research also finds that most of these farmers are directly contracting with the tobacco industry under unfavorable terms that undermine their ability to be paid fairly for their hard work. The evidence is clear: tobacco farming is very far from a lucrative endeavor. Put simply, most tobacco farmers are operating at an economic loss: tobacco farming costs are consistently greater than the revenues. Moreover, when farmers stop growing tobacco, on average they have 5.95 times more per capita household resources than those who continued growing tobacco.

Importantly, the survey results demonstrate that farmers have viable alternatives: many tobacco farmers are already successfully growing and selling other major crops suitable to each region, (e.g., vegetables, maize, sunflower, etc.). In fact, former tobacco farmers are making 1.73 times the sales of non-tobacco crops compared to tobacco-farming households.

The cost of tobacco-related illnesses in Uganda far outweighs the benefits of employment and tax revenue generated from the tobacco sector. In this study, the economic cost of tobacco use in Uganda is estimated using the cost-of-illnesses approach based on data collected from a survey of patients and caregivers in four major service centers in Mulago National Referral Hospital, for the year 2014. The total direct health care and non-health care cost of tobacco-related illnesses was USD 41.56 million. The total indirect morbidity and mortality costs from the loss of productivity due to tobacco-related illnesses were USD 11.91 million and USD 73.01 million respectively. The direct and indirect costs of tobacco use added up to USD 126.48 million, which is equivalent to 0.5% of GDP. The total health care cost of tobacco-related illnesses constitutes 2.3% of the national health care account. These results unequivocally demonstrate that stronger tobacco control measures need to be undertaken to reduce the disease and economic burden of tobacco use in Uganda. 

The affordability of tobacco products is widely recognized as an index for evaluating the efficacy of tobacco taxation in low- and middle- income countries. Typically, lower prices translate to increased consumption. A collaborative study led by the EHPR’s Dr. Nigar Nargis concludes that the current price and tax policy in Bangladesh falls short of the objective of effective tobacco control through taxation, as is evident from the increasing affordability of tobacco products there.

This recent report sponsored by the United Nations Development Programme and the Secretariat of the WHO Framework on Tobacco Control, and led by EHPR’s Dr. Jeff Drope, examines how good governance and particularly multisectoral cooperation within governments is a key factor in successful tobacco control efforts. The report provides a list of recommendations for facilitating better cooperation within countries.

This study of 421 tobacco farmers from 33 tobacco-growing municipalities in the Philippines found that tobacco farming is deeply entrenched in these regions. For example, the average survey respondent had been continuously farming tobacco for 18 years and cultivated around 0.9 hectares of land. Most heads of tobacco-growing households were more than 50 years old with a modal educational attainment of finishing high school. Moreover, tobacco farming continues to be a family affair in the Philippines, with half of household members reporting that they contributed to activities related to producing tobacco.

As the Philippines government moves to fulfill its treaty obligations to the WHO FCTC, it will need to consider the complexities examined in this report. In particular, access to credit fundamentally shapes what opportunities are available to farmers. Similarly, improved markets for other agricultural goods will provide incentive for farmers to try alternative crops.

Researchers from the American Cancer Society, Malawi's Centre for Agricultural Research and Development (CARD) and McGill University collaborated on a 2016 study about the economics of smallholder tobacco farming in Malawi, the world’s most tobacco-dependent economy. The alleged damage to economic livelihoods of tobacco growers is widely used as an excuse to slow or stop tobacco control efforts, but actual information about the quality of these livelihoods is scarce. Using a nationally-representative economic survey of nearly 700 farmers, this research finds that tobacco farming is not a lucrative livelihood for most farmers and it is the perception of easier market and credit access that typically keeps farmers in the sector.

A grant from the United States National Institutes of Health (National Institute on Drug Abuse, Fogarty International Center and National Cancer Institute, Prime Award No. 5R01DA035158-04) allowed the researchers to undertake this study.

Researchers from the American Cancer Society, the International Institute for Legislative Affairs, McGill University and the University of Ottawa collaborated on a 2016 study about the economics of smallholder tobacco farming in Kenya. Based on a survey of 585 smallholder tobacco farmers in the 3 main tobacco-growing regions in Kenya, this report provides evidence countering tobacco industry claims that tobacco farming is a prosperous economic livelihood for most farmers. Most tobacco farmers make only a small profit and many even lose money each year. Tobacco farming, therefore, should not be a part of a successful Kenyan economic development strategy.

To help tobacco farmers find better livelihoods, the government and partners need to:

• Develop markets – especially improved supply chains – for other viable products
• Help farmers to access credit
• Increase efforts of agricultural extension services to maximize the cultivation of other crops.

A grant from the United States National Institutes of Health (National Institute on Drug Abuse, Fogarty International Center and National Cancer Institute, (Prime Award No. 5R01DA035158-04) allowed the researchers to undertake this study.

Working with our colleagues at the International Tobacco Control Project at the University of Waterloo, our team – led by Dr. Nigar Nargis – helped to produce a timely report on tobacco taxation that was used to help convince legislators and other important actors in Kenya to support the recent major tobacco excise tax reform.

This report, a co-production of the University of Zambia School of Medicine and the American Cancer Society’s EHPR, examines the livelihoods of smallholder tobacco farmers in Zambia. Though governments and the tobacco industry argue that we should not pursue tobacco control because it will hurt the livelihoods of these farmers, this report demonstrates unequivocally that most tobacco farmers make a very poor living and would be better off pursuing other healthier economic endeavors.

Together with colleagues from Brazil’s National Public Health School, University of California-San Francisco and McGill University, we examine how Brazil has developed some of the most effective tobacco control policies in the world, and highlight some of the most pressing challenges they continue to face to implement public health policies. A Portuguese language version of this report is available upon request.

With our colleagues at Action for Economic Reforms and McGill University, we explore the challenges that the Philippines has faced to develop their tobacco control policies, with a particular emphasis on their recent landmark tobacco excise tax reform, which has become an example for countries around the world.