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African Health Sciences, Vol. 10, No. 2, July-December, 2010, pp. 201-203 Practice Point The tobacco industry tactics-a challenge for tobacco control in low and middle income countries D Doku University of Tampere, School of Public Health, Finland Correspondence Address:D Doku, Tampere School of Public Health, University of Tampere, Finland, daviddoku@ymail.com Code Number: hs10039 Tobacco use has fallen over the past decades in many developed countries. However in the developing countries smoking and tobacco use in general is now emerging. This commentary discusses the tactics of the tobacco industry and the challenges for tobacco in middle and low income countries in the 21st century. Currently, there are over 1.2 billion tobacco users in the world. It is worrying that of this; well over 800 million are living in developing. [1],[2] Out of the total burden of tobacco-related diseases globally, 70% will occur in developing countries by 2030. Tobacco consumption has fallen over the past 20 years in most high-income countries such as the United States, Australia, Britain, Canada, Finland and most European countries. [1] On the contrary; tobacco use has risen to unprecedented levels in middle and low-income countries, especially in Asia and Africa. [1] Thus, Africa and Asia are the current targets of the tobacco industry. In the pursuit of this agenda, the industry has employed various strategies and tactics including cigarettes smuggling, recruiting of new and young smokers, denying the health consequences of smoking, manipulating governments to delay tobacco control legislations and the sponsoring of health professionals and academic institutions to act in their favour. The tobacco manufacturers have been reported to be involved in organising smuggling of tobacco products in many developing countries. [3] This is aimed at making tobacco cheap and available on the market in order to outweigh governments′ efforts at controlling tobacco supply and consumption through increase taxation. The harmful effects of tobacco have been well established scores of decades ago, yet the tobacco industry still denies the health consequences of their products. Tobacco advertising, promotion and sponsorship possess another great challenge to the fight against tobacco control in developing countries. Tobacco advertising influences adolescent smoking. It encourages non-smokers to initiate smoking and existing smokers to increase consumption on one hand. On the other hand, a ban on advertising, promotion and sponsorship of tobacco product reduces its consumption. Studies have shown that smokers who noticed less tobacco advertising and promotion after the comprehensive ban of advertising in the UK were 1.5 times more likely to quit smoking. [3] Similarly, comprehensive bans in Finland, France, Norway and New Zealand were reported to have reduced the per capita consumption of cigarettes by 14-37%. The WHO estimates that the ban of tobacco advertising and promotion could reduce worldwide demand for tobacco products by 7%. [1] Such policies would contribute immensely to the effort of fighting against the menace in developing countries, especially in sub-Sahara Africa where the epidemic has already started. [4] Therefore a ban on advertising, promotion and sponsorship of tobacco product is a powerful tool in tobacco control. The health and economic benefits of such restrictions are well known. Besides, there are massive supports of civil society for such actions in many countries. However, being aware of the impact of these restrictions on tobacco consumption, the tobacco industry is fiercely confronting both directly and indirectly tobacco legislations, especially in low and middle income countries. Indeed, many nations (including most low and middle income countries) have embraced the Framework Convention on Tobacco Control (FCTC), the world′s first public health treaty, but there are more challenges in implementing the policies that will counteract the activities of the tobacco industry. For instance, Benin was one of the many 178 states that signed the FCTC but has admitted that the nation lack the power to interfere in the activities of the tobacco industry because of the jobs and revenue that the industry gives to the economy of that country. [4] The economy of many low and middle income countries such as Malawi and Brazil depend substantially on the cultivation and export of tobacco. In this era of global economic crisis such challenges for low and middle income countries are paramount. The youth of these countries are the most at the peril of any trade off between economic and job security in the fight against tobacco. One key target of the tobacco industry is the youth. The aim is to capture them while they are young so that they become life-time addicts and subsequently life-time buyers. Lately, to achieve this, tobacco is being associated with things that attract the youth; sexy looking girls, slimness, basketballs; movie acting etc. purposely to lure the youth into smoking. Recent studies conducted in Senegal and Indonesia indicate that most of the basketball courts in the cities in these countries are painted with the logos of cigarettes brands. [5],[6] In Guinea, there are the so called ′cigarette girls′ who are recruited and paid attractive salaries as marketing executives. These girls promote and market cigarettes at nightclubs, in front of shops and in public places. Report says that these girls virtually tour every corner of the country to promote and market this killer called tobacco. [4] In Ghana, for example, tobacco consumption is relatively low. Besides, there have been some commendable efforts of tobacco control in Ghana in recent years. Not until the beginning of the new millennium, there were a lot of huge billboards advertising one brand of tobacco product or the other. There were other tobacco promotional activities such as sponsoring of sporting activities, musical shows and beauty pageants. The peak of these was the painting of the front views of the then two large markets in Ghana, Kaneshie and Kejetia markets in Accra and Kumasi respectively, by the British American Tobacco company (BAT). Today, such physical and open strategies are out of sight and contrary to these, there are "no smoking" signs at a few public places, even though there is no tobacco legislation in Ghana. It is gratifying that today "no smoking" signs are visibly displayed on the main entrances of the Accra Mall-the largest one-stop shopping mall in the country. Despite these efforts, there are a number of issues that still raise concern about tobacco control in Ghana as well as in many low income countries. In Ghana, it is disturbing that, regardless of the outcry of the public, the draft tobacco bill presented to the cabinet since 2005 is yet to get to parliament for parliamentary nod into legislation. Also, more recently, occasionally, there are flashes of what may be called indirect promotion of tobacco on some popular TV channels in Ghanaian movies. In one of such movies there were scenes of young men smoking in an episode which portrayed smoking as urban lifestyle. In another movie, there were scenes of university girls smoking thus misinforming the public to believe smoking is a "cool" campus life. Such telecasts can be described as tobacco advertising, promotion and sponsorship as stated in Article 1 of the Framework Convention on Tobacco Control (FCTC) which defines tobacco advertising and promotion as, "any form of commercial communication, recommendation or action with aim, effect or likely effect of promoting a tobacco product or tobacco use either directly or indirectly"; and tobacco sponsorship as, "any form of contribution to an event, activity or individual with the aim, of effect or likely effect of promoting a tobacco product or tobacco use either directly or indirectly". [7] Certainly, such scenarios on televisions call for concern because the media has a significant role in the fight against tobacco use not only in Ghana but in Africa and in the world at large. Whiles lauding the demonstration of the political will of many governments both in low and middle income countries in tobacco control through such things as the signing of the FCTC, it is equally incumbent on these countries, especially those in African to work out pragmatic and realistic modus operandi of dealing with the menace in a way that will yield significant and sustainable results. The tobacco industry is seeing a bright market in the developing world, and an alternative to the losing markets the developed world. It has not given up yet. Governmental and non-governmental organizations and tobacco advocacy groups working in low and middle income countries must be constant and innovative in their fight against tobacco. Policy actions are urgently needed in the fight against tobacco use. Increase in tobacco taxation; ban on advertising; promotion and sponsorship; and public education on the health, environmental and economic consequences of tobacco use; and checking tobacco smuggling and surveillance are some of the measures that can nullify the strategies and tactics of the tobacco industry and consequently help control the tobacco epidemic particularly in developing countries and in the world at large. Acknowledgement Thanks to Mr. Mohammed Mukhtar and the anonymous reviewers for their comments which improved this paper. References
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