Elsevier

The Lancet

Volume 385, Issue 9972, 14–20 March 2015, Pages 1029-1043
The Lancet

Series
Exposing and addressing tobacco industry conduct in low-income and middle-income countries

https://doi.org/10.1016/S0140-6736(15)60312-9Get rights and content

Summary

The tobacco industry's future depends on increasing tobacco use in low-income and middle-income countries (LMICs), which face a growing burden of tobacco-related disease, yet have potential to prevent full-scale escalation of this epidemic. To drive up sales the industry markets its products heavily, deliberately targeting non-smokers and keeps prices low until smoking and local economies are sufficiently established to drive prices and profits up. The industry systematically flaunts existing tobacco control legislation and works aggressively to prevent future policies using its resource advantage to present highly misleading economic arguments, rebrand political activities as corporate social responsibility, and establish and use third parties to make its arguments more palatable. Increasingly it is using domestic litigation and international arbitration to bully LMICs from implementing effective policies and hijacking the problem of tobacco smuggling for policy gain, attempting to put itself in control of an illegal trade in which there is overwhelming historical evidence of its complicity. Progress will not be realised until tobacco industry interference is actively addressed as outlined in Article 5.3 of the Framework Convention on Tobacco Control. Exemplar LMICs show this action can be achieved and indicate that exposing tobacco industry misconduct is an essential first step.

Introduction

The inexorable rise in global deaths from tobacco is increasingly driven by trends in low-income and middle-income countries (LMICs)1 where, by 2030, it is estimated that 6·8 million of the 8·3 million tobacco-related deaths will occur.2 The changing global patterns of tobacco use that underpin these mortality trends reflect the presence and actions of the tobacco industry, whose role in expanding tobacco use globally3, 4, 5 has led to its label as the vector of the tobacco epidemic.

In recognition that the factors driving the tobacco epidemic, notably the actions of the tobacco industry, transcend national borders, WHO used its treaty-making powers for the first time in developing the Framework Convention on Tobacco Control (FCTC). Given overwhelming evidence of the tobacco industry's efforts to subvert public health policy making,6 the treaty includes Article 5.3, which requires parties to protect their public health policies from the “vested interests of the tobacco industry”.7 The FCTC, which is legally binding, entered into force in 2005 and, by December, 2014, 180 of the UN's 193 member states were Parties to the Treaty. Yet FCTC implementation has been slow and uneven in large part because of tobacco industry efforts to subvert progress in tobacco control.8

In this final paper in a three-part Series on a tobacco-free world, we provide an overview of tobacco industry practices focusing on LMICs given three factors: first, the growing importance of LMICs to the tobacco industry's future; second, the increasing tobacco-related disease burden faced by LMICs,9 which will increase the policy priority afforded to this issue; and third, the potential, through effective tobacco control policy implementation, to prevent full escalation of the tobacco epidemic, particularly in Africa. As well as exploring tobacco industry market expansion tactics and policy influence generally, we examine three mechanisms through which tobacco companies are increasingly attempting to prevent progress in tobacco control—the use of international trade and investment agreements, litigation, and the illicit trade in tobacco. Tobacco companies are also exploiting the opportunities presented by harm reduction10, 11 and regulatory developments such as Better Regulation to enhance their influence,12, 13 but these currently have less resonance in LMICs and are not, therefore, covered in detail. Finally, we outline how these problems might be addressed and highlight that, despite the egregious examples of industry influence detailed, some LMICs are exemplars in tobacco control and show what can be achieved by prioritising health over tobacco industry interests.14

Key messages

  • The tobacco industry's future depends on increasing tobacco use in low-income and middle-income countries, especially among women and young people, and, contrary to industry claims, tobacco marketing deliberately targets these groups

  • Tobacco companies consistently contest and seek to circumvent governments' authority to implement public health measures using highly misleading arguments frequently presented via third parties whose links to industry are obscured

  • Tobacco companies harness their resource advantages in, for example, establishing partnerships with governments to address the trade in illicit tobacco in which they have been complicit and using the threat of domestic litigation and arbitration under trade and investment agreements to intimidate governments against implementing comprehensive tobacco control measures

  • Article 5.3 of the Framework Convention on Tobacco Control and its guidelines offer governments a set of strategies to protect public health against the tobacco industry's appalling conduct, but are underused

  • An essential first step in addressing tobacco industry interference is changing attitudes to the industry through actively monitoring and exposing its conduct

Section snippets

The importance of LMICs

Tobacco industry conduct can be understood in the context of the global tobacco market and the growing importance of and opportunities presented by LMICs. Historically western-based tobacco companies expanded their global sales by using investment and trade liberalisation to enter new markets and acquire smaller companies—Latin America in the 1970s, parts of Asia in the 1980s, and the former communist bloc in the 1990s.4, 5 So assiduous was this expansion that the global industry is now

Political influence in LMICs

The evidence, including systematic reviews of political activity by the tobacco industry, indicates that tobacco companies predominantly use the same tactics and arguments repeatedly over time and across jurisdictions.49, 63, 66 Consequently, the existing literature, despite its predominant focus on HICs, can be used to anticipate and, therefore, counter industry activities elsewhere.49 The evidence also suggests some differences in approach, most notably that efforts to influence health policy

The way forward

Addressing tobacco industry interference should be simple. FCTC Article 5.3 guidelines outline the measures needed,7 technical reports flesh these out in detail,183, 184, 185, 186 and this paper shows that industry tactics are repeated over time and place and could therefore be predicted and countered.49 Yet, although growing numbers of countries have taken steps to prevent tobacco industry interference, successful implementation of Article 5.3 is almost non-existent.179

In practice, countering

Conclusion

Tobacco industry interference with governments' efforts to implement tobacco control policies remains one of the greatest challenges to prevention of the harm caused by this industry. Tobacco companies continue to promote their lethal product and circumvent or prevent development and implementation of effective tobacco control policies. Select countries in all income groups, including those where the industry is a significant economic player,193 show that actively addressing tobacco industry

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