“Put it out before it puts you out”: Why Is It So Difficult to Curb Tobacco Consumption?
By Fiorenzo Conte
According to WHO, tobacco is one of the main risk factors for a number of chronic diseases around the world and it kills around 5 million people every year. 80% of the smokers worldwide live in low and –middle-income countries, yet a number of countries have been slow in implementing legislations to curb tobacco consumption (such as legislation prohibiting tobacco advertising). Why? Part of the answer lies in external factors. Another part of the answer lies in internal barriers and has to do with history, national values and national champions. They are important barriers yet they often remain ignored.
External factors: As some authors have illustrated, the US is curbing tobacco consumption domestically through the implementation of strict anti-tobacco legislations. At the very same time that Washington is closing the door of the domestic market to tobacco multinationals it is opening the doors of the emerging markets to the same multinationals. Thomas Bollyky on FP explains how this is taking place
Nearly every trade and investment agreement that the United States has negotiated over the last decade reduces tobacco tariffs and improves the protection of tobacco-related investments overseas. The same new law that restricts cigarette marketing and labeling in the United States specifically excludes cigarettes destined for sale or distribution abroad.”
As a result of the benevolent and interested connivance of the American government, tobacco multinationals are outmaneuvering governments of low and middle-income countries whose defense toolkit against the tobacco industry is hindered by trade agreements. The interference of Washington and the free hand given to international tobacco multinationals, however, does not even tell the whole story.
Internal Dynamics: There are some countries whose high rates of smoking are not due to international corporations. Despite the fact that they had tried to enter these markets domestic manufacturers had got there before and closed the door behind them. One example is China: the country is a signatory of the WHO Convention on Tobacco Control and the Ministry of Health is trying hard to curb tobacco consumption. Yet the enemies against this campaign are not external: in fact it is the very same Chinese government. After the tobacco industry was initiated by the British it was nationalized by Mao. Since then tobacco and government have been one thing: more precisely the former is owned and regulated by the latter. As a result, the government has been so strictly associated with tobacco that smoking is in the popular imaginary one of the fundametal attributes of any politicians. Given the enormous economic benefit derived from the sale of tobacco products it does not come as a surprise that the progress on anti-tobacco legislation have been slower than WHO would have expected. Another factor also plays a role: tobacco is the economic pillar of some Chinese regions such as Yunnan. The region has been for so long associated with tobacco production that it can hardly see a way out of this image: Yunnan is and will be, so the tobacco manufactures claim, tobacco dependant. Furthermore, cigarettes play a social role in the community as the exchange of cigarettes is one of the most widespread gesture when friends meet: cigarette in other words is one of the elements which bonds the social fabric of the community together.
The same ingredients of a powerful national tobacco industry and smoking inscribed in social practices is present in the country which after India and China has the largest number of smokers in the world: Indonesia. In this country the tobacco industry has managed to present itself as the national industry par excellence: cigarette manufacturing, so the argument goes, contribute significantly to the total manufacturing employment and any attempts to raise taxes on cigarettes is an attempt to undermine the livelihood of millions. The industry has been so successful in putting forth this argument that the cost of smoking-related disease to the health-care system and the fact that the tobacco industry contribution to total employment is less than 1% since 1970s have been kept off the debate. In the end if the decision is between public health and the national interests political demagogues have an easy choice to make. Plus the kretek, a local type of cigarette, is not only widely accepted to be the attribute of any real Indonesian man but recently has also been elevated as symbol of Indonesian society in a time when the society is facing a process of westernization and islamization. In this context any attempt to attack the kretek can be easily presented as an attack against the Indonesian identity.
In sum, when one asks why anti-tobacco laws are in not in place a multitude of factors hold the answer: trade agreements, multinational and national tobacco corporations and the place smoking in the local imaginary. By ignoring any of these factors the international health community will fall short of curbing tobacco consumption.