Opinion: Public health can't pay for the tobacco industry's actions

With an ever more complex landscape of tobacco products, we face a daunting moment in tobacco control. The tobacco industry has made a resurgence, taking advantage of youth across media platforms that are rife with disinformation, and causing uptakes in smoking in surprising demographic categories. All of this is happening while gains in life expectancy are threatened and inequitably distributed.

Sea changes in tobacco use

New data by country and specifics on the efficacy of tobacco control policies are laid bare in the 7th edition of the Tobacco Atlas, published by public health organization Vital Strategies and Tobacconomics at University of Illinois Chicago. The research finds that we are marking a decrease in smoking prevalence globally, but with population growth, there are still more tobacco users in the world than ever before — more than 1 billion people. While there is welcome news that overall smoking prevalence has decreased — falling to 19.6% in 2019 from 22.6% in 2007 — use among youths aged 13-15 has increased in 63 countries. Unsurprisingly, this is mostly in nations with high poverty levels, where global disparities in health are hitting the hardest across many issues.

Furthermore, tens of millions of nonsmokers, disproportionately women and children, are exposed to lethal secondhand tobacco smoke, causing hundreds of thousands of deaths annually.

There are sea changes happening in tobacco use. The Atlas details how in countries such as Haiti and Mauritania, tobacco use is now more common among adolescent girls than adult women. And electronic cigarette use has exploded in popularity among younger consumers. In some countries, including those with young and rapidly growing populations, more than a quarter of all youth are reporting that they use e-cigarettes.

This is a staggering finding considering that just five years ago, these rates were close to zero. The changes are due to a mass global effort from the industry to grow new markets using a combination of traditional and novel tobacco products — and should serve as an SOS to policymakers. Governments must enact more aggressive measures including raising taxes, restricting marketing, and creating smoke-free spaces.

Stricter interventions needed

One way to make inroads is to ensure that policymakers across government departments are on the same page. In 2018, Canada passed a sweeping piece of legislation called the Tobacco and Vaping Products Act. It was enacted, in its own language, to “protect the health of Canadians in light of conclusive evidence implicating tobacco use in the incidence of numerous debilitating and fatal diseases.”

Yet Canada’s national government also chose to invest in a domestic pharmaceutical manufacturer, Medicago, to develop a COVID-19 vaccine, despite the fact that it's partially owned by tobacco company Philip Morris International. The World Health Organization subsequently blocked authorization of the resulting vaccine, but even though the Canadian government ultimately pledged to support a buy-out of the tobacco giant, it still served to enrich a company at cross purposes with the government’s public-health priorities, broadcasting a confusing message within and beyond its borders.

The Atlas also illustrates how increasing tobacco excise taxes is the single most effective policy intervention for driving down consumption. Yet, most governments are still doing so ineffectively. It is most dismal in countries with lower GDPs, where revenues from tobacco taxes could be a double win by both improving health and funding development.

In a recent The Guardian op-ed about tobacco control in Africa, authors drilled down into Tobacconomics’ updated Cigarette Tax Scorecard noting that, “Compared to leaders like Australia (4.13) and Denmark (3.38), who are making rapid progress, countries like Ethiopia (0.75), Zimbabwe (1.38), Chad, or Central African Republic (both 0.75), show that across much of the continent, tobacco products are cheap and lightly taxed.”

The justification in most cases where tobacco products are scarcely regulated is that taxes that reduce smoking rates would be detrimental to an industry that claims to “create jobs.” But we know that the financial ramifications for long-time smokers who develop heart and lung diseases and cancer — especially in nations with weaker health care infrastructure — are far more devastating. “Jobs” are not the tobacco industry’s priority: they are more than content to generate short-term profits at the expense of their users’ long-term well-being.

The onus is on policymakers to upend that paradigm and make it economically unpalatable for tobacco companies to market to existing customers and new, typically young and school-aged recruits. Strong tobacco control policies save lives and encourage people to spend their money in more healthful ways.

Risks beyond health

The Atlas emphasizes how the risks associated with tobacco use are broader than just health. They very often intersect with the harmful effects of everything from environmental damage, often seen in tobacco farming, to broader societal inequities, as seen in the United States and the disproportionate number of Black smokers — 88.5% — who use menthol-flavored cigarettes compared to white smokers — 29%. For many years, cigarette companies have aggressively targeted communities of color with these flavored products, particularly among youth.

In essence, tobacco control needs to be viewed as integral to overall health, well-being, and development, and that should inform local grassroots outreach, national big-picture strategy, and international allies committed to advancing health and other development goals. A coalition of like-minded advocates acting to promote each other’s interests and deploying a collective approach to beating back bad actors would present a potent check to a self-serving and harmful industry.

We are in a seemingly endless battle against deep-pocketed profiteers, an insidious industry that has withstood decades of assaults on its aims, methods, and bottom line. It has proven resilient and dogged in its pursuit of new ways to stay one step ahead of policy gains. If there’s one key takeaway from the latest Atlas findings, it’s that a more aggressive and interconnected counteroffense — one that effectively communicates tobacco companies’ callousness, while making a case for the benefits of promoting a more sustainable society — is how we fight back and win.

Read the full Tobacco Atlas at https://tobaccoatlas.org/