Source: The Lancet - Volume 351, Number 9106 Author: Cesar Chelala Contact: Website: http://www.thelancet.com/ Pubdate: Sat, 21 Mar 1998 NEW YORK: TOBACCO CORPORATIONS STEP UP INVASION OF DEVELOPING COUNTRIES Facing increasing restriction in the USA and other industrialised countries, transnational tobacco companies are increasingly marketed their products in developing countries, particularly among women and adolescents. While smoking rates in some industrialised countries are decreasing at about 1% a year, those in developing countries are increasing at around 3% per year. It is estimated that, if current trends persist for the next 30 years, 7 million people from developing countries will die every year from smoking-related diseases. Judith Mackay, director of the Asian Consultancy on Tobacco Control (Hong Kong, China) says that while smoking is decreasing in the West, transnational tobacco companies are turning to softer markets, particularly in Asia, where health information is less well known. For the past several years, corporations such as Philip Morris, RJ Reynolds, and British-American Tobacco have been expanding rapidly in Eastern Europe, Asia, Africa, and Latin America. In the USA, Blacks, Latinos, and other minority groups are special targets of tobacco-promotional campaigns. In many Black and Latino neighbourhoods, 80-90% of billboard advertising is for tobacco and alcohol. Tobacco-provoked deaths can only add to the inequities in health of ethnic and minority populations. As Jeanette Noltenius, executive director of the Latino Council on Alcohol and Tobacco (Washington, DC, USA) remarks, "In the US, minorities such as Hispanics have been specifically targeted by the tobacco companies since the early 1960s, and have received a double dose of advertising [in Spanish and English]". A study of Hispanic eighth graders in the USA revealed that 18·3% had smoked within the past 30 days, compared with 6·6% of Blacks and 17·8% of Whites. According to data from the Bureau of Census, US Department of Commerce, Latino youth will triple in size in 2020, increasing from 9% of the national youth population to 19%. Under a deal reached last June, five major tobacco companies have reached a US$368·5 billion agreement to settle existing lawsuits by states and smokers. That deal, which is now under consideration by Congress, practically ignores the cigarette makers' overseas operations, a critical area of concern. Since the early 1980s, US trade officials, with help from the Office of the US Trade Representative (USTR) have led a sustained campaign to open markets in Japan, South Korea, Taiwan, and Thailand among the Asian nations. In 1995, for example, the US Embassy in Thailand intervened on behalf of US tobacco companies when the government of Thailand proposed regulations that required the disclosure of ingredients of all brand-name cigarettes sold in Thailand. Senator Jesse Helms and other supporters of the tobacco industry's interests in Washington have used section 301 of the 1974 Trade Act to threaten retaliatory tariffs on those countries' exports unless they open their markets to US companies. Helms successfully used these prerogatives to pressure the Japanese government to open its markets to US tobacco products. In Taiwan, US officials' efforts to force Taiwan to open its markets to US tobacco products have resulted in increased smoking, particularly among women and children. Talking about US government support for American tobacco companies, a corporation executive remarked, "We expect such support. That's why we vote them in". These actions have prompted the Asia-Pacific Association for the Control of Tobacco to protest strongly at what they consider an invasion of their countries by US companies targeting Asian women and children. The Association has complained about the strong-arm tactics used by US government officials in their countries. A 1990 report from the US General Accounting Office established that, "US policy and programs for assisting the export of tobacco and tobacco products work at cross purposes to US health policy initiatives, both domestically and internationally". A prime target for those promoting increased tobacco use is China, where tobacco companies have been moving steadily inland, with intense promotional campaigns. It is estimated that of the world's 1·1 billion smokers, 300 million are in China. Smokers in the US consume 450 billion cigarettes a year, while those in China consume approximately 1·7 trillion during the same period. Lung cancer in China has been increasing at a rate of 4·5% a year. Lured by financial gains from growing tobacco, 1·8 million hectares in China are presently under cultivation. Gains from the sale of tobacco , however, may be just short-term, since the cost of treating lung cancer and other related diseases amply exceed the tobacco profits. According to Mackay, those excess costs are $200 billion annually on a global scale, one-third of which is incurred by developing countries. While anti-smoking efforts gather momentum in the USA, those efforts are far less effective in developing countries. Such countries' policies will not be as effective unless transnational tobacco firms are made to limit their aggressive advertisements. Countries in Asia and Latin America are conducting health-education campaigns and have passed legislation to control smoking. Up to now, 91 countries worldwide have enacted legislation to control tobacco consumption. Although in general this legislation has been passed at the national level, in the USA, Canada, and in several countries in Latin America and the Caribbean these laws are being enacted by state or local bodies. While the USA blames Colombia and other South American countries for their cocaine exports, the USA continues its indiscriminate promotional tobacco efforts in those countries, at a much higher human cost. As things stand now, only a multidisciplinary strategy including education, taxation, legislation, and regulation of trade practices of transnational corporations will be able to control this pandemic.