THE FIGHT AGAINST TOBACCO IN DEVELOPING-COUNTRIES

The battle to reduce the tobacco epidemic is not being won; the epidemic is merely being transferred from rich to poor countries. Tobacco-related mortality will rise from the present annual global toll of 3 million to over 10 million by the year 2025. Currently, most of these deaths are in developed countries but 7 out of the 10 million deaths will occur in developing countries by 2025. Developing countries cannot afford this increase, either in terms of human health or in economic costs, such as medical and health care costs, costs of lost productivity, costs of fires or costs of the misuse of land used to grow tobacco. As many of the tobacco-related illnesses, such as lung cancer or emphysema, are incurable even with expensive technology, the key to tobacco control lies in prevention. The essential elements of a national tobacco control policy are the same for all countries throughout the world - the only differences lie in fine tuning to a country's current situation. While indigenous production and consumption of tobacco remain a problem, of particular concern is the penetration of developing countries by the transnational tobacco companies, with aggressive promotional campaigns and the use of political and commercial pressures to open up markets and to promote foreign cigarettes. This includes specific targeting of women, few of whom currently smoke in developing countries. Also, tobacco advertising revenue prevents the media from reporting on the hazards of tobacco, a particularly serious problem in developing countries where awareness of the harmfulness of tobacco is low. Governments in developing countries are often preoccupied with other health or general matters, such as high infant mortality and communicable diseases, and few have experience in fighting this new type of epidemic. In developing countries the legislative controls and other measures which in industrialized countries succeed in limiting the use of tobacco currently lag far behind those taken in developed countries. However, systems are finally being put into place that will eventually reduce the tobacco epidemic - tobacco data are slowly being collected, health education programmes introduced, and legislation implemented.