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Viewpoint: Lighting Fires for Tobacco Control

IDRC Photo: M. Campbell

2002-12-06

When it comes to dealing with the ill-effects of tobacco consumption politicians don’t so much see the light as they feel the fire. The question for researchers is: how can we help light the fires that motivate people?

We must first bear in mind that funding for tobacco control research is woefully inadequate. The tobacco industry, on the other hand, has almost limitless resources. Moreover, internal tobacco industry documents point to a deliberate strategy on the part of the industry to bias the research results of studies they fund. This is why funding and research organizations recently agreed to the Ottawa Declaration on Tobacco and Sustainable Development. In essence, this Declaration calls for concerted international action to support timely and locally relevant research to demonstrate tobacco’s impact, and curb the influence of the tobacco industry in poor countries. Information must also be disseminated so governments can develop their own effective tobacco control policies and programs.

The research paradox

Tobacco control advocates attempting to translate scientific findings into fruitful public policy initiatives face a paradox. On the one hand, the logic in favor of restricting tobacco is very strong. There are an impressive number of research reports documenting the adverse environmental, economic, and health impacts of tobacco production and consumption — and these effects are known to be particularly hard-hitting in the developing world. Yet despite this, a lack of political "heat" has kept tobacco control well down on the list of global priorities — under-funded and often under-acknowledged as a development issue.

So, how can research help move the tobacco issue further onto the public policy agenda, particularly in the developing world?

In general terms, much is already known about the multi-faceted threat that tobacco poses for the developing world. As a health issue, smoking remains the world’s leading preventable cause of death and disability among adults. In developing countries, it accounts for the deaths of approximately 2 million people each year. However, by the year 2030, this figure is expected to rise to 7 million people per year, and to represent 70% of deaths caused by tobacco worldwide.

The rise of tobacco use in Asia

The challenge is to communicate the dangers of tobacco in ways that mesh with the priorities of countries dealing with a multitude of economic and other problems. For example, tobacco control is a hard sell in Asia — a region that prides itself on being "open to business" and therefore reluctant to interfere in the marketplace.

Cultural factors have also allowed tobacco companies a freer hand to expand their markets in Asia. New networks promoting anti-smoking non-governmental organizations (NGOs) and linking them with benefactor foundations have been slow to form. This is because of a historical aversion to advocacy, as well as a lack of a tradition of corporate philanthropy in the region. The difficulties of organizing across borders and the entrenched idea that smoking is a matter of personal choice, are also factors fueling an extraordinary rise in the number of tobacco users in Asia.

It’s a startling fact: there are now more smokers in China than there are people in the United States.

Encouraging track record

The good news, however, is that we know it is possible to roll back tobacco consumption. Jurisdictions that have been able to communicate the hazards of tobacco have been particularly successful at this. In California in the United States restrictions on tobacco use in public places are now so widely accepted that the public has been asking for smoke-free stadiums and smoke-free outdoor patios. In large measure, this can be attributed to the efforts of the State of California Department of Health Services. One of the tools of the department’s campaign has been the research that established the threat of second-hand tobacco smoke to non-smokers.

Of course, encouraging as this may be, it goes without saying that conditions in California are very different from those in developing countries.

What can be done, given the scarcity of resources in developing countries? The Thai Health Promotion Foundation has taken an instructive approach. It is this organization’s position that research must be precisely targeted to meet the needs of public health campaigns. Rather than beginning with research and moving forward to policy positions and a public communications campaign, the Foundation believes that the policy direction should be established first and the research program crafted to serve it.

How to move a mountain

It’s also the view of the Foundation’s general manager, Dr Supakorn Buasai, that tobacco policy can be substantially changed — if three key groups are involved and informed. Politicians must be willing to take action and be informed about the policy options that are open to them. The public and social movements need access to the existing information on the impact of tobacco, particularly as it applies to their own country. Beyond that, they also need access to policymakers and the media. And the research community is a precious resource for filling in the gaps. With all three elements in place, Dr Buasai believes it is possible to move mountains.

And in fact, Thailand has had uncommon success in resisting the plans of the multinational tobacco conglomerates, having won the right to impose some of the world’s strictest tobacco controls at a 1990 panel hearing of The General Agreement on Tariffs and Trade (GATT).

Asking important questions

Yet we cannot define the scientist’s role too narrowly. The tobacco industry’s habit of spending heavily on its own research, and refining its arguments to defend its practices, means that we have to keep asking probing question and finding answers.

In fact, it is only recently that the tobacco industry stopped disputing that their product is an addictive substance — a development that came about as the result of relentless work by researchers seeking to establish how the substance actually works. New questions are arising about tobacco which researchers should be concerned with. One of them is the whole question of why people smoke — whether it helps them cope with stress or regulate their emotional states — a puzzle that’s key to formulating more effective cessation programs. An apparent relationship between smoking and increased risk of depression and anxiety disorders is another matter that begs further inquiry.

In terms of relating research to policy work, it is necessary to link tobacco use with broader concerns that NGOs, governments, and international agencies are already engaged with. The drive to recruit more women smokers — and the implications of that for neo-natal health — is of obvious concern to those who are working to improve maternal and child health. The heavier use of chemical pesticides and fertilizers in growing tobacco is also a crucial environmental concern. That 70% of the world’s tobacco is grown in developing countries, places a disproportionate burden of that environmental impact on the South.

Poverty alleviation is another area of work where tobacco has clear implications. Often smokers in developing countries divert family income from food to tobacco. In Bangladesh, for instance, it’s estimated that the typical smoker’s daily tobacco expenditure could add 500 calories to the diet of one or two children.

The Ottawa Declaration

The Ottawa Declaration on Tobacco and Sustainable Development is meant to help push tobacco onto the radar screen as a development issue. With this Declaration, the researchers and funders of tobacco control research in developing countries are calling for recognition of the fact that tobacco use is not only an enormous threat to human life and health. It is also a serious hindrance to sustainable development and poverty reduction. We urge that tobacco control be elevated to high priority on the development agenda.

Dr Waverley Brigden is the Executive Director of Research for International Tobacco Control (RITC), an international secretariat housed at IDRC’s headquarters in Ottawa.

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