Tobacco control

December 14, 2010
IDRC Communications

In Canada people have come to recognize the harmful effects of tobacco on health. In many poorer countries, however, the globalization of the tobacco industry, the lack of tobacco control laws, and limited public awareness about the hazards of tobacco combine to create a growing health crisis. Currently, 70% of the world’s smokers live in developing countries.

In developing countries tobacco use has boosted rates of non-communicable disease, such as cancer, and has aggravated the impact of infectious diseases like tuberculosis. Currently, 5 million people die annually from tobacco-related illness; by 2030 this number could double.

To confront this growing crisis, in 2003 the World Health Organization (WHO) created the Framework Convention on Tobacco Control (FCTC) — the world's first health treaty, which more than 160 countries have ratified. In developing regions especially, tobacco can do serious economic harm. In Indonesia, for example, the poorest people spend some 15% of their income on tobacco products. Tobacco-related diseases burden fragile healthcare systems and hinder productivity.

Tobacco is farmed in more than 125 countries and the problems associated with this crop, particularly for small-scale growers, are legion. These include its extremely labour-intensive nature and resulting effects on families, and negative environmental and health impacts. Farmers often find themselves tied into cycles of debt bondage with tobacco companies.

IDRC funds research to minimize the threats from tobacco production and consumption.

Raising awareness

In many countries, decision-makers such as legislators remain uninformed about the FCTC. In India, IDRC supported a small but effective initiative to confront this problem. The research partner was the New Delhi-based organization HRIDAY — Health Related Information Dissemination Amongst Youth.

HRIDAY analyzed the strengths, weaknesses, opportunities, and threats of India’s Tobacco Control Act and pinpointed changes needed to make this domestic legislation comply with the FCTC. As well, a survey of the knowledge and attitudes of parliamentarians helped to inform those people about the FCTC and to remind them that Indian youth widely support its goals. This effort helped develop India’s first National Program for Tobacco Control.

The team also evaluated India’s laboratory capacity for testing tobacco products — as mandated by the FCTC — and as a result, the Government of India began discussions on training activities with international organizations.

The Ministry of Health and Family Welfare had indicated its intention to launch a series of pictorial health warnings for tobacco packs developed by the project. These warnings have not yet been implemented, however, and further work in this area continues.

New light on the narghile

Many people enjoy smoking tobacco in the traditional waterpipe known as the narghile or hookah, among other terms. The last 15 years have seen a dramatic increase in waterpipe smoking, particularly in the Eastern Mediterranean, and hookah bars are increasingly popular in other parts of the world. This popularity may be due to unsubstantiated assumptions about the relative safety of this form of tobacco use, the social nature of the activity, and the relatively recent innovation of flavouring the tobacco.

IDRC partners at the American University of Beirut (AUB) are global leaders in narghile research. Their analyses of the levels of toxins in waterpipe smoke helped persuade the WHO to issue a key 2005 health advisory. It stated: “Waterpipe smoking is associated with many of the same risks as cigarette smoking and may in fact involve some unique health risks.”

Follow-up studies pursue questions about the absorption of carcinogens, the nature of narghile addiction, the harm from second-hand narghile smoke, and the association between narghile smoking and coronary atherosclerosis, among other health issues.

Clean air for ourselves and our children

When Guatemala ratified the FCTC in 2005, it agreed to reduce second-hand exposure to tobacco smoke in “workplaces, public transport, and indoor public places.” At the time, Guatemalan law prohibited smoking in schools and hospitals — but had only partial bans in private workplaces and restaurants. There were no restrictions in bars.

This was in part the work of the tobacco industry, which encouraged designated smoking and non-smoking areas as well as ventilation as solutions to risks posed by second-hand smoke.

In 2006, a team led by an IDRC-supported researcher investigated nicotine levels in selected locations around Guatemala City. They found concentrations in restaurants and bars as much as 710 times higher than in equivalent spaces in Guatemalan hospitals. Designated non-smoking areas and expensive ventilation systems were found to be largely ineffectual.

Armed with this information, in 2007 the principal researcher worked closely with the Health Commission to draft Law 3309, which called for an outright ban on smoking in restaurants and bars; however, the bill languished in Congress.

The researchers then undertook a campaign to increase public awareness of the hazards of second-hand smoke. Publication in a respected medical journal, Cancer Epidemiology Biomarkers and Prevention, lent credibility to their research. They cultivated media contacts, leading to numerous newspaper articles, and gave frequent policy briefings to members of Congress.

The research findings and relentless dissemination efforts were highly influential in the December 2008 passage of Law 3309 — a significant victory for tobacco control efforts in Guatemala. The law, which took effect in February 2009, includes a comprehensive ban on smoking in all public places.

From tobacco to bamboo

Jacob Kibwage

Many small-scale tobacco farmers express a keen interest in exploring options to tobacco growing. IDRC is building a critical mass of evidence about alternative crops by supporting studies in a number of countries, including Bangladesh, Malawi, and Kenya.

In Kenya, researchers at Maseno University work with small-scale farmers in South Nyanza region to investigate the feasibility of growing giant bamboo instead of tobacco as a cash crop at 120 bamboo field experimentation sites. The potential market for bamboo and bamboo products is being assessed. Farmers have been trained to produce a variety of goods manufactured from bamboo and are selling them quite successfully.

This research has drawn considerable interest. The Kenyan government’s Ministry of Information and Communications has begun filming the farmers involved in the study. An awareness-raising video documents the economic problems associated with tobacco production — such as threats to food security when other crops are neglected — and captures the farmers’ optimism about the benefits of switching to bamboo. International scientific journals have also helped spread the technical findings of the research.

The researchers have concluded that, indeed, there is urgent need to diversify livelihoods in this region. On the basis of their findings they also believe that bamboo will address many of the problems associated with tobacco. They have recommended replicating the experiment in other tobacco-growing districts in Kenya.

IDRC gratefully acknowledges the funding support of the Department for International Development (DFID) in the UK.

To learn more

Download the PDF: IDRC on tobacco control

AT WHAT COST? : The Economic Impact of Tobacco Use on National Health Systems, Societies, and Individuals

SMOKE & MIRRORS : The Canadian Tobacco War

Tobacco and taxes: A winning strategy