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Briefing: tobacco in developing countries

There are around 1,100 million regular smokers in the world today, of which approximately 300 million are in economically developed countries and 800 million in the developing world.

While lung cancer deaths in the UK and other developed countries are now in decline, they are increasing very rapidly in many developing countries where smoking prevalence is high and general awareness of the risks of smoking is relatively low.

Developing countries offer an attractive marketing opportunity for tobacco manufacturers, whose Western markets are shrinking. Tobacco companies have been able to promote tobacco use in these countries, often with the help and support of their own governments via trade agreements.

Our research

Professors Richard Peto and Rory Colins in Oxford are monitoring the epidemic of death from tobacco in several countries including China. They have shown that worldwide deaths from tobacco are likely to increase from about 4 million per year at present to about 10 million per year by the time children of today reach middle age. Around 70 per cent of these deaths will be in developing countries.

Recommended measures

A range of measures need to be adopted to curb the growing tobacco epidemic in developing countries. Strategies, which have proved successful in the West over several decades, could be adopted by developing countries to prevent further growth in tobacco use. Effective public health and information programmes should be combined with significant taxation and with bans on all forms of tobacco advertising and promotion.

Cancer Research UK believes that the concept of wealthy countries, like the UK or USA, exporting the burden of death and disease to poorer countries, via tobacco promotion, is abhorrent. Tobacco control is now a global problem.

Treaty on tobacco control

In recognition of this the 192 Member States of the World Health Organisation set up an international treaty on tobacco control (Framework Convention on Tobacco Control - FCTC). The world's first public health treaty, the FCTC contains a host of measures designed to reduce the devastating health and economic impacts of tobacco. The final agreement, reached in May 2003 after nearly four years of negotiations, provides the basic tools for countries to enact comprehensive tobacco control legislation. Provisions in the treaty encourage countries to:

• Enact comprehensive bans on tobacco advertising, promotion and sponsorship; Place rotating health warnings on tobacco packaging that cover at least 30 percent (but ideally 50 percent or more) of the principal display areas and can include pictures
• Ban the use of misleading and deceptive terms such as "light" and "mild"; Protect citizens from exposure to tobacco smoke in workplaces, public transport and indoor public places
• Combat smuggling, including the placing of final destination markings on packs
• Increase tobacco taxes

The FCTC also contains numerous other measures designed to promote and protect public health, such as mandating the disclosure of ingredients in tobacco products, providing treatment for tobacco addiction, encouraging legal action against the tobacco industry, and promoting research and the exchange of information among countries.

The FCTC was adopted unanimously by the World Health Assembly on 21 May 2003 and was closed for signature on 29 June 2004. A minimum of 40 countries must ratify the FCTC before it enters into force, at which time the FCTC formally becomes an international agreement.

Cancer Research UK believes that the UK should lead the other EU Member States should ratify the treaty now, without further delay.

Within a year of entering into force, a subsidiary body - the Conference of the Parties - will begin meeting to review national reports, provide further guidance on proper implementation of the FCTC, initiate protocol negotiations and promote the mobilization of financial resources.

The Framework Convention is only legally binding on countries that ratify it. The onus will be on national governments to implement the FCTC and protocols. How effective the FCTC will be in reversing the tobacco epidemic will be determined by the how fully governments implement the obligations contained in the FCTC.