Smoking takes an enormous toll on human health – accounting for about 6% of all ill-health globally according to the best estimates. This is more than HIV and malaria combined. Despite this, smoking is on the rise in many developing countries as people become richer and can afford to buy cigarettes.
There appears to be a range of policies which have been shown to reduce smoking rates, which are usually not applied in developing countries. The most natural ways to tackle the problem through your career include becoming a health policy expert, or advocacy through journalism, think tanks and politics. This is a particularly promising cause for people living in a developing country with high smoking rates.
The damage done by smoking in developing countries is around 100 million years of health life annually, and this could plausibly be halved.
The collective value of philanthropy and bureaucrats working on tobacco control is between $100-$1,000 million.
Some relevant people are supportive but there’s significant opposition from the status quo.
April 6th, 2016
Table of Contents
- 1 What is the problem?
- 2 Why is this problem pressing?
- 3 What can you do about this problem?
- 4 Further reading
What is the problem?
The World Health Organization (WHO) estimates that tobacco is the largest cause of preventable death in the world. Smoking is responsible for almost 6 million deaths each year or the loss of 140 million years of healthy life, with nearly 80% of the burden falling on low- and middle- income countries (LMIC)1, a burden amounting to more than malaria and HIV combined.2 Each death as a result of pack-a-day smoking shortens life by around 10 years, as shown by data in the United States.3
Collectively, smoking is responsible for 5-6% of all ill health globally according to the Global Burden of Disease study, and its share is rising over time.
Why is this problem pressing?
What is our recommendation based on?
Many in the development4 and public health5 fields see the problem as an effective intervention for improving health. Reviews by global health charity evaluators and foundations The Open Philanthropy Project, Giving What We Can, Copenhagen Consensus and the Centre for Global Development (CGD) were mostly positive that tobacco control is a cost-effective public health intervention, with CGD calling tobacco taxes “The Single Best Health Policy in the World”. This page is largely based on their research.
That the Gates Foundation, has committed US$125 million over 5 years, and the Bloomberg Foundation has committed US$220 million over 4 years provides confidence that respected philanthropists see this as a pressing issue.
Why is it pressing?
Tobacco use is increasing in low- and middle-income countries and if no action is taken, the number of annual tobacco deaths is projected to rise to more than 8 million by 2030, amounting to the loss of more than 200 million years of healthy life.6 The Copenhagen Consensus Centre researchers estimate a total economic loss from tobacco of about 12.7 trillion dollars over the next 20 years – or about 1.3% of global GDP annually – as a result of tobacco causing one-third of deaths from vascular disease, half the cancers and 60% of chronic respiratory diseases.7
Furthermore, it is clear how tobacco use can be reduced, and many countries have succeeded in significantly reducing smoking rates. Taxing tobacco products seems to reduce consumption by about 4% for every 10% increase in price.8 Such a policy also costs the government nothing – rather it raises revenue. The main limiting factor is political enthusiasm for policies of this kind, which may be resisted by tobacco companies, smokers themselves and those who oppose interfering with people’s choice to smoke.
Despite the above, many developing countries do not have effective anti-tobacco programs. For example, The WHO Global Adult Tobacco Survey for China showed that only 23% of Chinese adults knew that smoking caused lung cancer, heart attacks and strokes. 9 The taxation share of the cost of a pack of cigarettes in China is also only 40%, significantly lower than in most developed countries and the level recommended by the WHO (75%).10
Efforts we could identify to discourage smoking amount to less than $1 per smoker in the developing world per year.
What are the major arguments against it being pressing?
- Tobacco companies will resist attempts to regulate cigarettes, making lobbying efforts challenging.
- There are already substantial efforts being made by some funders and public health experts to solve this problem (see “Who else is working on this problem?”).
- Some believe it is undesirably paternalistic to prevent people from smoking if they choose to do so, or even that it is rational to smoke given the enjoyment people get from it.
- In practice it may not be practical for our mostly English-speaking readers to influence tobacco policy in countries like China, where most of the growth in smoking is occurring. China is particularly interesting because all tobacco is sold by the government, and smoking accounts for 7-10% of central government revenue, suggesting there will be many interest groups to compete with on the issue.11
- It might turn out that improving health does not much affect the long term progress or direction of human civilization, making it less important than it would seem based on its short term effect on welfare.
Key judgement calls made to prioritise this problem
- Attempts to get policy change that discourages tobacco smoking will sometimes work at a reasonable cost.
- It is good to discourage people from smoking, because the health damage exceeds any gain people get from enjoying smoking.
- There are developing countries available that would listen to external experts to help them set tobacco control policies.
What can you do about this problem?
What’s most needed to contribute to this problem?
Most methods for reducing tobacco deaths are relatively well known and have been tested in developed countries. For example, the ‘MPOWER’ package of policies developed by the World Health Organisation1 recommends the following:
- Monitor tobacco use and prevention policies
- Protect people from secondhand tobacco smoke
- Offer help to quit tobacco use
- Warn about the dangers of tobacco
- Enforce bans on tobacco advertising, promotion and sponsorship
- Raise taxes on tobacco.
This approach and the likely impacts is described in detail in a recent WHO report.10
Promotion of electronic cigarettes is a new and potentially valuable way of helping people quit smoking, though controversial.12
As a result of the fact that the interventions are quite well studied and unlikely to be dramatically improved, implementation seems to be the key issue. This means designing and advocating for better government policy through public service, academia, think tanks and political parties.
Given the significant amounts of funding that have recently been made available (see ‘Who is working on this problem, below), this area is more likely talent constrained.
What skill sets and resources are most needed?
People with experience in:
- Health and economic policy
- Knowledge of appropriate policy responses
- Influence to implement or promote changes
- Public health
- Improving our knowledge of the effectiveness, and cost-effectiveness of each intervention to reduce tobacco consumption
Who is working on this problem?
- National governments, in particular health departments, many of whom have programs to discourage smoking.
- The World Health Organization provides support to countries that want to reduce tobacco use.
- A pair of foundations also provide significant support:
Including academics and public servants working on tobacco control along with philanthropic giving, we estimate that the resources going directly towards anti-smoking efforts are between US$100 – US$1,000 million per year.13
In considering how neglected the cause is, we should not forget supporters in the general public, who discourage people from smoking or vote in support of voting cessation policies, though we are not sure how to value them.
What can you concretely do to help?
- Complete graduate studies in policy, public health, evidence based social policy or economics.
- Conduct academic research into finding the most effective and cost-effective tobacco control policies; or study how those policies can be promoted in countries that do not yet have them.
- Apply to work at one of these organisations:
- Gates Foundation
- Bloomberg Foundation
- World Lung Foundation
- Campaign for Tobacco-Free Kids
- World Health Organization
- Centers for Disease Control and Prevention Foundation
- Johns Hopkins Bloomberg School of Public Health
A wide range of positions with a public platform can be applied part time to the problem of tobacco control. For example, someone could use their skills as:
- a journalist to report on tobacco as a public health issue and to push for enforcement of adopted policies, or to help other journalists do so;
- an academic or other researcher could write up policy proposals for a think tank;
- a politician to push for evidence based tobacco reduction or cessation policies; or
- a grassroots activist to raise the level of attention devoted to tobacco use.
These kinds of activism are particularly promising if you already have local experience in a poorer country that has high smoking rates. If you are in a position to do these things soon you could apply for a grant from the foundations listed above.
Finally, someone could earn to give and themselves donate to anti-tobacco organisations or campaigns. We have not investigated opportunities for philanthropy in this area, but some charities do accept donations, such as the Campaign for Tobacco-Free Kids. One could also simply donate to whichever projects the larger foundations in this area make grants to.
- The Open Philanthropy Project report on Tobacco Control in Low- and Middle-Income Countries.
- WHO Fact Sheet on Tobacco 2015.
- Centre for Global Development policy paper, The Single Best Health Policy in the World: Tobacco Taxes.
- Giving What We Can’s report on whether tobacco is a best buy for the developing world.
Notes and references
- “Tobacco is the single greatest preventable cause of death in the world today, killing up to half the people who use it. More than one billion people worldwide currently smoke tobacco – about one quarter of adults – and tobacco use currently kills more than five million people worldwide each year. Tobacco use continues to grow in developing countries due to steady population growth along with aggressive tobacco industry marketing efforts.” MPOWER: A policy package to reverse the tobacco epidemic Source Archive Nearly 80% of the more than one billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest.” WHO Fact Sheet on Tobacco 2013 Source Archive↩
- DALYs lost to: Malaria: 65,493,100 HIV: 69,363,400 Tobacco: 143,512,000 Source: Institute for Health Metrics and Evaluation, Global Health Data Exchange (GHDx), GBD 2013 Results by Risk Factor (Table 3), and GBD 2013 Disability-Adjusted Life Years (Table 1), 2013 Source Archive↩
- “Life expectancy was shortened by more than 10 years among the current smokers, as compared with those who had never smoked. Adults who had quit smoking at 25 to 34, 35 to 44, or 45 to 54 years of age gained about 10, 9, and 6 years of life, respectively, as compared with those who continued to smoke.” Jha, Prabhat, et al. "21st-century hazards of smoking and benefits of cessation in the United States." New England Journal of Medicine 368.4 (2013): 341-350. Source Archive↩
- Source Archive Citing (Peto et al, 2006; Jha, 2009)↩
- “Making the public health case for tobacco taxation” Patricio V. Marquez for the World Bank 07/06/2015 Source Archive↩
- “Unchecked, tobacco-related deaths will increase to more than eight million per year by 2030. More than 80% of those deaths will be in low- and middle-income countries.” WHO Fact Sheet on Tobacco 2013 Source Archive↩
- William Savedoff and Albert Alwang. 2015. "The Single Best Health Policy in the World: Tobacco Taxes." CGD Policy Paper 062. Washington DC: Center for Global Development. Source Archive↩
- Cheng Li (October 2012). "The Political Mapping of China’s Tobacco Industry and Anti-Smoking Campaign" (pdf).↩
- Electronic cigarettes for smoking cessation and reduction, Cochrane Database of Systematic Reviews, 2014 Source.’ Smoke and fire over e-cigarettes, Science, 2015 Source↩
- “Using fairly aggressive assumptions, Cynthia Callard of Physicians for a Smoke-Free Canada estimated that in 2008, global funding for tobacco control in middle- and low-income countries (including the Gates and Bloomberg funding discussed above) “is likely no greater than $240 million.”16 With a more conservative set of assumptions, Hana Ross and Michal Stoklosa of the American Cancer Society estimated that in 2008, global funding for tobacco control in middle- and low-income countries included $42 million in international assistance and $37 million in domestic public resources.17 Even on the higher funding estimate, tobacco control funding is approximately an order of magnitude less per person who suffers (i.e. smokes) or dies than funding for HIV/AIDS, malaria, or tuberculosis.18” Tobacco control, Open Philanthropy Project, 2013 Source Archive↩