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agencies culpable for investing in sin sectors like tobacco? Pranay Lal. International .... economies, but most donors ignored this call, including the IFC and IMF. ... ease Control and Prevention, National Center for Chronic Dis- ease Prevention ...
Tropical Medicine and International Health

doi:10.1111/tmi.12049

volume 18 no 3 pp 372–376 march 2013

Editorial

International aid, tobacco and the tobacco epidemic – are aid agencies culpable for investing in sin sectors like tobacco? Pranay Lal International Union Against Tuberculosis and Lung Disease, New Delhi, India

keywords development aid, tobacco industry, tobacco control, tobacco epidemic, perverse economics Aid, tobacco trade and the making of a global epidemic From the 1940s to the 1990s, donors provided assistance to war-ravaged, newly liberated, famine-stricken countries in the hope of creating stable democracies. Donors feared that these hot and crowded countries could implode under the burden of feeding their population. Food aid, population control and agriculture were priority areas (Adams 1991). In tropical countries, tobacco cultivation was encouraged (Economist Intelligence Unit 1983), even when the deleterious effects of smoking were becoming known in the developed world (Lock et al. 1998, Berridge 2006). The tobacco trade gave the world its first multinational enterprise – British American Tobacco (BAT), and cigarettes became the first global product to permeate every culture (Cox 2000), especially in India, China and Japan (Cox 1986). The British and US Governments fiercely contested trade tariffs when competition became stiff overseas. Over time, the tobacco industry gained tremendous clout with domestic and foreign governments and influenced their policy making (Barry 1991). During World War I, the British Government went out of its way to release BAT’s assets, which had been seized by the Germans. BAT returned this favour when the British Government was in knots during the sterling crisis of 1931, and again when it needed funds at the onset of World War II (Cox 2000). A 1988 BAT brief revealed that the US Government was manipulating a fragile coalition government (Tobacco Legacy Documents, undated) to reduce import tariffs for cigarettes and backing United States-based cigarette companies to capture Thailand’s cigarette market. During the reconstruction of Europe after World War I, tobacco was vital for aid programmes. In the early years (1948–57), USD 38 millions’ worth (or 65 million pounds) of surplus tobacco was shipped as conditional

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lending to Europe and Far East (Committee on Agriculture 1959, Milward 1987). The United States created a dedicated department for tobacco in 1957 (U.S. Department of Agriculture, 2012), while the British Government’s aid agency, the Overseas Development Administration (ODA) and its commercial arm, the Commonwealth Development Corporation (CDC), promoted it extensively between 1962 and 1989 (Woodroffe 1992). Tobacco aid supported cultivation (World Bank 1984, Maxwell 1989, FAO 1989), promoted manufacture, created markets (Anonymous 2002) and market mechanisms [seen recently in Turkey (Kayaalp 2012)]; it subsidised input costs such chemical inputs (Badiane et al. 1997) and fuel wood (Khattak & lqbal 1999); and it provided improved technologies (Haunlyar 1986). For some countries, the tobacco experience has turned tragic. Initial success was soon followed by crises due to fuel wood shortage in many countries (Geist 1999). In 1984, The World Bank predicted that rapid deforestation would lead to loss of all fuel wood within 8 years in Malawi (World Bank 1984), forcing it to shift from fluecured to air-dried tobacco. Other countries noticed the impending energy crisis and moved away from growing tobacco altogether (Anderson & Fishwick 1984). From 1979 to 1984, British aid promoted tobacco in sub-Saharan Africa, which compromised investments in cereals, livestock and subsistence farming (All-Party Group on Overseas Development 1985) and increased malnourishment and stunting (Peters et al. 2008, Barford 1991). By 1988, Malawi depended on its neighbours for grain and on the United States for food aid (Lele 1989). The emergence of HIV/AIDS further exacerbated the hunger in communities dependent on tobacco cultivation (Peters et al. 2008, Barford 1991, Charman 2006). In Malawi, leaf trade was dominated by just four leaf traders, each with a majority American partner (USAID 1993), which lowered US production costs by 30% (AID & Adams International 1985). The US Government was

© 2012 Blackwell Publishing Ltd

volume 18 no 3 pp 372–376 march 2013

Tropical Medicine and International Health P. Lal Editorial

aware of the growing concerns about health and liability rulings and how similar measures in the EC market could jeopardise its trade interests (USAID 1993). With cheaper tobacco imports, tobacco growing in the United States became unprofitable. The US Government inveigled a successful tobacco buy-out programme but left their farmers deprived (Benson 2012). Despite this, cigarette production increased manifold and companies garnered profits from exports and new offshore acquisitions and ventures. Malawi and Zimbabwe in particular are and will be most affected by their overdependence on tobacco. As two of the poorest countries in the world, they are vulnerable to fluctuations in global demand and falling prices (Diao et al. 2002). Double standards In just three decades, the epidemic shifted from developed to low- and middle-income countries (LMICs). In 1970, 76% of all smokers lived in rich and developed countries (Beese 1972). By 1995, 82% of smokers lived in LMICs (Gajalakshmi et al. 2000). Between 1972 and 1985, cigarette smoking increased by 2.5% in the United States and declined by 3% in the UK, while it rocketed by 26% in India, 18% in Pakistan, 22% in Poland, 40% in Taiwan and a whopping 97% in Egypt (Maxwell 1992). In 2011, tobacco use killed almost 6 million people; nearly 80% of these lived in LMICs. Although tobacco control is one of the most cost-effective public health interventions (Jamison et al. 2006, CDC 2007), it is the least funded (WHO 2011, Ross & Stoklosa 2012). Ironically, in most countries, tobacco taxes finance health budgets, but very little if any of national health budgets is dedicated to tobacco control: in India, it is