The Atlas

“When one has a thorough knowledge of both the enemy and oneself, victory is assured. When one has a thorough knowledge of both heaven and earth, victory will be complete.”

— General Sun Tzu The Art of War: A Treatise on Chinese Military Science c. 500 B.C. Publications of the World Health Organization can be obtained from: The Tobacco Atlas

Marketing and Dissemination Dr Judith Mackay World Health Organization 20 Avenue Appia and Dr Michael Eriksen 1211 Geneva 27 tel: +41 22 791 2476 fax: +41 22 791 4857 email: [email protected]

Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to:

Publications address as above fax: +41 22 791 4806 email: [email protected]

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The authors alone are responsible for the views expressed in this publication. The Tobacco Atlas © World Health Organization 2002 CONTENTS

All rights reserved Foreword 9 6 Consumption 30 First published 2002 Dr Gro Harlem Brundtland, Annual cigarette consumption per person. 10 9 8 7 6 5 4 3 2 1 Director-General, World Health Organization Top 5 countries. Global increases from 1880 to 2000. Increases in the average number of Preface 11 ISBN 92 4156 209 9 smoked in between 1952 and 1996. Acknowledgments 13 7 Health Risks 32 Produced for the World Health Organization by How harms you. Smoking in pregnancy. Myriad Editions Limited Photo Credits 15 Deadly chemicals. Proportion of lung cancer, 6–7 Old Steine, Brighton BN1 1EJ, UK COPD and ischaemic heart disease. Tobacco http://www.MyriadEditions.com About the Authors 17 industry quotes.

Edited and co-ordinated for Myriad Editions by 8 34 Paul Jeremy and Candida Lacey 1 The History of Tobacco 18 Harm caused by passive smoking. Children exposed Design and graphics by Paul Jeremy The global spread of tobacco from the Americas to passive smoking. Numbers affected by passive and Corinne Pearlman to the rest of the world. Historical highlights of smoking. quotes. Maps created by Isabelle Lewis key events and action taken to curb the epidemic. 9 Deaths 36 Printed and bound in Deaths from tobacco use in men and women. Produced by Phoenix Offset Limited Part One: PREVALENCE AND HEALTH Dying in your prime: 35- to 69-year-olds who die under the supervision of Bob Cassels, from tobacco. Past and future deaths from tobacco: The Hanway Press, 2 Types of Tobacco Use 22 1950 to 2030. Deaths in developed and developing Different forms of smoking and other forms countries. Number of people alive today who will This book is sold subject to the condition that it shall not by of tobacco, including cigarettes, pipes, bidis, eventually die from tobacco. Tobacco industry way of trade or otherwise, be lent, re-sold, hired out, or . quote. otherwise circulated without the publisher’s prior consent in any form of binding or cover other than that in which it 3 Male Smoking 24 is published and without a similar condition including this Smoking prevalence among men. Trends in Part Two: THE COSTS OF TOBACCO condition being imposed on the subsequent purchaser selected countries. Smoking among physicians. 10 Costs to the Economy 40 Top 10 countries. Tobacco industry quote. Health care costs attributable to tobacco. 4 Female Smoking 26 Working days lost due to tobacco. Costs of fires Smoking prevalence among women. Trends in and litter collection. Tobacco industry quotes. selected countries. Where women smoke as 11 Costs to the Smoker 42 much as men. Where men smoke ten times Cost of a pack of cigarettes or equivalent as much as women. Tobacco industry quote. international brand. Minutes of labour worked to 5 Youth 28 buy a packet of cigarettes. The cost of a pack of Tobacco use prevalence among male and female Marlboro cigarettes or equivalent international youth. Passive smoking. Youth perception of brand compared with food or clothing. smoking. Tobacco industry quotes. Part Three: THE TOBACCO TRADE 19 Politics 62 26 Legislation: Health Warnings 78 31 Projections by Industry 88 Buying influence: expenditure on lobbying in the Where health warnings are required by law. Projected rates of growth and decline of tobacco 12 Growing Tobacco 46 USA. Buying favours: tobacco companies’ Impact on smokers of Canadian warnings. Public consumption by country 1998-2008. Regional Land devoted to growing tobacco by country. contributions to federal candidates in the USA. support for visible health warnings. Tobacco projections. Leading producers of tobacco leaves. Deforestation Tobacco industry quotes. industry quote. due to tobacco. 32 The Future 90 20 Smokers' Rights Organisations 64 27 Health Education 80 Epidemiology, health, economics, the tobacco 13 Manufacturing Tobacco 48 Location of smokers’ rights groups worldwide. : participating countries, industry, action taken projected to 2050. Number of tobacco workers by country. Where Tobacco industry quotes. and themes from 1988 to 2002. Quit & Win the tobacco dollar goes. Less tobacco per cigarette. campaigns. Tobacco industry quotes. Additives. 21 Tobacco Industry Documents 66 Part Six: WORLD TABLES 92 Number of documents found on the Legacy 28 Quitting 82 14 Tobacco Companies 50 website by country. Tobacco industry quotes. Percentages of ex-smokers. Quitting calendar: Table A: The Demographics of Tobacco 94 Leading manufacturers by country. The Big Five: the benefits of stopping smoking. Effects on deaths Population. Adult prevalence. . revenue and market share of leading transnational if smokers quit. Effect of smoking restrictions at Youth exposed to passive smoking. Cigarette tobacco companies. Tobacco industry quote. Part Five: TAKING ACTION home and at work. Impact of interventions on consumption. Quitting. quitting. 15 Tobacco Trade 52 22 Research 70 Table B: The Business of Tobacco 102 Cigarette exports by country. Top 10 cigarette Global Youth Tobacco Surveys completed by 29 Price Policy 84 Land area devoted to growing tobacco; quantity importers. Top 10 leaf importers and exporters. country. Current foundation grant recipients. Tobacco tax as a proportion of cigarette price. produced. Number of tobacco workers; number of US import and export of tobacco leaves and Comparative National Institute of Health Cigarette price increases compared with cigarettes manufactured. Cigarette imports and cigarettes. expenditure on tobacco compared with other consumption in the UK. Government income from exports; tobacco leaf imports and exports. Cost health problems. Published research: PubMed tobacco. Cigarette tax as a proportion of price in of a pack of Malboro cigarettes or equivalent 16 Smuggling 54 search for tobacco compared with other journal the USA. Tobacco industry quote. international brand; minutes of labour needed to Estimated smuggled cigarettes as a percentage topics. Journals devoted to . buy a pack of cigarettes. Tax as a proportion of of domestic sales. Major recent or current 30 Litigation 86 cigarette price; tobacco tax revenues as a smuggling routes. Global smuggling. Tackling 23 Tobacco Control Organisations 72 Legal action against the tobacco industry: percentage of total tax revenue. Tobacco industry tobacco smuggling in the UK: projected percentage WHO, international and regional tobacco control personal injury, public interest, non-smokers’ documents. of market share if action is or is not taken. Lost organisations. Locations of all World Conferences. and government lawsuits. Cases brought by the revenue in EU. Tobacco industry quote. Tobacco industry quote. tobacco industry. Smuggling litigation. Tobacco Glossary 110 industry quote. 24 Legislation: Smoke- Areas 74 Sources 113 Part Four: PROMOTION Where smoking is prohibited or restricted in some areas at work, and where employers voluntarily Useful Contacts 125 17 Tobacco Industry Promotion 58 prohibit or restrict smoking. Sales before and after Most popular cigarette brand by country. World’s smoking bans in restaurants and bars in California. Index 126 most popular brands. How the advertising dollar is concentration in public places in spent in the USA. Changes in cigarette marketing Barcelona, Spain. The cost of workplace smoking. expenditure. Tobacco industry quote. Tobacco industry quote.

18 Internet Sales 60 25 Legislation: Advertising Bans 76 Internet sales. Internet search for sites. Internet Increases and decreases in adult cigarette cigarette vendors in the USA. Test ordering from consumption, and countries with comprehensive 12 websites. HM Customs and Excise quote. User advertising bans in the same period. Effect of comment posted on website. advertising bans. Tobacco industry quotes. FOREWORD

A message from

Dr Gro Harlem Brundtland Director-General World Health Organization

“ people smoke today than at any other time in human history. One person dies every ten seconds due to smoking-related diseases. Research evidence in the past five years shows a bleaker picture of the health danger of smoking than previously realised. Tobacco is the biggest killer, much bigger in dimension than all other forms of pollution. Children are the most vulnerable. Habits start in Our goals are to: youth. The tobacco industry knows it and acts • build “a vibrant alliance” between WHO, accordingly. This is a medical challenge, but also a UNICEF, the World Bank, and “partnerships with a cultural challenge. Let us all speak out: tobacco is a purpose” with non governmental organisations, the killer. It should not be advertised, subsidised or private sector, academic/research institutions and glamourised. donors. Adolescents should not be allowed to mortgage • try to get more people to work on and their lives to the seductive advertisements of the support tobacco control activities and ensure that industry. Girls and women are being targeted all more resources are committed to tobacco over the world by expensive and seductive tobacco research, policy and control. advertising images of freedom, emancipation, • develop the Framework Convention on slimness, glamour and wealth. Tobacco companies Tobacco Control (FCTC), the world's first public should be accountable for the harm caused by health treaty. The treaty will only be effective if it tobacco use. works in conjunction with, and builds upon, sound The day I took office I launched the Tobacco domestic interventions. Free Initiative (TFI) to spearhead the struggle to reverse the worsening trends in health caused by The good news is that the epidemic does not have tobacco and to add momentum to a critical public to continue this way. There is a political solution to health struggle. The initiative aims at heightening tobacco – a solution routed through ministries of global awareness of the need to address tobacco finance and agriculture as well as health and consumption. It also seeks to build new education. partnerships and strengthen existing partnerships We know that tobacco control measures can for action against tobacco; to commission policy lead to a reduction in smoking as witnessed among research to fill gaps; and, to accelerate national and some member states. WHO, the World Bank and global policy to implement strategies. public health experts have identified a combination The way it works illustrates the way we wish of the following as having a measurable and WHO to work in the future making the most of sustained impact on tobacco use: our own resources and knowledge and drawing • increased excise taxes; heavily on the knowledge and experience of others. • bans on tobacco advertising, sponsorship and 9 PREFACE marketing; These must all be implemented if the predicted • controls on smoking in public places and expansion of the epidemic as outlined in this atlas is workplaces; to be prevented. • expanded access to effective means of The picture is far from bleak. Globally, we have “When I was young, I kissed my first woman and smoked quitting; seen a sea change over the past few years. A my first cigarette on the same day. Believe me, never since • tough counteradvertising; groundswell of local, national and global actions is have I wasted any more time on tobacco.” • tight controls on smuggling. moving the public health agenda ahead. — Arturo Toscanini (1867-1957) DR GRO HARLEM BRUNDTLAND Geneva June 2002

This book is intended for anyone concerned with personal or political health, governance, politics, economics, big business, corporate behaviour, smuggling, tax, religion, internet, allocation of resources, human development and the future. The atlas maps the history, current situation and some predictions for the future of the tobacco epidemic up to the year 2050. It illustrates how tobacco is not just a simple health issue, but involves economics, big business, politics, trade and crimes such as smuggling, litigation and deceit. The atlas also shows the importance of a multifaceted approach to reducing the epidemic – by WHO, other UN agencies, NGOs, the private sector and, in fact, the whole of civil society. The publication of this atlas marks a critical time in the epidemic. We stand at a crossroads, with the future in our hands. We can choose to stand aside; or to take weak and ineffective measures; or to implement robust and enduring measures to protect the health and wealth of nations.

JUDITH MACKAY, Hong Kong MICHAEL ERIKSEN, Geneva June 2002

10 11 ACKNOWLEDGEMENTS

We would like to thank the Centers for Disease Prevention and Health Promotion (NPH), Control and Prevention (CDC), USA, for Noncommunicable Diseases and Mental Health providing financial support for this atlas. Cluster (NMH); Many people have helped in the preparation of Paula Soper, Tobacco Free Initiative (TFI), this atlas. Firstly our thanks to all those at the Noncommunicable Diseases and Mental Health World Health Organization: Cluster (NMH); Derek Yach, Noncommunicable Diseases and Headquarters, Geneva: Mental Health Cluster (NMH). Joyce Bleeker, Noncommunicable Disease Prevention and Health Promotion (NPH), Regional offices: Noncommunicable Diseases and Mental Health Karen Klimowski, Charles Maringo, AFRO; Cluster (NMH); Fatimah M S El Awa, EMRO; Douglas Bettcher, Tobacco Free Initiative (TFI), Patsy Harrington, Haik Nikogosian, Ionela Petrea, Noncommunicable Diseases and Mental Health EURO; Cluster (NMH); Heather Selin, Armando Peruga, PAHO; David Bramley, Health Information Martha Osei, SEARO; Management and Dissemination (IMD), Evidence Harley Stanton, WPRO. and Information for Policy Cluster (EIP); Gian Luca Burci, Office of the Legal Counsel For their advice on particular maps and subjects, (LEG); we would like to thank the following: Vera Luiza da Costa e Silva, Tobacco Free Initiative (TFI), Noncommunicable Diseases and 2. Types of Tobacco Use Mental Health Cluster (NMH); Samira Asma, CDC, USA; Prakash Gupta, Tata Emmanuel Guindon, Tobacco Free Initiative Institute of Fundamental Research, ; (TFI) Noncommunicable Diseases and Mental Health Cluster (NMH); 3. Male Smoking and 4. Female Smoking Ewa Carlsson Höpperger, Office of the Legal Marlo Corrao, American Cancer Society, USA; Counsel (LEG); Amanda Sandford, ASH UK; Prabhat Jha, Commission on Macroeconomics and Health (CMH), Evidence and Information for 5. Youth Policy Cluster (EIP); GYTS Coordinators; Wick Warren, CDC, USA; Alan Lopez, Evidence and Information for Policy Cluster (EIP); 6. Cigarette Consumption Garrett Mehl, Noncommunicable Disease Tom Capehart, Economic Research Service, Prevention and Health Promotion (NPH), USDA; Prakash Gupta, Tata Institute of Noncommunicable Diseases and Mental Health Fundamental Research, India; Cluster (NMH); Diana Munoru, Noncommunicable Disease 7. Health Risks Prevention and Health Promotion (NPH), Gary Giovino, Roswell Park Cancer Institute, USA; Noncommunicable Diseases and Mental Health Corinne Pearlman, Comic Company, UK; Cluster (NMH); Jonathan Samet, Johns Hopkins Institute for Global El Atifi Mustapha, Tobacco Free Initiative (TFI), Tobacco Control, USA; Stan Shatenstein, Noncommunicable Diseases and Mental Health Communications consultant, ; Cluster (NMH); Pekka Puska, Noncommunicable Disease 8. Passive Smoking Prevention and Health Promotion (NPH), Clive Bates, ASH UK; Corinne Pearlman, Comic Noncommunicable Diseases and Mental Health Company, UK; Jonathan Samet, Johns Hopkins Cluster (NMH); Institute for Global Tobacco Control, USA; Wick Leanne Riley, Noncommunicable Disease Warren, CDC, USA; 13 PHOTO CREDITS 9. Deaths 23. Tobacco Control Organisations Majid Ezzati, Resources for the Future, USA; Sibylle Fleitmann, European Network for Smoking front cover: Prevention, Belgium; Hughes, Framework Boy smoking, Seychelles 11. Costs to the Smoker Convention Alliance, ; Ruben Israel, Credit: Harry Anenden © WHO Luk Joossens, Belgium; Kenneth E Warner, GLOBALink, International Union Against Cancer University of Michigan, USA; Anna White, (UICC); Yussuf Saloojee, INGCAT, ; back cover: Partnership Programme, Essential Action's Taking David Simpson, International Agency on Tobacco Boy in the road selling packs to drivers and on Tobacco campaign; Ayda A. Yurekli, The World and Health, UK; passengers, Philippines Bank; Credit: Daniel Tan 24. Smoke-free Areas 12. Growing Tobacco and 15. Tobacco Trade Melanie Wakefield, Anti-Cancer Council of Woman tobacco worker, Tom Capehart, USDA; Victoria, Australia; Credit: Judith Mackay 14. Tobacco Companies 27. Health Education Men smoking water pipes, Gene Borio, , USA; Patrick Sandstrom, Quit & Win, Finland; Eeva Photo: Garrett Mehl © WHO Riitta Vartiainen, Quit & Win, Finland; 16. Tobacco Smuggling Part 1 Prevalence and Health Campaign for Tobacco Free Kids, USA; Luk 28. Quitting Man and child smoking, China Joossens, Belgium; Eric LeGresley, Tobacco Marlo Corrao, American Cancer Society, USA; Credit: Carol Betson Control Consultant, Ottawa, Canada; GlaxoSmithKline; David Graham, World Self Medication Industry; Pharmacia; Jerry Reinstein, Part 2 The Cost of Tobacco 18. Internet Sales World Self Medication Industry; Pharmacia; Tobacco leaves, Chris Banthin, NorthEastern University, Boston, Credit: Judith Mackay USA; Greg Connolly, Mass Dept of Public Health, 29. Price Policy USA; Kurt M. Ribisl, University of North Carolina Gene Borio, NYC, USA; Frank Chaloupka, Part 3 The Tobacco Trade at Chapel Hill, USA; Kenneth Warner, University University of Illinois, USA; Anne Jones, ASH, Woman tagging tobacco, tobacco factory, of Michigan, USA; Australia; Amanda Sandford, ASH UK; Michele Virginia, USA Scollo, VicHealth Centre for Tobacco Control, Credit: Ken Hammond © USDA 19. Politics Australia; Joy Townsend, London School of Sibylle Fleitmann, European Network for Smoking Hygiene and Tropical Medicine, University of Part 4 Promotion Prevention, Belgium; Anne Landman, Doc-Alert, London, UK. Boy in the road selling packs to drivers and Colorado, USA; passengers, Philippines For their general contributions, we would like to Credit: Daniel Tan 21. Tobacco Industry Documents thank Kjell Bjartveit, John Crofton, Nigel Gray, Lisa Bero, University of California, San Francisco, Ruth Roemer, Michael Pertschuk and Weng Part 5 Taking Action USA; Anne Landman, Colorado, USA; Jonathan Xinzhi; and, especially, John Mackay. “Smoking is Ugly” poster, Liberman, VicHealth Centre for Tobacco Control, created by Christy Turlington and reprinted Australia; For their creative and editorial expertise, diverse courtesy of the Centers for Disease Control and talents, and individual as well as collective Prevention (CDC) 22. Research contributions, we would like to thank the team at Linda Waverly Brigden, IDRC, Ottawa, Canada; Myriad Editions: Candida Lacey, Paul Jeremy, Part 6 World Tables Sibylle Fleitmann, European Network for Smoking Isabelle Lewis and Corinne Pearlman. Old Man, Sri Lanka Prevention, Belgium; Rowena Jacobs, University of Credit: Garrett Mehl York, UK; Rosemary Kennedy, IDRC, Ottawa, Finally, we want to thank our respective families Canada; Gerald Keusch, Fogarty International for their support during the preparation of this Center, NIH, USA; Aron Primack, Fogarty atlas. International Center, NIH, USA; Anthony So, Rockefeller, NYC, USA; Jacob Sweiry, Wellcome Trust, London, UK;

14 15 ABOUT THE AUTHORS

Dr Judith Mackay is a medical doctor and Senior Policy Advisor to the World Health Organization. She is based in Hong Kong where she is the Director of the Asian Consultancy on Tobacco Control. After an early career as a hospital physician, she became a health advocate. She is a Fellow of the Royal Colleges of Physicians of Edinburgh and London and the Hong Kong Academy of Medicine and author of The State of Health Atlas and The Penguin Atlas of Human Sexual Behavior. Dr Mackay has received many international awards including the WHO Commemorative Medal, the Fries Prize for Improving Health, the Luther Terry Award for Outstanding Individual Leadership, the International Partnering for World Health Award, and the Founding International Achievement Award from the Asia Pacific Association for the Control of Tobacco.

Dr Michael Eriksen is former Director of the U.S. Office on Smoking and Health and is currently a Distinguished Consultant at the Centers for Disease Control and Prevention in Atlanta. Since 2000, Dr. Eriksen has served as an Advisor to the World Health Organization in Geneva. He is a recipient of the WHO Commemorative Medal. He is a Past President and Distinguished Fellow of the Society for Public Health Education and is a thirty- year member of the American Public Health Association.

17 18-19 Tobacco History CYAN MAGENTA YELLOW BLACK

Europe and Middle East 1 The History of Tobacco UK First Report 1962 2000 1901 UK Imperial Tobacco Americas of the British Company and British Royal College of American Tobacco Physicians of “In ancient times, when the land was founded 1994 USA CEOs of London Smoking barren and the people were starving, the Asia 2000 USA Surgeons 1964 cigarette companies and Health Great Spirit sent forth a woman to save 1950s China State 1840 Frederic General’s Report testify before Chopin’s mistress, humanity. As she travelled over the world monopoly takes determines that Congress that it is everywhere her right hand touched the 2000 control of the 1900 the Baroness de smoking causes their opinion that UK First major 1950 soil, there grew potatoes. And everywhere tobacco business Dudevant, became lung cancer in men nicotine is not reports on her left hand touched the soil, there grew and foreign the first woman to addictive smoking (Doll corn. And in the place where she had sat, companies had smoke in public USA Reader’s Digest 1953 and Hill) there grew tobacco.” Huron Indian myth to leave 1900 publishes Cancer by 1913 USA Birth of the 1833 UK Phosphorus the Carton article “modern” cigarette: “The Spaniards upon their journey met 1900 China almost 1795 friction matches RJ Reynolds Sammuel Thomas with great multitudes of people, men and entirely 1950 introduced on 1900 USA Major report introduces the von Soemmering 1800 women with firebrands in their hands and First major 1981 penetrated by commercial scale, on smoking (Wynder brand reports cancers herbs to smoke after their custom.” report on dangers of foreign tobacco making smoking and Graham) of the lip in pipe Christopher Columbus’ journal, passive smoking companies more convenient (Hirayama) 1881 USA Invention of smokers 6 November 1492 USA First link 1939 1800 1858 China Treaty of c.1710 Peter the between smoking First 1761 “Smoking is a custom loathsome to the China Philosopher 1600s Tianjin allows Great encourages and lung cancer 1800 Canada study of effects eye, hateful to the nose, harmful to the Fang Yizhi points cigarettes to be his courtiers to (Ochsner) Tobacco first grown of tobacco (John 1700 brain, dangerous to the lungs, and in the out long years of 1800 imported into smoke tobacco and commercially Hill); snuff users drink coffee, seen as black, stinking fume thereof nearest smoking “scorches China duty-free 1862 USA First federal warned they risk resembling the horrible Stygian smoke one’s lung” fashionable and tobacco tax 1612 Americas nasal cancers of the pit that is bottomless.” 1603 Japan Use of pro-European introduced to help 1700 Tobacco first grown James I of England tobacco well- finance Civil War commercially A Counterblaste to Tobacco 1604 established 1614 England 7000 tobacco shops open 1531 Santo Domingo Death 1633 “I say, if you can’t 1700 1600 India Tobacco 1600 with first sale of European settlers penalty for send money, send tobacco.” introduced Virginia tobacco begin first US President George Washington’s cultivation request to help finance 1530–China 1566 France Jacques 1600 England 1604 Nicot sends snuff to the American Civil War, 1776 1600 Tobacco 1492 Cuba Columbus introduced via King James I Queen Catherine de discovers tobacco writes Medici to treat her Japan or the smoking and takes Philippines A Counterblaste migraine Within 150 years of Columbus’s 1600 it to Europe to Tobacco 1500 finding “strange leaves” in the 1558 Europe Tobacco circa Indigenous plant brought to New World, tobacco was being 1BC Americans begin Europe. Attempts 1500 used around the globe. Its rapid smoking and using at cultivation fail tobacco enemas Africa spread and widespread acceptance Early Middle East characterise the addiction to the 6000 Americas First 1500s Tobacco first BC cultivation of the plant Nicotina tobacum. Only the introduced Oceania tobacco plant when the Turks took mode of delivery has changed. In it to 2000 the 18th century, snuff held sway; Africa provides 2002 global leadership in the 19th century was the age of drafting a WHO 2000 the cigar; the 20th century saw Framework Convention on Australia Victoria the rise of the manufactured 1987 Tobacco Control first place to use 1700s Africa-US African cigarette, and with it a greatly tobacco tax to South Africa 1993 slaves initially used increased number of smokers. establish health passes Tobacco to work in tobacco At the beginning of the 21st foundation to Products Control 1700 fields, not on cotton counter tobacco Amendment Act plantations century about one third of adults 1800 in the world, including increasing 1650s South Africa 1788 Australia European settlers numbers of women, used tobacco. Tobacco arrives grow tobacco and use Despite thousands of studies with the First it as a form of Fleet showing that tobacco in all its 1600 currency forms kills its users, and smoking 1700 1769 1560 Africa Portuguese Captain James and Spaniards ship cigarettes kills non-users, people Cook arrives tobacco to East continue to smoke, and deaths smoking a pipe, Africa, where it and is promptly spread to Central and from tobacco use continue to doused in case Africa increase. he is a demon 18 19

02/Types CYAN MAGENTA YELLOW BLACK

Whether it is inhaled, sniffed, sucked or 2 Types of Tobacco Use chewed, or whether it is mixed with other ingredients, there is no safe way of using tobacco.

Smoking tobacco

Manufactured cigarettes consist of shredded or reconstituted tobacco processed with hundreds of chemicals. Often with a filter, they are manufactured by a machine, and are the predominant form of tobacco used worldwide. Bidis consist of a small amount of tobacco, hand-wrapped in dried temburni leaf and tied with string. Despite their small size, their tar and carbon monoxide deliveries The water pipe, also known as can be higher than manufactured shisha or hubbly bubbly, cigarettes because of the need to is commonly used in north Africa, the puff harder to keep bidis lit. Kreteks are Mediterranean clove flavoured Cigars are made of air-cured and region and cigarettes fermented with a tobacco parts of Asia. widely smoked wrapper, and come in many in . Bidis are found Cigarettes are available shapes and sizes, from cigarette- thoughout south-east throughout the world. sized cigarillos, double coronas, Asia, and are India’s Filter-tipped cigarettes are most used type of cheroots, stumpen, chuttas and usually more popular than tobacco. dhumtis. In reverse chutta and unfiltered cigarettes. Hand dhumti smoking, the ignited end rolled cigarettes are also of the cigar is placed inside the widely smoked in many mouth. There was a revival of countries. cigar smoking at the end of the 20th century, among both men and women. Kreteks are clove-flavoured cigarettes. They contain a wide In Southeast Asia clay pipes range of exotic flavourings and known as suipa, chilum and hookli are widely used. eugenol, which has an Other tobacco anaesthetising effect, allowing for Cigars are smoked deeper smoke inhalation. throughout the world. Chewing tobacco is also known Moist snuff is taken orally. A Dry snuff is powdered tobacco Pipes are made of briar, slate, Regional variations include as plug, loose-leaf, and twist. small amount of ground tobacco is that is inhaled through the nose or clay or other substance – tobacco cheroots and stumpen Pan masala, or betel quid consists held in the mouth between the taken by mouth. Once is placed in the bowl and inhaled (western and central of tobacco, areca nuts and staked cheek and gum. Increasingly widespread, its use is now in through the stem, sometimes Europe) and dhumtis lime wrapped in a betel leaf. They manufacturers are pre-packaging decline. (conical cheroots) used Tobacco is used orally through water. in India. can also contain other sweetenings moist snuff into small paper or throughout the world, but Sticks are made from sun-cured and flavouring agents. Varieties of cloth packets, to make the product principally in Southeast Asia. pan include kaddipudi,hogesoppu, tobacco known as brus and In Mumbai, India, 56% of easier to use. Other products wrapped in cigarette paper. women chew tobacco. gundi, kadapam, zarda, pattiwala, include khaini, shammaah and nass kiwam, mishri, and pills. or naswa.

22 23 3 Male smoking CYAN MAGENTA YELLOW BLACK

Smoking prevalence for men

3 Male Smoking ICELAND Smoking among males aged 15 and over FINLAND NORWAY latest available data

SWEDEN ESTONIA 60% and above 30% – 39% no data RUSSIAN LATVIA Smoking has been portrayed by its FED. DENMARK UNITED LITHUANIA 50% – 59% 20% – 29% sellers as a manly, masculine KINGDOM IRELAND habit, linked to health, happiness, GREENLAND 40% – 49% below 20% NETH. GERMANY POLAND BELGIUM fitness, wealth, power and sexual CZECH UKRAINE Top ten LUX. REPUBLIC SLOVAKIA success. In reality, it leads to REP. highest overall smoking rates HUNGARY MOLDOVA SWITZ. sickness, premature death and FRANCE SLOVENIA ROMANIA of men and women combined CANADA SAN CROATIA B-H YUGOSLAVIA 44% sexual problems. MARINO BULGARIA ANDORRA RUSSIAN FEDERATION FYR MACEDONIA Almost one billion men in the 48% ALBANIA SPAIN 47% world smoke – about 35 percent PORTUGAL KAZAKHSTAN of men in developed countries GREECE 47% MONGOLIA MOROCCO TUNISIA and 50 percent of men in UNITED STATES UZBEKISTAN KYRGYZSTAN ALGERIA MALTA GEO JAPAN OF AMERICA A AZER developing countries. Trends in RM TURKMEN TURKEY REP. KOREA both developed and developing SYRIAN ARAB REPUBLIC CHINA countries show that male smoking TUNISIA LEBANON ISL. REP. MOROCCO ISRAEL JOR IRAQ IRAN rates have now peaked and, WEST BANK & GAZA KUWAIT BAHAMAS ALGERIA LIBYAN NEPAL ARAB BAHRAIN slowly but surely, are declining. MEXICO QATAR JAMAHIRIYA EGYPT CUBA UAE DOMINICAN INDIA However, this is an extremely REPUBLIC SAUDI ARABIA Hong Kong MYANMAR LAO SAR HAITI OMAN PDR VIETNAM slow trend over decades, and in HONDURAS PUERTO RICO GUATEMALA PHILIPPINES SENEGAL THAILAND EL SALVADOR ST VINCENT & GRENADINES YEMEN the meantime men are dying in NICARAGUA SUDAN 45% GAMBIA CHAD DJIBOUTI their millions from tobacco. In COSTA RICA & TOBAGO GUINEA PANAMA VENEZUELA 52% A NIGERIA

CÔTE N PALAU A general, the educated man is D’IVOIRE H MALDIVES SRI LANKA G BRUNEI DAR. COLOMBIA giving up the habit first, so that SAO TOME & PRINCIPE smoking is becoming a habit of ÒThinking about ECUADOR DEM. REP. RWANDA 49% SEYCHELLES poorer, less educated males. Chinese smoking CONGO statistics is 44% UNITED REP. PAPUA China deserves special mention TANZANIA INDONESIA NEW like trying to GUINEA because of the enormity of the think about the MALAWI limits of PERU ZAMBIA problem. Comprising over 300 space.Ó ZIMBABWE million male smokers, this huge BOLIVIA 50% market is, according to Philip Rothmans, 1992 CHILE NAMIBIA AUSTRALIA KIRIBATI Morris, “the most important TOKELAU S SOUTH NAURU feature on the landscape.” AFRICA L SAMOA 54% TUVALU URUGUAY 50 NIUE FIJI VANUATU COOK Smoking trends TONGA percentage of male smokers Physicians who smoke NEW 1960–2000 selected countries ZEALAND over Smoking prevalence among physicians 12 2000 or latest available data 32 24 selected countries 81% 61% 52% 61 percentages 1960 1960 1965 55% 44% 78% 55 women 13 16 1970 1970 1970 70% 42% 38% 20 men 1 1980 1980 1979 61% 31% 28% 22 43 1990 1990 1990 40 41 54% 28% 26% 38 37 million 5 2000 1998 1999 0 men in China 28 29 30 Ð equal to the 0 entire population 21 1 of the USA Ð 18 1 14 6 are smokers 2 6 2 0 8 8 Japan USA 6 UK 4 Saudi Arabia

4 Spain Sweden Syrian Arab Republic UK Morocco Australia Bangladesh Bosnia and Herzegovina China Indonesia Democratic Republic Lao People’s Chile Colombia Denmark Iceland India Republic of Korea 3 Russian Federation 24 15 and over 16 and over 18 and over 25 Tobacco CYAN MAGENTA YELLOW BLACK

Smoking prevalence for women

4 Female Smoking ICELAND Smoking among females aged 15 and over FINLAND NORWAY latest available data

ESTONIA RUSSIAN SWEDEN FED. 50% and above 20% – 29% no data “…the current lower level of tobacco use LATVIA among women in the world…does not DENMARK UNITED LITHUANIA 40% – 49% 10% – 19% reflect health awareness, but rather social KINGDOM traditions and women’s low economic IRELAND 30% – 39% below 10% resources.” Dr. Gro Harlem Brundtland, GREENLAND NETH. GERMANY POLAND BELARUS Director General, WHO, 1998 BELGIUM CZECH UKRAINE LUX. REPUBLIC SLOVAKIA women smoke men smoke ten or more AUSTRIA HUNGARY REP. SWITZ. as much as men times more than women About 250 million women in the FRANCE SLOVENIA ROMANIA MOLDOVA CANADA CROATIA world are daily smokers. About SAN MARINO YUGOSLAVIA BULGARIA RUSSIAN FEDERATION ANDORRA ITALY FYR MACEDONIA 22 percent of women in SPAIN ALBANIA developed countries and 9 percent PORTUGAL GREECE KAZAKHSTAN of women in developing countries MONGOLIA MOROCCO smoke tobacco. In addition, many UNITED STATES MALTA UZBEKISTAN KYRGYZSTAN TUNISIA GEO JAPAN OF AMERICA ALGERIA AZER women in south Asia chew TURKMEN REP. ARMENIA KOREA tobacco. CHINA TUNISIA Cigarette smoking among see inset ISL. REP. women is declining in many IRAN MOROCCO LIBYAN PAKISTAN BAHAMAS ALGERIA BAHRAIN NEPAL ARAB QATAR developed countries, notably MEXICO JAMAHIRIYA UAE INDIA CUBA DOMINICAN BANGLADESH Hong Kong SAR Australia, Canada, the UK and the REPUBLIC MYANMAR PUERTO RICO LAO VIETNAM HAITI OMAN PDR USA. But this trend is not found HONDURAS GUATEMALA THAILAND PHILIPPINES in all developed countries. In EL SALVADOR ST VINCENT & GRENADINES SENEGAL YEMEN NICARAGUA BARBADOS CAMBODIA DJIBOUTI COSTA RICA TRINIDAD & TOBAGO GAMBIA several southern, central and GUINEA NIGERIA SUDAN PANAMA VENEZUELA A CÔTE N PALAU A SRI LANKA D’IVOIRE H MALDIVES eastern European countries G BRUNEI DAR. COLOMBIA cigarette smoking is either still UGANDA MALAYSIA

KENYA TURKEY SINGAPORE increasing among women or has ECUADOR DEM. REP. RWANDA SEYCHELLES CONGO not shown any decline. CYPRUS SYRIAN UNITED REP. ARAB REP. TANZANIA INDONESIA PAPUA LEBANON IRAQ The tobacco industry promotes NEW SOLOMON BRAZIL ISRAEL GUINEA cigarettes to women using ISLANDS MALAWI WEST BANK JORDAN PERU & GAZA seductive but false images of ZAMBIA KUWAIT ZIMBABWE MAURITIUS vitality, slimness, modernity, BOLIVIA EGYPT SAUDI NAMIBIA ARABIA PARAGUAY emancipation, sophistication, and CHILE KIRIBATI TOKELAU sexual allure. In reality, it causes AUSTRALIA SOUTH TUVALU SWAZILAND NAURU disease and death. Tobacco AFRICA SAMOA URUGUAY NIUE companies have now produced a LESOTHO FIJI ÒSmoking behaviour of women ARGENTINA VANUATU range of brands aimed at women. COOK differs from that of menÉ TONGA Most notable are the “women- more highly motivated to only” brands: these “feminised” smokeÉ they find it harder Smoking trends to stop smokingÉ women are percentage of female smokers 42% 34% cigarettes are long, extra-slim, 1960 1965 more neurotic than menÉ 32% NEW 1960–2000 selected countries 44% ZEALAND low-tar, light-coloured or there may be a case for 1970 1970 menthol. 37% 30% launching a female oriented 16% 1980 1979 14% 14% 14% 29% 23% cigarette with relatively 13% 1970 1980 1990 2000 1990 1990 high deliveries of 1960 26% 22% 1998 1999 nicotineÉÓ

1976 research report,

Japan UK USA 26 15 and over 16 and over 18 and over 27 05 Youth CYAN MAGENTA YELLOW BLACK

5 Youth BOYS

POLAND UKRAINE “If younger adults turn away from CANADA RUSSIAN FEDERATION smoking, the industry will decline, just as Over 40% of young people in Fiji, a population which does not give birth , Malawi, Nigeria, South Africa, will eventually dwindle.” Fewer than 5% of young people Sri Lanka and Zimbabwe think RJ Reynolds researcher, 1984 in Bahamas, Barbados, Costa Rica, boys who smoke have UNITED STATES Indonesia, Malawi, Montserrat, OF AMERICA more friends. The overwhelming majority of Poland, Russia, Singapore, Ukraine CHINA and Venezuela think girls who JORDAN BAHAMAS NEPAL smokers begin tobacco use before NORTHERN smoke more attractive. MEXICO CUBA MARIANA they reach adulthood. Among ISLANDS HAITI & BARBUDA INDIA those young people who smoke, MONSERRAT DOMINICA PHILIPPINES BARBADOS PALAU COSTA RICA TRINIDAD & TOBAGO A VENEZUELA N NIGERIA nearly one-quarter smoked their GUYANA A H SRI LANKA SURINAME G first cigarette before they reached KENYA the age of ten. SINGAPORE INDONESIA Several factors increase the risk COMOROS MALAWI PERU Tobacco users of youth smoking. These include MADAGASCAR BOLIVIA ZIMBABWE tobacco industry advertising and of young people MAURITIUS CHILE Percentage of 13–15 year olds promotion, easy access to tobacco who continue to SOUTH using tobacco products, and low prices. Peer smoke will die URUGUAY AFRICA 2001 or latest available FIJI pressure plays an important role from smoking ARGENTINA national, regional or city data Early smokers through friends’ and siblings’ Over 30% of children 30% and over smoking. Other risk factors smoked their first whole associated with youth smoking cigarette before age 10 20% – 29% in Ghana, Grenada, Guyana, include having a lower self-image 10% – 19% than peers, and perceiving that India, Jamaica, Palau, Poland, N Mariana Islands and St Lucia. tobacco use is normal or “cool” . under 10% Many studies show that parental variable 3% – 60% smoking is associated with higher no data youth smoking. ÒIt is important to know as While the most serious effects POLAND much assmoking possible patterns about teenage and UKRAINE of tobacco use normally occur RUSSIAN FEDERATION after decades of smoking, there attitudes. TodayÕs teenager is are also immediate negative tomorrowÕs potential regular customer, and the overwhelming health effects for young smokers. UNITED STATES majority of smokers first begin OF AMERICA to smoke while still in their Most teenage smokers are already CHINA addicted while in adolescence. teensÉ The smoking patterns of teenagers are particularly JORDAN BAHAMAS NEPAL NORTHERN The younger a person begins to MEXICO CUBA MARIANA important to Philip Morris.Ó HAITI ISLANDS JAMAICA 1981 ANTIGUA & BARBUDA INDIA smoke, the greater the risk of MONSERRAT DOMINICA PHILIPPINES Philip Morris Companies Inc. GRENADA BARBADOS eventually contracting smoking- PALAU

COSTA RICA TRINIDAD & TOBAGO A

VENEZUELA N NIGERIA

GUYANA A H SRI LANKA caused diseases such as cancer or SURINAME G heart disease. KENYA SINGAPORE The highest youth smoking rates INDONESIA can be found in Central and PERU MALAWI

Eastern Europe, sections of India, BOLIVIA ZIMBABWE and some of the Western Pacific CHILE islands. SOUTH URUGUAY AFRICA FIJI of children ARGENTINA worldwide are exposed to passive smoking at home GIRLS 28 29 Cigarette consumption CYAN MAGENTA YELLOW BLACK

Annual cigarette consumption

per person Cigarette Consumption ICELAND 6 FINLAND NORWAY 1998 or latest available data

SWEDEN ESTONIA 2,500 and above “Short, snappy, easily attempted, easily RUSSIAN FED. 1,500 – 2,499 completed or just as easily discarded UNITED DENMARK before completion – the cigarette is the KINGDOM symbol of the machine age." IRELAND 500 – 1,499 BELARUS New York Times, 1925 NETH. GERMANY POLAND BELGIUM CZECH UKRAINE 1 – 499 REPUBLIC SLOVAKIA REP. HUNGARY RUSSIAN Global consumption of cigarettes AUSTRIA MOLDOVA SWITZ. no data FRANCE SLOVENIA ROMANIA FEDERATION has been rising steadily since CANADA CROATIA YUGOSLAVIA BULGARIA manufactured cigarettes were ITALY introduced at the beginning of the SPAIN PORTUGAL 20th century. While consumption GREECE KAZAKHSTAN is levelling off and even MOROCCO TUNISIA UNITED STATES MALTA UZBEKISTAN decreasing in some countries, KYRGYZSTAN OF AMERICA ALGERIA JAPAN ARMAZER TURKMEN worldwide more people are TURKEY REP. KOREA smoking, and smokers are SYRIAN ARAB CHINA REPUBLIC AFGHANISTAN TUNISIA ISRAEL ISL. REP. smoking more cigarettes. MOROCCO WEST BANK IRAQ & GAZA IRAN China JORDAN KUWAIT PAKISTAN One in three The numbers of smokers will BAHAMAS ALGERIA LIBYAN NEPAL ARAB BAHRAIN cigarettes smoked MEXICO JAMAHIRIYA increase mainly due to expansion EGYPT in the world today are CUBA DOMINICAN BANGLADESH Hong Kong JAMAICA REPUBLIC SAUDI ARABIA smoked in China. of the world’s population. By INDIA LAO SAR BELIZE HAITI MAURITANIA PDR HONDURAS VIET NAM 2030 there will be at least another GUATEMALA MALI THAILAND EL SALVADOR SENEGAL NICARAGUA GAMBIA CHAD SUDAN 2 billion people in the world. China BARBADOS BURKINA PHILIPPINES GUINEA-BISSAU FASO 1,643 billion COSTA RICA TRINIDAD & TOBAGO

VENEZUELA A NIGERIA

Even if prevalence rates fall, the N

PANAMA GUYANA CÔTE O A G ETHIOPIA

SURINAME D’IVOIRE H MALDIVES SRI LANKA TO G C A R absolute number of smokers will COLOMBIA LIBERIA CAMEROON increase. The expected UGANDA MALAYSIA KENYA SINGAPORE ECUADOR GABON continuing decrease in male DEM. REP. R CONGO CONGO B smoking prevalence will be offset UNITED REP. TANZANIA INDONESIA BRAZIL SOLOMON by the increase in female smoking ANGOLA India ISLANDS Seven bidis rates, especially in developing Top 5 countries PERU MALAWI ZAMBIA are sold for every one countries. Billions of cigarettes consumed MADAGASCAR ZIMBABWE cigarette. The consumption of tobacco has 1998 BOLIVIA MAURITIUS MOZAMBIQUE PARAGUAY over reached the proportions of a CHILE SAMOA global epidemic. Tobacco AUSTRALIA FIJI SOUTH AFRICA companies are cranking out USA URUGUAY cigarettes at the rate of five and a 451 billion ARGENTINA 5,419 5,500 half trillion a year – nearly 1,000 billion cigarettes for every man, woman, cigarettes are Rising numbers and child on the planet. 4,388 Average number of NEW smoked worldwide ZEALAND Cigarettes account for the everyday manufactured cigarettes largest share of manufactured smoked per man per day tobacco products, 96 percent of Japan in China 328 billion 1996 total value sales. Asia, Australia 3,112 and the Far East are by far the 14 10 15 largest consumers (2,715 billion Global cigarette 2,150 cigarettes), followed by the consumption Russia Billions of sticks 1,686 Americas (745 billion), Eastern 258 billion Europe and Former Soviet 1880–2000 1,000 Economies (631 billion) and 600 Western Europe (606 billion). Indonesia 300 1952 1972 1992 1996 215 billion 10 20 50 100 30 1880 1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 31 07/health Risks CYAN MAGENTA YELLOW BLACK

Deadly chemicals HAIR How smoking harms you 7 Health Risks • Smell and staining Tobacco smoke contains over 4,000 chemicals, Parts of the body some of which have marked irritant properties EYES especially affected and some 60 are known or suspected carcinogens. BRAIN AND MENTAL EFFECTS • Eyes sting, water and blink more by tobacco use Tobacco is packed with harmful • Strokes (cerebrovascular accidents) • Blindness (macular degeneration)l Tobacco smoke includes as found in • Addiction / withdrawal • Cataracts and addictive substances. Acetone paint stripper • Altered brain chemistry SKIN Scientific evidence has shown Ammonia floor cleaner • Anxiety about harm caused by smoking • Wrinkles, Arsenic ant poison conclusively that all forms of premature ageing tobacco cause health problems Butane fuel Cadmium car batteries NOSE throughout life, frequently Carbon monoxide car exhaust fumes • Less sense of smell resulting in death or disability. DDT insecticide Hydrogen cyanide gas chambers TEETH HANDS Smokers have markedly • Poor circulation (cold fingers): increased risks of multiple Methanol rocket fuel • Discoloration and stains Babes in the womb Napthalene moth balls • Plaque peripheral vascular disease cancers, particularly lung cancer, Smoking in pregnancy Toluene industrial solvent • Loose teeth • Tar stained fingers and are at far greater risk of heart Vinyl chloride plastics • Gum disease (gingivitis) disease, strokes, emphysema and Increased risks: Spontaneous abortion / miscarriage many other fatal and non-fatal MOUTH AND THROAT Ectopic pregnancy • Cancers of lips, mouth, throat and larynx diseases. If they chew tobacco, Abruptio placentae • Sore throat Placenta praevia • Reduced sense of taste they risk cancer of the lip, tongue HEART and mouth. Premature rupture of the membranes • Breath smells of smoke Premature birth • Harms, blocks and weakens arteries of the heart Women suffer additional health RESPIRATION AND LUNGS • Heart attack risks. Smoking in pregnancy is Foetus: • Lung cancer Smaller infant (for gestational age) • Cough and sputum, shortness of breath dangerous to the mother as well CHEST Stillborn infant • Colds and flu, pneumonia, asthma as to the foetus, especially in poor • Cancer of oesophagus Birth defects, eg congenital limb reduction • Chronic obstructive pulmonary disease countries where health facilities Increased nicotine receptors in baby’s brain Time and emphysema ABDOMEN are inadequate. Increased likelihood of ticks away • Complicates tuberculosis infant smoking as a teenager • Stomach and duodenal ulcers Maternal smoking is not only • Cancer of stomach, pancreas, colon Possible physical and mental LIVER harmful during pregnancy, but • Aortic aneurysm long-term effects • Cancer has long-term effects on the baby Every cigarette takes 7 minutes after birth. This is often KIDNEYS and BLADDER off your life BONES • Cancer compounded by exposure to • Osteoporosis passive smoking from the mother, • Spine and hip fractures MALE REPRODUCTION father or other adults smoking. • Sperm: deformity, loss of motility, FEMALE REPRODUCTION While tobacco kills millions reduced number • Period pains • Infertility more than it helps, research is • Earlier menopause • Impotence underway examining any possible WOUNDS AND SURGERY • Cancer of cervix • Wounds take longer to heal • Infertility and delay in conception health benefits of nicotine and • Operation wounds take longer to heal also trying to find a safe use for • Longer to recuperate from surgery BLOOD tobacco, particularly in the field • Leukaemia of genetic modification. The aim DIABETES Sworn testimony • Noninsulin dependent diabetes mellitus is to produce vaccines or human BURNS Private statement (Type 2, adult-onset) • From fires caused by tobacco proteins for medical use, or even ÒI believe that nicotine is not LEGS and FEET to clean up soil that has been ÒNicotine is the smoking is responsible for IMMUNE SYSTEM contaminated with explosives. addicting agent in addictive.Ó • Increased leg pain and gangrene: • Weakened cigarettes.Ó peripheral vascular disease CEOs of the seven • Buerger’s Disease of all lung cancer Brown & Williamson leading tobacco official in 1983 companies in 1994 90% of chronic75% bronchitis and emphysema 32 of cases of25% ischaemic heart disease 33 08/ Passive smoking CYAN MAGENTA YELLOW BLACK

Harm caused 8 Passive Smoking by passive smoking Health effects on adults HAIR Harm caused “An hour a day in a room with a smoker is nearly a hundred times more likely to • Smell by passive smoking cause lung cancer in a non-smoker than Health effects on children 20 years spent in a building containing BRAIN AND asbestos.” Sir Richard Doll, 1985 MENTAL EFFECTS HAIR • Strokes • Smell The first conclusive evidence on "For internal use only" EYES BRAIN the danger of passive smoking ÒThere is no single • Sting, water and blink more came from Takeshi Hirayama’s • Possible association with brain tumours definable, reproducibly and long-term mental effects study in 1981 on lung cancer in characteristic entity NOSE known as ETS.Ó • Irritation non-smoking Japanese women EYES married to men who smoked. Secret poll for the US • Sting, water and blink more Philip Morris Issues RESPIRATION AND LUNGS Although the tobacco industry Tobacco Institute • Lung cancer Training Manual, 1995 EARS • Worsening of pre-existing immediately launched a multi- ÒWhat the smoker does to • Middle ear infections chest problems, such as million dollar campaign to himself may be his business, (chronic otitis media) but what the smoker does to asthma, chronic obstructive discredit the evidence, dozens of pulmonary disease the nonsmoker is quite a RESPIRATION AND LUNGS further studies have confirmed and emphysema different matter. This we • Respiratory infections the link. Research then broadened see as the most dangerous (including bronchitis and HEART pneumonia) into other areas and new scientific development yet to the • Harms, clogs weakens arteries • Asthma induction evidence continues to accumulate. viability of the tobacco • Heart attack, angina industry that has yet and exacerbation A complex mixture of chemicals • Chronic respiratory symptoms UTERUS is generated from the burning and occurred.Ó (wheezing, cough, breathlessness) • Low birthweight or • Decreased lung function smoking of tobacco. As a passive Roper Organization,1978 small for gestational age smoker, the non-smoker breathes • Cot death or Sudden Infant HEART Death Syndrome (SIDS) “sidestream” smoke from the • Deleterious effects on oxygen, after birth burning tip of the cigarette and arteries • Increased nicotine receptors “mainstream” smoke that has been BURNS inhaled and then exhaled by the • From fires caused by tobacco BLOOD smoker. • Possible association The risk of lung cancer in non- with lymphoma smokers exposed to passive Children exposed to passive smoking at home smoking is increased by between BURNS selected countries • From fires caused by tobacco 20 and 30 percent, and the excess 2001 or latest available data 69% percentages risk of heart disease is 23 percent. 68% 67% ROLE MODEL Children are at particular risk 63% • Greater likelihood of becoming a smoker as a teenager from adults’ smoking. Adverse 57% Numbers affected by passive smoking 55% health effects include pneumonia 53% in the USA 49% annual 1990s and bronchitis, coughing and 46% 45.5% wheezing, worsening of asthma, Lung cancer 3,000 middle ear disease, and possibly 34% 34% Ischaemic heart disease 35,000 to 62,000 31% neuro-behavioural impairment 29% and cardiovascular disease in Infants and children adulthood. Low birthweight 9,700 to 18,600 A pregnant woman’s exposure Cot death (SIDS) 1,900 to 2,700 to other people’s smoking can Bronchitis or pneumonia in infants 150,000 to 300,000

oland eru

harm her foetus. The effects are Cuba Argentina P Indonesia Chile Russian Federation China Ukraine Bolivia Mexico India Nigeria Haiti P Respiratory effects in children compounded when the child is Middle ear infection 700,000 to 1,600,000 exposed to passive smoking Asthma induction (new cases) 8,000 to 26,000 after birth. Asthma exacerbation 400,000 to 1,000,000 34 35 09/Deaths CYAN MAGENTA YELLOW BLACK

ÒÉwith a general lengthening of the 9 Deaths expectation of life we really need something for people to die ofÉÓ

Cigarettes kill half of all lifetime Report for Tobacco users. Half die in middle age – women Advisory Council, between 35 and 69 years old. industrialised countries No other consumer product is 0.5 million 1978 as dangerous, or kills as many people. Tobacco kills more than men AIDS, legal drugs, illegal drugs, developing countries road accidents, murder, and 1.8 million suicide combined. Tobacco already kills more men men in developing countries than in industrialised countries industrialised countries, and it is women 1.6 million likely that deaths among women developing countries will soon be the same. 0.3 million Deaths from tobacco use While 0.1 billion people died Total deaths as percentage of total deaths from tobacco use in the 20th Premature deaths MEN among men and women over 35 century, ten times as many will from tobacco 2000 regional estimates worldwide die in the 21st century. Maternal over 25% 10% – 14% smoking during pregnancy is 2000 20% – 24% 5% – 9% responsible for many foetal deaths total deaths and is also a major cause of 4.2 million 15% – 19% under 5% Sudden Infant Death Syndrome. Passive smoking in the home, men Dying in your prime 3.4 million more than 25% of workplace, or in public places 35 – 69 year olds also kills, although in lower women living above these lines numbers. However, those killed 0.8 million will die from tobacco use do not die from their own habit, but from someone else’s. Children are at particular risk of everyone alive today from adults smoking, and even smoking by other adults around a pregnant woman has a harmful effect on a foetus.

will eventually be killed by tobacco Past and future 7 Annual deaths due to tobacco million estimated worldwide projected 1950–2030 projected 3 million projected 2.1 2.1 2025 1.3 million million to million 2030 0.3 2025 0.2 million 2000 to 2000 1975 2030 million 1950 negligible 1975 1950 36 industrialised countries developing countries WOMEN 37

10/Costs to the Economy CYAN MAGENTA YELLOW BLACK

10 Costs to the Economy

The tobacco industry uses Smoking accounted UK $2.25 billion economic arguments to persuade for over Canada $1.6 billion governments, the media and the Germany $14.7 billion China 1987: general population that smoking World’s worst benefits the economy. It claims forest fire that if tobacco control measures caused by are introduced, tax revenues will cigarettes 300 killed fall, jobs will be lost and there of total health care 5,000 made homeless will be great hardship to the expenses in the USA 1.3 million hectares of economy. in 1999 land destroyed But the industry greatly exaggerates the economic losses, if any, which tobacco control USA $76 billion measures will cause and they Health-care costs never mention the economic costs China $3.5 billion which tobacco inflicts upon every Health care costs country. attributable to tobacco Tobacco’s cost to governments, 2002 or latest available estimates to employers and to the Philippines selected countries $600 million environment includes social, Average days off sick 6.16 welfare and health care spending, per year in the USA Every year loss of foreign exchange in 2001 4.53 1,000,000 importing cigarettes; loss of land 3.86 fires are started by that could grow food; costs of children using fires and damage to buildings cigarette caused by careless smoking; Workplace Australia $6 billion environmental costs ranging from smoking costs smokers deforestation to collection of ex-smokers never-smokers the USA smokers’ litter, absenteeism, decreased productivity, higher numbers of accidents and higher insurance premiums.

New Zealand $84 million billion ÒÉreflecting 5.23 years of life lost for the Trash collected every year Annual cost of loss average smoker Ð indirect $16.5 million in the USA positive effects [are from time off work that] public finance Telecom Australia 43 states 1996 ApologizesÒPhilip for Morris Report cigarette butts benefits from smoking employees Touting Benefits of 1994 20% indirectly,via savings on SmokersÕs Deaths.Ó Cost of fires caused by smoking Australian $ the health care costs Ð in annual global estimates pensions Ð and public 2000 $5.5 million housing costs savings.Ó Wal l S • percentage of all fire deaths: 10% headline,2001tre Report on the Czech et • total killed by fires caused by smoking: 300,000 Jou other rna • total cost of fires caused by smoking: US$27 billion Republic,commissioned by l 80% Philip Morris,2001

40 41 tobacco alcohol 11 Cost to the smoker CYAN MAGENTA YELLOW BLACK

The cost of smoking Costs to the Smoker ICELAND Cost of a pack of 20 Marlboro cigarettes 11 FINLAND NORWAY or an equivalent international brand US$ selected countries 2001 or latest available data SWEDEN RUSSIAN The economic costs of smoking to FED. $5 and above UNITED DENMARK smokers and their families include KINGDOM $4 – $4.99 IRELAND money spent on buying tobacco, NETH. GLOBAL TOBACCO GERMANY POLAND $3 – $3.99

T H A G E Y O U R H E A L S E R I O U S L Y D A M : S M O K I N G C A N E A L T H W A R N I N G BELGIUM G O V E R N M E N T H which could otherwise be used on CZECH LUX. REPUBLIC UKRAINE REP. 20 imported food, clothing and shelter, family MOLDOVA $2 – $2.99 AUSTRIA HUNGARY cigarettes costs holidays or a car. FRANCE SWITZ. ROMANIA RUSSIAN GLOBAL TOBACCO more than half CANADA CROATIA FEDERATION $1 – $1.99 As smoking kills a quarter of all YUGOSLAVIA BULGARIA average daily T H A G E Y O U R H E A L S E R I O U S L Y D A M : S M O K I N G C A N E A L T H W A R N I N G ITALY G O V E R N M E N T H smokers in their working years, SPAIN less than $1 income smoking deprives the smoker’s PORTUGAL GREECE no data family of many years of income.

Smokers also suffer loss of income UNITED STATES MOROCCO TUNISIA OF AMERICA GEORGIA JAPAN through illness. Following a AZERBAIJAN TURKEY REP. smoker’s premature death, a KOREA SYRIAN ARAB CHINA TUNISIA REPUBLIC partner, children or elderly ISRAEL ISL. REP. MOROCCO JORDAN

IRAN GLOBAL TOBACCO parents can be left destitute. KUWAIT LIBYAN PAKISTAN

MEXICO E A L T H A G E Y O U R H S E R I O U S L Y D A M : S M O K I N G C A N E A L T H W A R N I N G ARAB BAHRAIN G O V E R N M E N T H Family members of smokers JAMAHIRIYA EGYPT UAE BANGLADESH lose income through time taken Hong Kong PUERTO RICO SAUDI ARABIA SAR INDIA VIET NAM

looking after smokers when they GLOBAL TOBACCO GUATEMALA GLOBAL TOBACCO THAILAND PHILIPPINES SENEGAL

GLOBAL TOBACCO

L T H M A G E Y O U R H E A S E R I O U S L Y D A : S M O K I N G C A N E A L T H W A R N I N G are sick, and time lost taking G O V E R N M E N T H

L T H M A G E Y O U R H E A S E R I O U S L Y D A : S M O K I N G C A N E A L T H W A R N I N G G O V E R N M E N T H CAMBODIA

T H A G E Y O U R H E A L S E R I O U S L Y D A M : S M O K I N G C A N E A L T H W A R N I N G them to hospital. In some COSTA RICA G O V E R N M E N T H

VENEZUELA A

PANAMA CÔTE N NIGERIA A

developing countries a hospital D’IVOIRE H G BRUNEI DAR. SRI LANKA COLOMBIA CAMEROON visit can take days. MALAYSIA UGANDA GLOBAL TOBACCO KENYA SINGAPORE Smokers also have to shoulder ECUADOR GABON T H A G E Y O U R H E A L S E R I O U S L Y D A M : S M O K I N G C A N E A L T H W A R N I N G G O V E R N M E N T H higher health insurance Smokers in PAPUA premiums, and many other INDONESIA NEW BRAZIL Minhang, China GUINEA miscellaneous costs, such as PERU spent an average increased wear and tear on their ZAMBIA home, as well as increased fire ZIMBABWE

risk. PARAGUAY CHILE 60% AUSTRALIA SOUTH 158 AFRICA of their personal URUGUAY income on A hard day’s smoke ARGENTINA cigarettes Minutes of labour worked international brand NEW to purchase 20 cigarettes 102 ZEALAND local brand 2000 selected cities 92 A pack of Marlboro or equivalent international brand will buy… 77 62 62 62 56 56

38 40 33 23 23 20 20 20 19 16 11

…one and a half …a dozen …one kilogram Abu Dhabi Copenhagen Jakarta Johannesburg Montréal Mumbai Nairobi Santiago Shanghai Warsaw For the price of kilograms of …four pairs of coconuts in of fish in France, …six kilograms United Arab Denmark Indonesia South Africa Canada India Kenya Chile China Poland 20 Marlboro cucumbers in …a dozen eggs cotton socks in Papua New Ghana or of rice in Emirates you could buy… Georgia… in Panama… China… Guinea… Moldova… Bangladesh.

42 43

12/Growing Tobacco CYAN MAGENTA YELLOW BLACK

Land devoted to growing tobacco

ICELAND Area in hectares 12 Growing Tobacco FINLAND NORWAY 2000

SWEDEN ESTONIA over 100,000 1,000 – 4,999 RUSSIAN LATVIA FED. Tobacco is grown in over 125 DENMARK 10,000 – 99,999 under 1,000 UNITED LITHUANIA countries, on over 4 million KINGDOM IRELAND BELARUS 5,000 – 9,999 no tobacco grown hectares of land, a third of which NETH. GERMANY POLAND BELGIUM is in China alone. The global GREENLAND CZECH UKRAINE LUX. REPUBLIC SLOVAKIA REP. tobacco crop is worth AUSTRIA HUNGARY MOLDOVA SWITZ. tobacco is grown on more FRANCE SLOVENIA ROMANIA RUSSIAN approximately US$20 billion, a than one percent of CANADA CROATIA B-H FEDERATION BULGARIA small fraction of the total amount YUGOSLAVIA agricultural land ITALY SPAIN ALBANIA FYR generated from the sale of MACEDONIA manufactured tobacco products. PORTUGAL GREECE KAZAKHSTAN Tobacco is grown on less than MONGOLIA MOROCCO TUNISIA MALTA one percent of the world’s UNITED STATES UZBEKISTAN DPR ALGERIA KYRGYZSTAN OF AMERICA GEO KOREA JAPAN A AZER agricultural land, and on a wide RM TURKMEN TURKEY TAJ REP. variety of soils and climates. Since KOREA

T

U

N AFGHANISTAN I ISL. REP. the 1960s, the bulk of production BERMUDA S CHINA I IRAQ MOROCCO A see inset IRAN has moved from the Americas to KUWAIT PAKISTAN BHUTAN BAHAMAS ALGERIA LIBYAN NEPAL ARAB BAHRAIN Africa and Asia: land devoted to MEXICO TURKS & CAICOS JAMAHIRIYA QATAR WESTERN SAHARA EGYPT UAE CUBA DOMINICAN REP. tobacco growing has been halved BANGLADESH Hong Kong JAMAICA PUERTO RICO SAUDI ARABIA MYANMAR ANGUILLA INDIA LAO SAR in the USA, Canada and Mexico, BELIZE HAITI MAURITANIA OMAN PDR VIET NAM HONDURAS ST KITTS & ANTIGUA & BARBUDA MALI GUATEMALA NEVIS DOMINICA CAPE VERDE NIGER THAILAND SENEGAL ERITREA but has almost doubled in China, EL SALVADOR ST VINCENT & GRENAD. ST LUCIA YEMEN NICARAGUA GAMBIA CHAD SUDAN GRENADA BARBADOS BURKINA CAMBODIA PHILIPPINES GUINEA-BISSAU FASO DJIBOUTI

TRINIDAD & TOBAGO N

Malawi and United Republic of COSTA RICA I NIGERIA Brazil A VENEZUELA GUINEA N

E PANAMA GUYANA CÔTE N B SRI LANKA A ETHIOPIA PALAU TOGO Tanzania. SURINAME SIERRA LEONE D’IVOIRE H MALDIVES China G C A R FRENCH GUIANA (Fr) SOMALIA BRUNEI DAR. COLOMBIA CAMEROON MICRONESIA, LIBERIA MALAYSIA The production of tobacco India EQUATORIAL UGANDA FED. STATES OF GUINEA KENYA CYPRUS SYRIAN ARAB SINGAPORE leaves has more than doubled ECUADOR GABON Turkey SAO TOME DEM. REP. R SEYCHELLES REPUBLIC & PRINCIPE LEBANON CONGO CONGO B IRAQ since the 1960s, totalling nearly UNITED REP. USA ISRAEL PAPUA TANZANIA JORDAN INDONESIA NEW 7 million metric tons in 2000. SOLOMON BRAZIL WEST BANK GUINEA ANGOLA ISLANDS The greater use of fertilisers and countries COMOROS & GAZA PERU MALAWI EGYPT ZAMBIA MADAGASCAR pesticides, as well as the increased produce 2,661 SAUDI ARABIA ZIMBABWE mechanisation, that have BOLIVIA MAURITIUS BOTSWANA produced these higher yields are PARAGUAY NAMIBIA CHILE REUNION MARSHALL KIRIBATI MOZAMBIQUE environmentally damaging. The ISLANDS TOKELAU S AUSTRALIA 2 NAURU AMERICAN problem does not end with SOUTH L SAMOA SAMOA AFRICA URUGUAY WALLIS AND FUTUNA ISLANDS (Fr) growing tobacco: the processes COOK FIJI NIUE used in curing tobacco leaves ARGENTINA VANUATU 3 TONGA 45% cause massive deforestation. of the 41% There are millions of tobacco NEW worldÕs ZEALAND farmers worldwide. The tobacco tobacco 31% industry exploits them by 25% 26% contributing to their debt burden, 16% 18% 19% Leading producers of tobacco leaves

c while using their economic plight n i Thousands of metric tons l a e i b r to argue against efforts to control w u 2001 y a p b e S a e r tobacco. In the USA, the bond , n 701 b R o a a h K n t s m b i s 568 i n i e between the tobacco industry and a i f Z h a d r k o w y C d a 450 a A a l a r c the tobacco farmer finally is P l g u i o a l J n g b a u beginning to break down, and M u 260 r B p U 175 partnerships are developing e 147 132 130 120 Deforestation R 103 101 between the farmers and the Proportion of total annual deforestation public health community. attributable to tobacco China India Brazil USA Turkey Zimbabwe Indonesia Italy Greece Malawi Pakistan Argentina 1999 selected countries 46 47 MANUFACTURING TOBACCO CYAN MAGENTA YELLOW BLACK

Tobacco manufacturing workers

Number of workers 13 Manufacturing Tobacco FINLAND 1999 or latest available data SWEDEN over 200,000 RUSSIAN LATVIA FED. Each year, over five trillion DENMARK UNITED LITHUANIA KINGDOM 10,000 – 100,000 cigarettes are manufactured. IRELAND China is by far the largest NETH. GERMANY POLAND 5,000 – 9,999 BELGIUM cigarette manufacturer, followed CZECH UKRAINE REPUBLIC by the USA. Chinese cigarette 1,000 – 4,999 AUSTRIA HUNGARY production increased from 225 FRANCE ROMANIA RUSSIAN CANADA CROATIA B-H FEDERATION 1 – 999 billion cigarettes annually in 1960 YUGOSLAVIA BULGARIA ITALY to 1.7 trillion a year in 1995, a SPAIN ALBANIA FYR MACEDONIA no data PORTUGAL seven-fold increase. The GREECE economic value of tobacco MOROCCO TUNISIA products is vast, totalling UNITED STATES MALTA KYRGYZSTAN OF AMERICA ALGERIA JAPAN hundreds of billions of US dollars AZER REP. TURKEY a year. Very little of this money is KOREA T CHINA U CYPRUS N LEBANON

I spent on tobacco itself. More is S ISRAEL I ISL. REP. MOROCCO A IRAQ IRAN spent on paper, filters, and JORDAN PAKISTAN ALGERIA LIBYAN NEPAL MEXICO CUBA ARAB packaging than on tobacco. JAMAHIRIYA EGYPT Hong Kong SAR Nearly 2 million people are DOMINICAN BANGLADESH JAMAICA REPUBLIC MYANMAR Macau INDIA LAO SAR employed in the manufacture of BELIZE HAITI PDR GUATEMALA THAILAND PHILIPPINES NETH. ANTILLES CAPE VERDE tobacco products, two-thirds of ST VINCENT & GRENADINES SENEGAL YEMEN GAMBIA SUDAN GRENADA BARBADOS BURKINA CAMBODIA FASO whom are working in China, COSTA RICA TRINIDAD & TOBAGO

VENEZUELA A PANAMA GUYANA CÔTE N A ETHIOPIA India: India and Indonesia. Job losses SURINAME SIERRA LEONE D’IVOIRE H SRI LANKA G 6 million children, COLOMBIA CAMEROON LIBERIA MALAYSIA which would result from a UGANDA SOMALIA ages 4 to 14, reduction in tobacco consumption KENYA work full time in SINGAPORE ECUADOR GABON DEM. REP. are estimated to be fairly small. CONGO CONGO BURUNDI the bidi industry. PAPUA UNITED REP. INDONESIA Technological advances in both TANZANIA NEW BRAZIL GUINEA farming and manufacturing have a ANGOLA MALAWI much larger impact on jobs than PERU ZAMBIA MADAGASCAR FIJI ZIMBABWE tobacco control efforts. BOLIVIA MAURITIUS

AY Hundreds of chemicals are CHILE PARAGU added to tobacco in the AUSTRALIA manufacture of cigarettes. SOUTH AFRICA Additives make smoke easier to URUGUAY inhale into the lungs and allow for ARGENTINA less tobacco to be used in each Where the tobacco dollar goes 2.28 Less tobacco per cigarette ADDITIVES cigarette. Today’s cigarettes are For every dollar spent on tobacco in the USA… estimated lbs of leaf used NEW 2.05 Selected additives and effec ZEALAND highly engineered, exquisitely per 1,000 cigarettes ts designed “nicotine delivery 1.81 in the USA Ammonia changes pH and may 1960–1999 increase nicotine absorption devices”. 1.58 Flavourings enhance taste Besides using less tobacco per Because of the Sweeteners make more palata 1.33 ble cigarette, the composition of the use of additives 1.29 1.31 Eugenol and numb throat and cigarette is also changing. and other 1.15 Menthol facilitate inhalation technologies, such Cocoa Manufacturers are using more 0.91 dilate airways as “fluffing” and Others mask smell and invisibility reconstituted tobacco, which the use of of reconstituted makes it easier to add chemicals other additives: ammonia, ammonium tobacco, tobacco hydrox is for manufacturing is for state and local tax ide, beta- is for wholesale, retail & transport carotene, gentian ro is for federal tax ot

and to include leaf stems and dust

is for the tobacco itself

is for non-tobacco materials companies use which had previously been extract, levulinic acid, patchouli oil, urea, less and less met 43¢ 21¢ 11¢ 15¢ 4¢ hylcyclopent 7¢ enolene, snakeroot oil discarded. tobacco per cigarette. 1960 1965 1970 1975 1980 1985 1990 1995 2000

48 AGE YOUR HEALTH 49 ARNING: SMOKING CAN SERIOUSLY DAM GOVERNMENT HEALTH W 14/TOBACCO COMPANIES CYAN MAGENTA YELLOW BLACK

ICELAND 14 Tobacco Companies FINLAND NORWAY

SWEDEN ESTONIA British American RUSSIAN Tobacco LATVIA FED. Philip Morris is the world’s UNITED DENMARK LITHUANIA largest transnational tobacco KINGDOM IRELAND BELARUS company, whose Marlboro brand NETH. POLAND BELGIUM Reemsta is the world leader. In 1999 the CZECH UKRAINE LUX. GERMANY REPUBLIC company had sales of over FRANCE AUSTRIA HUNGARY SWITZ. US$47 billion. However, ROMANIA RUSSIAN FEDERATION CANADA CROATIA excluding the US domestic BULGARIA ITALY market, BAT sells the most SPAIN PORTUGAL cigarettes worldwide and has the GREECE largest network in the most KAZAKHSTAN Philip Morris MOROCCO TUNISIA countries. UZBEKISTAN DPR International ALGERIA The tobacco industry is a UNITED STATES KOREA JAPAN OF AMERICA TURKEY REP. mixture of some of the most KOREA CYPRUS LEBANON TUNISIA CHINA powerful transnational Philip Morris IRAQ ISL. REP. MOROCCO ISRAEL IRAN R J Reynolds commercial companies in the $47.1 billion JORDAN PAKISTAN ALGERIA LIBYAN BAHRAIN ARAB world. Tobacco companies, MEXICO JAMAHIRIYA EGYPT UAE CUBA DOMINICAN which frequently merge, own REPUBLIC SAUDI ARABIA BANGLADESH Hong Kong SAR JAMAICA INDIA MYANMAR OMAN VIET NAM other huge industries and run an HONDURAS GUATEMALA THAILAND PHILIPPINES EL SALVADOR intricate variety of joint ventures. NICARAGUA BARBADOS

State tobacco monopolies have COSTA RICA TRINIDAD & VENEZUELA TOBAGO A NIGERIA PANAMA GUYANA N SIERRA LEONE A been in decline since the 1980s. H SRI LANKA SURINAME G COLOMBIA CAMEROON About 7,000 medium to large MALAYSIA ÒWe see the new UGANDA state-owned enterprises were KENYA SINGAPORE markets opening up ECUADOR DEM. REP. privatised in the 1980s and a in Central Asia and CONGO UNITED REP. further 60,000 in the 1990s after the Commonwealth of TANZANIA BAT INDONESIA BRAZIL $31.1 billion the collapse of the former Soviet Independent States as really being the PERU MALAWI Union. From the late 1990s, the ZAMBIA future of BAT well BOLIVIA ZIMBABWE IMF has pressurised countries into the FIJI MAURITIUS such as the Republic of Korea, the century.Ó CHILE Republic of Moldova, Thailand AUSTRALIA BAT, 1994 SOUTH and Turkey to privatise their state AFRICA tobacco industry as a condition of URUGUAY JTI $21.6 billion loans. ARGENTINA 16.4% The remaining monopolies Leading manufacturer by country 15.4% represent a combined NEW ZEALAND consumption of 2 billion cigarettes or 40 percent of the world’s total headquarters location of The Big Five major transnational cigarette consumption. tobacco companies Since the early 1990s, the Leading transnational tobacco companies 1999 cigarette companies have Philip Morris Austria Tabak massively increased their 7.2% Reemsta manufacturing capacity in British American Tobacco (BAT) Gallaher $6.1 billion developing countries and eastern Japan Tobacco International (JTI) state monopoly Europe. Where once the rich percentage of global Altadis market share Reemsta countries exported “death and other $2.3 billion disease”, increasingly these are 2.6% Altadis no data 1.9% manufactured locally. revenue US$ billions 50 Philip Morris BAT JTI Reemsta Altadis 51 15/Tobacco Trade CYAN MAGENTA YELLOW BLACK

Cigarette exports

million of cigarettes 2000 15 Tobacco Trade Cigarette imports

over 100,000 1,000 – 4,999 below 100 Top 10 cigarette importing countries Tobacco trade is big business, for Manufactured cigarettes are also 10,000 – 99,999 100 – 999 2000 numbers of cigarettes 343 no data both the raw material (tobacco traded globally. Again, the USA is leaves) and the finished product the largest exporter of 5,000 – 9,999 (manufactured cigarettes). manufactured cigarettes, Brazil is the largest exporter of accounting for nearly 20 percent 33.6bn 45bn DENMARK IRELAND Top 10 tobacco leaf, and the Russian of the world total. Japan is the UNITED NORWAY KINGDOM NETH. Leaf exporters BELGIUM Federation and the USA are the largest importer of cigarettes. GERMANY CZECH RUSSIAN CANADA REPUBLIC thousand metric tons LUX. FINLAND FEDERATION FRANCE AUSTRIA SWEDEN 191 largest importers. Some countries According to government SWITZ. 1999 67.6bn CROATIA that grow tobacco, such as the reports, 846 billion cigarettes POLAND

164 20bn ITALY SLOVAKIA KAZAKHSTAN SPAIN USA, also import foreign tobacco were exported, but only PORTUGAL HUN REP. USA MOLDOVA 132 YUG BUL 129 AZERBAIJAN JAPAN as well as exporting their own 619 billion were reported to be UZBEKISTAN

120 ALB TURKEY GREECE REP. 73 SYRIAN ARAB KOREA 101 94 tobacco leaves. Interestingly, the imported. Statistics such as these CYPRUS 24.2bn 93 25.2bn 56.5bn REPUBLIC 83.5bn MALTA ISRAEL JORDAN CHINA USA exports approximately the provide a sense of the size of the PAKISTAN MEXICO EGYPT same amount of tobacco that it cigarette smuggling problem. CUBA DOMINICAN REP. SAUDI INDIA Hong MYANMAR Kong SAR BELIZE JAMAICA ARABIA Brazil USA Zimbabwe China Turkey India Greece Italy Malawi Argentina imports. Because US tobacco is China is quietly emerging as a GUATEMALA 20bn HONDURAS SENEGAL YEMEN THAILAND popular globally, and tends to be significant cigarette exporter, BARBADOS PHILIPPINES VENEZUELA CÔTE d’ SRI LANKA UK more expensive than tobacco increasing from virtually no SIERRA LEONE IVOIRE USA COLOMBIA CAMEROON M A L A Y S I A Egypt Japan France Poland from other countries, the value of exports in 1980 to over ECUADOR KENYA Ukraine SINGAPORE

Germany CONGO 55

60 UNITED REP. US tobacco leaf exports are about 20 billion cigarettes exported in 49.3bn INDONESIA 70 TANZANIA 71 double that of the same quantity 2001, worth about US$320 BRAZIL MALAWI 99 of imports. million. In 2005 the value of

Russian Federation ZIMBABWE

113 SAMOA REUNION PARAGUAY

129 China’s export trade in cigarettes Top 10 AUSTRALIA FIJI is predicted to be US$600 CHILE SOUTH

190 Leaf importers AFRICA URUGUAY thousand metric tons million. ARGENTINA 1999 ia 241 uss to R

263 NEW ZEALAND to 7,111 Denm ark n CANADA pa ermany 28,868 Ja to G to Netherla CANADA o 7,138 8,946 nds RUSSIAN t p. 4,681 1,130 5,134 Re FEDERATION a re 9,252 n 873 UNITED o ny a K ma m KINGDOM er DENMARK p Belgiu to G NETHERLANDS a to to to Belgium J GERMANY o 6,691 1,232 GERMANY 10,520 BELGIUM t BELGIUM USA 77,133 JAPAN USA SWITZERLAND 39,039 to Italy ITALY SPAIN AND TURKEY CHINA 2,121 LIECHTENSTEIN REP. 7,181 CYPRUS KOREA JAPAN hina LEBANON from m C to Cyprus ISRAEL Turkey fro 7,093 3,880 an 34,217 6,995 876 Jap 7,113 rael from y Is SAUDI e to f k ARABIA a r DOMINICAN r to esi o u ia 4,227 4,437 on m REPUBLIC f T es Lebanon nd ro o n I A m t o m f d ro r n ia f r M I b g o a ra e A m m la 12,218 o di n w r au 743 t i 7,696 f 10,637 S B o i t n r Tobacco leaves Cigarettes re a a po z nga SINGAPORE i to Si l metric tons 2000 metric tons 2000 3,388 BRAZIL INDONESIA INDONESIA total imported: 15,274 MALAWI total imported: 196, 597 total exported: 182, 519 total exported: 148,533 52,786 13,743 13,997 US imports US imports ARGENTINA US exports US exports 52 US imports and exports 53 16/ Smuggling CYAN MAGENTA YELLOW BLACK

Smuggled cigarettes 16 Smuggling Estimated smuggled cigarettes as percentage of domestic sales 1995

SWEDEN 30% or more ESTONIA RUSSIAN recent or current “…price is only one of many factors that LATVIA influence smuggling rates. Other more FED. 20% – 29% smuggling routes UNITED LITHUANIA important factors include: the tobacco KINGDOM where known industry’s own role in facilitating IRELAND NETH. 10% – 19% BELARUS smuggling; the lack of appropriate GERMANY POLAND controls on tobacco products in BELGIUM 5% – 9% CZECH UKRAINE REPUBLIC international trade; and the existence of LUX. SLOVAKIA RUSSIAN entrenched smuggling networks, FRANCE AUSTRIA HUNGARY FEDERATION 1% – 4% unlicensed distribution, lax anti- ROMANIA smuggling laws, weak enforcement and CANADA no data official corruption.” WHO, 2000 YUGOSLAVIA BULGARIA ITALY Andorra ALBANIA SPAIN Between 300 and 400 billion Montréal GREECE KAZAKHSTAN cigarettes were smuggled in Vladivostok 1995, equal to about one third of UNITED STATES UZBEKISTAN OF AMERICA AZER TURKEY TURKMEN all the legally imported cigarettes. REP. KOREA Cigarettes are the world’s most CYPRUS LEBANON AFGHANISTAN CHINA TUNISIA widely smuggled legal consumer ISL. REP. The Chinese government loses Port Said IRAN product. They are smuggled PAKISTAN BHUTAN LIBYAN Dubai NEPAL $1.8 billion ARAB across almost every national JAMAHIRIYA EGYPT in revenue each year from UAE BANGLADESH Hong Kong cigarette smuggling MYANMAR border by constantly changing ST. MAARTEN LAO SAR INDIA PDR NIGER THAILAND VIET NAM routes. Aruba CHAD Maradi SUDAN BURKINA FASO Cigarette smuggling causes CAMBODIA PHILIPPINES VENEZUELA DJIBOUTI immeasurable harm. International PANAMA GUYANA TOGO NIGERIA GHANA C A R SOMALIA brands become affordable to low- COLOMBIA SRI LANKA income consumers and to image- CAMEROON MALAYSIA SINGAPORE EQUATORIAL conscious young people in ECUADOR GUINEA developing countries. Illegal INDONESIA cigarettes evade legal restrictions BRAZIL Projected share and health regulations, and while if no action taken PERU the tobacco companies reap their 36% Global smuggling For every 2003-04 Numbers of smuggled cigarettes 1993 profits, governments lose tax 34% Iquique 20 2002-03 PARAGUAY 6% of world cigarette sales are smuggled revenue. 32% ÒÉtransitÉis cigarettes 2001-02 sold Some governments are now Encarnation essentially the suing tobacco companies for CHILE illegal import of rest of the world Eastern Europe brandsÉupon which 98 billion 85 billion 1 revenue lost due to smuggling is smuggled ARGENTINA no duty has been global total activities allegedly condoned by 25% paid.Ó 318 billion 2000-01 the companies. Measures needed Western Europe Asia-Pacific to control smuggling should BAT, 1989 50 billion 85 billion include monitoring cigarette routes, using technologically 2001-02 sophisticated tax-paid markings 2002-03 2000-01 22% Lost revenue on tobacco products, printing 21% 21% 2003-04 20% Tax revenue lost for each lorry load unique serial numbers on all 1999-2000 Projected share smuggled into the European Union 18% packages of tobacco if new measures are taken US$ 1997 products, and and duty increased by 5% Meat / butter increasing penalties. Live animals Milk powder $54,000 1998-99 $24,000 $36,000 12% Alcohol Cigarettes $480,000 $1,200,000 Tackling tobacco smuggling 1997-98 Cigarettes smuggled into the UK 1996-97 6% as percentage of market share 54 4% 1996 – 2004 projected 55

17/ Tobacco industry promotion CYAN MAGENTA YELLOW BLACK

Most popular cigarette brand by country

17 Tobacco Industry Promotion ICELAND 1999 or latest available data FINLAND NORWAY Marlboro John Player SWEDEN RUSSIAN Prima Cigarettes are possibly the most FED. UNITED DENMARK LITHUANIA marketed product in the world. KINGDOM Astra While there is no reliable IRELAND Benson & Hedges Sportsman NETH. GERMANY POLAND BELGIUM estimate of global cigarette CZECH Petra UKRAINE Bristol LUX. REPUBLIC marketing expenditures, it is Sopianae AUSTRIA RUSSIAN Casino other brands Players FRANCE HUNGARY Carpati clearly in the tens of billions of SWITZ. FEDERATION CANADA ÒSponsorship is a Memphis ROMANIA Delta named where known US dollars a year. form of advertising Victory Red ITALY BULGARIA In the USA alone over which enables us to SPAIN $10 billion is spent a year on introduce glamour SG PORTUGAL GREECE marketing cigarettes, and this at a and excitement.Ó MONGOLIA time when advertising is MOROCCO Mild Seven UNITED STATES Michael Whitbread, OF AMERICA JAPAN prohibited on television and Gallaher TURKEY REP. This The Marlboro radio, when there are limitations International, Rothmans KOREA Man was the top CYPRUS LEBANON Hongtashan on certain types of outdoor Hong Kong,1986 Time ad icon of the MOROCCO Red & White CHINA advertising and sponsorship, and Casa Sports ISRAEL KUWAIT PAKISTAN when cigarette sales are falling. MEXICO CUBA Cleopatra BAHRAIN Nacional QATAR 20th EGYPT UAE Annual marketing expenditure is DOMINICAN REPUBLIC BANGLADESH Hong Kong JAMAICA SAUDI ARABIA PUERTO RICO INDIA VIET NAM SAR century OMAN over $200 per smoker, and over Rubios HONDURAS Craven “A” GUATEMALA Wills THAILAND Vinataba according to 46 cents for every pack sold. EL SALVADOR NICARAGUA Hope BARBADOS PHILIPPINES Advertising Age Promotional allowances, that is COSTA RICA TRINIDAD & TOBAGO Three Rings Krong Thip VENEZUELA A PANAMA GUYANA N NIGERIA SIERRA LEONE A payments made to retailers to H SRI LANKA G Tresor COLOMBIA CAMEROON facilitate sales, account for 41 Diplomat UGANDA MALAYSIA

Stella KENYA SINGAPORE percent of the total expenditure ECUADOR DEM. REP. on cigarette marketing. CONGO Commodore Cigarette marketing is bolder INDONESIA BRAZIL and more aggressive in developing countries than it is in the Madison developed world. Cigarette BOLIVIA ZIMBABWE MAURITIUS advertising on television and radio CHILE (Philip Morris) is common, and a variety of other Peter Stuyvesant AUSTRALIA FIJI venues are exploited. These SOUTH Marlboro AFRICA include sports, arts, pop, fashion and street events, adventure ARGENTINA 350 billion tours, contests, give-aways and Holiday How the marketing $9,575m the internet. Changes in cigarette marketing NEW ZEALAND There are also the hidden dollar is spent in the USA expenditure in the USA 1970-99 2000 advertisements such as the Hongtashan US$ million cigarette consumption per person (China Monopoly) placement of cigarette smoking 4 amount spent US $million and tobacco products in films. In 233 265 310

93 $4,895m billion 52 3,914 addition there is sponsorship of 347 (Japan Tobacco)

3,516 (China Monopoly)

295 3,969 4,095 3,858 $3,992m 0.95 universities, good-will donations 9 3,400 (China Monopoly) for community events, and 2,827 Mild SevenRed China (China Monopoly) $2,476m 2,482 (Reemsta) advertising of other goods and 22 Baisha 128 1,975 Honghe Prima

products bearing the cigarette 705 $1,242m 130 130 name. Such marketing is seen billion billion sports $491m 110 direct mail advertising $361m billion 103 100 throughout both the developed newspaper advertising billion billion promotional allowances special offers and gifts coupons point of sale advertising entertainment sponsorship magazine advertising speciality item distribution internet advertising free samples outdoor advertising advertising on public transport and the developing world. 1970 1975 1980 1985 1990 1995 2000 World’s most popular brands 1999 58 59 18 INTERNET SALES CYAN MAGENTA YELLOW BLACK

18 Internet Sales DUTY BUY CHEAP FREE SPECIALS DISCOUNT CIGARS BIDIS PREMIUM TOBACCO

ALTH TH U R H EAL TH Y DAMAGE YOUR HE GE YOUR H EAL U S LY D A MAGE YO E YOUR HEALTH YOUR H E ALTH G E YOUR HEALTH CAN SERIOUSL S ERI OUSLY D A MA K ING CAN SERIO H LTH E RIOUS LY D AMAG IOUSLY DAMA G E E RIOUS L Y DAMA NIN G : SMOKI NG : SMOKI NG CA N WAR N I NG: SMO MAGE Y O U R H EALT GE YOU R HEA MOK ING CAN S N G C A N SER GE YOU R HE ALTH S MOK I NG CAN S T H EAL T H W AR A L TH WARN ING MENT HEALTH N SERIO U SLY DA SERIO U SLY DAMA L T H W ARNIN G: S WARNI NG: S MOKI ERI OUSLY D A M A H W ARN I NG: GOVERNMEN G OVER N MEN T HE G OVERN SMOKING C A : SMOKING C AN V ERNMENT HEA R NMENT HEA L TH S MOKING C A N S O V ERNMENT H EALT HEALT H WA R NING: H EALTH WARNING GO GOVE L TH WA RNIN G: G G O VERNMENT GOVERNMENT GOVER NMENT H EA “The ideal product to sell online would be easy to pack and ship, be much cheaper than what’s charged at the retail counter, and be craved by tens of millions of people every day. WHERE ARE THE GOODS? Cigarettes, the internet was made for you.” David Streitfeld, Washington Post, 2000 SELLERS INTERNET CIGARETTE SEARCH Google, 2002 Cigarette vendors are very easy to locate online by the simplest Test ordering from 12 websites search mechanisms. which claim to offer low price cigarettes WORLDWIDE This mode of purchase to the UK market 2001 Search term Results found translates into global penetration of tobacco products, discount cigarette 9,070 unprecedented access of 3 sites sent cigarettes BUYERS cigarettes to minors, cheap cheap cigarette 5,510 cigarettes through tax avoidance 1 site charged but did not send cigarettes and smuggling, and unfettered WORLDWIDE tax free cigarette 1,540 advertising, marketing and 8 sites took no money and sent no cigarettes promotion. mail order cigarette 374 It is often impossible to identify the country of origin of such Prices quoted for 200 cigarettes £10 – £27 vendors. The majority appear to be in Europe and the USA, but Retail price in UK £38.60 countries as varied as Cyprus and Panama also offer internet sales. Price in UK if intercepted by Customs £38.15 INTERNET CIGARETTE VENDORS, USA 2000 Strangely, some vendors take credit card details from prospective purchasers but then neither charge nor dispatch any “Wow!!!!!!!!!!!!!!!! cigarettes. What a great internet cigarette vendor sites 88 The internet is also used by “Philip Morris admits website for cigs. I “Most sites offering sites with Surgeon-General’s warning 24% tobacco interests to undertake cheap cigarettes are a rip being behind Wavesnet can’t believe I have sophisticated public relations, to off. All cigarettes bought website, an internet been looking all denigrate pro-health organisations sites selling bidis 8% via the Internet must company set up to run over the web for and individuals, to undermine the cheap cigs and here science of tobacco, and to attack bear UK taxes. There are fashion parades and rave sites with special promotions 33% no allowances or loopholes. parties where cigarettes you were all the tobacco control legislation (see time...... with a map 20). Legislation has not yet Cigarettes bought from are sold at a discount.” sites with age warning 81% complete list of caught up with this new threat to sites that do not arrange health. payment of UK taxes are Australian Associated companies. Thanks types of age verification required: Sales of cigarettes and other liable to forfeiture. In Press, 2000 a lot!” forms of tobacco over the the last year Customs customer self-reporting they are over 18 49% internet started in earnest in the have destroyed over 10 typing in a birth date 15% mid-1990s, and are predicted to million such cigarettes.” rise in future. entering driving license information 9% HM Customs and Excise, UK User comment posted on 2000 discount cigarette site, 2002 US teenagers with internet access over 50%

60 61 19 Politics CYAN MAGENTA YELLOW BLACK

19 Politics Small shopkeepers were enlisted to write protests to members of We have got the unions Parliament; the letters The tobacco industry spends the US Congress have received fundraisers. As well as campaign to support industry in some with deliberate several countries. millions of dollars trying to over $5 million in contributions contributions, tobacco companies typographical errors to Prominent have been the influence public policy. It makes from tobacco companies, and conduct direct lobbying and create the aura of efforts they have made authenticity, were on the tax issues in the major contributions to elected nearly six out of ten have sophisticated public relations Philip Morris and the prepared by the UK where they were very officials and political parties, accepted tobacco money. campaigns, including paid media, industry are positively (tobacco) industry for involved in a letter payments to governments to The tobacco industry sought to to influence the opinions of impacting the government the shopkeepers. writing campaign to decisions of Bahrain, support infrastructure such as delay, and eventually defeat, the political decision-makers. Members of Parliament. mass transit and large investments EC directive on tobacco Comprehensive tobacco Philip Morris, 1990 Kuwait, Oman, Qatar, Saudi Arabia and the UAE through Philip Morris, 1985 in sophisticated public relations advertising and sponsorship by legislation was defeated in the US the creative use of market campaigns. The industry also seeking the aid of figures at the Senate in 1998. Those who voted specific studies, position gives money to civic, educational highest levels of European politics against the legislation had papers, well briefed and charitable organisations and a while at times attempting to received on average, nearly four distributors who lobby, host of others. conceal the industry’s role. times as much money from the media owners and consultants Since 1995 US tobacco Parliamentarians in Europe have tobacco industry in the two years companies have donated more accepted money and even senior before their last election, as those Philip Morris, 1987 than $32 million in political positions in tobacco companies. who voted in favour of the bill. contributions to state and federal Tobacco companies also attempt Buying influence and favours candidates and political parties in to influence the political process, through political contributions is the USA, with over 80 percent of by subsidising the air travel of common practice; however, most Turning now to primary this paid to influence federal candidates and their staff, funding countries do not require and passive smoking To get more favorable elections and officeholders. From political conventions and mandatory reporting. press, 1995 to 2000 current members of inaugurations, and hosting we are contemplating organizing another journalists conference similar to the one we Buying influence put together in Madrid Expenditure on lobbying by for Latin American US tobacco companies journalists in 1984. Smokeless Tobacco Council $1.8m USA 1997 Philip Morris, 1985 Tobacco Institute $2.1m

Lorillard-Loews $2.6m

Buying favours The International Top tobacco contributions $15.8m Tobacco Growers $3.7m to federal candidates Philip Morris $10.2m Association could Brown & Williamson (BAT) USA 1995–2000 front for our third world lobby activities $4.1m at WHO, and gain support US Tobacco Company Philip Morris from nations hostile to multinational US Tobacco Company $5.4m corporations RJ Reynolds Brown and Williamson (BAT) $3.4m

$4.7m INFOTAB, $2.9m

Tobacco Institute (tobacco industry

“What are we trying to accomplish? Smokeless Tobacco Council pressure group), 1988 Conwood Company Lorillard Tobacco Pinkerton Tobacco Company Prevent further deterioration of overall Swisher International “Unless countervailing $1.2m social, legislative and regulatory climate, RJ Reynolds

steps are taken (such as lobbying), $0.6 $0.6m

Total: $35.5 million $0.4 and ultimately, actually improve the $0.3m public decision-making will march $0.2m with public opinion.” climate for the marketing and use of RJ Reynolds, 1978 tobacco products.” Philip Morris, 1990

62 63 20 smokers rights CYAN MAGENTA YELLOW BLACK

Smokers’ Rights Organisations 20 Smokers’ Rights 2002 where known FOREST: Freedom Organisation for the Right Organisations Norway to Enjoy Smoking Tobacco • Roykringen FORCES: Fight Ordinances & Restrictions to Control & Eliminate Smoking Denmark Sweden • Hen-Ry • Smokepeace Sweden Netherlands • Vänliga Rökares • FORCES Internationella Netherland Germany Förbund • Stichting Rokers Russian Canada • Raucher Club Belangen Deutschland Federation • FORCES Canada • FORCES RUSSIAN FEDERATION • Smokers Unity International CANADA Network United NORWAY Kingdom SWEDEN • FOREST DENMARK Poland Belgium UK NETH • Towarzystwo • The Smoking POLAND Ochrony ÒSmokers are not a BEL GERMANY Palacych constituency that can be France FRANCE • Association SWITZERLAND easily rallied. They are du Calumet de defensive, often self- UNITED STATES la Paix ITALY OF AMERICA USA deprecating, somewhat shamed. • FORCES International SPAIN May see themselves engaged in • American Smokers Spain GREECE Greece a habit they wish they could Alliance • Club de • Eleftheria • National Smokers quit. They are a passive Fumadores por Italy ÒWe try to keep Philip Alliance la Tolerancia Switzerland group. Expressing very little • FORCES Italiana Morris out of media issues • Tobacco • Associazione anger or resentment. There is Friends Club like taxation, smoking bans Italiana Fumatori no sign among them of any • Federazione and marketing restrictions. significant determination to Tabaccai Instead, we try to provide assert their rights as the media with statements smokers.Ó in support of our positions from third party sources, RJ Reynolds, 1978 which carry more The tobacco industry has long company funding. In a 1988 ÒFirst we must work harder credibility than our appreciated the importance and document, the head of Philip at getting smokers to help company and have no difficulty of mobilising smokers to Morris said, “Should we strive to the industry. If we are to apparent vested interest.Ó speak out on behalf of smokers’ set up FOREST type have any success at changing the climate of rights. Consequently the tobacco organisations throughout our Philip Morris, 1993 opinion, we have to get the companies have investigated ways regions?”. smokers more on our side, that they could “stimulate” the At the request of Philip Morris or at least enough of them development of groups of the public relations firm of to start to make a smokers, so as to have the Burson-Marstellar formed the difference.Ó support, or at least the National Smokers Alliance, a ÒTo sum up, then, on Philip Morris, 1985 appearance of support from smokers rights group, in 1993. using our natural smokers and other “natural or Philip Morris initially provided allies. We have made a third party allies”. the National Smokers Alliance start; we have proved There are fewer than two dozen with $4 million in seed funding. that it can be done; we ÒIn Australia too, smokers’ rights organisations in Documents show that Philip have found that they can through FOREST, be a very effective AUSTRALIA the world, and all are in the Morris formed similar groups we have awakened force; and we intend to the public in the tax developed world. The tobacco throughout Europe. These do more in the future.Ó area, with carefully industry documents illustrate that “grassroots” groups, with their orchestrated while many of these organisations facades of “independence” from Philip Morris, 1985 campaigns.Ó purport to be independent of the the industry, allowed them to do tobacco industry, at least some and say things publicly that Philip Morris, 1985 New Zealand • FORCES NEW are dependent on tobacco tobacco companies could not. New Zealand • Smokers of ZEALAND the World Unite 64 65 21 tobacco Industry documents CYAN MAGENTA YELLOW BLACK

Legacy website

Number of documents relating to each country found Tobacco Industry Documents Guildford: FINLAND 21 ICELAND British American on the Legacy website of tobacco industry documents 2002 NORWAY Tobacco SWEDEN ESTONIA The higher the figure, the more important the country is RUSSIAN LATVIA to the industry. “On May 12, 1994, an unsolicited box FED. DENMARK of what appeared to be tobacco company LITHUANIA 5,000 and above documents was delivered to Professor IRELAND UNITED Stanton Glantz…The documents in the box BELARUS KINGDOM NETH. POLAND dated from the early 1950’s to the early GERMANY 1,000 – 4,999 BELGIUM 1980’s. They consisted primarily of CZECH UKRAINE LUX. REPUBLIC SLOVAKIA confidential internal memoranda related REP. 500 – 999 AUSTRIA HUNGARY MOLDOVA to B&W and BAT. Many of the documents SWITZ. FRANCE SLOVENIA ROMANIA RUSSIAN contained internal discussions of the CROATIA 100 – 499 CANADA B-H FEDERATION tobacco industry’s public relations and SAN MARINO SPAIN YUGOSLAVIA BULGARIA legal strategies over the years, and they MONACO ITALY FYR MACEDONIA under 100 were often labelled “confidential” or ANDORRA ALBANIA no data or ’privileged.’ The return address on the box PORTUGAL no data or other countries was simply ‘Mr Butts’.” GREECE KAZAKHSTAN

TUNISIA MONGOLIA MOROCCO MALTA UZBEKISTAN JAPAN UNITED STATES Minnesota: KYRGYZSTAN So starts The Cigarette Papers, the ALGERIA GEO OF AMERICA ARMAZER Philip Morris TURKMEN TURKEY first report chronicling the release RJ Reynolds TAJIKISTAN REP. Brown & Williamson/BAT KOREA T CHINA of previously secret tobacco U N AFGHANISTAN Lorillard IS see inset IRAQ ISL. REP. industry documents. Public The Tobacco Institute MOROCCO IA IRAN

The Council for Tobacco Research KUWAIT PAKISTAN BHUTAN release of these documents clearly ALGERIA LIBYAN NEPAL BAHAMAS ARAB BAHRAIN MEXICO JAMAHIRIYA QATAR illustrated their power in EGYPT UAE CUBA DOMINICAN REPUBLIC SAUDI ARABIA BANGLADESH exposing tobacco industry JAMAICA PUERTO RICO INDIA MYANMAR LAO BELIZE HAITI AN PDR VIET NAM ST KITTS & ANTIGUA & BARBUDA OM HONDURAS MALI corporate behaviour, and they GUATEMALA NEVIS DOMINICA CAPE VERDE NIGER THAILAND SENEGAL EL SALVADOR ST LUCIA ERITREA YEMEN NICARAGUA ST VINCENT & GRENADINES GAMBIA CHAD SUDAN profoundly influenced public GRENADA BARBADOS BURKINA CAMBODIA PHILIPPINES TRINIDAD & TOBAGO GUINEA-BISSAU FASO DJIBOUTI

COSTA RICA IN NIGERIA A VENEZUELA GUINEA N

E opinion. PANAMA GUYANA CÔTE N

B A ETHIOPIA PALAU TOGO SURINAME SIERRA LEONE D’IVOIRE H MALDIVES SRI LANKA G C A R Following the release of the BRUNEI DAR. COLOMBIA CAMEROON MICRONESIA, LIBERIA SOMALIA MALAYSIA BAT documents and as a result of " EQUATORIAL UGANDA FED. STATES OF GUINEA KENYA SYRIAN ARAB CYPRUS REPUBLIC SINGAPORE ECUADOR GABON litigation and legal settlement SAO TOME R SEYCHELLES LEBANON & PRINCIPE B ISRAEL IRAQ million UNITED REP. PAPUA agreements in the USA, WEST BANK JORDAN TANZANIA INDONESIA AND GAZA NEW documents introduced through pages BRAZIL GUINEA SOLOMON COMOROS ISLANDS ANGOLA legal discovery have had to be MALAWI of once secret PERU ZAMBIA EGYPT SAUDI ARABIA made publicly available by the MADAGASCAR internal tobacco ZIMBABWE MAURITIUS BOLIVIA NAMIBIA tobacco industry in physical industry BOTSWANA MOZAMBIQUE KIRIBATI PARAGUAY depositories in Minneapolis, USA documents are CHILE TOKELAU TUVALU and Guildford, UK. now in the public S AUSTRALIA NAURU SOUTH SAMOA AFRICA L As a result of the 1998 Master domain URUGUAY COOK VANUATU NIUE Settlement Agreement between FIJI ARGENTINA TONGA 46 states and the tobacco industry, the documents of the NEW Minnesota Depository are to be ÒNaturally, some people ZEALAND duplicated online via searchable ÒWorkto develop a ÒAsia is now the priority will suspect that we at websites maintained by each of system by which Philip target for the world the Tobacco Institute have anti-tobacco movement. the companies. Morris can measure trends ÒA law prohibiting spent so long fighting the We should remember that as on the issue of Smoking tobacco advertising was cigarette controversy that U.S. cigarette exports to Òdocument retention and Islam. Identify passed in Ecuador but, we have become a little Asia account for close to policy.Ó Islamic religious leader after a mobilization of paranoid. But let me assure ÒOur workin 70% of our volume and who oppose journalists from you that paranoia is Senegal resulted in 97% of our profitsÉ BATÕs description of interpretations of the throughout Latin America justified. They are a new advertising The implications for our the policy under Quran which would ban the and numerous out there; they are out to decree which businessÉshould this league which thousands of use of tobacco and international get us.Ó reversed a total be successful, incriminating documents encourage support for organizations, it was advertising ban.Ó are significant.Ó were destroyed. these leaders.Ó vetoed by the President.Ó Tobacco Institute, USA, 1979 Philip Morris, 1986 Philip Morris, 1989 Australia, 2002 Philip Morris, 1987 Philip Morris, 1986 66 67