How does tobacco growing impact advancement in demand reduction measures?

Tobacco consumption remains a dire global health issue and the tobacco industry continues to find nefarious ways of keeping demand and consumption high. In the background lies the challenging, and often neglected, issue of tobacco growing and supply. Tobacco growing has proven to be a problematic practice due to its detrimental environmental impact¹, the deeply troubling health implications of growing and processing², and the precarious economic livelihoods of most farming households^3-5. What requires particular attention is the critical relationship between tobacco supply (e.g. growing, processing, and manufacturing) and demand reduction measures. Here, we provide a glimpse into the ways that tobacco growing affects the ability of governments to institute demand reduction measures in tobacco growing countries.

Many governments and other stakeholders in tobacco growing countries believe that commercial tobacco cultivation, particularly among small family-run farms, presents a path to macro- and micro-economic prosperity. On a macro-level, governments particularly value the export and foreign exchange potential and the perceived contribution to employment. Tobacco can generate significant exports and foreign exchange, but the reward calculus tends to be superficial, overlooking the costs to farming households and the environment.

Tobacco cultivation does employ thousands of farmers in some countries, but governments (and especially industry) typically oversimplify the nature of this employment. First, in most countries where researchers have rigorously measured livelihoods, many – often most – farmers consistently lose money cultivating tobacco^4-8. Second, tobacco is typically only part, and sometimes a small part, of a farmer’s crop portfolio and research demonstrates that many other crops and/or off-farm economic activities generate greater household resources⁹. The labour demands of tobacco are also great, with widespread use of child labor¹⁰. Third, tobacco farming causes Green Tobacco Sickness, a form of acute nicotine poisoning, among many who handle the leaf¹¹. Fourth, the chemical overuse and deforestation from growing and curing tobacco devastate ecosystems and thereby the long-term health and economic prosperity of entire communities^6,12. Put simply, if farmers reallocated their labor, land and/ or precious capital to other activities, it is likely that overall employment would increase and farmers’ livelihoods and communities would improve.

The misguided beliefs about the economic potential of tobacco growing have prompted governments to enact policies that encourage tobacco growing. By encouraging greater production, these policies typically drive down the costs and prices of tobacco thereby increasing consumption and motivating powerful actors to undermine tobacco control efforts. For example, in the latest Seventh National Development Plan, 2017–21, Zambia’s government included tobacco growing as a priority crop, stating that tobacco ‘has great potential to contribute to the growth of the economy through employment and wealth’ (p. 146,11)¹³. There are detailed plans to support the production of tobacco growing and processing. In North Macedonia, tobacco is the most heavily subsidized crop even though the rewards of these subsidies appear to accrue mainly to the tobacco companies that buy the leaf. A recent World Bank report states unequivocally: ‘Farm support does not improve efficiency and productivity and has a very low impact on poverty reduction’¹⁴. In Argentina, the significant revenue raised by the Special Tobacco Fund (Spanish acronym: FET) on cigarettes is reallocated back to the tobacco-growing provinces, which motivates the powerful sub-national governments to oppose any tobacco control measures that might mitigate consumption¹⁵.

This policy and institutional context enhances the power of the tobacco industry in tobacco growing countries. This power is expressed in two ways. The first expression of power is through direct and indirect involvement with government institutions that govern the tobacco market. It is common for tobacco industry representatives to sit on boards that dictate the price and processes of tobacco leaf sales¹⁶. This involvement situates formal decision-making power with these representatives. This involvement also indirectly exerts influence within government by influencing norms, such as the primacy of perceived economic goals as opposed to health goals, in tobacco policy, thus positioning tobacco as an economic commodity of sustained importance^17,18. The other expression of power is through industry control of the supply chain. Tobacco farming has come under increasing control of leaf buying companies in the form of direct contractual relationships with farmers. Governments leave companies to manage the supply chain with little or no oversight. For example, in Kenya, tobacco is listed as an ‘unscheduled’ crop¹⁹, meaning that extension services and other supports to farmers common to other crops are not provided by government²⁰. Contracts typically include the provision of loans and agricultural inputs like seeds and fertilizer for tobacco growing, and purports to guarantee a buyer at harvest time. This type of industry power affects demand reduction by harnessing the political support of farmers in opposition to tobacco control policies. The most pronounced example of this is the work of the International Tobacco Growers Association, a body that coordinates and mobilizes national branches of the organization to ostensibly channel the interests of tobacco farmers in policy contexts²¹. Despite mounting evidence discrediting the narrative that tobacco farming is a lucrative economic activity, this narrative continues to be applied and adopted by government officials both domestically and in international forums^17,22.

The dynamics discussed above create an institutional environment that produces challenges for health ministries to institute comprehensive tobacco control measures. To begin, the suffusion of industry interests within government shapes the ways that these interests are handled and viewed by the economic sector. For example, the Philippines, Brazil and a number of other countries, that have established intersectoral tobacco control boards in accordance with Article 5.2 of the FCTC, have either overtly included industry representatives or have indirectly included these interests through consultation^23-25. The decisions to include these interests are justified with reference to dominant economic norms that view industry as a legitimate stakeholder in government decision-making²⁶. Health ministries must contend with these entrenched norms and their manifestation through the inclusion of industry interests. In Zambia, significant delays in adopting FCTC compliant tobacco control legislation have been attributed to the presence of tobacco growing and related interests²⁷. Comprehensive tobacco control measures require participation and support across government sectors including agriculture, labour, trade and industry, and when these sectoral mandates are supportive of tobacco as an economic commodity, intractable conflicts emerge that undermine health-focused tobacco control efforts.

The most consequential supply-based threat to tobacco control is the political power that tobacco growing gives the tobacco industry, and the closely-related institutional entrenchment of tobacco interests within government. The industry continues to successfully promote the supposed threat from tobacco control to farmers’ livelihoods and/or the broader economy as a reason not to enact stronger policies such as higher excise taxes on these products. Yet, these claims are contradicted by a growing body of evidence that demonstrates that the micro- and macro-economic contributions of tobacco are not only significantly less important than the industry claims but, in many cases, may be fundamentally undermining governments’ economic development efforts.

CONFLICTS OF INTEREST

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.

FUNDING

There was no source of funding for this research.

PROVENANCE AND PEER REVIEW

Commissioned; internally peer reviewed.