health social justice

The link between tobacco and poverty

Here’s an example of a story picked up by reading outside the normal news channels. In Indonesia, the second highest contributing factor in poverty is tobacco. Cigarette smoking contributed 10% to the poverty rate, according to the country’s National Development Planning Board. The biggest contributor is rice consumption.

Indonesia has the cheapest cigarettes in the world, and two thirds of men smoke. Because the government depends on tax revenues, it has been reluctant to curb tobacco use, and the industry lobby reliably pushes back on any efforts to raise taxes or restrict advertising. The most popular brands are locally made clove cigarettes, often with no filter. HM Sampoerna is the largest brand, with 35% of the market. It is owned by Philip Morris, the American tobacco giant.

While Indonesia has its share of local companies in the market, this is a recurring theme. Western governments have slowly but eventually tackled the issue of smoking, but there are fat profits to be made elsewhere. Philip Morris and the other multinationals promote smoking around the world, and lobby against government action. The British government isn’t shy of supporting ‘business interests’, and last year the Foreign Office was caught lobbying the Bangladeshi government to waive a tax bill that British American Tobacco was contesting.

Two things to say about this: first, tobacco is a global injustice. Big companies are listed on the London and New York stock exchanges, returning profits to countries where smoking is in decline. Shareholders benefit from a product that is known to be harmful and contributes to poverty, and they exploit the fact that the harmful effects of smoking are less understood in poorer countries. Of the big five tobacco companies, one is owned by the Japanese government and one by the Chinese government, so it’s not a ‘west vs the rest’ phenomenon. But both Western and Eastern companies known where future profits lie: Africa has relatively low smoking rates, and is therefore seen as a potential growth market.

Secondly, there’s a wide open opportunity for action here. If smoking is a factor in poverty rates in Indonesia, then encouraging people to stop smoking would be a big boost to ending poverty. The same will be true elsewhere, in any country or community where there is a culture of smoking, where cigarettes are cheap and advertising makes it attractive. A global campaign against tobacco would improve health, redress injustice, reduce pressure on developing world healthcare systems, and alleviate poverty.

So where’s the campaign? The World Health Organisation gathers statistics and encourages governments to make plans, but it has no popular presence on the ground. Then you’ve got the memorably named Framework Convention Alliance, which tries to coordinate smaller local organisations to apply the WHO’s recommendations. I’ll admit that I know very little about smoking, but I’m not aware of a global anti-smoking NGO. More troubling than my own ignorance, Google isn’t finding me one.

This looks like a job for the Effective Altruism movement. One of their key principles in effective giving is to find high impact interventions that are currently overlooked. The most cited example is worming tablets. I’ve argued that road safety in developing countries is a perfect opportunity. Anti-smoking charities and support for quitting could well be another.

6 comments

  1. Interesting article – but a bit of a misleading headline in the Jakarta Post…
    When they say “Cigarette consumption is the second largest contributor to poverty”, they actually mean “cigarettes represent the second-largest proportion of poor people’s spending”. The poverty line is calculated based on what people living on subsistence diets spend their money on. The article says that people earning on the poverty line in Indonesia spend 25% on rice, 10% on cigarettes, 5% on meat and 60% on other things.
    So the causality isn’t as clear as the article makes out – cigarettes aren’t “causing” poverty any more than rice is! If people consumed fewer cigarettes, the official poverty line would be adjusted downwards to reflect this, and the number of “poor” people would say exactly the same!
    Of course, none of this changes your other points. Just bad economics by the Jakarta Post!

    1. It is a slightly strange way of expressing it, but that was the way the Planning Board representative framed it, and the JP just reported it. We would talk about ‘energy poverty’ and use a percentage of spending, so I figured it was okay. But I take your point.

  2. While I’m not a smoker so can’t speak of this from personal experience but we mustn’t underestimate the joy simple pleasures like smoking can give to people who live lives of drudgery. Most people smoke because they enjoy it, at least to begin with and few seek to give it up just because they are addicted. Avoiding the consequences to health is the main driver for those who try to quit.

    Of course it is life shortening but most of the negative consequences come later in life. Given that in many developing countries old age is associated with increasing poverty dying in your late 50s rather than 70s might spare you from that condition and actually reduce poverty rates overall.

    1. I wouldn’t want to deprive anyone of their simple pleasures, but surveys show that 70% of smokers want to quit. 45% of smokers will try and quit in any given year, and over 90% of them will fail. So taking up smoking is something of a curse, and not one we should be passing on.

      Besides, there is a real difference between someone taking up smoking in Britain and in Sub-Saharan Africa. Here one is fully aware of the effects, from school and from warnings on packets. Since much is done to deter people from smoking, it would only be through a deliberate choice. There is plenty of support to quit, and the NHS will be there to help us out should we ignore all the advice and get sick later.

      Those are luxuries that many others don’t have – no support to quit, no health services, and cheaper cigarettes are usually unhealthier as well. There are no limits to advertising, no age limits for buying them in some cases, and tobacco companies have been known to give away free cigarettes for people to try. They know full well it’s addictive, but the recipient may not. That’s nothing short of exploitative, simple pleasures or not.

      As for your last paragraph, it sounds like you’re suggesting that poor people would be better off smoking and dying young. Are you sure you want to commit that opinion to the internet?

      1. I’m suggesting that it may be a rational choice by some people to trade a shorter life for a merrier one. I’m not advocating it but I favour letting people make their own choices.

        In an predominately Muslim country like Indonesia other social drugs such as alcohol are restricted (Indonesia levies high taxes and its banned in Aceh). That smoking isn’t as controlled pushes people in that direction. What we shouldn’t do is veer towards suggesting people in the developing world are more ignorant and simple than us and need protecting from themselves. Nanny doesn’t always know best.

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