Tobacco is highly addictive. Almost 1.3 million (10) people currently smoke worldwide, the majority of whom are in countries with medium levels of human development, where the tobacco epidemic is pervasive, having moved through the developed world. The tobacco epidemic is now poised to afflict poorer developing countries with low levels of human development.

Tobacco kills one in two long-term users-4.9 million such deaths occurring each year. Tobacco is responsible for more deaths worldwide than any other risk factor except high blood pressure. While total consumption of cigarettes remained stable in the developed world between 1970 and 2000, it trebled in the developing world. Over the next 25 years, total cigarette consumption will rise by 60% in countries with medium levels of human development and by 100% in countries with low levels of human development. This latter group of nations will by then consume more tobacco than either medium or high human development countries.

One hundred million deaths were attributed to tobacco during the 20th century, mostly in developed countries. Given current patterns of consumption, one billion deaths due to tobacco are expected this century, but now mostly in developing countries. Half of these deaths will be among those in middle-age (35-69 years old), with harmful effects on national economies. Tobacco is the second leading cause of death in developed and low mortality developing countries, and sixth in high mortality developing countries. Tobacco also accounts for a large portion of the disease burden in developing countries, and is currently ranked fourth in the world in its contribution to years of life lost.

As poverty has fallen and economies have grown, the major transnational tobacco companies have expanded their influence into the developing world. Over time, they have moved into South America, Asia, Eastern Europe and Africa. Trade liberalization has placed additional pressure on the developing world. Studies in more than 80 countries show that trade liberalization increases tobacco consumption, especially in low and middle income countries.

In this study we establish links between each of the eight MDGS and tobacco. We also outline required future action in relation to tobacco and poverty to achieve the MDGS. Key points are summarized below.

MILLENNIUM DEVELOPMENT GOAL 1

Eradicating extreme poverty and hunger: the role of tobacco

In terms of MDG 1, economic growth is essential to poverty reduction. Progress since 1990 has been substantial. In 2000, 1.2 billion people in the world lived on less than US$ 1 a day. However, all regions of the world are on target to achieve the goal of a 50% reduction in those living on $1 a day, except for sub-Saharan Africa, by 2015.

Malnutrition is less tractable, with less than half of the relevant nations on-track to halve it. Hunger and malnutrition are made worse where scarce resources are used on tobacco. In the year 2000, 800 million people were malnourished, of whom 140 million were children. And yet tobacco use often sits side by side with poverty and malnutrition.

Two- thirds of the poor nations for which data are available have male smoking rates above the 35% prevalence rate in the developed world. In Uganda, for example, about 50% of men smoke, while 80% of the population lives on less than $1 a day, and half of the children under five are malnourished. In Cambodia, two-thirds of the men use tobacco, while nearly half of the children are malnourished. Although smoking rates have been low in much of Africa, between 1995 and 2000 cigarette consumption jumped by nearly two-thirds. There are many low and middle income countries with large pockets of poverty and high smoking rates. In India, the world’s most populous low income country, where poverty still abounds among some sections of the population, tobacco will kill 80 million males currently aged 0-34 years. In China, 200 million people live on less than $1 a day and 300 million males, or nearly two-thirds of all males, smoke. Tobacco will kill 100 million Chinese males currently aged between 0 and 29 years, with half of these in the productive middle years. This will deprive families of breadwinners, diminish the productive workforce and slow the conquest of poverty.

Smoking rates for females in the developing world are much lower than for males, but this is set to change.

Data from the Global Youth Tobacco Survey show that many girls in their early teens are taking up smoking in the developing world. Data from many countries show that the poor are most likely to smoke. An analysis of 74 studies from 41 high, medium and low income countries found that, regardless of country income, poorer individuals were those more likely to use tobacco, accounting for much of the mortality gap between rich and poor. In low and middle income countries, including Brazil, Cambodia, China, India and Viet Nam, smoking rates among the uneducated or less educated outstrip rates among the more educated.

For poor people, the opportunity costs of tobacco use can be very high. In countries such as Bulgaria, Egypt, Indonesia, Myanmar and Nepal, household expenditure surveys show that low income households spend 5-15% of their disposable income on tobacco. Many poor households spend more on tobacco than on health care or education. In Bangladesh, households with an income of less than $24 a month smoke twice as much as those on much higher incomes. The average amount spent on tobacco by the poorest 10 million male smokers could buy an additional 1400 calories of rice per day, or significant amounts of protein for each family. If these men quit, and put 70% of their saved income into food, this would provide enough calories to save 10.5 million Bangladeshi children from malnutrition. Besides cutting access to food, diverting limited household income to tobacco reduces family capacity to seek medical attention for a sick child, or to send children to school. Tobacco consumption ruins the health of poor people by causing respiratory and lung diseases, heart disease, strokes and cancers. This impacts on national economies in terms of health costs and lost productivity. In 2000, three tobacco-related illnesses-heart disease, stroke and cancer-cost the Indian government $5.8 billion. Productivity lost due to tobacco-related premature deaths is $82 billion per annum in the United States of America and already $2-4 billion in China.

Cultivating tobacco also damages people’s health. Tobacco farmers use pesticides that can cause respiratory, nerve, skin and kidney damage. Those who harvest or cure tobacco experience “green tobacco sickness’: Children who work in tobacco may experience stunted growth.