Tobacco: the spreading menace

The growing popularity of smoking in Brazil and much of the Third World reflects the success of American and European tobacco companies' efforts to diversify their markets.

Richard H. Hart, M.D., Dr. P.M., is professor and chairman, Department of Preventive Medicine, Loma Linda University.

In Brazil in 1981, 2.1 percent of the population was directly supported by tobacco-related activities. Cigarette sales taxes provided 11.6 percent of the country's total taxes. The World Health Organization estimates that 22,500 of Brazil's cardiovascular deaths and 18,000 cancer deaths are caused by smoking each year. 1

In a family with limited resources smoking can contribute to poor nutrition and inadequate child care. In one Sao Paulo suburb, expenditures for cigarettes average 9.8 percent of the family in come, compared to 5.8 percent spent for transportation and 8.3 percent for milk.2

The growing popularity of smoking in Brazil and much of the Third World reflects the success of American and European tobacco companies' efforts to diversify their markets. In 1983 Joseph Cullman III, chairman of Phillip Morris, Inc., told the Tobacco Merchants Association, "We recognized early that ours is a global business, and built markets around the world. Our future is particularly bright in developing areas, where income and populations are growing."

The stimulus for this move to undeveloped areas comes in part from the waning popularity of smoking in the United States and some Western European countries. Forty-three percent of Americans smoked in 1970, but recent surveys indicate that only 30 percent smoke now. While overall smoking is on the decrease, smoking is still on the increase among adolescent American girls.

The increase among girls should be a matter of deep concern because studies show that women have a harder time breaking tobacco addiction than men, and within the past few years lung cancer has surpassed breast cancer as the most common fatal cancer among women.

Surgeon General C. Everett Koop has thrown the influence of his office behind the antismoking movement. However, the government speaks with a forked tongue on the issue tax dollars are still being spent to subsidize tobacco production and export.

Third World increase

In much of the Third World, little or nothing is being done to curb tobacco use. Instead, some governments actually encourage it. The cigarette companies make no apologies for their eagerness to infiltrate developing countries. In fact, they often work together with governments in co-ownership projects that are seen as mutually beneficial. It is difficult for governments of cash-poor countries to resist the temptation to cooperate with tobacco companies that promise a quick infusion of capital for industrial and agricultural development.

Tobacco industries are often government-controlled and generate significant taxes and local income as well. Health-care systems in many countries are still concentrating on infectious diseases and malnutrition, and have not yet felt the impact of smoking-related diseases.

On the local level, farmers typically gain two to five times more profit from raising tobacco than they can gain from other cash crops. As a result they raise tobacco on their best land, which leads to decreased food production. Tobacco companies seek to avoid this criticism by encouraging continued food crop production, but diversion of resources to tobacco production is a serious problem. Deforestation has been accelerated in some areas by farmers seeking wood for curing tobacco.

Popularity of smoking

People in many developing societies still perceive smoking as a part of Western culture worthy of emulation. Following the Fourth World Conference on Smoking and Health in Stockholm, Sweden in 1979, an internal memo from a cigarette company executive zeroed in on the importance of social acceptability as a key issue in the Third World. Refer ring to the director general of the World Health Organization, who is known as a powerful voice against smoking, the executive noted that "he pointed out the central role of the social acceptability is sue. In this field nothing came up which was new to us. It was just a confirmation of our own analysis that the social accept ability issue will be the central battle ground on which our case in the long run will be lost or won. "3

Western magazines such as Time and Newsweek carry large cigarette ads. Advertising efforts are aimed at the upwardly mobile groups in each country, and make smoking appear to be a necessary part of the climb up the social ladder. Advertising has a powerful impact in countries that have not yet been immunized by information overload. Many people still tend to believe anything that is published or broadcast.

In Africa and the Asian subcontinent the marketing and distribution system for tobacco is truly awesome. Cigarettes are readily available in virtually every village shop in India. The tobacco distribution system is far better than most food distribution programs.

Because of the long lead time of smoking-related diseases, few people living where smoking is just now gaining popularity have ever seen or known of someone dying from lung cancer, emphysema, or heart disease. Despite their ignorance smoking is already taking a heavy toll on their society. Worldwide more than 2 million smokers die annually from heart disease, lung cancer, and emphysema caused by their addiction. 4

"It is now feared that involuntary expo sure to cigarette smoke causes more cancer deaths than any other pollutant.5 Nonsmoking wives of smoking husbands have two to three times the normal incidence of several smoking-related diseases including lung cancer. Children living in homes in which one or both parents smoke have more upper respiratory infections and miss more school days from sickness. And perhaps the most tragically affected involuntary smoker is the unborn fetus. With nicotine restricting blood flow, and carbon monoxide inactivating red blood Cells, these victims are born smaller and have a higher probability of contracting disease.

Should churches be involved?

Should pastors and their congregations be concerned about tobacco consumption? Some would argue that the decision to smoke or not to smoke is a private, individual option in which the church should not interfere. But how can we take such a position in the light of the adverse effects smoking has on nonsmokers? How can pastors in the United States continue to support, through their own tobacco consumption, companies that are spreading tobacco's curse to unsuspecting multitudes around the world?

Isn't it time for Christians to take a stand against this insidious poison that robs so much from our society?

In Australia, some clergy have joined physicians, teachers, and others to form an organization called BUGA-UP (Bill board Utilizing Graffitists Against Unhealthy Promotions). Members use spray paint cans to "reface" cigarette billboards with satire pointing out the great ironies of free societies allowing death-dealing products to be promoted publicly. Although these activists are occasionally arrested, the fines have been small, and BUGA-UP lawyers have turned around the legal charge of "malicious damage" (the definition of which involves "indifference to human life and suffering") to suggest that the billboards haven't been damaged but improved. They say BUGA-UP activities are akin to breaking into a burning house to save children—the illegal act is committed to prevent a greater evil.

While civil disobedience may not be the answer to the problem, there are ways that churches can legally handicap the tobacco companies. The most obvious is, of course, for all members to simply quit using their products. The latest survey results indicate that 69 percent of Americans belong to a church. 6 If all church members suddenly quit smoking, the in come loss would hamper if not cripple tobacco production in this country.

If all churches sponsored anti-tobacco campaigns, it would help get the word about tobacco's harmful effects out. It is estimated that 25 to 50 percent of the U.S. population is unaware of the dangers inherent in smoking. Ignorance of tobacco's harmfulness is even more prevalent in other parts of the world. Churches could provide an effective counterbalance to the marketing influence of the tobacco companies.

For the past 25 years the Seventh-day Adventist Church has been sponsoring smoking cessation programs. Millions of people (chiefly from among other denominations and the unchurched) have kicked the habit in church-sponsored Five-Day Plans. The Five-Day Plan has recently been updated and upgraded. It is now called the Breathe-Free Plan to Stop Smoking. Adventist churches and hospitals typically sponsor one or more of these every year. Other churches should get involved in similar programs, or encourage their smoking members to attend a Breathe-Free program.

Tobacco consumption is not a problem that will solve itself. We can no longer ignore its harmful impact. And we should not sit back and idly watch as the world becomes the tobacco companies' golden goose.

1. F. L. Lokschin and F. C. Barros, "Smoking or Health: the Brazilian Option," New York Journal of Medicine 83, No. 13 (December 1983): 1314.

2. Silveira Lima et al., "Implicacoes medicos e socio-economicas do tabagismo en familias de baixa renda em Sao Paulo," J. Pediat 52:325-328.

3. "The Social Acceptability Issue Will Be the Battleground," New York Journal of Medicine 83, No. 13 (December 1983): 1323.

4. William U. Chandler, "Banishing Tobacco," The Futurist, May-June 1986, pp. 9-15.

5. Ibid., p. 10.

6. Emerging Trends, June 1987.

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Richard H. Hart, M.D., Dr. P.M., is professor and chairman, Department of Preventive Medicine, Loma Linda University.

March 1988

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