Apart from the authors' highlights on the environmental impacts of tobacco production,1 additional problems include farmers smoking raw tobacco, which leaves the majority of them sick; for example, more than 75% of tobacco farmers in Tanzania smoke raw tobacco.2 Farmers also die in curing barns due to carbon monoxide poisoning.3 Increased tobacco farming due to industry sensitisation has resulted in increased labour demands with people engaging in human trafficking; for example, in Tanzania, people sold to big farmers for between US $80 and US $100 are subjected to harsh conditions, working long hours for just food and substandard shelter, ending up as slaves.3

The problems of tobacco companies' policies and practices are common to both high income as well as low- and middle-income countries although the latter are more vulnerable. These companies lure government and other leaders into believing that tobacco is an economically viable crop and a major source of revenue, while hiding the truth about the accompanying environmental and health losses. For example, while Tanzania earns about US $50 million annually from tobacco revenue, more than US $40 million is spent to treat tobacco-related cancers alone.4 Environmentally, tobacco farming is responsible for causing more than 4% of the desert area in Tanzania and, Urambo, one of the major tobacco growing districts, lost about 1.3 m³ trees worth more than US$10.5 million in 2010/2011 alone.5 Tobacco companies also lie in claiming that farmers have no economically viable alternative crops. In Tanzania, more than 70% of tobacco farmers interviewed preferred alternative crops which they also identified; their only worry was sustainable markets for such crops.6 7

Apart from further research to quantify the health impacts of tobacco farming and evaluate potential alternative crops, collaboration at national, regional and global levels is necessary to strategise on how best to counter the emerging solidarity among tobacco companies that are working towards paralysing tobacco control efforts, particularly in low- and middle-income countries. Educating and sensitising government and other leaders and supporting tobacco farmers through the process of adopting alternative crops while securing sustainable markets will enhance environmental health sustainability efforts.