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Decisions governments will make in the next 5–10 years may determine whether we must continue fighting against the tobacco epidemic well into the second half of yet another century, or whether we can finally bring this ghastly, industrially produced epidemic of disease to an end. Smoking is plummeting in many high-income countries, and dropping even in some countries with very high prevalence, like China. But there are other countries, like Indonesia, where smoking prevalence remains shockingly high and is projected to go higher. And in African countries, where tobacco companies see their new markets for cigarettes emerging, the epidemic may be only just beginning.1 This is a preventable tragedy.
Despite their many smarmy statements about ending smoking, tobacco companies remain the biggest obstacle to achieving a tobacco-free world. They have no intention of going quietly into that good night where they have sent prematurely millions of their former customers. Instead, they are now absolutely desperate to ‘engage’ with governments, public health programmes and agencies, and scientists. In pleading for engagement, they seek to undermine the basic precept of the WHO Framework Convention on Tobacco Control Article 5.3, which led many governments to finally recognise that public health interests and tobacco industry interests are fundamentally incompatible.2 The tobacco companies’ frantic bleats for ‘dialogue’ are intended to further the idea that their own ‘creative destruction’ is finally at hand now, and the answer is—wait for it—sales of more addictive products produced by the same companies whose products have accounted for more than 100 million deaths in the last century. This is called ‘sustainability’—not for the consumers, necessarily, of course, but for the industry and its eager apologists.
In this issue, a collection of papers demonstrates that despite their many versions of saying ‘we’ve changed’, tobacco companies continue their old, nicotine-fueled habits. Through innovative pricing strategies, they keep tobacco products cheap enough to thwart the effects of government-imposed tobacco taxes designed to discourage consumption, thereby keeping people from quitting. Through innovative packaging and marketing, they increase the affordability and attractiveness of their products. Through development of innovative products, like flavour capsules and heated tobacco products, and through averting regulations aimed at limiting additives that increase attractiveness and addictiveness, they seek to attract new consumers and keep those who might otherwise quit hooked and buying. Through innovative, non-transparent partnerships with governments, tobacco companies have sought to impede and infiltrate effective regulation of illicit trade. It’s clear that there really is a wide range of ‘innovation’ happening. For example, it was innovative for the makers of the e-cigarette Blu to create a fake ‘warning’ about the positives of the product which countered the impact of authentic warning messages.
Given that the Cape Town Declaration on Human Rights and a Tobacco-Free World, adopted at the 17th World Conference on Tobacco or Health and signed by more than 160 organisations, affirms that ‘the manufacture, marketing and sale of tobacco are incompatible with … human rights obligations’,3 it was quite innovative to hire a former United Nations human rights lawyer to trot around the world suggesting that selling cigarettes is essential to financing the ‘creative destruction’ we keep hearing about, as Philip Morris’s Social Impact and Sustainability Lead did in a recent Brazilian interview.4 The poor things just don’t have enough money to manage it otherwise.
It’s true that the tobacco industry isn’t just ‘Big Cigarette’ any more, although the money trail almost always leads back to the same companies that have done ‘corporate makeovers’ so many times they must have scar tissue. Public health must now also contend with a plethora of new ‘nicotine consumer’ organisations, non-profits funded by tobacco companies, burgeoning types of untested nicotine products, and a widely transmitted conspiracy narrative suggesting that health advocates concerned about the implications of all this innovation really want to keep smokers using cigarettes. Where to begin? Maybe start with questioning harder whether, as the industry-funded advocates for ‘creative destruction’ suggest, the answer to our global health crisis really is a ‘sustainable’ tobacco industry.
Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.