Third World Smoking— The New Slave Trade

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The epidemic of tobacco smoking is quickly spreading to developing countries with the encouragement of UK- and US-based companies. A 1983 World Health Organization (WHO) report catalogues the evidence that the smoking diseases have already arrived in the developing countries. High death rates for lung cancer are reported from India, China, Hong Kong, and Cuba, and in the Bantu of Natal. Coronary heart disease associated with cigarette smoking is a major feature in India, Pakistan, and the Philippines. Perinatal mortality rates are doubled in Bangladesh women who smoke. WHO makes a strong appeal for effective change. The question is whether governments and health ministries will face up to this challenge any more than they did to 2 earlier WHO reports on smoking. Developing countries are now urged to give high priority to smoking control activities. Although malnutrition and infectious diseases may seem to be more pressing, only action now can prevent their exacerbation by smoking-related diseases. Each country should establish a central agency with responsibility for smoking control action. Special steps should be taken to safeguard the health of children through educational programs. The sale of cigarettes to minors should be prohibited. Particular attention should be paid to traditional smoking materials as a cause of ill health, and advertising and promotion of tobacco products should be banned. Where tobacco is a commercial crop, every attempt should be made to reduce its role in the national economy and to investigate alternative use of land and labor. The UK bears considerable responsibility for the present situation. Yet, far from discouraging exports to developing countries, the reverse is true. Britain offers no overseas assistance for anti-smoking programs. Instead, it has provided funds for the development of tobacco industries. Individual doctors in Britain can provide an example by pressing for smoking control policies in all hospitals and health service premises. They can voice their concern at the activities of the tobacco companies both at home and abroad, and they can consider the propriety of holding tobacco shares either themselves or via the universities or institutions with which they are associated.