Given that World No Tobacco Day (WNTD) is coming up on May 31st, it is crucial that we reflect on the opportunities and challenges in combating the actions of transnational tobacco companies (TTCs) in expanding commercial tobacco use globally (1). The global tobacco use epidemic continues to be one of the greatest public health threats, killing more than 7 million people annually (2). This year’s campaign centers on the link between tobacco and heart disease, which includes raising awareness about actions that governments can take to reduce the risks to heart health posed by tobacco (1). WNTD 2018’s theme is appropriate, considering that tobacco use and second-hand smoke exposure contribute to approximately 12% of all heart disease deaths (1). This is quite alarming, given that cardiovascular disease is the leading cause of death worldwide for males over the age of 30 and females over the age of 50 (1,3).
While the overall global smoking prevalence among adults aged over 15 years has been declining, progress has not been uniform (4). The greatest reductions in smoking prevalence have been occurring in high-income countries (4). If current smoking patterns persist, it has been projected that by 2030, there will be 8.3 million tobacco-related deaths worldwide, with more than 80% of deaths occurring in low-income and middle-income countries (LMICs) (5). LMICs are at the epicentre of the global tobacco epidemic, where TTCs expansion tactics and policy influence undermine progress on tobacco control (6).
Recognizing the actions by TTCs in driving the global tobacco epidemic, the WHO’s Framework Convention on Tobacco Control (FCTC) was adopted by the World Health Assembly in 2003 (6,7). As the only global public health treaty, the FCTC aims to strengthen global tobacco control norms through providing governments with strategies to implement effective policies against TTCs. Tobacco industry denormalization is a tobacco control mechanism that shifts the focus from an individual’s choice to smoke, to how TTCs are marketing a deadly product (8). Specifically, Article 5.3 of the FCTC requires parties to protect public health policies from the vested interests of TTCs (9). To complement the FCTC, the WHO released six proven measures to reduce tobacco use worldwide, which are known as MPOWER (10). One of these measures includes the need for countries to enforce bans on tobacco advertising, promotion, and sponsorship. The constraints for LMICs in signing the FCTC and meeting this measure will be explored further considering WNTD’s goal to encourage countries to strengthen the implementation of the MPOWER measures.
As LMICs move towards the adoption and implementation of the FCTC, corporate social responsibility (CSR) has become a business strategy used by TTCs to maintain themselves as political insiders (6). CSR is understood as a way for corporations to demonstrate their commitment to be socially responsible. However, it also serves the purpose of improving the corporation’s public relations, and ultimately profits (11). Corporations exist for the sole purpose of maximizing profits for their shareholders, which is a fiduciary responsibility (12). Any impediments to profit-making are subject to shareholder scrutiny or legal action. Therefore, despite TTCs participating in CSR, their end goal is always to increase their profits by countering tobacco control initiatives.
TTCs use CSR to work towards legitimizing and normalizing programs, policies, and positions that will convince the public they are preventing or mitigating some of the societal ills that are caused by smoking (13). For example, by funding campaigns that claim to tackle youth smoking, they are hoping to increase public credibility and be seen as an important partner for society (14). In turn, they hope to avoid regulations or minimize the impact of regulatory measures. CSR has the potential to mask, but not resolve, the fundamental problem with tobacco products – which is, when used as directed, they are deadly (13). When understanding TTCs’ version of CSR as a marketing and relations tactic, the strategy falls in direct conflict with the Framework Convention on Tobacco Control (FCTC)’s rules against advertising, promotion, and sponsorship. Furthermore, there is evidence that industry-sponsored prevention programs do not work and often do more harm than good (14). For example, research on industry-sponsored youth smoking prevention campaigns in the United States found that they promoted smoking as a choice, but only for adults, and failed to discuss the health dangers of smoking (15). As a result, the industry was able to generate good publicity, while undermining public health campaigns by making it seem that age is the only reason not to smoke (15).
Malawi will be used to illustrate the complexity of TTCs’ use of CSR in LMICs, as well as highlight the unique constraints such countries experience in progressing tobacco control policies. As one of the few countries in the world not signed on to the FCTC, the people of Malawi are more vulnerable to TTCs and their tactics, such as CSR (16). Malawi is one of the world’s poorest countries, but also the world’s most tobacco-dependent economy, as the country produces 6.6% of world burley tobacco exports (16). This accounts for over 70% of the country’s foreign earnings (16). In 2013 it was estimated that 18-22% of men and only 1-3% of women smoked daily. However, tobacco consumption among Malawian adolescents was most concerning (17). Smoking has become more common among adolescents due to exposure to tobacco advertising (17). Presently, the country’s tobacco control policies are mainly targeted at controlling the tobacco supply chain, as opposed to enacting laws that would limit the promotion of tobacco (16).
In 1989, TTCs and other large transnational corporations faced increased pressure by labour and human rights activists, and the public, to address child labour practices in Malawi (18). As a result, British American Tobacco (BAT) launched the Eliminating Child Labor in Tobacco Growing Foundation (ECLT) campaign in 2000, despite financially benefiting from tobacco produced by children as young as 5. The ECLT was proven to be ineffective, as the foundation contributed nominal sums of money to projects largely unrelated to efforts to end child labour (18). If BAT was committed to eliminating child labour in Malawi, they could have, for example, enforced a policy of not purchasing any tobacco grown using child labour given the country’s economic dependence on tobacco (18). Rather, the ECLT was used to co-opt the child labour issue to present themselves as socially responsible, while distracting the public’s attention from how they profit from low wages and cheap labour (18).
CSR is one of TTCs’ final marketing tools left to promote tobacco consumption. As we celebrate the achievements in tobacco control this World No Tobacco Day, we should also stay vigilant on the need to further regulate activities described as CSR. LMICs are more vulnerable to TTCs tactics such as CSR because of how the industry overemphasizes their value for social and economic development (6).
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- Mahood, G. Tobacco Industry Denormalization. (2004). Available at: http://nbatc.ca/en/uploads/TID_GarMahood_PDF_001.pdf. (Accessed: 12th March 2018)
- WHO. Guidelines and policy options and recommendations for implementation of the WHO FCTC. WHO (2018). Available at: http://www.who.int/fctc/guidelines/en/. (Accessed: 12th March 2018)
- WHO. MPOWER. WHO (2018). Available at: http://www.who.int/cancer/prevention/tobacco_implementation/mpower/en/. (Accessed: 12th March 2018)
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- Bialous, S. Corporate Social Responsibility Programs. (2007). Available at: http://globaltobaccocontrol.org/sites/default/files/lectures/en/pdf/tobaccoControl-3.2a.pdf. (Accessed: 12th March 2018)
- Landman, A., Ling, P. M. & Glantz, S. A. Tobacco Industry Youth Smoking Prevention Programs: Protecting the Industry and Hurting Tobacco Control. Am J Public Health 92, 917–930 (2002).
- Otañez, M. G., Mamudu, H. M. & Glantz, S. A. Tobacco Companies’ Use of Developing Countries’ Economic Reliance on Tobacco to Lobby Against Global Tobacco Control: The Case of Malawi. Am J Public Health 99, 1759–1771 (2009).
- Kulik, M. C., Bialous, S., Munthali, S. & Max, W. Tobacco growing and the sustainable development goals, Malawi. WHO (2017). doi:10.2471/BLT.16.175596
- Otañez, M. G., Muggli, M. E., Hurt, R. D. & Glantz, S. A. Eliminating child labour in Malawi: a British American Tobacco corporate responsibility project to sidestep tobacco labour exploitation. Tobacco Control 15, 224–230 (2006).