There are 933 million smokers in low-and middle-income countries, comprising 82 % of smokers worldwide. Researchers say there is an increase in smoking among the poor, illiterate and less educated in these regions.

According to a recent World Bank report on the economics of tobacco, many transnational tobacco companies are relocating to sub-Saharan Africa, Latin America and the Caribbean, among other low-income economies, where smoking is on the increase. Global trends on the use of tobacco indicate that there are 209 million smokers in the United States, Western Europe, Canada and Japana. However, there are 933 million smokers in low-and middle-income countries, comprising 82% of smokers world wide. So far, the emerging scenario is that there is an increase in smoking among the poor, illiterate and less educated, while there is a decline among the educated public. 'Ostensibly the smoking habit is spreading from its original focus on men in high-income countries to men in low-income regions,' says Dr Frank Chaloupka, who co-ordinated the World Bank study. Even then, researchers noted an upward trend of smokers among women in affluent high-income societies, says the report. Researchers calculated that 68,000 to 84,000 adolescents from low-and middle-income areas joined the ranks of smokers each day, against 14,000 to 15,000 in high-income countries. 'This means that each day world wide, between 82,000 and 99,000 young people start to smoke, and risking addiction to nicotine,' says David Ferranti, the World Bank's Vice President of Human Development Network. The identification of low-level education as a marker for the rise in smoking in developing countries is worrying for sub-Saharan Africa, where for decades illiteracy has been going up in comparison to other regions globally. Researchers estimate that 35% of all males aged 15 years and above in the sub-region are regular smokers. Undoubtedly, the penetration of sub-Saharan Africa by transnational tobacco companies has been partly due to economic factors. Attempts to have the tobacco crop classified as a weed have been resisted in countries where tobacco-growing is an economic lifeline. For instance, tobacco accounts for 61% of export earnings in Malawi, and 23% in Zimbabwe. In many parts of Eastern and Central Africa, tobacco is a highly attractive crop to farmers, providing higher income yield per unit of land than most cash crops and substantially more than food crops. According to Dr. David Patched, an agricultural economist at the Commonwealth Secretariat, tobacco is 6.5 times more profitable than maize in Zimbabwe and Malawi. It also earns 22 times more than cotton and 60 times more than sorghum. The two countries are ranked sixth and eighth respectively among the world's tobacco producers. Altogether, sub-Saharan African countries produce about 500,000 tons of tobacco, of which 192,000 tons are produced in Zimbabwe and 157,000 tons by Malawi. Other important producers in the sub-region include South Africa (35,000), Tanzania (25,000), Kenya (24,000) and Nigeria (15,000). The emerging scenario is that on average, the share of global production in developing countries has risen from 40% to 60% in less than a decade. However, during the same period, production in high-income countries has dropped from 30% to 15% Amid commercial pressures, price incentives and other subsidies on tobacco production from transnational cigarette companies, the report says, by 2030 tobacco is expected to be the biggest cause of death in sub-Saharan Africa. 'Seventy per cent of more than 10 million people who will die of smoking-related diseases each year by 2020 will be in poor countries,' says Dr Jie Chen of the World Health Organisation, the co-author of the report. Most victims, Chen says, will die of cancers of the lung, bladder, kidney, throat, mouth, pancreas and stomach. Others will die of respiratory disease, ischemic heart disease and other circulatory diseases. However, in countries where tuberculosis is prevalent, smokers are at greater risk than non-smokers of dying from this disease. The researchers noted that smoking is widening the health gap between the rich and the poor. 'Whereas the rich are quitting smoking in large numbers, the poor are smoking themselves to death', says Dr John Nkuchia, a Kenyan epidemic intelligence officer at the Atlanta-based Centres for Disease Control. So far, the linkage between low socio-economic status and smoking does not augur well for sub-Saharan Africa. Already, most economies in the sub-region are devastated and can barely support health, education and other vital services. The added burden of smoking diseases will effectively reduce the life expectancy of many people in the region. Researchers warn that child mortality among under-fives will shoot up in sub-Saharan African countries where cigarette-smoking had been on the rise. According to Nkuchia, such countries include Tanzania, Malawi, Zimbabwe, South Africa, Kenya and Uganda, where cigarette-smoking has risen by 50% in a decade. Over 35% in a decade. Over 35% of babies exposed to smoking in these countries are expected to die in infancy. If the current trends persist, 500 million people - most of them in sub-Saharan Africa, South Asia, Latin America and other low-income regions world wide - will eventually be killed by tobacco. Half of them will die at a productive age, losing 20-25 years of life, says the World Bank report. Despite stark realities of health risks posed by smoking, there is little evidence of curbing the epidemic by reducing the supply. Studies carried out in several tobacco-growing countries in Africa show that farmers are happy with tobacco prices and willing to increase the output. Across Africa, farmers are reluctant to replace tobacco with alternative crops that would not attract price incentives or production support. Even if crop substitution were to succeed, there is little evidence that this would reduce tobacco consumption. While a price increase on cigarettes has been viewed as a measure to control smoking among the poor, the strategy is not working in sub-Saharan Africa. Millions of people who could not afford manufactured cigarettes are increasingly turning to smoking bidis. These are hand-rolled cigarettes traditionally common in India and South-East Asia, but now taking root in Africa So far, governments in Africa have avoided action to control smoking as intervention might trigger harmful economic consequences on their fragile economies. In Tanzania, Kenya, Zimbabwe and Malawi, there is a general fear that reduced tobacco production would mean a permanent loss of jobs and lower government revenue. The economic fragility of sub-Saharan African countries has created perfect market conditions for transnational cigarette companies, currently facing stern legal and health regulatory measures in high-income countries. The tobacco industry estimates that out of 33 million people engaged in tobacco farming world wide, one million are in sub-Saharan African countries and the number is still growing. Quite worrying for smoking-control pressure groups is the emerging evidence that partial bans on cigarette advertising and promotional campaigns in sub-Saharan Africa have had little or no effect on smoking patterns. Researchers say most smokers in the region start smoking when too young and are addicted quite early.

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