Tobacco industry attempts to counter the World Bank report curbing the epidemic and obstruct the WHO framework convention on tobacco control

Abstract

In 1999 the World Bank published a landmark study on the economics of tobacco control, Curbing the Epidemic: Governments and the Economics of Tobacco Control (CTE), which concluded that tobacco control brings unprecedented health benefits without harming economies, threatening the transnational tobacco companies' ability to use economic arguments to dissuade governments from enacting tobacco control policies and supporting the WHO Framework Convention on Tobacco Control (FCTC). We used tobacco industry documents to analyze how tobacco companies worked to discredit CTE. They hired public relations firms, had academics critique CTE, hired consultants to produce “independent” estimates of the importance of tobacco to national economies, and worked through front groups, particularly the International Tobacco Growers' Association, to question CTE's findings. These efforts failed, and the report remains an authoritative economic analysis of global tobacco control during the ongoing FCTC negotiations. The industry's failure suggests that the World Bank should continue their analytic work on the economics of tobacco control and make tobacco control part of its development agenda.

Introduction

Tobacco use is the largest preventable cause of disease and death in the world, causing about five million deaths annually, a toll projected to rise to 10 million by the 2020s, 70% of which will be in developing countries (Bettcher et al., 2001). This epidemic is promoted by an industry that has argued that efforts to reduce tobacco use would have dire economic implications, especially in developing countries, and that efforts to regulate the production and marketing violate international trade laws (Warner, 2000). Because policy-making within the United Nations, including its World Health Organization (WHO), is state-centric, tobacco companies have used these economic arguments to convince member states to obstruct tobacco control policy development.

In 1995, the World Health Assembly, WHO's policy-making body, began developing what became the 2003 WHO Framework Convention on Tobacco Control (FCTC) (WHO, 2003). WHO Director General Gro Harlem Brundtland made tobacco control a cabinet project, and the FCTC passage one of her two priorities (along with malaria) when she took office in 1998.

When Brundtland took office, the World Bank was developing recommendations on tobacco control. To provide an authoritative review of the economics of tobacco control, researchers in the Bank's Health, Nutrition and Population sector, led by Prahbat Jha, started a study that, in May 1999, resulted in the Bank's publication Curbing the Epidemic: Governments and the Economics of Tobacco Control (CTE) (Jha & Chaloupka, 1999). CTE concluded that, with the exception of a very few agrarian countries heavily dependant on tobacco, tobacco control can bring unprecedented health benefits without harming economies.

WHO used CTE as a background technical document to provide the economic justification for the FCTC, as did the Framework Convention Alliance (FCA), the organization of civil society organizations that lobbied for a strong FCTC (Mamudu & Glantz, in press). As a financial institution with substantial influence in developing countries¹ (Ruger, 2005), the Bank's publication of CTE threatened to undermine the tobacco companies' economic arguments. As a consequence, the companies worked, without success, to discredit CTE and to counter its conclusions through a public relations campaign, critiques prepared by paid academics, “independent” economic analyses and front groups (particularly the International Tobacco Growers' Association, ITGA^2,3).

Tobacco companies resist tobacco control at all levels of governance (Saloojee and Dagli, 2000, WHO, 2000), whether domestic, (Brandt, 2007, Landman et al., 2002, Mandel et al., 2006, Ong and Glantz, 2001, Tsoukalas and Glantz, 2003) regional, (Ashraf, 2002, Barnoya and Glantz, 2002, European Commission, 2004, Gilmore and McKee, 2004, Neuman et al., 2002), or global (Francey and Chapman, 2000, Landman et al., 2008, Muggli and Hurt, 2003, Ong and Glantz, 2000, Satcher, 2001, WHO, 2000, Yach and Bettcher, 2000). The industry worked directly and through surrogates to divert attention from the public health issues raised by tobacco consumption, attempting to reduce budgets for WHO's scientific and policy activities, pitting other UN agencies against WHO, distorting scientific studies, and trying to convince developing countries that tobacco control is a “First World” agenda.

The companies' activities can be understood as transnational corporations' behavior in the world political economy with the instrumental motive of maximizing profit (Charney, 1983, Gilpin, 2001, Keohane and Nye, 1972, Sikkink, 1986, Sklair, 2002). The major tobacco companies – Philip Morris (PM), British American Tobacco (BAT), and Japan Tobacco International (JTI), which together control over 41% of the worldwide tobacco market – are based in developed countries, but operate globally (Davis et al., 2007, Mackay et al., 2006, Sklair, 2002, Yach and Bettcher, 2000). This globalization of the industry, which makes it difficult for a single country to regulate it (Charney, 1983, Lowi, 2001) and the associated tobacco epidemic, stimulated the creation of the FCTC (Bettcher and Subramaniam, 2001, Satcher, 2001, WHO, 2003).

International political and legal action can lead to significant pressure on transnational corporations from domestic laws or political-economic decisions that follow from the development of international norms (Charney, 1983). The tobacco industry is not just an economic entity but also an organized interest group (Charney, 1983, Grant et al., 1989, Lowi, 2001, Sklair, 2002) aware of the necessity to promote its interests in the international treaty-making process (Charney, 1983, Lowi, 2001, Malanczuk, 2000). The FCTC negotiation rules made state the only formal participants, with non-state actors (including the tobacco industry) as observers (Mamudu & Glantz, in press). Because the companies could not represent themselves directly in the negotiations, they lobbied delegates during the FCTC negotiations in Geneva and policy-makers at the country level (Charney, 1983, Higgot, 1996, Mamudu and Glantz, in press, Sally, 1996, Strange, 1992, Wilson, 1990).

Having lost the argument on the health effects, the industry focused on the potential-economic implications of the FCTC for developing countries, particularly its alleged negative impact on employment and government revenue. Because the industry selected this frame to oppose the FCTC, it became particularly important for them to undercut CTE because it was the key WHO (and FCA) technical background document on these issues. These efforts, however, did not undermine acceptance of CTE during the FCTC negotiations and CTE has remained an authoritative economic analysis of global tobacco control.