Tobacco Control in Developing Countries: Tanzania, Nepal, China, and Thailand as Examples

This paper illustrates case studies of four developing countries and compares them as to relative advancement intobacco control as prescribed by the Framework Convention on Tobacco Control. Tobacco-control efforts firstseem to involve assessment of tobacco use prevalence and passage of tobacco-control legislation (e.g., warninglabels). Tanzania, Nepal, and China serve as examples. Eventually, an integrated tobacco-control stance thatdemonstrates several cycles of tobacco-control activities occurs, as is shown in Thailand. Through these casestudies, one can achieve a sense of the direction of progress in tobacco control in developing countries.IntroductionMore than 1billion people worldwide smoke. Ifcurrent trends continue, 8.4million smokers areestimated to die annually of smoking-related deathsby the year 2020 (Kaufman & Yach, 2000). Partly inresponse to the expansion of the World TradeOrganization’s Global Agreement on Tariffs andTrade (GATT) to agricultural products in 1994,which opened up international trade as a nondiscri-minatory enterprise, tobacco industries now areoperating as transnational organizations that havebeen able to provide tobacco products at relativelylow prices. These tobacco companies seek to team upwith local growers, provide incentives to localstoreowners, and market themes of sophistication,wealth, or attractiveness that promote a globalcosmopolitan cultural demand for tobacco products(Chaloupka & Nair, 2000). Tobacco industry docu-ments indicate a desire for global penetration inmarkets throughout Europe, Asia, and Africa (Yach& Bettcher, 2000). From 1993 to 1996, exports oftobacco products increased 42%, coupled by a 5%increase in international consumption (Chaloupka &Nair, 2000). Trade liberalization has been associatedwith increased cigarette smoking, particularly in low-to-middle income countries (Taylor, Chalouka,Guindon, & Corbett, 2000).In May of 2003, the member countries of theWorld Health Organization (WHO) adopted theFramework Convention on Tobacco Control(FCTC). The FCTC is an internationally basedagreement that would commit countries to adoptstrong tobacco-control policies. It entered into forceon February 27, 2005. A total of 168 countries havesigned the treaty, and currently 144 have becomeparties to the treaty (as of February 6, 2007). Tobecome binding agreements, countries must becomeparties to the treaty (i.e., ratify the agreement). TheFCTC contains no punitive provisions for states that