London School of Hygiene & Tropical Medicine

People living in poor countries are exposed to more intense and aggressive tobacco marketing than those living in affluent countries, according to a new study published in the Bulletin of the World Health Organization.

The study is the first to compare levels of tobacco marketing statistically across a wide range of countries since 2005, when those signed up to the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) have been required to adopt strict tobacco control measures, including marketing bans.

The research shows that tobacco marketing, which drives the uptake of smoking especially among young people, is still thriving despite many countries' efforts to ban it. It highlights the major threat to people's health in low-income countries if steps are not taken to control tobacco marketing.

The study was carried out by researchers at the Tobacco Control Research Group at the University of Bath, in collaboration with the London School of Hygiene & Tropical Medicine and more than 25 other institutions.

Study author Martin McKee, Professor of European Public Health at the London School of Hygiene & Tropical Medicine, said: "Despite claiming to act responsibly, this study confirms that the tobacco industry does whatever it can get away with. Without strong laws on marketing, effectively enforced, it will continue to promote its products, shortening even further the lives of some of the world's poorest people."

Between 2009 and 2012, the researchers recorded the number of tobacco advertisements and outlets selling tobacco products along a one- kilometre walk in 462 communities across 16 countries. They also interviewed nearly 12,000 people, asking them to recall whether they had seen tobacco marketing in different types of media, including on television, radio, posters, signage, online, in print or in the cinema, in the previous six months.

They found tobacco advertising was at its most intense in the low-income countries studied (India, Pakistan and Zimbabwe), where the researchers observed 81 times more tobacco advertisements per study community than in the high-income countries (Canada, Sweden and the United Arab Emirates).*

Among the communities studied, the number of outlets selling tobacco was two and a half times greater in the low-income and lower middle-income countries (China, Colombia and Islamic Republic of Iran) than in the high-income countries covered by the research. 

The findings showed that, overall, almost 10% of interviewees reported seeing tobacco marketing on at least five types of media in the previous six months and 45% reported seeing such marketing on at least one type of media.

The researchers also found that in low-income countries 64.2% of selected stores sold single cigarettes compared with just 2.8% in high-income countries. The sale of single cigarettes is an important way of attracting children who can't afford to buy a whole packet of cigarettes, highlighting the particular concern for young people who are susceptible to tobacco marketing. In many countries the vast majority of adult smokers begin smoking before the age of 18.

Study author, Professor Anna Gilmore, director of the Tobacco Control Research Group at the University of Bath, said: "The tobacco industry's sales are falling in high-income countries and so its future profitability depends on getting young people hooked on smoking in low-income countries. Our study reveals the extent of its effort to do this."

Tobacco-related diseases are the single most important cause of preventable deaths in the world. It is projected that tobacco use will cause 8.4 million deaths by 2020, 70% of which will occur in developing countries, where about 900 million smokers live.

Unless the WHO FCTC obligations are promptly and fully implemented, these figures are expected to rise dramatically.

*India has since become a lower middle-income country, according to the World Bank's classification.

Publication:

• Emily Savell, Anna B Gilmore, Michelle Sims, Prem K Mony, Teo Koon, Khalid Yusoff, Martin McKee, Sumathy Rangarajan, Salim Yusufc & Clara K Chowbb et al. The environmental profile of a community's health: a cross-sectional study on tobacco marketing in 16 countries. Bulletin of the World Health Organization.