Developing-World Lung Cancer: Made in the USA

Even as America has curtailed smoking at home, it has helped Big Tobacco thrive abroad. Will the double standard ever end?

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We want to stop American kids from smoking—so why don't we seem to care as much about Asian or African kids?

It was 1997 when Senator John McCain asked that question on the floor of the Senate about U.S. trade policy on tobacco. Nearly 15 years later, that question is still being asked. Thankfully, new trade talks on tobacco—the first launched by the Obama administration—may provide an answer, finally bridging the gap between our domestic and international policies.

For most of the eighties and nineties, domestic and international policies on tobacco diverged. At home, innovative anti-smoking campaigns, higher excise taxes, and civil and criminal lawsuits cut 1965 smoking rates in half for American adults. Abroad, U.S. trade officials pressured emerging Asian economies to open their markets to imported cigarettes. The entry of multinational tobacco companies sharply increased tobacco use in these countries, which were unprepared for intensive marketing, particularly to women and youth.

These companies now employ the same tactics in developing countries—including cartoon characters, billboards, and music sponsorships—that are prohibited in the United States.

In 2001, President Clinton issued an executive order barring U.S. government agencies from promoting the sale or export of tobacco or tobacco products abroad. That order remains, but so does the gulf between domestic and international tobacco policy. While we crack down domestically with higher taxes and graphic warning labels, nearly every trade and investment agreement that the U.S. has negotiated over the last decade reduces tobacco tariffs and helps protect tobacco investments overseas.

Trade liberalization is driving up tobacco use in poor countries. Tariff reductions lower the price of imported cigarettes in developing nations that lack the strong taxation systems to compensate. Meanwhile, cigarette companies use investments in local tobacco production and so-called "corporate social responsibility" programs to win government allies and future customers, and they use dispute resolution, which is built in to trade and investment agreements, to block tobacco labeling and advertising restrictions. These companies now employ the same tactics in developing countries—including cartoon characters, billboards, and music sponsorships—that are prohibited in the United States. Young women, who have historically smoked less than men in most parts of the developing world, are a major target.

There are now 1.2 billion smokers worldwide, roughly one-third of the world's adults. Seven hundred million children—approximately 40 percent globally—are exposed to secondhand smoke at home. According to the World Health Organization (WHO), tobacco use now kills more people annually than HIV/AIDS, malaria, and tuberculosis combined. Unless we take action, and soon, tobacco is expected to kill hundreds of millions more in the coming decades. Eighty percent of those deaths will occur in developing countries.

Luckily, there have been signs of tentative improvement in U.S. trade policy on tobacco. The recent refusal of Office of the U.S. Trade Representative (USTR) to sue Canada over its new tobacco control regulations, despite strong Congressional pressure to do so, should be applauded. But a new and critical test looms.

The Obama administration recently launched its first trade agreement negotiation, known as the Trans-Pacific Partnership (TPP) Agreement. Philip Morris International has asked American officials to use these talks to eliminate tobacco tariffs and block the use of large health warning labels on cigarette packs. It is unclear whether U.S. trade officials will agree.

The question is not merely academic. One of the countries participating in the TPP talks is a lower-income country—Vietnam. The arrival of multinational tobacco companies in Vietnam would be disastrous. WHO and Centers for Disease Control and Prevention data show that nearly half the men in Vietnam already smoke, but only 2 percent of women do. A state-owned tobacco company dominates local sales, so there is little incentive for advertising. Vietnam took the important step of joining the WHO Framework Convention on Tobacco Control in 2007, but it is still failing to implement the Convention's tobacco control programs. Cigarette taxes are much lower and warning labels smaller than the WHO recommends. No-smoking legislation still doesn't exist, even in hospitals and schools.

The United States need not exclude tobacco from the TPP talks. Indeed, lower tobacco subsidies and improved coordination on regulation would advance U.S. trade and tobacco control goals. But we must not seek lower tobacco tariffs in Vietnam. And we must not prevent trading partners from using the most effective health warnings on cigarettes.

The United States has shown great courage and leadership in protecting its children from the perils of tobacco. It's past time that we adopt trade policies that support the world's poorest countries in their efforts to do the same.

Image: Yannis Behrakis/Reuters

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Thomas Bollyky is the senior fellow for global health, economics, and development at the Council on Foreign Relations and an adjunct professor of law at Georgetown University. He writes regularly at CFR.org.

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