Do you smoke? Your answer may say less about your propensity for addiction than where you live. Today, some 80% of the world’s 1.1 billion smokers reside in low- and middle-income countries. Decades ago, most smokers were in high-income
countries. What’s changed? For one thing, death. Tobacco kills up to half of its users. But mortality is not the main reason why today’s smokers are likely to be poorer. This is a shift fueled by marketing. During the 1950s and 1960s, Big Tobacco lured young people in the West with flashy ads and free stuff, all with the goal of getting people hooked. It worked. In 1965, nearly 50% of the adults in Britain, and 42% in the United States, smoked regularly. But eventually, wealthy governments caught on to the enormous health and social costs of tobacco use. Taxes were imposed, point-of-sale warnings implemented, anti-smoking campaigns were launched, and tight limits were placed on the content of advertising and the media where it could appear. In the last half-century, much of the West has kicked the habit. That’s been good for human health, but bad for Big Tobacco. So, in the search for new consumers, tobacco companies have set their sights on countries in the Global South – and especially in Africa and Asia. In both places, it’s the 1960s all over again. According to one study by the World Health Organization, people in low-income countries are exposed to 81 times more tobacco ads than those in high-income countries. And, as in the West, this marketing is having an effect. In Sub-Saharan Africa, tobacco consumption surged 52% between 1980 and 2016. In Lesotho, one of Africa’s poorest countries, just 15% of the population smoked in 2004; by 2015, aggressive tobacco marketing had brought the share to more than half. With the hidden price of tobacco measured in higher medical costs, diminished productivity, and lost wages, the Global South has every reason to quit. Ending sales to minors, taxing products, regulating production, and limiting advertising would be a good way to start. At the moment, however, Big Tobacco appears to have the upper hand. Tobacco firms spent decades winning over smokers in the Global North with lobbying, litigation, and lifestyle marketing. And now they are deploying the same tactics in the world’s poorest countries, where weaker health-care systems and lower regulatory capacity all but guarantee an even higher death toll.