What We Do

Tobacco Control

Strategy Overview

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Indoor smoking bans are among several inexpensive measures that have been proven to reduce overall tobacco use.

our goal:

to reduce tobacco-related death and disease in developing countries by preventing the initiation of new smokers, decreasing overall tobacco use, and reducing exposure to secondhand smoke.

The Challenge

At A Glance

Nearly 6.3 million people die of tobacco-related diseases each year, including 600,000 nonsmokers who are exposed to secondhand smoke.

If current trends persist, tobacco will kill more than 8 million people a year by 2030—80 percent of them in low- and middle-income countries.

Tobacco use is the second biggest risk factor for disease globally.

To reduce and prevent tobacco use, the foundation supports evidence-based policies that align with the WHO Framework Convention on Tobacco Control—in particular, tobacco taxes that increase the price of cigarettes, graphic warning labels, advertising bans, and smoke-free environments.

Our Tobacco strategy is led by Cynthia Lewis, deputy director of Global Policy & Advocacy, and is part of the foundation’s Global Policy & Advocacy Division.

Tobacco use is the world’s leading cause of preventable death. Each year, nearly 6.3 million people die prematurely from tobacco-related diseases—more than from AIDS, tuberculosis, and malaria combined. If current trends continue, tobacco will cause 8 million deaths a year by 2030—80 percent of them in developing countries.

Worldwide, more than 1 billion people use tobacco products. Tobacco use, as well as exposure to secondhand smoke, can cause lung disease, cancer, heart disease, low birth weight, stillbirths, diabetes, increased mortality among tuberculosis patients, and many other health problems.

In recent years, sales of tobacco products have decreased or stagnated in wealthier countries while tobacco use has accelerated in low- and middle-income countries. The tobacco industry is increasing its aggressive marketing of tobacco products to people in the developing world, often targeting women and children and distributing free cigarettes in connection with sports, music, and other events. Many of these countries lack strong tobacco control policies and have little awareness of the health effects of tobacco. In countries that grow tobacco and produce tobacco products, the tobacco industry has enormous influence and actively challenges the adoption of tobacco control policies.

The Opportunity

A number of cost-effective policies have proven successful in preventing the initiation of tobacco use, reducing exposure to secondhand smoke, and encouraging smokers to quit. They include:

  • Tobacco taxes that raise the price of cigarettes for the consumer
  • Comprehensive bans on tobacco advertising
  • Graphic health warning labels on cigarette packaging and plain cigarette packaging
  • Indoor smoking bans

In 2003, the World Health Organization (WHO) adopted the Framework Convention on Tobacco Control (FCTC), the world’s first global public health treaty, which compels its signatories to meet minimum standards governing the packaging, sale, advertising, and taxation of tobacco products. With 176 signatory countries, the FCTC has led to stronger tobacco control policies in many parts of the world.

Tobacco control policies not only save lives but also raise much-needed domestic revenue for public health and development efforts. When policy change approaches are combined with social marketing to educate the public and change attitudes and perceptions related to tobacco use, they are mutually reinforcing and can lead to significant and lasting change.

Our Strategy

The Bill & Melinda Gates Foundation supports advocacy at the country level for full implementation and enforcement of FCTC provisions. We work with our partners to convey the benefits of tobacco control policies and thereby reduce tobacco-related death and disease in developing countries. Our efforts are focused on Africa, China, and Southeast Asia.

Bill Gates and Michael Bloomberg have called on government and business leaders to make the fight against tobacco use a higher priority.

Our strategy is centered on three priorities:

  • Supporting implementation and enforcement of proven tobacco control policies: tobacco taxation, advertising bans, graphic warning labels, and smoke-free environments
  • Supporting social marketing campaigns that increase public and policymaker knowledge of the harmful effects of tobacco and change attitudes and perceptions related to tobacco use
  • Funding global and locally-based research to inform our ongoing policy and social marketing efforts

While clinical smoking cessation services are not a primary focus of our strategy, we acknowledge their critical role in limiting overall tobacco-related death and disease and we applaud the efforts of our partners and other organizations in this area. We also recognize the importance of other needs in tobacco control, such as researching alternative livelihoods for tobacco farmers and addressing cross-border smuggling. We track these efforts closely and take them into account when we make strategic decisions about how to allocate our funds most effectively to reduce tobacco use.

Areas of Focus

Since 2008, the foundation has committed US$134 million to fund projects and partnerships in Africa and Asia that address the tobacco epidemic. One of our largest investments is in the Bloomberg Initiative to Reduce Tobacco Use, which has been at the forefront of the global effort to fight tobacco use. In 2008, the foundation and New York City Mayor Michael Bloomberg made a joint commitment of US$375 million to the initiative.

Africa

As incomes rise for a growing African population, tobacco use could double in the coming years if strong tobacco control measures are not implemented. Although most governments in Africa have committed to the FCTC, tobacco control remains a lower priority than other health challenges and governments often lack data on tobacco-related health issues. Given that the tobacco epidemic in Africa is at a relatively early stage, now is a critical time to invest in campaigns and research to support policies that can prevent a large-scale epidemic.

We support two resource centers in Africa: the Centre for Tobacco Control in Africa, sponsored by WHO, and the African Tobacco Control Consortium, sponsored by the American Cancer Society (ACS). These centers work with a range of regional and country partners, including governments and civil society organizations, to offer technical assistance, resources, and guidance in implementing tobacco control interventions in Africa. In addition, they serve as a model of cross-sector collaboration in the region. We also support economists at WHO and ACS who work with governments, advocates, and African researchers on the economics of tobacco control.

Asia

China is the world’s largest producer and consumer of tobacco. An estimated 27 percent of the population—more than 350 million people—are smokers, and 1 million Chinese die of tobacco-related illnesses each year. As many as 100 million Chinese men currently under the age of 30 will die from causes related to tobacco use.

We are working with the Red Cross Society of China to build support for tobacco control among China’s leadership and encourage a shift in attitudes so both smokers and nonsmokers perceive tobacco use as undesirable and unacceptable. Through a partnership with the Baidu Charitable Foundation, we are working to highlight the risks of secondhand smoke. According to the 2010 Global Adult Tobacco Survey, less than one-fourth of Chinese adults believe that secondhand smoke can lead to heart attacks, stroke, and cancer. We also work with Emory University and other partners and donors on city-level policy change and other initiatives in China.

In Southeast Asia, we are funding the Southeast Asia Tobacco Control Alliance, which encourages regional collaboration, advocates for policy change, and provides technical assistance to tobacco control efforts in Indonesia, Cambodia, Laos, the Philippines, and Vietnam. The project aims to demonstrate the effectiveness of tobacco taxes and graphic warnings on cigarette packaging; this, in turn, can build support for more expansive policy change.

Evidence

Without accurate information on the size and nature of the challenges and successes in tobacco control, governments in developing countries are understandably reluctant to spend more money to address tobacco use and have limited ability to draft effective policies. In addition, models of tobacco control that have been used successfully in Western countries are not always readily accepted or equally effective in other countries. Tobacco control advocates need local information and data to support the case they present to governments—and to counter the tobacco industry’s promotional campaigns. Countries also need new and updated economic analyses on tax policy, tobacco consumption, and the burden of tobacco-related disease.

In partnership with the Bloomberg Initiative, we support a range of efforts to provide advocates and policymakers with the evidence they need to promote change in government policies. These include global adult and youth tobacco surveys, a series of country-specific papers detailing the economic impact of tobacco and tobacco taxation, and research on tobacco industry marketing strategies, cigarette smuggling, and tobacco policy effectiveness. We also provide advocates with grants for essential research, allowing them to respond quickly and effectively to emerging needs.

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