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Imagine this: There's a female subsistence farmer in Burkina Faso, one of Africa's least developed nations. For years she's made her living gathering nuts and pounding them into a butter used in food, pharmaceutical creams, and cosmetics sold in Europe. She makes about $80 a month. But recently she and other women formed a collective and landed a contract with an overseas cosmetics company, which ordered an unprecedented 100 tons of butter and doubled her yearly income. As she contemplates her new prosperity, she lights a Virginia Slims cigarettethe international symbol of confidence, independence, and economic empowerment. As she inhales the heady smoke, the well-known tag line drops into her thoughts: "You've come a long way, baby."
This scenario is a dream for Philip Morris, the world's biggest cigarette maker and a leader in targeting women and minors in the developing world as the next big smoking market. But it's a nightmare for health advocates, which is why they've made this issue the focus of the 11th World Conference on Tobacco OR Health, a six-day gathering of more than 4000 scientists and tobacco-control activists that began Sunday in Chicago. If the tobacco industry's marketing onslaught isn't stopped, says Matt Myers, president of Tobacco-Free Kids, "there will be a global health crisis of epic proportions."
There are already about a billion smokers globally, but only 236 million are womenabout 12 percent. By the year 2025, the number of women smokers is expected to triple, to more than 600 million. Over 80 percent of those new female smokers will live in developing countries, places with limited medical capacity and little infrastructure for early cancer detection or other programs to limit the harm of smoking.
That doesn't seem to bother big tobacco, which is working diligently to build new markets to compensate for losses elsewhere. Among men in industrialized nations, the smoking rate is 39 percent, a sharp drop from 70 percent earlier this century. Only 23 percent of American women over 18 smoked during the 1990s, down from a peak of 33 percent in the '60s and '70s. Meanwhile, in the third world, the male smoking rate is up to 59 percent; smoking among females has climbed to 9 percent, rising along with the proliferation of American-style cigarette ads. Such gains translate into big money: Philip Morris's international tobacco profits have increased 256 percent in the past 10 years, while domestic profits rose only 16 percent.
Tobacco companies began expanding into developing nations in the early '70s, but focused mainly on the male demographic. Women were initially considered a secondary market. That was partly because of social resistance (only "bad girls" smoked), but also because disposable income among women was practically nonexistent. Instead, tobacco makers focused on more potentially lucrative female markets in the United States and Europe, where they successfully sold "ladies' brands" by linking them to the growing feminist movement. "You've Come a Long Way, Baby" became associated with a whole generation of women joining the workforce in the '60s and '70s.
Three decades later, big tobacco is recycling that "smoking = liberation" message for the third world. "I'm going the right waykeeping the rule of the society," reads a Virginia Slims ad developed for the Asian market and translated by antismoking activists, "but at the same time I am honest with my own feeling. So I don't care if I behave against the so-called 'rules' as long as I really want to." Surrounding this faux-empowerment copy is an image of a slender woman with ambiguous lookspossibly Asian, possibly Europeanembracing a fair-haired man, and beneath the woman the words "BE YOU" are written in big, bold letters. Despite the apparent contradiction of telling Asian and African women to "be themselves" in ads featuring a clearly Western aesthetic, campaigns like these are tremendously effective. "These countries want to emulate America like never before," explains Nancy Kaufman, vice president of the Robert Woods Johnson Foundation in D.C., "so it's easy for tobacco execs to exploit the idea of freedom and rebellion in their ads."
Not only do tobacco companies promote a link between smoking and independence, they also deliberately choose images linking smoking to better health. "My pleasure!" states another ad, featuring an athletic blond woman taking a boxing class. In the U.S., most viewers probably know there's a good chance she's increasing her odds of lung damage. But a recent study showed that in China, which has the largest number of potential female smokers worldwide, two out of three women think smoking is harmlessnot because they can't understand the danger, but because they simply aren't being told.
Myers and other health advocates consider it despicable to pitch cigarettes as healthy despite massive evidence to the contrary, but in the developing world tobacco makers are under no real obligation to disclose risks. Even in countries where warning labels are required, tobacco companies are under no obligation to be specific: "Smoking Causes Impotence" was the only warning on cigarette packs in Thailand for many years. Moreover, there are few if any laws banning TV or billboard advertising, no requirements that companies disclose how much they've spent on lobbying and "donations" to politicians, and few restrictions on promotionit's perfectly legit to provide free street signs for a small village, then plaster the signs with cigarette logos, as one American company did.
No matter where they live, women who succumb to such merchandising face plenty of trouble. "One of the saddest things we've learned," says Myers, referring to the 50-year sweep of smoking through the U.S. and Europe, and into Mediterranean countries, "is that as women smoke like men, they die like men." Lung cancer and heart disease rates for women are exploding throughout the developed world. In the U.S., lung cancer has surpassed breast cancer as a leading killer of women. Women who smoke and use oral contraceptives have an increased risk of strokes and cancer, and "low-tar" and "light" cigarettesbrands marketed almost exclusively to womencan cause very rare and malevolent carcinomas in lung tissue. Women smokers have a higher risk of osteoporosis and cervical cancer, not to mention complications with fertility and pregnancy.
Tobacco-related illnesses already cost the global economy an estimated $200 billion a yearand this without the added burden of several hundred million women and child smokers in the third world. Fearful of where that number could be in 20 years, the World Bank, an institution that traditionally has supported multinational tobacco companies, has begun to rethink its policies. In a report issued earlier this year, Curbing the Epidemic, the World Bank found that a "falling demand for tobacco does not mean a fall in a country's total employment level," subverting an oft repeated claim by tobacco companies that millions of farmers and businesses are dependent on their products.
The World Health Organizationwhich just released a study showing tobacco companies spent years working to undermine its antismoking campaignsis also getting into the act. Attendees at this week's conference will spend much of their time hammering out details for WHO's Framework Convention on Tobacco Controla treaty that WHO hopes will eventually be signed by all 191 members of its governing body. It will attempt to restrict advertising, but above all it will try to force manufacturers to fully disclose the dangers of smoking. If cigarette companies violate these regulations, they can be held accountableas they are beginning to be in the U.S., where a Miami jury recently decreed that five tobacco companies pay $145 billion in punitive damages to sick Florida smokers.
Someday, perhaps, that farmer in Burkina Faso will be sufficiently empowered to sue. "It has not escaped our attention," says Kaufman, "that the tobacco industry is expanding in locations where the litigation of individual rights is very limited. The industry thinks it won't be facing lawsuits from women in these countries for a very long timeif ever. But we think they are wrong. That's what this conference is about."