The opium wars of the 21st century: Tobacco and the developing world he opium wars of the 21st centry: Tobacco and the developing worldSince the 1964 report of the Surgeon enerals Advisory Committee on Smoking and Health 38 million adults in the United States have quit smoking. 1 During the 1990s, the retreat of cigarette companies has become a near rout in some industrialized countries. The tobacco industry, quite to the contrary, is not on its knees nor about to surrender. Its long range global strategy is to maintain sales roughly onstant in industrialized countries, while investing mammoth resources to increase market share in the Third World, in the former Soviet Union and in Eastern Europe. The struggle ainst tobacco is not being won, it is being relocated. In the past decade United States obacco consumption dropped 17 percent while exports have skyrocketed 259 percent. At present, the two American giants, Philip Morris and R.J. Reynolds sell more than two thirds of their cigarettes overseas and half their profits come from foreign sales. 2 The tobacco wars of the next century will increasingly be waged among vulnerable populations ill quipped to cope with the slick marketing techniques and the dirty tricks perfected by the tobacco industry. Most developing countries have no advertising controls, lack adequate health warning requirements, and have a dearth of pressure groups campaigning for stricter obacco controls. They have set no age limits, nor imposed restrictions on smoking in public places. Their populations are poorly educated on the health hazards nor is formation being provided to the burgeoning numbers of teenagers who are most usceptible to vertising hype. Tobacco already exacts an inordinate toll in the developing world. In Mexico, cording to the Center for Disease Control CDC, death rate for all smoking related disease has increased substantially, ranging in mortality increases of 60 for cerebrovascular disease to 220 for lung cancer. 3 In Brazil cigaretterelated disease now leads infectious diseases as the principal cause of death.4 In Bangladesh, as a result of increased smoking, cancer of the lung has become the third most common cancer among men and perinatal mortality is 270 per 1000 children of smoking mothersmore than twice the rate for children of nonsmokers. 4 In India, a sixfold increase in mortality from bronchitis and emphysema has been noted, coincident with that countrys skyrocketing cigarette consumption.4,5 In developing countries, not only is the use of tobacco surging, but the cigarettes are more addictive and more lethal because of higher tar and nicotine content. In Asia smoking is growing at the fastest rate in the world accounting for half of global cigarette use . The largest number of recruits are among the young and women. 6 The tobacco industry finds the Asian market particularly inviting because of its size and the love for smoking. In China 61 percent of men and 10 of women over 15 now smoke. These 320 million smokers consume 1.7 trillion cigarettes annually. While the Chinese account for a third of all smokers world wide, as yet this lucrative market has not reached its potential limit. The staggering health costs is a reckoning for the future. The Chinese Academy of Preventive Medicine forecasts 3.2 million deaths annually by the year 2030. 7, 8 The United States has played a key role in promoting the global consumption of tobacco. More than a century ago the American tobacco magnate James B. Duke entered China. 9 Until his arrival very few Chinese smoked, mostly older men using a bitter native tobacco, usually in pipes. Duke hired teachers, who traveled from village to village in Shantung province, marketing a milder North Carolina tobacco leaf and instructing curious onlookers how to light up and hold cigarettes. Duke installed the first mechanical cigaretterolling machine in China and unleashed a panoply of promotional materials, including cigarette packs isplaying nude American actresses. He set the precedent of having the United States government pressure the Chinese to permit the import of American cigarettes. Pushing deadly merchandise abroad if anything it has intensified in recent years. In 1985 when US began its campaign to open Asian markets to tobacco exports, it shipped 18 billion cigarettes; by 1992 the figure had risen to 87 billion or nearly fivefold. The US government, while discouraging smoking at home, successfully pressured Japan, Taiwan, South Korea and Thailand into breaking their domestic tobacco monopolies to allow the sale of American cigarettes.6 These national monopolies did not advertise and sold cigarettes largely to male adults. After US companies penetrated their markets smoking soared among young people. Two years after the entry of American cigarettes in Japan, their import increased by 75 percent with 10fold increase in the number of television advertisements to encourage smoking. The US broke a healthy taboo against smoking by Japanese women. In but a few years the number of women smokers more than doubled. 6, 10 In a single year after the ban against American tobacco was lifted, smoking among Korean teenagers rose from 18.4 to 29.8 percent and more than quintupled among fem

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