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Less than a decade ago in the UK, it was possible to smoke in pubs and restaurants as much as you liked. Go back just a few more years, to 2002, and it was still possible to see adverts for cigarettes on billboards in the street.
Now the UK, along with Ireland and France, is following Australia’s lead in introducing plain packaging, a step that demonstrates just how far restrictions on smoking have come in a relatively short space of time.
Leave western Europe and the picture is more mixed. While smoking is in general becoming less popular and regulation is getting tougher, it remains a killer that takes the lives of 6m people each year, according to the World Health Organisation. Although wealthier countries have been successful in controlling the sale of cigarettes, lower-income nations face an uphill struggle.
“Globally [regulation] only ever moves in one direction, which is to become tighter,” says James Bushnell, an analyst who covers the tobacco industry for Exane BNP Paribas. But for some poorer countries, Mr Bushnell adds, the money required “to come up with a regulatory framework and enforce it is not there”.
There are over a billion smokers in the world, according to the WHO, with four big international tobacco companies that between them made $20bn profit after taxes in 2015.
The industry has long since accepted that its products are indeed harmful, but it remains an opponent of stricter regulation, sometimes using international courts to pursue claims against national governments.
Philip Morris International, for example, sued Australia over plain packaging by claiming the measures violated a bilateral trade agreement with Hong Kong. The company, which is the world’s largest international cigarette seller, has also sued Uruguay in an international court, challenging the introduction of health warnings covering 80 per cent of a packet of cigarettes.
Last year, Michael Bloomberg, owner of the Bloomberg financial media organisation, and Bill Gates, the founder of Microsoft, pledged $4m to a fund designed to help lower-income countries defend themselves against legal action from tobacco companies.
At the time, Mr Bloomberg said tobacco companies used legal action to “intimidate” poorer countries that may lack the funds or expertise to mount a defence.
Despite the efforts of the tobacco industry, regulation has largely advanced in many countries around the world. To a considerable extent, this is driven by an international treaty — a WHO initiative ratified by 180 countries — called the Framework Convention on Tobacco Control, or FCTC, which came into force in 2005.
That was a landmark moment, says Dr Ehsan Latif, director of tobacco control at the International Union Against Tuberculosis and Lung Disease, a health advocacy group.
In the years since, countries such as Brazil and Russia have made significant changes to smoking legislation. Two years ago, Russia prohibited smoking in restaurants, thus extending a public smoking ban enacted in 2013 along with new restrictions on advertising. The Russian government accompanied these measures with a series of tax increases.
Dr Latif, however, points to emerging market countries such as Indonesia as examples of the work that is yet to be done.
Studies put Indonesia’s smoking rate at about 60 per cent for men. Advertising is allowed on television, in newspapers and on billboards, according to the WHO.
Over the next two years, the country will be a crucial source of growth for tobacco companies. BNP Paribas estimates profits from cigarettes will grow faster in Indonesia over that period than in any other country in the world.
The Indonesian government in Jakarta has passed some tobacco control laws, says Dr Latif, but it has not signed up to the stricter international standards required by the FCTC. “Despite all efforts, Indonesia is not moving on that front,” he says. “They just don’t come to the party.”
The problem lies not just in persuading politicians to enact reforms, however, but also in ensuring proper implementation after that.
“If you take Asia, specifically Southeast Asia, there are countries that have adopted the policies but they have not been able to implement them because they don’t have public health infrastructure,” says Dr Latif. “Also the political will waxes and wanes.”
Another chief source of worry is Africa, which has comparatively low rates of smoking. While South Africa is known for having strong regulations on smoking, much of the rest of the continent has lighter rules.
Antismoking campaigners are keen to see restrictions introduced in advance of African incomes increasing and cigarette smoking becoming more popular. “It’s similar to any consumer product,” notes Dr Latif. “Once your purchasing [power] improves you can buy cigarettes.”
The challenge is as much cultural as it is regulatory and may extend beyond the reach of richer nations. “The developed countries pass the laws,” he adds, “and they think enough has been done.”
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