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Abu Dhabi, UAEFriday 16 November 2018

The long read: smoking kills so why is Big Tobacco’s toxic business thriving in the Middle East?

Sixty years after the link between cigarettes and cancer was confirmed, smoking is thriving, especially in the Middle East. Jonathan Gornall investigates how the industry is able to lure a new generation into lighting up.
Young schoolchildren wear anti-smoking masks during a ‘No Tobacco’ rally in Kolkata in 2012. World No Tobacco Day is observed around the world every year on May 31 and is one of the important World Health Awareness days organized by the World Health Organisation (WHO). Dibyangshu Sarkar / AFP photo
Young schoolchildren wear anti-smoking masks during a ‘No Tobacco’ rally in Kolkata in 2012. World No Tobacco Day is observed around the world every year on May 31 and is one of the important World Health Awareness days organized by the World Health Organisation (WHO). Dibyangshu Sarkar / AFP photo

Thirty-five years ago this month, worried executives at British Ame­rican Tobacco flew the company’s commercial partners in the Arab world to London for an urgent conference to discuss “Smoking and Health in the Middle East”.

The agenda awaiting the dele­gates from Abu Dhabi, Dubai, Kuwait, Oman, Saudi Arabia, Egypt and Bahrain who flew to the United Kingdom for the meeting on July 23, 1980, was not concerned with the health of their customers.

Instead, they had been summoned to HQ to discuss BAT’s concerns over the increasing efforts being made by governments in the Middle East, including the UAE, to reduce the harm caused by smo­king – and to return home armed with a strategy to undermine those efforts in the interests of the company’s vast profits, according to papers archived in the Legacy Tobacco Documents Library. More of which later.

Graphic: A look at the global tobacco epidemic

Three-and-a-half decades on, Big Tobacco wears a different face. Today, it would have the world believe it is a good corporate neighbour, dedicated to reducing the harm caused by cigarettes and developing, what it likes to call, “new generation” or “reduced-risk products”, such as e-cigarettes.

Behind all the platitudes and talk of corporate responsibility and “harm reduction”, Big Tobacco remains the same old ruthless, steely-eyed killer it has always been, determined to push its deadly core product for as long as possible.

In 2015, 60 years after the link between smoking and cancer was first established beyond doubt, it would be reasonable to assume that the tobacco industry is in its death throes. After all, worldwide, the regulatory noose is tightening – health warnings appear on cigarette packs, advertising is banned in magazines and on television and taxes are raised to ever higher levels.

But, as I discovered during the course of a recent investigation for the British Medical Journal, far from being a slain dragon, Big Tobacco is thriving – and nowhere is this more true than in the Middle East.

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For the tobacco industry, the global market for its toxic product is like a balloon. If it is squeezed by public-health regulation in one place, it simply expands in another. And today, as Big Tobacco’s sales and profits are squeezed in other, increasingly health-conscious areas of the world, parts of the Middle East and Asian markets are becoming more important to its deadly business than ever.

Take Philip Morris International, which, with 25 per cent of the global market, is the world’s largest tobacco company. Last year, the American company shipped 287 billion cigarettes to the industry-designated EEMEA (Eastern Europe, the Middle East and Africa) region, which generated 34.2 per cent of the company’s total income of US$29.8 billion (Dh109.5bn). Only Asia, where the company shifted 288 billion cigarettes, performed better.

In its annual report, the company notes it continues to benefit from “innovations” to its “iconic” Marlboro brand – such as its Smart Seal technology, “which maintains product freshness with a novel, state-of-the- art re-seal mechanism [and] has been a key driver of Marlboro’s reinvigorated performance in the Arab Gulf”.

Somehow, over the years, the company has managed to shrug off the negative PR caused by the deaths, from smoking, of no fewer than four of the actors who played Marlboro Man in the adverts that ran from the 1950s onwards.

In its most recent annual report, Japan Tobacco International, the world’s third-largest cigarette company, doesn’t break down its total of 266 billion cigarettes into regional sales, but does offer this helpful analysis of regional opportunities.

In mature markets, it notes, the overall number of cigarettes sold is in decline, “reflecting various factors such as limited economic growth, tax increases, tightening regulations, and demographic changes.” But in emerging markets, “total consumption tends to increase, driven by population growth and economic development, particularly in Asia, the Middle East and Africa”.

So, 35 years after that London meeting, how is BAT, the world’s second-largest tobacco company, faring in the region?

Last year, BAT reported a global profit of £6.1bn (Dh34.7bn). Its annual report for last year showed that while the share of that profit in Western Europe was down by 0.98 per cent, in the industry-designated EEMEA region it was up by 9.1 per cent.

In the report, a BAT director singled out and celebrated the company’s “strong performance” in the Middle East. The region as a whole provided BAT with a revenue of £4.355bn – 28 per cent of its total income and more than that generated by any other region – and a healthy profit of £1.62bn.

Healthy, that is, for the company’s shareholders.

As the World Health Organisation (WHO) points out, Big Tobacco has the dubious distinction of being the only industry on the planet whose products kill 50 per cent of all people who use them as intended. Around the world, says WHO, that adds up to a death toll of almost six million people a year.

Seen in that light, the six trillion cigarettes consumed around the world each year start to look a little like bullets. But when it comes to destroying lives, the arms industry has nothing on Big Tobacco.

All the wars of the 20th century, including both global conflicts, claimed the lives of 72 million people. Tobacco’s score over the same period? One hundred million.

Imagine the outcry and panic if a pandemic such as Middle East Respiratory Syndrome were claiming the lives of millions of people each year, rather than the 1,300 thought to have been killed by the disease to date. Even the death toll of the 2014-15 Ebola outbreak (11,200 cases by the beginning of July, according to WHO) pales against tobacco’s harvest of lives.

The problem, of course, is that tobacco is a vastly lucrative business for the companies, their shareholders and the governments that tax them – heavily, but never quite punitively enough to kill the golden goose.

Just four companies account for most of the cigarettes smoked in the world outside China and, according to their most recent annual reports, their combined annual profit amounts to more than £21bn. They are Philip Morris (£9.2bn), British American Tobacco (£6.1bn), Japan Tobacco International (£3bn) and Imperial Tobacco (£2.9bn).

While some individual investors and institutions draw the ethical line at profiting from such a business, there remains no shortage of people prepared to take advantage of one of the best investments around. Between March 2008 and December 2014, for example, the combined shareholder return from the Standard & Poor 500 was 81.5 per cent. Over the same period, the tobacco sector yielded more than 117 per cent.

The tobacco industry points to its new interest in e-cigarettes as evidence that it is concerned about public health. In fact, as Simon Capewell, professor of public health and policy at University of Liverpool’s Institute of Psychology, Health and Society, says: “If tobacco companies were genuinely concerned about the harm they caused, they would cease production [and] go into e-cigarette production 100 per cent.”

Many countries have been taken by surprise by the rise in popularity of e-cigarettes and have no legislation in place to deal with the phenomenon. Others, such as the UAE, have banned their sale.

Scientists, meanwhile, have also been caught flat-footed and are divided on key questions: do e-cigarettes actually help people to give up smoking, or are they used interchangeably with tobacco and hence contribute very little to harm reduction? Worse, there is, as yet, no agreement on whether e-cigarettes are acting as a gateway to smoking for the young.

Professor Capewell and colleagues would prefer governments to err on the side of caution, as the UAE has done. He believes e-cigarettes are being cynically exploited by the industry, both to glamorise and renormalise smoking and to win it a place at the table in discussions with health ministries: “They are now saying ‘this is all about harm minimisation, we’re part of the solution, we’re no longer the problem’.”

Meanwhile, while posing as a champion of harm reduction, Big Tobacco has also been sidling into another boom market – shisha. Increasingly popular among the young in the Arab world, shisha has benefited from the mistaken belief that it is somehow safer than cigarette smoking.

And, in the same way that it has gobbled up almost all indepen­dent producers of e-cigarettes, Big Tobacco is now muscling in on shisha – in March 2013, Japan Tobacco bought Egyptian company Al Nakhla, the leading producer and exporter of shisha tobacco in the Middle East.

Evidence from a cache of 14 million internal industry documents from 1950 to 2009, released into the public domain over the past decade as a result of litigation between 46 states of the United States and the major tobacco companies, suggests cynicism is the industry’s default setting.

The Legacy Tobacco Documents Library, maintained online by the University of California in San Francisco, amounts to an indictment of an industry that clearly knew for decades that its products were killing people, and yet deliberately hid the truth.

As one analysis of the documents by WHO concluded, “in the face of mounting damning evidence against their product, the companies responded by creating doubt and controversy surrounding the health risks” and “lulled the smoking public into a false sense of security”.

The papers reveal that by the early 1960s, industry scientists were working on producing “safer” cigarettes – the very work to which it is returning with such self-congratulatory fanfare now – but that its lawyers advised that to do so was to admit that its other products were unsafe. As one internal memo from the time put it: “Ignorance is bliss”.

A confidential internal Philip Morris memo from March 15, 1961, concedes in passing that, in addition to being “stimulating, pleasurable and flavorful”, the “biologically active” materials in tobacco are “cancer causing, cancer promoting [and] poisonous”.

Compare this internal admission with the delusional propaganda handed out by BAT to its Middle East reps almost 20 years later at its London summit in 1980, recorded in a paper among the millions now held at the Legacy Tobacco Documents Library.

Diseases such as cancer could be described only as “allegedly associated with smoking”, Mike Scott, BAT’s public affairs manager, told the delegates. “A considerable controversy still exists,” he said, and there are “two sides to the argument. The anti-smokers would have everyone believe that ‘causation’ is proven beyond all reasonable doubt and that there is nothing further to debate.”

The document reveals that the delegates were then provided with “the necessary general information on smoking and health” and dispatched back to their countries equipped with a strategy to undermine attempts to reduce tobacco harm.

Such a deliberate attempt to subvert the will of a government working to protect the health of its citizens might seem shocking, but one should hardly be surprised. As a 1978 document from the Legacy archive reveals, BAT had already proposed a public-relations strategy for the entire industry.

The document outlining the strategy contains the callous observation that, “with a general lengthening of the expectation of life we really need something for people to die of.” Absence “the effects of war, poverty and starvation, cancer, as the disease of the rich, developed countries, may have some predestined part to play”.

This argument was “obviously not one that the tobacco industry could use publicly. But its weight, as a psychological factor in perpetuating people’s taste for smoking as an enjoyable, if risky, habit, should not be under-estimated.”

More evidence of the industry’s manipulation of its customers comes from a BAT creative- advertising brief from January 1995, highlighting the sales opportunities to be had from exploiting Ramadan.

The holy month of Ramadan, it said, was “a time when Muslims try to live a healthier life and … many people may try to give up smoking”. What better time, then, to exploit the fact that “smokers will not have had a cigarette for around 14 hours” and persuade them to switch to supposedly “milder” brands instead?

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In March, Abu Dhabi hosted the 16th World Conference on Tobacco or Health, which saw the launch of the latest edition of The Tobacco Atlas, published by the American Cancer Society and the World Lung Foundation.

Smoking rates were dropping in many high-income countries, noted Peter Baldini, chief executive of the World Lung Foundation, in the foreword to the report. But in response the industry was simply focusing on “addicting hundreds of millions in emerging markets”.

One of the co-authors, Dr Judith Mackay, a Hong Kong-based senior adviser to the World Lung Foundation, has spent most of her professional life working to reduce the harm caused by tobacco and, despite all the apparent advances in regulation and education, she offered a gloomy prognosis.

“There’s no tobacco farmer or manufacturer who need worry about their job in my lifetime,” she says. “Here’s an industry that is going to be expanding for the next several decades.”

It is true that in some parts of the world, the proportion of people who smoke is falling. But the population of the world is going to rise by a billion in the next decade, reaching as much as 9.5 billion by 2050, “so even if you bring the prevalence [of smoking] down ... the reality is that population expansion will exceed any decrease in prevalence”.

The result, she says, is that – e-cigarettes and all of the other white noise of so-called “harm reduction” notwithstanding – “by 2030 or 2040 we will have a lot more smokers in the world than we do today and the industry is certainly going to be selling a lot more cigarettes than it does today”.

It was a naive question, but I asked BAT why, if it really was serious about reducing the harm caused by its core products, it didn’t just stop making them.

“We have made meaningful steps in our journey to tobacco harm reduction,” says Will Hill, BAT’s public-relations manager.

But, he admits the “lion’s share” of BAT’s revenue and profits for the foreseeable future is “going to come from the traditional cigarette side of our business ... Simply to turn off that ... would not be acting in the best interests of our employees, our partners and suppliers or, of course, our shareholders”.

No mention, in that sentence, of the best interests of Big Tobacco’s two largest groups of stakeholders – its customers and the six million killed each year by cigarettes.

Jonathan Gornall is a freelance journalist based in London.