The harsh reality is that, a decade later, many low- and middle-income countries [LMICs] are still as ripe a market as ever for exploitation by the tobacco industry.

Smoking currently costs the global economy more than $1 trillion a year. Yet the global health and economic burden of tobacco use is increasingly borne by low- and middle-income countries (LMICs).

Eighty percent of smokers live in LMICs. While smoking prevalence is falling in some high-income countries, the total number of smokers worldwide is not decreasing, largely due to population growth in these countries where poor people are targeted by the tobacco industry.

Poor people targeted by the tobacco industry

The number of tobacco-related deaths is projected to increase from around six million deaths annually to eight million annually by 2030. More than 80 percent of these deaths occurring in LMICs.

By 2030, the number of African smokers is projected to increase by 40 percent.  If the tobacco industry is allowed to operate as they want to, the current 77 million adult smokers in Africa will increase to a staggering 572 million this century. This potentially makes Africa the future epicentre of the tobacco epidemic.

The number of tobacco-related deaths is projected to increase from around six million deaths annually to eight million annually by 2030.

But it does not and cannot come to that. As history has shown, the key to protecting people from the exploitation of the tobacco industry is to mobilise and unite governments and civil society on tobacco control.

A new approach to public health policy

Protecting health policies from tobacco industry interference has to become a major priority throughout the region. This will necessarily involve suffering some pain for gain – and a new approach to public health policy which will see the government committed to transparent and curtailed dealings with the tobacco industry.

Simultaneously, action is needed across the continent on tobacco taxation. Not only is raising taxes on tobacco the most powerful measure for reducing tobacco use in the long term, when used properly, it can both fund national tobacco control programmes sustainably into the future and direct increased revenue to provide a much-needed boost for other health services.

Again, this requires commitment and collaboration from multiple government departments – ministers of health and finance working together to protect and promote the physical and economic health of citizens. If we want to truly advance tobacco control, it must become a whole-of-government issue.

Robust regional conversations

A similarly robust regional conversation will also need to be had sooner than later with the tobacco farmers themselves. They need to be reassured that there are alternatives to tobacco farming. We know that the number of jobs dependent on tobacco has been falling in most countries.  For those countries that are particularly reliant on tobacco farming and exports, the time to act is now.

Authorities need to work  with the farming community and begin mapping out alternative livelihood programmes that in in the long term will positively impact on current tobacco farmers, their families and communities, by ensuring a smooth transition to equally, if not more profitable crops.

We know that the number of jobs dependent on tobacco has been falling in most countries.

Governments across the region also need to protect those groups being targeted by the tobacco industry’s powerful marketing tactics – young people and women. Total bans on tobacco advertising, promotion and sponsorship is the only way to achieve this. And Corporate Social Responsibility schemes must also fall under this ban.

As well as the growing burden of tobacco-related disease, a number of countries across the region like South Africa have, over the past three decades, have endured the overwhelming effects of the AIDS and tuberculosis (TB) epidemics. If those crises have taught us one thing (in Africa and globally) it is that effective management of epidemics of this magnitude means including communities that are affected in the response.

Impact of tobacco-related disease

In some parts of Africa that will also necessarily translate into considering the impact of tobacco-related disease on the health of a person living with an infectious diseases like HIV, and on the susceptibility of certain smoker populations who are also vulnerable to TB. Such considerations are long overdue.

In 2018, the biggest public tobacco control conference in the world is coming to Africa for the first time. Make no mistake, this represents a major opportunity for Africa and the developing world to get tobacco control policy right and move forward in Cape Town with the task of uniting the world for a tobacco-free generation.

Olalekan Ayo-Yusuf, Director, Africa Center for Tobacco Industry Monitoring is the Co-Chair of the 17th WCTOH Scientific Committee President of the 17th World Conference on Tobacco or Health (WCTOH) to be held 7-9 March, 2018 in Cape Town, South Africa.

Harry Lando is a Distinguished International Professor in the Division of Epidemiology and Community Health, School of Public Health at the University of Minnesota and the Chair of the 17th WCTOH Organising Committee.

Gan Quan is the Director of Tobacco Control at the International Union Against Tuberculosis and Lung Disease (The Union) and Co-Chair of the 17^th WCTOH Scientific Committee.