Columbia International Affairs Online: Working Papers

CIAO DATE: 07/2012

Incentives for Life: Cash-on-Delivery Aid for Tobacco Control in Developing Countries

Thomas J. Bollyky, Amanda Glassman

April 2012

Council on Foreign Relations


Fewer people are smoking in the United States, Europe, and most of the developing world. Excise taxes, bans on smoking in public places, and graphic health warnings are achieving such dramatic reductions in tobacco use in developed countries that a recent Citigroup Bank investment analysis speculated that smoking could virtually disappear in wealthy countries over the next thirty to fifty years. But as tobacco use declines in the United States and most developed countries, it is on the rise in low- and middle-income countries. Despite widespread participation in the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), tobacco taxes remain lower and warning labels smaller than the WHO recommends in most developing countries. No-smoking requirements often do not yet exist or go unenforced, even in hospitals and schools. With stagnating sales in high-income nations, multinational companies target low- and middle-income countries with still-limited tobacco tax and regulatory systems, using cartoon characters, sports sponsorships, purse packs, and other advertising gimmicks long prohibited in most of the developed world. Unless international tobacco control efforts improve, and soon, the WHO projects that tobacco will kill hundreds of millions in the coming decades, mostly in developing countries.