World Health Organisation exploits tobacco farmers, the hungry, sick and poor in its crude activism.

On World No Tobacco Day, the WHO launches a campaign to "grow food, not tobacco" supposedly to address hunger and tackle tuberculosis (TB). None of it makes any sense.

WHO continues its mission to become the most foolish and inept international organisation to bestride the globe. This time with an absurd ill-judged campaign about tobacco farming.

Introduction – credibility haemorrhage

WHO seems to be getting more weird and erratic. In May, it really went for it.

15 May: WHO got into its stride, claiming that there are “Deadly long-term consequences” for users of artificial sweeteners based on crude misreporting of a systematic review.  As an expert ruefully noted: “If anyone actually takes these guidelines seriously, the ultimate outcome will be increased sugar consumption.”

29 May: WHO Executive Director Tedros high-fived Russia for Russia’s excellent work “to advance maternal and child health” – somehow overlooking the indiscriminate bombing, torture, rape and sexual abuse of civilians and its apparently systematic (by which I mean with genocidal intent) abduction and deportation of children from Ukraine to Russia.

31 May: WHO adds North Korea to its 34-member Executive Board “for balance”. Most neutral observers were horrified, but at least the move won the respect of Donald Trump, the former president who wanted to abolish WHO.

World No Tobacco Day – “Grow food, not tobacco”

31 May: but WHO surpassed itself on World No Tobacco Day. WHO is burning more of its credibility with a campaign against tobacco farming: Grow food, not tobacco, including a press release arguing that we should Grow food, not tobacco, to end TB and a report, Grow food, not tobacco that provides a veneer of sophistication, but on closer examination is just a string of baseless activist talking point. [note authorship and funding of this report are unclear]

Let me make ten observations about this nasty little PR package…

First, to be clear…  tobacco farming practice makes no difference to the public health impacts of smoking. For tobacco leaf, supply follows demand.  Farm gate prices of cured tobacco are significantly less than one US cent per cigarette – far too low to affect demand through price variations. The supply will expand or contract with expanding or contracting demand; limiting supply through farm diversification cannot cause demand to contract, only displace to somewhere else. Demand for different types of tobacco (e.g. Burley vs Virginia) may vary in response to changes in regulation and taste preferences, but the market will ultimately clear to match supply with demand.

Second, the typical tobacco farmer is just selling a cash crop at an auction or under contract. It is usually sold at the market or under contract to a merchant, who then sells it to tobacco companies. After it is sold to the merchant, the farmer has no stake in what happens next. Tobacco farming is about agricultural practice, livelihoods, and any health or environmental risks arising to tobacco farmers (farms of all types put farmers at some degree of risk). For WHO, it’s about as relevant as tackling whoever makes the cellophane for the cigarette wrappers. It just has no bearing, nil, on WHO’s objectives regarding smoking and non-communicable diseases.

Third, growing cash crops (tobacco, tea, coffee, cotton etc.) is a common farming model worldwide – the farmers do not go hungry because they do not produce food, but they sell their products and buy food with the money they make. This is also true for food crops – most farmers grow to sell.  The worst form of agricultural livelihood is subsistence farming, where the farm household does rely on their own food production. This is an extremely vulnerable and precarious existence. The most important goal for farmers living in poverty is to raise household income, usually by growing and selling more produce at higher prices.

Fourth, if we were concerned about tobacco farmers’ welfare, and WHO really is not, then we would focus on improving tobacco farming productivity and modernisation. This is how to raise farm income. This means raising the yield (kg per hectare) and improving the quality (reflected in $ per kg sold).  Roughly speaking, yields can vary from 500-4,000 kg/ha and prices from $1-6/kg within a given market. Within this productivity frontier, there is usually considerable room for improvement on a given farm. Such improvements would be achieved through agronomic advice services, improved use of fertiliser and pesticides, use of irrigation rather than rain-fed systems, improved curing barn technology, and more sustainable fuels for curing. If we cared about the welfare of these farmers, we would be drawn to issues like land tenure reform (secure tenure can provide collateral for investment), the availability of finance, how well the contract farming model operates compared to selling in a spot market, and anti-competitive practices. We would oppose production-based subsidies but look kindly at development finance. This sort of approach would increase farm income and welfare, reduce the share of labour inputs, allow some land area to be released for farm diversification and press more marginal farms into abandoning tobacco farming. This is not what WHO has in mind. In fact, it sees support for productivity improvements as a problem – a trap:

In most countries, farmers have had trouble shifting away from tobacco because of the incentives provided by the tobacco companies, such as seeds, fertilizers, construction of barns or access to finance or credits

WHO, Grow food, not tobacco, 2023, page 4.

Or worse still, efforts to reduce deforestation because of, er, deforestation.

The tobacco industry is also notorious for greenwashing its tactics. In 2022, Philip Morris International launched a programme of zero net deforestation of managed natural forests and no conversion of natural ecosystems to protect natural habitats, particularly biodiversity sites of global importance and protected areas. Meanwhile, tobacco growing accounts for about 5% of total deforestation.

WHO, Grow food, not tobacco, 2023, page 17.

And promoting diversification and improving living standards is just a diversion from authentic suffering.

Additionally, the tobacco industry has set up several organizations and programmes which aim to support the livelihoods of tobacco-growing communities through crop diversification methods and schemes that aim to improve living standards of farmers. Introducing new crops while continuing to grow tobacco does not eliminate the risks of tobacco growing. These efforts divert public attention away from the real costs of tobacco farming, such as poor health outcomes, environmental degradation and poverty (19).

WHO, Grow food, not tobacco, 2023, page 17.

Fifth, there is no global food security case.  A shortage of available land NEVER causes hunger. Hunger is almost always caused by systemic disruption of food supply – typically arising from conflicts, autocracies, trade embargoes, import barriers or exchange rate policies, and poor resilience to natural or man-made environmental hazards. Action on Hunger identifies six countries with the worst hunger problems in the world: Afghanistan, Ethiopia, Nigeria, Somalia, South Sudan, and Yemen. What do these have in common? It isn’t tobacco farming.  And it doesn’t take much to discover this, assuming you actually want to understand hunger and malnutrition rather than just use the suffering of others as a rhetorical gambit.

In fact, according to FAOSTAT data, tobacco land use is at its lowest point since 1961 (start of records):

However, before everyone celebrates the end of smoking, note that tobacco production is about where it was in the early 1980s.

This is because average productivity has improved (by about 13 kg per hectare per year globally). The chart below is constructed from the two curves above.

Sixth, the idea that the wrong crops are somehow being grown is extremely naive. WHO says, “Tobacco is grown in over 124 countries, taking up land that could be used to grow crops that feed millions of people, driving down food insecurity.”

WHO turns this idea into an emotional appeal in the following image:

WHO World No Tobacco Day campaign website

This is a picture of child exploitation. But, in this case, the abuser is WHO, and the child in the photo has been exploited to personify a baseless argument in a misguided PR campaign. There are plenty of good reasons to quit smoking, but starving children is not among them. This is profoundly unethical.

In fact, according to the UN Food and Agriculture Organisation (FAOSTAT), tobacco growing accounts for less than 1/1000th of land used for crops globally (in 2020, 3.17 million hectares were used for tobacco versus 4,741 million hectares for all other agriculture. See my explanatory graphic here and below). 

Seventh, there is no particular reason to single out tobacco compared to any other economic use of land, though the land area dedicated to tobacco is so absurdly small it cannot make any impact on global food production. Why not golf courses? Why not coffee?

What would make a difference is a widespread change of diet to consume less meat and dairy. The land footprint of livestock is huge – but meat and dairy supply a comparatively small share of food calories and protein. The analysis below is from the amazing data geeks at Our World in Data, Hannah Ritchie and Max Roser. See Global land use for food production (though note that not all land used for livestock can be repurposed for growing crops, and some crops are grown to feed livestock).

Eighth, the claim built into the World No Tobacco Day slogan “Grow food, not tobacco, to end TB” treats the reader like an idiot. How will doing something (vaguely specified) about tobacco farming help to “end TB”? Obviously, it won’t. Nevertheless, WHO explains:

Undernutrition and tobacco use are major determinants of TB globally. In 2021, of the 10.6 million people who fell ill with TB, 2.2 million were attributable to undernutrition and nearly 0.7 million to tobacco smoking. People who smoke tobacco have double the risk of TB disease, slower recovery, and a higher risk of unfavourable TB treatment outcomes, including recurrence of TB, death, and post-TB pulmonary and cardiovascular disease. Smoking cessation during TB treatment can improve treatment outcomes and has been shown to reduce the risk of TB infection and TB disease among household contacts as well. Improving food security and reducing tobacco smoking globally will therefore contribute significantly to the fight to end TB.  

World Health Organisation, 31 May 2023

The reasoning here is facile and fails completely on two counts.

(1) doing anything about tobacco farming has zero effect on smoking or TB, which is not caused by tobacco farming. There just is no mechanism by which some sort of farm diversification activity reduces supply, increases cigarette prices by a detectable amount, or alters consumption.

(2) Food insecurity is not caused by tobacco growing or land shortages. It is usually down to conflict or other forms of food system disruption. Tobacco farmers sell tobacco to buy food and other essentials and make the economic choices available to them. If it were possible to somehow convert all tobacco-growing land to food production, that would have a negligible impact on the global food supply, hunger, malnutrition or TB. Far larger forces are at work.

Ninth, how does WHO end up producing emotive but deeply misleading nonsense like this? Where is WHO’s internal quality control discipline? Why don’t its member states (its paymasters) or its Executive Board (its governance) hold it more robustly to account? Where is the value for money? Where is even a rudimentary argument? What is the WHO’s impact on tobacco-related disease? Why is the WHO claiming it has something to do with TB? WHO is wasting everyone’s time on the wrong issues and not doing anything about the issues that count – getting people to stop smoking.

Tenth and finally, there are, of course, many problems facing tobacco farmers. There are challenges like climate change facing farmers of every crop in every country, especially in poorer countries. For example, child labour on farms in poor countries is a generic problem (see coffee, for example), and the ILO estimates 112 million children are engaged in agricultural labour and another 48 million in industry and services. That’s not to excuse it in the tobacco sector but to recognise it has deeper causes with a view to finding ways to address it. And there are also specific problems associated with tobacco farming in relation to handling the crop and curing barns – again, modernisation is the key.

But while there is demand for tobacco, there will be tobacco farming. The question for international agencies (and the tobacco supply chain) is how to address those generic and specific problems to the extent possible as if the welfare of the tobacco farmers was a primary concern. WHO offers nothing in that regard – just baseless advice to grow something else.

The right way to help farmers is through the lenses of livelihoods, welfare, and farm economics. It is not through an ill-advised spin-out of an incoherent public health or anti-industry campaign by an agency that seems to have no idea what it is doing. WHO is blundering around and embarrassing itself in an area outside its mandate. The Food and Agriculture Organisation (FAO) has the food and agriculture brief in the UN system. The International Labour Organisation (ILO) has the brief for workers and child labour. Ultimately, the decline of tobacco farming will arise from a decline in tobacco use and possibly the greater use of synthetic nicotine in the supply of pharmaceutical nicotine. WHO should be using its resources to address the demand side, not the supply. Maybe the WHO should leave the relevant expert agencies to get on with the job and focus its energies on reducing smoking through prevention, cessation and harm reduction.

Why would I comment on this? Well, it is important to everyone that the World Health Organisation functions as a credible and neutral problem solver at the international level. It should have a critical role in the international system as the primary advocate for public health. It should not be playing infantile rhetorical games like some kind of naive activist NGO. The fundamental lack of seriousness will not serve WHO well in tobacco policy or in any other area. WHO has an endowment of public trust – but that is on license and can be withdrawn if it continues to mislead, oversimplify and ignore real-world analysis.

Other posts about WHO’s failings in tobacco policy

On tobacco policy and, worse, on tobacco harm reduction WHO has terrible form:

Note. I spent four years from 2014-18 living in Zimbabwe, which is a significant tobacco-growing state, and tobacco plays a big role in its politics – so I learnt something about it. I’m not claiming to be an expert on tobacco farming – far from it… but it is not difficult to see straight through the arguments made by WHO. I really don’t like WHO taking liberties with those suffering from hunger, TB, smoking-related disease, and, yes, the adverse effects of tobacco farming. They are misappropriating and trivialising them for a PR initiative that will be forgotten within a week.

Photo: Clive Bates, 2017

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