Tobacco has long been known to be linked with multiple negative health outcomes and it thought to be the number one cause of mortality in the US. At the time of my birth, more than half of all American adults smoked and over the course of my lifetime, the efforts of the medical and public health community, in addition to changing attitudes toward health and well being, have resulted in that number being halved. However, the majority of present day smokers are among the poorest of Americans. This results in increased health costs for a group which largely has no health insurance, in addition to a fair proportion of an already strained income going into the coffers of corrupt tobacco companies and federal, state and local tax funds. Put it this way, in 2010, a pack a day smoker will spend approximately $150 a month on cigarettes, or $1800 per year. A minimum wage smoker in Michigan working full time will spend 11% of his or her pre-tax income on cigarettes. This, of course, not only endangers health, but reduces opportunities for increasing living standards, thus exacerbating the cycle of poverty, a condition which tobacco companies could really care less about.

American tobacco companies, feeling the pinch of a declining number of customers have been looking abroad for new patrons. As developing economies expand and residents move from completely agrarian to cash based economies, the mix of addiction, access to monetary income, low awareness of long term negative health effects and nonexistent regulation will result in a windfall for such companies. Indeed, wordlwide production of tobacco is slated to be higher now than at any point in human history and the number of smokers has reached unprecedented levels, mostly in developing economies such as those in Africa and Asia.

Malawi is a major tobacco producer. Tobacco is grown on farms owned by British Tobacco at the expense of farmland that could be used to grow food. Tobacco requires curing, which requires that forests be cut to provide wood, further decimating the already bare landscape and creating prime mosquito habitat, excellent for the spread of malaria. Yet, despite this, tobacco was seen by my colleagues as an important economic hope for the future of Malawi, as if they were oblivious to the clear exploitation of foreign companies indifferent to the future well being of the country.

I recently encountered a story of a 2 year old in Indonesia (which is what inspired this post) who smokes 2 packs a day at the encouragement of his own father. It is worth mentioning that British American Tobacco recently purchased a large stake in the Indonesian tobacco industry. I wondered how much awareness people in the developed world have of how corrupt American companies, unable to do business here due to the political power of wealthy democracies, export their poisons elsewhere. It makes me think that about the oil spill in the Gulf of Mexico. We will be willing to place heavy restrictions of the production of oil in our waters, but will be happy to support off shore drilling in Nigeria, far away from our own interests.