If your income is low, you’re likely a smoker

As any smoker will tell you, smoking costs some serious money. Even if you don’t feel it full way due to cost spreading, if you look back at a life spent being a smoker and run the numbers you might surprise yourself with the things you went without and could have bought or experienced — since, evidently, you had the money. But you spent it smoking. I should know, I saved a lot of money by quitting. But that’s beside the point.

About a year ago my partner and I decided we had to quit. We had both been smoking for some years. And so we did; we just went cold turkey and didn’t touch cigarettes for the rest of the year. Now we cheat from time to time, whenever we’re in social situations that require a Camusian attitude.

But one thing she told me a few months into our more “healthy” lifestyle got me thinking: looking around, the only people she saw that were smoking were people that didn’t seem that well off. Was she right? I thought so, too (and still do). Seeing how I’ve started this blog in the meantime, I decided to explore the topic and see if it is or isn’t true that poor people smoke more.

Researching the habit, I found out not only that it’s spread across the whole planet — but that it’s also quite old. It’s widely believed that humanity’s first instances of smoking date back to as early as 5000 BC — but we can’t really tell the exact spot or time. What we do know is that it was first used somewhere in the Americas, and that prior to the arrival of Europeans, native Americans would use tobacco as a barter item.

Sourced from Wikipedia Commons — The earliest image of a man smoking a pipe, from Tabaco (1595) by the British pamphleteer Anthony Chute.

But the plant also held an important role in spiritual ceremonies; tobacco was seen as a gift from the gods, and the smoke exhaled, the medium of communicating with the other world. Europeans failed to grasp the spiritual aspects of tobacco (at least in its raw form) and instead found it useful for the sole reason that it was enjoyable to smoke. Brought home by the Spanish in the year 1528, tobacco slowly started spreading from there, and exploded as a worldwide consumer product once cigarette rolling machines were invented.

Sourced from Wikipedia Commons — American inventor, James Bonsack’s cigarette rolling machine, as shown in U.S. patent 238,640 (1881).

But prior to mass production of cigarettes, smoking tobacco wasn’t so widespread a practice amongst developing countries. The habit has, without a doubt, increased in frequency in recent decades, after the more mature economies of yesteryear started exporting cigarettes to new markets in the developing world.

Thereafter all it took was a little time for those nations to start growing tobacco in order to produce cheaper cigarettes, and make some money exporting themselves.

Data from the Tobacco Atlas (which serves as major source for this post) shows that in 2014 the country with the largest number of smoked cigarettes, worldwide, was Montenegro — with 4125 cigarettes smoked per capita. This would add up to about half a pack per day, per person. Honorable mentions include Belarus with 3831, Lebanon with 3023, Macedonia with 2732 and Russia with 2690.

There are more than 4000 chemical substances in cigarette smoke; 50 of them are known to cause cancer.

Tobacco is the most common plant smoked around the world and it’s truly spread across the whole planet. Nowadays it’s laced with additives so that the production process of cigarettes can be controllable and standardizable, with side effects all too known: there are more than 4000 chemical substances in cigarette smoke; 50 of them are known to cause cancer, and 250 more are proven to be harmful.

And most cigarettes, by quite the margin, are made in middle-income nations (as defined by the World Bank). High-income nations come in second by volume, going up to roughly ¼ global production and ⅓ of middle-income nations’ production. What’s left (low-income countries) barely make a dent in global cigarette production.

So poor nations make the least amount of cigarettes, and middle-income nations pretty much build the world market.

It’s worth looking into this a bit more in detail, if only just for context. China — which is, according to the World Bank, a middle-income nation — produces more cigarettes than the following 14 countries combined!

The only cohort which expects an increase in the number of smokers by the year 2025 is that of men in countries with low income.

While smoking is a practice less condoned in high-income nations, it’s becoming ever more popular in middle and poor income countries, especially amongst men with little to no earnings.

My own research has come to a similar conclusion. By using data from the Tobacco Atlas and the World Bank I’ve found that the only cohort which expects an increase in the number of smokers by the year 2025 is that of men in countries with low income.

All other cohorts are set to expect a drop in the percent of smokers they have, with the highest drop foreseen in countries with high income. But this isn’t all good news since models also predict that the 21st century might still see 1 billion deaths as a result of smoking alone.

The numbers go down everywhere, but smoking is far from dying out.

The World Health Organization estimates that tobacco kills roughly half of its users, which means up to 6 million people per year — with 10% of those deaths being caused by secondhand smoke.

600.000 people die every year from secondhand smoking.

This is the case despite over 1 billion people having been covered by tobacco consumption control measures since 2008. What’s more, about 4 out of 5 people on Earth have little to no cessation programs if they’re looking for help in quitting the habit. Given all of the above, the efficiency of such programs is set to drop significantly from what they were originally supposed to achieve.

There are a certain few techniques that do work, at least most of the time. Banning tobacco advertising, promotion or sponsorship altogether are supposed to reduce overall tobacco use in a population. Even though most might see smoking as a habit independent of market forces, it’s not always the case.

Habits get reinforced via advertising so that smokers don’t forget that they are smokers in the first place. The World Health Organization predicts that a total ban on such adverts could result in a consumption decrease from 7% to as much as 16%.

The first anti-smoking campaign took place in Nazi Germany.

What’s more, mass media campaigns also take a hit at the numbers of smokers. And there’s a long love-hate history between the press and tobacco companies. The first anti-smoking campaign took place in Nazi Germany, where scientists had been trying to define the relationships between smoking and health problems for some years — no doubt in part due to Hitler’s aversion for cigarettes. Science, etiquette and the cult of personality ultimately lead to a ban on smoking in public places, first enforced in the year 1941.

Anti-smoking adverts on packs of cigarettes also reduce smoker counts by discouraging younger segments of the population and tend to increase the frequency of quitting. Yet only 19% of the world (42 countries) have such programs in place. There are multiple reasons why this is, but I’ll get to that in a minute.

Ultimately, a comprehensive study by the World Health Organization in 2003 found that the most effective approach to getting people to quit is a combination of:

• bans on positive advertising
• education campaigns for the wider public
• restrictions on consumption where it’s already present
• and price increases.

Which brings me to money. Tobacco taxes are, say the World Health Organization, the most cost-effective way to reduce tobacco use, especially among the poor and the young of society. Their math adds up to this:

“(…) increase tax 10% and you’ll see 4% decrease in smoking in high-income countries, and 5% in poor or middle-income countries.”

Yet I see some plot holes in this story; the largest of which is that over-taxation creates black markets. For those unfamiliar with this, the idea is in itself very simple: if cigarettes are too expensive for the income of a people, then some of those people will start smuggling in contraband cigarettes to better meet the demand.

Anyway, since we already know that high-income nations are already seeing the largest drop in smokers’ count and will continue this trend in the next few years, it should come as no surprise that these nations also enforce the highest excise taxes.

Half of the price of a pack of cigarettes is excise tax if you’re buying in a high-income nation; whereas only about a third (give or take a few percents) of the price is tax if you live in middle to low-income nations.

So why don’t we see higher taxes practiced all over the world? The answer can be boiled down to a few major points:

1. One is that governments in poor income countries often face a choice between spending on tobacco awareness programs, and collecting taxes from cigarette consumption. If the choice isn’t black and white yet, add this bit of context: roughly $9100 is collected in excise tax for every $1 spent on prevention (at least according to a 2012 study published in British medical journal The Lancet).

2. The other factor is much more sombre: in nations with low income, dying from smoking-related affections just isn’t that big of an issue yet. You can think of it like this: in some ways, having a lot of deaths from tobacco-related complications means that your society doesn’t encounter other major issues, such as disease outbreaks, wars or famine — all of which are prone to low-income nations. This is one of the reasons why in developed nations we see much larger percentages of people dying from smoking than in low-income nations. Death from smoking means that, for better or worse, your life wasn’t systemically violent.

Death from smoking means that, for better or worse, your life wasn’t systemically violent.

Still, only 18% of the world’s population is protected by smoke-free legislation. Most if not all of that 18% is comprised of people living in developed nations.

Which brings me to this: since poor nations are poor for lack of money, shouldn’t they smoke less? I mean, since people have smaller amounts of disposable income, shouldn’t it follow that they can’t spend money on buying cigarettes?

When taken into context, this becomes ever the more pertinent question, since on average a pack of cigarettes in poor countries values fifteen times what its price tag states.

So even though you get taxed more in high-income states, it’s overall much more affordable to get your hands on a pack of cigarettes in such a place than if you were in a low-income nation. Middle-income nations come to average out the gap between the two extremes, but a pack there is still valued at about double what it would be in absolute currency.

High-income nations have the overall highest prices per pack, but that doesn’t make them the most expensive. It’s really the poor countries of the world where cigarettes are most valuable. So how in the world can poor countries still smoke more than more developed ones, given the situation and context?

Let’s start with how our minds are hardwired: a Duke University study from a few years ago published results that highlighted how being stressed by living conditions and social insecurity erode a young person’s sense of self-control, and that the said lack of control is often times a leading cause of people starting to smoke.

This comes to explain why people start in the first place, but in a way, it would apply to all places where life is tough, regardless of income segment. With such high (especially when adjusted) costs, how are young people in low-income nations in a position to smoke in the first place?

The answer is simple: just buy one cigarette at a time.

The answer is both simple, and quite silly, considering it doesn’t take much brain power to implement. Just buy one cigarette at a time. A study by the Tobacco Control Research Group in the UK found that in poor countries 64.2% of stores sell single cigarettes, compared to just 2.8% in high-income nations. Add to this how it’s possible for multiple people to pitch in with money to buy one pack and you quickly see how it’s possible to spread out the costs and get access to cigarettes even in poor countries.

So even though costs are high, if people want to smoke it looks like they’ll find a way. Youngsters with little or no income all over the world have proven this point over and over again ever since tobacco first got a price tag.

So it’s only natural we also take a look at this demography as well. Looking at the percentages of children aged between 13 and 15 years in 2005 that were smokers, we can see that by the year 2025 (so when these children will be 35) the smallest drop predicted will be in the low-income tier of nations, with double that drop in middle-income and double that in high-income nations.

So much about demand, but what about supply?

Given the evident fact that they’re losing business in the developed parts of the planet, tobacco companies are now shifting their markets to poor and developing parts of the world.

This adds necessary contrast to see the accurate picture of why poor nations do, in fact, smoke more. It isn’t all bad decisions and escapism from a harsh life; it seems that people in less developed parts of the world are nowadays falling for the same things that made the developing world of yesteryear embrace smoking.

As researcher Gary Giovino stated in The Lancet when speaking of smoker demographics, the “burden of tobacco use is moving”. It is predicted that 1.5 to 1.9 billion people will be smokers in 2025, most of them in low and middle-income nations — and there doesn’t seem to be any real willpower to protect people from smoking in places other than high-income nations.

So how do tobacco companies target poor people? Well, the simple answer is advertising (more and bigger ads) and of course marketing to younger and poorer people (including selling cheaper cigarette brands in poorer areas).

The burden of tobacco use is moving.

A 2015 study measured how people living in low-income countries were exposed to a whopping 81 times more tobacco advertising than people in high-income countries. Cigarette companies target these people very specifically; they market to their wanting to escape from the realities of their lives and create fantasies by which collectives of smokers somehow enjoy the little things in life more, and more often.

The fact that such practices are still up and running should tell us that tobacco companies are encountering some success with the last population segments they can still hope to win over. Looking at continents highlights the following:

• Africa is projected to pick up smoking, even more, reaching about 40% saturation in 2025. All income segments are expected to increase consumption. This is where tobacco companies are waging their campaigns — the biggest of which aren’t sore on the eye, but just… there. Africa is slowly receiving the supply of cigarettes the rest of the world is trying to quit. This market is very young, so the growth prospects are pretty big.
• Europe is projected to see a drop until 2020, and then an even sharper fall until 2025 when about 30% of people will be smokers. Even given encouraging decline, Europe’s market is mature and already hosts some of the most smoke-happy people in the world (smoking became cool in Europe, even if thanks to American advertising tactics).
• Asia is a diverse place. Poor countries will have some of the sharpest drops in smoking frequency worldwide; and well-off countries (where a pack counts for very, very little) will encounter very slight increases until the early 2020’s — only to go down after that. That makes the overall picture very stable with fluctuations of under 10% when in fact, the continent is undergoing some heavily dynamic changes.
• North America will see a drop in smoking as well, except for countries with low income. Even given this, this continent is expecting a drop till about ⅕ people will be smokers in 2025.
• Oceania, a relatively uncharted land when it comes to tobacco consumption, will see a slower drop in smoking until the turn of the 2020’s only to drop harder until about ⅓ of people will smoke — much like Europe.
• South America, where we only see middle-income nations, is on the brink of a sharp decline which will culminate in 2025 with the continent hosting the lowest percentage of smokers on the planet: just 19.78% of South Americans will consume tobacco in ten years time.

So whether you’re a smoker, former smoker or never-have-been in the first place, the lessons here are simple: smoking is bad and we’re just waking up to this reality. But you didn’t have to read my article to think that.

What you should understand from this is that poor people really do smoke more and that it’s by design: they’re the new target market of big tobacco.

Thanks for reading.

PS last week I got called a linguistic neocolonialist by a reader because I highlighted the versatility of English. You can do the same if you reach out on Twitter.

• West, Robert; Shiffman, Saul (2007). Fast Facts: Smoking Cessation. Health Press Ltd. p. 28. ISBN 978–1–903734–98–8.
• Doll, R.; Hill, B. (Jun 2004). “The mortality of doctors in relation to their smoking habits: a preliminary report: (Reprinted from Br Med J 1954:ii;1451–5)”. BMJ (Clinical research ed.). 328 (7455): 1529–1533; discussion 1533.doi:10.1136/bmj.328.7455.1529. ISSN 0959–8138. PMC 437141. PMID15217868.
• http://www.who.int/mediacentre/factsheets/fs339/en/ — Tobacco fact sheet
• Guindon, G. Emmanuel; Boisclair, David (2003). Past, current and future trends in tobacco use (PDF). Washington DC: The International Bank for Reconstruction and Development / The World Bank. pp. 13–16.
• http://www.theatlantic.com/international/archive/2013/05/which-countries-smoke-most-and-which-have-the-best-anti-smoking-ads/276422/ — Which Countries Smoke Most … and Which Have the Best Anti-Smoking Ads
• http://siteresources.worldbank.org/INTETC/Resources/375990-1089904539172/001TO008.PDF — study by Prabhat Jha, Frank J. Chaloupka, and Phyllida Brown
• http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61307-5/fulltext — Curtailing tobacco use: first we need to know the numbers — Jeffrey Koplan, Judith Mackay — The Lancet
• http://edition.cnn.com/2012/08/16/health/world-smoking-study — Largest-ever tobacco study finds ‘urgent need’ for policy change
• http://edition.cnn.com/2014/03/26/opinion/sandel-poverty-smoking/ — Why do poor people smoke more?
• http://www.sciencedirect.com/science/article/pii/S0091743504002646 — Tobacco advertising in communities: associations with race and class — Elizabeth M. Barbeau, Kathleen Y. Wolin, Elena N. Naumova, Edith Balbach
• http://pophealthmetrics.biomedcentral.com/articles/10.1186/1478-7954-12-5 — Cigarette smoking prevalence in US counties: 1996–2012, Laura Dwyer-Lindgren, Ali H Mokdad, Tanja Srebotnjak, Abraham D Flaxman, Gillian M Hansen and Christopher JL Murray
• http://www.ncbi.nlm.nih.gov/pubmed/3623663 — Spread of smoking to the developing countries — PubMed
• http://www.fctc.org/fca-news/opinion-pieces/1374-tobacco-marketing-zeroes-in-on-poor-countries — 81x more tobacco marketing in poor countries — Framework Convention Alliance
• Lloyd, John; Mitchinson, John (2008–07–25). “The Book of General Ignorance”. Harmony Books. ISBN 0–307–39491–3.
• Wigand, Jeffrey S. (July 2006). “ADDITIVES, CIGARETTE DESIGN and TOBACCO PRODUCT REGULATION” (PDF). Mt. Pleasant, MI 48804: Jeffrey Wigand. Retrieved 2009–02–14.
• Burns, Eric (2006–09–28). “The Smoke of the Gods: A Social History of Tobacco”. Temple University Press: 134–135. ISBN 978–1–59213–480–9. Retrieved 2009–03–22.