Tobacco Road -- New Internationalist

new internationalist 127 September 1983

HEALTH

Australia's barefoot doctors

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Tobacco Road
Smoking sentences one million people to death each year from cancer, heart disease and respiratory infection. Compulsory health warnings are beginning to loosen tobacco’s hold on the rich world. But, as Dexter Tiranti reports from Malaysia, this has led to increased efforts in the poor world to hook people onto the deadly habit.

Whether it is Winston’s (‘the taste of America’), Rothmans (‘the kingsize cigarette of International success’), or simply the gold box of Benson and Hedges, cigarette promotion in Malaysia has been through the promise of status and success. And all over the country farmers, fishermen and rubber tappers, drinking toddy or sitting in coffee shops, have their flip-top packets prominently on the table in front of them — symbol that they too can share the good life.

In a recent survey of rural spending habits, at least two members smoked about 30 cigarettes a day in 70 per cent of households. And sales have been increasing — at a steady five per cent a year. Now more than 50 per cent of men and 20 per cent of women smoke (compared with 37 per cent of American males and 29 per cent of women). The major difference however, is that in Malaysia, as in most of the Third World, figures are rising; whilst in the US, Britain and most other Western countries per capita consumption has been steadily declining.

Whilst tobacco exports and imports are easy to track, the deadly consequences — in terms of heart disease, cancer and bronchial complaints — are more elusive. In Malaysia only 31 per cent of deaths are medically certified. But even these figures show a startling surge to top-of-the-league position for cigarette-connected illnesses and deaths. There are now 5,000-6,000 cases of cancer every year at the Radiotherapy Institute in Kuala Lumpur.

The three companies that dominate Malaysia’s cigarette market are Malayan Tobacco Company, Rothmans and Reynolds. The Malayan Tobacco Corporation (MTC) — part owned by the Malaysian government — is a subsidy of British American Tobacco, Britain’s second biggest company, ranked 49th largest in the world. MTC controls roughly three quarters of the Malaysian cigarette market, reckoned to be worth $350 million a year.

MTC’s biggest seller is Benson and Hedges. But what Malaysian smokers may not realise is that this, their favourite brand, racks up 31 milligrams of tar and nicotine while the British equivalent only has 17 milligrams. MTC has claimed that these figures are inaccurate: the real levels are much lower. ‘However for competition reasons we cannot disclose the exact figures.’ But MTC spokesmen have made it clear that the technology exists in their local cigarette-making factories to reduce tar and nicotine content ‘if and when there is a shift in preferences towards lower tar and nicotine cigarettes.’

Building up local allies has been central to MTC’s success. Working hand-in-glove with the government’s National Tobacco Board, they have encouraged expansion in tobacco growing. Today more than 55 per cent of Malaysia’s tobacco consumption is grown locally by over 44,000 farming families — who receive expert advice from government and industry representatives, guaranteed prices, and subsidies totalling $7.5 million from private companies and government funds over five years.

World tobacco consumption. The Government obviously welcomes a cash crop that increases the income of small farmers. Even more welcome is the revenue from tobacco taxes which supplies something like a half of the country’s income. But the authorities are also aware of the cost to Malaysians’ health.

In response to a nationwide campaign last year by more than a hundred organisations, including the Malaysian Medical Association and spearheaded by the Consumer Association of Penang (CAP), the government banned cigarette adverts on television and radio. They also prohibited smoking in all government offices, outlawed cigarette advertising in government publications, encouraged state governments to forbid billboard advertising, and raised cigarette taxes.

But the newspaper headline ‘Ban on smoking won’t affect tobacco industry’ late last year was probably accurate. The tobacco industry’s future still looks bright, said the newspaper, because of government support for increases in tobacco farming, stable prices and expansion of the National Tobacco Board’s credit scheme.

As CAP’s President Mohammed Idris has remarked, ‘There is no point in issuing weak and ineffective warnings that "Smoking is hazardous to your health" and at the same time devoting 35,000 acres of land to tobacco cultivation.’

Dexter Tiranti is an editor of New Internationalist, currently working for the International Organisation of Consumers’ Unions in Penang, Malaysia.

Taking a rough ride

The Toddy shop looked dirty. It was dirty – the irregular concrete floor littered with scores of cigarette butts, Guinness bottles and empty cigarette packets. The slowly revolving rook fan didn’t make much of an impression on the haze of smoke. In one corner was a man who’d just lit up. Taking the cigarette out of his mouth, he focussed his eyes through a none-too-clear pair of horn-rims and smiled disingenuously.

Did he mind being asked about smoking? Fire away he replied, taking another drag. This was Muhtu, caretaker of the toddy shop and proud father of six. His brand was Rough Rider: an appropriate choice. At 25 cents for 20 they were the cheapest in Malaysia – less than a third of the cost of Gold Leaf, Benson & Hedges or Winston.

He smoked about 20 a day, he said, had begun when he was ten and – now over 50 – declared it hadn’t done him any harm. Mind you, he looked over 60. And he didn’t mention aa time a few years back when he had been laid up in hospital for a month. They had thought it was tuberculosis. With a wink, another drag and a deep draught of toddy, he confided that he hadn’t let the doctor know he smoked; but had just emerged, after a month and some x-rays, none the worse.

Was he worried about cancer? No, only modern people with their fancy tinned goods go down with it. If you stick to good old fashioned spicy food with lot of chillies you’ll be all right. It depends on your body. A strong constitution stands you in good stead. Another factor in his favour, he said, was that he didn’t switch brands. That helped. Leaning back on the wooden and clearing away the fish bones and greasy newspaper in front of him, he warmed to his explanation. In fact he would have medical problems if he did give up. He had tried for a day or so and felt very ill.

Did the smoking affect his job? No problem there. I get up at five, brush my teeth, my wife brings me some water and I have my first cigarette. It’s like the one last thing at night. It relaxes you. Then it’s off on the trishaw to collect and distributes vegetables from the central market. Pedalling isn’t much of a problem except for the cough. I take it slowly. That’s over by eight o’clock.

Then after breakfast I come here and clean out the toilets. It’s good to smoke then. After that I clean up the floor. Judging by the litter, he obviously didn’t strain himself doing that.

What about the family? We could dismiss the women and girls, they didn’t smoke of course. Why not? Women don’t What if his wife did? I’d wallop her. Men have a right to do what they like. Women do what they’re told. Anyway smoking is more necessary for men. Look around. He gesticulated. Nearly everyone in the toddy shop had a cigarette in their hand. You see men have to smoke because they are in company more often. Finally, what about his sons? Two of the oldest smoke. But without my knowledge, he said with a twinkle in his rheumy eyes.