The World Health Organization reports that more than six million people die each year from tobacco-related diseases. Moreover, changing markets have generated a dramatic shift in consumption from high-income countries (HICs) to low- and middle-income countries (LMICs), and by 2030 more than 80% of the disease burden from tobacco use will fall on LMICs. To help facilitate this shift, opponents of tobacco control ? led by the tobacco industry and even some governments ? have successfully used the supposed harm from tobacco control measures to smallholder tobacco farmers as a reason to slow, stop and even reverse tobacco control interventions, particularly in LMICs. This complex nexus of economic, agricultural and public health policymaking may prove to be home to one of the largest threats facing tobacco control. The emerging battleground is concentrated in countries with weaker governance capacity, more politically vulnerable governments and a greater economic reliance on tobacco, which includes many countries in Sub-Saharan Africa and Southeast Asia. While there is a small literature examining some of these dynamics, there is a lack of cross-country and deep, individual-level evidence about the actual livelihoods of these farmers and the political economic context in which these dynamics are unfolding. Understanding the complexities of these livelihoods is a crucial component to addressing this challenge: helping policymakers to develop strategies to integrate public health and agro-economic policies positively, and in particular, to assist farmers in finding viable economic alternative livelihoods. Such policies supporting viable alternatives are needed to counter many existing ones that serve to propel or entrench tobacco cultivation. This project aims to fill the large research gap in this area by examining rigorously the economic lives of these farmers, and the political and economic processes that frame their livelihoods, in four major tobacco- growing LMICs ? Indonesia, Kenya, Malawi and Zambia. To reach this aim, we will first collect and analyze existing data and scholarship relevant to the economics and politics of tobacco farming in these regions. Informed by these findings, we will implement individual-level economic surveys of nationally-representative samples of farmers in four major tobacco-growing countries in Africa and Southeast Asia. We will complement the surveys with focus group discussions with farmers across the major tobacco-growing regions of each case country. Finally, using the expert consultation of the in-country co-investigators, we will extensively interview relevant actors in these countries, including relevant farmer organization representatives, ministry officials, civil society advocates, representatives of intergovernmental organizations, and industry representatives in order to illuminate the broader structures, policies and other important contexts that frame farmers' livelihoods. One of the project's principal aims is to improve research and policy analysis capacity in this vital substantive area in the region. Accordingly, there will be close cooperation among the HIC and LMIC co- investigators not only for research collaboration, but also to train a select cohort of graduate students (four in total) and two post-doctoral or post-graduate researchers in African universities and two in Indonesia who focus specifically on the political economy of tobacco control in LMICs. There is also a component in which three LMIC researchers will visit one of the North American institutions for post-doctoral studies. As the final component of our capacity-building strategy, the multi-disciplinary team will present the key findings to major stakeholders ? policymakers, advocates and scholars ? in a series of workshops across the region that elucidate the complexities of tobacco farming with an ultimate goal of creating a policy environment that is conducive to reducing the supply of tobacco parallel to efforts to control demand. At the same time, we will conduct workshops to present our findings to the survey and FGD participants so they can directly benefit from the researching to which they are contributing. These workshops will be accompanied by a corresponding set of country-specific reports and policy briefs that will also be distributed to key stakeholders. Finally, co-investigators will cultivate relationships with key stakeholders and engage in the presentation of research results and meaningful policy discussions in much smaller settings.

Public Health Relevance

Identifying how the tobacco industry and its allies successfully use the narrative of tobacco control harming the economic livelihoods of tobacco farmers will lead to more effective implementation of demand-side tobacco control policies generally and the provisions of the World Health Organization's Framework Convention onTobacco Control (WHO FCTC) specifically (e.g., taxation, smoke-free, marketing restrictions, packaging & labeling provisions, etc.). These provisions form the foundation of a coordinated global attempt to protect people around the world from the dangers of the number one risk factor for non-communicable disease, tobacco use. Similarly, rigorously capturing the nature of these livelihoods will equip public health proponents with the information necessary to counter these tobacco industry strategies more effectively. Government officials and civil society organizations in low- and middle-income countries (LMICs) will use this research to inform their strategies to address the tobacco industry's myths about the alleged harms of tobaccocontrol to tobacco farmers in order to protect existing and to promote better public health legislation. The research will also help to inform governments' attempts to encourage tobacco af rmers to try other economically viable livelihoods, which is not only a provision of the WHO FCTC (Article 17), but also central to healthier lives for the millions of tobacco farmers in LMICs.

National Institute of Health (NIH)
Fogarty International Center (FIC)
Research Project (R01)
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Special Emphasis Panel (ZCA1)
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Levintova, Marya
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American Cancer Society, Inc.
United States
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Lencucha, Raphael; Reddy, Srikanth K; Labonte, Ronald et al. (2018) Global tobacco control and economic norms: an analysis of normative commitments in Kenya, Malawi and Zambia. Health Policy Plan 33:420-428
Magati, Peter; Drope, Jeffrey; Mureithi, Leopold et al. (2018) Socio-economic and demographic determinants of tobacco use in Kenya: findings from the Kenya Demographic and Health Survey 2014. Pan Afr Med J 30:166
Labonté, Ronald; Lencucha, Raphael; Drope, Jeffrey et al. (2018) The institutional context of tobacco production in Zambia. Global Health 14:5
Appau, Adriana; Drope, Jeffrey; Labonté, Ronald et al. (2017) Disentangling regional trade agreements, trade flows and tobacco affordability in sub-Saharan Africa. Global Health 13:81
Makoka, Donald; Drope, Jeffrey; Appau, Adriana et al. (2017) Costs, revenues and profits: an economic analysis of smallholder tobacco farmer livelihoods in Malawi. Tob Control 26:634-640