Tobacco industry, regional trade agreements and tobacco control in Sub-Saharan Africa

Over 80% of estimated global deaths from tobacco-induced diseases by 2030 are expected to occur in low- and medium-income countries, where tobacco industry has aggressively penetrated new markets. More importantly, tobacco industry has taken advantage of trade and investment agreements, which lower tobacco production and distribution costs. Additionally, many of these agreements have been created regionally, enabling tobacco industry to freely move goods and services within a region. We used mixed-methods approach to assess the impact of regional trade agreements (RTAs) in Africa on cigarette sales and analyze how tobacco industry used these RTAs to expand operations and undermine tobacco control. Four RTAs in Africa were thematically coded using Nvivo 9, followed by time-series analysis to determine cigarette sales rates between 2003 and 2011. Cigarette sales did not only increase but also significantly increased among those with stronger RTAs. Moreover, tobacco companies concentrated production of cigarettes in specific countries while taking advantage of larger markets provided by RTAs to promote their products. Tobacco companies capitalized on RTAs in Africa to promote tobacco, which calls for governments in RTAs to develop strategies to ensure that the companies do not take advantage of such agreements to promote their products and undermine tobacco control. The increase in tobacco sales in areas with more liberalized RTAs suggests the need for public health community to be concerned with how trade and investment impact tobacco use and health, especially without an explicit provision on trade and health in the WHO Framework Convention on Tobacco Control.