When a young paralegal in Mumbai or Hanoi lights up, it feels so good in so many ways. She loves the nicotine hit, of course, but she loves even more to exhale in the sexy way Scarlett Johansson did in A Love Song For Bobby Long. All over the developing world, young women with rising incomes and new freedom to make their own decisions are taking up smoking to chase their dreams -- and, in turn, making the dreams of cigarette marketers no longer welcome in rich industrialized countries come true. This gives the folks at the World Health Organization nightmares.
According to the new edition of The Tobacco Atlas, about 200 million women smoke cigarettes worldwide, compared to 800 million men. This gender gap is widest in Africa, Asia and the Middle East. In Vietnam, for example, more than half the men smoke -- but fewer than 2 percent of the women do.
Cigarettes killed almost 6 million people in 2011, 80 percent of them residents of low and-middle-income countries. And the toll is sure to rise in next few years, as the rising tide of men who've been smoking heavily for a lifetime pay the piper. But looking decades down the road, the magnitude of the body count will largely depend on the choices made by women in the developing world.
The battle for their hearts and lungs is already raging. On one side, tobacco companies are spending billions of dollars in less-exploited markets to portray women who smoke as liberated, sexy and slender. On the other is the World Health Organization, which, in league with local activists, is attempting to head off Big Tobacco with campaigns to educate women about the decidedly unsexy consequences of inhaling.
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No small challenge. Public health campaigns in developing countries have traditionally been focused on the infectious diseases associated with poverty. These diseases are (relatively) easy to fight -- you can, for example, contain malaria by bombing mosquitoes with pesticide and handing out nets. But fighting the diseases of affluence, like heart disease and cancer, means playing the Grinch, asking people to deny themselves a modest perquisite of affluence.
Countries typically experience the tobacco epidemic in four stages. In the first, wealthy and educated people start using. In the second, tobacco use spreads through the population. In the third, smoking starts to fall among the early adopters, while lower-income, less-educated groups persist. In the fourth, the overall rates of smoking decline, even as the delayed effect of smoking increases tobacco-related deaths.
The United States is now moving through the fourth stage. The percentage of Americans who smoke declined from 42 percent in 1965 (the year after the US Surgeon General's famous report) to 19 percent in 2010. Only 6 percent of Americans with graduate degrees now smoke (though 25 percent of high school dropouts are still puffing). Some 23 percent of deaths in the US are tobacco-related.