Intended for healthcare professionals

Observations Heads Up

Exporting disease, disability, and death

BMJ 2014; 348 doi: (Published 08 April 2014) Cite this as: BMJ 2014;348:g2221
  1. Krishna Chinthapalli, associate editor, BMJ
  1. kchinthapalli{at}

The tobacco epidemic is only just starting in most of the world

When the cigarette rolling machine was invented in 1881, the first words of James Duke, the founder of British American Tobacco, were, “Bring me the atlas!” He leafed through the population figures for each country until he stopped at China: 430 million people. “That is where we are going to sell cigarettes,” he said.1

A century later, in Duke’s home state of North Carolina, Senator Jesse Helms led efforts in the United States to open up foreign markets to British American Tobacco and other transnational tobacco companies. Section 301 of the US Trade Act 1974 allowed for retaliatory trade sanctions against any country that had “unreasonable” laws discriminating against US companies—which meant any obstacle to transnational tobacco companies advertising in those countries. In 1992 China agreed to lift all licensing requirements on foreign cigarettes to avoid the US imposing $4bn of tariffs on Chinese goods.2 The companies have since provided technology and expertise to the China National Tobacco Corporation, helping it to churn out 2300 billion cigarettes a year.3

In the 1980s cigarette advertising was banned in Taiwan. But the ban was lifted …

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