摘要：Transnational tobacco manufacturing and tobacco leaf companies engage in numerous efforts to oppose global tobacco control. One of their strategies is to stress the economic importance of tobacco to the developing countries that grow it. We analyze tobacco industry documents and ethnographic data to show how tobacco companies used this argument in the case of Malawi, producing and disseminating reports promoting claims of losses of jobs and foreign earnings that would result from the impending passage of the Framework Convention on Tobacco Control (FCTC). In addition, they influenced the government of Malawi to introduce resolutions or make amendments to tobacco-related resolutions in meetings of United Nations organizations, succeeding in temporarily displacing health as the focus in tobacco control policymaking. However, these efforts did not substantially weaken the FCTC. Malawi began exporting tobacco in 1893, 1 and today it is the world's most tobacco-dependent economy. Tobacco accounts for 70% of Malawi's foreign earnings, 2 , 3 and 600 000 to 2 million members of the country's total workforce of 5 million people are directly employed in the tobacco sector, which consists primarily of tobacco farming and factory processing jobs. 4 US-based tobacco leaf–buying companies Universal Corporation and Alliance One International control tobacco prices and influence trade policies in Malawi, restricting competition, depressing tobacco prices for Malawi's farmers, and contributing to the country's poverty. 5 Cigarette manufacturers and global leaf companies (merchant companies that buy tobacco leaf through prearranged contracts with manufacturers) fund child labor “corporate social responsibility” projects in Malawi to distract public attention from how they profit from low wages and cheap tobacco. 6 In addition, British American Tobacco (BAT), other cigarette manufacturers, and the International Tobacco Growers’ Association (ITGA), an organization created by tobacco companies in 1984 to weaken global tobacco control activities, 7 – 9 have used the governments of Malawi and other developing countries to lobby against global tobacco control efforts, 7 , 10 particularly the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC; Table 1 ). 11 The FCTC is an international treaty designed to reduce the health damage of tobacco by committing signatories to enact laws that control the tobacco industry's production and promotion of tobacco, increase taxes, and promote education about the dangers of tobacco use and secondhand smoke. The FCTC was passed in February 2005, and, as of April 2009, 164 countries (not including the United States) had ratified and were implementing the framework. TABLE 1 Malawi, Global Tobacco Control, and the Framework Convention on Tobacco Control: Timeline Date Event June 19–23, 1983 Nick Hauser meets with David C.W. Kambauwa in Italy to develop a program to work with Malawi to promote tobacco's economic importance. March 29, 1985 A Philip Morris official gives a speech to the company's executives and notes that the company lobbied Malawi to pressure the FAO to take a pro-tobacco stance in FAO publications on tobacco. 1988–1992 Hetherwick Ntaba successfully argues in WHO meetings that tobacco control negatively affects developing-country economies. November 1992 Allyn Taylor publishes article on WHO's power under Article 19 of its constitution to use international instruments to control tobacco. November 3, 1993 Martin Oldman states that tobacco industry reports will ensure that ITGA members are “singing off the same hymn sheet” to counter global tobacco control. October 10–14, 1994 WCTOH adopts recommendation (International Strategy for Tobacco Control) urging collective action on tobacco control. May 1995 World Health Assembly adopts Resolution WHA48.11, which integrates the recommendations of the WCTOH, to begin feasibility studies on the FCTC. May 1996 World Health Assembly adopts Resolution WHA49.17, requesting the director general of WHO to initiate the development of the FCTC in accordance with Article 19 of its constitution. May 1998 Gro Harlem Brundtland elected WHO director general and makes the FCTC one of her 2 top priorities (the other being malaria). July 1998 Tobacco Free Initiative is created. May 1999 World Bank publishes report Curbing the Epidemic: Governments and Economics of Tobacco Control ; WHO presents the report to the 52nd World Health Assembly as a technical document providing economic justification for the FCTC. May 1999 World Health Assembly adopts Resolution WHA52.18, creating FCTC Working Group and INB to initiate negotiation of the FCTC. October 1999 Lome Declaration (no information available on whether Malawi signed the declaration) October 25–29, 1999 First session of the FCTC Intergovernmental Working Group November 2000 Tobacco Control Commission of Malawi argues that WHO tobacco control would reduce Malawi's tobacco earnings by 10% a year. March 2000 ITGA conducts road show media event in Malawi in an effort to discredit World Bank evidence of the public health benefits of tobacco control. April–May 2000 ITGA works through Malawi's task force on the FCTC to attempt to undermine and delay meetings of the FCTC Working Group. March 27–29, 2000 Second session of the FCTC Intergovernmental Working Group May 2000 British American Tobacco and ITGA lobbying of Malawi and other tobacco-growing countries contributes to FCTC draft treaty text in which protocol language is weaker than the language of the original proposal. May 2000 53rd World Health Assembly adopts Resolution WHA53.16 to begin formal negotiation of the FCTC. July 2000 Yusuf Juwayeyi criticizes the WHO treaty process for lack of transparency, overestimation of tobacco-related death and disease in relation to HIV/AIDS and malaria, and underestimation of jobs generated by tobacco. October 12–13, 2000 FCTC public hearings in Geneva, Switzerland October 23–28, 2000 Malawi signs Nairobi Declaration at the Intercountry Meeting on Tobacco Control Policy and Programming. October 16–21, 2001 First meeting of INB March 12–14, 2001 Malawi signs Johannesburg Declaration at meeting of 21 countries from the WHO African Region. April 30–May 5, 2001 Second meeting of INB October 2–4, 2001 Algiers Declaration ratified at the consultative meeting of the WHO African Region; Malawi does not sign declaration. November 22–28, 2001 Third meeting of INB February 26–March 1, 2002 Malawi signs Abidjan Declaration at the consultative meeting of the WHO African Region on the FCTC. March 18–23, 2002 Fourth meeting of INB September 2–6, 2002 Malawi signs Lilongwe Declaration at the 4th subregional meeting of African countries on the FCTC. October 14–25, 2002 Fifth meeting of INB 2003 FAO releases report on the impact of tobacco control and the FCTC on world economies that notes Malawi's extreme reliance on tobacco. February 18–27, 2003 Sixth meeting of INB May 21, 2003 At the 56th World Health Assembly, 192 member states unanimously adopt Resolution WHA56.1 on the FCTC. February 27, 2005 FCTC becomes international law after 40 countries ratify it. February 2006 First Conference of Parties meeting June 30–July 6, 2007 Second Conference of Parties meeting November 2008 Third Conference of Parties meeting Open in a separate window Note . FAO = Food and Agriculture Organization of the United Nations; FCTC = Framework Convention on Tobacco Control; INB = Intergovernmental Negotiating Body; ITGA = International Tobacco Growers’ Association; WCTOH = 9th World Conference on Tobacco or Health; WHO = World Health Organization. As of April 2009, Malawi had not signed or ratified the FCTC. Malawi is an extreme but not unique case of how transnational tobacco companies have used developing countries’ economic reliance on tobacco to oppose global tobacco control. 11 As part of a broader strategy involving other tobacco-growing countries such as Argentina, Brazil, Turkey, and Zimbabwe, BAT and the ITGA sought the assistance of Malawi grower representatives and government officials in the Ministry of Foreign Affairs to argue tobacco's economic contribution in Malawi and pressure United Nations (UN) organizations involved in tobacco control to stress this contribution, diluting the health focus of tobacco control and delaying passage of the FCTC. The tobacco industry's influence on health policymaking in Malawi involves relationships between institutions and power and between the global and local levels 12 : “the constellation of actors, activities, and influences that shape policy decisions and their implementation, effects, and how they play out.” 13 (p 30 ) Researchers and social scientists have applied an anthropology of policy approach to the study of the influence of industrialized farming on communities, 14 to discussions of language and power in written policy documents on economic development, 15 and to the effects of contrasting meaning structures on environmental conflicts. 16 Despite transnational tobacco manufacturing and leaf companies’ high level of influence on health policies and tobacco-growing societies, anthropologists and health researchers have ignored the policy chain from tobacco farmers (policy recipients) to tobacco companies (policy influencers) and government officials (policymakers) that shapes policy directions and relationships ( Figure 1 ). We analyzed tobacco companies’ use of economic arguments regarding the benefits of tobacco in Malawi to obstruct the FCTC between 1992, when the idea of the framework first took shape, and the time at which the framework was passed. Our rationale is that if tobacco control efforts are to be effective in tobacco-growing societies, tobacco companies’ interference in health policymaking in those countries needs to be understood and ended. Open in a separate window FIGURE 1 Tobacco policy chain in Malawi. The influence of transnational tobacco manufacturing and leaf companies on the creation and obstruction of Malawi's tobacco control policies, as well as the policies of WHO and other UN bodies, reveals the economic and political power of tobacco companies in the global health policy arena. At the same time, possible outcomes of the successful implementation of the FCTC were changes in social norms and health behaviors and reductions in the power of tobacco manufacturing and leaf companies to undermine health policies.
