Growth market for death

With U.S. sales in decline, tobacco firms push their product in developing countries, particularly in Asia

Consider China, where more than 300 million people smoke. You'd think China's doctors would be fighting hard against this tsunami of risk. But a 2007 study found that more than 40 percent of the country's male doctors smoke; almost 40 percent of the smoking physicians say they light up in front of patients. China is one of 74 countries that still allow smoking in hospitals.

Big Tobacco has focused particularly on women. In many developing countries, few women smoke, usually because it's seen as improper. In China, the rate is 3 percent; in India, it's below 2 percent. Jonathan Samet, a professor at the Johns Hopkins Bloomberg School of Public Health, says that historically, national tobacco companies tended not to target women. The multinationals have no such reservations, he says: Throughout the developing world, the companies are introducing new brands and flavors aimed at women.

What to do? Since 1999, WHO has been pushing a global treaty, the Framework Convention on Tobacco Control, that requires countries to adopt a range of anti-tobacco measures. The pact has been ratified by more than 150 countries, and is beginning to show results. Since signing the agreement, for example, Mexico has passed a law that prohibits smoking in all workplaces.

Michael R. Bloomberg and Bill Gates have put up $500 million toward an anti-smoking campaign targeting the 15 countries with the worst tobacco problems, including China, India and Indonesia. It will use a comprehensive strategy focused on raising tobacco taxes; banning tobacco ads and promotion; limiting secondhand smoke; educating people about tobacco's hazards; and helping smokers quit.

This approach can work. After the Thai government adopted strong anti-smoking policies in the 1980s, it cut smoking among men by almost half over the next two decades. In the U.S., 24 states and hundreds of cities - including Baltimore - have banned smoking in restaurants and bars. Two decades ago, such limits would have seemed unlikely if not unimaginable. With planning and some help, the developing world can achieve similar success.

David Kohn, a reporter for The Baltimore Sun, spent last year as a

Nieman/Gates Fellow studying global health. His e-mail is

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