Jennifer Fang and Kelley Lee
Despite 7 million deaths annually and counting, tobacco control worldwide continues to be seriously underfunded as a public health priority. This funding gap is especially acute in low-income countries and among certain historically disadvantaged populations. It is into this space that the Philip Morris International (PMI) financed Foundation for a Smokefree World (FSFW) has stepped in to flash the cash in a search for allies. In 2018, the Foundation provided funds to create the Centre for Research Excellence: Indigenous Sovereignty and Smoking in New Zealand. Indigenous peoples in settler countries, such as the Maori population in New Zealand, have higher smoking rates and, consequently, disproportionate levels of tobacco-related disease and deaths. The appropriateness of accepting tobacco industry funding, to address a problem created and sustained by that same industry, has been deeply controversial.
It is in a similar context that the Foundation has gone knocking in Malawi. The country’s economy is the most tobacco leaf-dependent in the world. While the government accepts the need to diversify, many development agencies have declined to engage with farmers due to their association with the tobacco industry. This presents an opportunity for the FSFW to step in with funding to “address the agricultural impact of smoking cessation.” Its engagement in Malawi includes plans to establish a Center for Agricultural Transformation and a “signature” regional conference to “inform a strategy and action plan to drive economic diversification.” In November 2018, one of the authors conducted interviews with policy makers, farmers unions and ex-tobacco industry employees in Malawi to understand the role of China in Malawi’s tobacco industry. We found positive interest in Malawi in the planned centre’s capacity to “assist the country to diversify”. Knowledge of its PMI was not mentioned by interviewees. The centre has the potential to embed FSFW (and through it, PMI) within policy making networks, and create a position of ongoing influence, in the country.
A further strategic target of the FSFW’s largesse is China, where the official annual number of tobacco-related deaths has now reached one million. We conducted interviews with tobacco control experts in China in July 2016 to understand local perceptions of the tobacco industry’s corporate social responsibility projects and found the longstanding shortfall in tobacco control resources was gravely apparent, with funding largely coming from external organizations.. In 2019, the FSFW Board Governance Committee recommended the appointment of “a director with expertise in China.” Anticipating challenges in navigating China’s complex policy landscape, a US$1.3 million budget was allocated to engage APCO Worldwide to “establish the necessary framework for the Foundation, including governance, infrastructure, staffing and support pieces.” It enhances the industry’s presence in Asia, where the vast majority of the world’s smokers reside. In the absence of institutional public statements against engaging with the PMI-funded Foundation in China, the entry of a controversial funder with deep pockets would be a major public health setback.
The three cases above suggest a pattern to how the FSFW is seeking footholds with underserved populations. Recipients welcome new resources to address longstanding needs. For PMI, this engagement strategy casts its FSFW in hero mode, undermining global tobacco control solidarity against the industry while sustaining its business plan to globally dominate both the traditional and alternative nicotine product markets.
Jennifer Fang is a Research Fellow at the Faculty of Health Sciences, Simon Fraser University, Canada. She is supported by the Social Sciences and Humanities Research Council grant 430-2018-00736. Kelley Lee is a Professor and Tier 1 Canada Research Chair in Global Health Governance, Faculty of Health Sciences, Simon Fraser, Canada.