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Tobacco Control

Strategy Overview

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Tobacco industry marketing has contributed to increased smoking rates among women in low- and middle-income countries.

our goal:

to reduce tobacco-related death and disease in low- and middle-income countries by preventing the initiation of new smokers, decreasing overall tobacco use, and reducing exposure to secondhand smoke. 

The Challenge
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At A Glance

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Tobacco use is the world’s leading cause of preventable death, with nearly 6 million people dying of tobacco-related diseases each year.

Tobacco use has accelerated in low- and middle-income countries, where the tobacco industry is increasing its aggressive marketing, often directed at women and children.

We support the Framework Convention on Tobacco Control, an international treaty that compels its 179 signatory countries to meet minimum tobacco control provisions.

We support partners who are working to address the tobacco epidemic in more than 30 countries in Africa and Asia.

Our Tobacco Control strategy is led by Cynthia Lewis, deputy director of Global Policy & Advocacy, and is part of the foundation’s Global Policy & Advocacy Division.

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Worldwide, more than 1 billion people use tobacco products—the only consumer products that, when used as directed, will kill half of all users. Tobacco use is the world’s leading cause of preventable death, with nearly 6 million people dying of tobacco-related diseases each year, including more than 600,000 nonsmokers who are exposed to secondhand smoke. If current trends persist, tobacco will kill more than 8 million people each year by 2030—80 percent of them in the developing world.

In recent years, tobacco use has stagnated in higher-income countries while accelerating in low- and middle-income countries. Tobacco industry revenue continues to climb, and aggressive marketing of tobacco products in the developing world is increasing, often directed at women and children. Many of these countries lack strong tobacco control policies and have little awareness of the health effects of tobacco. In countries that grow tobacco and produce tobacco products, the tobacco industry has enormous influence on public policy and wages relentless and well-funded advertising, promotion, and sponsorship campaigns.

The Opportunity
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In 2003, the World Health Organization adopted the Framework Convention on Tobacco Control (FCTC), the world’s first and only global public health treaty. The FCTC compels its 179 signatory countries—many of which are low- and middle-income—to meet minimum standards in tobacco control provisions, offering a powerful lever for tobacco control efforts worldwide. The measures contained in the FCTC provisions have proven cost-effective and successful in reducing tobacco use in higher-income countries and have the potential to significantly advance tobacco control efforts in low- and middle-income countries. We see great opportunities in the following regions and countries:

  • Africa. The tobacco epidemic in Africa is at a relatively early stage, so now is a critical time to invest in campaigns and research to support policies that can prevent a large-scale epidemic. As incomes rise for a growing African population, tobacco use could double in the coming years if strong tobacco control measures are not implemented.
  • China. China is the world’s largest producer and consumer of tobacco, and an estimated 27 percent of the population—more than 350 million people—are smokers. Tobacco control progress in China will mean vast benefits in terms of improved health and lives saved.
  • Southeast Asia. In Southeast Asia, where tobacco consumption is relatively high and regulation remains quite low, the opportunity exists to make a significant health impact as economic growth accelerates in many countries. 

Our Strategy
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Many of the FCTC’s 179 signatories are low- and middle-income countries, where tobacco control has often been a lower priority than other health challenges. Governments frequently lack data on tobacco-related health issues, tobacco industry interference remains high, and the capacity of tobacco control advocates and policymakers to implement control measures is uneven.

Bill Gates and Michael Bloomberg have called on government and business leaders to make the fight against tobacco use a higher priority.

The Bill & Melinda Gates Foundation’s Tobacco Control program works to address these challenges by supporting a well-coordinated network of strategic partners who are based primarily in the regions where we work—Africa, China, and Southeast Asia—and who are able to effect change through effective sub-grants and efforts to build the capacity of civil society organizations and governments. Since 2008, we have committed nearly US$210 million to partners who are working to address the tobacco epidemic in more than 30 countries in Africa and Asia. Bloomberg Philanthropies is a key partner in this work; we closely coordinate our tobacco control efforts in Asia and support highly complementary efforts in other geographies.

While clinical smoking cessation is not a focus of our investments, we acknowledge its critical role in limiting overall tobacco-related death and disease and we applaud the efforts of other organizations in this area. We also recognize the importance of other needs in tobacco control, such as considering alternative livelihoods for tobacco farmers and addressing cross-border smuggling. We monitor these issues closely and take them into account when we make strategic decisions about how to allocate our funds to reduce tobacco use.

Areas of Focus
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Policy Interventions 

Tobacco control policy interventions save lives. Among them, tobacco taxation offers a particularly crucial advantage in addition to reducing tobacco use—it can provide much-needed domestic revenue to help fund a range of public health and development efforts. Working through strategic partners in Africa, China, and Southeast Asia, we support education and advocacy at the country level for implementation of FCTC provisions, particularly tobacco taxes that raise the price of cigarettes for the consumer, comprehensive bans on tobacco advertising, graphic health warning labels and plain cigarette packaging, and indoor smoking bans. We support local, regional, and global partners who can coordinate with and build the capacity of advocates and policymakers to implement these measures.

Social Marketing 

When policy change approaches are combined with targeted and creative social marketing to educate the public and policymakers and shift perceptions related to tobacco use, the two efforts can be mutually reinforcing and lead to significant and lasting change. We support partners in Africa and Asia who are leading both traditional mass media campaigns as well as more targeted and innovative campaigns to shift knowledge, attitudes, and perceptions about tobacco use, tobacco products, and the tobacco industry among current tobacco users and those at risk.

Building the Evidence Base 

Without accurate information on the size and nature of the challenges and successes in tobacco control, governments in low- and middle-income countries have limited ability to draft or implement effective policies. Tobacco control advocates need local data to support the case they make to governments—and to counter the powerful influence of the tobacco industry’s misinformation. We support local and global research efforts to build this critical evidence base, including new and updated economic analyses on tax policy and the economic impact of taxation, data on tobacco consumption among youth and adults, global tobacco industry tracking, and research on cigarette smuggling.

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