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Home » What We Do » Tobacco Control » Tobacco Control Projects » Tobacco and Poverty: Research and Capacity Building

Tobacco and Poverty: Research and Capacity Building

Introduction

This project seeks to increase knowledge and awareness of the relationship between tobacco and poverty in selected countries, while identifying similarities and differences in each that could be applicable elsewhere in the region and throughout the world. The project complement and built on earlier research undertaken by HealthBridge and its partners, and reflected new issues and realities that had emerged while expanding the cadre of researchers and organizations with skills to undertake research for advocacy.

Objectives

The objectives of this project were:

• To increase the capacity of existing researchers to address issues of tobacco and poverty through research for advocacy.
• To increase government, civil society, and media attention to the tobacco-poverty connection to support the development and implementation of improved tobacco control policies.
• To foster global coherence and collaboration around tobacco and poverty.

Results and Impact

OVERVIEW:

HealthBridge facilitated the design and implementation of ten tobacco and poverty research for advocacy projects in twelve countries in Asia, Latin America, and francophone Africa. Each of these projects was developed to build research and advocacy skills within partner organizations and to reflect issues and realities specific to their respective countries, recognizing the importance for policy-makers to have locally-relevant evidence on which to build local or national policies. At the same time, they examined the production and use of tobacco as a root cause of poverty that must be addressed if policy makers are actually going to improve the lives of the poor.

The level of technical assistance and training provided by HealthBridge to build the skills and capacity of the partner organizations varied depending on the researchers’ previous experience and needs. Broadly speaking, it ranged from ad hoc input to the clarification of research goals and protocols, and analysis and interpretation of results to a more substantive step-by-step, hands-on process of working directly with the researchers to identify research gaps, define research goals and methodologies, and analyse the results. One of the partners (Mexico) was qualified and able to provide mentorship to the other Latin American partners as needed. HealthBridge also worked closely with its partners to write publishable research reports that would continue to be used beyond the life of the project itself. The results from two studies – those in Vietnam and Bangladesh – were published by the journal Tobacco Control. The results from the Indonesian study are in the process of being prepared for publication. In several of the other countries, research results were presented in local publications and, in all cases, the results were covered by the media.

In all cases, HealthBridge’s research partners generated new, locally-relevant evidence to substantiate the link between tobacco and poverty. In Argentina, Bangladesh, Indonesia, Mexico, Peru, Vietnam, and Cameroun, Mali, and Senegal, researchers demonstrated the significant opportunity cost of tobacco use – that is, the basic necessities that a household forgoes when scarce income is diverted to tobacco use. The implications of such opportunity costs are tremendous: families living in food poverty that could otherwise afford to better feed themselves, children denied educational prospects, and increased health care expenditures. The extremely poor quality of tobacco-related employment was highlighted by researchers in Bangladesh, Brazil, Honduras, India, and Vietnam. In spite of the tobacco industry’s claims that it contributes significantly to employment generation and poverty reduction in tobacco-producing countries, the reality of entrenched poverty, hazardous and exploitative working conditions, and child labour belies the industry’s propaganda. While politicians in many of these countries also use employment-related arguments to stymie tobacco control efforts, researchers were able to demonstrate the  possibility of generating higher paid jobs with better working conditions if spending on tobacco were shifted to other goods and services. In fact, as the Vietnam study demonstrated, tobacco control could actually increase overall national employment.  

The Indonesian study also explored the issue of tobacco and poverty from a different angle, by examining the impact of household tobacco use on child health status. The researchers demonstrated a potential causal link between parents’ smoking status and the prevalence of children’s infections, children born with low birth weight, and childhood wasting. These results contribute to broader studies of the health impacts of smoking and second-hand smoke, particularly among the poor.

Research results have been shared in a number of ways, including through national and international conference presentations, through workshops, seminars, and meetings with politicians, and through publication in international peer-reviewed journals. The researchers also used their study results to develop a variety of materials that centred on five key advocacy messages: (i) higher tobacco taxes and prices help to reduce poverty; (ii) tobacco control will not have a negative effect on overall employment; (iii) tobacco employment is not sustainable employment; (iv) household tobacco use negatively affects child health status; and (v) poverty reduction strategies must address tobacco production and use.

HealthBridge’s establishment of an electronic Tobacco and Poverty Network has also facilitated both the sharing of research results with a wider international research community and the identification of potential future researchers.

Already, demonstrable impacts are evident from the researchers’ advocacy activities. In several countries, politicians (and would-be politicians) have embraced specific tobacco control measures, such as increasing tobacco taxes and prices, after their awareness of the tobacco and poverty link was increased. Research results have been incorporated into school programs in Argentina and into summer courses for political representatives in Mexico.  In Vietnam, the research results informed the drafting of the country’s first national tobacco control law, while in Peru the results were used to defend the constitutionality of the country’s tobacco control law. In Africa, the preliminary research studies demonstrated the lack of basic information on which to carry out any kind of analysis of tobacco and poverty, which in turn highlighted the need to conduct more systematic and focused research for advocacy relevant to the political environment in each country.  

Tobacco and poverty research is an important mechanism to support advocacy campaigns for stronger tobacco control laws and policies. In many countries, the research needs to be based on locally-gathered data in order to be seen as relevant to policy-makers in that country, hence the need to “replicate” similar research studies in various countries.  Research results, especially when presented in a way that generates media attention, can do much to gain the attention of policymakers, and thus motivate them towards positive tobacco control action that can also play a significant role in reducing poverty.  

OBJECTIVE 1: TO INCREASE THE CAPACITY OF EXISTING RESEARCHERS TO ADDRESS ISSUES OF TOBACCO AND POVERTY THROUGH RESEARCH FOR ADVOCACY

• Capacity increased within twelve organizations to undertake tobacco and poverty research.
• Partners included both experienced tobacco control researchers/advocates (Bangladesh, India, Indonesia, Vietnam, Brazil, and Mexico) and organizations engaged in tobacco control but new to research for advocacy (Argentina, Honduras, Peru, Cameroun, Senegal, and Mali). Only the partners in Bangladesh and Vietnam had worked specifically on tobacco and poverty issues previously.
• Capacity and skills building focused on identifying research gaps, designing research for advocacy projects, implementing the projects, analyzing research findings, developing advocacy messages reflective of the research results, writing research reports, and writing materials for publication and dissemination.
• Capacity and skills building provided through various means, including workshops, email exchange, and in-person discussions. Training also based on a research protocols/guidelines manual created for the project.

OBJECTIVE 2: TO INCREASE GOVERNMENT, CIVIL SOCIETY, AND MEDIA ATTENTION TO THE TOBACCO-POVERTY CONNECTION TO SUPPORT THE DEVELOPMENT AND IMPLEMENTATION OF IMPROVED TOBACCO CONTROL POLICIES

OBJECTIVE 3: TO FOSTER GLOBAL COHERENCE AND COLLABORATION AROUND TOBACCO AND POVERTY

Lessons Learned

Key lessons learned include: (i) even experienced researchers benefit from ongoing, targeted support; (ii) conducting an orientation workshop prior to research studies being designed and implemented considerably strengthens the results; (iii) protocol design, analysis, and interpretation of results is a specialized skill that needs ongoing and sometimes intensive guidance to result in effective advocacy messages; (iv) it is important to establish direct and ongoing contact with researchers throughout the process of research design, analysis, and interpretation.

Recommendations

Based on the project’s results, a phase II project was developed to further build and strengthen relationships to expand the cadre of organizations engaged in addressing tobacco and poverty from various angles. The new project was designed to support the recruitment, training, and mentoring of NGOs and other groups in tobacco control, emphasizing direct advocacy for effective policies to reduce tobacco production and use and tobacco-related poverty. The necessity of including such policy issues on the international development agenda will also be promoted. This phase II project  has just been approved to commence in September 2011.

Contact person:

Sian FitzGerald

Executive Director

Project profile

Key Partners: WBB Trust (Bangladesh), Voluntary Health Association of India (India), Centre for Health Research, University of Indonesia (Indonesia), HealthBridge Vietnam (Vietnam); Instituto Nacional de Salud Pública (Mexico); Acción Para la Promoción de Medio Ambientes Libres de Tabaco (Honduras); Centro de Información y Educación para la Prevención del Abuso de Drogas (Peru); Instituto de Ciencia y Tecnologia Regional (Argentina); Association for la Defense des Droits des Commsommateurs (Chad)

Location: International

Donor: The Bloomberg Initiative To Reduce Tobacco Use, through the International Union Against Tuberculosis and Lung Disease

Duration: 2009 - 2011

Reports and Resources

Reports

Publications

• Research for advocacy projects designed and implemented in twelve countries.
• Following presentations of results, awareness of the tobacco and poverty link raised among audiences at several international conferences, including the WLC (2009), APACT, COP IV, and CIFCOT II (2010).
• Plans also underway for further presentation of results at upcoming Latin American and Caribbean Conference on Tobacco or Health (Peru, Nov 2011) and the WCTOH (March 2012).
• Partners presented results at a wide range of local, national, and regional workshops, seminars, and conferences, such as the National Health Promotion Conference in Indonesia.
• Partners also developed and disseminated research results via posters, brochures, T-shirts, calendars, stickers, banners, factsheets, letters to politicians and the press, and TV and radio talk shows.
• More than 100 newspaper articles published about the research results.
• Research results highlighted in the publications of other organizations, such as the Framework Convention Alliance.
• Research results from Vietnam and Bangladesh published in the international journal Tobacco Control.
• The Indonesian researchers published a book entitled Cigarettes, Poverty, and the Lost Generation.
• Some key results of the research studies are already evident: In Argentina, research results incorporated into a tobacco control awareness/capacity building program for grade eight students in the province of Jujuy. This school project has been endorsed by the Ministry of Education for the province, and may be expanded to other provinces; in Bangladesh, bidi worker livelihood issues were included in the 2011 national budget debate and tobacco control advocates are using WBB’s research results to lobby for higher tobacco taxes. At the same time, some key MPs and the National Board of Revenue Chair have indicated their support for tax increases and have requested that the researchers provide more detailed information to bolster the stance of those working to ensure that tobacco tax increases are implemented; the Mexican research results used to develop a political briefing note to support the Secretary of Health’s advocacy efforts for stronger tobacco control policies. In December 2010, the Secretary of Finance and Public Loans approved a small increase in tobacco taxes, in part as a result of the study’s research results that demonstrated the links between tobacco and poverty; in Peru, research results prompted political candidates to include TC strategies in their election agendas while some prestigious law schools and the courts used the research results to successfully defend the country’s tobacco control law; in Vietnam, researchers used the literature review results as an evidence base to push for the incorporation of strong measures in the new national tobacco control law that is currently being developed.
• Compilation results book entitled Making the Tobacco and Poverty Link: Results from Research for Advocacy Projects in Africa, Asia, and Latin America written, translated into French, Spanish, Arabic, Chinese, and Russian and posted on HealthBridge’s website. Hard copy of the English version also printed for wider dissemination.

• Greater cadre of researchers engaged in tobacco and poverty research and increased interaction among researchers engaged in tobacco and poverty research.
• Researchers’ virtual network on tobacco and poverty created and coordinated throughout the project; membership in the network increased during the project’s lifetime.
• Project listserv linked to other networks to enhance the dissemination of information and research results.
• Workshop in Spanish organized preceding the WLC in Cancun for potential researchers from Latin America to stimulate discussion and interest in tobacco and poverty.
• Face-to-face meetings of PIs held as opportunities arose.

For more details on these and other results, please see the final project report.

Related Links – external:

International Union Against Tuberculosis and Lung Disease