Tobacco and the Harms of Trade

A key feature of the post-war order, it is often said, is the unprecedented pace, scale, and scope of global trade and investment. Few deny that the integration of the global economy has brought with it considerable benefits. Since Ricardo and Smith, economists have typically agreed that international trade is a catalyst for growth and prosperity. But trade may also involve harms and, much like the benefits of trade, these raise difficult questions regarding the justice of their distribution. In this article, I examine a particularly important, yet often neglected, form of harm: namely, the public health effects of trade and investment in tobacco. In at least one important way, tobacco is a unique commodity: it is the only legal consumer product that kills up to half of its users. With around 6 million deaths per year, tobacco-related diseases are the leading cause of premature mortality worldwide, claiming more lives than HIV/Aids, malaria, and tuberculosis combined. And the death toll is only set to increase. If current trends persist, the 100 million tobacco-attributable deaths in the 20th century will rise to a billion in this century. Relatively few of these deaths will occur in high-income countries, where increased public health efforts have succeeded in driving smoking rates down. They will primarily occur in lowand middle-income countries. Throughout Africa, for example, the number of adult smokers is estimated to increase from 77 million in 2013 to 572 million in 2100. The steep rise in tobacco consumption in lowand middle-income countries is causally linked to the liberalization of international trade and foreign investment. In at least three different ways, our current global trade regime has allowed