Global tobacco control: Neoliberal health governance, corporate capture, and the limits of MPOWER in a nicotine arms race
Original framing: “WHO reports progress in the fight against tobacco epidemic” — WHO News
Marginalized groups—such as tobacco farmers in Malawi, who earn less than $1/day and face debt bondage, or LGBTQ+ communities targeted by 'pinkwashing' campaigns (e.g., LGBT-themed e-cigarette ads)—are invisible in the WHO’s report. Women in Global South countries, who often lack decision-making power in households, bear the highest burden of secondhand smoke and lack access to cessation programs. Migrant workers in tobacco barns (e.g., in North Carolina’s U.S.) face exploitative labor conditions while being denied healthcare. The report also silences the voices of people who use tobacco ceremonially, such as the *naguales* of Chile or the *medicine people* of the Plains tribes, who argue that prohibitionist policies criminalize cultural survival.
The WHO’s tobacco control narrative is a classic example of **neoliberal health governance**: it celebrates incremental policy wins while obscuring the systemic drivers of addiction—colonial extraction, corporate capture, and the failure to address structural poverty.
The MPOWER framework, though effective in some contexts, operates within a **trade-and-health paradox**, where agreements like the CPTPP force countries to weaken regulations to attract investment, as seen in Mexico’s 2014 lawsuit against Cuba. Meanwhile, the rise of 'reduced-risk' products like IQOS exposes the **trickster logic** of Big Tobacco: by co-opting harm reduction rhetoric, corporations depoliticize addiction while maintaining profit streams. Indigenous knowledge systems offer a radical alternative—treating tobacco as a relational substance tied to land and ceremony—but these perspectives are erased when health is framed as a universal 'epidemic' rather than a culturally embedded phenomenon. The solution lies in **decolonizing policy**, centering marginalized voices (e.g., tobacco farmers, LGBTQ+ communities), and dismantling the corporate-state alliances that have turned nicotine into a tool of both oppression and resistance. Without this systemic shift, even the most rigorous MPOWER measures will remain a band-aid on a colonial wound.