Funders Haven't Forgotten About Smoking. But Why Aren't They Spending Bigger?

Tobacco use kills about 6 million people worldwide every year, which is far more than AIDS and malaria put together, and that number is projected to rise to 8 million by 2030. 

So it's no surprise that a few major global health funders are spending millions in this area. If their investments can bend the mortality curve, even by a little, millions of lives will be saved.

What is surprising, though, is that more funders aren't working in this area. 

The Gates Foundation and Bloomberg Philanthropies are among the only big funders fighting smoking and they are working closely together. Last month, Gates gave BP $24 milllion to support its global work to reduce tobacco use, which has long been a major focus of Bloomberg's philanthropy. In fact, aside from his support of John Hopkins University, it's hard to think where Bloomberg has spent more money over the years than in global investments to reduce tobacco use. While an exact tally is hard to calculate, we're talking hundreds of millions of dollars. 

Bloomberg is a famously technocratic philanthropist, so you can see why he would direct big bucks to curbing smoking. Not only is the death toll sky high here, but the solutions are well-known, since developed countries have successfully reduced smoking deaths in recent decades. Bloomberg's other biggest global health issue is roadway safety, which is another example of low-hanging fruit, with accidents causing many deaths and obvious solutions available that have worked in wealthy countries. 

What's puzzling is why Gates hasn't put more money into anti-smoking efforts, since this funder, too, is keenly attuned to the metric of dollars spent vs. lives saved. 

While the Gates Foundation does have a tobacco control program, grantmaking here is small potatoes compared to the other stuff the foundation is into. In the same round of grants last month where the Gates Foundation gave $24 million to support Bloomberg's anti-smoking work (and another $10 million for global work by the Campaign for Smoke-Tobacco Free Kids), Gates made a $222.6 million grant to eradicate polio. 

Polio is a dread disease, to be sure, but only 225 new cases of polio were reported in 2012. The other top health priorities of Gates—malaria, HIV, and TB—also claim fewer lives than tobacco use. 

So why the greater focus on high-profile killers over the more pedestrian annual holocaust caused by smoking? The answer may lie in understanding the different strands of technocratic philanthropy. Bill Gates is a technologist who made his fortune by inventing new forms of software, and you can see why he'd be attracted to giving where there's a potential for major breakthroughs, like permanently eliminating a scourge like polio or finding the magic bullet to stop the HIV epidemic in its tracks. Innovation was a key to Mike Bloomberg's initial rise, too, but both his private and public career has been more about the antiseptic and relentless focus on results.

The bigger picture, of course, is that global health threats like HIV and malaria have provoked worldwide concern and activism. When was the last time you heard Bono or Angelina Jolie talking about tobacco? Probably never, and smoking just feels like yesterday's issue, even as tomorrow's projected body count is off the charts. If 8 million people die per year through the 2030s, the total would be over 80 million deaths from tobacco in that decade.