As smoking gradually decreases in developed countries, the tobacco epidemic is overtaking developing countries, where the legislative controls and other measures, which in industrialised countries succeed in limiting tobacco use, either do not exist or are, at best, inadequate. Of particular concern is the penetration of developing countries by the transnational tobacco companies, who with aggressive promotional campaigns and the use of political and commercial pressures, open up markets to promote foreign cigarettes. The number of smokers in developing countries will inevitably increase, due to the rise in population, increased smoking among youth and women, lack of awareness of the harmfulness of tobacco, shortage of funding for tobacco control measures, and difficulties in implementing legislation. An appalling increase is predicted in disease, disability, and death from tobacco in developing countries. Developing countries must exercise their own public health responsibility and implement measures to reduce the growing tobacco epidemic. Health concerns in Western countries can assist by bringing these issues to public and government attention in order to ensure that transnational tobacco companies, at minimum, adhere to the same standards of product, marketing, promotion, and sales in developing countries as are required in their country of origin; that these tobacco companies should desist from lobbying and pressuring the governments of developing countries to prevent the passing and implementing of antitobacco measures; that the United States and UK governments desist from helping their tobacco companies with export activities; and that Western expertise in countering the tobacco epidemic be shared with developing countries so that the West becomes an exporter of health rather than of tobacco-related diseases.