South Korea’s public health insurance system spends $2.7 billion each year treating tobacco-related illnesses, an unrivalled expense. Jung Ki-suck, a lung doctor and president of the country’s public health insurer, highlighted the amount in a July statement accompanying a petition signed by 1.5 million people that he sent to the Seoul High Court. The petition demanded tobacco companies pay for some of the costs of smoking. 

That demand remains a distant dream — in South Korea and most of the rest of the world. 

Nearly three decades ago, Western tobacco giants agreed to landmark settlements with U.S. states to recover hundreds of billions of dollars spent on treating smoking-related illnesses. As part of the deal, companies disclosed millions of internal documents showing they misled the public about cigarettes’ cancer risk and other harms.

Emboldened by the settlements, governments around the world launched their own cases. More than 30 national, regional and local governments, including those of Guatemala, Nicaragua and Thailand, came to U.S. courts to sue tobacco giants like Philip Morris Companies, British American Tobacco and other heavyweights that have since been absorbed by different corporations. National and state governments in Nigeria and Brazil sued British American Tobacco and Philip Morris International at home. In South Korea, Jung’s agency sued the local affiliates of those companies and KT&G.

All told, at least 60 national, regional and local governments in 21 countries, following the lead of U.S. states, have sued tobacco companies to recover some of the costs of treating the many chronic diseases associated with smoking. With the exception of provincial governments in Canada, which started receiving billions in compensation in August from a tobacco settlement, most of these cases have been dismissed, were dropped or have gotten stuck in legal purgatory, a review by The Examination found. 

Though the litigation has foundered for different reasons, one recurring challenge for governments has been convincing courts that they have the standing to sue — that they suffered direct harm, and that the tobacco companies could be held responsible. 

Because the tobacco companies settled with the U.S. states, this foundational tenet was never fully tested in the wave of cases filed by their attorneys general.  

In at least eight cases, courts ruled that governments’ losses — the medical bills they paid to treat diseases contracted by smokers — were too far removed from the companies’ actions. 

In other cases, judges found that governments hadn’t presented enough evidence to prove that the industry’s misconduct boosted smoking rates, or that health care costs had increased as a result of smoking. 

South Korea’s lawsuit was deliberately narrow, seeking $37.3 million to help cover the costs of treating some long-term smokers who developed three cancers closely linked to tobacco. Even that modest claim hit a wall; a court dismissed the case in 2020. In the ruling, the court said the government had to prove that smoking likely caused each cancer patient’s disease, a high threshold that lawyers say would require the government to analyze each patient’s potential risk factors. The government appealed and is now awaiting a ruling. 

Other tobacco cases have fallen apart for procedural reasons or have progressed slowly amid challenges from tobacco lawyers. Legal experts and public health advocates credit the tobacco companies’ aggressive defense strategies, including delaying tactics that have stretched litigation across years. 

The strategy is to “keep pushing, keep delaying, keep filing pointless legal appeals,” said Andrew Higgins, a professor of civil justice systems at the University of Oxford and chair of an international committee that has studied tobacco company accountability. “They have lawyers to burn,” he said. “Money to burn.”

Many governments abandoned their cases when success seemed unlikely. 

At stake are billions of dollars that could be used to fund health systems strained by smoking-related illnesses or to pay for programs to prevent people from smoking in the first place or help them quit. 

Beyond the money, winning lawsuits or securing settlements can uncover hidden wrongdoing by forcing companies to disclose records, and they can curb smoking rates by changing how they act, said Rob Cunningham, senior policy analyst with the Canadian Cancer Society, a research and advocacy nonprofit.

“It’s a matter of justice that the tobacco companies be held to account for their wrongdoing,” he said.

Tobacco companies British American Tobacco, Altria, and Japan Tobacco International didn’t answer The Examination’s written questions. KT&G said the company didn’t have an official stance to share because any statement could be interpreted as representing the collective position of all tobacco companies involved in the South Korean lawsuit.

Corey Henry, Philip Morris International’s director of U.S. corporate communications, said in a written statement that the company’s affiliates sell legal and highly regulated products.

“Courts across the world have dismissed smoking and health claims time and again, under well-established legal principles,” he said.

How U.S. states broke through

Sick smokers started suing tobacco companies in the mid-1950s, as scientific studies began to link cigarettes to cancer. But for four decades, smokers routinely lost their cases. The companies argued that smokers chose to light up and were responsible for any ill health effects that came about as a result. 

In the early ’90s, a group of lawyers led by Mississippi Attorney General Mike Moore developed a novel legal argument that they thought could provide an avenue to hold tobacco companies accountable. State governments hadn’t smoked a single cigarette, and yet they had to pay to treat smoking-related diseases through publicly funded health insurance. 

The lawyers would soon get ammunition for the case. A big leak of industry documents revealed that tobacco companies had known for decades that their products were addictive and harmful, and they withheld these facts from the public. 

Armed with the new evidence, Moore sued major tobacco companies, including Philip Morris Inc., British American Tobacco affiliate Brown & Williamson, R. J. Reynolds Tobacco Company and Lorillard.  

Mississippi’s lawyers argued tobacco companies were liable for the state’s health care costs because the industry had knowingly sold harmful products while misleading the public about their risks and marketing them to children. 

“When we filed our case, nobody had done anything like that before,” Moore said. Over the next four years, dozens of other states launched their own cases. 

But it wasn’t clear if state courts would agree they had standing to sue. 

In many cases, tobacco companies pushed back by claiming that states hadn’t been directly harmed by the companies' alleged misconduct.

Several courts partly agreed, ruling that under certain legal theories the higher cost of health care was too indirect a consequence to justify a claim. 

However, those courts allowed the lawsuits to proceed because attorneys general could rely on state laws such as consumer protection statutes or those banning companies from colluding. Those laws didn’t require proving direct harm.

As several cases approached trial and tobacco companies faced the risk of paying huge sums, pressure mounted on them to settle.  

In 1997 and 1998, following years of litigation, U.S. states and tobacco companies signed landmark settlements, including the Master Settlement Agreement. 

Companies agreed to pay states for as long as they sell cigarettes in the U.S., give $1.7 billion to fund an anti-smoking foundation, reform their marketing practices, release internal documents and disband industry-funded public relations and research groups.

Because the companies settled the cases, the states’ novel legal arguments were never fully tested. 

Over the following decades, both American and international courts would largely reject cases based on similar arguments.

Why other governments lost

Since 1997, governments from Guatemala to Ukraine to Thailand have filed lawsuits seeking to recover the costs of treating smoking-related diseases, either in their national courts or American courts, which can hear cases involving U.S. companies.

Many of these cases failed or were withdrawn. U.S. courts dismissed some cases using the same argument employed by companies against many attorneys general.

In these cases, courts applied a legal test called “remoteness” to figure out whether the companies would be liable for the alleged harms. Under this doctrine, people and companies are liable only for harms that are directly tied to their actions. For example, a speeding driver who causes an accident that leads to a traffic jam, which in turn delays a doctor from arriving at a hospital in time to save a dying patient, could reasonably claim that the harm was too remote from their driving. 

Following this logic, judges ruled that governments’ health care costs were not a direct consequence of tobacco companies’ conduct. The chain of causation was complicated by a smoker’s individual choice to smoke, they said. While tobacco companies may have misled the public and governments about the risks, the immediate harm was suffered by smokers themselves, not by the state. 

Courts also said it would be too difficult to calculate how much of governments’ health care spending could be attributed to the companies’ alleged actions.

Tobacco companies praised the dismissals. Philip Morris lawyer Steven B. Rissman told The Washington Post that a ruling against Guatemala in 1999 “should send a strong message to foreign governments looking to use the U.S. court system to generate cash windfalls for their government’s treasuries.”

Andres C. Pereira, a lawyer who represented multiple governments that lost or dropped their cases, including Guatemala and Nicaragua, said he was “perplexed by the decisions.”

Beyond the legal arguments used to dismiss his cases, Pereira said he thinks U.S. judges believed tobacco companies had been held accountable through the state settlements and didn’t want to “open the floodgates” for countries from around the world to sue in the U.S.

Several courts outside the U.S. also ruled against governments bringing similar cases. In 2002, the Supreme Court of the Marshall Islands dismissed one case, saying the government hadn’t proven that tobacco companies’ alleged misconduct — such as misrepresenting health risks — had caused the financial losses the government was trying to recover. 

"While anecdotal evidence can probably [be] found to assert that Tobacco’s marketing behavior caused certain smoking-related illnesses and therefore some health care costs, the Government offers no evidence to quantify such a contention," the judges ruled.

In ruling against the public health insurer in South Korea, the court concluded the agency couldn’t rely solely on broad scientific evidence showing that smoking drives up cancer rates. 

How might a court reach such a conclusion? Higgins, the University of Oxford professor, said many judges and lawyers simply lack an understanding of population health studies. “What they want is evidence that a cigarette butt was found inside your lung and therefore it must have been Philip Morris that killed you,” he said.

The art of delay

Litigation is often long and complex. But lawyers and anti-tobacco activists told The Examination that tobacco companies’ legal teams have mastered the art of stretching out cases in the hopes that governments and smokers would give up or run out of money.

Nigeria and Brazil faced these aggressive delaying tactics, they said.

Beginning in 2007, Nigeria’s federal government and at least eight states sued British American Tobacco, its affiliate or Philip Morris International. All the cases were dropped, dismissed or remain pending as of February of this year.

The companies challenged various courts’ jurisdictions or argued that the governments failed to properly serve legal papers. 

In the federal case, Philip Morris International refused to accept court papers from a DHL courier sent to its Swiss location, according to court documents. Nigeria’s attorney general spent two years trying to serve the company with notice of the suit. The Nigerian court at one point allowed the attorney general to serve the company by placing advertisements in two Swiss newspapers, but Switzerland’s Ministry of Justice objected. The attorney general then tried to notify the company through the Nigerian and Swiss governments. He dropped Philip Morris International from the suit in 2010 after the judge threatened to suspend the case indefinitely unless the company was served or dropped. 

“We are disappointed that it has been extremely difficult to use the legal system to bring the tobacco companies to justice,” said Akinbode Oluwafemi, executive director of Corporate Accountability and Public Participation Africa, a human rights nonprofit.

Brazil launched a lawsuit against Philip Morris International, British American Tobacco and their local affiliates in 2019.

The lawsuit also faced delaying tactics, said Daniel Dorado, tobacco campaign director at Corporate Accountability. 

Philip Morris International and British American Tobacco’s Brazilian affiliates initially objected to being served with legal papers meant for their parent companies. The Brazilian judge rejected their argument.

Then the parent companies argued that Brazilian courts lacked jurisdiction over them because the companies’ Brazilian affiliates are independent and the parent companies never sold cigarettes in the country.

Thalita Dias, a lawyer with the Brazilian public health advocacy nonprofit ACT Health Promotion, said that characterization doesn’t match the reality of the business.

“International parent companies such as BAT and PMI control global strategy, set marketing and product engineering policies, determine legal defense lines, and directly benefit from the profits earned by their national affiliates,” she said. 

The industry has long relied on delaying and draining opponents’ bank accounts, tobacco control advocates said. In a 1988 memo, a lawyer representing American tobacco company R.J. Reynolds wrote, “The way we won these cases was not by spending all of Reynolds’ money, but by making that other son of a bitch spend all his.”

Canada’s winning formula

The only country outside the U.S. where governments have received compensation from tobacco companies is Canada. In 2024, after litigation that stretched back 26 years, its provinces and territories accepted a settlement with the Canadian affiliates of Philip Morris International, British American Tobacco and Japan Tobacco.

Two smokers and an anti-smoking group paved the way for the deal by successfully launching class action lawsuits against the Canadian affiliates. When the smokers won, the affiliates quickly filed for bankruptcy protection and sought to settle other suits they faced.

The $23.1 billion settlements included $17.6 billion for governments, $2.9 billion for the smokers in the class actions and $712 million to fund a foundation focused on tobacco-related disease. The rest covered other potential creditors and costs.

Though billions were awarded, the amount earmarked for governments was less than 3% of the estimated costs of treating smoking-related diseases, according to estimates calculated as part of the settlement process. Tobacco control advocates criticized the deal for failing to include measures to cut smoking rates or require companies to release documents.

Still, Rob Cunningham, with the Canadian Cancer Society, said the win could be replicated elsewhere. He said the key to Canadian governments’ success was passing laws before suing, which overcame the barriers that stymied others.

Those laws ensured provinces had the legal standing to sue and created the presumption that company misconduct such as deceptive advertising caused disease, Cunningham said. They also allowed governments to use population-level data to prove harm, which avoided the burden of having to prove that smoking caused disease in individual patients.

This was essential, Cunningham said. “The chances of the Canadian provinces would have been excellent if they got to trial.” 

Now, lawyers await Brazil’s ruling, expected in 2026. It could be the first government in the global south to win, said Dorado, of Corporate Accountability. And that could lead to a new wave of lawsuits.

“That’s the biggest fear that the industry has,” he said. “When someone succeeds in any of these tobacco control measures, the cascading effect continues.”

Foreign currency values were converted to U.S. dollar values as of Oct. 15, 2025.

ACT Health Promotion has received support from Bloomberg Philanthropies, which also provides financial support to The Examination. The Examination operates independently and is solely responsible for its content.