Since the mid-1980s, tobacco companies have intensified market expansion strategies in several African countries. They have used music to target youths and children. They organised fashion shows to entice women into smoking. They offered kids free cigarettes on the streets and for a very long time undermined efforts by governments to put in place effective tobacco legislation. They actively participated in the smuggling of tobacco products into the continent. Worse still, tobacco companies persuaded some African governments to promote tobacco cultivation as a major source of foreign earnings. And in recent years, the tobacco industry has resorted to using Corporate Social Responsibility (CSR) to massage its image and cover its tracks. British American Tobacco (BAT), which is the focus of this paper, had a virtual monopoly in parts of Africa, both in terms of tobacco manufacturing and sales of cigarettes. In eleven African countries BAT had more than a 90% share of the cigarette market. This paper examines some of the health, social and economic impacts of BAT’s activities in Africa from 1985 to 2010 using Cameroon as a case study. The paper concludes that though the full effects of rising tobacco consumption (namely a steep rise in smoking-induced illness and premature death) was at the dawn of the 21st century, Africa was already in the grip of a major tobacco epidemic. There is no doubt therefore that, BAT’s heavy footprint on the African continent wreaked havoc on the economy, health and welfare of the people, thus partially contributing to the non-realisation of the Millennium Development Goals (MDGs) that were designed to help the world’s poorest people.