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Nations that cannot fight tobacco industry should raise taxes, says WHO

Jul 13th, 2017
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World Health Organization says many governments have neither funds nor expertise to take on big tobacco companies

https://www.theguardian.com/world/2017/jul/12/nations-that-cannot-fight-tobacco-industry-should-raise-taxes-says-who

African nations whose attempts to regulate cigarettes are increasingly bogged down in the courts by wealthy tobacco companies should impose high taxes to deter people from developing a smoking habit, the World Health Organization says.

Vinayak Prasad of WHO’s Tobacco Free Initiative said many African governments were at a disadvantage in the fight against the industry over regulatory controls, like graphic health warnings on packs, which are the norm in the west. They have neither the funds nor enough expertise to deal with the big tobacco companies’ threats, intimidatory letters and law suits.

His comments follow the exposure by the Guardian of the attempts by multinational tobacco companies to delay and dilute regulatory controls in Africa through litigation and threats. At least eight African governments have been pressured by the industry.

“Just focus on getting the tax raised,” urged Prasad. WHO, the World Bank and others were trying to encourage and assist countries in changing their tobacco taxation, which countries from the Philippines to India had demonstrated could raise millions of dollars for healthcare or other essential government spending.

Developing nations do not have enough money or staff devoted to public health, he said. Often those in government who lead on tobacco control are also the key players for other areas, such as mental health.

“The tobacco epidemic has already reached the African continent. Countries have started to prioritise it but inherently the systems are weak. They need to build human resource capacity and technical capacity to respond to industry threats,” he told the Guardian. “We are working extremely hard [to help them] but we need to do more.”

Reacting to the Guardian’s reports, former public health minister Caroline Flint said: “It is sad to see firms like BAT fighting African governments for years over health warnings on cigarette packages and modest taxes. In any western nation they would have conceded these issues years ago. It speaks volumes about their approach to Africa that the tobacco giants appear willing to fight on all fronts to protect their sales.”

Lord Rennard, the vice chair of the all-party parliamentary group on smoking and health, said a tax on the profits of firms “could provide funds for legal support to governments in poorer countries seeking to resist tobacco damaging the health of their local populations”.

The tobacco industry also vigorously opposes hikes in the taxation of cigarettes, which is proven to reduce the numbers who smoke. The companies and tax advisers who intervene on their behalf with governments claim that tax hikes lead to smuggling from countries where the prices are lower. Prasad says that is not so if taxation is simplified, so that the same sum is levied on every carton regardless of brand.

Deborah Arnott, chief executive of campaigning group Ash, said the revelations showed that the industry had not turned over a new leaf, focusing on vaping and aiming for a smoke-free future, as it claims. “The Guardian has thrown a spotlight on the dirty truth, the leopard hasn’t changed its spots, it’s still promoting the same old lethal products the same way it always did, in countries where it can get away with it,” she said.

“Last century 100 million people died from smoking; if Big Tobacco isn’t stopped then this century a billion will be killed by their lethal products and most of them will be from low and middle income countries. The tactics being used in Africa of denial, deception and delay were used very successfully in the UK in the last century, but they’re no longer being allowed to get away with it here and smoking rates have plummeted as a result. Africa needs to learn from our experience, if you regulate the industry strictly the smoking epidemic can be halted and reversed.”

Dr Tom Frieden, former director of the Centers for Disease Control and Prevention in the US, said in a tweet that the revelations showed the “outrageous and shameful activities of tobacco industry in Africa”. US senator Richard Blumenthal, who spent his career promoting anti-smoking legislation, and was one of 46 state attorneys general to secure hundreds of billions of dollars in damages from tobacco companies in a 1990s settlement, said that in developing markets “tobacco companies have actively resisted” health regulation. “They have actively intervened with governments, and particularly so in Africa.”

José Luis Castro, president and chief executive officer of Vital Strategies, an organisation that promotes public health in developing countries, said: “The danger of tobacco is not an old story; it is the present. The industry is using every tool at its disposal to hook new smokers, especially kids, in Africa and other parts of the world.” There is a huge gap between what the industry says and what it does, he said. “It’s time this sham was called out in every country and in every public forum. When the tobacco industry gets near government, it poisons efforts to protect health.”

The multinational companies say they do not oppose tobacco regulation that is sound and evidence-based. “However, where there are different interpretations of whether regulations comply with the law, we think it is entirely reasonable to ask the courts to assist in resolving it,” British American Tobacco told the Guardian.

Imperial Tobacco also said it supported regulation, but it would “continue to make our views known on excessive, unnecessary and often counter-productive regulatory proposals”.

Philip Morris International said it has contact with public authorities on a range of issues, “such as taxation, international trade, and tobacco control policies. Participating in discussions and sharing points of view is a basic principle of public policy making and does not stop governments from taking decisions and enacting the laws they deem best”.

This content is funded, in part, by Vital Strategies.

Threats, bullying, lawsuits: tobacco industry’s dirty war for the African market

Jul 12th, 2017
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Revealed: In pursuit of growth in Africa, British American Tobacco and others use intimidatory tactics to attempt to suppress health warnings and regulation

https://www.theguardian.com/world/2017/jul/12/big-tobacco-dirty-war-africa-market

British American Tobacco (BAT) and other multinational tobacco firms have threatened governments in at least eight countries in Africa demanding they axe or dilute the kind of protections that have saved millions of lives in the west, a Guardian investigation has found.

BAT, one of the world’s leading cigarette manufacturers, is fighting through the courts to try to block the Kenyan and Ugandan governments’ attempts to bring in regulations to limit the harm caused by smoking. The giant tobacco firms hope to boost their markets in Africa, which has a fast-growing young and increasingly prosperous population.

In one undisclosed court document in Kenya, seen by the Guardian, BAT’s lawyers demand the country’s high court “quash in its entirety” a package of anti-smoking regulations and rails against what it calls a “capricious” tax plan. The case is now before the supreme court after BAT Kenya lost in the high court and the appeal court. A ruling is expected as early as next month.

BAT in Uganda asserts in another document that the government’s Tobacco Control Act is “inconsistent with and in contravention of the constitution”.

The Guardian has also seen letters, including three by BAT, sent to the governments of Uganda, Namibia, Togo, Gabon, Democratic Republic of Congo, Ethiopia and Burkina Faso revealing the intimidatory tactics that tobacco companies are using, accusing governments of breaching their own laws and international trade agreements and warning of damage to the economy.

Extract – court document

“The Regulations are unlawful in their entirety as a result of procedural impropriety … The warning requirements [on cigarette packets] constitute an unjustifiable barrier to international trade.”

A petition by British American Tobacco Kenya to the country’s high court against aspects of the Kenyan government’s proposed tobacco regulations, 16 April 2015

BAT denies it is opposed to all tobacco regulation, but says it reserves the right to ask the courts to intervene where it believes regulations may not comply with the law.

Later this month, BAT is expected to become the world’s biggest listed tobacco firm as it completes its acquisition of the large US tobacco company Reynolds in a $49bn deal, and there are fears over the extent to which big tobacco can financially outmuscle health ministries in poorer nations. A vote on the deal by shareholders of both firms is due to take place next Wednesday, simultaneously in London at BAT and North Carolina at Reynolds.

Professor Peter Odhiambo, a former heart surgeon who is head of the government’s Tobacco Control Board in Kenya, told the Guardian: “BAT has done as much as they can to block us.”

Experts say Africa and southern Asia are urgent new battlegrounds in the global fight against smoking because of demographics and rising prosperity. Despite declining smoking and more controls in some richer countries, it still kills more than seven million people globally every year, according to the WHO, and there are fears the tactics of big tobacco will effectively succeed in “exporting the death and harm” to poorer nations.

There are an estimated 77 million smokers in Africa and those numbers are predicted to rise by nearly 40% from 2010 levels by 2030, which is the largest projected such increase in the world.

In Kenya, BAT has succeeded in delaying regulations to restrict the promotion and sale of cigarettes for 15 years, fighting through every level of the legal system. In February it launched a case in the supreme court that has already halted the imposition of tobacco controls until probably after the country’s general election in August, which are being contested by parliamentarians who have been linked to payments by the multinational company.

Extract – court document

“[A proposal for a new 2% tax on the industry in Kenya] … is arbitrary, capricious and inaccessible … it will have a significant effect on cigarette manufacturers and importers putting at risk further investment and direct and indirect employment opportunities in Kenya.”

A petition by British American Tobacco Kenya to the country’s high court against aspects of the Kenyan government’s proposed tobacco regulations, April 16th 2015

In Uganda, BAT launched legal action against the government in November, arguing that the Tobacco Control Act, which became law in 2015, contravenes the constitution. It is fighting restrictions that are now commonplace in richer countries, including the expansion of health warnings on packets and point-of-sale displays, arguing that they unfairly restrict its trade.

The court actions are brought by BAT’s local affiliates, BAT Kenya and BAT Uganda, but approved at Globe House, the London headquarters of the multinational, which receives most of the profits from the African trade. In its 2016 annual report, BAT outlined the “risk” that “unreasonable litigation” would be brought in to control tobacco around the world. Its response was an “engagement and litigation strategy coordinated and aligned across the Group”.

‘Focus on emerging markets’

At its annual meeting in March, chairman Richard Burrows toasted a “vintage year” for BAT, as profits rose 4% to £5.2bn after investors took their cut – their dividend had increased by 10%. When asked about the legal actions in Africa, he said tobacco was an industry that “should be regulated … but we want to see that regulation is serving the correct interests of the health mission and human mission which should lie behind it”.

Extract – court document

“Your Petitioner alleges and shall demonstrate that the Tobacco Control Act, read as a whole, has the effect of unjustifiably singling out the tobacco industry for discriminative treatment.”

A petition of British American Tobacco Uganda in the constitutional court against the Ugandan government’s Tobacco Control Act

So, “from time to time it’s necessary for us to take legal action to challenge new regulation” which he said was led by “the local board”.

BAT says it is “simply not true that we oppose all tobacco regulation, particularly in developing countries”. Tobacco should be appropriately regulated as a product that has risks to health, it said, but “where there are different interpretations of whether regulations comply with the law, we think it is entirely reasonable to ask the courts to assist in resolving it”. It was opposed to only a handful of the issues in Kenya’s regulations, not the entirety, it said in a statement.

Although most countries in Africa have signed the World Health Organisation (WHO) treaty on tobacco control, none has yet fully implemented the smoking restrictions it endorses.

The WHO predicts that by 2025, smoking rates will go up in 17 of the 30 Africa-region countries from their 2010 level. In some countries a massive hike is expected – in Congo-Brazzaville, from 13.9% to nearly half the population (47.1%) and in Cameroon from 13.7% to 42.7%. In Sierra Leone it will be 41.2% (74% among men) and in Lesotho 36.9%.

In contrast, research showed last year that just 16.9% of adults smoke in the UK; and last month new figures showed UK heart disease deaths had fallen 20% since that country’s indoor smoking ban.

“The tobacco industry is now turning its focus toward emerging markets in sub-Saharan Africa, seeking to exploit the continent’s patchwork tobacco control regulations and limited resources to combat industry marketing advances,” said Dr Emmanuela Gakidou and colleagues at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, publishing an analysis of smoking prevalence around the world in the Lancet in April.

Extract – letter

Uganda’s economy has “benefitted… significantly” from BAT’s tobacco business, employing 200 Ugandans and 1500 extra in the tobacco buying season. “This has helped to alleviate poverty and improve welfare in urban and rural areas …”

Extracts of a letter from Jonathan D’Souza, managing director of BAT Uganda to the chairperson of the Uganda Parliamentary committee on health, 14 April 2014

Africa’s growing numbers of children and young people, and its increasing wealth, represent a huge future market for the tobacco industry. The companies deny targeting children and cannot sell packs smaller than 10, but a new study carried out in Nairobi by the Johns Hopkins school of public health in the US and the Kenya-based Consumer Information Network found vendors selling cigarettes along the routes children take to walk to primary schools.

WHO-congo-smoke

Stalls sell single Dunhill, Embassy, Safari and other BAT cigarette sticks, costing around 4p (5 cents) each, alongside sweets, biscuits and fizzy drinks. The vendors split the packets of 20 manufactured by BAT. “They are targeting children,” said Samuel Ochieng, chief executive of the Consumer Information Network. “They mix cigarettes with candies and sell along the school paths.”

BAT said that its products were for adult smokers only and that it would much prefer that stalls sold whole packets rather than single sticks, “given our investment in the brands and the fact there are clear health warnings on the packs.

“Across the world, we have very strict rules regarding not selling our products to retailers located near schools. BAT Kenya provides support to many of these independent vendors, including providing stalls painted in non-corporate colours, and providing youth smoking prevention and health warnings messages. We also educate vendors to ensure they do not sell tobacco products near schools.”

Links with politicians

The Kenya case, expected to be heard after the elections on 8 August, is seen as critical for the continent. If the government loses, other countries will have less appetite for the long and expensive fight against the wealthy tobacco industry.

BAT has around 70% of the Kenyan market; its Kenyan competitor, Mastermind, has joined in the legal action against the government.

Extract – letter

“If these measures are brought into effect, the economic and social impact will be extremely negative. They could even threaten the continuation of our factory which has operated in Bobo Dioulasso for more than fifty years with more than 210 salaried employees.”

Excerpt from letter from Imperial Tobacco to the prime minister of Burkina Faso, 25 January 2016, concerning new regulations on plain cigarette packaging and large graphic health warnings.

Concerns have been raised about links between politicians and the tobacco companies. “There are allegations of some of them having been bribed in the past,” said Joel Gitali, chief executive of the Kenya Tobacco Control Alliance.

BAT whistleblower Paul Hopkins, who worked in Africa for BAT for 13 years, told a British newspaper he paid bribes on the company’s behalf to the Kenya Revenue Authority for access to information BAT could use against its Kenyan competitor, Mastermind. Hopkins has also alleged links between certain prominent opposition Kenyan politicians and two tobacco companies, BAT Kenya and Mastermind. Hopkins, who says he alerted BAT to the documents before the company made him redundant, claimed BAT Kenya paid bribes to government officials in Burundi, Rwanda and the Comoros Islands to undermine tobacco control regulations. Gitali is concerned about the outcome of the election: “If the opposition takes over government we shall be deeply in the hands of the tobacco companies.”

BAT denies any wrongdoing. A spokesperson said: “We will not tolerate improper conduct in our business anywhere in the world and take any allegations of misconduct extremely seriously. We are investigating, through external legal advisors, allegations of misconduct and are liaising with the Serious Fraud Office and other relevant authorities.”

Extract – letter

“Once the decision to smoke is taken by an adult smoker, the pack provides adult consumers with pertinent information”

British American Tobacco letter to the prime minister of Gabon, 1 January 2012

‘We grow up dreaming we can be one of them’

Tih Ntiabang, regional coordinator for Africa of the Framework Convention Alliance – NGOs that support the WHO treaty – said the tobacco companies had become bolder. “In the past it used to be invisible interference, but today it is so shameful that it is so visible and they are openly opposing public health treaties like the case in Kenya at the moment … Today they boldly go to court to oppose public health policy. Every single government is highly interested in economic growth. They [the tobacco companies] know they have this economic power. The budget of tobacco companies like BAT could be as much as the whole budget of the Africa region.

“Our health systems are not really well organised. Our policy makers can’t see clearly what are the health costs of inaction on tobacco control because our health system is not very good. It puts the tobacco industry at an advantage on public health.”

The sale across the whole of Africa of single cigarette sticks was a serious problem because it enabled children to buy them. “They are extremely affordable. Young teenagers are able to purchase a cigarette. You don’t need £1 for a pack of 20,” he said.

WHO-africa-deaths

BAT has a reputation in Africa as an employer offering steady and well-paid jobs, said Ntiabang, based in Cameroon. “When I was about 10, I was always dreaming I could work for BAT. They have always painted themselves as a responsible company – a dream company to work for. All the staff are well-off. The young people think ‘I want to work for BAT’. They promote a lot of events and make their name appear to young people. We grow up dreaming we can be one of them.”

In Uganda in 2014, BAT managing director, Jonathan D’Souza, sent a 13-page detailed attack on the tobacco control bill, then going through parliament, to the chair of the government’s health committee.

BAT was contracting with 18,000 farmers and paid them 61bn Ugandan shillings for 16.8m kg of tobacco in 2013, said the letter. The economy has “benefited significantly” from BAT Uganda’s investments, it said. “This has helped to alleviate poverty and improve welfare in urban and rural areas,” it says.

Extract – letter

“The draft regulations which you have published deal with a wide range of issues which will have a massive impact not only on the tobacco industry but also on a wider scale on the Namibian economy at large.”

Excerpt from a letter from the general manager of BAT in Namibia to the minister of health and social services, 17 November 2011

BAT Uganda (BATU) agreed tobacco should be regulated while “respecting the informed choices and rights of adults who choose to smoke and the legal rights of a legal industry”. But it cited 11 “areas of concern”, claiming there is no evidence to support a ban on tobacco displays in shops, that large graphic health warnings on packs are ineffective, that proposals on bans on smoking in public places were too broad and that prohibiting smoking under the age of 21 was unreasonable, since at 18 young people are adults and can make up their own mind.

Documents made public by the University of Bath show that BATU had another concern: the ban on the sale of cheap single cigarettes. Adults should be “free to purchase what they can afford”, says an internal leaked paper. BATU also took action against the MP who sponsored the bill. A letter informed him that the company would no longer be contracting with the 709 tobacco farmers in his region. There is evidence that the company also lobbied other MPs with tobacco farmers in their constituencies.

The Tobacco Control Act became law in 2015, and in November last year, BAT sued. Many people choose to smoke, said an affidavit to the court from managing director Dadson Mwaura and it was important to ensure regulation did not lead to “unintended consequences that risk an untaxed and unrestrained illegitimate trade in tobacco products”. BATU’s legal product contributed to the Ugandan economy “in many dimensions”.

The Guardian has seen letters showing that at least six other African governments have faced challenges from the multinational tobacco companies over their attempts to control smoking.

Democratic Republic of Congo: Letter to the president sent in April 2017 by the Fédération des Entreprises du Congo (chamber of commerce) on behalf of the tobacco industry, listing 29 concerns with the proposed tobacco control regulations, which they claim violate the constitution, international agreements and domestic law.

Burkina Faso: Letter sent in January 2016 to the minister of health from Imperial Tobacco, warning that restrictions on labeling and packaging cigarettes risks economic and social damage to the country. Previous letter sent to the prime minister from the US Chambers of Commerce in December 2013 warning that large health warnings and plain packaging could put Burkina Faso in breach of its obligations to the World Trade Organisation.

Ethiopia: Letter sent in February 2015 to the ministers of health and science and technology by Philip Morris International, claiming that the government’s tobacco directive banning trademarks, brands and added ingredients to tobacco breached existing laws and would penalise all consumer retailers.

Togo: Letter to the minister of commerce in June 2012 from Philip Morris International opposing plain packaging, which “risks having damaging consequences on Togo’s economy and business environment”.

Gabon: Letter from BAT arguing that there is no evidence that plain packaging reduces smoking, citing the Deloitte report of 2011, alleging its introduction would put Gabon in breach of trade agreements and promote smuggling.

Namibia: Letter to the minister of health from BAT, warning that planned tobacco controls will have “a massive impact … on the Namibian economy at large”.

Extract – memo

“As a country whose economy heavily relies on exports, Togo can ill afford to anger its international partners by introducing plain packaging.”

Excerpt from memo on plain packaging from chief executive of Philip Morris West Africa to the minister of commerce of Togo, to reiterate its concerns following a meeting, 21 June 2013

Bintou Camara, director of Africa programs at Campaign for Tobacco-Free Kids, said: “British American Tobacco, Philip Morris International and other multinational tobacco companies have set their sights on Africa as a ‘growth market’ for their deadly products”. Throughout Africa, tobacco companies have tried to intimidate countries from taking effective action to reduce tobacco use, the world’s leading cause of preventable death, he added.

“Governments in Africa should know that they can and should move forward with measures aimed at preventing and reducing tobacco use – and that they do so with the support of the many governments and leaders around the world that have taken strong action to protect public health.”

Cloe Franko, senior international organizer at Corporate Accountability International, said: “In Kenya, as in other parts of the world, the industry has resorted to frivolous litigation, aggressive interference … to thwart, block, and delay lifesaving policies. BAT’s actions are emblematic of a desperate industry grasping to maintain its hold over countries and continue to peddle its deadly product.”

Philip Morris said it is regularly engaged in discussions with governments. “We are approached by or approach public authorities to discuss a range of issues that are important for them and for us, such as taxation, international trade, and tobacco control policies. Participating in discussions and sharing points of view is a basic principle of public policy making and does not stop governments from taking decisions and enacting the laws they deem best.” It said that it supports effective regulation, “including laws banning sales to minors, mandatory health warnings, and advertising restrictions”.

Imperial Tobacco said it sold its brands “where there’s a legitimate and existing demand for tobacco and take the same responsible approach in Africa as we do in any Western territory”. A spokesman said it supported “reasonable, proportionate and evidence-based regulation of tobacco”, including “health warnings that are consistent with global public health messages”. But, it said, Imperial would “continue to make our views known on excessive, unnecessary and often counter-productive regulatory proposals”.

Sunday Interview: Dr Mackay, tobacco industry’s worst nightmare

Jun 4th, 2017
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ANTI-TOBACCO advocate Professor Dr Judith Longstaff Mackay has been identified as ‘one of the three most dangerous people in the world’ by the industry. She was instrumental in developing the World Health Organisation’s Framework Convention on Tobacco Control. In her recent visit to Malaysia, she shares her experience campaigning against tobacco in Asia since 1984.

“I HAVE been described as a ‘psychotic human garbage, a gibbering Satan, an insane psychotic, power-lusting piece of meat, Hitler and a nanny’ and they (the tobacco industry allies) threatened to destroy me. But such threats and offensive words never once diverted me from my cause,” says Professor Dr Judith Longstaff Mackay.

Dr Mackay, 73, wears many hats. The World Health Organisation (WHO) senior policy adviser is also senior adviser to Vital Strategies, part of the Bloomberg Initiative to Reduce Tobacco and director of the Asian Consultancy on Tobacco Control.

Her recent visit was part of her capacity as a visiting professor at the University Malaya Centre of Addiction Sciences.

A recipient of British Medical Journal Lifetime Achievement Award (2009) and a Special Award for Outstanding Contribution on Tobacco Control (2014), she has published 200 papers, and addressed over 460 conferences on tobacco control.

Dr Mackay has received many international awards in recognition of her contribution on tobacco control. She was selected as one of Time’s 60 Asian Heroes (2006) and of Time’s 100 World’s Most Influential People (2007).

Question: Born in Britain, you moved to Hong Kong in 1967 after earning a medical degree from the University of Edinburgh in 1966. What led to your resignation as a physician in 1984, and then becoming a leading campaigner and advocate for tobacco control for the last 30 years?

Answer: I had a complete career change from cure to prevention and there were three main reasons for making the shift.

First, when I was working in a hospital in Hong Kong, we had a maxim on our male medical wards that every person we admitted was a smoker with tobacco illnesses, like heart diseases, cancer and chronic chest problems, which were often too late and too advanced to be cured.

I realised we had to go a step “higher upstream” to prevent this rather than merely providing the ambulance services at the end-stage.

I came to feel that hospital medicine was important but it works like a band-aid in comparison with prevention.

You may be able to save hundreds of lives in a lifetime in hospital medicine, but millions of lives could be saved if you work in prevention. It is a completely different ball game, and yet the money, prestige and attention all go to curative medicine; and that is similar around the world.

Second, was the realisation that although women’s health those days was defined very gynaecologically, more women were being killed by tobacco than by every method of contraception combined. I was particularly concerned that the tobacco industry was enticing women with promises of beauty, fame, emancipation and freedom.

The third reason was that the tobacco industry felt Asia was theirs for the taking.

They said it themselves — when asked about their future in the 1980s, “What do we want? We want Asia”.

Q: Why did the tobacco industry had their eyes set on Asia?

A: They wanted the huge populations and the large number of men already smoking who could be persuaded to smoke their brands of cigarettes.

They galloped into Asia with the dream of converting the 60 per cent of men who smoked local cigarettes to switch to international brands, and the second dream of persuading Asian women to start smoking. If this happened, their markets would be enormous.

It would not matter if every smoker in Britain stopped smoking tomorrow if they could capture the massive Asian markets.

Also, Asia was becoming more affluent, so, it was easier for people to afford cigarettes.

Thirdly, when I wrote an article in the South China Morning Post on banning cigarette advertising, a tobacco giant came down on me and labelled me as “entirely unrepresentative and unaccountable”.

The tobacco industry claimed that they were the best source of information on tobacco and they even said it has not been proven that “illness was actually caused by smoking”.

I was so outraged that it was just one of those tipping points in life in 1984. Everything came together and I realised that I really had to work on prevention rather than cure.

Ever since, I have been working principally with governments on the policy level to try and get the tax and the laws in place in tobacco control.

Q: You are known as one of the three most dangerous people in the world by the tobacco industry. What do you have to say about this?

A: Well yes, I’m proud of that. The reason that I got that title was essentially location. I happen to be in Asia and the tobacco companies wanted Asia. They saw this region as their future, but I set about thwarting their goals.

I went early on to countries like China, Indonesia, Malaysia, Mongolia, Vietnam and Cambodia and more recently to North Korea upon learning that British American Tobacco had gone into the country to get laws in place.

Q: In campaigning against tobacco use, what are some of the challenges you have faced?

A: I have had many problems, and was subjected to verbal abuse and even had death threats from allies of the tobacco industry.

Twice, I was threatened by the tobacco industry publicly, saying they would take me to court.

Nothing came of it, so it was either an attempt to intimidate me or to cast doubt on my credibility in the minds of the public.

In a television interview in South Africa, I openly said “I’m not a suicidal type, and if I were to be found knocked down by a bus, you need to find out if the tobacco industry is behind it before you look anywhere else.” And the industry was apparently furious with me for saying that.

However, their tactic now is not so much to attack people individually, but to threaten governments.

They threaten them under Constitutional Law on the rights of their products to advertise, and on freedom of speech and they attack them under trade treaties.

This is intimidating to governments and it can cost anything up to US$50 million (RM214 million) to fight these threats.

Q: You were one of the key persons in formulating the Framework Convention on Tobacco Control (FCTC), the first international treaty on public health. Malaysia is currently drafting the Control of Tobacco and Smoking Bill after lobbying for it since 2004 and they have sought your expertise. What do you have to say about this?

A: If you look at Malaysia and Hong Kong, many of the things that these two jurisdictions have done in the last 30 years are similar, yet Hong Kong has managed to half its male smoking rate.

Hong Kong is down to 10 per cent smokers now, whereas prevalence rates in Malaysia have not really decreased (at around 22.8 per cent). I understand it is not something that can be done overnight.

But the fact that the prevalence has not decreased is either because the excise tax imposed on cigarettes is not high enough, or that the laws that have been passed are not being enforced. In the case of the tobacco bill, the tobacco industry has been an unseen hand behind the scenes.

Q: The Health Ministry plans to increase prices of cigarettes from RM17 to RM21.50 in the near future to deter people from smoking. Several industry players were quick to say that increasing the tax would only lead to increased sales of illicit cigarettes. Is this true? What is the link between the increase in excise tax and contraband cigarettes?

A: There is zero truth in this. This sounds to me suspiciously just like what the tobacco industry would say. Economists, tax, finance and customs officials know, or they should know, that putting up a tobacco tax is not related to any increase in smuggling.

Our Customs chief in Hong Kong, for example, had said quite categorically there is no relationship between the amount of tax that is put in place and smuggling, and that is the position of the WHO too. But the tobacco industry keeps repeating it so often that some governments have come to believe it.

This is one of their tactics. A United States-based non-governmental organisation (NGO) has been going around the world, saying “don’t put up the tax, otherwise, there will be a rise in illicit cigarettes”. What many governments do not realise is that it is funded by the tobacco industry.

Q: WHO proposes that the tax imposed on cigarettes should be at least 75 per cent of the retail price. How efficient would this be in reducing smoking prevalence particularly among Malaysia’s young as compared with other measures, such as school education programmes?

A: Ten experts from around the world were present at a conference held in Hong Kong and, each speaker was asked “If you have one thing to do in tobacco control, what would that be?” and every single one said “tax”. This is because higher prices make cigarettes unaffordable to young people.

Taxation is the most effective approach to controlling the spread of tobacco. Creating smoke-free areas is the second measure, followed by things like advertising bans and smoking cessation.

Some people say health education in schools is crucial. Certainly, everybody likes health education, but it has not been proven effective in bringing down the prevalence of youth smoking.

And you can tell it is not effective because the tobacco industry does not oppose it. They oppose tax increases, plain packaging and smoke-free areas. And because the tobacco industry fights them, we know these are the measures that work.

Q: What needs to be done to improve our health education programmes at schools?

A: School health promotion programmes do not work because traditionally they say that if you smoke, you will get cancer when you are 60 years or heart attack when you are 70 years. If you are only a 11-year-old child, it is totally meaningless.

We need to do much more to revitalise and revamp health promotion and health education. Smoking and non-smoking youth have, in fact, the same level of health knowledge about the harms of smoking. The difference between the two groups is whether they think smoking is cool or a dirty expensive habit.

We have got to make it attractive to be a non-smoker in the teenage years.

Q: The Control of Tobacco and Smoking Bill currently being drafted would see the minimum age for buying cigarettes raised to 21 years old, ban on displaying tobacco products and making it illegal to smoke in vehicles with children inside, among others. How effective would this be in tackling smoking prevalence?

A: (People aged) 8 to 23 years is a vulnerable period. If you can stop children from smoking at this age, they are less likely to smoke. Whereas before that, they do not have the kind of mature judgment to analyse what it will mean to actually smoke.

The tobacco industry is very interested in youth and young adults because one has to only smoke 100 cigarettes and he or she will become lifelong smokers. It is so addictive.

Q: Besides health effects, what are the other impacts of cigarette smoking to the country and its people?

A: Two out of every three smokers die from cigarette smoking, so, you are losing skilled workers. One in every three fires in the world is caused by careless smoking.

There is also loss of productivity. Smokers go out for seven minutes to smoke. So, that’s seven minutes every time they smoke. Smokers are sicker and die on average a decade before non-smokers, so families lose their bread-winner.

There are medical and health costs. There is smoke damage to buildings and fabric.

And then there is a massive cost of cleaning up all the litter, billions of cigarette ends, packets, matches and lighters that are discarded every day in the world.

The tobacco industry claims that tobacco control would harm workers and farmers. This is not true. We have got so many projects now, including right in the heart of tobacco-growing in China showing that if farmers grow alternative crops they actually earn more.

The second fallacy is that if restaurants go smoke-free, they would lose revenue. Nowhere in the world has that happened. The revenue, including in Hong Kong and California, where they have introduced smoke-free policies, has gone up and not down.

Another fallacy is the government would lose money if it puts up the tax.

This does not happen. Some smokers will still pay more for cigarettes, so the revenue goes up. The number of smokers will come down particularly among the young and the poor.

There are so many economic fallacies that some non-governmental organisations propagate. Sometimes, governments almost innocently believe these economic arguments.

Q: If the situation is so dire, why can’t countries impose a blanket ban on cigarettes?

A: No country has put a blanket ban on cigarettes. Authorities have learnt from the prohibition of alcohol in the United States (1920-1933), for example, that it leads to much bigger implications particularly with crime and corruption cases.

So, the idea is to slowly push tobacco use back, so that the reduction is genuine and it is done throughout the community. This is what every government is really trying to do rather than actually ban it.

Q: Malaysia aims to be smoke-free (the End Game of Tobacco) by 2045. Are we moving in the right direction?

A: I strongly commend Malaysia for the foresight in establishing the 2045 goal and targets; few countries have yet to do this.

Recently the prevalence of male smokers has begun to decrease.

It is going to require a major commitment by the government and a huge effort by academia as well as non-governmental organisations in achieving this goal.

The Health Ministry has worked out a year-by-year plan of reducing prevalence up to 2045. It has developed a roadmap and has filled in what needs to be done each year to achieve the goal.

But it is not a quick process: if a country reduces its prevalence by one per cent a year, it is doing quite well.

So, it’s possible for Malaysia, but it will be challenging.

WHO China launches smoke-free campaign targeting youth

Jun 3rd, 2017
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The World Health Organization (WHO) started a “smoke-free generation” media campaign in Beijing Thursday targeting young Chinese.

http://www.china.org.cn/china/2017-06/03/content_40957899.htm

China is in the grip of a national tobacco epidemic, and children are most susceptible with cigarettes portrayed as fashionable and alluring in popular culture, said Bernhard Schwartlander, WHO Representative in China at the launch event.

According to WHO, over half of Chinese adult men smoke, two thirds of whom started as young adults. By 2014, 72.9 percent Chinese students had been exposed to secondhand smoke.

“There is nothing cool about smoking, but there is something empowering about choosing to live a healthy, smoke-free life,” said Schwartlander.

Since China ratified the WHO Framework Convention on Tobacco Control in 2005, the country has made a number of tobacco control efforts, including banning tobacco advertisements, increasing tobacco taxes and putting forward regional smoking bans.

As of 2016, 18 cities, including Beijing, Shanghai and Shenzhen, had implemented regional smoking bans.

China has set a target to reduce the smoking rate among people aged 15 and older to 20 percent by 2030 from the current 27.7 percent, according to the “Healthy China 2030″ blueprint issued by the central authorities last October.

WHO urges government to control tobacco use

Jun 2nd, 2017
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The World Health Organisation (WHO) has urged the government to introduce policies to control the use of tobacco because it is a leading risk factor for some serious non-communicable diseases.

The Country Representative of WHO, Dr Owen Kaluwa, who made the call suggested, for instance, the imposition of high taxes on tobacco companies to deter them from going into production.

http://www.graphic.com.gh/news/general-news/who-urges-government-to-control-tobacco-use.html

In the event of the companies paying such taxes, he said, the revenue generated should be used to finance health delivery.

He was speaking at a public forum to mark World No-Tobacco Day (WNTD) in Accra last Wednesday.

Avoid tobacco

Dr Kaluwa said globally, tobacco kills about 7.2 million people every year, over 80 per cent of whom are from low or middle-income countries.

“In Africa, about 146,000 adults aged 30 years and above die every year due to tobacco-related health diseases,” he added.

He said the use of tobacco was a leading preventable risk factor for non-communicable diseases such as cardiovascular diseases, cancer and chronic lung disease.

“Up to half of all tobacco users will die prematurely from tobacco-related causes, and on average, tobacco users lose 15 years of their lives,” he said.

Mr Kaluwa added that the growing of tobacco had affected agricultural lands in some areas.

Public education

At her turn, a Deputy Minister of Health, Mrs Tina Mensah, said adequate public education was important in dealing with the problem of tobacco use.

She reiterated the fact that tobacco use was dangerous to human health and damaging to national economic development.

“Tobacco-related illnesses and premature mortality impose direct and indirect cost to individuals and government,” she said.

She noted that tobacco production companies tried to influence the young generation to become addicted to smoking, which was a national threat.

She applauded the Food and Drugs Board (FDB) for its intervention in combating the use of tobacco by preventing tobacco companies from advertising their products.

Mrs Mensah said the ministry, for its part, would continue to support the fight against the use of tobacco in the country.

Preventive measures

Outlining some measures that had been put in place to check tobacco usage, the Chief Executive Officer (CEO) of the FDA, Mrs Delese A. Darko, mentioned the prohibition of smoking in public places, advertising prohibition and sponsorship as examples.

She added that packaging, labelling and health warnings on tobacco packages were other ways of preventing and discouraging tobacco consumers from patronising the product.

“These prohibitions have shown to be effective in reducing the demand for tobacco,” she said, adding that public sensitisation and education would, accordingly, be increased to meet the target groups.

“As we get funding, we will continue to do more to inform the public about the harmful effects of the use of tobacco,” Mrs Mensah said.

In connection with the celebration, Smoking Cessation Guidelines and a declaration on WNTD 2017 were launched.

WHO launches smoke-free celebrity campaign targeting youth

Jun 2nd, 2017
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World No Tobacco Day, which took place on May 31 this year, was themed “Tobacco – a threat to development.”

http://www.ecns.cn/2017/06-02/259994.shtml

The Chinese arm of the World Health Organization (WHO) launched a “smoke-free next generation” media campaign on June 1, inviting Chinese celebrities to encourage youngsters not to smoke. Four young Chinese celebrities, actor Wang Jia, actress Guan Xiaotong, Yiyang Qianxi of the music group TFBoys, and visual artist Chen Man, were invited to join the campaign.

“Tobacco is a threat to any person. It brings suffering, disease, death, and impoverishes families. I had never thought about smoking before, and after the event I am more determined not to smoke,” Yiyang Qianxi, member of the TFBoys, said.

“Smoking is harmful not only for the smokers, but also for nonsmokers through passive smoking,” Guan Xiaotong added.

Tobacco control is a global health issue, and reminding young people of the danger of smoking plays an important role in curbing the tobacco epidemic.

According to WHO, up to 10 billion cigarettes per day are smoked, and more than seven million deaths are linked to tobacco use every year. WHO predicts that the number of deaths caused by tobacco might grow to more than eight million a year by 2030, intensive action is not taken.

In fact, more than half of adult men are smokers in China, two-thirds of whom started smoking as young adults.

“There is absolute nothing cool or fashionable about developing lung cancer, oral cancer and yellow teeth. In other words, there’s nothing cool about smoking, But, there is something empowering about choosing to live a healthy, smoke-free life,” said Dr. Bernhard Schwartländer, the WHO representative in China.

Tobacco endangers the lives of millions of people around the world. It threatens our future and the development of economies and the environment. Tobacco harms our health and destroys our efforts to build a healthier, more prosperous and peaceful world.

Please say no to tobacco.

High cigarette prices can really make you quit smoking

Jun 1st, 2017
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WHO says increased taxation on tobacco is least expensive and most effective tool in reducing smoking worldwide.

http://www.aljazeera.com/indepth/interactive/2017/05/high-cigarette-prices-quit-smoking-170525092939544.html

Tobacco remains one of the major risk factors for a number of chronic diseases, including cancer, lung and cardiovascular diseases. The World Health Organization (WHO) estimates that tobacco is responsible for the death of around seven million people across the globe every year.

Over the last two decades, there has been a significant reduction in the percentage of people smoking every day across the world, but the WHO says a lot more needs to be done to deter people from smoking cigarettes.

In a bid to curb consumption, governments have been enforcing stricter regulations on tobacco products and their usage.

Several countries are increasingly implementing strategies to tighten their tobacco policies in the hopes of deterring smoking, especially among young people.

Raising taxes on tobacco products is seen to be one of the least expensive and the most effective tools in countering the influence of tobacco companies. But it is also the least implemented, with only 10 percent of the world’s population currently living in countries with sufficiently high taxes.

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A 2010 WHO report found that 78 percent of those aged 15 years and over in the WHO member states were non-smokers.

By 2025, the number of non-smokers is expected to rise to around 5 billion out of a projected 6.1 billion people aged 15 and over.

Currently, nearly a third of all men are smokers, making the prevalence of smoking among men considerably higher than among women. Over the past 30 years, smoking among men has decreased by 10 percent.

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The price of a pack of cigarettes

Increasing prices and adding tax measures on tobacco products has been used to decrease the demand for cigarettes.

Many countries have successfully used tax policies to regulate the price of cigarette products. In Australia, a pack of cigarettes can cost up to $18, making it the most expensive country to buy cigarettes.

A report by the Australian Institute of Health and Welfare (AIHW) in 2016 found that the smoking rate in the country was at an all time low. In the last 20 years, smoking had decreased by almost 50 percent.

The study showed that less than 13 percent of Australians are daily smokers and fewer people are starting to smoke.

The report cites Australia as having one of the lowest smoking rates in the world, in part because of their implementation of increased taxes on tobacco products, plain packaging, and more restrictive smoke-free environment laws.

prices-cigs

Illicit trade in tobacco products

The tobacco industry and other interest groups argue that increased taxes on tobacco products allows an illicit black market trade in tobacco to thrive.

But the WHO says that high-income countries with taxes on tobacco products do not face widespread issues related to illicit trade, while low-income countries continue to do so, precisely because of weaker tobacco-control programmes and taxes. Nearly 80% of the world’s smokers live in low to middle-income countries.

cig-consumption

High cigarette prices can really make you quit smoking

Jun 1st, 2017
by Editor.
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WHO says increased taxation on tobacco is least expensive and most effective tool in reducing smoking worldwide.

http://www.aljazeera.com/indepth/interactive/2017/05/high-cigarette-prices-quit-smoking-170525092939544.html

Tobacco remains one of the major risk factors for a number of chronic diseases, including cancer, lung and cardiovascular diseases. The World Health Organization (WHO) estimates that tobacco is responsible for the death of around seven million people across the globe every year.

Over the last two decades, there has been a significant reduction in the percentage of people smoking every day across the world, but the WHO says a lot more needs to be done to deter people from smoking cigarettes.

In a bid to curb consumption, governments have been enforcing stricter regulations on tobacco products and their usage.

Several countries are increasingly implementing strategies to tighten their tobacco policies in the hopes of deterring smoking, especially among young people.

Raising taxes on tobacco products is seen to be one of the least expensive and the most effective tools in countering the influence of tobacco companies. But it is also the least implemented, with only 10 percent of the world’s population currently living in countries with sufficiently high taxes.

A 2010 WHO report found that 78 percent of those aged 15 years and over in the WHO member states were non-smokers.

By 2025, the number of non-smokers is expected to rise to around 5 billion out of a projected 6.1 billion people aged 15 and over.

Currently, nearly a third of all men are smokers, making the prevalence of smoking among men considerably higher than among women. Over the past 30 years, smoking among men has decreased by 10 percent.

The price of a pack of cigarettes

Increasing prices and adding tax measures on tobacco products has been used to decrease the demand for cigarettes.

Many countries have successfully used tax policies to regulate the price of cigarette products. In Australia, a pack of cigarettes can cost up to $18, making it the most expensive country to buy cigarettes.

A report by the Australian Institute of Health and Welfare (AIHW) in 2016 found that the smoking rate in the country was at an all time low. In the last 20 years, smoking had decreased by almost 50 percent.

The study showed that less than 13 percent of Australians are daily smokers and fewer people are starting to smoke.

The report cites Australia as having one of the lowest smoking rates in the world, in part because of their implementation of increased taxes on tobacco products, plain packaging, and more restrictive smoke-free environment laws.

Illicit trade in tobacco products

The tobacco industry and other interest groups argue that increased taxes on tobacco products allows an illicit black market trade in tobacco to thrive.

But the WHO says that high-income countries with taxes on tobacco products do not face widespread issues related to illicit trade, while low-income countries continue to do so, precisely because of weaker tobacco-control programmes and taxes. Nearly 80% of the world’s smokers live in low to middle-income countries.

Stronger Tobacco-control Measures Vital, WHO Warns

May 30th, 2017
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The World Health Organization warns that more than 7 million people die prematurely every year from tobacco-related causes, and it’s a costly drain on national economies.

https://www.voanews.com/a/stronger-tobacco-control-measures-vital-world-health-organization-says/3878184.html

In advance of World No Tobacco day, to be observed Wednesday, the global health agency urged governments to implement strong tobacco control measures for the health of their people and their economies.

WHO calls tobacco a threat to development. Besides the heavy toll in lives lost, global estimates show that “tobacco costs the global economy $1.4 trillion a year,” or 1.8 percent of global gross domestic product. The WHO notes this estimate takes into consideration “only medical expenses and lost productive capacities.”

Despite effective tobacco control measures, WHO reports the number of people dying from smoking is increasing because those dying today have mostly been long-term smokers and it takes time for tobacco control policies to make an impact.

Vinayak Prasad, program manager of the WHO’s Tobacco Free Initiative, told VOA, “What we are seeing is that if the policies were not in place, the number of 7.2 million would have been higher. We are seeing a reduction of tobacco use prevalence in most countries. The only regions now which are seeing higher growth are the African continent and Middle Eastern region. The rest of the world is seeing a decline.”

Diseases, disabilities

Besides leading to premature death, the WHO has found, countless millions of people who smoke suffer from a wide variety of tobacco-related diseases and resultant serious disabilities, including blindness, amputation, impotence and poor oral health.

Andrew Black of the WHO Framework Convention on Tobacco Control Secretariat noted that smoking is an addiction largely taken up in childhood and adolescence, “so it is crucial to reduce the number of young people taking up smoking in the first place. We must stop the tobacco industry’s powerful advertising and promotion, which can all too often be oriented toward young people.”

Black said tobacco widens social inequalities and is a driver of poverty around the world.

“We know that those living on lower incomes in virtually all countries are likely to smoke, and therefore more likely to suffer the consequences of tobacco use,” he said.

Black said that by 2030, about 80 percent of the world’s tobacco-related mortality will be in low- and middle-income countries.

“High rates of tobacco use being promoted by aggressive strategies from the tobacco industry are projected to lead to a doubling of the number of tobacco-related deaths in low- and middle-income countries between 2010 and 2030,” he said.

Study issued

To mark World No-Tobacco Day, the U.N. Development Program and the Secretariat of the WHO Framework Convention on Tobacco Control issued a study that focuses on the harmful effects of tobacco on both health and on efforts aimed at achieving the U.N.’s sustainable development goals (SDGs).

Dudley Tarlton, UNDP program specialist on health and development, told VOA that tobacco undermines the SDGs because “household consumption on tobacco displaces consumption on other goods and services that might lead to a better end.

“So, it affects poverty. It affects hunger. Education is affected. Children get ear infections because they are exposed to household smoke in the home,” he said.

For the first time, the WHO and UNDP released a joint report showing the bad impact tobacco has on the environment.

Prasad acknowledged that the data received from the tobacco industry and from governments were relatively weak. Nevertheless, he said, “the evidence is really astounding as to how tobacco is extremely dangerous and harming the environment.”

He said using land to grow tobacco “can lead to severe damage because of the widespread use of agrochemicals.”

Use of trees

Prasad noted that more than 11 million metric tons of wood was required to cure and dry tobacco, “which essentially means deforestation is already happening.”

The report found that tobacco waste contains over 7,000 toxic chemicals that poison the environment, including human carcinogens, and that tobacco smoke contributes “thousands of tons of human carcinogens, toxicants and greenhouse gases to the environment.”

Prasad said that cigarettes are bad news for tree lovers because “for every 300 cigarettes, we need to cut a tree. … Even conservatively, if we are looking at 6 trillion cigarettes, we are looking at almost 15 to 20 billion trees to cut.

“We have 6 trillion trees in the world, so we are almost looking at a big cut, which is going to happen, if we do not hold this,” he said.

And regarding the sullying of the world’s environment, he noted that cigarette butts “account for 30 to 40 percent of all items collected in coastal and urban cleanups.”

Colombia, Ecuador and Peru to receive WHO World No Tobacco Day Award

May 30th, 2017
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The World Health Organization (WHO) will distinguish Colombia, Ecuador and Peru with its 2017 World No Tobacco Day Award, which recognizes institutions, organizations and individuals who have made outstanding contributions in the fight against smoking in their country.

http://www.paho.org/hq/index.php?option=com_content&view=article&id=13381%3Acolombia-ecuador-y-peru-recibiran-el-premio-del-dia-mundial

In total, 29 countries from all regions of the world will be awarded by the World Health Organisation (WHO) in the framework of World No Tobacco Day (31 May), whose theme this year seeks to highlight the threat posed by tobacco to social development.

The winners have contributed to the implementation of the WHO Framework Convention on Tobacco Control (FCTC) and its Protocol for the Elimination of Illicit Trade.

The three winners of the award in the Americas region are:

  • Ministry of Finance and Public Credit of Colombia, Ministry of Health and Social Protection of Colombia and the Citizens coalition to oversee tobacco control policy (Veeduría ciudadana para el Control de Tabaco).
  • Internal Revenue Agency of Ecuador (Servicio de Rentas Internas – SRI).
  • Ministry of Economy and Finance of Peru.

The awards to the winners of the region will be presented by the Pan American Health Organization (PAHO), regional office for the Americas of the World Health Organisation, starting on May 31.

The FCTC was the world’s first health treaty negotiated under the auspices of WHO and went into effect in 2005. A legally binding accord, it commits States Parties to implementing a series of tobacco control measures aimed at reducing tobacco consumption and saving lives.

In the Americas, 30 countries have ratified the Convention, and a number have made significant progress in implementing its provisions, particularly smoke-free indoor public spaces and health warnings on tobacco packages.

Tobacco is the only legal consumer product that kills up to half its regular users when consumed exactly as the manufacturer intends. Worldwide, approximately 14 persons die from a tobacco-related disease every minute, equivalent to nearly 7 million lives lost each year.

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