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‘Quitting tobacco can decrease cancer chances eight times’

Increase in tobacco consumption has led to rise in cancer cases among the youth in recent years. “It is most common in people between 25 and 40 years of age,” said Dr Satsheel Sapre, HoD of Head and Neck Cancer Department at Rashtrasant Tukdoji Regional Cancer Hospital (RST).

http://timesofindia.indiatimes.com/city/nagpur/quitting-tobacco-can-decrease-cancer-chances-eight-times/articleshow/59814866.cms

Sapre was speaking at an awareness programme organized by RST and Indian Medical Association (IMA) to mark Head and Neck Cancer Day, on Thursday, on the premises of the hospital. “Vidarbha is world capital of tobacco related cancers. Quitting tobacco can decrease chances of cancer eight times,” he said.

“Young people mostly start smoking or chewing tobacco due to peer pressure or perceive it as something glamorous. But smoking causes lung cancer and increases development of unwanted, uncontrolled and abnormal cells,” Sapre added.

Making an appeal about quitting smoking, Sapre said, “Our body does not need tobacco. It only harms our body, still many youths take the suicidal path. According to WHO, one among every eight persons is likely to be affected with cancer before death.”

Talking about symptoms of cancer, Sapre said, “Bleeding from mouth, constipation, change in voice, stink from mouth and fever or cough for more than 15 days can be symptoms of cancer. Patients must visit doctors for fighting cancer, it will not disappear by itself.”

A cancer survivor Shrimad shared his experience. “In 2000, I developed a small lump on my chick, which was due to cancer. I use to chew tobacco but I didn’t lose hope and fought it. Now I am living a normal life. I will suggest everyone not to eat tobacco and never lose hope because you can fight cancer. Doctors are your closest friend against diseases like cancer,” he said.

A small play on banning tobacco, alcohol and smoking was also staged at the programme. It illustrated cancer as the ‘boss’ of all addictive materials that are driving people towards destruction.

Dr BK Sharma, director of RST, and Dr Avinash Wase, president of IMA, were also present at the programme.

Report claims tobacco laws could change post Brexit

The Department of Health has issued a report that shows Brexit will allow some aspects of standardized tobacco packaging to be re-evaluated.

https://www.packagingnews.co.uk/news/markets/tobacco/cpma-brexit-offers-tobacco-pack-deregulation-21-07-2017

The government report, ‘Towards a Smokefree Generation – A Tobacco Control Plan for England’, includes a section titled ‘Leaving the European Union’ which states:

“Over the course of this Tobacco Control Plan, the government will review where the UK’s exit from the EU offers us opportunities to reappraise current regulation to ensure this continues to protect the nation’s health. We will look to identify where we can sensibly deregulate without harming public health or where EU regulations limit our ability to deal with tobacco.”

Mike Ridgway of the CPMA said that he acknowledges the objective of sensible and balanced regulation in tackling the issues surrounding smoking and health. However, he argues that that Brexit offers opportunities to re-appraise current regulation and identify where deregulation can take place.

He cites two examples from a packaging perspective would allow for the re-introduction of cigarette packs of tens and reducing the R-Y-O loose tobacco minimum limit of 30g where the restrictions have adversely affected packaging manufacturers.

“Both existing regulations currently encourage the purchasing of more product and the spending of more cash by the consumer on tobacco products in direct contradiction of the objectives of the tobacco control advocates to reduce consumption,” said Ridgway. “A further relaxation in pack shape design would allow an additional degree of packaging innovation which would add complexity to the packaging and reduce further opportunities for counterfeiting,” concludes Ridgway who has been opposing the “excessive regulation” of packaging on consumer products for many years.

WHO report gives India high marks for fighting tobacco use

A new report by the World Health Organisation on the global use of tobacco shows India, Bangladesh and Bhutan on top of the list of South East Asian countries that have achieved a high level of tobacco control.

http://www.domain-b.com/organisation/who_collaborating_centre/20170721_tobacco.html

The prevalence of tobacco use in India has fallen from 34.1 per cent to 28.6 per cent over the last seven years, the report says, comparing data from two rounds of the Global Adult Tobacco Survey (GATS) in 2009-10 and 2016-17.

The WHO report titled Global Tobacco Epidemic, 2017: Monitoring Tobacco Use and Prevention Policies, was released in New York on Wednesday on the sidelines of the United Nations High-Level Political Forum on Sustainable Development. The report covers 194 countries, divided into The Americas, South East Asia, Europe, Eastern Mediterranean, Western Pacific, and Africa. There are 11 countries in the South East Asia group, including India.

Though the population worldwide protected by tobacco control measures has grown almost five-fold than ten years ago, the World Health Organisation (WHO) on Wednesday called on countries to do more to prioritise these life-saving policies.

In India, Mumbai, Kolkata, Delhi, Hyderabad, Bengaluru, Pune, Surat, Kanpur, Jaipur, Lucknow and Nagpur are among the top 100 cities across the world named for the strict implementation of policies to prevent tobacco use. The report lists the cities population-wise, using figures published in the UN Statistics Division’s Demographic Yearbook.

Globally, the WHO report said about 4.7 billion people, or 63 per cent of the world’s population, are covered today by at least one comprehensive tobacco control measure. Ten years ago, in 2007, the number was only one billion, or 15 per cent of the world’s population.

However, tobacco use has still become the leading single preventable cause of death worldwide, killing over seven million people each year.

Its economic costs are also enormous, totalling more than $1.4 trillion in healthcare and lost productivity, according to WHO.

Meanwhile, the tobacco industry continues to hamper government efforts to fully implement life- and cost-saving interventions, by, for example, exaggerating the economic importance of the tobacco industry, discrediting proven science, and using litigation to intimidate governments, the report says.

Poor countries ahead
More than half of the top national performers on tobacco control are low- and middle-income countries, showing that progress is possible regardless of economic situation. A tracking of MPOWER measures – introduced by WHO in 2007 to assist in the country-level implementation of measures to reduce the demand for tobacco – has revealed that the number of people protected by at least one best-practice measure has quadrupled to 4.7 billion – or almost two-thirds of the world’s population.

As many as 121 out of 194 countries have introduced at least one MPOWER measure at the highest level of achievement (not including monitoring or mass media campaigns, which are assessed separately).

Thirty-four countries with a total population of 2 billion have adopted large graphic pack warnings. Six countries (Afghanistan, Cambodia, El Salvador, Lao People’s Democratic Republic, Romania and Uganda) have adopted new laws making all indoor public places and workplaces smoke-free. Six countries (El Salvador, Estonia, India, Jamaica, Luxembourg and Senegal) have advanced to best-practice level with their tobacco use cessation services, the report says.

India and Nepal are regional and global leaders in implementing large, pictorial warning labels on tobacco packaging. With the increase in the size of pack warnings to 85 per cent of both front and back panels on all tobacco products, India now has the third largest pack warning label among all countries.

The findings of GATS-2 showed that graphic warning labels depicting throat cancer and oral cancer are a strong tool to discourage the youth from initiating tobacco, and have motivated 275 million current users to quit.

Dr Vinayak Prasad, Geneva-based head of the WHO Tobacco Free Initiative, told The Indian Express that among the many measures to control tobacco in India was the joint WHO-International Telecommunication Union initiative mCessation, launched in 2015 with the Ministries of Health and Family Welfare and Communication and Information Technology. ”The programme to encourage people to quit tobacco use registered more than two million users last year and the initial evaluation showed that more than 7% quit successfully after six months,” Dr Prasad said.

The WHO Framework Convention on Tobacco Control (WHO FCTC), the first international treaty negotiated under the auspices of WHO, was adopted by the World Health Assembly in 2003, and entered into force in 2005. It has since become one of the most widely embraced treaties in UN history.

Tobacco companies interfere with health regulations, WHO reports

Tobacco industry is interfering with government attempts to regulate products and aggressively pursuing new markets in Africa, World Health Organization says

https://www.theguardian.com/world/2017/jul/19/tobacco-industry-government-policy-interference-regulations

Cigarette manufacturers are attempting to thwart government tobacco controls wherever possible, even as governments make progress regulating the products, a new World Health Organization report has found.

World health officials also warn that tobacco companies have moved their fight to the developing world, such as Africa, where smoking rates are predicted to rise by double digits in the coming decades.

“Tobacco industry interference in government policymaking represents a deadly barrier to advancing health and development in many countries,” said Douglas Bettcher, director of the WHO’s department for the prevention of noncommunicable diseases. “But by monitoring and blocking such activities, we can save lives and sow the seeds for a sustainable future for all.”

Tobacco-related diseases are the leading preventable cause of death worldwide. The products kill more than 7 million people each year – more than HIV and Aids, tuberculosis and malaria combined. The effects of the substance are also costly. Researchers believe that tobacco-related harm costs the world $1.4tn in healthcare costs and lost productivity.

A recent investigation by the Guardian found that tobacco companies, including British American Tobacco, threatened African countries with domestic and trade lawsuits if certain anti-smoking measures were put in place. BAT says it is not against all regulations but needs to take action from “time to time”.

A Reuters investigation found that BAT’s arch-rival, Philip Morris International, developed a vast lobbying campaign to delay and prevent tobacco controls. PMI says there is nothing improper about its executives engaging with government officials.

Wednesday’s WHO report, which was funded by Bloomberg Philanthropies, comes on the same day as a shareholder vote on a $49bn merger between BAT and Reynolds American Incorporated, a deal that would make BAT the largest listed tobacco company in the world.

“The epicentre of this epidemic has moved to the developing world,” said Dr Vera Luiza da Costa e Silva, head of WHO’s convention secretariat. “Low- and middle-income countries struggle to combat a tobacco industry seeking to pursue new markets, often through shameless interference with public health policymaking.”

Currently, the World Health Organization recommends countries put in place six regulations health officials see as critical to reducing smoking: systems to monitor smoking rates; laws to protect people from secondhand smoke; tools to help people quit; warnings about the dangers of tobacco use; enforcement of advertising bans, and increased taxes on tobacco products.

Six in 10 countries have implemented at least one of the six protections, officials said, four times the population that was protected in 2007.

However, progress is lopsided. Some recommendations have been far more widely accepted than others. For example, 3.5 billion people in 78 countries are protected by graphic warnings on cigarette packs, but only 15% of the world’s population is protected by a comprehensive advertising ban, and high tobacco taxes, while very effective, are one of the least-implemented measures.

Even some wealthier nations have had trouble getting tobacco control measures in effect. In the United States, for example, there are no graphic warnings on cigarette packs because of industry lawsuits and regulatory delay, and tobacco taxes remain low.

Anti-tobacco lawmakers and campaigners in the US blame the slow progress on “pervasive” tobacco industry influence, which reaches all the way to top officials in the Trump White House.

“Working together, countries can prevent millions of people from dying each year from preventable tobacco-related illness,” said Tedros Adhanom Ghebreyesus, the WHO director-general. “Governments around the world must waste no time”.

Bloomberg Philanthropies funds Vital Strategies, which part funds the Guardian’s Tobacco: a deadly business series, the content of which is editorially independent.

UN Reports More People Warned Against Tobacco Use

Despite measures protecting a majority of people from tobacco-related illness and death, the tobacco industry continues to hamper Government efforts to fully implement life and cost-saving interventions, the United Nations health agency reported.

http://www.womenofchina.cn/womenofchina/html1/features/health/1707/4690-1.htm

“One-third of countries have comprehensive systems to monitor tobacco use. While this is up from one-quarter of countries monitoring tobacco use at recommended levels in 2007, Governments still need to do more to prioritize or finance this area of work,” according to the UN World Health Organization’s WHO report on the global tobacco epidemic, which was launched today on side-lines of the UN High-level political forum on sustainable development in New York.

The report shows that some 4.7 billion people – more than 60 per cent of the population – are protected by at least one “best practice” tobacco control measure from the WHO’s Framework Convention on Tobacco Control (WHO FCTC). These measures include no smoking areas and bans on advertising tobacco products, for example.

In the foreword to the report, the head of WHO urged Governments to incorporate all the provisions of the WHO FCTC into their national tobacco control programmes and policies, and to fight against the illicit tobacco trade.

“Working together, countries can prevent millions of people from dying each year from preventable tobacco-related illness, and save billions of dollars a year in avoidable health-care expenditures and productivity losses,” said Tedros Adhanom Ghebreyesus, WHO Director-General.

The report, funded by Bloomberg Philanthropies, noted that systematic monitoring of tobacco industry interference in government policymaking protects public health by shedding light on tobacco industry tactics.

Such tactics include “exaggerating the economic importance of the tobacco industry, discrediting proven science and using litigation to intimidate governments.”

Douglas Bettcher, director of WHO’s Department for the Prevention of Noncommunicable Diseases (NCDs), said tobacco industry interference in government policy making represents “a deadly barrier to advancing health and development in many countries.

Controlling tobacco use is a key part of the 2030 Agenda for Sustainable Development. The Agenda includes targets to strengthen national implementation of the WHO FCTC and a one-third reduction in premature deaths from NCDs, including heart and lung diseases, cancer and diabetes, according to a press release launching the report.

“The progress that’s been made worldwide – and documented throughout this report – shows that it is possible for countries to turn the tide,” said Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases and founder of Bloomberg Philanthropies.

Comprehensive Tobacco Bill Drafted

Minister of Health, Dr. the Hon. Christopher Tufton, says a comprehensive Tobacco Control Bill has been developed and is under review.

http://jis.gov.jm/comprehensive-tobacco-bill-drafted/

Making his contribution to a private member’s motion brought by Member of Parliament for Central Kingston, Rev. Ronald Thwaites, on public health issues arising from tobacco and ganja use, in the House of Representatives on July 18, Dr. Tufton said the comprehensive legislation seeks to address critical matters which have not been addressed under the existing Tobacco Control Regulations.

These, he said, include: regulating the interactions of Government officials with the tobacco industry; and regulating price and tax measures in a manner that will effectively contribute to the reduction of tobacco consumption.

Other focus areas of the Bill include: testing and measurement of the contents and emissions of tobacco products and provisions for the disclosure of toxic substances to the public; full prohibition on tobacco advertising, promotion and sponsorship, including a ban on point-of- sale tobacco displays; and Jamaica’s commitment to eliminate all forms of illicit trade in tobacco products.

“The Bill will also prohibit sale of all forms of tobacco products to and by minors. The Child Care and Protection Act (CCPA) does not prohibit the sale of tobacco products in general (including electronic nicotine delivery systems) to and by minors,” Dr. Tufton
said.

He noted that the current provision restrictively references cigarettes, cigars, cheroots and cigarillos.

The Minister added that attempts were being made by the Office of the Children’s Advocate to amend the CCPA to accord with the Framework Convention on Tobacco Control (FCTC) requirements.

“Therefore priority areas for the Government include: full implementation of a comprehensive ban on tobacco advertising, promotion and sponsorship; enacting a comprehensive tobacco control legislation; and reducing demand on tobacco products
through increased taxes,” Dr. Tufton said.

He noted that multi-sectoral collaborations on the drafting of the Bill have been completed and a report is to be submitted to each of the portfolio ministries for their final comments.

The Ministry has also engaged the Ministry of Foreign Affairs and Foreign Trade to lead the process, which involves deliberations among legal personnel from the various ministries.

A Cabinet submission is to be developed in relation to this legislation.

Raise tax on tobacco and make smokers pay for health costs

I support Gauri Venkitaraman’s plea for bans in public areas where the permeation of cigarette smoke is harmful for passers-by or those trying to enjoy the outdoors (“Smoking in public leaves even non-smokers in Hong Kong facing serious health risks [1]”, July 11).

Non-smokers in proximity risk having their asthma flare up. Curious toddlers could become poisoned by ingesting carelessly discarded butts.

The fire contagion risk posed by still-burning cigarette ends is well known during the height of Australia’s bush-fire-prone sizzling summer and hot summers elsewhere.

Less smoking means fewer discarded butts posing a fire hazard. Another reason to impose smoking bans is to prevent adverse lifestyle role modelling for impressionable children.

From a public health perspective, raising tobacco sales tax is likely to reduce daily cigarette consumption and, more importantly, dissuade adolescents from taking up smoking. The cost disincentive of a higher tax holds the potential to improve the community burden of heart and lung disease that consumes avoidable health-care outlays.

It’s about time smokers who adopt unhealthy life habits subsidised the huge expense incurred in treating the acute exacerbation of chronic lung disease, pulmonary community rehabilitation as well as stents and bypass surgery required to alleviate coronary artery disease. Smokers have an addiction requiring an external agency to help them give up.

Imposing higher taxes on fast food and alcohol offers opportunities to improve public health related to “diabesity” (diabetes plus obesity), alcohol-related trauma and interpersonal violence. If we can extend sales tax disincentives to fast food and alcohol, then claims that a tobacco tax discriminates against smokers cannot be justified.

Joseph Ting, associate professor, School of Public Health and

Social Work, University of Queensland, Brisbane, Australia
________________________________________
Source URL: http://www.scmp.com/comment/letters/article/2103457/raise-tax-tobacco-and-make-smokers-pay-health-costs

Taxation: Most effective but still the least-used tobacco control measure

source: Infographic: Stop Smoking: It's Deadly and Bad for the Economy

source: Infographic: Stop Smoking: It’s Deadly and Bad for the Economy

A new report by the World Health Organization (WHO) shares some good news: Six in 10 people worldwide are now protected by at least one of the WHO Framework Convention on Tobacco Control (FCTC)-recommended demand reduction measures, including taxation. The report, launched on the sidelines of the UN high-level political forum on sustainable development, also makes clear that raising taxes to increase tobacco product prices is the most cost-effective means to reduce tobacco use and prevent initiation among the youth. But it is still one of the least used tobacco control measures.

https://blogs.worldbank.org/health/taxation-most-effective-still-least-used-tobacco-control-measure

The facts about this global public health scourge are undisputable:

  • Tobacco use is the leading single preventable cause of death worldwide, killing over 7 million people each year.
  • Cigarettes are addictive by design, and smoking cigarettes can damage every part of the body, causing different cancers from the head or neck to the lungs and cervix and other chronic conditions such as stroke and heart disease, which lead to early death.
  • The direct and indirect economic costs are also enormous, totaling more than US$1.4 trillion.
  • Controlling tobacco use is critical for the achievement of the health and social and economic targets in the 2030 Agenda for Sustainable Development.

But we know what needs to be done and governments are acting. Governments are implementing “MPOWER”, six tobacco control measures in line with the WHO Framework Convention on Tobacco Control (FCTC). MPOWER includes:

  • Monitoring tobacco use and prevention policies;
  • Protecting people from tobacco smoke;
  • Offering help to quit tobacco use;
  • Warning about the dangers of tobacco;
  • Enforcing bans on tobacco advertising, promotion and sponsorship; and
  • Raising tobacco taxes.

The WHO report indicates that 43% of the world’s population (3.2 billion people) are now covered by two or more MPOWER measures at the highest level, nearly seven times the number covered in 2007. Eight countries, including five low- and middle-income ones, have implemented four or more MPOWER measures at the highest level: Brazil, Islamic Republic of Iran, Ireland, Madagascar, Malta, Panama, Turkey, and the United Kingdom of Great Britain and Northern Ireland.

Some additional findings are noteworthy:

  • Monitoring: Several countries, such as Nepal, India, and the Philippines, that conducted WHO-backed initiatives to monitor tobacco use have used the information to adopt measures to protect people from tobacco use. For example, Philippines’ landmark Sin Tax Reform Law was passed in 2012 after its 2009 global adult tobacco survey showed high smoking rates among men (47.4%) and boys (12.9%). The implementation of this policy measure has contributed to declining tobacco use as evidenced by the country’s 2015 adult tobacco survey results.
  • Protect: Comprehensive smoke-free legislation is currently in place for almost 1.5 billion people in 55 countries. Dramatic progress has been witnessed in low- and middle-income countries, 35 of which have adopted these laws since 2007.
  • Offer: Appropriate cessation treatment is in place for 2.4 billion people in 26 countries.
  • Warn: More people are protected by strong graphic pack warnings than by any other MPOWER measure, covering almost 3.5 billion people in 78 countries – almost half (47%) the global population. And, 3.2 billion people live in a country that aired at least one comprehensive national anti-tobacco mass media campaign in the last two years.
  • Enforce: Bans on tobacco advertising, promotion, and sponsorship interfere with the tobacco industry’s ability to promote and sell its deadly products and reduce tobacco use. But only 15% of the world’s population is currently covered by a comprehensive ban.
  • Raise: Raising taxes to increase tobacco product prices is the most cost-effective measure to reduce tobacco use and encourage users to quit, but it is one of the least used tobacco control measures globally.

What the World Bank Group is doing

As an institution, the Bank has long been committed to tobacco control as reflected in its unambiguous Operational Directive 4.76 of 1999 that mandates that the World Bank Group does not lend directly or provide credits, grants, or guarantees for tobacco production, processing, or marketing. The Bank’s policy advice and technical assistance support tobacco tax increases to protect the population from health risks and to mobilize additional domestic resources.

Over the past two decades, Bank teams have carried out substantial analytical work to build the global knowledge base on issues related to tobacco control.

In recent years, the Bank, in partnership with the Gates and Bloomberg Foundations, and in coordination with WHO, has supported countries in the design of tobacco tax policy reforms to raise prices, reduce consumption, and mobilize domestic resources in accordance with the 2015 Financing for Development Addis Ababa Action Agenda.

In addition to support provided to the reforms in Philippines in 2012, in Botswana in 2013, in Ghana in 2014, and in Peru in 2015, the Bank’s assistance to Armenia, Colombia, Moldova, and Ukraine contributed to the adoption of significant tobacco tax increases in 2016. The total population covered by these policy actions is about 250 million people.

Ongoing support is being provided in 2017 to an additional set of countries across regions, including Montenegro, where the government recently announced that tobacco taxes will be increased over the next 3 years in line with the European Union Tobacco Tax Directive’s target rates, and in Lesotho, as part of the 2017 budget presented by the new government to Parliament.

In moving the global tobacco control agenda forward, as the findings of the 2017 WHO report suggest, a dedicated focus by governments with support of the international community is required to raise tobacco taxes since it continues to be the least used tobacco control measure. This is of critical importance to make these deadly products unaffordable, reduce consumption among current smokers, and prevent smoking initiation among children and youth.

While health is the main objective, we also need to argue, on the basis of country evidence from across the world, that raising tobacco taxes can generate a significant fiscal benefit by helping to expand a country’s tax base and increase the budgetary capacity of governments to fund priority investments and programs that benefit the entire population.

Philip Morris takes aim at young people in India, and health officials are fuming

The tobacco giant is pushing Marlboros in colorful ads at kiosks and handing out free smokes at parties frequented by young adults – tactics that break India’s anti-smoking laws, government officials say. Internal documents uncovered by Reuters illuminate the strategy.

http://www.reuters.com/investigates/special-report/pmi-india/

S. K. Arora spent more than three years trudging through the Indian summer heat and monsoon rains to inspect tobacco kiosks across this sprawling megacity, tearing down cigarette advertisements and handing out fines to store owners for putting them up.

But as fast as he removed the colorful ads, more appeared.

The chief tobacco control officer at the Delhi state government, Arora asked the major cigarette companies to put a stop to the cat-and-mouse routine. In official letters and face-to-face meetings, he told them India’s tobacco control laws barred such public advertising and promotion of cigarettes.

That included the Indian arm of Philip Morris International Inc, the world’s largest publicly traded tobacco company. Early last year, Arora said, he met with a Philip Morris director for corporate affairs in India, a man named R. Venkatesh, and told him the signs were an unequivocal violation of Indian law.

Like other tobacco companies, Philip Morris kept up its ad blitz.

Venkatesh says Philip Morris is doing nothing wrong. In response to questions from Reuters, he said the company’s advertising is “compliant with Indian law” and that Philip Morris has “fully cooperated with the enforcement authorities” on the matter.

But Indian government officials say Philip Morris is using methods that flout the nation’s tobacco-control regulations. These include tobacco shop displays as well as the free distribution of Marlboro – the world’s best-selling cigarette brand – at nightclubs and bars frequented by young people.

In internal documents, Philip Morris International is explicit about targeting the country’s youth. A key goal is “winning the hearts and minds of LA-24,” those between legal age, 18, and 24, according to one slide in a 2015 commercial review presentation.

As with the point-of-sale ads at kiosks, public health officials say that giving away cigarettes is a violation of India’s Cigarettes and Other Tobacco Products Act and its accompanying rules.

Philip Morris’ marketing strategy for India, which relies heavily on kiosk advertising and social events, is laid out in hundreds of pages of internal documents reviewed by Reuters that cover the period from 2009 to 2016. In them, Philip Morris presents these promotions as key marketing activities. In recent years, they have helped to more than quadruple Marlboro’s market share in India, where the company is battling to expand its reach in the face of an entrenched local giant. Reuters is publishing a selection of those documents in a searchable repository, The Philip Morris Files.

The company’s goal is to make sure that “every adult Indian smoker should be able to buy Marlboro within walking distance,” according to another 2015 strategy document.

In targeting young adults, Philip Morris is deploying a promotional strategy that it and other tobacco companies used in the United States decades ago. A study published in the American Journal of Public Health in 2002 found that during the 1990s, “tobacco industry sponsorship of bars and nightclubs increased dramatically, accompanied by cigarette brand paraphernalia, advertisements, and entertainment events in bars and clubs.”

With cigarette sales declining in many countries, Philip Morris has identified India, population 1.3 billion, as a market with opportunity for significant growth. “India remains a high potential market with huge upside with cigarette market still in infancy,” says a 2014 internal document.

According to government data, India has about 100 million smokers. Of those, about two-thirds smoke traditional hand-rolled cigarettes. Tobacco use kills more than 900,000 people a year in India, and the World Health Organization estimates that tobacco-related diseases cost the country about $16 billion annually.

Philip Morris is not alone in using marketing methods that Indian officials say are illegal. The country’s largest cigarette maker, ITC Ltd, uses similar tactics, such as advertising at kiosks. British American Tobacco Plc and Indian state-run companies have large, passive stakes in ITC, which controls about 80 percent of the market.

Tobacco-control officer Arora, a short, mustachioed man with a gruff demeanor, sent a letter to Philip Morris and other tobacco companies in mid-April, giving them until the end of the month to remove all advertisements. “Legal action will be initiated against the company” if it did not comply, he wrote in the letters, copies of which were reviewed by Reuters.

A day after Arora’s deadline passed, he and his team conducted a raid in an affluent area of cafes and coffee shops in New Delhi that showed his letters did not have the desired effect.

On that hot afternoon in May, the team cut down about a dozen advertisements for Marlboro and various ITC brands. As word of the raid spread, worried vendors covered their ads with newspapers or took them down.

One kiosk owner, Rakesh Kumar Jain, removed his Marlboro ads before Arora’s team arrived. Jain said the signs had been put up by Philip Morris representatives. In return, he said, he received free cigarettes each month worth about 2,000 rupees (about $30). Jain knew that putting up the posters was illegal, but they helped improve sales, he said.

About a dozen kiosk owners interviewed by Reuters said that tobacco companies paid them a monthly fee for advertisements and product displays, with the amount determined by factors such as location, volume of business and type of promotional material.

In payment receipts seen by Reuters, Philip Morris’ India unit promised to pay 500 Indian rupees ($7.50) a month to a cigarette seller with a small roadside kiosk in New Delhi for putting up Marlboro ads. The receipts were signed by a company representative.

During the raid, fines were issued to some vendors, many of them repeat offenders, and they were threatened with court action if the ads went up again.

Like Philip Morris, ITC says that it is in full compliance with India’s 2003 tobacco control law. If it wasn’t, the company said in a statement to Reuters, then “the relevant government authorities would have initiated action.”

Since Arora’s threat of legal action in April, there are fewer Philip Morris advertisements outside cigarette shops in the capital. But both Philip Morris and ITC say that advertising inside a shop is allowed.

“Advertisements of tobacco products at the entrance and inside the shops selling tobacco products are clearly and categorically permitted,” ITC said in response to questions from Reuters.

Arora, however, said all advertising is prohibited – “There are no two ways about it,” he insisted – but he can’t start legal proceedings until getting further guidance from the federal government. He has yet to receive an answer.

Federal health officials say in interviews that the ads are out of bounds. Amal Pusp, a director for tobacco control at the health ministry, told Reuters that “there is no confusion”: All advertisements – inside and outside shops – are illegal.

The 2003 law allows tobacco companies to advertise at shops, but subsequent rules issued by the government prohibit it.

“India remains a high potential market with huge upside with cigarette market still in infancy.”

From a 2014 internal Philip Morris document

In 2004, India became one of the first countries to ratify the World Health Organization’s Framework Convention on Tobacco Control (FCTC) treaty. The pact has 181 members and contains a raft of anti-smoking provisions, including tobacco taxes, warning labels on cigarette packs and advertising bans. The country enacted its national tobacco control law the year before ratifying the FCTC, and since then the government has added rules to strengthen the law in line with the treaty’s provisions.

The health ministry published rules in 2005 that banned any display of brand names, pack images or promotional messages. The rule specified that tobacco retailers could only display a 60-by-45 centimeter board, roughly 24 by 18 inches. The sign can have a description of the type of tobacco products sold – such as cigarettes or chewing tobacco – but cannot include any brand advertising and must carry a large health warning.

The health ministry’s rules were challenged in court by a group of cigarette distributors and put on hold by a state-level High Court for seven years. They finally came into force in 2013 on orders of India’s Supreme Court.

The High Court had overlooked the fact that advertisement of tobacco products “will attract younger generation and innocent minds, who are not aware of grave and adverse consequences of consuming such products,” the Supreme Court said in its ruling.

Philip Morris has lobbied against the passing of stricter tobacco control rules by the Indian government. In documents detailing the company’s plans for the biennial FCTC treaty convention in India last November, Prime Minister Narendra Modi emerges as a prime target. A key goal: to pre-empt Modi from taking “extreme anti-tobacco measures” before delegates were to gather from around the world for the treaty meeting, according to a 2014 corporate affairs PowerPoint presentation.

Excerpts from the Philip Morris Files

Reuters reviewed hundreds of pages of internal Philip Morris International documents relating to India. These excerpts show the company’s marketing and lobbying tactics, which are aimed at bolstering the Marlboro brand among young adults and blocking the “enactment of extreme anti-tobacco measures.” Letters from Indian officials detail the government’s efforts to enforce the country’s tobacco control regulations. (Some documents include highlighting by Reuters.)

A slide from a Philip Morris training manual shows the kinds of people the company aims to target for Marlboro sales in India. LAS = legal age smokers.

A slide from a Philip Morris training manual shows the kinds of people the company aims to target for Marlboro sales in India. LAS = legal age smokers.

A slide from a 2014 strategy presentation shows Philip Morris’ goals for marketing Marlboro Red in India. LA-24 = legal age to 24-year-old smokers.

A slide from a 2014 strategy presentation shows Philip Morris’ goals for marketing Marlboro Red in India. LA-24 = legal age to 24-year-old smokers.

This slide from a 2012 marketing presentation shows where Philip Morris planned to target 18-to-24-year-old smokers in India.

This slide from a 2012 marketing presentation shows where Philip Morris planned to target 18-to-24-year-old smokers in India.

A Philip Morris training manual lays out rules for how those marketing its cigarettes should look. FWP = field work personnel.

A Philip Morris training manual lays out rules for how those marketing its cigarettes should look. FWP = field work personnel.

Another slide from the Philip Morris training manual includes instructions for company representatives handing out free cigarettes at kiosks as part of brand promotion. (IPM = India Philip Morris; GPI = Godfrey Phillips India; POS = point of sale.)

Another slide from the Philip Morris training manual includes instructions for company representatives handing out free cigarettes at kiosks as part of brand promotion. (IPM = India Philip Morris; GPI = Godfrey Phillips India; POS = point of sale.)

Kiosk owners in Delhi say that Philip Morris pays them a monthly fee to put up its advertisements. Names have been redacted on this Philip Morris receipt.

Kiosk owners in Delhi say that Philip Morris pays them a monthly fee to put up its advertisements. Names have been redacted on this Philip Morris receipt.

Keshav Desiraju, then a senior health ministry official, wrote to state governments in January 2013, instructing them to stop all tobacco advertisements.

Keshav Desiraju, then a senior health ministry official, wrote to state governments in January 2013, instructing them to stop all tobacco advertisements.

 In April, S.K. Arora, the chief tobacco control officer in Delhi, warned Philip Morris International in a letter that it could face legal action over its advertising.

In April, S.K. Arora, the chief tobacco control officer in Delhi, warned Philip Morris International in a letter that it could face legal action over its advertising.

An excerpt from a 2013 letter from a health ministry official to state governments shows specifications for the board that can be displayed at shops selling tobacco products. According to Indian law, the board cannot include any brand names. Beedis are traditional hand-rolled cigarettes.

An excerpt from a 2013 letter from a health ministry official to state governments shows specifications for the board that can be displayed at shops selling tobacco products. According to Indian law, the board cannot include any brand names. Beedis are traditional hand-rolled cigarettes.

Ahead of the World Health Organization’s global tobacco control treaty meeting in India last November, Philip Morris planned to engage Prime Minister Narendra Modi in an effort to head off new anti-tobacco measures. The slide is from a 2014 corporate affairs document. CoP7 = Conference of the Parties, the biennial treaty meeting.

Ahead of the World Health Organization’s global tobacco control treaty meeting in India last November, Philip Morris planned to engage Prime Minister Narendra Modi in an effort to head off new anti-tobacco measures. The slide is from a 2014 corporate affairs document. CoP7 = Conference of the Parties, the biennial treaty meeting.

The company planned to gain Modi’s ear through those close to him. It identified several people in this group, including Commerce Minister Nirmala Sitharaman, Health Minister Jagat Prakash Nadda, and Amit Shah, president of the ruling Bharatiya Janata Party.

Modi and the other politicians didn’t respond to requests for comment. Philip Morris International also didn’t comment on the plan.

The tobacco giant’s efforts to fend off anti-smoking steps have had limited impact so far. Last year, for instance, India ordered manufacturers to cover 85 percent of the surface of cigarette packs with health warnings, up from 20 percent. The rule, which is still being challenged in a state court by the tobacco industry, including Philip Morris’ India partner, was implemented by order of the Supreme Court.

Marlboro has just a 1.4 percent share of the almost $10 billion cigarette market in India. The industry is dominated by ITC, which has a strong grip on distributors and retailers.

One major method Philip Morris is deploying to gain ground, the marketing documents show, is the free distribution of cigarettes at bars and nightclubs – known as Legal Age Meeting Points, or LAMPs, in company jargon. The hiring of young women and men to work at these gatherings is outsourced to event management companies, according to people with knowledge of the gatherings.

Some of the recruiting takes place online. “Hey girls…We are searching A++ Hot & Gorgeous girls for the Marlboro pub activity…Pay: 2000/day…Work: Promotion in clubs in Delhi,” read one post on a Facebook public group in June last year. There was no company name attached to the ad.

At several parties attended by Reuters in Delhi and Mumbai, young women dressed in the colors of the latest Marlboro variant handed out packs of cigarettes. During one party at a nightclub in a Delhi hotel, a young woman walked around with a tablet showing an ad that highlighted Marlboro features. A television screen played a video promoting the brand: “For trendsetters, for forward thinkers, a smooth and balanced smoking experience.”

In many ways, it was right out of the Philip Morris 1990s playbook. The American Journal of Public Health study, drawing on previously secret industry documents, found that Philip Morris ran bar promotions in 1990 using racing jackets, and added “neon message boards and cocktail trays” in 1991. The study described methods for collecting names for a company database “to generate smoker profiles, direct mailing campaigns, and conduct telephone research studies after the bar events.”

At the parties in India, people who took the Marlboro packs were asked their names, ages and preferred brands. Philip Morris calls this distribution of free cigarettes “sampling,” which it says in an internal document is allowed under the law.

The company has spent millions of dollars on these activities. In 2014, for example, Philip Morris estimated it spent $1.6 million on LAMP events and sampling at kiosks in India, according to the 2015 commercial review presentation.

The company planned to use LAMPs in 2015 to generate 30,000 “trials,” or samplings of cigarettes. And it planned to generate another 500,000 trials that year through sampling at cigarette shops and kiosks, according to the 2015 strategy document.

The company instructs employees to watch their words. An undated training manual for market researchers says: “Do not say this is a ‘PROMOTION’ or ‘ADVERTISING’.”

Indian health ministry officials say that anyone who hands out free cigarettes, whatever the circumstances, is breaking the law.

The Health Ministry’s Amal Pusp says the law against distribution of free cigarettes is unambiguous. He cites Section 5 of the country’s tobacco control act, which says: “No person, shall, under a contract or otherwise promote or agree to promote the use or consumption of” cigarettes or any other tobacco product. The law carries a fine of up to 1,000 rupees (about $15) and a sentence of up to two years in prison for a first conviction.

“We believe we market our products in a responsible manner, and in compliance with Indian regulations,” Philip Morris’ Venkatesh said, without elaborating.

In October last year, the month before India was due to host delegations from around the world at the biennial FCTC tobacco control conference in Delhi, tobacco-control officer Arora said he suddenly started getting traction.

The cigarette ads vanished and Delhi was “cleaned,” he said.

That success couldn’t have come at a better time for Arora and his colleagues at the federal health ministry: They wanted to make sure foreign delegates visiting India saw the country was serious about its tobacco regulations.

Weeks after the FCTC delegates left town in November, however, kiosks in the capital were again displaying ads for Marlboro.

STOREFRONT ADS: Marlboro advertisements can be seen on this kiosk in a marketplace in New Delhi in April. Despite warnings from health officials, Philip Morris has continued to advertise its Marlboro cigarettes. REUTERS/Adnan Abidi

STOREFRONT ADS: Marlboro advertisements can be seen on this kiosk in a marketplace in New Delhi in April. Despite warnings from health officials, Philip Morris has continued to advertise its Marlboro cigarettes. REUTERS/Adnan Abidi

Additional reporting by Aditi Shah in New Delhi, and Abhirup Roy and Swati Bhat in Mumbai.

The Philip Morris Files
By Aditya Kalra, Paritosh Bansal, Tom Lasseter and Duff Wilson
Design: Troy Dunkley
Photo Editing: Tom White and Altaf Bhat
Edited by Peter Hirschberg

Big tobacco bullies the global south. Trade deals are their biggest weapon

The industry has a long history of using trade to force their products into new markets. This has led to at least a 5% increase in cigarette deaths

https://www.theguardian.com/commentisfree/2017/jul/17/big-tobacco-trade-deals-new-markets-bat

Cigarette packets often carry the warning to “protect children: don’t make them breathe your smoke”. In 2014, the Kenyan government attempted to do just that – banning the sale of single cigarettes, banning smoking in vehicles with a child and keeping the tobacco industry out of initiatives aimed at children and young people.

But as the Guardian reported last week, British American Tobacco, in an effort to keep Kenyans breathing their smoke, fought the regulations on the grounds that they “constitute an unjustifiable barrier to international trade”.

In fact, big tobacco has a long history of using trade and investment rules to force their products on markets in the global south and attack laws and threaten lawmakers that attempt to control tobacco use.

Back in the 1980s, as cigarette consumption fell off in North America and western Europe, US trade officials worked aggressively to grant American companies access to markets in Asia, demanding not only the right to sell their products, but also the right to advertise, sponsor sports events and run free promotions. Smoking rates surged.

In the 1990s, World Trade Organisation agreements led to a liberalisation of the international tobacco trade, with countries reducing import tariffs on tobacco products. The impact, according to a joint study of the World Health Organisation and the World Bank, was a 5% increase in global cigarette consumption and accompanying mortality rates.

Big tobacco’s lawyers were quick to discover the value of “next generation” trade agreements. In the 1990s, Canada dropped a plain packaging initiative after US manufacturers threatened a suit using the first next-gen trade deal, the North American Free Trade Agreement (Nafta). A few years later, Philip Morris threatened Canada again after it prohibited terms such as “light” and “mild” cigarettes. Philip Morris argued it would be owed millions in compensation for damage to its brand identity.

Philip Morris was able to credibly wield this threat because of the extraordinary powers that Nafta grants international corporations: the right to sue governments in private tribunals over regulations that affect their profits.

A toxic combination of far-reaching and poorly defined “rights” for investors, eye-watering legal costs, and tribunals composed of corporate lawyers with the power to set limitless awards against governments makes investment arbitration and the modern “trade” agreement a formidable weapon to intimidate regulators.

And what big tobacco learned in the global north it has been replicating in the global south, where threats carry greater force against poorer countries that may lack the resources to see down a legal challenge.

In 2010, Philip Morris launched a $25m claim against Uruguay after it introduced graphic warnings on cigarette packs. Though Uruguay successfully defended the measure, it still faced millions in legal costs. And Philip Morris effectively won, as Costa Rica and Paraguay held off introducing similar measures.

Such are the fears around big tobacco’s aggressive use of trade and investment rules that the US-negotiated Trans-Pacific Partnership trade deal featured a carve-out excluding big tobacco from investment protections – an explicit admission of the problem.

But this does not go far enough. The important thing to realise is that the problem goes beyond big tobacco. Big oil, big pharma and big mining follow the same playbook, launching investment arbitration cases to defend their business models from governments that would regulate to protect public health, the local environment or the climate.

Rather than target individual companies or sectors, we must push our governments to reform trade and investment rules that grant such extraordinary powers to corporations. That means removing special investor rights and investment courts from trade agreements. It means removing limits on the freedom of governments to protect public health, labour and human rights and the environment.

Of course, this is easier said than done. Robert Lighthizer, US trade representative, served as deputy in a Reagan administration that pressured countries to open their tobacco markets to US exporters in the 1980s.

Vice-President Mike Pence’s record includes opposing smoking regulation, taking huge campaign donations from big tobacco, and denying the causal link between smoking and lung cancer. The EU commission, meanwhile, has been criticized for its meetings with big tobacco while it was negotiating EU-US trade talks.

The good news is that from Brazil to India to Ecuador, countries are stepping away from outdated trade and investment rules. In the UK, the Labour party manifesto opposes parallel courts for multinationals and proposes to review the UK’s investment treaties.

But until we scrap the powers that we grant big tobacco and others to frustrate and bypass our laws, efforts around the world to protect public health will continue to go up in smoke.