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Progress against ‘global tobacco epidemic’ made but not enough

Tobacco treaty has helped cut smoking rates, yet more work is needed

http://www.timesofmalta.com/articles/view/20170325/health-fitness/Progress-against-global-tobacco-epidemic-made-but-not-enough.643389

The WHO warns against tobacco use which kills about six million people a year globally and imposes a huge burden on the world economy.

A global tobacco treaty put in place in 2005 has helped reduce smoking rates by 2.5 per cent worldwide in 10 years, researchers said, but use of deadly tobacco products could be cut even further with more work on anti-smoking policies.

In a study published in the Lancet Public Health journal, researchers from Canada’s University of Waterloo and the World Health Organisation (WHO) found that while progress against what they called the “global tobacco epidemic” has been substantial, it has still fallen short of the pace called for by the treaty.

The WHO Framework Convention on Tobacco Control (FCTC), which came into effect in 2005, obliges the 180 countries signed up to have high tobacco taxes, smoke-free public spaces, warning labels, comprehensive advertising bans and support for stop-smoking services.

Smoking causes lung cancer and is a major risk factor for cardiovascular illnesses such as heart disease and strokes, which kill more people than any other diseases.

The WHO says tobacco kills about six million people a year globally and imposes a huge burden on the world economy. Annual healthcare and lost productivity costs for those made ill from smoking are estimated at around $1 trillion.

The study analysed WHO data from 126 countries – 116 of which are signatories to the FCTC – and tracked and compared the implementation of the five key measures from 2007 to 2014 to look at links between strong policies and smoking rates.

It found that, on average, smoking rates dropped to 22.2 per cent in 2015 from 24.7 a decade earlier. But the trends varied, with rates falling in 90 countries, rising in 24 and remaining steady in 12.

Countries that fully implemented more FCTC measures saw significantly greater reductions in smoking rates, the study found. Overall, each additional measure was linked with a drop in smoking rates of 1.57 percentage points – corresponding to 7.1 per cent fewer smokers in 2015 compared with in 2005.

The study was not a full global analysis, since only 65 per cent of countries had the data needed, but it did include countries from all income levels and regions. The researchers also noted that the lower smoking rates could be influenced by factors other than FCTC policy recommendations.

“The data did not allow a detailed analysis of the impact of individual policies,” said Geoffrey Fong of Waterloo University, who co-led the work.

He called for more studies that are specifically designed to evaluate the impact of all FCTC policies and would “help provide guidance to countries about what policies may offer the greatest benefits”.

FCTC cut smoking 2.5 per cent over 10 years; study

A decade of tobacco control efforts by the Framework Convention on Tobacco Control (FCTC) has reduced the global smoking rate by 2.5 per cent, according to an evaluation by the International Tobacco Control Policy Evaluation Project.

http://www.tobaccojournal.com/FCTC_cut_smoking_2_5_per_cent_over_10_years_study.54157.0.html

Although the international treaty, an adjunct of the World Health Organisation, has made substantial progress in combatting use of tobacco products, implementation of FCTC measures has fallen short of its objectives, according to the study. “While the progress of WHO Framework Convention on Tobacco Control has been remarkable, there are still far too many countries where domestication of the treaty and its implementation has fallen short,” said Dr Geoffrey Fong, a study author from the University of Waterloo, Canada. “One important cause of this is the tobacco industry’s influence, particularly in low- and middle-income countries.”

Conducted with assistance from WHO, the study analysed data from 126 countries and determined the smoking rate in those countries declined on average from 24.7 per cent in 2005 to 22 per cent in 2015. FCTC obligates 180 signatory countries to raise tax on tobacco products, create smoke-free public spaces, implement warning labels on packaging, ban advertising and support stop-smoking services.

Tripling tobacco taxes: Key for achieving the UN Sustainable Development Goals by 2030

Since the World Health Organization (WHO) adopted the Framework Convention on Tobacco Control (FCTC) a decade ago, over 180 countries have signed the treaty. Progress has been made in expanding the coverage of effective interventions–more than half of the world’s countries, with 40% of the world’s population have implemented at least one tobacco control measure, and despite increasing global population, smoking prevalence has decreased slightly worldwide from 23% of adults in 2007 to 21% of adults in 2013. How can greater reductions in smoking be achieved in the next decade and contribute to reaching the health and social targets of the UN Sustainable Development Goals (SDGs) by 2030? We review some key issues in the epidemiology and economics of global tobacco control.
Smokers face a three-fold higher risk of death versus otherwise similar non-smokers, resulting in a loss of at least one decade of life. While the hazards of smoking accumulate slowly, cessation is effective quickly. People who quit by age 40 get back nearly the full decade of life lost from continued smoking; quit by 50, get back six years; quit by 60, get back four years. Cessation is now common among adults in high-income countries. For example in Canada there are over 1 million more ex-smokers than just a decade ago. However, due in large part to the marketing and pricing strategies of the tobacco industry, cessation remains a major public health challenge in most low and middle-income countries (LMIC) where 85% of smokers live.

http://blogs.worldbank.org/health/role-excise-tax-meeting-sdg

Global annual cigarette sales rose from five trillion cigarettes in 1990 to about six trillion today. Cigarette production has increased by 30% in China since 2000, which consumes 40% of the world’s cigarettes. Global tobacco industry profits of about $50 billion – or $10,000 per tobacco death – enable it to access finance officials, fund pricing research, and run interference against tobacco control–summarised wonderfully by comedian John Oliver. Serious control of tobacco must counter these strategies on the basis of robust health, social and economic data that document the negative societal impact of tobacco use.

WHO has recommended a 30% reduction in smoking prevalence by 2025, which would avoid at least 200 million deaths by the end of the 21st century among current and future smokers. The only plausible way to reduce smoking to this extent would be to triple tobacco excise taxes in most LMICs. A tripling of the excise tax would roughly double the retail price and reduce tobacco consumption by about 40%. As of 2015, WHO reported that only 28 LMICs had comprehensive policies covering counter advertising, restrictions on public smoking, and on appropriately high taxes, and that few had made progress on raising taxes.

The common strategy of tobacco producers is to lobby governments to keep cigarettes affordable by keeping tax hikes below the rate of income growth, and by taxing different cigarettes at different rates to enable smokers to change to cheaper brands or lengths. Smart taxation needs to simplify taxes by adopting, ideally, a high, uniform excise tax on all types of cigarettes (both filter and nonfilter) to reduce downward substitution (let’s not forget, all cigarettes will kill you!). The Government of India has recently made modest tax reforms in this direction, the 2015 tobacco tax adjustment in China is reducing consumption and increasing fiscal revenue, and in 2016 World Bank teams supported the work of government teams in Armenia, Colombia, Moldova and Ukraine for the undertaking of comprehensive tax reforms that were approved by Parliaments, including reforms on tobacco tax structures and rate levels—additional work is being supported in other countries worldwide. Smart taxes can follow the example of Canada’s tax hike of about 5 cents a pack in 2014, as well as the Sin Tax Reform (both tobacco and alcohol) in the Philippines of 2012 that helped mobilize domestic resources to fund the expansion of universal health coverage. There have been other successes: Botswana, Ecuador, Mauritius, Mexico, and Uruguay, where local political champions, paired with expert taxation advice, achieved large tax hikes. South Africa also raised taxes in the last decade and has curbed consumption per adult by half.

Non-price interventions also play an important role as they help to reduce the social acceptability of tobacco use. Young American women took up smoking in large proportions in the 1960s and 1970s due in part to aggressive advertising (“The “Virginia Slims” epidemic”). Advertising bans or restrictions are likely one reason why young Chinese or Indian women have not yet done so. Australia has adopted plain packaging, and other countries are starting to follow this example. Simple questions on past smoking status to death certificates or to verbal autopsies could enable low-cost monitoring of the consequences of tobacco use in many populations.

Governments and international agencies with accumulated know how and expertise in data sciences such as the World Bank Group and OECD along with WHO could also help countries create accessible and independent sales, revenue and smuggling data sources as a basis for rational tobacco tax policy. Country finance officials should refuse advice from tobacco lobbyists to avoid falling into conflict of interest situations, as WHO recommends for health officials.

Implementing the FCTC more effectively in the next decade is required to raise cessation rates in LMICs. The World Bank recommended taxation as the core strategy in its 1999 publication, Curbing the Epidemic: Goverments and the Economics of Tobacco Control. Similar recommendations follow in recent reports on tobacco taxation by WHO, and by the International Monetary Fund. Building upon accumulated evidence and country experiences, a tripling of the worldwide excise tax might be the only way to achieve the 2030 UN Sustainable Development Goal of reducing non-communicable disease deaths by 30%!

Global tobacco control

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Controlling corporate influence in health policy making

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Philippines: Department of Health backs Ecigs restrictions supported by WHO

Philippines are going towards one of the toughest tobacco control on Southeast Asia. The government back e-cigarette restrictions decided at the CoP7 and include vaping in smoking bans.

The presence of Alicia Bala, Civil Service Commission (CSC) Chairperson, rather than Department of Health (DOH) Secretary Paulyn Jean Ubial at the head of the Philippine delegation in New Delhi to lead the negotiations with the Worldwide Health Organization (WHO) has been deemed beyond of their expertise.

The delegation clarified that the CSC lead initiatives on tobacco control within governmental agencies. Indeed, in 2009 and 2010, CSC tobacco control initiatives have been to issue an absolute ban on smoking in all government offices and to impose to all government officials and employees not to interact with the tobacco industry unless to supervise, regulate or control tobacco production.

Department of Health agrees with WHOs position on potential risks to the health

During the last CoP7, the Framework Convention on Tobacco Control (FCTC) encouraged parties to “to prohibit or restrict the manufacture, importation, distribution, presentation, sale and use of ENDS,” in response to what the WHO describes as a “tobacco epidemic.” The global organization discourages the use of ENDS until it is deemed “safe and effective, and of accepted quality by a competent national regulatory body.”

As a signatory of the WHO’s treating since 2005, Philippines, the Southeast Asia’s second-most populous country, has committed to prioritise public health over other interests in relation to the manufacture, sale, and use of tobacco products.

To clarify the position of the Government with respect to the ecigarette, the Department of Health (DOH) declared it agrees with WHOs position on potential risks to the health of users, as these have not yet been clearly determined.

The determination of a president to have Philippines smoke-free

After his election on June 30, 2016, Rodrigo Dutertre’s government proposed increasing taxes on cigarettes and other tobacco products. To confirm president Dutertre’s determination to enforce nationally an anti-smoking law that he experimented as a mayor for 22 years of a 1.5 million citizen city, Davao, the government spokesman Ernesto Abella declared “Certainly in Davao, the sentiment and business establishments support a smoke-free Davao. The president sees it as something that’s not ideal for health… and this is part of the public well-being”. DOH Secretary, Paulyn Jean Ubial, told Reuters she was supportive with the president to curb smoking in public places, including parks, bus stations, and even in public vehicles.

During his term as a mayor in Davao, Reuters reports that he once personally forced a man to stub out his cigarette and eat it after he refused to stop smoking in a restaurant. His nickname, “The Punisher”, was inherited from his governance ruled by harsh laws like a ban on late-night drinking and karaoke, and a 10 p.m. curfew for school children in addition to his smoke-free policy in Davao.

Tobacco industry, a powerful lobby

A Sin Tax Law signed by former president Benigno Aquino III in 2012 strengthened the lobby of cigarette manufacturers and kept the tax structure on alcohol and cigarettes complicated and weak. The system was believed to encourage corruption among state agents and to constitute a loss of earnings for the DOH to manage issues arising from abuse in the use of alcohol and cigarettes.

Tobacco Companies Seeking To Influence Policy Are Violating the Framework Convention on Tobacco Control

Tobacco industry representatives are continuing to meet with and are attempting to influence government officials in many countries.

http://www.cancertherapyadvisor.com/iaslc-2016/tobacco-control-companies-seeking-influence-policy-violations-cancer/article/577761/

Tobacco industry representatives are continuing to meet with and are attempting to influence government officials in many countries, which is a direct violation of those countries’ commitments under the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), according to a report presented at the International Association for the Study of Lung Cancer (IASLC) 17th World Conference on Lung Cancer (WCLC) in Austria.1

Luke Clancy, MD, of the Tobacco Free Research Institute in Dublin, Ireland, said that the tobacco industry’s access to tobacco control policy makers has had a harmful impact on public health and provides the companies with a direct avenue to influence public policy.

The tobacco industry manipulates contacts in government under the guise of helping national governments negotiate harmonization of tobacco excise tax deadlines, for example, but Dr Clancy said that this directly contravenes FCTC Article 5.3, which aims to prevent industry from influencing policy development.

Tobacco use remains “stubbornly high” in Europe, despite the existence of widely recognized and effective interventions, such as raising the price of tobacco products through taxation, adopting smoke-free legislation to prevent exposure to secondhand smoke in the workplace, and banning advertising and promotion of tobacco use, said Dr Clancy.

In a related press conference, Dr Clancy indicated that although all 27 European Union member state countries have initiated some type of strategy to become smoke free, there is still much work to be done.2

“Despite this progress, the prevalence of smoking in Ireland is 18.5%. The prevalence of smoking in Europe as a whole remains at approximately 29% of the adult population, and seems to be increasing among females in some European countries,” he said. “Ireland hopes to be tobacco free by 2025. Full implementation of the WHO FCTC recommendations may not be enough to achieve this in Ireland.”

WHO recommends the monitoring of smoking and the provision of cessation programs, but the implementation of services to support cessation of tobacco use in line with Article 14 of the FCTC “can and should be significantly improved,” said Dr Clancy. He contended that the tobacco industry and its allies have worked to oppose price increases by attempting to persuade finance ministers that a price increase will lead to a loss of revenue through an increase in smuggling despite evidence to the contrary.

Smoke-free policies can achieve their positive effect by educating the public about the health benefits of quitting smoking, limiting opportunities to smoke, and promoting an attitude of denormalization of smoking, he concluded.

References
1. Clancy L. Tobacco Control. Paper presented at: 17th World Conference on Lung Cancer; December 2016; Vienna, Austria.
2. Clancy L. Press Conference at: 17th World Conference on Lung Cancer; December 5 2016; Vienna, Austria.

National Cancer Institute – The Economics of Tobacco and Tobacco Control

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COP7 decisions: an overview

http://www.fctc.org/fca-news/opinion-pieces/183-news/1499-cop7-decisions-an-overview

FCA identified three interlinked implementation-related priorities for COP7 of the Framework Convention on Tobacco Control (FCTC):

  • Follow-up on the 30-percent prevalence reduction target agreed at COP6;
  • Establishment of an implementation review mechanism (IRM: i.e. a system to review Parties’ reports);
  • Action on fundraising for national-level implementation, building on the work of the sustainable measures working group.

At the meeting there was action on all three, though with a somewhat surprising twist with respect to IRM. Rather than immediately establishing an implementation review committee, Parties instead set up a working group to draft a “strategic framework” for the FCTC – which should deal with a range of implementation issues, including a possible IRM. The working group will also review and prioritize Parties’ needs for implementation assistance and will reflect them in the strategic framework.

It is quite common for treaty bodies to draw up strategic plans, and these have proven to be helpful both to keep a tight focus on priority issues and to raise funds.

30-percent target

On the 30-percent target, Parties requested that the Secretariat and WHO hold a technical consultation between COP7 and COP8 to identify necessary actions that the COP could take to ensure that the global voluntary target is achieved. The decision also requests that the Secretariat collect information regarding national targets.

There were other notable debates at COP7. On the Illicit Trade Protocol, unlike during previous COP sessions, there was widespread recognition that people shouldn’t wait until the ITP is in force before thinking about some of the implementation issues that are likely to arise.

On e-cigarettes, Parties spent a considerable amount of time re-hashing the issue, and butted heads for quite a while on the exact wording of a decision. The COP7 decision is quite similar to what was decided at COP6.

Finally, there were a host of other decisions. (COP7 had the longest list of official documents of any COP session to date.) These included:

Art 5.3 Knowledge Hub

  • On Article 5.3, a decision to establish a Knowledge Hub, and to ask the Secretariat to continue promoting measures to address tobacco industry interference among UN agencies.
  • On Article 9/10, additions to the existing guidelines were adopted. These included provisions to regulate design features that increase attractiveness (e.g. slims), and disclosure to governments of the contents of tobacco products.
  • Continuing work on Article 17&18, including a request to WHO to develop guidelines for surveillance, prevention and early diagnosis of occupational harms and risks specific to tobacco cultivation and manufacture.
  • Endorsement of a toolkit on Article 19 developed by an expert group, as well as some follow-up by the Secretariat.
  • On the FCTC impact assessment submitted to COP7, the COP welcomed the findings but did not commit to repeating the exercise immediately, instead encouraging Parties to consider evaluating on a regular basis the impact of the Convention at country level.

Cross-border advertising

  • On cross-border advertising, establishment of a new expert group to provide recommendations on operationalizing the implementation of Article 13 and its Guidelines on cross-border advertising and TAPS in entertainment media.
  • On Waterpipe: a request for a report to COP8 including a situation analysis and an overview of challenges and recommendations for improving the prevention and control of water pipe tobacco use.
  • On Gender: the Secretariat and WHO were requested to prepare a paper for COP8 on opportunities and challenges in implementing gender-specific tobacco control policies.
  • On trade and investment agreements, the COP called on Parties to increase coordination and cooperation between health and trade/investment departments, including in the context of negotiations of trade and investment agreements. It also requested a report for COP8 on a number of topics, including on practices in promoting and safeguarding public health measures under trade and investment agreements.
  • Moving to institutional matters, COP7 decided the following:

‘Voluntary’ no more

  • Parties’ mandatory payments to the FCTC budget will now be called Assessed Contributions (not Voluntary Assessed Contributions). The COP also agreed on a scheme of penalties should a Party fail to provide these payments.
  • The Convention Secretariat should consider holding a financing dialogue to raise extra-budgetary funding for the FCTC budget and to alert funders to the implementation needs of Parties. It was also agreed that when raising funds from stakeholders other than Parties, the Secretariat should follow the practices agreed on in WHO’s Framework for Engagement with Non-State Actors (FENSA).
  • The Secretariat was tasked to undertake a review of accreditation of intergovernmental organizations (IGOs) with the status of observer to the Conference of the Parties, as proposed by the COP7 report. At COP8, results of this review will be discussed and further decisions, such as whether this review should take place on a regular basis or whether observer status may be discontinued for some IGOs, might be taken.

New Observers

  • The observer status of non-governmental organizations (NGOs) was extended for most of the current observers. In addition, the following three NGOs were granted an observer status: American Cancer Society, Inter-American Heart Foundation, Vision mondiale de la santé / World Vision Health. A number of organizations were denied observer status per the recommendation of the Bureau.
  • The Secretariat was encouraged to apply for observer status to a number of UN bodies and other relevant entities, including UNDP, World Bank, ILO, FAO, and WTO. The Secretariat’s participation at governing body meetings of these organizations could raise the profile of the treaty and its provisions, including the Article 5.3 principles.
  • Synergies between the WHO and FCTC governing bodies – the Conference of the Parties (COP) and the World Health Assembly (WHA) – were strengthened by agreeing that reports on decisions from COP will be presented to WHA and vice versa.

WHO and FCTC agreement

  • The Bureau was requested to oversee and guide the preparation of the draft hosting terms between the Convention Secretariat and WHO. Once finalized, the hosting agreement should clarify the exact WHO contributions to support the work of the Convention Secretariat.
  • A dedicated methodology to review performance of the Head of the Secretariat was agreed upon. The review of performance for the current Head is set to take place in 2017, as her mandate expires in mid-2018.
  • The COP took no decision on transparency of Party delegations (i.e. whether Party delegates should make a declaration on any links with the tobacco industry, and what possible follow-up steps should take place). This point will be reviewed again at COP8.

Finally, on the issue of the FCTC budget, it was decided that the budget for 2018-2019 covered by Parties’ mandatory payments will be lowered by nearly US$300,000 compared to the budget for the current biennium. As a result, virtually all activities included in the workplan for 2018-2019 will need to be funded by extra-budgetary contributions.

Please note that the above summary is not an exhaustive list of all the decisions taken at COP7, and there may be surprises in the final version of the decisions when they are published (in part because many decisions were not finalized till very late in the session.)

– See more at: http://www.fctc.org/fca-news/opinion-pieces/183-news/1499-cop7-decisions-an-overview#sthash.giEvrPnq.dpuf

Tobacco Industry And Front Groups Pump Up Their Propaganda For COP7

http://www.asiantribune.com/node/89760

Over the past year, governments across the globe have continued to make new agreements with the tobacco industry, as shown above. However there is a ray of hope from Namibia, which is choosing to grow more food crops.

The tobacco industry is very angry that the Conference of the Parties (COP) is using Article 5.3 of the Framework Convention on Tobacco Control (FCTC) to protect the policy-making process from industry interference.

The industry has hijacked the “public space” of the COP. FCTC Parties have responded in recent sessions by not allowing participation from the “public”, which is dominated by industry representatives. For COP7, FCA is recommending Parties adopt pre-screening processes for the public and for the media. (Presently, media is in the category public).

The industry has gone on the offensive: conducting an international campaign to attack and discredit the COP and the World Health Organization (WHO) about lack of transparency. Industry representatives have written angry letters to both the COP and WHO and published many statements in the media criticizing the COP’s lack of ‘transparency’, which strikes a chord with broader society.

The industry throws a tantrum whenever it does not get its way, and has no qualms in criticising the 180 governments that are FCTC Parties. In one statement, a representative of Japan Tobacco International (JTI) said the industry wants to see change, (read, “we want to influence the COP”), and that it needs to “keep raising our voice about these censorship practices”.

Since the tobacco industry has no credibility to criticise the COP and tobacco control, it has recruited front groups, think tanks and sympathetic individuals to sing from its song sheet.

The Institute of Economic Affairs (IEA) is one such close ally. It advises the industry to talk more about “due process and fairness and less about the specifics of tobacco policy in drawing attention to this issue”.

According to the IEA, “With regard to [Article] 5.3 and COP, the industry needs to find allies amongst groups who take an interest in transparency, openness and constitutional structures. Such groups needn’t be sympathetic to the regulatory agenda of the industry; indeed they may even be antagonistic to the industry and tobacco products in general. That needn’t matter—the issue here is about the manner in which policy is developed and created, not the exact content of the policy.”

Another industry funded group, the International Tax and Investment Centre (ITIC), has stepped up its efforts to protect industry interests ever since the FCTC Secretariat issued a Note Verbal in 2014 about its activities. Earlier this year, an ITIC consultant, Gary Johns, wrote to several civil society groups involved in tobacco control taking issue with the critiques they had done on the ITIC’s skewed research. In a 36-page letter he sent to the Southeast Asia Tobacco Control Alliance (SEATCA) earlier this year Johns wrote, “vested interests are not the problem – debate behind closed doors is”.

The letter was riddled with false accusations against SEATCA, mischaracterizations of fact and law, disparaging comments about the WHO, the Framework Convention Secretariat and FCTC Parties. SEATCA published an open letter in response.

In September, Johns, a former Australian Labor Minister, released a publication attacking WHO for not conducting its business in “transparent fashion and in public view.” The tobacco industry publicized his report in the Tobacco Reporter.

Another industry front group, the International Tobacco Growers Association (ITGA), which routinely rounds up its members to rabble rouse at COP sessions, has stepped up its misinformation campaign. ITGA’s Indian member Federation of All India Farmer Associations (FAIFA) has been applying pressure on the Indian government to allow its members to the COP using arguments of “principles of transparency and equity”

ITGA’s president has also claimed that the FCTC had banned dozens of officials representing tobacco-growing countries from participating in COP7.

A similar statement was made by a new NGO representative cum journalist, who claimed, “The policy of banning delegates having associations with tobacco production is said to be so broad that it will almost certainly prohibit finance ministers, economic development secretaries, public health officials, and even presidents and prime ministers …”

In September, ITGA members from North and South America, India, Europe, Africa, and Indonesia were in New Delhi for a two-day seminar to prepare their protests for COP7.

The ITGA claims COP decisions are being made “only by health officials and activists”. This is simply not true. Government delegations have included officials from non-health departments, such as ministries of agriculture, industry and trade, as official COP records show (Table 1).

In 2008, FCTC Parties adopted Article 5.3 guidelines. They include recommendations 4.9 and 8.3, which explicitly state that Parties should not nominate any person employed by the tobacco industry, or any entity working to further the industry’s interests, to serve on delegations to COP or other FCTC meetings, nor should any representatives of state-owned tobacco industries be included on government delegations.