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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.

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“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.

Inside Philip Morris’ campaign to subvert the global anti-smoking treaty

The world’s largest publicly traded tobacco company is deploying its vast resources against international efforts to reduce smoking. Internal documents uncovered by Reuters reveal details of the secret operation.

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

A group of cigarette company executives stood in the lobby of a drab convention center near New Delhi last November. They were waiting for credentials to enter the World Health Organization’s global tobacco treaty conference, one designed to curb smoking and combat the influence of the cigarette industry.

Treaty officials didn’t want them there. But still, among those lined up hoping to get in were executives from Japan Tobacco International and British American Tobacco Plc.

There was a big name missing from the group: Philip Morris International Inc. A Philip Morris representative later told Reuters its employees didn’t turn up because the company knew it wasn’t welcome.

In fact, executives from the largest publicly traded tobacco firm had flown in from around the world to New Delhi for the anti-tobacco meeting. Unknown to treaty organizers, they were staying at a hotel an hour from the convention center, working from an operations room there. Philip Morris International would soon be holding secret meetings with delegates from the government of Vietnam and other treaty members.

The object of these clandestine activities: the WHO’s Framework Convention on Tobacco Control, or FCTC, a treaty aimed at reducing smoking globally. Reuters has found that Philip Morris International is running a secretive campaign to block or weaken treaty provisions that save millions of lives by curbing tobacco use.

In an internal document, the company says it supported the enactment of the treaty. But Philip Morris has come to view it as a “regulatory runaway train” driven by “anti-tobacco extremists” – a description contained in the document, a 2014 PowerPoint presentation.

Confidential company documents and interviews with current and former Philip Morris employees reveal an offensive that stretches from the Americas to Africa to Asia, from hardscrabble tobacco fields to the halls of political power, in what may be one of the broadest corporate lobbying efforts in existence.

Details of those plans are laid bare in a cache of Philip Morris documents reviewed by Reuters, one of the largest tobacco industry leaks ever. Reuters is publishing a selection of those papers in a searchable repository, The Philip Morris Files.

Dating from 2009 to 2016, the thousands of pages include emails between executives, PowerPoint presentations, planning papers, policy toolkits, national lobbying plans and market analyses. Taken as a whole, they present a company that has focused its vast global resources on bringing to heel the world’s tobacco control treaty.

Philip Morris works to subvert the treaty on multiple levels. It targets the FCTC conferences where delegates gather to decide on anti-smoking guidelines. It also lobbies at the country level, where the makeup of FCTC delegations is determined and treaty decisions are turned into legislation.

Excerpts from the Philip Morris Files

Reuters uncovered thousands of pages of internal Philip Morris International documents. These excerpts show the company’s tactics for combating the Framework Convention on Tobacco Control, or FCTC, a treaty aimed at reducing smoking worldwide. (Some documents include highlighting by Reuters; some names have been redacted.)

01

A slide from a 2014 Philip Morris corporate affairs presentation about the FCTC, the global anti-smoking treaty. CoP5 and CoP6 refer to the biennial meetings of treaty nations in 2012 and 2014. “ENDS” refers to e-cigarettes.

Another slide from the 2014 PowerPoint presentation. “Paradigm shift” refers to an expected boom in what the company calls “reduced-risk products.”

Another slide from the 2014 PowerPoint presentation. “Paradigm shift” refers to an expected boom in what the company calls “reduced-risk products.”

A slide from the 2014 presentation shows Philip Morris plans for tracking anti-smoking groups, which the company calls anti-tobacco organizations, or ATOs.

A slide from the 2014 presentation shows Philip Morris plans for tracking anti-smoking groups, which the company calls anti-tobacco organizations, or ATOs.

The same 2014 document shows objectives for corporate affairs executives. “Roadblocks” refers to delays in implementing anti-smoking steps. “MoH” refers to ministries of health.

The same 2014 document shows objectives for corporate affairs executives. “Roadblocks” refers to delays in implementing anti-smoking steps. “MoH” refers to ministries of health.

Another slide from the 2014 document shows the characteristics that a Philip Morris corporate affairs (“CA”) person should possess.

Another slide from the 2014 document shows the characteristics that a Philip Morris corporate affairs (“CA”) person should possess.

A more detailed account of Philip Morris’ corporate affairs tactics from the same 2014 presentation.

A more detailed account of Philip Morris’ corporate affairs tactics from the same 2014 presentation.

A list of methods the company has devised for opposing the implementation of plain packaging, a measure advocated by the FCTC that bars the use of logos and distinctive coloring on cigarette packs.

A list of methods the company has devised for opposing the implementation of plain packaging, a measure advocated by the FCTC that bars the use of logos and distinctive coloring on cigarette packs.

This slide from the 2014 presentation shows some of the resources Philip Morris deployed at the FCTC treaty meeting in Moscow that year (CoP6), as the company looked ahead to the 2016 session in New Delhi (CoP7). ITGA = the International Tobacco Growers’ Association.

This slide from the 2014 presentation shows some of the resources Philip Morris deployed at the FCTC treaty meeting in Moscow that year (CoP6), as the company looked ahead to the 2016 session in New Delhi (CoP7). ITGA = the International Tobacco Growers’ Association.

Philip Morris pushes for more delegates to FCTC treaty meetings from government agencies that deal with economic and trade issues. This slide from the 2014 presentation shows the company’s plan to lobby for more delegates from outside of public health on India’s delegation at the treaty meeting last year.

Philip Morris pushes for more delegates to FCTC treaty meetings from government agencies that deal with economic and trade issues. This slide from the 2014 presentation shows the company’s plan to lobby for more delegates from outside of public health on India’s delegation at the treaty meeting last year.

Excerpt from an October 18, 2014, email from Chris Koddermann, who led the Philip Morris team at the treaty meeting in Moscow that year.

Excerpt from an October 18, 2014, email from Chris Koddermann, who led the Philip Morris team at the treaty meeting in Moscow that year.

An October 18, 2014, email from Nguyen Thanh Ky, a Philip Morris corporate affairs executive, about his meeting with the Vietnamese delegation to the 2014 Moscow treaty conference.

An October 18, 2014, email from Nguyen Thanh Ky, a Philip Morris corporate affairs executive, about his meeting with the Vietnamese delegation to the 2014 Moscow treaty conference.

Excerpt from an October 2014 email from Gustavo Bosio, then Philip Morris manager for international trade, a few days after the end of the Moscow meeting.

Excerpt from an October 2014 email from Gustavo Bosio, then Philip Morris manager for international trade, a few days after the end of the Moscow meeting.

Excerpt from a Philip Morris briefing paper on trade arguments, ahead of the treaty meeting in India last year. The company has long argued that the biennial Conference of the Parties (COP) should leave trade issues to the World Trade Organization (WTO).

Excerpt from a Philip Morris briefing paper on trade arguments, ahead of the treaty meeting in India last year. The company has long argued that the biennial Conference of the Parties (COP) should leave trade issues to the World Trade Organization (WTO).

Excerpt from a Philip Morris briefing paper on potential risks ahead of the treaty meeting last year, “COP7” in India. ENDS, or Electronic Nicotine Delivery Systems, refers to electronic cigarettes.

Excerpt from a Philip Morris briefing paper on potential risks ahead of the treaty meeting last year, “COP7” in India. ENDS, or Electronic Nicotine Delivery Systems, refers to electronic cigarettes.

Excerpt from a 2011 draft Philip Morris plan for responding to moves in Israel to pass new anti-smoking measures.

Excerpt from a 2011 draft Philip Morris plan for responding to moves in Israel to pass new anti-smoking measures.

 In this slide from a Japan corporate affairs presentation, some ministers in the Japanese cabinet are identified according to their positions on tobacco. The two ministers designated “Pro-tobacco” did not respond to questions from Reuters.

In this slide from a Japan corporate affairs presentation, some ministers in the Japanese cabinet are identified according to their positions on tobacco. The two ministers designated “Pro-tobacco” did not respond to questions from Reuters.

This slide, also from the Japan presentation, talks about Philip Morris Japan maintaining good relations with members of Japan’s FCTC delegation, and a Philip Morris executive meeting with members of the country’s FCTC delegation. (MOF = Ministry of Finance; MOFA = Ministry of Foreign Affairs; JT = Japan Tobacco.)

This slide, also from the Japan presentation, talks about Philip Morris Japan maintaining good relations with members of Japan’s FCTC delegation, and a Philip Morris executive meeting with members of the country’s FCTC delegation. (MOF = Ministry of Finance; MOFA = Ministry of Foreign Affairs; JT = Japan Tobacco.)

This slide, also from the Japan presentation, reveals the company’s plans for opposing moves in Australia to bar the use of logos or distinctive coloring on cigarette packs. The measure is known as plain packaging, or PP. The Tobacco Institute of Japan, or TIOJ, declined to comment.

This slide, also from the Japan presentation, reveals the company’s plans for opposing moves in Australia to bar the use of logos or distinctive coloring on cigarette packs. The measure is known as plain packaging, or PP. The Tobacco Institute of Japan, or TIOJ, declined to comment.

A slide from a Philip Morris training document.

A slide from a Philip Morris training document.

“Our everyday business”

Philip Morris International’s full response to Reuters findings:

“As a company in a highly regulated industry, speaking with governments is part of our everyday business. We publicly supported the creation of the framework convention on tobacco control, were involved in the consultation process prior to its establishment, but have not since been invited to contribute to any discussions on tobacco control measures. With our product knowledge, technical expertise and our vision to replace cigarettes with less harmful alternatives, we believe we have something to contribute and we look for a range of legitimate opportunities to express our views to decision-makers. The fact that Reuters has seen internal emails discussing our engagement with governments does not make those interactions inappropriate. We believe that the active participation of public health experts, policy-makers, scientists, and the industry is the best way to effectively address tobacco regulations in the genuine interest of today’s billion smokers. It is our hope that moving forward, all tobacco policy makers will invite open dialogue, and in the meantime we will continue to speak with governments about policies that can address the impact of smoking on health.”

– Tony Snyder, Vice President of Communications, Philip Morris International

The documents, combined with reporting in 14 countries from Brazil to Uganda to Vietnam, reveal that a goal of Philip Morris is to increase the number of delegates at the treaty conventions who are not from health ministries or involved in public health. That’s happening: A Reuters analysis of delegates to the FCTC’s biennial conference shows a rise since the first convention in 2006 in the number of officials from ministries like trade, finance and agriculture for whom tobacco revenues can be a higher priority than health concerns.

Philip Morris International says there is nothing improper about its executives engaging with government officials. “As a company in a highly regulated industry, speaking with governments is part of our everyday business,” Tony Snyder, vice president of communications, said in a statement in response to Reuters’ findings. “The fact that Reuters has seen internal emails discussing our engagement with governments does not make those interactions inappropriate.”

In a series of interviews in Europe and Asia, Philip Morris executive Andrew Cave said company employees are under strict instructions to obey both the company’s own conduct policies and local law in the countries where they operate. Cave, a director of corporate affairs, said that while Philip Morris disagrees with some aspects of the FCTC treaty and consults with delegates offsite during its conferences, ultimately the delegations “make their own decisions.”

“We’re respectful of the fact that this is their week and their event,” said Cave in an interview in New Delhi, as the parties to the treaty met last November. Asked in an earlier interview whether Philip Morris conducts a formal campaign targeting the treaty’s biennial conferences, Cave gave a flat “no.”

When the FCTC delegates gather, lives hang in the balance. Decisions taken at the conferences over the past decade, including a ban on smoking in public places, are saving millions of lives, according to researchers at Georgetown University Medical Center.

Between 2007 and 2014, more than 53 million people in 88 countries stopped smoking because those nations imposed stringent anti-smoking measures recommended by the WHO, according to their December 2016 study. Because of the treaty, an estimated 22 million smoking-related deaths will be averted, the researchers found.

According to the WHO, though, tobacco use remains the leading preventable cause of death – and by 2030 will be responsible for eight million deaths a year, up from six million now.

There was jubilation among anti-smoking advocates when the treaty was adopted in 2003. The treaty, which took effect in 2005, made it possible to push for measures that once seemed radical, such as smoke-free bars. About 90 percent of all nations eventually joined. A big holdout is the United States, which signed the treaty but has yet to ratify it.

Since the FCTC came into force, it has persuaded dozens of nations to boost taxes on tobacco products, pass laws banning smoking in public places and increase the size of health warnings on cigarette packs. Treaty members gather every two years to consider new provisions or strengthen old ones at a meeting called the Conference of the Parties, or COP, which first convened in 2006 in Geneva.

But an FCTC report shows that implementation of important sections of the treaty is stalling. There has been no further progress in the implementation of 7 out of 16 “substantive” treaty articles since 2014, according to a report by the FCTC Secretariat in June last year.

A key reason: “The tobacco industry continues to be the most important barrier in implementation of the Convention.”

Indeed, the tobacco industry has weathered the tighter regulation. There has been only a slight 1.9 percent decline in global cigarette sales since the treaty took effect in 2005, and more people smoked daily in 2015 than a decade earlier, studies show. The Thomson Reuters Global Tobacco Index, which tracks tobacco stocks, has risen more than 100 percent in the past decade, largely due to price increases.

“Some people think that with tobacco, you’ve won the battle,” said former Finnish Health Minister Pekka Puska, who chaired an FCTC committee last year. “No way,” he said. “The tobacco industry is more powerful than ever.”

With 600 corporate affairs executives, according to a November 2015 internal email, Philip Morris has one of the world’s biggest corporate lobbying arms. That army, and $7 billion-plus in annual net profit, gives Philip Morris the resources to overwhelm the FCTC.

The treaty is overseen by 19 staff at a Secretariat office hosted by the WHO in Geneva. The Secretariat spends on average less than $6 million a year. Even when buttressed by anti-smoking groups, the Secretariat is outgunned. Its budget for this year and last year for supporting the treaty clause on combating tobacco company influence is less than $460,000.

Vera Luiza da Costa e Silva, head of the FCTC treaty Secretariat, is the person tasked with preventing the industry from neutering the agreement.

In two interviews at her Geneva office, da Costa e Silva, a medical doctor who holds a PhD in public health and has a dyed pink streak in her hair, explained why the FCTC banned attendance by any member of the public at the 2014 biennial conference in Moscow. The ban came in response to efforts by tobacco executives to use public badges to get inside the venue, she said, adding that industry representatives then started borrowing badges from delegates they knew to gain entry.

“It’s a real war,” said da Costa e Silva.

tobacco

“Some people think that with tobacco, you’ve won the battle. No way… The tobacco industry is more powerful than ever.”

Former Finnish Health Minister Pekka Puska, who chaired an FCTC committee last year

But she had only a partial picture of the forces ranged against her. She wasn’t aware of the fact that Philip Morris had a large team operating throughout the convention in Moscow, or the details of its activities in New Delhi last November.

“This is so disgusting. These are the forces against which we have to work,” da Costa e Silva said in May after being told about the Philip Morris documents. “I think they want to implode the treaty.”

The idea of a global tobacco treaty had been discussed among health advocates since at least 1979, when a WHO committee suggested the possibility. Gro Harlem Brundtland, a former prime minister of Norway who became director-general of the WHO in 1998, made it happen.

She was aided by outrage over documents that surfaced as part of the landmark 1998 Master Settlement Agreement, in which the four largest U.S. tobacco companies agreed to pay more than $200 billion to 46 U.S. states. The internal communications showed that tobacco executives lied for years about their knowledge of the deadly nature of cigarettes.

A 1989 document revealed one company’s plan to fight threats to the industry. “WHO’s impact and influence is indisputable,” the document said. It went on to contemplate “countermeasures designed to contain/neutralize/re-orient the WHO.”

That company was Philip Morris.

In 2008, Altria Group Inc split up its Philip Morris business. Philip Morris USA, which remains a subsidiary of Altria, sells Marlboro and other brands in the United States. Philip Morris International was spun off, and handles business abroad. Since the split, Philip Morris International shares have more than doubled and Altria’s have more than tripled.

Philip Morris International’s operational headquarters are in Lausanne, Switzerland, down the street from a patch of Gallo-Roman ruins, in a sleek building with a cafeteria, gym and a patio facing Lake Geneva. From there, the company is working to hobble the treaty.

Internal company communications reveal the scope of Philip Morris’ operation during the 2014 FCTC treaty meeting in Moscow. The company set up a “Coordinating Room” that could seat 42 people, according to the 2014 PowerPoint presentation, titled “Corporate affairs approach and issues.”

Leading the operation was executive Chris Koddermann. Formerly a lawyer and lobbyist in Canada, Koddermann joined Philip Morris in 2010. He is now a director of regulatory affairs in Lausanne. The PowerPoint describes the ideal corporate affairs executive as someone who is able to “play the political game.” Koddermann previously worked for federal and provincial cabinet ministers in Canada, according to his LinkedIn profile.

Reached on his cell phone in March, Koddermann said he wouldn’t be able to meet and that any questions should be directed to Philip Morris International.

At the end of the Moscow meeting, on Oct. 18, 2014, Koddermann sent an email congratulating a 33-person Philip Morris team on their success in diluting or blocking measures intended to strengthen tobacco controls and reduce cigarette sales. The gains he touted at the end of the week-long conference were the culmination of a two-year effort, his email said.

The documents shed light on one key objective in Philip Morris’ FCTC campaign: Keep tobacco within the ambit of international trade deals, so that the company has a way to mount legal campaigns against tobacco regulations.

In Moscow, one proposal initially called for carving out tobacco from trade pacts. International trade treaties often include provisions, such as the protection of trademarks, that Philip Morris has used to challenge anti-smoking measures. If tobacco were taken out of the treaties, as suggested by the proposal, Philip Morris could be deprived of many such legal arguments.

An early draft asked parties to support efforts to exclude tobacco from trade pacts and to prevent the industry from “abusing” trade and investment rules. In the end, the proposal was watered down. The final decision only reminded parties of “the possibility to take into account their public health objectives in their negotiation of trade and investment agreements.” There was no mention of excluding tobacco.

Koddermann, in his email to colleagues on the last day of the conference, declared victory, describing the change as “a tremendous outcome.” Overall, the company achieved its “trade related campaign objectives,” including “avoiding a declaration of health over trade” and “avoiding the recognition of the FCTC as an international standard,” he wrote.

The win was significant. A former Philip Morris employee said the company has routinely used trade treaties to challenge tobacco control laws. The aim, he said, was “to scare governments away from doing regulatory changes.” Even though the tobacco industry has lost a series of major legal battles, its suits have served to discourage the implementation of regulations that curb smoking. Those delays can yield years of unimpeded sales.

As the Philip Morris PowerPoint presentation from 2014 put it: “Roadblocks are as important as solutions.”

One roadblock was a campaign to stop the 2011 introduction of rules in Australia banning logos and distinctive coloring on cigarette packs. The company’s litigation and arbitration against the measure ultimately were dismissed – but not before five countries filed complaints against Australia on the same subject at the World Trade Organization. The global trade body has yet to announce a decision in the matter.

The attempt to undo Australia’s regulations has had a chilling effect elsewhere. It slowed the introduction of plain-packaging rules in New Zealand. Citing the risk that tobacco companies may “mount legal challenges,” the government announced in 2013 that it was postponing the move and waiting to “see what happens with Australia’s legal cases.” The legislation is now scheduled to go into effect next year.

In his Moscow conference email, Koddermann also expressed pleasure at the fate of a proposal on farmers. Initial language would have recommended that countries restrict support for tobacco growers. The proposal was “significantly watered down,” he wrote. “This is a very positive result.”

Gustavo Bosio, at the time a manager for international trade, chimed in a few days after the conference in an email: “These excellent results are a direct consequence of the remarkable efforts of all PMI regions and markets during the past two years and throughout the intense week in Moscow.”

Philip Morris isn’t alone in seeking to weaken the treaty. Ahead of the 2012 FCTC conference, in Seoul, four cigarette giants – Philip Morris, British American Tobacco (BAT), Japan Tobacco International and Imperial Brands Plc – formed an “informal industry Working Group” to oppose various proposals on tobacco taxation, according to an internal BAT document reviewed by Reuters.

The 45-page paper, whose existence hasn’t been previously reported, noted that the group would coordinate “to the extent that these issues do not raise any anti-competitive concerns.” The paper outlined a global campaign planned by BAT to counter the FCTC, which was “increasingly going beyond” its mandate. And it listed objectives, including a bid to block discussions around the introduction of a minimum 70 percent tax on tobacco.

BAT declined to answer questions about the industry working group. Both Imperial and Japan Tobacco International said they didn’t want to comment on a document from a competitor. Japan Tobacco International said its tax experts met with counterparts from other tobacco companies to discuss treaty guidelines on taxation ahead of the 2012 conference. Philip Morris did not comment on the document.

The Philip Morris emails and documents don’t explicitly detail how the company pulled off the victories in Moscow. But they provide insight into the importance it places on wooing delegates.

The FCTC traditionally makes decisions by consensus, and so influencing a single national delegation can have an outsized impact. The treaty has a key clause meant to keep the industry from unduly influencing delegations. Article 5.3, as it’s known, says nations should protect their public health policies from tobacco interests. Guidelines that accompany Article 5.3 recommend that countries interact with the industry only when “strictly necessary.”

But the article – a single sentence – contains a loophole Philip Morris has exploited. The sentence ends with the words “in accordance with national law,” opening the door to arguments by pro-tobacco forces that any lobbying that’s legal in a certain country is permissible when interacting with that country’s representatives. They also argue that a sentence in a related document, the guidelines for Article 5.3, allows for such interactions to take place as long as they are conducted transparently.

Philip Morris International: Facts & figures

• Has its roots in a small tobacconist shop in London in 1847.
• Now operates in more than 180 markets.
• Famous for its iconic Marlboro Man advertising.
• Has six of the world’s top 15 cigarette brands, including Marlboro, L&M and Chesterfield.
• Spun off from the Richmond, Va.-headquartered Altria Group in March 2008.
• Operational headquarters are in Switzerland.
• Produces over 800 billion cigarettes a year.
• Share price has more than doubled since the 2008 spin-off from Altria.

Sources: Philip Morris International website; Reuters reporting

Lobbying strategy

The Philip Morris International documents uncovered by Reuters include guidelines and country-specific lobbying plans aimed at hobbling the WHO’s global tobacco control treaty and national anti-smoking measures. Strategies include:
• Lobbying lawmakers, bureaucrats and other government officials
• Trying to move tobacco issues away from health departments
• Deploying third parties, including retail groups, to make its case and exert pressure on decision-makers
• Engaging the media on tobacco issues and generating public debate to influence decision-makers

The tabs below show the company’s strategy in action in three countries in recent years, according to internal company documents. The extent to which Philip Morris’ actions affected the outcome in each case is unclear.

In September 2011, Israel’s health ministry proposed new measures to regulate flavoring and advertising of tobacco products. In a draft company strategy document from October 2011, Philip Morris said the proposals included “a few excessive and disproportionate measures” such as restricting the use of fruit or chocolate flavorings in tobacco products, and broadly prohibiting advertising and marketing of tobacco. Elements of the campaign: 1: Leverage established relationships with different government ministries, mobilize retailers to advocate against “excessive” provisions, and lobby the health ministry. 2: Lobby the government through third parties such as an Israel-based supplier of licorice. 3: Use Philip Morris’ database of more than 60,000 adult smokers to reach consumers and create a public debate through the media “to influence MPs,” or members of parliament. OUTCOME: The bans on advertising and ingredients did not go through.

In September 2011, Israel’s health ministry proposed new measures to regulate flavoring and advertising of tobacco products. In a draft company strategy document from October 2011, Philip Morris said the proposals included “a few excessive and disproportionate measures” such as restricting the use of fruit or chocolate flavorings in tobacco products, and broadly prohibiting advertising and marketing of tobacco. Elements of the campaign:
1: Leverage established relationships with different government ministries, mobilize retailers to advocate against “excessive” provisions, and lobby the health ministry.
2: Lobby the government through third parties such as an Israel-based supplier of licorice.
3: Use Philip Morris’ database of more than 60,000 adult smokers to reach consumers and create a public debate through the media “to influence MPs,” or members of parliament.
OUTCOME: The bans on advertising and ingredients did not go through.

A 2010 Philip Morris document shows the company drawing up plans to lobby Sweden in an effort to influence the European Commission’s new tobacco regulations for member states, known as the Tobacco Products Directive (TPD). Elements of the campaign: 1: Engage the justice ministry to “put pressure” on the health ministry so that the Swedish representative on the European Commission committee opposes plain packaging and “excessive” health warning labels, and supports lifting the ban on snus, a smokeless tobacco product. 2: Build a “broad coalition” of “third-party stakeholders,” such as the Stockholm Chamber of Commerce, and get them to pressure the government. (The chamber told Reuters that it does not lobby on behalf of individual companies.) 3: Establish a retailer network and contact bloggers and journalists to voice concerns about issues, including plain packaging and point-of-sale display bans. OUTCOME: Plain packaging and point-of-sale display ban were not included in the directive, which came into force in May 2014.

A 2010 Philip Morris document shows the company drawing up plans to lobby Sweden in an effort to influence the European Commission’s new tobacco regulations for member states, known as the Tobacco Products Directive (TPD). Elements of the campaign:
1: Engage the justice ministry to “put pressure” on the health ministry so that the Swedish representative on the European Commission committee opposes plain packaging and “excessive” health warning labels, and supports lifting the ban on snus, a smokeless tobacco product.
2: Build a “broad coalition” of “third-party stakeholders,” such as the Stockholm Chamber of Commerce, and get them to pressure the government. (The chamber told Reuters that it does not lobby on behalf of individual companies.)
3: Establish a retailer network and contact bloggers and journalists to voice concerns about issues, including plain packaging and point-of-sale display bans.
OUTCOME: Plain packaging and point-of-sale display ban were not included in the directive, which came into force in May 2014.

In January 2013, Osaka Prefecture in Japan held a public consultation on a proposal to abolish existing smoking rooms, with a “roadmap towards total smoking prohibition in all public places,” according to a February 2014 Japan corporate affairs presentation. The Philip Morris document describes it as an “extreme proposal.” Elements of the campaign: 1: Ensure that “relevant stakeholders” oppose the move. Philip Morris field sales staff engaged retailers and others. 2: Engage local politicians and work with the industry in pushing back against the proposal. OUTCOME: The proposal was withdrawn.

In January 2013, Osaka Prefecture in Japan held a public consultation on a proposal to abolish existing smoking rooms, with a “roadmap towards total smoking prohibition in all public places,” according to a February 2014 Japan corporate affairs presentation. The Philip Morris document describes it as an “extreme proposal.” Elements of the campaign:
1: Ensure that “relevant stakeholders” oppose the move. Philip Morris field sales staff engaged retailers and others.
2: Engage local politicians and work with the industry in pushing back against the proposal.
OUTCOME: The proposal was withdrawn.

One of the company’s targets has been Vietnam.

The day the Moscow meeting ended, Koddermann received an email from his colleague Nguyen Thanh Ky, a leading corporate affairs executive for Vietnam. Ky said he had a “debrief lunch” with the Vietnamese delegation and had a good outcome to report: The delegation was in favor of “moderate and reasonable measures” to be implemented over a “practical timeline,” he wrote. He did not specify which measures they discussed.

The Vietnamese delegation spoke up often during the Moscow meeting. A review of notes compiled by tobacco-control groups accredited as observers showed Vietnam’s interjections frequently mirrored Philip Morris’ positions on tobacco-control regulations. Just like the tobacco giant, the Vietnamese said a higher tax on cigarettes would lead to more illicit sales. Like Philip Morris, they said the FCTC should stay out of trade disputes. And like Philip Morris, they opposed proposals to set uniform parameters for the legal liability of tobacco companies.

The FCTC guidelines on taxation did ultimately include a WHO recommendation for a minimum tax of 70 percent – something Philip Morris opposed. But the proposal to give the treaty more sway over trade disputes was weakened, and measures to strengthen the legal liability of cigarette companies were delayed.

Vietnam’s foreign ministry did not respond to questions from Reuters.

As soon as the conference ended, the documents show, Philip Morris turned to the next one: the 2016 meeting in India.

The 2014 PowerPoint presentation outlined the need to identify ways to gather intelligence during the Delhi conference. In a separate 2015 planning document, the company talks about the arrangement of farmer protests in the run-up to the meeting. Such protests did take place – including one in front of WHO offices in New Delhi. Reuters couldn’t determine whether Philip Morris was behind those demonstrations.

While other major tobacco companies also sent people to Delhi in November, Philip Morris was distinguished by its stealth. Executives from the company did not sign in with their tobacco industry colleagues at the FCTC convention center and stayed at a hotel about an hour’s drive away.

The anonymity and distance helped Philip Morris approach delegates covertly. On the second day of the conference, a white Toyota van pulled away from the front of the Hyatt Regency hotel – where Philip Morris had its operations room – and headed for the FCTC treaty venue. The van was carrying Ky, its corporate affairs executive from Vietnam.

OFFSITE MEETING: During the treaty conference on the outskirts of New Delhi last year, a Philip Morris representative met privately with a member of the Vietnamese delegation, Nguyen Vinh Quoc. In the first picture (left to right), Quoc can be seen emerging from a session at the treaty conference on Nov. 8. In the second picture, a van that left a Delhi hotel carrying a Philip Morris representative heads for the convention center. In the third picture, Quoc can be seen exiting the convention center moments before climbing into the van. REUTERS/Duff Wilson; Tom Lasseter

OFFSITE MEETING: During the treaty conference on the outskirts of New Delhi last year, a Philip Morris representative met privately with a member of the Vietnamese delegation, Nguyen Vinh Quoc. In the first picture (left to right), Quoc can be seen emerging from a session at the treaty conference on Nov. 8. In the second picture, a van that left a Delhi hotel carrying a Philip Morris representative heads for the convention center. In the third picture, Quoc can be seen exiting the convention center moments before climbing into the van. REUTERS/Duff Wilson; Tom Lasseter

Ky’s driver talked his way past police at the barricade outside the conference center, where FCTC-issued credentials were checked, explaining that he was driving “VIPs,” the driver later told Reuters.

A few minutes later, a man in a dark suit walked out of the conference center, passed the van and stopped at a street corner. The van did a U-turn, and a Reuters reporter saw the man in the suit quickly climb in. He was a senior member of Vietnam’s delegation to the FCTC conference: Nguyen Vinh Quoc, a Vietnamese government official.

The driver, Kishore Kumar, said in an interview that he dropped the two men off at a local hotel. Kumar said that on several other occasions that week, he took Ky to pick up people from the Hotel Formule1, a budget lodging where Vietnam’s delegation was staying during the conference.

Ky and Quoc did not respond to requests for comment.

Asked by Reuters about the interaction between Ky and the Vietnam representatives, Philip Morris executive Andrew Cave thumped on the table in a bar at the hotel where company representatives were staying. Reuters should focus, he said, on efforts by the industry to develop so-called reduced-risk products – those that deliver nicotine without the burning of tobacco and which the company says reduce harm.

When pressed about the meetings with Vietnam, Cave thumped the table again: “I’m angry that you’re focusing on that, rather than the real issues that matter to real people.”

In a subsequent email, Cave said: “Representatives from Philip Morris International met with delegates from Vietnam” during the Delhi conference “to discuss policy issues and this complied fully with PMI’s internal procedures and the laws and regulations of Vietnam.”

Delegates, Cave said in separate interviews, are reluctant to meet openly with Philip Morris because they are afraid of being “named and shamed” by anti-smoking groups.

Some delegates questioned the extent to which Philip Morris shaped the decisions made at the Moscow conference, saying attendees genuinely disagreed on certain issues. Nuntavarn Vichit-Vadakan, a Thai delegate, oversaw many discussions as the chair of an FCTC committee at the Moscow conference. She said delegates differed over the regulation of e-cigarettes, for instance, and any lobbying the company carried out would not have determined the outcome.

The Philip Morris documents leave questions unanswered. In some cases, the documents show the company hatching plans to change an anti-smoking regulation or to monitor activists, but don’t always make clear to what extent or how the plans were executed, if at all. The 2014 PowerPoint presentation called for “achieving scrutiny” of tobacco control advocates and said a “global project team” had been established for this purpose. It did not list what means would be used.

In some instances, Philip Morris’ lobbying plainly failed. In July 2015, the Ugandan parliament passed sweeping new anti-tobacco laws inspired by the treaty. All that was needed was President Yoweri Museveni’s signature, and the small African nation would become a leader on the continent in implementing a strict interpretation of the FCTC.

Philip Morris sent an executive, a younger white man, to tell the septuagenarian president, who long ago had helped topple dictator Idi Amin, why the tobacco act was a bad idea. Sheila Ndyanabangi, Uganda’s lead health official for tobacco issues who was present at the meeting, described the executive’s approach as lecturing the statesman.

“He said, ‘Ugandan tobacco will be too expensive’ and ‘it will not be competitive,’” Ndyanabangi said. Her account was confirmed by a senior Ugandan government official who was also present.

Museveni stared for a moment at the Philip Morris executive and a representative from a major tobacco buyer who’d come with him. The president then declared: “Slavery ended a long time ago.” There was a long silence in the room, recalled Ndyanabangi. Museveni said Uganda didn’t need tobacco, and the meeting was over. The president signed the bill that September.

Museveni’s office did not respond to requests for comment.

Over time, however, the industry’s lobbying has slowed the treaty’s progress. At the biennial conferences, the discussions have changed. In Moscow, for instance, there was a strong focus on trade and taxes. “You could see from the floor that interventions were very, very, very much focusing on the trade aspects, many times even putting trade over health,” the FCTC’s da Costa e Silva said in an interview last year.

The composition of FCTC delegations sent by governments has changed to include more members who aren’t involved in health policy. That’s in line with what Philip Morris and other tobacco companies want: Philip Morris, as well as British American Tobacco, has sought to move the balance of the membership away from public health officials and toward ministries like finance and trade. Such agencies, said the former Philip Morris executive, benefit from tobacco tax revenues and attach less weight to health concerns.

“The health department would just want tobacco to be banned, while for the finance ministry it’s more like how can we leverage or get as much money as we can,” he said.

The object of Philip Morris’ efforts, according to the 2014 PowerPoint on corporate affairs, is to “move tobacco issues away” from health ministries and demonstrate there are broader public interests at play – that “it’s not about tobacco.”

Cave, the Philip Morris corporate affairs executive, confirmed the company tries to persuade governments to change the composition of delegations. Health officials, he said, aren’t equipped to handle the intricacies of issues such as taxation.

“You’re looking at illicit trade, you’re looking at tax regimes, you’re looking at international law,” he said. “Now each of these areas, it’s logical, if you want to really tackle the trade and tobacco smuggling, illicit trade, who would you go to? You wouldn’t go to the health ministry.”

TOBACCO FARMERS: A worker tends to a tobacco crop in the farming community of Beatrice, Zimbabwe. At the treaty meeting in Moscow in 2014, a proposal calling for countries to limit support for tobacco growers was weakened. “This is a very positive result,” wrote Chris Koddermann, a Philip Morris executive, in an email. REUTERS/Philimon Bulawayo

TOBACCO FARMERS: A worker tends to a tobacco crop in the farming community of Beatrice, Zimbabwe. At the treaty meeting in Moscow in 2014, a proposal calling for countries to limit support for tobacco growers was weakened. “This is a very positive result,” wrote Chris Koddermann, a Philip Morris executive, in an email. REUTERS/Philimon Bulawayo

“I’m angry that you’re focusing on that, rather than the real issues that matter to real people.”

Philip Morris executive Andrew Cave, when asked about the company’s interaction with FCTC delegates

Reuters analyzed the rosters of the almost 3,500 accredited delegation members who have attended the seven FCTC conferences since 2006. The analysis found that there were more than six health delegates for every finance-related delegate in 2006. In Delhi last year, that ratio had fallen to just over three health delegates for every finance delegate. The number of delegates from finance, agriculture and trade fields has risen from a few dozen in 2006 to more than 100 in recent years.

Vietnam’s delegation, for example, has changed markedly. At the first FCTC conference in 2006, none of its four delegates were from finance or trade ministries. By 2014, in Moscow, there were 13 delegates, with at least four from finance-related ministries, including the chief delegate. Vietnam’s foreign ministry did not respond to questions about the delegation.

Da Costa e Silva isn’t opposed to having delegates from trade ministries, but she says their primary focus needs to be on health. And she was concerned by the makeup of the Vietnamese delegation. In a letter to the Vietnamese prime minister in late 2015, she asked that tobacco industry employees be excluded from the delegation. If they weren’t, she wrote, Vietnam might be “unable to play a full part in discussions.”

In 2016, Vietnam brought 11 delegates to the conference, of whom six were from health agencies, including the chief representative.

Some tobacco-control activists who attended the Delhi meeting in November say it was the worst so far in terms of passing new anti-smoking provisions.

Matthew Myers, who heads the Campaign for Tobacco-Free Kids, said multiple countries came prepared to consciously block action. He said he heard delegates making arguments “I haven’t heard in 25 years.”

A Nigerian delegate, for instance, asked to remove a reference to “the tobacco epidemic” from a draft proposal on liability for tobacco-related harm, according to notes taken by anti-smoking groups.

Asked for comment, Christiana Ukoli, head of the delegation in Delhi, said the “Nigerian delegation strongly dissociates itself from [that] statement.”

The Delhi conference ended as it began, with treaty Secretariat officials not knowing where Philip Morris had been or what it had done. The company had flown in a team of executives, used a squad of identical vans to ferry officials in New Delhi, and then left town without a trace.

Watering down

Just days after the FCTC conference in Moscow ended in October 2014, Philip Morris executive Gustavo Bosio sent an email to colleagues highlighting what he said was the company’s success in pushing back on three treaty proposals related to trade issues. “These excellent results are a direct consequence of the remarkable efforts of all PMI regions and markets during the past two years and throughout the intense week in Moscow,” wrote Bosio, then manager for international trade. The first two columns in each tab below show the initial proposal and the final outcome, and are from an analysis Bosio attached to his email. The third column contains extracts from his email explaining what happened in each case.

fctc1

fctc2

fctc3

 

Source: Internal Philip Morris documents; emphasis added by Philip Morris. Note: “AMRO” refers to the Americas regional office of the World Health Organization.

Additional reporting by Joe Brock in Johannesburg, Ami Miyazaki in Tokyo, Mai Nguyen, My Pham and Minh B. Ho in Hanoi, Elias Biryabarema in Kampala, Enrico Dela Cruz in Manila, Stephen Eisenhammer and Anthony Boadle in Brasilia, Alexis Akwagyiram and Ulf Laessing in Lagos, and Patturaja Murugaboopathy in Bengaluru.

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

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

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.

Implementing rules for smoking ban out in July Tuesday, May 30, 2017

THE implementing rules and regulations (IRR) of Executive Order (EO) 26, which sets strict guidelines on designated smoking areas, will be released in July,

http://www.sunstar.com.ph/manila/local-news/2017/05/30/implementing-rules-smoking-ban-out-july-544704

Health Secretary Paulyn Ubial said Tuesday. “We are looking at coming out with the IRR inside the 60-day effectivity period provided by the EO, likely before SONA,” said Ubial. Ubial said they are already crafting the IRR along with Philippine Amusement and Gaming Corp., Philippine Ports Authority, Land Transportation Office, Civil Aviation Authority of the Philippines, Maritime Industry Authority, Department of Tourism, Office of the President, Department of Environment and Natural Resources, Department of Justice, Department of Interior and Local Government, Department of Education, and Civil Service Commission.

Noticeably absent from the list is a representative from the tobacco industry. “We don’t think that their representation would in fact add value to the EO,” said Ubial.

To note, the Inter-Agency Committee-Tobacco (IAC-Tobacco) created under the Tobacco Regulation Act of 2003, has a representative of the tobacco industry as among its members.

Earlier this month, President Rodrigo Duterte signed EO 26, which imposes a nationwide smoking ban in public places. The IRR is expected to complement the provisions of the EO 26. But even without the IRR, the health chief said local government units (LGUs) may already come out with their respective tobacco control ordinances. “We hope that if we come up with the IRR, the specifics there will be clearer in the implementation. But even without the IRR, it is already implementable,” said Ubial.

She said LGUs can easily refer to the Framework Convention on Tobacco Control (FCTC) as basis for their ordinances. “The FCTC is an international treaty that we signed and ratified. That can be the reference point of local ordinances,” said Ubial.

The health chief noted how there are local ordinances that are even stricter than the EO 26’s provisions as they are anchored on the FCTC, such as the LGU recipients of the Red Orchid Awards. “Actually, there are LGUs with ordinances stricter than our EOs. That can continue,” said Ubial. (HDT/SunStar Philippines)

Indonesian tobacco watchdog urges govt to sign FCTC to protect people

Ahead of World No Tobacco Day on May 31, the National Commission on Tobacco Control (Komnas PT), a coalition of organizations that has been staunchly campaigning on tobacco issues in Indonesia, has asked the government to draft a comprehensive regulation on tobacco control to protect society.

http://www.thejakartapost.com/news/2017/05/30/indonesian-tobacco-watchdog-urges-govt-to-sign-fctc-to-protect-people.html

Komnas PT chairman Prijo Sidipratomo said on Tuesday that the most important thing was for the government to immediately sign the Framework Convention on Tobacco Control (FCTC) to protect society from the dangers of smoking.

“Second, the existed tobacco bill that is being discussed by the government and the House of Representatives must be dropped,” Prijo asserted in a press statement.

Prijo said the demand was in line with President Joko “Jokowi” Widodo’s statement in February during the 2017 National Health Meeting, saying that we should not let the money that was supposed to increase children’s nutrition to be instead used to buy cigarettes.

The Komnas PT asked every party to join hands to protect the young generation from the dangers of nicotine addiction that could degrade the nation’s productivity.

Without a comprehensive regulation, more than 250 million people are left unprotected when facing the dangers of the cigarette industry that always looks for profits while harming the environment, economy, society and human rights, he added.

The commission criticized the House for wanting to delete the existing article declaring a “total ban of cigarettes advertisement in broadcasting” in a revision of the Broadcasting Law. (hol/dan)

Smokers Undeterred as Bills Keep Rising

Since the beginning of the past fiscal year (ended in March) the taxes collected on tobacco products are paid to the Health Ministry (50%), Education Ministry (25%) and Ministry of Sports and Youth Affairs (25%) for anti-smoking campaigns

https://financialtribune.com/articles/people/65335/smokers-undeterred-as-bills-keep-rising

Iranians spend $1-1.5 million (40 to 50 billion rials) on tobacco products each day and the cost of treating tobacco-related disease is almost three times more than the amount spent on tobacco consumption.

During the past five years, the rate of tobacco consumption has only slightly decreased, studies conducted by the Health Ministry indicate. The rate is still high among adolescents and young people (the peak age for first trying of smoking has decreased from 13 to 10). The figure has also increased dramatically compared to the past decade, the Persian language weekly ‘Salamat’ reported.

“In 2006, Iranians smoked 50 billion cigarettes (worth $33.3 million). The figure reached 60-70 billion cigarettes in 2016,” said Dr Mohammadreza Madani, head of the Iranian Anti-Tobacco Association (IATA).

Another concern is the high prevalence of hookah (water pipe) for smoking flavored tobacco among young people. One hour of smoking hookah exposes a smoker 100-fold to the amount of smoke inhaled from a single cigarette. Even those people around a hookah smoker inhale smoke equal to 10 cigarettes.

Every year on May 31, the WHO marks World No Tobacco Day (WNTD), highlighting the health and additional risks associated with tobacco use, and advocating effective policies to reduce tobacco consumption.

The theme for World No Tobacco Day 2017 is ‘Tobacco – a threat to development.’

But irrespective of the programs to create awareness on the harmful effects of smoking, statistics show that 14-15% of Iranians from the 80 million population are regular cigarette smokers (more than 3% are women, and 20% men).

“Though most of the cigarette smokers are men, hookah smoking doesn’t vary by gender; 21.3% of women and 21.7% of men are hookah smokers,” Madani said.

Dodging Taxes

Iran is one of the nations that has signed the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), by which a country is committed to reduce the rate of tobacco consumption every year (by implementation of both price and tax measures as well as non-price measures to reduce demand for tobacco).

Pointing to Article 8 of the National Comprehensive Law on Tobacco Control, Madani said, “According to the law passed in 2006, every year taxes on cigarettes should be increased by 10%.”

“However, there have been always obstacles in its implementation. For example, in 2010 the figure decreased to 5% due to ‘manipulative tactics’ by the powerful tobacco lobby. Tobacco producers said that high taxes on cigarettes would lead to an increase in cigarette smuggling, and thus managed to reduce the tax.”

However, in January this year, lawmakers passed cigarette and tobacco tax slabs to be implemented under the sixth five-year economic development plan (2017-22).

Based on the new law, the tax slab on locally-produced tobacco and cigarettes is 10%; for local brands jointly produced by domestic and foreign manufacturers, it is 20%; for domestically produced cigarettes with foreign brand names the slab is 25%; and for imported cigarettes and tobacco, it is 40%.

Lawmakers also mandated the Ministry of Industries, Mining and Trade to announce the retail prices of cigarettes and all tobacco products to the relevant authorities for taxation purposes and for printing the tax rates on cigarette packs.

“Since the beginning of the past fiscal year (ended in March) the taxes collected on tobacco products are paid to the Health Ministry (50%), Education Ministry (25%) and Ministry of Sports and Youth Affairs (25%). The Education Ministry is required to spend the money on increasing students’ awareness of harms associated with tobacco smoking,” Madani said.

Earlier, the tax money was given to the ministries of health and sports and youth affairs.

Facts About Tobacco

There are more than 7 million deaths from tobacco use every year, a figure that is predicted to cross 8 million by 2030 without effective and intensified action. Tobacco consumption is a threat to any person, regardless of gender, age, race, cultural or educational background. It brings suffering, disease, and death, impoverishing families and national economies.

Tobacco use costs national economies enormously through increased healthcare costs and decreased productivity. Some 80% of premature deaths from tobacco occur in low- or middle-income countries, which face increased challenges to achieving their development goals, the WHO website reports.

Tobacco growing requires large amounts of pesticides and fertilizers, which can be toxic and pollute water supplies. Each year, tobacco growing uses 4.3 million hectares of land, resulting in global deforestation between 2% and 4%. Tobacco manufacturing also produces over 2 million tons of solid waste.

By increasing cigarette taxes worldwide by $1, an extra $190 billion could be raised for development. High tobacco taxes contribute to revenue generation for governments, reduce demand for tobacco, and offer an important revenue stream to finance development activities.

What’s keeping Indonesia, China addicted to smoking?

A World Trade Organisation ruling backing Australia’s hard line on cigarette packaging highlights a gulf between Asia and much of the rest of the world

http://www.scmp.com/week-asia/society/article/2094162/whats-keeping-indonesia-china-addicted-smoking

It was during a trip to Egypt in 1995 when Edison Siahaan first felt that something wasn’t quite right with his throat. Four decades had gone by since he started smoking at the age of 15. His voice had been raspy for years. Maybe this was just the dry air tickling the back of his throat.

But it wasn’t dry air and it wasn’t a tickle. It was cancer. Doctors excised a portion of his trachea leaving a hole the size of a nickel at the base of the throat. He lost his bank job because for a year following the surgery he couldn’t speak. Even now, what passes for speech makes him sound like the emperor from Star Wars only with more hissing. Now 79, Siahaan, a kindly old gent with a full head of hair, is tough to look at. “I see kids smoking all the time here,” he says, gesturing back and forth along the length of the street from his front room. “It makes me sick to think they are going to ruin their life. I point at this hole in my throat and say to them: do you want to look like this?”

Asian men already account for the lion’s share of the world’s tobacco related illnesses, yet a World Trade Organisation ruling this week that upheld tough anti-smoking rules introduced in Australia in 2012, showed that if anything, the gap in attitudes between Asia and the rest of the world may be widening.

“Tobacco in China is absolutely devastating,” says Dr Angela Pratt who helps handle external relations at the World Health Organisation’s office for the Western Pacific in Manila.

In China, roughly 300 million people smoke, according to the WHO. Most of these are men. More than half of Chinese adults are smokers and two-thirds of young Chinese men start smoking. While smoking rates are steady, the absolute number of smokers is rising in line with population growth. Chinese smokers account for 44 per cent of all the cigarettes puffed in the world. At current rates 200 million Chinese will die this century from tobacco-related illnesses, Pratt says. “That’s a huge burden. The people afflicted are often the sole income earners,” she says.

This week, the WTO ruled that Australia’s plain packaging rules, which ban branding and distinctive colouring from packs of cigarettes, were a legitimate public health measure. The ruling knocked back a complaint from Indonesia, Cuba, Honduras and the Dominican Republic, who said the rule amounted to an illegal trade barrier. As the former chief of staff to the Australian health minister who introduced the plain packaging measures, Nicola Roxon, Pratt helped develop the policy, bulletproofing it from court challenges from tobacco companies and governments.

“We were proud to be taking on plain packaging,” Pratt recalls. “But we wanted to be sure to be able to defend it.”

Together with graphic warnings and taxes that will push cigarettes up to A$40 (HK$230) per pack by 2020, the measure is credited with accelerating the fall in Australia’s smoking rate. The most recent figures show about 13 per cent of Australian adults smoke and less than five per cent of school children. A dozen countries, from Canada to Chile and Britain to Uruguay are either introducing similar rules or seriously considering them.

At the other extreme is Indonesia. The most recent figures, which date back to 2013, show 240,000 Indonesians die every year from tobacco related illnesses. Two-thirds of Indonesian men and boys, over the age of 15, smoke, according to the Ministry of Health.

Most troubling are the numbers of new young smokers throughout the archipelago, says Dr Widyastuti Soerojo, chair of the tobacco control unit at the Indonesian Public Health Association. She says some 16 million Indonesian youngsters between the ages of 10 and 19 experiment with smoking every year – a rate of about 44,000 every day.

Indonesia is among the few countries that are not signatories to the United Nation’s Framework Convention on Tobacco Control, which among other things aims to curb the appeal of smoking for children.

Indonesia television and billboards feature handsome intrepid men jumping out of planes or into business meetings. Roadside kiosks individually sell clove cigarettes, known as kretek, for as little as 10 US cents each.

Governments in Jakarta and local governments in vote-rich provinces, such as Central Java and East Java, fend off calls for more curbs on smoking saying they provide badly needed jobs to rural families.

But mechanisation and growing taste for machine-made cancer sticks rather than hand-rolled types, belie that argument. Tobacco accounts for about half of one per cent of all jobs in Indonesia, according to the Southeast Asia Tobacco Control Alliance. Campaigners are quick to point out the country’s richest families have tobacco to thank.

The Hartonos, Indonesia’s richest family and worth US$17 billion, own kretek maker Djarum.

Indonesian cigarette sales totaled US$16 billion in 2015. Sampoerna, which is more than 90 per cent owned by Philip Morris, is Indonesia’s most valuable company.

“The government treats tobacco like it’s a normal industry but really this is neocolonialism by tobacco companies,” Dr Soerojo says.

In China, the culprit for health advocates is the China National Tobacco Corporation, which controls more than 98 per cent of the local market. Implementation of the UN tobacco convention falls to the Ministry of Industry, which is also home to the body that owns China Tobacco. “A parallel would be, back when I was with the health ministry, meetings were chaired by a representative of Philip Morris,” Pratt said. “There’s plenty of room for conflict of interest.”

Still, there’s progress. Beijing, Shanghai and Shenzhen, with a combined population of more than 60 million, have banned smoking in public areas. China hiked taxes on cigarettes in 2015. The move resulted in a 20 per cent jump in the retail prices of the cheapest brands. Owing to its massive market, that move alone resulted in a more than 2 per cent drop in world tobacco consumption in 2016.

In Indonesia, smoking is banned in most public spaces but enforcement peters out the further one travels from the centre of Jakarta. Indonesia introduced graphic warnings on packaging in 2012 and hiked excise taxes on cigarettes by 15 per cent in 2016. Even so, additional hikes for this year were scotched. Glimmers of light are on the horizon, says WHO’s Pratt, but plain packaging is still “a long way off”.

For Siahaan, his government’s halting go-slow approach is proof that cigarettes are insidious, and for him, more ruinous than narcotics. “At least with drugs you can get help,” he gasps. “For cigarettes, you see them everywhere.”

Tobacco Control Program

Context

Tobacco use, and its negative health, social and economic impacts, is a significant global health challenge.

http://www.worldbank.org/en/topic/health/brief/tobacco

According to the 2015 World Health Organization (WHO) Report on the Global Tobacco Epidemic, in 2013, 21% of adults globally were current smokers – 950 million men and 177 million women. Despite increasing global population between 2007 and 2013, smoking prevalence has actually declined worldwide from 23% in 2007, preventing an increase in the number of smokers in the world. The total remains at 1.1 billion smokers globally in 2013.

Tobacco use is a leading global disease risk factor and underlying cause of ill health, preventable death, and disability. It is estimated to kill more than 5 million people each year across the globe. If current trends persist, tobacco will kill more than 8 million people worldwide each year by 2030, with 80% of these premature deaths taking place in the developing world.

In 2015, the “Addis Ababa Action Agenda” adopted at the Third International Conference on Financing for Development held in Addis Ababa, Ethiopia — and later endorsed by the United Nations as part of the Sustainable Development Goals (SDGs) — recognized that public policies and mobilization, and effective use of domestic resources, underscored by the principle of national ownership, are central to the common pursuit of sustainable development, including achieving the SDGs.

Clause 32 of the Addis Ababa Action Agenda states that price and tax measures on tobacco are viewed as an effective and important means to reduce tobacco consumption and health care costs, and represent a revenue stream for financing for development in many countries.

The Action Agenda also stresses that the tobacco tax agenda is fully consistent with obligations acquired by 180 countries that are parties to the WHO Framework Convention on Tobacco Control (FCTC) (an additional seven countries have signed the FCTC but have not ratified it, and only nine countries are neither signatories or parties to the FCTC).

World Bank Group Tobacco Control Program

The World Bank Group’s Global Tobacco Control Program assists countries in fostering and implementing tobacco tax reforms to achieve public health goals by reducing tobacco affordability and consumption, and for mobilizing domestic resources to expand the fiscal space to fund priority programs and investments that benefit the entire population, and controlling illicit trade on tobacco by strengthening customs systems. Work has been carried out over 2013-2016 in Philippines, Bostwana, Ghana, Namibia, Vietnam, Georgia, Indonesia, and Peru; more recently, for the support of tobacco tax reforms adopted in 2017 in Armenia, Colombia, Moldova, and Ukraine, and assessments done over 2016-2017 in Nigeria, Ethiopia, Lesotho, Belarus, Turkey, Chile, and on the European Union tax harmonization process. Work is currently underway or being initiated in the Indonesia, Sierra Leone, China, and Montenegro. In addition, the program supports knowledge exchange, including peer-to-peer advice and support, among selected countries on the economics of tobacco control (for example, through the Joint Learning Network, which includes more than 30 countries).

The preparation of a Tobacco Taxation Module as part of WBG/IMF Tax Policy Assessment Framework (TPAF) is underway as part of a new WBG/IMF initiative launched ahead of the Financing for Development Conference in Addis Ababa, held in July 2015, to help member countries strengthen their tax systems. One of the pillars of the initiative includes the development of “improved diagnostic tools to help member countries evaluate and strengthen their tax policies.” Building on their collective expertise, the Bretton Woods Institutions (BWIs) aim to play a fuller role in enabling all of their member countries to assess tax policy performance in order to identify priority tax policy reforms, and design the requisite support for their implementation. The TPAF is a diagnostic framework to provide systematic and structured assessment of a country’s tax policy system, and to develop options for improving such system given a set of policy objectives.

More specifically, the program assists government agencies in developing capacity to assess the health and social costs of tobacco use, and design, enact, administer and monitor tobacco taxation policies. Enhanced capacity will enable countries to increase prices and reduce tobacco use, taking into account the macro-economic and fiscal situation of each country, tax laws, and existing tax administration structure and processes. This process includes assessments and discussions related to fiscal revenues and allocation; smoking patterns and taxes at country level; and socio-economic and health impacts of increasing tobacco tax rates, under different tax policy scenarios, and including impacts on employment, smuggling and other likely impacts of tobacco tax reforms.

The Bank team engaged in this program is multi-sectoral, and includes experts in health, governance, and macro-economics and financial management. Initial discussions are being held to mobilize knowledge and expertise from the International Monetary Fund’s Fiscal Affairs team. The Bank team is also working closely with other international partners, such as the World Health Organization and the Campaign for Tobacco-Free Kids.

The Bank’s Tobacco Control Program is implemented through a multi-donor trust fund financed by the Bill & Melinda Gates Foundation and the Bloomberg Philanthropies. These donors take part in governance of the trust fund and participate in the selection of priority countries included for support under the program.

Joint Learning Network Module: The Joint Learning Network (JLN), connects practitioners and policymakers across countries, facilitating peer-to-peer learning and sharing of knowledge and experience. As part of the Bank’s program, the network is currently developing a Tobacco Tax and Illicit Trade on Tobacco Module targeting member countries in Asia, Africa, Latin American and the Caribbean, and Europe, as well as a diverse group of international, regional, and local partners. The module is expected to focus on tobacco taxation, tax administration, and illicit trade control measures.

In 1991 the World Bank adopted a mandatory operational policy not to lend, invest in, or guarantee investments or loans for tobacco production, processing, or marketing. The Bank’s activities in the health sector discourage the use of tobacco products.

Why the emphasis on tobacco taxation?

Raising taxes on tobacco products is one of the most cost-effective measures to reduce consumption of products that increase mortality , while also generating substantial domestic revenue for health and other essential programs—investments that benefit the entire population. Given this, the World Bank Group Tobacco Control Program gives priority attention to tobacco taxation.

Findings in the 2015 WHO Report on the Global Tobacco Epidemic show that while only 33 countries impose taxes that constitute more than 75% of the retail price of a pack of cigarettes—the taxation level recommended to have an impact on consumption —most countries that do tax tobacco products have extremely low tax rates. And some countries do not have a special tax on tobacco products at all.

Given this situation, the World Bank Group’s program supports governments to look at accumulated country evidence and use tax measures to increase the retail price of tobacco products as one of the best available public health policy measures.

Some important lessons from international experience about how to effectively implement tobacco taxation policy to achieve public health objectives can be adopted and adapted in policy dialogue and operational support to countries. Such lessons include:

  • While nearly all countries tax tobacco products, an excise tax is the most important type of tobacco tax, since it applies uniquely to tobacco products and raises prices relative to prices for other goods and services.
  • Simpler tobacco tax structures are more effective than complex ones, since tiered tax structures are difficult to administer and can undermine the health and revenue impacts of tobacco excise taxes.
  • Use of specific excise taxes enhances the impact of tobacco taxation on public health by reducing price gaps between premium and lower-priced alternatives, which limits opportunities for users to switch to less-expensive brands in response to tax increases. Taxing all tobacco products comparably reduces incentives for substitution.
  • Ad valorem taxes are difficult to implement and weaken tax policy impact. Since they are levied as a percentage of price, companies have greater opportunities to avoid higher taxes and preserve or grow the size of their market by manufacturing and selling lower-priced brands. This also makes government tax revenues more dependent on industry pricing strategies and increases the uncertainty of the tobacco tax revenue stream.
  • Specific excise taxes need to be adjusted for inflation to remain effective.
  • Tax increases should reduce the affordability of tobacco products. In many countries, where incomes and purchasing power are growing rapidly, large price increases are required to offset growth in real incomes.
  • Strong tax administration is critical to minimize tax avoidance and tax evasion, to ensure that tobacco tax increases lead to higher tobacco product prices and tax revenues, as well as reductions in tobacco use and its negative health consequences.
  • Regional agreements on tobacco taxation can be effective in reducing cross-border tax and price differentials and in minimizing opportunities for individual tax avoidance and larger scale illicit trade.

For more information, please contact:

Patricio V. Marquez

Lead Public Health Specialist

World Bank Group Health, Population and Nutrition Global Practice

Email address: pmarquez@worldbank.org

Blanca Moreno-Dodson

Lead Economist

World Bank Group Macro Economics and Fiscal Management Global Practice

bmorenododson@worldbank.org

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.