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Chain-smoking children: Indonesia’s ongoing tobacco epidemic

SOUTH SUMATRA, Indonesia — Surrounded by farmland and plantations in the small village of Teluk Kemang Sungai Lilin in South Sumatra, a boy, just 8 years old, sits smiling with his mother.

But this boy has a tumultuous past and a reputation that precedes him, having undergone a recovery most children will never face.

Six years ago, Aldi Suganda, also known as Aldi Rizal, was a 2-year-old chain smoker addicted to cigarettes, smoking packs each day. “It was hard for me to stop,” he said. “If I am not smoking, my mouth taste is sour and my head feel dizzy.

“I am happy now. I feel more enthusiastic, and my body is feeling fresh,” he said.

He became a global sensation as the “chain-smoking toddler,” with video clips of him puffing excessively on an endless cigarette supply watched by millions around the world.

His mother, Diana, thinks back to that period and recoils at the memory. Her son would get angry, she remembers, and throw tantrums if she withheld cigarettes from him or failed to give him money to obtain them. “He (would) start to smash his head to the wall. He was crazy, hurting himself if he didn’t get a cigarette,” she said.

People would accuse her of being a bad mother and regularly question her parenting skills, she said. “I am a weak mom. He always threaten me if I didn’t give him money. … I (was) afraid he (was) going to die.”

Aldi is the youngest of three boys born to Diana and her husband, who requested not to be named. But he is far from the only child who picked up the habit across the islands of Indonesia: More than 267,000 children there are estimated to use tobacco products every day.

A childhood habit

Diana believes Aldi’s addiction began with peer pressure and exposure to smokers. He accompanied her each morning to the market where she sells vegetables grown on their land. People there could have taught him to smoke, and he could easily get cigarettes by asking at the market, she said.

In many regions of the world, this might seem unrealistic and like an excuse, but in Indonesia, it’s highly likely. The country has the highest percentage of male smokers globally and among the highest rate of adolescent and child smokers in the world — fueled by lack of control over advertising, relaxed sales and low prices.

Today, Aldi is a healthy young boy who attends school and gets good grades, but to get here, it took years of rehabilitation with the country’s leading child psychologist, Dr. Seto Mulyadi, chairman of the nation’s National Commission for Child Protection. His road also didn’t end with his tobacco cravings. Soon after his recovery, he replaced tobacco with food and began to overeat as a means of compensation, eventually becoming obese.

But a second bout of rehabilitation to tackle this overeating created the healthy, stable young boy sitting beside his mother today.

Mulyadi believes the one benefit of working with children who have an addiction is their mental agility. In Aldi’s case, his age and intelligence meant he responded quickly to his treatment, in which Mulyadi distracted the 8-year-old with running, climbing and playing while slowly reducing the number of cigarettes he smoked each day. But treatment was intense and required Aldi to go to Jakarta for a few months to be with Mulyadi every day.

“He was just 3 years old, and he smoked four packs a day,” Mulyadi said. “(But) I was confident because he is still very young. Psychologically, as a child, he is very flexible and easier to be cured.”

And cured he is — at least for now.

“I don’t want to smoke anymore. I don’t want to get sick,” said Aldi, who now wants to help prevent other children going through a similar ordeal. “Please don’t smoke. Don’t even try it. It’s hard to quit.”

In 2013, more than 57% of men were reported to be smokers in Indonesia and more than 42% of teens ages 13 to 15, according to the Tobacco Atlas, compared with 17% and 8.2%, respectively, in the United States. It’s estimated that more than 217,000 people die from diseases linked to tobacco use each year in Indonesia, including heart disease and respiratory conditions such as emphysema and lung cancer.

With smoking so commonplace and numbers remaining steady or even rising among some groups in recent years, Aldi’s message could go unheard, believes Dr. Lily Sulistyowati, director of prevention and control of noncommunicable diseases at Indonesia’s Ministry of Health.

“I’m very worried about smoking in Indonesia,” she said, especially among teens ages 15 to 19.

No sign of decline

While rates in most countries fell between 2013 and 2016, the rate of smokers under 18 in Indonesia rose from 7.2% to 8.8%.

But more worryingly, among 10- to 14-year-olds, more than 3% were smokers in both 2013 and 2016 — the majority of them boys — and more than 18% of boys and more than 9% of girls 10 to 14 had tried a cigarette, according to Indonesia Basic Health Research data reported in 2013.

The research also found that 1.5% of boys and 1.4% of girls 5 to 9 years old had tried a cigarette.

Sulistyowati believes the problem is worse in rural areas and among poorer populations. “Poor people are spending their money on cigarettes,” she said.

In 2013, the richest fifth of the population used 7.1% of their monthly expenditures on tobacco and betel leaf to wrap tobacco, while the poorest fifth spent 12.5%, according to Indonesia’s Central Bureau of Statistics. The poorest fifth spent similar proportions of their wages on grains and tobacco — 15.5% and 12.5%, respectively — and spent six times more on tobacco than on dairy and egg products.

Rural regions also tend to be populated with people with lower incomes. There, parents’ priorities are working and earning money for their families, which can leave children vulnerable to influences such as smoking while parents are distracted. “(These areas) are a different situation. Parents focus on how to work and get money, not on the health of their children,” Sulistyowati said.

In addition, children begin working young to earn money that they can then spend on cigarettes, said Dr. Aman Pulungan, president of the Indonesian Pediatric Society, who has been monitoring and working on the issue of childhood smoking for decades. “It’s country life,” he said.

Smoking among children and teens is still a problem in the cities, highlights Silistyowati, but there, people know that the habit is bad for their health and children instead hide their addiction from their parents, she said. “They try it with friends,” she said.

This was the case for Icha, 16, in the capital, Jakarta, who began smoking when she was 13 after a friend offered a cigarette to smoke together. “The first time, I felt dizzy and coughed a lot,” she said. “But later on I (felt) the taste is good.”

Icha now smokes at least one pack of 12 cigarettes each day and says half of her classmates also smoke, some in front of their parents. Her own parents tried to ban her from smoking but after little success now just ask that she try to reduce her habit.

“There is no parental control,” Pulungan said.”They just do it, because no one says no.”

Pulungan added that many parents don’t fully understand the risks associated with smoking and that its prevalence among adults helps that ignorance persist, particularly in rural areas.

Part of the problem, Sulistyowati and other experts say, is the ease of access and pervasiveness of smoking in Indonesian culture.

Marketing and image invasion

“The problem is big,” Pulungan said, adding that smoking has been an issue in Indonesia for more than 40 years. “But it’s getting worse.”

He believes that in addition to peer influence, the root causes of the epidemic include advertising, lack of laws — or enforcement — in public spaces, sponsorship of venues by big tobacco companies and the way cigarettes are sold.

Nonsmoking sections in restaurants are very small, he said. In addition, tobacco companies are still sponsoring sporting and musical events as well as public buildings or clubs. This sponsorship has come down in recent years, he said, but he now believes that hidden advertising is growing — through TV and culture. “(Kids) think if you want to become a man, you have to smoke,” he said.

The issues of advertising and masculinity linked to smoking faced many other countries just a decade or two ago, but while rates across the West declined, companies and efforts to boost tobacco interest transferred to countries where bans and laws did not prohibit their existence, such as Indonesia, Pulungan believes.

In rural areas, “the small shops, grocery shops, are sponsored by cigarette companies, and they can put adverts anywhere,” he said. “No one controls this.” He also mentions sports clubs that have tobacco companies as part of their names.

“Advertising is of more interest to the youth,” Sulistyowati said, adding that companies entice adolescents by associating cigarettes with success and fame. “Schools can get sponsorship” from big companies, she said.

Again, while many countries have had bans against this for some time, Indonesia has no national laws in place — though some municipalities have introduced them, she said, including Western Sumatra.

Of the big six global tobacco companies, Phillip Morris International dominates the market in Indonesia, according to 2013 data from the Tobacco Atlas. The company did not respond to a request for comment.

The Ministry of Health is now working with the Ministries of Education and Communication to help prohibit sponsorship and advertising, as well as the Ministry of Transport to implement and enforce existing smoking bans on public transport.

Almost half of the country’s municipalities have regulations in place for smoke-free areas, said Sulistyowati, and universities have committed to having smoke-free campuses through the Ministry of Education. Graphic health warnings were also introduced on cigarette packets in 2014 to put people off the habit.

But “it all depends on the commitment of the local head, or mayor, of a district,” Sulistyowati said. “Indonesia is a big country,” at more than 1.9 million square kilometers (more than 740,000 square miles).

Easy access and affordability

The final hurdle is the cost and ease with which people can buy cigarettes: They can be bought individually — which makes them more affordable to people with lower incomes — and a pack of 12 can cost as little as $1 at most vendors and kiosks, said Sulitsyowati.

All 34 provinces have had regulations in place since 2012 to prohibit the sale of individual cigarettes, but enforcement has not been that effective.

“They buy one cigarette, not a pack usually … and everywhere you go, you can buy one cigarette, so it’s easy,” Pulungan said. “Shops easily sell them.”

One kiosk vendor in Jakarta, who did not provide his name, said most children buy individual cigarettes from him even though selling them in this form is breaking the law. “Everyone sells cigarettes to them,” he said.

Globally, experts agree that one of the strongest tobacco-control policies has been taxation. The rising cost of the habit, linked to higher taxes, has meant that many can no longer afford to smoke, and those who can smoke provide revenue for anti-smoking campaigns and quitting support services, to name a few options.

“The evidence suggests increasing pricing is the single most effective way to reduce demand,” said Vaughan Rees, director of the Center for Global Tobacco Control at the Harvard T.H. Chan School of Public Health, in a previous report by CNN.

“In states where we see the highest tax rates, we see the lowest prevalence,” he said, highlighting New York City, where former Mayor Michael Bloomberg introduced city taxes on top of state taxes in 2010.

In Indonesia, “the price of cigarettes is very cheap,” Sulistyowati said. “Everyone can buy them.”

Pushing for change

Now, the Ministry of Health is working to align with other ministries as well as international organizations, such as the World Health Organization, to tackle the appeal of cigarettes once and for all. This includes aligning with the WHO’s Tobacco Free Initiative and its strategy to reverse the global tobacco epidemic, known as MPOWER, which features six policies that have been proved to make an impact, such as protecting people from smoke, enforcing bans on advertising, and raising taxes.

The ministry also hopes to provide greater support for people trying to quit smoking and to increase public awareness about tobacco’s harms — as well as push harder for the country to join the Framework Convention on Tobacco Control, a global public health treaty formed in 2005 to tackle the global tobacco epidemic. Today, 181 states have signed the convention. Indonesia is not one of them.

With all this eventually in place, Aldi’s message may finally reach those who need to hear it: young children facing the allure of smoking tobacco.

Though cases like Aldi’s seem very rare on the surface, there are similar ones in Indonesia that don’t get serious attention, said Mulyadi, who treated Aldi.

“Aldi was very lucky because in his case, we get a fast response from the government and public. … Local and international media give him big attention,” he said. “Other children are not that lucky.”

The Indonesian government is not strict enough, he said. “As long as cigarette ads are spread out massively on TV, radio, newspapers, outdoor signage, everywhere, the problem of child smokers will get worse and worse.”

Tobacco Consumption: Going Up in Smoke

In a reassuring move, the Delhi government has warned of legal action against tobacco companies if they violate laws and advertise at outlets selling their products

http://www.indialegallive.com/health-updates/tobacco-consumption-going-up-in-smoke-34241

We all know how tobacco companies sneak in surrogate advertising as they are not allowed to advertise their products. But Philip Morris International (PMI) Inc., the 160-year-old tobacco giant, pushed its top cigarette brands like Marlboro blatantly. It approached small shops and kiosks selling cigarettes and gave them free attractive boards with its advertisement to adorn the front of their shops and paid shopkeepers around Rs 500 as an incentive to break the law. The tobacco major roped in smart, young executives, mainly girls, to gift cigarette packs to youngsters in bars, discos and at parties.

However, after the Cigarettes and other Tobacco Products Act of 2003, which allowed tobacco companies to advertise in shops, was amended, these ads were prohibited. And in mid-August, the Delhi government’s Directorate General of Health Services shot off a stern warning to Philips Morris threatening legal action if it did not remove advertisements from kiosks and other point of sale outlets. The letter asked the company why appropriate punitive action could not be initiated against it and its directors. The letter was sent when the health ministry realised that the tobacco company was violating India’s tobacco control law by advertising at outlets where it was selling its products. It also sent these notices to two other tobacco companies, Indian Tobacco Company Ltd., and Godfrey Philips.

But this was after a series of earlier warnings which were ignored by these tobacco companies. On March 24 this year, the government had told them to get the ads removed. This was largely ignored. Their stand was that the law only stipulated that the ads should not be outside the outlets and did not mention that these could not be carried within the establishments or shops. Last month, the government shot of another letter reiterating the same, but this too was ignored. An internal document of Philip Morris said that the India market had high potential.

Dr SK Arora, additional director, health, Delhi, and also the state tobacco control officer, told India Legal: “In the last three years, we have been constantly writing to tobacco companies like Philips Morris, Indian Tobacco Company and Godfrey Phillips that their ads on posters and billboards were not allowed as they were violating Section 5 of the Cigarettes and other Tobacco Products Act (COTPA-2003). Our teams used to challan vendors who displayed these ads. But they would again put up the ads after we left as they were paid by the tobacco companies.”

Though the government told the companies that they would be held responsible and legal action could be initiated against them, it made no difference as they said it was not being done by them, but by distributors and vendors. When the Act was amended in 2005, it clearly said that there would be no such ads outside shops.

Though the government told the companies that they would be held responsible and legal action could be initiated against them, it made no difference as they said it was not being done by them, but by distributors and vendors. When the Act was amended in 2005, it clearly said that there would be no such ads outside shops.

Arora added: “So the tobacco companies removed the ads outside the shops, but started putting them inside, arguing that the Act did not mention that they should not be within shops or point of sale counters. Recently, the government clarified there should be no such ads both outside and inside. The tobacco companies are now pleading that they be allowed to advertise within the shop or on counters. We have no fight with these companies as long as cigarettes can be sold legally. But they have to sell them within the legal provisions.”

A source from the health ministry said that as far as Delhi was concerned, most of the ads had now been taken off and if they spotted any new ones, legal action would be initiated. Till the Delhi government carries out its threat of cracking down on violators, it is unlikely they will ever comply with the rules.

This is not the first controversy that PMI has faced. In 2010, the tobacco giant admitted to using child labour at its production facility in Kazakhstan. Human Rights Watch documented 72 cases of children used as forced labour.

India alone has some 100 million smokers. Government data says that tobacco use annually kills over 9,00,000 people. WHO estimates that tobacco-related diseases annually cost India $16 billion. Arora warned: “Tobacco is a leading cause of 40 percent of all cancers, 90 percent of oral cancer, 30 percent of tuberculosis, and 20 percent of diseases like heart attack, diabetes and hypertension apart from other respiratory diseases. While we are rapidly developing curative strategies like setting up huge cancer, diabetics and hypertension clinics, we are not doing enough to work on a preventive strategy to ensure that these diseases do not happen.”

The reach and marketing power of tobacco companies is huge. According to a 2002 study in the American Journal of Public Health, the tobacco industry in the 1990s increasingly sponsored entertainment events in bars and nightclubs where it displayed cigarette brand paraphernalia and advertisements.

Globally, anti-tobacco campaigners have accused PMI of breaking an ethical code when it deliberately targeted new young smokers. Often, cigarettes were given free to those who had just entered the legal age to smoke. The company had earlier aggressively run an advertising campaign in about 50 countries, cleverly targeting the young. Internal documents of the company indicated that those between 18 and 24 years had to be zeroed in. Company executives were specifically told that they must never use the word “promotion or advertising” when they were interacting with sellers or potential users.

In 2013, Germany banned promotional images of Marlboro, saying it encouraged children as young as 14 to start smoking. But other countries did not do so despite the fact that seven anti-tobacco organisations in a report charged that Philip Morris was trying to get a new generation hooked to tobacco. The ads of PMI appealed to teenagers as they used attractive models partying, falling in love, travelling, exploring, being cool and even confused. PMI violated its own ethical code which stated that it would not use images and content that would appeal to minors.

India enacted the national tobacco control law in 2004 before being one of the first countries to ratify WHO’s Framework Convention on Tobacco Control treaty. It contains a raft of anti-smoking provisions, including tobacco taxes, warning labels on cigarette packs and advertising bans. India, thereafter, strengthened the law in line with the provisions of the treaty. It was ultimately signed by 181 countries.

A group of cigarette distributors challenged the law. But in 2013, the Supreme Court ordered that the law be implemented. It said advertisement of tobacco products would attract the younger generation and innocent minds who were not aware of the grave and adverse consequences of consuming it.

Delhi has acted strongly, but what about other states? The central government is supposed to monitor and supervise implementation of the Act all over India. Had it done that, all states would have cracked down on tobacco companies the way Delhi has done.

The Tobacco Control Programme has the infrastructure and manpower, but lacks commitment to crack down on the tobacco lobby. An anti-tobacco activist said these companies used to set aside a budget to ensure that monitoring officials were well-inclined towards them.

It is time to act before matters go up in smoke.

Scottish anti-smoking strategy shows ‘positive impact’

The Scottish government’s efforts to reduce smoking in Scotland are working, according to a new report.

http://www.bbc.com/news/uk-scotland-41095421

The review, conducted by the University of Edinburgh and NHS Health Scotland, said the tobacco control strategy had shown a “positive impact” over the past five years.

However, the report’s authors cautioned that smoking continued to be a bigger problem in more deprived areas.

The aim is to have a “smoke-free generation” in Scotland by 2034.

The report concluded progress had been made across all three areas of tobacco policy: prevention, protecting people from second-hand smoke and helping people stop smoking.

Reviewing the strategy, the authors highlighted that:

  • Tobacco products in supermarkets and shops had been moved out of sight
  • Number of children exposed to second-hand smoke in home was cut from 11% to 6%
  • Smoke-free NHS grounds policies have been introduced

The review also said there had been a reduction in cigarette brand awareness in young people, which was attributed to products being moved from view.

Dr Garth Reid, principal public health adviser at NHS Health Scotland, said: “The evidence shows the positive impact of tobacco policy, ranging from the display ban which put tobacco out of sight in small shops and supermarkets to the introduction on smoke free NHS grounds.

“Yet, levels of smoking are still highest in Scotland’s most deprived areas, with 35% of people living in the most deprived areas smoking compared to 10% in the most affluent areas.

“It is clear that further action to reduce inequalities in smoking is necessary if the aim of making Scotland tobacco-free by 2034 is to be achieved.”

When the strategy was published in 2013, the number of adults smoking in Scotland was already falling, but NHS Health Scotland said it was still the single most preventable cause of ill health and premature death in the country.

There are more than 13,000 deaths – a quarter of all deaths – and 56,000 hospital admissions related to smoking every year, according to the body.

Dr John McAteer, senior research fellow at the University of Edinburgh said: “One of the aims of the 2013 tobacco control strategy was to reduce second-hand smoke exposure among children by 2020.

“The most recent Scottish Health Survey shows that second-hand smoke exposure fell from 11% to 6% between 2014 and 2015. This equates to 50,000 children having been protected from the harms of daily second-hand smoke exposure at home.

“Scotland has some of the most progressive tobacco control policies in the world, and Scottish smoking rates have fallen from 31% in 2003 to 21% in 2015.”

Report claims tobacco laws could change post Brexit

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

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

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

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

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

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

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

WHO report gives India high marks for fighting tobacco use

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comprehensive Tobacco Bill Drafted

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

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

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

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

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

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

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

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

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

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

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

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

Raise tax on tobacco and make smokers pay for health costs

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

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

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

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

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

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

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

Joseph Ting, associate professor, School of Public Health and

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

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

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

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

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

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

The facts about this global public health scourge are undisputable:

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

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

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

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

Some additional findings are noteworthy:

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

What the World Bank Group is doing

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From a 2014 internal Philip Morris document

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

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

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

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

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

Excerpts from the Philip Morris Files

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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