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April, 2017:

How tobacco firms flout UK law on plain packaging

Brands use competitive price labels to avoid restrictions on marketing

https://www.theguardian.com/society/2017/apr/09/tobacco-companies-flout-law-plain-packaging

An insider in the tobacco industry has revealed some of the unscrupulous tactics it is using to avoid new restrictions governing the marketing of cigarettes that come into force next month.

One strategy – sticking competitive pricing labels on packets, a move designed to attract cost-conscious poorer smokers who make up the majority of the market – is already in breach of the regulations, according to legal advice obtained by Action on Smoking and Health (Ash).

The whistleblower, until recently employed by Imperial Tobacco, one of the UK’s largest companies, told the Observer that all four of the industry’s main players were employing a range of branding initiatives involving pack design to differentiate their products before the new regulations come into force on 20 May. From this date, cigarettes must be sold in dark green packs of 20 that carry health warnings covering at least 65% of the box.

Plain packaging was first introduced in May last year. “Any branded stock you see out there now will have been produced before 20 May last year,” said the whistleblower who used the pseudonym, Martin Sempah. “So the cigarette companies have been on a massive stock building exercise to make sure they have their branded packs in the market for as long as possible, to leverage the brand benefit.” But, under the new regulations, any packs manufactured after 20 May last year must be devoid of eye-catching price labels, something that severely limits the tobacco companies’ ability to market them aggressively.

“Price with cigarettes is massive,” Sempah said. “It’s what drives growth in market share. You get your price mark wrong and you can lose market share and millions. The issue for Imperial was that from 20 May 2016 until 20 May 2017 they’d have branded packs out there but no way of controlling the price on them.”

The solution was to employ a separate agency to add promotional price stickers to the packets’ cellophane wrappers, a practice known in the trade as “stickering”, that, according to Sempah, involved “millions and millions” of packs and which the tobacco firms insist is not in breach of the regulations because it is not part of the manufacturing process.

Imperial employed an agency called Clipper to add the stickers, Sempah said. Ash has written to the other three major tobacco companies –JTI, BAT and PMI – saying it is aware that they have been employing a similar strategy.

The health organisation has received a legal opinion from Peter Oliver, a barrister at Monckton Chambers, that suggests the strategy breaches the regulations which state that cigarette packets must be wrapped in cellophane that is “clear and transparent” and must not be “coloured or marked”.

“Once again, the tobacco companies seem to be stretching the law to snapping point,” said Deborah Arnott, chief executive of Ash. “They have already wasted thousands of legal hours and millions of pounds in fees trying to get the standardised packaging rules scrapped and failed miserably. Now it seems they are trying to get round the rules, by adding stickers to cigarette packs after the 20 May 2016 and claiming that this is not part of the production process. But, as our legal opinion confirms, such claims are false and the behaviour unlawful. We would like to see appropriate enforcement action taken against any tobacco manufacturer engaged in this practice without delay.”

Stickering is only one weapon in the industry’s arsenal, Sempah suggested. “When the regulations came out they started to look for loopholes. They said: how can we use particular varnishes and finishes on our plain packs to make them more tactile in a person’s hands, to make them more attractive? Do we use a different type of foil? If you look at a pack of Marlboro Gold it has got a trademark type of foil – it’s resealable. There are methods they are using to get round the regulations to increase the brand equity in their packs.”

Another strategy is to use key words to signify different “strengths” of cigarette – something that is banned. The word “real” is being used to suggest “full flavour” while “bright” denotes cigarettes that were once labelled ‘light’.

Two, separately wrapped, packs of 10 cigarettes inserted inside a 20-size pack have been developed to appeal to smokers who prefer smaller packs.“They’re going to be investing a lot more in festivals and nightclubs,” Sempah said. “You can’t say ‘sponsored by’ but you can create a fantastic experience which kind of looks like a cigarette brand.

“For example, last year Golden Virginia did stuff at the Latitude festival. They had a bar and a smoking area – all green furniture and green T-shirts for staff. It was a slightly different green from Golden Virginia and it was called Roll and Rock rather than Golden Virginia but at the bar you could only buy Golden Virginia.”

In their written responses to Ash all four tobacco companies and Clipper insisted that they complied with all the regulations. Sempah said most in the tobacco industry doubted the marketing strategies would have much of an impact in the long run. “Nobody really expects this to work, but there’s so many big salaries tied up in marketing in the tobacco companies they have to try to make it work.”

Smoking causes one in ten deaths globally, major new study reveals

Efforts to control tobacco have paid off, says study, but warns tobacco epidemic is far from over, with 6.4m deaths attributed to smoking in 2015 alone

https://www.theguardian.com/society/2017/apr/05/smoking-causes-one-in-ten-deaths-globally-major-new-study-reveals

One in 10 deaths around the world is caused by smoking, according to a major new study that shows the tobacco epidemic is far from over and that the threat to lives is spreading across the globe.

There were nearly one billion smokers in 2015, in spite of tobacco control policies having been adopted by many countries. That number is expected to rise as the world’s population expands. One in every four men is a smoker and one in 20 women. Their lives are likely to be cut short – smoking is the second biggest risk factor for early death and disability after high blood pressure.

The researchers found there were 6.4m deaths attributed to smoking in 2015, of which half were in just four populous countries – China, India, USA, and Russia.

Major efforts to control tobacco have paid off, according to the study published by the Lancet medical journal. A World Health Organisation treaty in 2005 ratified by 180 countries recommends measures including smoking bans in public places, high taxes in cigarettes and curbs on advertising and marketing.

Between 1990 and 2015, smoking prevalence dropped from 35% to 25% among men and 8% to 5% among women. High income countries and Latin America – especially Brazil which brought in tough curbs on tobacco – achieved the biggest drops in numbers of smokers.

But many countries have made marginal progress since the treaty was agreed, say the authors of the study from the Institute of Health Metrics and Evaluation at the University of Washington in the US. And although far more men smoke than women, there have been bigger reductions in the proportions of men smoking also, with minimal changes among women.

Senior author Dr Emmanuela Gakidou said there were 933m daily smokers in 2015, which she called “a very shocking number”. The paper focused only on those who smoke every day. “The toll of tobacco is likely to be much larger if we include occasional smokers and former smokers and people who use other tobacco products like smokeless tobacco. This is on the low end of how important tobacco is,” she told the Guardian.

There is much more that needs to be done, she said. “There is a widespread notion that the war on tobacco has been won but I think our evidence shows that we need renewed and sustained efforts because the toll of smoking in 2015 is much larger than most people would think, so we absolutely have a lot more to do. We need new and improved strategies to do it and a lot of effort and political will.”

Traditionally there have been far fewer women smoking around the world than men, but it was a huge problem for both, she said.

“There are some really worrisome findings – for example in Russia female smoking has increased in the last 25 years significantly. There are also some western European countries where about one in three women are smoking. So it is true globally that a lot fewer women smoke than men but there are some countries where it is a big problem for women,” she said.

Dr Kelly Henning of Bloomberg Philanthropies, which is committed to tobacco control and co-funded the study with the Bill and Melinda Gates Foundation, said: “I think the study highlights the fact that the work is not finished on tobacco. The good news is the decline in daily smoking among men and women … however there are still many smokers in the world and there is still a lot of work to do. I think we have to keep our eye on the issue and really do more.”

Countries with some of the highest death tolls such as China and Indonesia “really don’t need those health problems – they have so many other issues they are trying to address. But tobacco control is critically important in those places,” she said.

“China has more than a million deaths a year from smoking related diseases and China is only beginning to see the effects of their high male smoking rate. That is only one instance of what is expected to become an extremely major epidemic,” she said.

Writing in a linked comment, Professor John Britton from the University of Nottingham said: “Responsibility for this global health disaster lies mainly with the transnational tobacco companies, which clearly hold the value of human life in very different regard to most of the rest of humanity.” British American Tobacco, for instance, sold 665bn cigarettes in 2015 and made a £5.2bn profit.

“Today, the smoking epidemic is being exported from the rich world to low-income and middle-income countries, slipping under the radar while apparently more immediate priorities occupy and absorb scarce available human and financial resources,” he writes. “The epidemic of tobacco deaths will progress inexorably throughout the world until and unless tobacco control is recognised as an immediate priority for development, investment, and research.”

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015

http://thelancet.com/journals/lancet/article/PIIS0140-6736(17)30819-X/fulltext?elsca1=tlpr

Summary

Background

The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed.

Methods

We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI).

Findings

Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2–25·7) for men and 5·4% (5·1–5·7) for women, representing 28·4% (25·8–31·1) and 34·4% (29·4–38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7–7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015.

Interpretation

The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking’s global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.

Funding

Bill & Melinda Gates Foundation and Bloomberg Philanthropies.

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015

Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015

http://thelancet.com/journals/lancet/article/PIIS0140-6736(17)30819-X/abstract

Summary

Background

The scale-up of tobacco control, especially after the adoption of the Framework Convention for Tobacco Control, is a major public health success story. Nonetheless, smoking remains a leading risk for early death and disability worldwide, and therefore continues to require sustained political commitment. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) offers a robust platform through which global, regional, and national progress toward achieving smoking-related targets can be assessed.

Methods

We synthesised 2818 data sources with spatiotemporal Gaussian process regression and produced estimates of daily smoking prevalence by sex, age group, and year for 195 countries and territories from 1990 to 2015. We analysed 38 risk-outcome pairs to generate estimates of smoking-attributable mortality and disease burden, as measured by disability-adjusted life-years (DALYs). We then performed a cohort analysis of smoking prevalence by birth-year cohort to better understand temporal age patterns in smoking. We also did a decomposition analysis, in which we parsed out changes in all-cause smoking-attributable DALYs due to changes in population growth, population ageing, smoking prevalence, and risk-deleted DALY rates. Finally, we explored results by level of development using the Socio-demographic Index (SDI).

Findings

Worldwide, the age-standardised prevalence of daily smoking was 25·0% (95% uncertainty interval [UI] 24·2–25·7) for men and 5·4% (5·1–5·7) for women, representing 28·4% (25·8–31·1) and 34·4% (29·4–38·6) reductions, respectively, since 1990. A greater percentage of countries and territories achieved significant annualised rates of decline in smoking prevalence from 1990 to 2005 than in between 2005 and 2015; however, only four countries had significant annualised increases in smoking prevalence between 2005 and 2015 (Congo [Brazzaville] and Azerbaijan for men and Kuwait and Timor-Leste for women). In 2015, 11·5% of global deaths (6·4 million [95% UI 5·7–7·0 million]) were attributable to smoking worldwide, of which 52·2% took place in four countries (China, India, the USA, and Russia). Smoking was ranked among the five leading risk factors by DALYs in 109 countries and territories in 2015, rising from 88 geographies in 1990. In terms of birth cohorts, male smoking prevalence followed similar age patterns across levels of SDI, whereas much more heterogeneity was found in age patterns for female smokers by level of development. While smoking prevalence and risk-deleted DALY rates mostly decreased by sex and SDI quintile, population growth, population ageing, or a combination of both, drove rises in overall smoking-attributable DALYs in low-SDI to middle-SDI geographies between 2005 and 2015.

Interpretation

The pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, and sex, and as highlighted by more recent trends, maintaining past rates of decline should not be taken for granted, especially in women and in low-SDI to middle-SDI countries. Beyond the effect of the tobacco industry and societal mores, a crucial challenge facing tobacco control initiatives is that demographic forces are poised to heighten smoking’s global toll, unless progress in preventing initiation and promoting cessation can be substantially accelerated. Greater success in tobacco control is possible but requires effective, comprehensive, and adequately implemented and enforced policies, which might in turn require global and national levels of political commitment beyond what has been achieved during the past 25 years.

Funding

Bill & Melinda Gates Foundation and Bloomberg Philanthropies.

Government releases new pictorial warnings for tobacco products

Replacing the existing images, the Health Ministry has released a new set of pictorial warnings for mandatory display on packets of cigarettes, bidis, and chewing tobacco with effect from April 1 this year. Under the new rules, manufacturers will now need to display graphic pictures of throat cancer on cigarette and bidi packets and pictures of mouth cancer on chewing tobacco packets.

http://www.newindianexpress.com/nation/2017/apr/04/government-releases-new-pictorial-warnings-for-tobacco-products-1589510.html

According to the public notice on the Health Ministry’s website, the government notified the new health warnings on October 15, 2014 and issued a notification dated September 24, 2015 for mandatory display of new health warnings covering 85 per cent of the principal display area on all tobacco products from April 1, 2016.

“As per Rules, during the rotation period of 24 months, two images of specified health warnings as notified in the Schedule, shall be displayed on all tobacco product packages and each of the images shall appear consecutively on the package with an interregnum period of 12 months.

“Further as per notification dated March 24, 2017, all tobacco products manufactured on or after April 1, 2017 shall display the second image of specified health warning,” the notice said. It further said any person engaged directly or indirectly in production, supply, import or distribution of cigarettes or any other tobacco products shall ensure that all tobacco product packages have these specified health warnings.

“Violation of the provisions is a punishable offence with imprisonment or fine as prescribed under section 20 of the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act 2003,” it said.

India is third among countries with the largest pictorial warnings on tobacco products, according to a recent report. The Health Ministry has implemented, from April 2016, large pictorial health warnings occupying 85 per cent of the principal display area of tobacco packs and on all forms of tobacco.

NHMRC CEO Statement: Electronic Cigarettes (E-Cigarettes)

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Justice Ministry says iQOS product will be treated as ordinary tobacco

Previously, the company asked the US Food and Drug Administration to recognize iQOS as “modified-risk product.”

http://www.jpost.com/Business-and-Innovation/Health-and-Science/Justice-Ministry-says-iQOS-product-will-be-treated-as-ordinary-tobacco-485912

The world’s largest tobacco company, Philip Morris International, faced an obstacle in Israel that has apparently influenced its position toward its heated-tobacco product iQOS.

Previously, the company asked the US Food and Drug Administration to recognize iQOS as “modified-risk product.”

Last week, Israel’s Justice Ministry notified the company that it accepted the position of three voluntary organizations in Israel that the product is actually a “tobacco product,” and all the restrictions that apply to tobacco products should apply to iQOS.

In parallel, Philip Morris reversed its previous position towards the FDA and now wants iQOS to first be recognized as a “tobacco product.”

The small Society for Progressive Democracy thus “made history,” as the new position will set the definition of the product for deliberations by the FDA.

The Israel Medical Association, the Israel Cancer Association and the small Society for Progressive Democracy thus “made history,” as the new position will set the definition of the product for deliberations by the FDA.

While the Israel Cancer Association and the Israel Medical Association sent letters to the authorities to protest against Health Minister Ya’acov Litzman for preventing restrictions on the sale and marketing of iQOS in Israel, the Society for Progressive Democracy headed by lawyer Shabi Gatenio actually applied to the High Court of Justice and asked for an Injunction againt him.

“It is a story of the little David toppling Goliath, Philip Morris,” commented lawyer Amos Hausner, the chairman of the Israel Council for the Prevention of Smoking.

The limitations that now apply to all tobacco products will include iQOS, such as prohibiting its sale to minors, prohibiting smoking it in all public places where conventional cigarettes may not be smoked, excluding it from advertising in the electronic media and media for children and teens, and other restrictions for which violators are fined.

Under the rules of administrative law, the position of Justice Ministry professionals is binding upon all governmental agencies in Israel, and their position supersedes the one expressed by any political figure – in this case, the health minister.

Attorney-General Avichai Mandelblit has yet to decide on a petition by Avir Naki, a voluntary organization that aims to fight smoking, to prohibit Litzman from having any involvement in decisions on tobacco matters.

Dubek, the Israel tobacco producer and importer, has also filed an application in the High Court against Litzman, arguing that he was giving Philip Morris benefits that Dubek did not enjoy.

Hausner said that Philip Morris “officially changed its position here while its application was pending in the FDA, as a negative consequence in Israel might have negatively influenced the company’s position in its deliberations with the US over iQOS. We clearly learn from this case that politicians cannot determine policy on major public health issues like this; they must leave it to ministry professionals to set policy.

It turned out that Litzman was more protective of Philip Morris than the company itself demanded. As to Philip Morris, Hausner said that their products should meet the requirements of professionals and not only of the politicians.”

Commenting on the Justice Ministry decision, Philip Morris Ltd.’s spokesman in Israel said that it would “continue to market iQOS in Israel in a responsible way according to law so that adult smokers would have better alternatives than continuing to smoke cigarettes.”

The ministry said in a statement after the court decision was announced that “while waiting for the FDA’s position, we plan at this stage to place on the product all restrictions on tobacco products regarding marketing, advertising and smoking in public places.”

Estimating the distributional impact of increasing taxes on tobacco products: In Armenia

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Tobacco Taxation in the European Union: An Overview

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Tobacco Taxation in Turkey: An Overview of Policy Measures and Results

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