Embed Size (px)
Citation preview
NEWS ANALYSIS...............................................................................
Germany: tobaccoindustry still dictatespolicyThe majority of the German public (over60% in independent surveys) who supportcomprehensive smoke-free legislation willhave been disappointed by the recent,farcical turn of events in Germany. Forthe tobacco industry, used to dictatingtobacco control policy in Germany,December was surely business as usual.
Triggered by the success of smoke-freelegislation in other European countriesand recent estimates that over 3300deaths per year can be attributed tosecondhand smoke in Germany, lastSeptember, two groups of parliamentar-ians made independent proposals forcomprehensive national smoke-free leg-islation. Both gained large support inparliament, and the grand coalition gov-ernment established a working group tocraft a comprehensive law. While smok-ing restrictions in schools, public build-ings and hospitals were largely accepted,those in restaurants, pubs and bars werehighly controversial, stimulating a mediacircus and strong opposition from theVerband der Cigarettenindustrie (VdC),the tobacco industry’s trade organisationin Germany.
VdC representatives engaged in a high-profile lobbying campaign, contactingpoliticians directly and appearing onnumerous TV talk shows to promote theusual tobacco industry arguments aboutfreedom and choice. Moreover, accordingto media reports, the tobacco industryinfluenced the working group’s draftlegislation to such an extent that thegrand coalition government (whose fed-eral ministries of health and consumerprotection were both represented on thegroup) was labelled an industry ‘‘pup-pet’’. Not only was the text severelyweakened, with pubs and bars totallyexcluded and restaurants partiallyexempted but, text citing verbatim aVdC position paper reportedly found itsway into the draft.
After heated negotiations, on 1December, the working group presentedplans for national smoke-free legislation.Although the proposed ban would hardlyhave been effective—smoking would stillbe allowed in bars and pubs and inenclosed smoking rooms in restaurants,and enforcement was weak—the fact thatnational tobacco control legislation wasbeing contemplated was itself exceptionalfor Germany, which has long favouredindustry self-regulation.
The surprise was perhaps even greatergiven that one such ineffective voluntaryagreement had only recently beenreached between the government andthe German hotel and restaurant associa-tion (DEHOGA). Furthermore, PhilipMorris, with impeccable timing, had justco-sponsored the annual convention ofthe Christian Democratic Union, thepolitical party of the Chancellor, AngelaMerkel (as it does for most other politicalparties).
Just a few days later, however, govern-ment leaders expressed concern thatnational legislation to protect the publicfrom secondhand smoke was unconstitu-tional. The federal health ministry foughtstrongly for national legislation, arguingthat constitutional law allows the federalgovernment to take measures againstpublic health risks. But the federalministries of justice and internal affairscountered that the law required suchhealth risks to represent an immediatedanger to the public and thus did notcover involuntary smoking. On this sub-ject, the media repeatedly quoted oneprominent opponent of the legislation:Rupert Scholz, university professor oflaw, former minister of defence and amember of parliament.
What was not mentioned, however, wasthe apparent longstanding link betweenScholz and the German tobacco industry.According to internal tobacco documentsreleased through litigations in the USA, inthe early 1990s, Scholz was the vice-chair-man of VERUM, a foundation that fundsresearch (its name is a shortened form of itslong title in German, meaning a foundationfor behaviour and the environment).VERUM was established and financed bythe tobacco industry and Scholz still serveson its board. Moreover, in 2002, theGerman news magazine Stern reported thatScholz received 50 000 Deutsche Marks(US$33 000) in 1994 from the VdC forconsultancy services. It is interesting tospeculate about the extent to which Scholz
used his influence with the federal minis-tries of justice and internal affairs, andwhether he declared any conflict of interestin his dealings with them.
These events demonstrate that thetobacco industry continues to enjoy astaggering amount of influence inGermany. In contrast with other highincome countries, the tobacco industryremains a credible partner and continuesto enjoy close links to German politicians.Furthermore, the failed effort shows arecurring intragovernmental conflictbetween the health ministry and otherfederal ministries when it comes to tobaccocontrol. In Germany, with health seen aslow on the political agenda, the healthministry always loses.
THILO GRUNINGANNA GILMORE
London School of Hygiene & Tropical Medicine,London, UK; [email protected]; anna.
Australia: BritishAmerican Tobacco‘‘addresses’’ youthsmokingBritish American Tobacco Australia (BATA),whose website states with anodyne ironythat it ‘‘is helping to build effective pro-grammes to address youth smoking’’, hasgiven us a further clue about what it mightmean by ‘‘address’’. The company haslaunched a range of twin-compartmentDunhill Distinct ‘‘wallet’’ packs.
Once out of the cellophane, the pack(see figure) folds apart. Separated by athoughtfully perforated edge, it is readyto tear into two iPod-sized packs, onewith 13 cigarettes and another with 7.Public health groups branded them ‘‘kid-die packs’’, designed to appeal to price-sensitive children who can split the costwith their school lunch money and thensplit the pack as they step out of the shop.
Packs in Australia must contain a mini-mum of 20 cigarettes to deter children’spurchasing. It must never have crossedBATA’s mind that their nifty new tear-in-half packs might be a great way to beat theprice barrier and provide two easily con-cealable packs for intrepid young smokers.
But someone in the company mighthave a lot of egg on their visage. Once the
All articles written by David Simpsonunless otherwise attributed. Ideas anditems for News Analysis should be sentto: [email protected]
2
www.tobaccocontrol.com
on February 25, 2021 by guest. P
rotected by copyright.http://tobaccocontrol.bm
j.com/
Tob C
ontrol: first published as on 12 February 2007. D
ownloaded from
twin pack is torn in half, the larger sectionis without the mandatory pictorial warning(such as a fetching picture of a gangrenousfoot) arguably breaching the TradePractices Act. Complaints from healthgroups to Australia’s regulator, theAustralian Competition and ConsumerCommission (ACCC), in November sawthe Federal Court of Australia uphold aninjunction sought by the ACCC that BATAshould stop selling the packs. With thepacks having to be removed from shops,BATA will be back in court in February2007, potentially facing a maximum fine ofover A$1 million, equivalent toUS$789 000, and a criminal record.Should this happen, such a record willnot be lost as an extra descriptor forAustralia’s largest tobacco company.
Although BATA’s website drips withpublic relations saccharine about thecompany’s youth smoking preventionprogrammes, in 2002–3, the value oftobacco sales to the Australian youthmarket was A$124.7 million (US$98.4million), with A$18.7 million (US$77.6million) going to manufacturers such asBAT. The companies keep the lot.
An internal BATA training DVD leakedto me a few years back showed seniorexecutives jawing about how the interna-tional parent company saw its Australianoperation as a global training ground fordeveloping ‘‘a different skill set’’ in howto operate in the ‘‘darkest markets’’ onearth (Australia and Canada being namedas the very darkest), where all tobaccoadvertising is banned. Strategicallylabelled ‘‘limited edition’’, the DunhillDistinct venture looks in every way like alimits-testing exercise to see whether theACCC and the courts would bite. Ifcriminal prosecutions follow, they mayget more than they bargained for.
SIMON [email protected]
Hong Kong, China: badatmosphere for publichealthAfter deliberations lasting no less than6 years, the government of the specialadministrative region of Hong Kongfinally announced new tobacco controlmeasures last October. After such a longwait and in view of Hong Kong’s previousrecord as a public health leader in theregion, there was bound to be disappoint-ment at anything less than a modelpackage. Unfortunately, several strangeclauses found their way into the final law,and as the fifth annual conference of theInternational Society for the Preventionof Tobacco Induced Disease (ISPTID-http://www.hku.hk/ptid/) convened inHong Kong a month later, the newmeasures came in for intense discussionby experts from around the world.
As previously reported in these pages,individuals with tobacco industry linksare to be found embedded in manyimportant institutions in Hong Kong,and it often seems that business interestsdominate even when life and death issuesare debated by local politicians (TobaccoControl 2005;14:151–2; and 2003;12:10–11). Some major loopholes in what couldand should have been an industry-proofpolicy for Hong Kong, and a model for theregion, have done nothing to dispel thisimpression.
First, brand-stretching promotions areto continue, allowing the sort of adver-tisements that greet international visitorsas soon as they arrive at Hong Kongairport. Having fought their way fromHong Kong being an adventure play-ground for young tobacco advertisers inthe 1980s, to a near promotion-free zone,health experts were bitterly disappointedby this omission. They spent yearsexplaining to politicians that tobaccocompanies do not spend vast sums oftheir shareholders’ money advertisingnon-tobacco products with cigarettebrand names unless it benefits cigarettesales. Yet, in this business-dominatedregion, even business-related argumentssuch as this failed to be heard against theconstant black noise of tobacco industrypropaganda.
Second, and probably generating evenmore adverse comment in the media, wasthe exception whereby bars and certainother leisure venues, such as massageestablishments and mah jong parlours,could register to continue allowing smok-ing until 1 July 2009. Apart from seeingthis as a licence to poison hospitalityindustry workers for another 2K years,creating a messy legal quagmire on anow unequal playing field, public health
workers feel certain that the tobaccoindustry will use the exemption periodto lobby for it to be made permanent.Ominously, as if pointing to the door onwhich the industry should push, thegovernment said it will study the feasi-bility of smoking rooms in restaurantsand entertainment venues. It is hardly asif this has not been studied around theworld for years, always with the sameconclusion, provided that the studieswere not funded by tobacco interests.
Interestingly, another related publichealth story dominated local mediathroughout the ISPTID conference:mounting concern about air quality.Thousands of factories across the borderin China belch out toxic fumes, withmuch of the pollution drifting over HongKong. The government has continuallytried to reassure the public, while medicalresearchers publish data showing increas-ing respiratory problems in children andother adverse health consequences.
It remains to be seen how receptive tohealth arguments about air quality theMinister for Environment, Transport andWorks, Sarah Liao Sau-tung, turns out tobe. In 1990, she obtained substantialfunding to study air quality in HongKong; but the funding was from PhilipMorris, via the largely tobacco-fundedCentre for Indoor Air Research. However,even if business interests and argumentsimpress her more than health statistics,there is little hope of an early solution.Observers say that the government’sinaction is not so much a fear of upsettingthe mainland, as the fact that so many of
Australia: BAT’s Dunhill pack split into its twosections.
Hong Kong: how outdoor advertising used tobe—public health workers fear the return ofmassive iconic advertisements now that thegovernment has decided to allow continuedcigarette brand-stretching promotions.
News Analysis 3
www.tobaccocontrol.com
on February 25, 2021 by guest. P
rotected by copyright.http://tobaccocontrol.bm
j.com/
Tob C
ontrol: first published as on 12 February 2007. D
ownloaded from
the culprit factories burning low-gradefuels are owned by Hong Kong busi-nesses.
So perhaps the solution to environ-mental problems lies with other sectorsof the business community. As presscoverage about air pollution continuedto grow, the international financial man-agement and advice company MerrillLynch recommended investors to sellHong Kong property and buySingaporean instead because of HongKong’s poor air quality. Those whothought that this might be treated moreseriously than health arguments wereagain disappointed. It was rubbished bythe government, which stated that lifeexpectancy in Hong Kong was one of theworld’s highest, and claimed it was themost environmentally friendly place forexecutives. There was no mention,though, of the health of the executives’workers, or the workers’ families. Sowhile many fathers in the hospitalityindustry will continue to work insmoke-filled bars, their children willcontinue to breathe heavily polluted air,while being brainwashed into associatingcigarette brand names with the goodthings in life.
USA: alcohol controlmovement follows FCTCleadThe American Public Health Association(APHA), at its November annual meet-ing in Boston, adopted a strong policystatement calling for an internationalalcohol treaty modelled on theFramework Convention on TobaccoControl (FCTC). Founded in 1872, the
APHA is the oldest, largest and mostdiverse organisation of public healthprofessionals in the world.
Drawing heavily on the experience ofthe tobacco control movement, the APHAis urging the World Health Organizationto adopt a Framework Convention onAlcohol Control (FCAC), akin to the FCTCadopted in 2003. APHA believes that anFCAC could help thwart the expansion ofalcohol markets, strengthen national andlocal regulation of alcohol, and helpreduce the harmful consumption of alco-holic beverages.
Dr Georges C Benjamin, executivedirector of APHA, says that the globalburden of disease for alcohol is approach-ing that of tobacco, and the currentinternational climate favours such atreaty. However, the alcohol controlmovement is keenly aware of the chal-lenges confronting the FCTC, the need forstrong enforcement, the continuingattempts of corporate involvement innational and local policy development,and the threats presented by global tradeagreements. By learning from the tobaccomovement, a framework convention onalcohol would help strengthen the handof countries in setting policies that protecthuman health. It may take years of strongadvocacy before an alcohol conventionbecomes a reality, but calls for it by theWorld Medical Association and now theAPHA are important steps.
DON ZEIGLERAmerican Medical Association; donald.
UK: pulling thepolonium adAs news that Russian former secret agentAlexander Litvinenko had been poisonedwith polonium 210 swept round theworld in November, many great mindsin public health thought alike. Why notbuild on publicity about this dangerouselement to tell smokers that polonium210 is one of the many and variouspoisons they inhale with every puff oftheir cigarettes?
As it happened, Cancer Research UK, aspart of a health promotion partnershipwith the British government, had justbeen working on a mass media campaignabout tobacco featuring six chemicalsthat most smokers have heard of, andwould rate as poisons, but may not knowto be present in tobacco smoke. The ideaof the radio and television advertise-ments, and small but high visibilityposters, was to trigger a move towardsgiving up smoking, or at least helpsmokers to the first stage of the cessation
loop. One of the poisons was polonium210, with smokers being informed, forexample, that a study had found thatsomeone smoking one and half packs aday receives the equivalent amount ofradiation as someone having 300 chest xrays a year. The other poisons featured inthe series were arsenic, benzene, cad-mium, formaldehyde and hydrogen cya-nide.
Just as the advertisements were com-ing up for launch, the Department ofHealth decided to pull the one onpolonium, at least temporarily, to sparethe feelings of the murdered man’sfamily. Some health agencies criticisedthe move as a sign of weakness, whileothers supported it by warning that itsimmediate airing would have led topanic-stricken smokers jamming cessa-tion telephone lines, an argument neces-sarily based on conjecture rather than oncomparable experience elsewhere.
Whatever would have been the out-come, all sides seem to think that thepolonium link should and probably willin some form be used later. If so, itremains to be seen whether smokers’residual awareness of polonium 210 wellafter the peak of the Litvinenko story willbe sufficient to result in a greater effect inleading them towards cessation thanpublicity about the other chemicals, andthen only if it is properly evaluated.Whether the delay in airing the poloniumfilm has wasted what could have been a
Hong Kong: a Marlboro clothing advertisementgreets passengers arriving at Hong Kong’s ChekLap Kok international airport.
UK: one of the new advertisements about chemicalsin tobacco, run by Cancer Research UK.
4 News Analysis
www.tobaccocontrol.com
on February 25, 2021 by guest. P
rotected by copyright.http://tobaccocontrol.bm
j.com/
Tob C
ontrol: first published as on 12 February 2007. D
ownloaded from
significantly greater prompting effectwhile the story was hot will never beknown.
Brazil: tin cigarettecases as a marketingstrategyBrazilian legislation limits tobacco mar-keting to the point of sale. Nevertheless,tobacco companies are constantly devis-ing new marketing strategies to maintainand increase market share and sales. Oneof the latest of such strategies by PhilipMorris took place recently after in Brazilin Rio de Janeiro. To stimulate sales of itsPall Mall Blue brand (the one with thehighest machine measured tar content),the company issued a ‘‘Collector’s’’ cigar-ette pack carrier in the form of a metalbox. While a pack of Pall Mall sells forR$2.25 (approximately US$1.05), for anadditional R$2.25, the consumer couldbuy the can. The outside was printed withcar license plates from cities around theworld, together with the words, ‘‘Imagineyourself Pall Mall.’’
The cans carried all the mandatoryhealth warnings. Inside, there was atriple-section folded brochure. The frontpage states, ‘‘Renew Always. This will beyour new habit.’’ In the middle, the titlestated, ‘‘Renew Always. This is PallMPac’s commitment’’, with text explainingthat the new pack was more than just apack, it was ‘‘a new way to reach you’’.The back of the pamphlet asked, ‘‘How do
you want to try the Pall Mall quality? Justchoose’’, with an accompanying photo ofthe three Pall Mall types: Blue, Orangeand Silver.
The tin cans became hard to find in allretail outlets, mostly convenience storesin fuel filling stations, where large num-bers of young people congregate, and atnews stands. The design clearly appealedto a young crowd, and fitted withintobacco companies’ continued attemptsto target young people, especially thosewho want to emulate young adults’ life-style choices.
LETICIA CASADONational Cancer Institute, Ministry of Health, Rio
de Janeiro, Brazil; [email protected]
UK: Scotland the braveAmong the success stories of recent yearsare the total public smoking bans adoptedin Europe. And one of the most gratifyingaspects has been the speed with whichboth the workforce newly protected bythe ban and the general population in thecountries concerned have embraced thebenefits of being able to live and work intotally smoke-free environments.
In Scotland, which went smoke-free atthe end of last March, more than nine outof 10 bar staff said that their workplaceswere healthier in an opinion poll commis-sioned by Cancer Research UK just6 months after the ban, with almost eightout of 10 of believing that the legislationwould benefit their health in the long
term. Even smoking bar workers wereoverwhelmingly positive about the healtheffects of the new law, with 89% report-ing that their work environment washealthier because of it, and 69% believingthat it would benefit their health in thelong term. Interestingly, more youngpeople than older people thought thatthe ban was benefiting their health.
Public health workers in Scotlandbelieve that the success of the Scottishban could lead to further progress inother areas. It was led from the top,following decisions taken by the stillrelatively new, devolved Scottish parlia-ment. The fact that they did it well aheadof England, which follows suit in July,has not been lost on Scottish politicians.Nor has the fact that it was the result ofclear, health-led political leadership. Bycontrast, the English ban resulted fromwhat is now a real political rarity, a freevote allowed to members of parliament,uninfluenced by political party managers,to end a fiasco of indecision, U-turns andeverything except leadership from thecabinet in London. Buoyed up by success,Scottish politicians may now feel bullishabout winning more public health vic-tories ahead of the ‘‘ancient enemy’’south of the border.
USA: smoke-freebehind barsIn many countries, prisons are almost aby-word for smoking. It is embedded inprison systems, part of their subculturesand special vocabularies. In Britain, forexample, tobacco is ‘‘snout’’ and thosewho illicitly trade in it are ‘‘barons’’. Thethought of being able to stub out smokingin prisons has normally been regarded aslittle more than a pipedream.
All credit, then, to the prison autho-rities in California, the largest and mostdiverse US state, which now allows notobacco at all on state property. Noemployee, visitor or inmate is exempted.With 33 prisons and 170 000 prisoners,seven out of 10 of whom are smokers, thisis an extraordinary achievement, espe-cially in light of its description as thecountry’s most overcrowded and gang-ridden prison system. However, the effectof living and working under the ban willeventually have substantial health bene-fits, for the 95% of inmates who willeventually leave prison, and also for the40 000 staff who look after them.
Despite state legislation coveringindoor smoking since 1998, covert smok-ing had continued, and both staff andinmates complained and filed lawsuitsbased on harm from secondhand
Brazil: special Pall Mall ‘‘collector’’ pack tinsproved highly popular with fashion-consciousyoung smokers.
UK: a stubbed-out cigarette in the shape ofScotland celebrates the successful Scottishworkplace-smoking ban.
News Analysis 5
www.tobaccocontrol.com
on February 25, 2021 by guest. P
rotected by copyright.http://tobaccocontrol.bm
j.com/
Tob C
ontrol: first published as on 12 February 2007. D
ownloaded from
smoking. Spurred on by this, and by thehealth, fire and maintenance costs argu-ments that apply to any workplace, newstate regulations were passed in July 2005
with bipartisan support, including that ofCalifornia’s Republican governor.
It cannot be said that inmates had achoice about stopping smoking, nor that
nicotine replacement therapy was there tohelp them—it is contraindicated forprisoners in California—but in a tele-phone evaluation survey covering prisonsin 58 counties, virtually no problems werereported. On the contrary, a number ofrecurring, positive comments wererelayed by prison health staff. Manyprisoners expressed gratitude for theopportunity to stop smoking for good,and some even felt that their success inbeating tobacco might empower them totake other, positive steps in their lives. Akey factor in many success storiesappeared to be the total absence oftobacco: prisoners said that neither seeingnor smelling it, far less handling the stuff,apparently made quitting easier. This issomething most would-be exsmokers inthe general community do not have ontheir side, and it reinforces the oft-repeated advice to temporarily avoid oldhaunts and the company of smokers for awhile after stopping smoking.
As with many such success stories,showing that one tough nut can becracked encourages public health officialsto reach for another. Legislation to makeall California’s state mental hospitalssimilarly tobacco-free is currently beingpursued. (Further information: Stephen LHansen, [email protected])
UK: unusual methodsmake hospital smoke-freeFrom a general hospital in the midlandsof England comes a curious tale of directaction to enforce health service smoke-free regulations. The problem was asinstructive as the solution. National andlocal medical and health organisationshave been pressing for totally smoke-freehealth service premises for more than aquarter of a century. So, with a deadlineof December, 2006 for all National HealthService premises to finally be smoke free,many would say it was long overdue.
Nevertheless, it was often a long, messystruggle to agree to and implement a ban.At the hospital in question, those resist-ing the move invoked the spectre ofpatients, some possibly elderly, lonelyand in the last few months of life, whoseonly comfort and pleasure was smoking.Mostly, the resisters were smoking mem-bers of staff, and the price eventually paidfor their agreement to the ban was theestablishment of a small, former nurses’sitting-room as a smoking area. If it wassupposed to be for the benefit of the mosttobacco-dependent patients, doctors soonnoticed that in reality, it was only everused by a hard core of hospital employees.
Tanzania: selling single cigarettes The marketing of single cigarettes is a well-recognised strategy toincrease sales among poor people and children, who may find it difficult to obtain the sums necessaryto purchase a pack of 20 cigarettes. Yet it is a widely used practice, with Action on Smoking andHealth, UK recently drawing attention to its use by BAT in Kenya. As the figure of an advertisementpictured last August shows, the practice is also being employed in Tanzania. Individual cigarettes(sigara mojo) are being advertised by the Tanzania Cigarette Company, a joint venture between RJReynolds, a subsidiary of Japan Tobacco International, and the Tanzanian government. The price of asingle cigarette is only 40 Tanzanian shillings, equivalent to less than a third of one US cent. [Photo:Martin McKee]
UK: Smoke free bus In July, a total ban on smoking in all workplaces, like the bans already in place inScotland, Ireland and Italy, will come into force throughout England. For the past year, this bus hasbeen travelling all over the Yorkshire and Humber region in the northeast of England, promoting its‘‘Liberate the workplace’’ campaign, and now the upcoming workplace legislation.
6 News Analysis
www.tobaccocontrol.com
on February 25, 2021 by guest. P
rotected by copyright.http://tobaccocontrol.bm
j.com/
Tob C
ontrol: first published as on 12 February 2007. D
ownloaded from
All sorts of strategies were consideredto end the exemption, but the prospect ofre-entering a painfully slow cycle of talkswith staff representatives was just toomuch for one doctor. He simply visited alocal hardware shop and bought a pad-
lock and the necessary steel fittings. Onenight, having brought the necessary toolsfrom home, and checked that no one wasinside, he fitted the hardware to thesmoking room door, clicked the padlockshut and crept away to await develop-
ments. The outcome was both remarkableand unexceptional. It was as if the roomhad never existed: no one said a word.The problem was solved, finally and forgood.
The Lighter Side.................................................................................
E Slowpoke, by Jen Sorensen. www.slowpokecomics.com. Study referenced here is ‘‘Stay away from them until you’re old enough to make adecision’’: tobacco company testimony about youth smoking initiation (Tobacco Control 2006;15(Suppl 4):iv44–iv53.)
News Analysis 7
www.tobaccocontrol.com
on February 25, 2021 by guest. P
rotected by copyright.http://tobaccocontrol.bm
j.com/
Tob C
ontrol: first published as on 12 February 2007. D
ownloaded from
