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INDIA: SURROGATES AND SPOOFS

All articles written by David Simpson unless otherwise attributed. Ideas and items for News Analysis should be sent to: d.simpson@iath.org

Barely a week after the World Conference on Tobacco OR Health had closed in Mumbai, India, the city was awash in the glamour of the Wills Lifestyle Fashion Week, a five-day media extravaganza and a feast for fashion photographers. News reports were carried around the world, including in newspapers for which the tobacco conference did not appear to have happened, decorated by photographs of exotic models wearing equally exotic designer creations. Yet Wills has been one of India's best known cigarette brands for as long as most people can remember. Comprehensive tobacco control legislation is in place, so how can such diametrically opposed uses of the brand name be permitted?

Indians' awareness of Wills cigarettes dates from the days of British colonial rule, when in 1910 the UK-based British American Tobacco (BAT) set up an Indian subsidiary, Imperial Tobacco Company (the original long form name of modern ITC). Through ITC, BAT made and promoted cigarettes including Wills, Gold Leaf and John Player, though ironically, the rights to make these British brands in BAT's own home country were later sold off to a UK rival. In recent decades, ITC has become progressively more diversified and Indian-owned, though as recently as last year, BAT still earned a tidy £117 million from its minority stake in the company.

Meanwhile, part of ITC's diversification had been carried out under a title that was bound to raise suspicion among health advocates. In 2000, it had entered what it termed the “lifestyle retailing” business, with Wills Sport (casual clothes), later expanded to include Wills Classic formal wear (2002) and Wills Clublife evening wear (2003), with John Players menswear along the way, in 2002. In 2006, it launched Wills Lifestyle India Fashion Week, with Miss Players young women's fashion clothes being added a year later. Giving a presence on the street, a chain of Wills Lifestyle stores were set up to sell the new ranges of clothes.

To the fashion-wear ranges were added, among other goods, Essenza Di Wills cosmetics and grooming products and Fiama Di Wills and Vivel De Wills soaps and bath products. A cynic might suspect that all these fragrant goods were specially selected for being at the very opposite end of the spectrum of olfactory experience from the products that made Wills a household name over the past century.

How and why did all this happen? One motivating factor cited by commentators at the time was a law passed in 1994 prohibiting direct or indirect advertising of tobacco or alcohol on commercial broadcasting and cable networks. In ensuing years, as some interpreters wondered whether it was the end of cigarette brand extension and surrogate advertising, the government issued a raft of what were billed as “fine-tuning” clarifications. Even the wisest of lawyers or philosophers might have been hard pressed to understand, but in effect, the authorities seemed to be saying that the new rules did not to apply to “genuine products”, but only to those that were new or had hardly been established.

In 2004, ITC specifically acknowledged the problems of using the Wills name in both tobacco and non-tobacco products when it announced that it was dissociating the Wills brand name from its cigarettes. This was, it said, so that Wills Lifestyle products could be promoted without being accused of surrogate advertising. Dissociating? Well, not entirely. As the boss of ITC's tobacco division put it, the Wills brand name would become “inconspicuous” and the product sold and promoted as Navy Cut.

Certainly, the Wills name is now separate from and smaller than the rest of the name on a pack of Navy Cut cigarettes. However, it is hardly a shrinking violet among the names and logos on the pack. Its prominence in embossed gold is enhanced by the familiar WD & HO Wills coat of arms above it, which in turn is oddly reminiscent of the WLS—for Wills Lifestyle—that appears in association with some of the new non-tobacco products.

To health advocates, it looks as though ITC may have things both ways. Many are not impressed with the purported inconspicuousness of the Wills name, arguing that even if it never appeared at all on cigarette packs, it is so well known from decades of promotion as a cigarette that its use should not be permitted on any other products.

To draw attention to this, cancer surgeon Dr Pankaj Chaturvedi, who daily sees the ravages caused by often terminal diseases caused by tobacco, created a spoof logo for a notional event remarkably reminiscent of Wills Fashion Week. Dr Chaturvedi's work will already be familiar to readers of this journal (see Tobacco Control 2009;18:9 and 17:297). It may now be quite familiar to ITC's people, too, since between operating on some of tobacco's hundreds of thousands of victims in India each year, his artistic talents have focused on lampooning some of ITC's own, less lifesaving operations. For example, his thoughts on Wills Lifestyle make fun of the brand name's proximity to the last will and testament that many tobacco users have to make as they anticipate their premature demise.

This sort of creative health promotion had an unforeseen benefit due to the accuracy of the internet search engine Google. It seems that if Indian web surfers entered Wills Fashion Week Logo into Google, they got Dr Chaturvedi's spoof rather than the official logo. Similarly, a remarkable number of searches for other tobacco-related word sequences also led Indians to some of his other creations (http://chaturvedi.pankaj.googlepages.com/tobaccokills). Perhaps health advocates in other countries will be in for similar, pleasant surprises. In India, anyway, it seems that in some ways, the pen can be mightier than the scalpel.

India: the Wills Lifestyle Fashion Week logo (above) and Dr Chaturvedi's spoof logo (left).

India: concept for an advertisement involving wills, as seen by cancer surgeon Dr Chaturvedi.

NORWAY: $2 BILLION SALE OF TOBACCO STOCK

The Norwegian Government announced on 3 April that it is to divest its funds from all companies which take more than five percent of their profits from tobacco production. Its pension fund, Global, reputedly the second largest in the world, has until recently held an estimated US$ 2.1 billion in the tobacco industry. A debate over divestment of tobacco holdings from the pension fund has been going on in Norway since 2004, when ethical guidelines were introduced for the fund. Tobacco control activists from a number of national non-governmental organisations had rallied politicians since the guidelines were introduced, arguing that the investments were neither morally viable nor economically sensible. Among the tools used by health advocates as they lobbied their elected representatives was an impressive-looking book solemnly entitled, The Tobacco Industry Code of Ethics: Moral Guidelines for a New Millennium. Those politicians who had never thought much about the topic were the only ones likely to have got a surprise when they opened it. Every single page was blank (see front cover).

Norway was an early leader in comprehensive tobacco control legislation, including a total ban on tobacco promotion since the mid-1970s, one of the components most bitterly fought against by tobacco companies. It therefore set an important precedent for other European countries. Now, once again, it plans to take the lead to become the first country in the world to implement the recently released guidelines for the World Health Organization's Framework Convention on Tobacco Control (WHO FCTC). These advise governments to divest all holdings in tobacco companies in order to keep public health interests free from adverse economic influence.

Norway has long demonstrated above-average concern for the welfare of low income countries, with a disproportionately large and effective contribution to development projects. Similarly, health organisations hope the government's new move will have a knock-on effect in low-and middle-income countries. The Secretary General of the Norwegian Cancer Society, Ms Anne Lise Ryel, said, “The tobacco industry is exploiting vulnerable populations in developing countries to fill their own pockets. Norway has taken clear action to show that it wants no part in this practice.” The WHO's Director-General who presided over the concept and negotiations for the FCTC was Dr Gro Harlem Brundtland, a public health doctor by profession—and formerly the prime minister of Norway.

HONG KONG, CHINA: TAX RISE AT LAST

As readers of this journal will know, the apparent lack of need for extra tax revenue has been among the most unusual aspects of the special administrative region of Hong Kong, China for many years (see Hong Kong, China: smoking ban boosts business. Tobacco Control 2009;18:6–9). Thus the driver for many countries' regular reviews of tobacco tax has been missing, compounding what appears to be lessening political concern about the ill heath caused to Hong Kong citizens by tobacco and the apparently relatively greater concern given to representations from tobacco interests. Hong Kong used to be a shining beacon of tobacco control leadership for the region, all the more powerful due to its success as a free trade haven, but nowadays this light shines far less brightly.

In fact, among public health professionals, the government's failure to raise tobacco tax for more than eight years, with a consequent cheapening of smoking in real terms, vied for top place as a cause of frustration with its dithering on whether to go all the way on public places clean air legislation. As the annual budget announcements approached, health organisations went into overdrive. A series of programmes on leading broadcasting stations presented a tough health position in support of a rise. In a high visibility campaign, Hong Kong Council on Smoking and Health (COSH), together with hundreds of medical and nursing students and students of Chinese traditional medicine, marched to the Treasury to present a petition demanding a tobacco tax rise, something that many finance ministers would give a lot to receive.

Tobacco interests had long been busy lobbying against any change in the consumption-friendly status quo and less than a month before the announcement, an apparently well informed insider reckoned the rise would not happen. However, it seems as though the increasing volume of the health campaign was heard in the corridors of power, especially as the Finance Secretary, making the announcement of a rise at last, said it was for health reasons. Although the rise he announced, 50 per cent, may sound a lot, and despite the wide range of personal disposable income in Hong Kong, it still leaves cigarette prices comparatively low in Hong Kong, as the tax rate before the rise accounted for such a small proportion of the retail price. The end result is that the companies have only raised the retail price of an average pack by around 5.7 per cent, which still leaves it little over half the price of a pack in some of the higher-taxing countries of Europe.

Time will tell whether this heralds a new chapter in Hong Kong's roller coaster of tobacco control. Many are sceptical, especially after the Finance Secretary said, incredibly, that he hoped not to receive increased revenue from the rise. While this could mean he hoped for reduced tobacco use and something near the notional diminishing returns that have never been reached even with much higher tax and prices in similar economies, some think it indicated a lingering resentment among senior government personnel about giving in to public health demands. After all, they point out, the government has removed all tax from beer and wine and shows no sign of reversing this extraordinary situation, even in a period of economic downturn. One thing that is clear, however, is that a well organised, well informed public health lobby does seem to be able to persuade even an unwilling government to take pro-health action.

SRI LANKA: INDUSTRY PROMOTION

Sri Lanka enacted comprehensive tobacco control legislation in December 2006 under the requirements of the World Health Organization's Framework Convention on Tobacco Control. In parallel, it set up a new monitoring and enforcement agency, the National Tobacco and Alcohol Authority (NATA), though health advocates say this is still in its infancy. The new law bans sales to minors and smoking in enclosed public areas. In addition, it imposes a comprehensive ban on tobacco advertising and promotion, including sponsorship.

According to health advocates, the prohibition of smoking in enclosed public areas is not very successful so far, as smokers find various loopholes to exploit. In response, the government has been saying that it will extend the law to all public areas. As for promotion, in a country where it has long been widespread, and despite British American Tobacco having a near monopoly, it was inconceivable that efforts to increase sales would suddenly stop.

In recent months, retailers have reported significant encouragement to increase their tobacco sales, including lavish parties and offers to refurbish their shops and sales booths. One retailer in a remote area felt so oppressed by such overtures, including offers of commercially attractive discounts and stocks on loan, that he decided to take exactly the opposite action to that intended by the tobacco marketing people: he completely stopped selling cigarettes. Instead, he posted a simple notice to his customers above the entrance to his shop. Painted in the Sinhala language, it says, “For the sake of you and your children I have stopped selling cigarettes here.”

Sri Lanka: industry pressure to sell more cigarettes pushed this shopkeeper to stop selling tobacco altogether. The sign above him explains to customers that his decision is for the sake of his customers and their children.

UKRAINE: LARGE TAX RISE

On 31 March, the Ukrainian Parliament voted in favour of a law that will impose a four-fold increase in tobacco tax. The new law mandates an excise of 40-45 per cent of the retail price, starting on 1 May. This is a four-fold increase from previous levels and will bring Ukrainian tobacco taxes closer to European standards, as well as higher than in neighbouring Russia. It is estimated that the increase will bring in additional annual revenue for the government equivalent to around one billion US dollars.

BANGLADESH: HUMAN CHAIN AGAINST CULTIVATION

On 21 March, a human chain was organised to demand an end to tobacco cultivation in environmentally sensitive areas in Bangladesh such as the country's hill tracts. The demand was made by the Bangladesh Anti-Tobacco Alliance and Pratyasha, an organisation working against drugs, that tobacco cultivation be stopped in environmentally sensitive areas, that trees no longer be cut down to cure tobacco, and that non native trees no longer be planted in sensitive areas. They also demanded that farmers be assisted in growing alternative crops, particularly food for local consumption. The human chain was held in front of the National Museum in the capital, Dhaka.

BRAZIL: SMOKE-FREE

São Paulo’s parliament passed a total ban on smoking indoors, including bars, restaurants and hotels on 8 April. There are no exceptions permitted and the law was passed in the face of massive opposition from the hospitality industry and some newspapers. Health advocates see the victory as all the more significant in view of São Paulo state's role model status and size—it has 40 million inhabitants. The historic move was led by the state governor, José Serra, a former health minister, supported by ACTBR, a broad coalition of organisations working with the state government.

WORLD CONFERENCE: NOTES FROM THE FIELD

Presentations on a data stick? Check. Back-up copies on the laptop and a CD? Check. Hard copy too, just in case all technology fails? Check. These are always my final thoughts before setting off to attend a conference. I also get this familiar feeling of nervousness combined with excitement—what if no one comes to my presentation; will I finally get to meet that mystery man from Globalink; which speaker will be outrageous enough to make the audience audibly gasp; and most importantly, will the food be any good?

I’ve only been to one other world conference, the one held three years ago in Washington DC, so it was hard not to compare the two. In Washington, I remember feeling totally overwhelmed at the vast number of concurrent sessions and the ocean of participants assembled at the opening plenary. The feeling was much more intimate at the India conference—and this is not to say it was somehow lacking in participants or content. Quite the opposite. There were enough people—more than 2000 from 108 countries—to make you feel that something really important was happening, but not so many that you were a faceless follower among the tobacco control masses.

No one likes reading fawning and dull conference reports, so in an effort to present pithy and I hope interesting field notes, here are some of the things that left an impression on me.

People like seeing the “Who’s Who” names of tobacco control engaged in a sizzling debate. Harm reduction, second-hand smoke and breast cancer, smoking in the movies—these were just a few of the topics where temperatures ran high and the experts clearly didn’t agree. Let’s have more of this at future conferences; it is far more engaging than back-slapping and hand-holding.

The FCTC was a strong background presence throughout the conference. Cynthia Callard of Physicians for a Smoke-Free Canada said that plain (generic) packaging and the adoption of an international convention on tobacco control were both resolutions from the 1994 world conference held in Paris, France and had been proposed in several countries before that. Fifteen years later, who would have known that getting the FCTC ratified by more than 160 nations would be achieved before getting plain packaging adopted in even a single country?

From the large number of presentations on tobacco marketing and sales, it was all too clear that the tobacco industry still has innumerable avenues through which to market and sell their products to pretty much whoever they like, wherever they like, and whenever they like. This both depresses and inspires me to keep working in the field.

MPOWER is a big brand with big money. My only previous knowledge of this acronym had been through the WHO tobacco epidemic report (the one that came with the packet of coloured pens). While on the one hand I wholeheartedly welcome this critical source of funding for fundamental projects, my inner socialist is left squirming at the feeling that tobacco control NGOs are being forced to adopt a corporate-style identity.

Diversity and new voices were most evident at the concurrent and poster sessions. I challenge the organisers of the 15th World conference, to be held in Singapore, to extend this mix to the plenary sessions.

Mumbai is a city of contradictions: abject poverty alongside serious wealth; gorgeous sunsets thanks in part to the heavy pollution; high tech wizardry amongst the oxen carts. And peaceful and historic Elephanta island versus the glitz and glamour of Bollywood.

Finally, as I’m sure was true of many other speakers, it was with great relief I found that people did attend my presentations. The best conference gift ever was an 8 gigabyte data memory stick—something practical that I will actually use! And I met the Globalink mystery man, there was plenty of audience gasping during the Luther Terry Award speeches (someone buy Glantz a new watch, please), and the food really was quite tasty.

BECKY FREEMAN

University of Sydney, Australia

bfreeman@health.usyd.edu.au

India: the Gateway to India, the most famous landmark in Mumbai, venue of the World Conference on Tobacco OR Health.

BMJ JOURNALS AWARD

Dr Judith Mackay, who has worked on tobacco control since the 1980s, first in Hong Kong, China, where she is based, and later internationally, in the Asia-Pacific region and with the International Union Against Lung Disease, was awarded the British Medical Journal (BMJ) Group Lifetime Achievement Award in April. This year saw the launch of this awards scheme, which the BMJ Group, publishers of Tobacco Control and more than thirty other specialist journals in addition to the BMJ, intends to make an annual event. There are nine other, more specific clinical and professional categories. Apart from honouring Dr Mackay, many will see her choice for the first Lifetime Achievement award as a significant seal of approval for tobacco control in particular and public health in general, both of which tended to lack the degree of status and general approval afforded other specialties in the past.

JUDY WILKENFELD AWARD

The second annual recipient of the Judy Wilkenfeld Award for International Tobacco Control Excellence is Rachel Kitonyo of Kenya. A lawyer by training, Ms Kitonyo left practice in 2005 to establish the Institute for Legislative Affairs (ILA), of which she is Executive Director. The ILA took a leading role in strengthening a stalled tobacco control bill and helped guide its parliamentary approval, giving Kenya one of Africa's strongest tobacco control laws. The award was created to recognise international advocates who have made a major contribution to reducing tobacco use and united and inspired others to do the same, in the spirit exemplified by Judy Wilkenfeld when she led the international efforts of the Campaign for Tobacco Free Kids.

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