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All articles written by David Simpson unless otherwise attributed. Ideas and items for News Analysis should be sent to: David.Simpson{at}ctsu.ox.ac.uk

Jamaica: more tobacco, Despite FCTC

Going against trends in most of the rest of the world, especially among countries committed to implementing to the WHO's Framework Convention on Tobacco Control (FCTC), Jamaica is increasing tobacco production. It is not just that the department of agriculture has decided to stimulate tobacco leaf growing, but recent events suggest a larger and more sinister trend. The most striking illustration of how little the Jamaican government seems to understand the tobacco problem and what the FCTC is all about is a notorious collaboration with Carreras Limited, local subsidiary of British American Tobacco (BAT), on a youth education programme.

When the government announced the proposed increase in leaf production, the Jamaica Coalition for Tobacco Control put out a press release pointing out that the move was in breach of the spirit of the FCTC, which Jamaica signed in 2003 and ratified in 2005. The press release included an open letter to Jamaica's prime minister, addressing the government's apparent disregard for the FCTC. Apart from the tobacco growing announcement and the education ministry's collaboration with BAT on the youth education programme, Jamaica has still not initiated any significant implementation of the treaty. In addition, the coalition cited other examples of disturbing pro-tobacco signals coming from the government, such as the acceptance of direct financial support from BAT for repairing police vehicles.

The coalition, based at the country's heart foundation, is part of the Caribbean tobacco control project, a four-country project (with Barbados, Guyana and Trinidad and Tobago) funded by the Bloomberg Global Initiative. It is an example of how competent non-government organisations are now at work in many areas where in the past, the industry often went unchallenged. And a challenge is obviously how BAT saw the coalition's press release and letter. Within two days, its local corporate and regulatory affairs manager had written an article for the country's leading daily newspaper, the Jamaica Gleaner, published below the supremely inappropriate and misleading headline, ‘Clearing the air on tobacco control.’

In addition to BAT's predictable line on the expansion of tobacco production and the FCTC, the article reminded readers—as the company no doubt regularly reminds the government—of the company's “almost 50-year involvement and support” for empowering people through education, civic and community life, arts, culture and the environment, and its “continued willingness to sit down with the government to discuss how the company can continue aligning its corporate social investments to areas of national priority.”

Following the publication of this large dose of classic tobacco-speak, the health coalition replied with what it diplomatically called a ‘clarification’ of key issues in the tobacco man's article. In the meantime, however, the coalition's open letter to the prime minister had been picked up by the US-based Corporate Accountability International (formerly known as Infact), one of whose major projects is tobacco control. It placed the letter on its website, asking supporters to sign a petition against increasing tobacco production, and to write to the Jamaican prime minister. More than 3000 people did just that, creating a volume of international pressure that evidently was neither unnoticed nor welcomed by the Jamaican administration.

Health advocates everywhere know that tobacco companies want to prevent the implementation of the FCTC, or if that proves impossible, to at least delay it for as long as possible, convincing evaluation, if it were needed, of the treaty's potential. Has receipt of tobacco money, such as the police vehicle repair funds, been a significant factor in delaying action in some of the Caribbean countries? In a region with co-operation in many areas of government, why has legislation on smoking in public places been passed in Trinidad and Tobago, and Barbados, but not elsewhere? And why have none of the countries yet implemented the effective, comprehensive legislation covering all major aspects of tobacco control that the FCTC requires?

Netherlands: plan to cut all health education

The minority coalition government that came into power in the Netherlands in October 2010 has announced that it is to cut all health education campaigns in the country, including tobacco control programmes, as well as to weaken existing tobacco control policies. The first act of the new minister of health was to partially reverse smoke-free legislation, to allow smoking in bars of less than 70 m2 in area, and with no employees, instead of being subject to the total public places smoking ban passed in July 2008 (see Netherlands: going backwards. Tob Control 2011;20:7).

The coalition agreement of September 2010 included large budget cuts for all ministries in response to the global economic recession. The agreement explicitly states that budget cuts to the Ministry of Health will include a 50 million Euro (US$72 million) budget cut in the area of health education. In January 2011, the health minister stated that she intended to stop all mass media health education campaigns, reasoning that people were themselves responsible for their lifestyle and, thus, it was unnecessary to influence people through persuasive campaigns or invasive regulations.

The minister's reasoning ignores the well-documented contributions of mass media to tobacco control, but could only be considered even partly sound if Dutch smokers are indeed well-informed about the harms of smoking and of secondhand smoke. However, recent findings from the International Tobacco Control (ITC) policy evaluation project show that the level of knowledge among Dutch smokers is seriously at odds with the minister's assumption. Only 61 per cent of Dutch smokers believe that cigarette smoke is dangerous to non-smokers, by far the lowest score among the 12 ITC countries with which comparisons could be made (eg, compared with 96 per cent of smokers in France). Furthermore, only 20 per cent of Dutch smokers reported that they often thought about the harm of smoking to themselves and only nine per cent often thought about the harm to others, lower than any of the 11 other ITC countries. In comparison, 36 per cent of Chinese smokers often think about the harm of smoking to others.

These findings were published in an ITC project report, which was offered to the health minister and the Dutch press in March (http://www.itcproject.org). The findings clearly demonstrate that the Dutch government should increase, rather than discontinue, funding for tobacco education campaigns to increase awareness of the health effects of smoking. In the coming months the new Dutch prevention policy is being finalised. This includes a meagre section on tobacco policy, with no proposals for new regulations, and no money for counter-advertising campaigns. Instead, the policy is restricted to youth education, very much in line with tobacco industry preferences, and once again ‘Big Tobacco’ will have free reign in the Netherlands.

GERA E NAGELHOUT

Maastricht University, Netherlands

gera.nagelhout{at}maastrichtuniversity.nl

GEOFFREY T FONG

ITC Project, University of Waterloo, Canada

Figure1

Netherlands: a recent health education poster about smoking. Now the government is to axe all spending on health education, on all areas of heath, as part of its economic budget cuts.

USA: Tobacco ‘not hard to quit’, pm boss tells nurse

While tobacco is addictive, admitted the chief executive of Philip Morris International Inc at the company's annual shareholder meeting in New York in May, it is not that hard to quit. Louis Camilleri was responding to a question from Elisabeth Gundersen, a cancer nurse from San Francisco and member of the campaigning nurses' group, The Nightingales, who have often challenged Big Tobacco at corporate events. Ms Gundersen reminded the meeting, which was celebrating the company's annual revenue topping US$27 billion, that tobacco use killed more than 400 000 Americans and five million people worldwide each year. She also spoke about a patient who had told her the previous week that of all the addictions he had beaten, including crack, cocaine and methamphetamine, cigarettes had been the most difficult.

Camilleri's reply veered between complaint and confession. He complained that the company did not receive enough recognition for the efforts it made “to ensure that there is effective worldwide regulation of a product that is harmful and that is addictive,” while his mention of addictiveness reflected the relatively recent public admission of addiction by tobacco companies. Matthew Myers, president of the Campaign for Tobacco-Free Kids, said Camilleri's comments on quitting represented the “most irresponsible form of corporate double-speak.”

Despite Camilleri's upbeat response, he and his top executives were forced to spend much of the meeting defending their company against protests by health advocates and corporate accountability campaigners, who together accounted for around a sixth of the 250 or so at the gathering. Meanwhile, Corporate Accountability International released an ‘alternative’ annual report on PMI's activities. The report sets out the human cost of making the company's profits and the tactics it uses to ensure they keep rising. These range from litigation, particularly pegged on international trade agreements, to ‘corporate social responsibility’ initiatives and strategic partnerships to buy political influence and defeat tobacco control policies; and from the use of front groups to the targeting of women and young people through deceptive promotional activities. The report is available from: http://www.stopcorporateabuse.org/.

Japan: PM & JTI exploit disaster

The devastating earthquake and the tsunami that followed it in March may have caused the most appalling toll of human loss and suffering, but for at least one transnational tobacco company, they presented an opportunity to increase local sales. Philip Morris International (PMI) stepped in rapidly when supply and distribution disruptions forced Japan Tobacco Inc to suspend cigarette shipments in Japan. PM was well placed to fill the gap, as all the cigarettes it sells in Japan are made outside the country and consignments arriving at Japanese ports were being unloaded normally. In a recent interview, PMI's chief financial officer Hermann Waldemer was asked whether he saw the events in Japan as a potential to grow and sustain PM's market share in the country. Acknowledging that “the country in trouble” would lead to different behaviour among smokers, and that retention levels probably would be lower than they would be in another country, he said, “Some of them, of course, we will be able to retain, I would think.” No doubt PMI's sales people in Japan were already working on it.

In addition, national news media reported that along with sleeping bags urgently needed by people forced to take up residence in emergency shelters, a famous Japanese mountain climber Ken Noguchi had also distributed cigarettes. Noguchi is associated with Japan Tobacco International, taking part in some of its ‘corporate social responsibility’ programmes. Health advocates feel that the problem of passive smoking inside the shelters likely to be suffered by those living there amounts to corporate social irresponsibility.

UK/World: imperial's low-tax cigarette device

British health advocates have reacted angrily to Imperial Tobacco's latest move in the UK to sell cigarettes in a ‘make your own’ kit, claiming the move is specifically designed to help smokers pay less tax, which will therefore lead to their smoking more. While Imperial is the market leader in the UK, it is also set on growth in Eastern Europe, Africa, the Middle East, Asia and the USA.

At the beginning of April, 10 days after parliament had been presented with the government's economic budget, including the latest tobacco tax increases, Imperial launched a novel cigarette-making kit that cuts the price of a pack of 20 JPS Silver cigarettes by over a fifth. The smoker pays a one-time cost of £3.09 (US$5.07) for the cigarette making machine and then separately buys 100 empty tube cigarettes and hand-rolling tobacco. A quantity of tobacco and the tube are then placed in the machine, which makes a cigarette. The tobacco industry believes the market for the device could be worth £2 billion (US$3.3 billion) per year.

Imperial defended the move, saying it was designed to stop its customers buying illegal cigarettes or hand-rolling tobacco, and would ensure that smokers continued to buy in the legitimate market. But many retailers remain sceptical of the move because the product does not actually compete with products sold on the black market.

Health experts argue that the Imperial's move is a ploy by the company to avoid tax and that the government should stop the tobacco industry from launching the new products. The UK tax and customs authorities, however, said that the new kits were simply another extension of hand-rolling tobacco and therefore would be taxed as tobacco, not as cigarettes, so were not a tax avoidance method.

Tobacco tax experts, however, point out that the tobacco industry tried a similar tax avoidance route in Germany before the European Commission put a stop to it. A ruling by the European Court of Justice in November 2005 forced tobacco companies to stop selling long, ‘single’ cigarettes, pre-rolled cartridges of tobacco which were then cut and made into cigarettes, as hand-rolling tobacco in Germany. At the time, Imperial was selling an estimated seven billion ‘single’ cigarettes, or a third of this sector of the German market.

Documents from the tobacco archives show that Philip Morris (PM) devised ‘Make Your Own’ cigarettes as an anti-tax device. In 1993 and 1994 PM ran a programme called ROYCE, based on the acronym for ‘roll-your-own’ cigarette. Confidential PM documents stated that the objective of Project Royce was to develop a ‘make-your-own’ cigarette product in anticipation of a 75 US cents per pack federal tax increase. Imperial's latest move looks like a very similar move.

NEW Zealand: smoke-free by 2025?

In November last year, a far-reaching report was published by the Māori Affairs Parliamentary Cross-party Select Committee (MASC) at the end of a prolonged enquiry into the tobacco industry and the consequences of tobacco use for Māori, the country's indigenous people. The report covers tobacco policy proposals thought to be unique for such a report in a developed country, in particular, the annual reduction (by a set percentage) of imported tobacco, the quantity of tobacco products sold at each outlet, and the number of retail outlets. Other recommendations are for reducing additive and nicotine levels; setting a goal of halving smoking prevalence by 2015 across all demographics; and a longer-term goal of making New Zealand a smoke-free nation by 2025.

Many of the recommendations are supported by the public and, largely, by smokers, both Māori and non-Māori. Half of the public surveyed agreed with the statement, “Cigarettes and tobacco should not be sold in New Zealand in 10 years' time”, with only 30 per cent disagreeing.

The MASC report resulted from the efforts of many groups and individuals, with more than 260 submissions being received, and 96 groups and individuals making oral submissions. The evidence included a smoker's heart in a plastic bag, tabled by the transplant recipient himself.

Following release of the report, the health minister responsible for tobacco control, Tariana Turia of the Māori Party, announced plans to legislate on several of the recommendations, including a point-of-sale display ban. However, it is less certain whether there is adequate political will for responding to the bolder recommendations of the report. The government has agreed to set specific mid-term targets and adopt an ‘aspirational’ goal of making New Zealand essentially a smoke-free nation by 2025, but no commitments have been made for annual above-inflation tax rises, or plain pack legislation, which neighbouring Australia is currently pursuing.

GEORGE THOMSON, NICK WILSON

University of Otago Wellington, New Zealand

george.thomson{at}otago.ac.nz

Germany: most bars still allow smoking

A new study has shown that more than four out of five bars in Germany use legal loopholes or simply break the law to allow customers to smoke in their premises, almost three years after a public places smoking ban was imposed. DKFZ, the German cancer research centre, sent a team to almost 3000 pubs, bars and restaurants in 10 cities including Berlin, Munich and Dusseldorf to undertake the study. Smoking has been banned in bars and restaurants since July 2008, but there are widespread exceptions that allow it in separate rooms and in pubs smaller than a specified size. DKFZ described the results as alarming and demonstrated the urgent need for Germany to have a simple, comprehensive and exception-free law, like bans already implemented successfully in many other European Union countries.

UK: rats to sniff out illict cigs

There is talk of training rats to help sniff out illicit cigarettes hidden in the smaller retail outlets where smuggled and forged cigarettes are usually sold. Compared to the more commonly encountered, canine variety of sniffer quadrupeds, rats are apparently less costly to train. They also work harder than dogs, which require such niceties as rest breaks. Moreover, according to a company which trains and supplies sniffer rats, the animals do not, unlike dogs, tend to bond with their handlers, which come as a relief to trading standards officials to whom the company hopes to supply them. An almost dreamy article in a recent edition of a retail trade journal positively extolled the virtue of the specialist rodents. However, to humans trained to sniff out tobacco industry propaganda aimed at trying to sustain the idea that high taxes have caused ‘the scourge of illicit tobacco’, the story has more than a whiff of tobacco industry public relations.

Canada: running through the smoke

As 31 May, World No Tobacco Day (WNTD) approached this year, few tobacco control advocates would prove themselves willing to go as far as Errol Povah did last year to mark the day. On 31 May 2010 he left the comforts of Victoria, British Columbia, the provincial capital and a small jewel of a city on Canada's West coast, to embark upon a journey that would take him well over 6000 kilometres to Montreal and then South across the USA border to New York City. Povah covered this great distance on foot, alternately running and walking a full marathon of 26.2 miles (42.2 kilometres) most days on his ‘Journey for a Tobacco-Free World.’

A retired ferry pilot, Povah, 57, has long been a tobacco control volunteer, and currently serves as President of Airspace Action on Smoking and Health. He frequently appears at events dressed as the Grim Reaper, a striking reminder of the tobacco industry's true face. Lacking sponsorship, much of Povah's trip across Canada was a demanding solo traverse of a vast country, second largest in the world after Russia, with Povah covering several miles eastwards, then doubling back to his van before moving forward a set distance and advancing the run from that point. Quixotic or not, he persisted and was rewarded with a spirited demonstration at the Montreal head office of Imperial Tobacco Canada, a wholly-owned subsidiary of British American Tobacco, where he denounced the industry as it continued “to mock public health by developing new products ever more attractive for young people.”

Povah, who ended his travels with a homecoming run this past January, knew from the start that his efforts could never garner the kind of attention given to the Terry Fox Run, still an important element of cancer cause fundraising in Canada, but his persistence paid off in the completion of a high-minded mission and an increase in tobacco control awareness. More information on his journey is available on his website, http://www.tobaccofreeworld.ca.

STAN SHATENSTEIN

Figure2

UK: a ‘Make Your Own’ machine sold by Imperial Tobacco, together with a box of 100 empty paper tubes with filters and a pack of tobacco, part of a starter kit for the new product.

China: David Frost promotes dunhill

Figure3

Canada: Errol Povah on the run he began on World No Tobacco Day last year, from the west of Canada to New York, to draw attention to the tobacco epidemic.

Thailand: Asian award for Bungon Ritthiphakdee

Bungon Ritthiphakdee, director of the Southeast Asia Tobacco Control Alliance (SEATCA), was one of only three people in Asia to be chosen for Honourable Mention by the editors of the Asian editions of Reader's Digest in the Asian of the Year 2010 awards. Bungon has worked full time in tobacco control for more than 20 years. Her early days in this area of public health were with Action on Smoking and Health Foundation Thailand, playing a pivotal role in her country's bold resistance to the onslaught of the international tobacco industry trying to force four Asian countries, including Thailand, to open up their tobacco markets. Her steady presence, knowledge and skills encouraged numerous organisations to participate and support tobacco control activities, helping to make Thailand an acknowledged leader in the region. As she widened her field of activities with SEATCA, her experience and leadership have become an invaluable resource for the region and for the world, recognised by a received an award from the WHO in 2001 and the Luther Terry Award from the American Cancer Society in 2006.

Figure4

China: visitors to Beijing, the Chinese capital, earlier this year were greeted by this large billboard at the international airport, featuring British-born television interviewer Sir David Frost on a promotion for Dunhill, one of British American Tobacco's ‘Global Drive’ cigarette brands.

Figure5

Bungon Ritthiphakdee

Dietrich Hoffmann

Dietrich Hoffmann, who has died aged 86 in Larchmont, New York state, USA, was one of the first scientists in the public health community to develop a detailed understanding of the biochemistry of smoking and disease. He was born and brought up in Germany, gaining his doctorate in 1957, when he moved to the USA to join the late Dr Ernst L Wynder in New York, collaborating with him for the next 32 years on environmental cancer research.

Among his achievements was pioneering work on the importance of nitrosamines from tobacco smoke in cancer causation. He published more than 500 scientific papers as primary investigator, co-author or editor, and was an advisor and expert to various US Surgeon Generals' advisory committees on tobacco, and to other committees studying tobacco in both the USA and Canada, as well as to the US National Cancer Institute, the International Agency for Research on Cancer (IARC), and the WHO. Dr Nigel Gray, the veteran tobacco control leader who was for many years director of the Anti-Cancer Council of Victoria, Australia, said the ‘Hoffmann list’ (of substances in tobacco smoke that should be tested) assured Hoffmann's place in history.

DIETRICH K HOFFMANN

10 December 1924–20 April 2011

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