Article Text

PDF

Worldwide news and comment

Statistics from Altmetric.com

The theme for World No Tobacco Day 2014 (WNTD), held on 31 May, was ‘Raise taxes on tobacco’, a measure considered to be the most cost effective for tobacco control. In 2010, the World Health Report indicated that a 50% increase in tobacco excise taxes would generate a little more than US$1.4 billion in additional funds for 22 low-income countries. If these funds were hypothecated to health, government health spending in these countries could increase by up to 50%.

Evidence from around the world indicates best practice is for the final consumer price of tobacco to consist of at least 70% tax. The 2013 WHO report on the global tobacco epidemic showed that in the Africa region, only two countries—Madagascar and Mauritius—met this benchmark for the most widely sold brand of cigarettes. In the majority of other African countries, tax made up less than 50%. Other regions had a higher number of countries with taxation above 70%, but taxation levels lagged in low and middle income countries in all regions, even while rising incomes have increased the relative affordability of cigarettes.

In this issue, we highlight two countries where legislation to increase taxes have recently been passed, Ukraine and Chile, as well as the latest country to ratify the WHO Framework Convention on Tobacco Control (FCTC). Other reports from World No Tobacco Day will be posted on our website at

All articles written by Marita Hefler unless otherwise attributed. Ideas and items for News Analysis should be sent to: marita.hefler@menzies.edu.au

http://blogs.bmj.com/tc/.

World No Tobacco Day 2014 infographics by the Southeast Asia Tobacco Control Alliance (SEATCA). Source: http://seatca.org/?p=3914.

World No Tobacco Day 2014 infographics by the Southeast Asia Tobacco Control Alliance (SEATCA). Source: http://seatca.org/?p=3914.

Ukraine: 25% tax increase from July 2014

Even amidst its current political turmoil, Ukraine will be among the countries showing the way on tobacco taxes following WNTD 2014, with a 25% excise duty increase to come into effect on 1 July 2014. The draft law was signed by the acting president in late March.

The decision followed a public campaign led by tobacco control activists and advocates for a higher increase than 8%, which was initially planned by the Cabinet. The Smoke Free Ukraine Coalition advocated an increase of 30%, supported by analysis with alternative calculations and budget income projections by Life Regional Advocacy Centre. The campaign was also supported by the All Ukrainian Patients Union.

Tobacco control advocates have warned that the tobacco industry may try to warehouse stocks to avoid the increase, risking a tax loss of US$30 million, according to Smoke Free Ukraine Project Coordinator Andriy Skipalskiy, and have urged the government to enact legislative measures to avoid this occurring.

Chile: tax increased in reform measures

The Finance Committee of Chile's lower house of congress voted in favour of a 10% tax increase on tobacco in April. It was approved as part of a range of tax reforms by the lower house on May 15, and is expected to pass the upper house.

Although the country has among the highest tobacco taxation rates in the Americas region (and the world), the increase will be an important measure, given Chile's high smoking prevalence. Around 33% of 13–17-year-olds in Chile smoke, and tobacco consumption is estimated to be responsible for 16 000 deaths annually.

While the increase was welcomed by Tobacco-Free Chile (Chile Libre de Tabaco, CLT), there was some concern that the rise may be small enough to be absorbed by the tobacco industry, and therefore not be sufficient to reduce consumption. CLT cited a recent study by economist Guillermo Paraje who estimated that a 20% rise in the retail price of cigarettes would lead to a reduction in smoking initiation of between 3.9% and 6.6% per year. He also noted that government revenue is less than the health damage and cost to the public health budget caused by smoking.

El Salvador: latest country to ratify FCTC

El Salvador ratified the FCTC in April, bringing the total number of countries in the Americas which have ratified it to 30 out of 35. The ratification was signed by President Mauricio Funes in February, and approved by the legislative assembly on 9 April. Adult smoking prevalence is relatively low in El Salvador, at 11.7%. However 14.6% of youths consume tobacco, indicating the need for the full range of MPOWER measures to be implemented urgently to reduce prevalence early, and avoid the escalation in smoking-related morbidity and mortality seen elsewhere.

Europe: FCTC article 5.3 complaint

Corporate Europe Observatory (CEO), a not-for-profit research and campaign group which works to expose and challenge corporate influence and lobby groups in European Union (EU) policy making, lodged a complaint with the European Commission (EC) on 7 May. The complaint alleges that the EC has failed to properly implement Article 5.3 of the WHO FCTC to protect policy making from tobacco industry influence. It follows open letters sent by CEO to the Commission President Barroso on 17 January 2013, and to European Commissioner Maros Sefcovic on 11 December 2013, in addition to questions on numerous other occasions.

The complaint points to controversy around alleged tobacco industry attempts to influence the EU's Tobacco Products Directive, the opaque scandal surrounding the resignation of Commissioner John Dalli in 2012 (reportedly due to undisclosed meetings with tobacco lobbyists), and the reappointment of Michele Petite (a lawyer whose former clients included Philip Morris International) to the Ad Hoc Ethical Committee, which provides advice on conflicts of interest and other ethical issues. Mr Petite's appointment was investigated by the European Ombudsman, sparked by a February 2013 complaint by Lobby Control, Corporate Accountability International and CEO (detailed in the May 2013 issue of Tobacco Control, available at http://tobaccocontrol.bmj.com/content/22/3/180.full).

Included in the complaint are documented examples of at least 14 undisclosed meetings between EC officials and tobacco industry representatives, obtained through freedom of information requests, which include meetings with President Barroso's cabinet, the Secretariat-General and other commission departments. The complaint notes that DG SANCO (Directorate General of Health and Consumer Affairs) does partially implement Article 5.3 guidelines by listing and publishing minutes of meetings with the tobacco industry online. However, it is the only Directorate General to do so, despite clear evidence that others, including the office of the Secretary General, have been involved in decision making on the Tobacco Products Directive.

The complaint outlines a response from Secretary General Catherine Day to a previous letter from CEO (co authored by several other organisations), stating that the Commission has in place an ethical framework that is ‘fully compatible’ with the guidelines of Article 5.3. However, the complaint notes that undisclosed meetings violate Article 5.3 guidelines and numerous other specific recommendations are not followed. It also rebuts a claim by Ms Day that releasing documents under Freedom of Information regulations is sufficient to fulfil Article 5.3 obligations, stating “this reactive and restrictive approach is neither sufficient nor compatible with the FCTC Article 5.3 guidelines”, noting it places the burden on the public to investigate undue claims of influence.

Among the list of measures recommended to bring the Commission into line with Article 5.3, CEO recommends effective measures to limit interactions with the tobacco industry and ensure transparency when these occur, implementing a code of conduct on relations, and ensuring registration and disclosure of tobacco industry lobbyists.

Full details and text of the complaint can be accessed at http://corporateeurope.org/power-lobbies/2014/05/ceo-submits-ombudsman-complaint-about-eu-commissions-failure-implement-un.

Poland: ‘Truth’ style counter tobacco industry campaign

Poland has launched its first counter campaign to the tobacco industry. ‘Sfajerowani’ comes from two Polish words: ‘fajki’ means cigarettes and ‘sfrajerować’ means deception. The campaign was designed and started with the help of a grant from the Polish ministry of health.

The campaign is intended to fill the gap in Poland where no counter tobacco industry activities previously existed. It is modelled on the broad experience and proven effectiveness of The Truth Campaign in the USA, and used tools from the National Social Marketing Centre in the UK.

A team of teenagers were established to design the most effective messages and ways to target youth. Based on online strategies featuring a website and social media channels, youth were encouraged to create pictorial memes and upload them to the website http://www.sfajerowani.pl. Hundreds of memes were uploaded, each of which have been further spread through Facebook and other portals.

Ironically, the Sfajerowani campaign launch coincided with the Poland's biggest fight as an ally of the tobacco industry against the recently published EU Tobacco Product Directive. Although Poland is the second biggest tobacco leaf producer in Europe and a strong supporter of the industry, the Sfajerowani campaign shows that anti-tobacco industry messages can reach audiences even in pro-tobacco regions. As in the case of this campaign, sometimes they are even funded by the same government that works alongside the tobacco industry.

Łukasz Balwicki Małgorzata Balwicka-Szczyrba

Medical University of Gdansk, Poland

balwicki{at}gumed.edu.pl

A screenshot of some of the memes uploaded to the counter tobacco industry campaign website http://www.sfajerowani.pl.

Czech Republic: Presidents, Philip Morris…and Catering

Philip Morris International (PMI) is the largest tobacco manufacturer in the Czech Republic. It monopolises about half of the cigarette market, and employs close to 1500 people. The company also enjoys support at the highest levels. In 2009 a new part of the PMI factory in Kutna Hora was opened by president Vaclav Klaus. Continuing the tradition of high level political support, on 16 October 2013 his successor, Milos Zeman, visited the factory. Mr Zeman is a heavy smoker of 40 cigarettes per day. In his speech he asserted that because he started to smoke at the age of 27 when his body was fully developed, smoking could not cause any damage and it was safe. He recommended to Czechs the same practice, based on the entirely false belief that adult smoking is not harmful. During his visit a distinctly non-traditional refreshment was served alongside meat, bread and cheese: Philip Morris cigarette brands Sparta and L&M.

Eva Kralikova

Charles University & General University Hospital in Prague, Czech Republic

EVA.KRALIKOVA{at}LF1.CUNI.CZ

Refreshment served to Czech president Milos Zeman, during his visit to the Philip Morris factory in Kutna Hora in late 2013. Photo: František Vlček/MAFRA/Profimed.

World: poor sales blamed for factory closures

April 2014 saw a spate of factory closures announced by Philip Morris International (PMI) and Imperial Tobacco in Britain, France, the Netherlands and Australia.

The most significant among these is Philip Morris’ Bergen op Zoom factory in the Netherlands, the largest PMI production facility worldwide in terms of capacity. The closure will eliminate 1230 jobs, 90% of the total workforce at the facility. PMI cited a decline in sales of 20% in 4 years as a reason, and also singled out the new EU tobacco-control law which will ban flavoured cigarettes and mandate bigger warning labels on packets (presumably expecting that the law will achieve exactly what it aims to do!)

In mid April, Imperial Tobacco announced that it was shutting its Nottingham plant in England, which will mark the end of cigarette production in Britain, and the loss of 540 jobs. Within the UK, this closure will leave only one factory, owned by Japan Tobacco International in Northern Ireland.

Imperial also will close the largest Gauloises-producing factory in Nantes, France, with 320 job losses. It blamed the France and Britain closures on declining sales in Europe, which it attributed to tough economic conditions, increasing regulation, duty increases and growing black market trade. It plans to shift production to Germany and Poland.

Meanwhile in Australia, tobacco manufacturing has effectively become extinct, with Philip Morris International closing its Melbourne factory and planning to move to Korea. While Australia's strong tobacco and comprehensive tobacco control measures would be the obvious reason for declining sales, and generic packaging likely to continue to decrease uptake among young people, PMI blamed the reduced fire risk requirements that were introduced in 2010. As veteran Australian tobacco control warrior Simon Chapman noted on Twitter “Gee, so sorry we tried to stop cig fires and deaths”!

These closures are a welcome indication of the progress in tobacco control in each of the countries concerned. However, the move to more tobacco industry-friendly locations highlights the need for ongoing surveillance, and the urgency for improved tobacco control legislation and enforcement in the new host countries.

Germany: international vaporfair

On 26 and 27 April 2014 the first international exhibition specialising in e-liquids, e-cigarettes, e-shishas and related products, VaporFair, took place in Frankfurt, Germany. The fair was organised for manufacturers and distributors to promote their products. Although primarily aimed at traders, it was also open to the public above 18 years. Several new innovations, such as variable voltage or blue tooth e-cigarettes, shisha-to-go, e-pipes, traditional hookahs with electronic heating element or inbuilt e-cigarette, and even cannabis e-cigarettes were on display. An entire portion of the exhibition was dedicated to liquids, with one manufacturer claiming ‘220 billion variations’.

A large number of flavours, with or without nicotine, were offered for trial ‘vaping’ (inhalation of aerosol) at several stalls. Vaping was promoted as a harmless lifestyle activity and this was conveyed by using descriptions such as ‘no nicotine, no tobacco’, ‘no tar, no odour’ as well as ‘natural’ or ‘pharmaceutical quality’. Claims such as ‘Made in Europe’, ‘certified quality’ or ‘developed with doctors’ were used to create an impression of high quality and healthy products.

Several manufacturers have recognised some mandatory regulatory guidelines which will come into force with the new EU Tobacco Products Directive. Accordingly, their products have child-proof caps, and packages carry more or less visible warnings such as “not suitable for pregnant, nursing or people sensitive to content”, “toxic in contact with skin”, “toxic if swallowed”, “nicotine fluid is addictive and harms health”, “keep out of reach of children”, “do not sell to minors (<18)”, “not for non-smokers”. However, it appeared that manufacturers do not solely address adult smokers, but also young people. The wide range of fruit and candy flavours and product packaging are likely to be highly attractive to children and adolescents. Some of the flyers and glossy pamphlets with photos of sophisticated and glamorous young people are reminiscent of cigarette advertising and are likely to be appealing to young people, particularly young women.

A novel vending machine for e-cigarettes and liquids with an in-built age-verification system was prominently displayed. Such machines will make e-cigarettes available round the clock. This easy availability and accessibility, in combination with the high attractiveness of the products to young people, is a matter of great concern, given the already reported global increase in the use of e-cigarettes and e-shishas among adolescents. Initiation with appealing flavours can easily progress to include nicotine.

VaporFair highlighted the urgent need for effective regulation to prohibit marketing and sales to minors of all electronic inhalation products such as e-cigarettes and e-shisha, regardless of nicotine content.

Katrin Schaller

German Cancer Research Center (DKFZ)

k.schaller{at}dfkz.de

Examples of products and promotional pamphlets with high youth appeal as seen at VaporFair, Germany.

Examples of products and promotional pamphlets with high youth appeal as seen at VaporFair, Germany.

Malaysia: empowering dentists into smoking cessation

In December 2013 at the Malaysian Dental Deans’ Council meeting, smoking cessation became part of the Minimum Competency Exit list for undergraduate dental curricula nationally under the discipline of Preventive Dentistry. For the first time, this commits all dental schools in Malaysia to have a minimum level of tobacco control training.

This milestone can be traced to 2009, when the nascent Nicotine Addiction Research and Collaborating Centre at the University Malaya Centre of Addiction Sciences (UMCAS), undertook a survey of the involvement of dentists in tobacco control in Malaysia. A key finding of the research was the almost complete absence of tobacco cessation education in dental undergraduate curricula. Only one university, University Kebangsaan Malaysia, had a tobacco cessation counselling programme in their undergraduate programme, established in 2006. This study also found that given enough training and support, the dentists who participated were committed and confident to provide tobacco cessation service.

In late 2010, another positive step forward was the inclusion of tobacco cessation as a key performance indicator in the National Oral Health Plan 2010–2020 (NOHP). Little else happened until 2012, when the UMCAS research findings were presented at a national symposium that included dentists in the scientific programme. Later that year, UMCAS invited academics in medical and dental schools across the nation to work together to develop a standard tobacco control curriculum for undergraduate health professionals. Since then, three dental schools have incorporated tobacco cessation in their curriculum.

In 2013, a major national tobacco awareness campaign organised by a dental specialist group, the Malaysian Association for Dental Public Health Specialists (MADPHS), included the launch of a tobacco control quarterly newsletter for health personnel, initiated by UMCAS, that reserved a segment specifically for dentists. The campaign was launched by Malaysia's Deputy Minister of Health, giving the profession the impetus to move forward.

MADPHS and UMCAS are continuing to work together to promote tobacco control education at both undergraduate and postgraduate dental curricula. In March 2014, they led a workshop at the First Biennial Dental Public Health Conference, with an unexpectedly high turnout. The same leadership is urgently needed amongst other health professional groups—in particular medicine—and might just be the ‘tipping point’ needed to push Malaysia into fast forward on tobacco control.

Amer Siddiq Amer Nordin Rahimah Abdul Kadir

University Malaya Centre of Addiction Sciences, Malaysia

amersiddiq{at}um.edu.my

Christopher Bullen

National Institute for Health Innovations, New Zealand

New Zealand: duty free tobacco limits cut

Tobacco duty free limits in New Zealand will be reduced from November 2014, from 200 cigarettes to 50 cigarettes or 50 g of tobacco products, in line with a similar measure introduced in Australia in 2012. The new limit was announced in the May budget, which also included abolishing a duty free gift allowance that had previously been allowed on tobacco products sent from abroad, and plans to reduce the price differential between retail and duty free tobacco over the next 2 years.

View Abstract

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.