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Tob Control 26:6-9 doi:10.1136/tobaccocontrol-2016-053573
  • News analysis

Worldwide news and comment

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

INDIA: JAMES BOND ACTOR SHAKEN & STIRRED BY SOCIAL MEDIA PROTESTS

On 7 October 2016, people in India woke up to saturation coverage of Pierce Brosnan (former James Bond actor) promoting Pan Bahar, a pan masala brand. The advertising campaign could be seen everywhere – plastered across the front page of daily national newspapers, on television advertisements, and large roadside hoardings (billboards).

Some of the reaction on Twitter to Pierce Brosnan's endorsement of Pan Bahar

The Irish star had stunned all, but not by the suave 007 charm he projects so well. Indians know pan masala as a cheap and addictive product. Its users spit red-stained saliva, making public walls and roads filthy. Most long-term users end up having dirty red-black stained teeth. Many end up suffering from oral submucous fibrosis, a chronic and painful premalignant condition, in which the patient experiences lockjaw.

Pan masala is often mixed with tobacco by users to make gutka, a smokeless tobacco product banned in India. The popularity of pan masala, a known carcinogen, is reflected in the incidence of mouth cancer in India, which is among the highest in the world. Though Pan Bahar categorises itself as ‘premium class’ pan masala, its inexpensive portion size (with prices as low as US0.07c) tells a different story. Its cheapness and accessibility means it is popular with young people.

The response to the campaign on social media was swift and damning. On Twitter, people shared pictures from newspapers and billboards satirising James Bond. Some wags attributed Brosnan's involvement in the campaign to the ‘Brexit’ effect – suggesting that tough economic times were making him desperate. #PierceBrosnan and #JamesBond became top trends on Twitter. Facebook too was filled with images, jokes and sarcasm shaming Brosnan for what he was endorsing. These were widely shared and retweeted. YouTube was also filled with spoofs and news videos.

While many parodied and criticised Brosnan for choosing to be part of the campaign, others wondered if he was aware of the true nature of the product he was recommending. Professor Pankaj Chaturvedi, a leading Indian head and neck cancer surgeon, wrote an open letter to the actor, questioning whether he was aware he had agreed to promote a product that kills one million Indians every year. The social media flurry attracted widespread television news coverage.

On 20 October, less than two weeks after the launch of the campaign, and 24 hours after Professor Chaturvedi's open letter, Brosnan gave an exclusive statement to People, in which he offered “sincerest and heartfelt apologies”. He said that his contract was to advertise a “breath freshener/tooth whitener,” which wouldn't include an ingredient that turns saliva red. Brosnan said that he agreed to advertise a single product only, and that it was presented as “all-natural containing neither tobacco, supari, nor any other harmful ingredient”. He added, “As a man who has spent decades championing women's healthcare and environmental protection, I was distressed to learn of Pan Bahar's unauthorised and deceptive use of my image to endorse their range of pan masala products”.

The 63 year old actor said in his own personal life, he had endured the loss of his first wife and daughter, as well as numerous friends to cancer, and demanded Pan Bahar remove his image from all its products. Pan Bahar countered that it had not deviated from the contract, stating that its product does not contain tobacco or nicotine and that Brosnan knew the product he was promoting.

In fact, Pan Bahar packets do carry the statutory warning “chewing of pan masala is injurious to health”. In the adverts, Brosnan was holding the product in question, prompting some to question how he could miss the warnings (although as Professor Chaturvedi noted in his open letter, the warnings were inconspicuous and unreadable in the advertisement). Nevertheless, with an angry Brosnan bowing out, the campaign – which Pan Bahar had expected to run for at least two years – is now effectively over.

Social media activists achieved in just 14 days what public health activists could not do in years. It is interesting to note that many of India's Bollywood film celebrities have long endorsed pan masala brands, despite protest from public health experts. Pan Bahar itself was previously endorsed by Saif Ali Khan. Vimal, Pan Vilas, Paan-E-Shahi and Paras have been endorsed by Ajay Devgan, Shahrukh Khan, Govinda, and Arbaaz Khan respectively. Objections have come from the highest levels; the Delhi government itself has written to these celebrities aiming to persuade them to not endorse a pan masala brand. However, rampant endorsement by Bollywood stars continues unabated. Arbaaz Khan earlier said that he will keep his commitment (to the brand) as per his contract. No Bollywood celebrity has moved out of his contract. The difference is that Bollywood celebrities have never been subject to the kind of uproar on social media as happened with Brosnan.

The Pan Bahar campaign was created by DDB Mudra (part of Omnicom/DDB Worldwide Group, a global marketing giant) for Ashok and Co. Pan Bahar Ltd. Shot in Texas, USA by Chakri Toleti (an Indian American filmmaker), it shows Brosnan eliminating enemies with a tin of Pan Bahar and ends claiming “Pan Bahar: class never goes out of style”. This association of two PBs (Pan Bahar & Pierce Brosnan) was clearly intended to make waves. It did, but for all the wrong reasons!

It may never be known if Brosnan was really uninformed or if he merely pleaded ignorance as a way to address the social media backlash. However, a true “Bond” has emerged here, the common man connected and empowered by social media. Interestingly, such a social media campaign is not guided by an individual or by the agenda of any organisation. It doesn't depend on any funding source, is self-propagating and hence sustainable. Are public health activists and social marketing gurus listening?

Gaurav Kumar

MAMTA Health Institute for Mother & Child, India

gauravkumar067{at}yahoo.com

BANGLADESH: CIVIL SOCIETIES DEMAND GOVERNMENT MINISTERS WITHDRAW FROM BAT BOARD

In recent years, the Bangladesh government has implemented several initiatives to discourage the production, marketing and use of tobacco products to protect public health. While it has achieved enviable progress in tobacco control, some notable contradictions remain.

Of considerable concern is the fact that government organisations hold shares in British American Tobacco Bangladesh (BATB). In addition, according to recent media reports, the secretaries of four different ministries (Agriculture, Labour, Employment and Industry) are members of BATB's Board of Directors. It is difficult to imagine a more blatant conflict of interest, and this represents a clear breach of Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC).

The revelations prompted the Bangladesh Anti-Tobacco Alliance (BATA), a civil society organisation, to organise a protest on 23 November 2016 in front of the national press club. The protest was attended by representatives of several health groups, human rights organisations, and universities. BATA and its allies called attention to the government's tobacco control goals to protect public health and the contradictions of policymakers and government profiting from tobacco sales.

It is clear that in order to implement the Bangladesh prime minister's aim of a tobacco free Bangladesh by 2040, it is necessary to remove government officials from BAT's board of directors and end such conflicts of interest. The current situation of government officials being on the board of directors of a company that produces deadly products is both morally and legally untenable, and an embarrassment to the country in the context of global tobacco control.

Anti tobacco activists hope that those government officials will heed their message, and leave BAT to absolve themselves of guilt for causing death and diseases of their fellow citizens, whose interests they are supposed to represent.

Aminul Islam Sujon

Swamaswar, newsletter of Bangladesh Anti Tobacco Alliance (BATA)

info{at}bata.net.bd

PAKISTAN: NEW REPORT DEMANDS PROTECTION FOR CHILDREN & STRONGER LEGISLATION

A report released in late November by the Network for Consumer Protection in Pakistan has detailed aggressive marketing and point of sale promotion to systematically target young children. The ‘Report on Monitoring Tobacco Advertising, Promotion, Sponsorships and Point of Sale Advertising included results from a national survey conducted in schools of six cities in Pakistan.

Two of the children who attended the launch of a report by the Network for Consumer Protection in Pakistan detailing tobacco industry marketing. Credit: Nadeem Iqbal and Maria Ahmed Qureshi.

The survey found widespread use of marketing tactics which violate Pakistan's laws. Apart from near universal use of powerwalls behind cash counters and placement of cigarettes with candies and snacks, the survey also found that a majority of shops (89%) do not display signage about the prohibition of tobacco sales to minors. A smaller, but not insignificant proportion (14%) allowed special offers or free gifts for cigarette purchases.

The results were presented by Dr Maria Ahmed Qureshi at the launch of the report. Attendees, including education officials and child protection civil service organisation, also heard directly from children and teenagers about their experiences of being able to freely purchase cigarettes. Together, the Network and the children attending the event, jointly called for action to strengthen and enforce existing legislation.

A five point charter of action was proposed to ensure protection of children from tobacco marketing: (1) introduce a comprehensive ban of tobacco advertising, promotion and sponsorship, in line with Pakistan's obligations under article 13 of the FCTC, (2) ensure strict enforcement of the 2002 law which bans the sale of cigarettes around schools, (3) action to be taken against shopkeepers who sell cigarettes to minors, (4) disallow loose or single stick sales and ensure a 20 stick minimum per pack, (5) enforce mandatory licensing for retail tobacco sales.

USA: TAXES, TRUMP & THE FDA – MIXED NEWS FOR USA TOBACCO CONTROL

It was easy to miss among coverage of the recent US election, but on the day that Donald Trump became the president-elect, the state of California voted in favour of increasing its tobacco tax. The measure (Proposition 56), which increases the tax per pack from 87 cents to $2.87, is the first increase since 1999, and means that California will move from being the state with the 35th highest tax to the ninth highest tobacco tax in the country. Also included in Proposition 56 was a provision to apply a tax on nicotine-containing vaping products for the first time.

Additional state revenue raised from the increased tax is expected to be between $1–1.4 billion per year in 2017–18, with lower revenues expected in future years as the tax has its intended impact of reducing smoking prevalence. The additional revenue will primarily be used to augment spending on health care for low-income Californians. Smaller amounts will be allocated to schools for smoking prevention, while the University of California-administered Tobacco-Related Disease Research Program will receive 5% for research about tobacco-related diseases and the renowned California Tobacco Control Program will receive additional dedicated funding.

Four years ago, a similar proposition in California for a $1 per pack increase was narrowly defeated after a much-critiqued campaign that focused primarily on health issues. The outcome of Proposition 56 was based on a simple majority in favour or against and the proponents this time around fought back with strong anti-tobacco industry messaging; the overall yes vote was just over 64%. The success came after a campaign led by a coalition of individuals and organisations including civic and environment, education, child advocates, business associations, unions and health organisations. Opponents included Philip Morris USA and RJ Reynolds tobacco companies, and a range of libertarian organisations, retailers and advocates for lower taxation.

As in previous tobacco tax votes in California, the opponents were backed by a much higher level of funding, although the gap was narrower this year than in previous votes. In 2006, opponents outspent supporters of a proposed $2.60 tax increase by a factor of four; in 2012, the difference was five times higher for opponents of the proposed $1 increase. For Proposition 56, the No campaign raised over $71 million, while supporters received $35.5 million. Unsurprisingly, the No campaign was overwhelmingly funded by tobacco companies.

Audaciously for a campaign supported by an industry which has epitomised corporate malfeasance for half a century, the No vote campaigned on the basis that Yes proponents were advocating on behalf of vested interests to “use the new revenue to enrich their top executives [with] no requirement to treat even one more patient”. The official voter information guide listed pro and con arguments for the measure, with the latter claiming that Proposition 56 would cheat schools out of hundreds of millions of dollars per year. In reality, the vote did not change how the existing 87 cent tax was allocated. Instead, it used new revenue to replace revenue lost from lower tobacco consumption, and allocated additional funds to new health measures.

Similar propositions to raise tobacco taxes were put to the vote in Colorado, Missouri, and North Dakota, all of which were defeated. Missouri has the lowest tobacco tax in the country, at 17 cents per pack, while North Dakota has the fourth lowest, at 44 cents per packet.

Nationally, signs are ominous for tobacco control at the federal level under a Trump presidency. Vice president elect Mike Pence has shown staggering scientific illiteracy when it comes to the harms of smoking, having famously claimed as recently as 2000 that smoking doesn't kill. To be fair, this claim may not be entirely due to an inability to grasp basic science – perhaps it is attributable to wilful ignorance facilitated by big tobacco's ongoing financial support for Pence's political career.

In 2009, Pence was one of a minority of US house of representatives members to vote against the Family Smoking Prevention and Control Act. When Pence subsequently ran for governor of the state of Indiana in 2012, he received funding from big tobacco. During his term, he slashed tobacco tax and tobacco control funding, and relaxed legislation to make it easier to create cigar bars. His actions had predictable results for public health, and for tobacco industry coffers; today Indiana has the seventh highest smoking prevalence in the US, and the proportion of pregnant women who smoke is twice the national average.

Pence is also a climate change science denier. Along with Myron Ebell, who will lead the Environmental Protection Agency ‘transition’ (the organisation is expected to either cease to exist or be severely constrained in its functioning), they represent the nexus between big tobacco and the fossil fuel industry. The collusion between the two industries to manufacture doubt and misinformation about climate change science and the harms of tobacco, in order to fight regulation, is well -documented. Together, their efforts have spawned a global network of corporate-funded thinktanks and fake grassroots groups. Many Trump staffers have been drawn from such groups.

The USA is one of the few nations to hold out against ratifying the FCTC. Despite this, many states have achieved considerable success in reducing smoking prevalence. It remains to be seen whether such progress can be sustained and advanced under a president and administration made up of individuals who collectively have a clear record of palpable hostility to science, public health and evidence-based policy making.

One ray of hope is a lawsuit filed by several health and medical groups, together with several paediatricians, to force the Food and Drug Administration (FDA) to issue a final rule requiring graphic health warnings. The warnings were mandated under the 2009 Family Smoking Prevention and Tobacco Control Act, and specified that warnings cover the top half of the front and back of cigarette packs. The FDA issued the rule, but it was struck down in a 2012 legal challenge. However, the ruling applied only to the images proposed by the FDA and did not apply to the law's underlying requirement. The USA already lags behind over 100 countries in implementing graphic health warnings; success in this suit would be a considerable step forward.

KENYA: GRAPHIC WARNING LABELS COME INTO FORCE

New tobacco control legislation has come into force in Kenya. From late September, it joined the growing list of countries which have implemented graphic health warnings on cigarette packets, in line with requirements under the FCTC. The measure is now in place in 105 countries, with more than half requiring that warnings cover an average of at least 50% of the front and back of the pack.

In Kenya, images are only required to cover about 40% of the packet, and they are also placed at the bottom of the pack below the logo and brand name. However, that could soon change. The health ministry is expected to review the current images and possibly replace them with larger images within six months.

The fifth edition of ‘Cigarette package health warnings: international status report’ published by the Canadian Cancer Society, ranks Kenya 110th globally for the adequacy of its tobacco health warnings.

NEW ZEALAND: ‘COST OF SMOKING’ CAFÉ POSTERS

This image is from a resource which was developed for cafes, restaurants and bars who participated in the Marlborough Smokefree project in New Zealand. On World No Tobacco Day, all central business district eateries with outdoor dining areas went completely smokefree as a one day promotion.

Marlborough Smokefree project, reproduced with permission.

WORLD: 7TH FCTC CONFERENCE OF THE PARTIES

The 7th FCTC Conference of the Parties was held in New Delhi, India from 7–12 November. Representatives from approximately 180 countries attended. Issues covered included regulating the sale of e-cigarettes, alternative livelihoods for tobacco farmers, healthcare costs, protection of policy-making from vested interests, reviewing the 30% prevalence reduction target agreed at COP6, and action on fundraising for national-level implementation. Full coverage is available on the blog section of the Tobacco Control website.

A poster to protest FCTC measures as being against farmers' interests, and a reworked version of the poster created by tobacco control advocate Pankaj Chaturvedi.

One issue that gained significant local coverage in India in the lead up to the meeting was the impact on farmers. Posters from the Federation of All India Farmers Associations showed a farmer with his hands in a prayer like pose with the appeal ‘Protect our Livelihood’. Prominent tobacco control advocate Professor Pankaj Chaturvedi ‘reworked the poster to show the risks of tobacco farming and highlight that farmers are also victims of tobacco, with the tagline ‘FCTC helps both’.

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