World: 20 years of news

A review of 20 years of News Analysis prompts three summary comments. First, extraordinary progress has been made in tobacco control worldwide since the first story in the first edition, in 1992, which reported plans for legislation to ban tobacco advertising in the member states of the European Union. Second, the sheer range and scale of tobacco industry dishonesty and recklessness in trying to block public health efforts to prevent disease caused by its products, and to preserve business as usual, while known to all for so long, is still astonishing. And third, since colleagues all over the world have submitted so many accounts of their best health initiatives and the industry's worst perfidy, and with every edition available free in our online archive, researchers and historians have a unique and extraordinary resource charting the development of the global response to the tobacco pandemic over two decades.

That first story, headlined, ‘Brussels sprouts plan for tobacco ad ban’ (puns, sometimes verging on the painful, were not uncommon in early headlines), illustrated the key aspiration of tobacco control 20 years ago: government action, by legislation. A few pioneering countries had comprehensive tobacco control laws, but this first story promised a whole group of countries enacting legislation together. Many early news stories dealt with trying to obtain laws, or implementing them in the face of tobacco industry attempts to test them to destruction. The policy areas most featured were those of greatest importance in reducing tobacco consumption, thus those resisted most furiously by the industry: banning promotion, not just regular advertising; banning smoking in public places (especially when, rather late in the day, all places of work were included); and raising tax to increase price.

The most important news of all over the two decades must be the creation and development of the WHO's Framework Convention on Tobacco Control (FCTC). However, the necessarily slow progress of negotiations and subsequent implementation meant that some stages were reported only indirectly. Nor was it certain at the beginning of the process that the FCTC would actually happen, or whether, if it did, it would prove effective. More recent coverage, for example of the meetings of the Conference of the Parties that develop guidelines for governments on individual areas of policy, reflect not only the growth of the FCTC itself, but also the swiftly growing confidence of the tobacco control community in the convention's potential.

In pre-FCTC days, tobacco control success stories were often the result of action by individual citizens and their civil organisations. In the USA and Canada, for example, non-smokers' rights organisations led the way to clean air laws in entire states, counties and cities, showing other nations what could be done. Similarly, even before the journal began publishing, individuals angered by the gross deceptions of tobacco advertising in Australian cities took matters into their own hands by ‘improving’ advertisements. These were the famous Billboard Utilising Graffitists Against Unhealthy Promotions, better known by their acronym, BUGA-UP (see figures). More recently, civil society associations in India, Sri Lanka and Bangladesh have been achieving remarkable results, often involving court action.

Tobacco Control's News Analysis has always tried to cover tobacco news from low income countries and in terms of government action against huge odds, Thailand has rightly featured frequently. In Africa, non-governmental organisations played a crucial role during FCTC negotiations. In the journal's second year, a report from Senegal about a brand called Nelson, clearly purloining the most famous of African names (‘Long live Nelson! … for brave people’, ran the ads), was accompanied by a letter from Nelson Mandela recording his astonishment, and his assurance that, had he been asked, he would certainly have withheld his permission to exploit his name in marketing deadly products. Appropriately, South Africa has provided vital leadership for other African countries to emulate.

Comparing early news stories with those of more recent editions, it is heartening how many ‘bad news’ stories featured countries from which today the news is good. Happily, colleagues in countries featured in the first category have been keen to send us stories reporting improvements. As Tobacco Control moves forward into its second 20 years, readers are urged to keep helping us to place on record the best—and the worst—news as they witness it. Their experiences can equip, inspire and embolden others still struggling to achieve similar aims. To educate a recalcitrant health minister, say, or to encourage a keen one battling to obtain tougher action, there is nothing like a published piece in a prestigious international journal to show what is taking place elsewhere. We look forward to continuing to report news from every corner of the world, until the tobacco pandemic exists only as part of history.

Australia: citizens' action ‘improved’ tobacco billboards such as this iconic Marlboro billboard in Sydney, seen before and after treatment, in the early days of tobacco control.

Indonesia/world: using music to target youth

2011 provided numerous reminders of the need for the global tobacco control community to be vigilant in the fight against the tobacco industry using music to target youth, particularly in countries yet to sign or effectively implement the WHO's FCTC. Several youth-friendly international stars performed in one such country not yet bound by the FCTC, Indonesia, under tobacco industry sponsorship, despite some being active in a range of campaigns to support children, health research and other social causes in their own countries. In response to protests by music fans and tobacco control activists, bands typically remained silent, or defended the sponsorship as an issue beyond their control and not something from which they profited.

Among the more notable events was the Irish boy band Westlife performing under the sponsorship of Clas Mild, an Indonesian kretek (clove-flavoured cigarette) brand in October, generating protests from ASH Ireland and the Irish Cancer Society. A few weeks before they performed in Jakarta, Sophie Ellis-Bextor also performed at the LA Lights-sponsored Java Soul Nation Festival, despite the fact that she was the star of an EU anti-smoking ad in 2002. Contacted about it on the social networking medium Twitter, she responded that she was “intrigued to hear she was promoting tobacco, and wasn't aware of it.” However, she took no action to distance herself from the promotion.

The annual Java Rockin'Land festival was held in July 2011, sponsored by Gudang Garam, a major kretek manufacturer. Despite an online petition against the sponsorship, none of the bands involved took any action. US band Neon Trees came in for particularly heavy criticism, as they are all practising Mormons who have been outspoken about their position as drug- and alcohol-free role models. They were sufficiently embarrassed to announce they would donate their fees to an Indonesian cancer charity. The announcement generated plenty of publicity for the band, but more than 6 months later repeated requests to confirm details of the donation went unanswered by the band's management.

Perhaps Neon Trees were taking their cue from US band Maroon 5, which was scheduled to perform in Indonesia for the kretek brand Surya Pro Mild in April. The band's management responded swiftly to an online campaign, asking the band to drop the sponsor. They also announced that they would make a substantial donation to a local cancer charity. However, by the end of the year there had been no confirmation that the donation was received, and even after the tobacco branding for the sold-out concert was dropped, a Facebook competition for tickets continued to run, allowing the tobacco company to gather the personal details of thousands of fans.

Meanwhile in other countries, including Russia, Ukraine and Turkey, Japan Tobacco International's (JTI) Camel cigarette brand continues to run massive dance parties and concerts under the auspices of the internet-based, youth-oriented Urban Wave social networking community, featuring hugely popular international DJs such as Armin Van Buuren. The Tobacco Commons website (http://www.tobaccocommons.com) sets out details of many of these events, which continue largely untroubled by international scrutiny, and with ever-increasing use of social media sites such as Facebook to develop sophisticated, individually-tailored marketing which connects directly with young people.

In 2008, US singer Alicia Keys immediately removed tobacco sponsorship from her Jakarta gig when it was brought to her attention, and apologised to her fans. Nowadays, however, despite significant advances in many other areas of tobacco control in the intervening 3 years, few if any international popular music acts seem prepared to take a similarly principled stand. More than ever, the global public health community needs to become organised to stand up to this continuing challenge.

MARITA HEFLER

University of Sydney, Australia

marita.hefler{at}sydney.edu.au

Indonesia: posters promoting a concert to be given by Irish ‘boy band’ Westlife, sponsored by Clas Mild cigarettes. Photo: Indonesia National Commission for Child Protection.

Europe: fury over bat's ‘dreams of Europe’ scHeme

In November last year, the German subsidiary of British American Tobacco (BAT) launched an internet-based project called ‘Dreams of Europe.’ Astonishingly, the internet site set up especially for the project featured a picture and endorsement from Jose Manuel Barroso, president of the European Commission (EC), the secretariat of the European Union. Beside him was a picture of the senior BAT man who runs Stiftung für Zukunftsfragen (SFZ—the name translates as Foundation for Future Studies), a body founded and sponsored by BAT, which is running the project.

Such implicit EC backing for the project, and its overt collaboration with the tobacco industry, is clearly in breach of one of the most basic tenets of the WHO's FCTC, by which the European Community and its member states are bound. Also posted were ‘dreams’ for the future of Europe by eight Members of the European Parliament (MEPs), two from Germany and one each from Austria, Bulgaria, the Czech Republic, Hungary Slovenia, and Spain. It appeared that these politicians had been approached for their contributions in advance of the site being opened to ordinary citizens of Europe and the wider world.

In a truly emetic introduction on the scheme's website, BAT explained, “Like all dreams, this one started with an idea… to find a vision, an identity, a dream for Europe.” It goes on to relate how it interviewed 15 300 citizens from Russia, Denmark, Italy, Poland, Turkey, Greece, Spain, Austria, Germany, the UK, France, the Netherlands and Switzerland about their lives (which might prove handy for future marketing), as well as asking politicians, scientists and other key citizens for their thoughts on the future of Europe; “But we want to get an even bigger impression so we asked you!” Enticements to participate included the possibility of winning a trip to Brussels.

Almost immediately the site was open, responses began to appear on the website, some of them as incredulous about the participation of the EC and the MEPs as they were about this latest example of an unrepentant industry's cynicism. Several organisations and individuals approached various levels of the EC bureaucracy.

Some ‘dreams’ posted by individuals showed that many had seen straight though the anodyne public relations nonsense to the true nature of the scheme. Their ‘dreams’ varied widely: some, who may have been health professionals, dreamed of, for example, “a world where my hospital isn't filled to the brim with people hacking and coughing their way to an early grave”; and one who possibly worked on comparable projects for worthwhile companies dreamed of a time “when my industry, marketing, isn't sullied by people masquerading as foundations and think tanks when in fact all they are interested in doing is selling more cigarettes.” Still more aimed straight at the EC, “…where the President of the EC doesn't put his face to a website run as a front for Big Tobacco firms” or directly at BAT and SFZ “…where The Foundation for Future Studies actually discusses the issue of lung cancer and smoking-related diseases, rather than acting as a front for a cigarette company.”

Most of the negative responses were from people in countries with an established history of public information and understanding about tobacco. Some of these pulled no punches, using satire or dark humour to make their points. One dreamed of “making tobacco more aspirational. Lung cancer is a human right! COPD is glamorous! Impotence for all! Let's hold hands with each other and BAT to make this happen!” and another of a time “when the decaying corpses of cancer victims rise up from their graves and eat the brains of the tobacco executives who cooked up the shameless and ill-advised attempt to promote their filthy product.”

Not surprisingly, such posts were quickly removed. The photographs of Mr Barroso and the BAT man also disappeared almost immediately, as did the ‘dreams’ of the MEPs, together with many of the more extreme rebuffs. SFZ itself posted a new message, beginning, “We are aware that in the past few days, several dreams have been posted that specifically refer to tobacco and, in particular to BAT Germany, our founder. No doubt, the tobacco industry is a controversial sector.” It added the assurance that BAT believed in “an open and ongoing dialogue with consumers, stakeholders and the public”; and indeed, some negative comments were allowed to remain.

One of these, a longer and strikingly cogent posting, was made by Stan Shatenstein, a long-time associate of this journal, urging visitors to the website to understand what this shameful exercise was all about. The tobacco industry did not sponsor dreams, it crushed them, he explained: “Professor Dr Ulrich Reinhardt, the scientific head of [SFZ] and chair of its board of trustees, has been, since 1999, research associate at BAT's leisure research institute. Four other, senior BAT executives sit on the executive board, the board of trustees or both.

“It is important to be reminded that smokers and their families and friends cannot enjoy their ‘leisure’ years because smoking has ruined their ability to breathe if it hasn't actually killed them off before they retire,” wrote Shatenstein. “These soulless sellers of poison have asked you to pour out your hearts and share your visions of what Europe can be, but they kill Europeans—and Asians, and Africans, and Americans and Oceanians—for a living. The better they and their shareholders do, the more Europeans, our fellow men, women and children, will die prematurely and unnecessarily… BAT's dream is everyone else's nightmare.” Shatenstein's full text was also placed on the BMJ Group's Tobacco Control blog pages, where it may be viewed at: http://blogs.bmj.com/tc/2011/11/18/british-american-tobaccos-united-dreams-of-europe/

Complaints to EC officials reportedly received extraordinary responses, including the assurance that the President's contribution had not been related to the issue of tobacco nor to the tobacco industry; and that while the project co-ordinator worked for a tobacco company, this did not detract from the value of the project, which had no links with tobacco. Such assertions seem strangely at odds with the prominent references to BAT on the web pages, and with the fulsome thanks to BAT that appeared in the subsequently published book listing a selection of ‘dreams’ posted on the website.

The lofty-sounding aims of SFZ convey benign, even academic endeavour. In practice, such operations may be as much about market research as an exercise in corporate public relations (or ‘corporate social responsibility’, as BAT would no doubt prefer to put it). ‘Dreams of Europe’ is no exception, incorporating as it does research that could be exploited for a variety of corporate objectives, particularly those involving the newest generation of European citizens—or youth, as tobacco marketing people might more accurately refer to their premium target audience.

Europe: part of the front page of BAT's Dreams of Europe book, which featured the President of the European Commission (top left), as did the website, though his picture was soon removed from the latter.

Cambodia: KT&G? ‘Korean tomorrow & global’, of course…

Cambodia banned all tobacco advertising and sponsorship with effect from August 2011, but tobacco companies were soon trying their luck to see at what point the authorities would move to enforce the ban. Testing the waters most noticeably was the South Korean company known for years as Korean Tobacco and Ginseng (KT&G), which did a make-over of its billboards by merely removing the image of a cigarette pack, but leaving the original tobacco advertising slogans. Away from the capital KT&G's local distributor continued to maintain eight billboards. When the government issued a warning letter over the ads, the company reportedly replied that its billboards did not violate any law as they did not show cigarette packs, nor did they contain any mention of the Khmer word for cigarette, but only some words in English targeting foreigners.

But it was not just the billboards that KT&G had altered. The most radical part of its makeover was a major change of name, from KT&G to Korean Tomorrow and Global. So, significantly, it is still KT&G in the abbreviated form of its new name. But why would a tobacco company eliminate the word ‘tobacco’ from its name and re-brand itself to such an innocuous, unspecific identity? Is it simply indicating that it hopes it will still be in business ‘tomorrow’, and that the global market is where it hopes its future profits will come from? Or is it primarily so it can continue to advertise using a shorthand name well known for cigarettes, especially in Asia, in circumvention of laws banning tobacco advertising? If and when challenged, it can simply claim that it sells non-tobacco products, too, resurrecting a tactic employed by western-based transnational tobacco companies in the bad old days, to circumvent advertising bans in many countries around the world.

KT&G has a long international reach, marketing its best-selling brand Esse in 40 countries. It almost doubled Esse's exports from 11.2 billion sticks in 2009 to 20.8 billion in 2010. Esse is aimed primarily at women: a trade publication reported how the brand “gained the love and trust of female smokers shortly after its introduction to the market” in Eastern Europe. Women appear to be a key target in all Esse's markets. The trade journal Tobacco Asia, describing KT&G as ‘Masters of the Super Slim’, recently examined the company's ‘growth segments’. It quoted KT&G's views, infused with familiar industry euphemisms, of the super slim and low tar sector: “Since the segment grew fast from the beginning on account of health concern[s] and the perceived well-being of Korean smokers, we anticipate that the super slim and low tar segment will enjoy steady market expansion.”

It seems that KT&G, not to be outdone by the big three transnational tobacco companies, is jumping on the emerging market band wagon to grab a bigger piece of the Asian tobacco market, where historically low smoking rates make women the obvious target for growth. Cambodia is a good example of this, with 42.5% of men but only 3.5% of women being regular smokers. As a low income country, it is salutary to consider that annual tobacco expenditure by smoking households is equivalent to some US$69.44 million, the same as the cost of around 274 000 tons of high quality rice, 1.4 million bicycles or almost 28 000 large wooden houses in the provinces.

In July last year KT&G further strengthened its foothold in Asia by buying a controlling share of Indonesia's sixth largest tobacco company, PT Trisakti Purwosari Makmur, which sold some 3 billion sticks in 2010. This latest acquisition was the company's third in 6 years in Indonesia, one of the world's largest tobacco markets, with 57 million smokers comprised mainly of low income and young people. Esse advertisements were soon lining the streets of Jakarta, and to reach out to internet savvy young people, a Facebook account was also set up, Esse Indo. Promotions in Indonesia can be expected to intensify as tobacco companies compete to recruit more young women and girls. The Indonesian government has so far failed to ratify the WHO's FCTC and remains the only country in Southeast Asia to still allow tobacco advertising. It is therefore little surprise that predatory transnational companies are rushing in, including Asian companies such as KT&G.

However, if governments can be persuaded or pressured to enact legislation based on the highest standards, including comprehensive bans on all forms of advertising, direct and indirect, and plain packaging, and perhaps most important of all, if they enforce their legislation without compromise, companies such as KT&G may find that a make-over of the company name will not be sufficient to prevent the protection of human lives.

MOM KONG

Cambodia Movement for Health, Phnom Penh

kongmom{at}ymail.com

MARY ASSUNTA

Southeast Asia Tobacco Control Alliance

mary.assunta{at}cancer.org.au

Cambodia: a KT&G Esse brand billboard after the advertising ban.

Cambodia: an Esse ad on Facebook.

New zealand: pack seal can cover warnings

Adhesive seals contained in packets of Dunhill cigarettes, made by BAT, may be helping smokers cover up New Zealand's graphic health warnings. ONE News, the news section of television network TVNZ, examined a range of cigarettes on sale in New Zealand, made by several tobacco companies. Dunhill was the only product found with a seal inside that can be taken out and stuck on the outside of the packet after it has been opened.

The Dunhill seal is labelled ‘exclusively Dunhill’ and is exactly the size to cover the pack's health warnings. New Zealand's regulations require pack health warnings to cover 30% of the front and 90% of the back of cigarette packets. The Dunhill sticker can cover most of the larger warning on the back of packets, or the one on the top and front of the hinged lid, which is opened form the front.

Michael Colhoun of Action on Smoking and Health New Zealand (ASH) said, “Nothing about a tobacco packet is accidental and the sticky seals have been included deliberately.” BAT responded to criticism by claiming that the seal was only there for keeping the cigarettes fresh, and denied that that the design was intended to undermine the law. ASH has made an official complaint to the health ministry about the inclusion of the stickers, believing that they may breach the country's Smokefree Environments Act.

New Zealand: the sticker inside this pack of BAT's Dunhill cigarettes can be stuck over the health warning on the lid, or to cover most of the larger health warning on the back of the pack.

World: in praise of bolder women

As Australia's plain packaging bill passed into law after weathering long and hard storms of tobacco industry opposition, health advocates and pro-health politicians applauded the courage and determination of the two women responsible: health minister Nicola Roxon and prime minister Julia Gillard. An early female leader in the same region, Helen Clarke, then health minister and later prime minister of New Zealand, was responsible for her country taking an international lead in banning tobacco promotion. And on the other side of the world, a much earlier pioneer was Simone Veil; as health minister in France in the 1970s, she was responsible for a European model law banning tobacco advertising, which today bears her name, the ‘Loi Veil’.

However, it is on the international front that a woman has achieved the most far-reaching success for tobacco control. Public health doctor and former prime minister of Norway Dr Gro Harlem Brundtland, as Director-General of the WHO, presided over the concept, negotiation and eventual passing into international law of the first and still the only international legal instrument on a health topic, the FCTC.

Elsewhere, at national level, other women have achieved great improvements to health, often against significant opposition and traditional prejudices. One of only two female members of the Japanese cabinet, minister of health, labour and welfare Yoko Komiyama, fought for a large increase in tobacco tax last year, and then announced her intention of pressing for more.

Brazil's president Dilma Roussef can also be considered an important leader, signing a law last year that will make Brazil the largest country in the world to become completely smoke-free in the workplace and in all public places, a move protecting the health of more than 190 million people. In the same region, from 2005 to 2010, as health minister of Uruguay, María Julia Muñoz played a crucial role in tobacco control, fearlessly facing the media and the tobacco industry in defence of her policy. Dr Esperanza Martinez, health minister of Paraguay, is similarly admired for her strength in opposing tobacco industry efforts to thwart recent presidential decrees on banning smoking in enclosed public spaces and on regulating tobacco labelling and packaging.

Japan: JTI sponsors women's volleyball

Last November, JTI earned the unusual dishonour of being criticised by name by the WHO after the Japanese national team player Risa Shinnabe, a star volleyball player whose picture is doubtless on the bedroom walls of thousands of teenage Japanese girls, was pictured wearing a JTI logo as she waved to adoring fans after her team beat US opponents in Tokyo. JTI's logo was reportedly emblazoned not only on team uniforms, but also on digital billboards round the volleyball court, on television advertisements and gift packs handed to schoolgirls, mothers and children entering the Yoyogi national stadium and other arenas across Japan during the Volleyball World Cup tournament.

A spokesman for WHO's Tobacco Free Initiative said WHO was contacting the international governing body of volleyball to convey WHO's disappointment and to remind it that in 2002 it publicly committed to making volleyball a tobacco free sport. WHO hoped JTI would soon abide by its international commitments to the FCTC.

In responding to widespread criticism over the sponsorship, JTI claimed to abide by all laws and voluntary codes in Japan. “Nowhere in our corporate sponsorship of volleyball games do we advertise our cigarette brands or products,” a spokesman said. A sports journalist added that JTI was a sponsor “in the beverage category” because it also had a division selling tea, coffee and other drinks.

Dr Manabu Sakuta, a Tokyo doctor and head of Japan's society for tobacco control, said, “This is complete nonsense. It seems that they are not a national team, but a Japan Tobacco team.” Other observers voiced the fear that Japan risked losing its bid to host the 2020 Olympic Games because of growing local and international opposition to JTI's sponsorship of World Cup volleyball.

Japan: a poster being put up to promote the World Cup volleyball tournament, showing female players wearing JTI clothing. Photo: Christopher Johnson, http://www.globalite.posterous.com

Australia: plain packaging bill clears last hurdle

In December, Australia's world-leading bill to ban all but uniform plain packaging for tobacco products, was finally passed into law. Confirming the importance of the move in terms of its potential long term effects on consumption, Australian tobacco control advocates reported that the fight put up by the tobacco industry had exceeded even that experienced when tobacco promotion was banned. Industry tactics included what the health department described as ‘vexatious’ claims under freedom of information law: of 63 freedom of information requests that ‘swamped’ the department during the passage of the bill through parliament, 52 were from tobacco companies, describing the action as a specific and deliberate attempt to divert resources.

Several lawsuits have already been filed against the government by tobacco companies, including PM, BAT and Imperial Tobacco. However, Australian health advocates say the government is confident of winning any such cases, having taken extensive legal advice when drafting the bill. Appropriately, in a subsequent cabinet re-shuffle, the health minister who took the bill through parliament, Nicola Roxon, has been appointed as Australia's new Attorney-General.

Under the new law, which will come into force in December this year, tobacco can only be sold in dull, plain packaging, with no branding, but with graphic health warnings. The name of each brand will only appear in relatively small print in a standard typeface. Several countries around the world, including New Zealand and the UK, have announced the intention of consultations about following Australia's lead.