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Worldwide news and comment
  1. Marita Hefler
  1. Sydney, New South Wales, Australia
  1. Correspondence to Marita Hefler; marita.hefler{at}menzies.edu.au

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World no tobacco day 2018: time to end the heartbreak

World No Tobacco Day (WNTD) is held each year on 31 May; this year marked the 30th anniversary since the first WNTD in 1988. As noted in an Unfairtobacco newsletter (https://mailchi.mp/25270b75535d/a-day-that-shouldnt-exist), around 200 million people have died because of tobacco since the first WNTD. It is a day that should not exist.

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

Despite these depressing statistics, and the tragic stories behind each and every tobacco-caused death, progress is being made. WNTD is an important occasion to focus both the public and policy-makers on changing the course of tobacco epidemic. This year’s theme ‘Tobacco Breaks Hearts’ focused on the fact that tobacco use is a leading risk factor for cardiovascular disease, something which has low awareness among many sections of the public.

The extraordinary leadership of Uruguayan President Tabaré Vázquez which has seen Uruguay become a global tobacco control leader, was recognised with the WHO Director-General’s Special Recognition Award for WNTD. Dr Vázquez, a former oncologist, first served as Uruguay’s president from 2005 to 2010. During this time, Uruguay implemented smoke-free policies in all enclosed spaces except private homes, introduced health warnings to cover 80% of cigarette packs, banned most tobacco advertising and sponsorship, banned misleading descriptors such as light and mild, increased taxes to 70% of the pack cost and limited tobacco companies to sell only one variant of a brand.

In addition to his achievements, scaling up tobacco-control efforts in accordance with the Global Action Plan for the Prevention and Control of Noncommunicable Diseases, and the 2030 Sustainable Development Agenda for Uruguay, Dr Vázquez in 2017 was host of the WHO Global Conference on non-communicable diseases, where he played a pivotal role in influencing other heads of state to implement similar policies.

In many countries, WNTD and the time leading up to it are an opportunity for civil society to raise awareness with policy-makers and argue the case for stronger tobacco-control policies. In Bangladesh, a delegation of Bangladesh Anti-Tobacco Alliance met with the Secretary of Health Services Division, Ministry of Health and Family Welfare on 13 May 2018. The team, along with Work for a Better Bangladesh Trust’s spokesperson made the case for increasing tobacco taxes in the upcoming budget and formulating a strong tobacco tax policy. Discussions were also held about various issues, including activation of mobile apps by the National Tobacco Control Cell for law implementation. Other issues and recommendations included immediate formulation and implementation of the National Tobacco Control Plan, graphic health warning enforcement and ensuring implementation of local tobacco sales licensing.

In Israel, a number of initiatives coordinated with WNTD, with a particular focus on smoke-free environments. The Israeli Healthy Cities Network, a member of the Smoke-Free Israel Coalition, celebrated WNTD by advocating for smoke-free environments and encouraging smokers to try and quit. Twenty different municipalities engaged with their communities with various activities. The city of Ashdod presented the most innovative initiative. As a coastal city, they focused their activity on the sea shore. Each smoker on the beach was asked to give up his or her cigarette and received a bottle of water to replace it.

Ashkelon Academic College (AAC) in the south of Israel started a programme of ‘Tobacco Free Campus’ as part of a large programme that the students of the Public Health Department have developed.

At the event, held on WNTD, the AAC Smoke-Free Campus Declaration, supported by both students and staff, was signed by the College Director, President, Rector and by the Head of the Public Health Department.

The declaration covers several commitments: prevention of exposure to secondhand smoke, complete prohibition of smoking within buildings, prohibition of onsite sale and marketing of cigarettes, supporting employees and students in smoking cessation, clinical research and training leadership in tobacco-control efforts. The college’s target is to have a totally smoke-free campus within 3 years.

In Germany, Unfairtobacco joined the environmental organisation NABU in the northeastern city of Greifswald. A day of action was organised to inform people about the environmental toll of tobacco and clean some streets of Greifswald from cigarette butt waste.

The Southeast Asia Tobacco Control Alliance (SEATCA) highlighted the tobacco industry and its actions in the Association of Southeast Asian Nations (ASEAN) region, and called on all governments to strengthen regulatory policies and measures to ‘stop the industry in order to stop the problem’. In the ASEAN region where half of all adult men smoke and where 10% (125 million) of the world’s smokers live, tobacco-caused diseases kill about 500 000 people per year.

SEATCA highlighted strategies such as tobacco company-funded illicit trade studies to fight tobacco tax increases in many countries such as Vietnam and Philippines. It noted that Imperial Tobacco continues to short-change the Lao government by exploiting an unfair 25-year investment deal. In Singapore and Thailand, the industry is fighting plain packaging efforts, after blocking plans in Malaysia. In Indonesia, tobacco companies fight all tobacco-control measures to keep the country a profit paradise for the industry.

Citizen News Service recorded two webinars, including one with a focus on holding tobacco corporations accountable and legally liable for the damage they have caused, not just to public health, but also to the development of the human race.

As noted on the webinar website: ‘The tobacco industry has used its economic power, lobbying and marketing machinery, and manipulation of the media to discredit scientific research and influence governments in order to propagate the sale and distribution of its deadly product. Furthermore, the tobacco industry continues to inject large philanthropic contributions into social programs worldwide to create a positive public image under the guise of corporate social responsibility.’

The webinar looks at how holding the industry accountable, in line with WHO Framework Convention on Tobacco Control (FCTC) Article 19 could be a step forward for both public health and corporate accountability. Called ‘Holding tobacco industry liable will be a gamechanger for health and development’, the 60 min webinar can be accessed at https://archive.org/details/endtobacco.

Contributors

Syed Mahbubul Alam Tahin

The Union, Bangladesh

Milka Donchin MD, MPH, Yael Bar-Zeev, MD, MPH

On behalf of the Smoke-Free Israel Coalition, Osnat Bashkin, Ashkelon Academic College

Israel

Sonja von Eichborn, Unfairtobacco

Germany

World/USA: campaign to separate tobacco industry from advertisers builds momentum

A campaign aimed at separating the tobacco industry from the vendors that make their dirty work possible, especially advertising agencies, has seen over 85 organisations sign up.

Quit Big Tobacco, launched at the World Conference on Tobacco or Health in Cape Town, South Africa, in March, is an initiative of Vital Strategies. It is calling on non-profit organisations with health in their mission to pledge not to work with the tobacco industry and affiliated advertising agencies that aid and abet the industry’s effort to hook a new generation of tobacco users.

According to Rebecca Perl, vice president of partnerships and initiatives—policy, advocacy, and communication at Vital Strategies, “This campaign is targeting advertising agencies that work with the tobacco industry because they promote deadly products, through ad campaigns that appeal to youth and are responsible for hooking a generation of new smokers to a lifetime of poor health and an untimely death. We can’t think of anything more reprehensible.”

The campaign launched with a website at QuitBigTobacco.org and a social media campaign, #QuitBigTobacco. The idea is to expose these affiliations and pressure marketing and advertising agencies to drop their relationships with the tobacco industry. At the heart of the campaign is the recognition that the tobacco industry uses aggressive marketing to hook young people and turn them into life-long smokers; advertising is a culpable vector for the death and misery it causes.

Some organisations and their ad agencies have decided not to work with the tobacco industry, but others continue to do so. However, some ad agencies have tobacco industry clients while working with health organisations. For example, Marlboro’s global Don’t Be a Maybe campaign is the work of Leo Burnett, the same advertising agency behind recent ads for United Healthcare, a leading health insurance company, who may be unaware of the situation. This is an unacceptable contradiction.

Organisations concerned about health and well-being, including hospitals, insurance companies, international non-profits, sports companies, universities and some food and nutrition companies , have a win–win proposition at their fingertips. They can Quit Big Tobacco and make a clear statement about their organisational values, use the power of their purses to work against the tobacco epidemic and pose no risk to their business operations or their missions.

Vital Strategies is encouraging organisations that care about health to check that their current suppliers do not work with the tobacco industry. If they do not already have them, organisations might consider including a conflict of interest clause in standard vendor contracts to prevent their vendors from also working with tobacco companies.

The Quit Big Tobacco campaign is also encouraging organisations to not accept funding from tobacco companies or the Philip Morris-funded Foundation for a Smoke Free World, in line with statements from the WHO, numerous universities and more recently the Polish government. It is also asking organisations such as promoters, not to allow tobacco sponsorship.

More information and links are on the Tobacco Control website at https://blogs.bmj.com/tc/2018/05/20/quitbigtobacco-saying-no-to-helping-the-tobacco-industrys-dirty-work/

Netherlands: supermarket chain Lidl to phase out tobacco sales

The supermarket chain Lidl has announced that it will phase out sales of tobacco in its Netherlands stores by 2022. According to media reports, Lidl has seen a decline in cigarette sales, and they are no longer profitable. It will be the first Dutch supermarket to remove cigarettes from sale.

Lidl has been ahead of legislation, having placed tobacco products out of sight last year in order to discourage smoking. Legislation preventing supermarkets from displaying tobacco products will come into force in 2020. The decision by Lidl is a strong rebuttal to the common strategy by the tobacco industry of using retailer front groups to argue against tobacco-control policies on the basis that they will be economically harmful.

USA: San Francisco tobacco flavour ban receives strong support

More than two-thirds of voters have voted to uphold a ban on flavoured tobacco and e-cigarette liquids in San Francisco, in the US state of California. The resounding support for the proposition in a ballot on 6 June was achieved despite a US$12 million campaign by tobacco company RJ Reynolds. The campaign, with multimedia ads in four languages, compared the ban to alcohol prohibition and tried to evoke fears of a black market crime wave.

The San Francisco measure, first passed by the Board of Supervisors and challenged through the ballot initiative process by RJ Reynolds, will put an end to sales of products with candy and other flavourings that clearly appeal to children. It also includes menthol which is used disproportionately by African-Americans and which is associated with ease of initiation. The co-chairman of the African-American Tobacco Control Leadership Council, Dr Phil Gardiner, told the New York Times: “The ban on menthol cigarettes is a monumental step forward for health equity and social justice for communities of colour.”

The ban is in line with increasing international moves to restrict flavours. A menthol ban has already been introduced in Canada and will start in the European Union from 2020. The resources poured into campaigning for the ‘no’ cause by RJ Reynolds suggests it saw the potential for the ban to set a precedent for other areas of the USA. If the results of the San Francisco ballot are anything to go by, it could be in for a long and expensive losing battle.

Pakistan: tobacco-industry campaign influenced warning labels

The latest Reuters investigations of tobacco industry activities details an alleged tobacco industry-wide campaign in Pakistan which ultimately resulted in legislation to increase the size of health warning labels being watered down. The original legislation, announced by the health ministry in February 2015, would have increased the size of warnings from 40% to 85%, among the largest in the world. Implementation was set for 30 March 2015.

According to the report (https://in.reuters.com/article/pakistan-tobacco/insight-pakistan-diluted-proposed-tobacco-health-warnings-after-philip-morris-bat-lobbying-idINKCN1IV08F), British American Tobacco was the first to mobilise, sending a delegation to the finance minister to argue against the measure; he obligingly formed a review committee. The implementation date for the new warnings was subsequently delayed, initially for 2 months, by the health ministry.

Internal Philip Morris documents also suggest that the company had a campaign in place, although details were not specified. However both Philip Morris and BAT attended interministerial committee meetings to deliberate the health warnings. The final recommendation, which was eventually adopted, was for the health warning size to be decreased to 50%, with a future increase to 60%.

The lobbying strategies used by Philip Morris and BAT show a remarkable consistency with interference and lobbying in other countries: ensure legislation is delayed, involve officials from agencies outside the health ministry (in this case, the Board of Revenue, Finance Minister and Prime Minister himself), stoke fears of ‘unintended consequences’ including lost revenue, illicit tobacco and increased crime, and question the evidence base of proven public health measures.

Both BAT and Philip Morris defended their actions with the standard line that—like any other company—they should be free to talk to government about issues that affect their business. Of course, that is a patently absurd defence. Tobacco companies are not like any other companies, and governments which are parties to the FCTC (including Pakistan) are legally obligated to protect policy-making from tobacco interests and limit contact with the industry. The question is whether the Pakistan officials involved in this case were ignorant of their obligations or if there is another explanation.

This type of policy-making interference—repeated wherever governments initiate evidence-based strategies to reduce smoking and improve the health of their people—continues wherever the tobacco industry thinks it can protect its business.

Canada: warnings on cigarette sticks being considered

Canada could be the first country to include a provision for health warnings to appear directly on cigarettes, according to comments by the country’s health minister on WNTD. Launching the country’s new tobacco-control strategy, Petitpas Taylor noted that while Canada has come a long way, there is more to be done. She indicated that she would be in favour of putting health warnings directly on cigarettes, stating that she likes the ‘bold’ idea.

The concept of extending the impact of plain packaging by including health warnings on cigarette sticks was the subject of a 2015 research paper published in Tobacco Control. It found that dissuasive sticks could enhance the effect of standardised packaging, particularly among older smokers who are often more heavily addicted and resistant to change. The paper Dissuasive cigarette sticks: the next step in standardised (‘plain’) packaging? can be accessed at http://tobaccocontrol.bmj.com/content/25/6/699

On the Tobacco Control website

Tobacco Control publishes podcasts of interviews with authors of selected papers published in the journal. The most recent episode is about dual use of electronic nicotine delivery systems and cigarettes. To listen to the podcast, and to access the paper, go to: https://soundcloud.com/bmjpodcasts/the-social-and-physical-motives-behind-dual-use-of-electronic-and-smoked-cigarettes?in=bmjpodcasts/sets/tc-podcast

Many of the articles published in Worldwide News and Comment are published on the Tobacco Control website at blogs.bmj.com/tc, often with additional links. Other articles are also published between issues. Ideas for blog articles can be sent to marita.hefler@menzies.edu.au.

Member of the delegation that highlighted need to improve tobacco control in Bangladesh. From left to right: Syed Mahbubul Alam, Saifuddin Ahmed, Aminul Islam, Syed Anonna Rahman, Serajul Huq Khan (Secretary, Health Service Division, Ministry of Health and Family Welfare), Dr Rumana Huque, Khairul Alam Sheikh (Joint Secretary, National Tobacco Control Cell), Aminul Islam Sujon.

Members of a Bangladesh delegation to raise awareness about the need for tobacco control to be strengthened in Bangladesh. From left to right: Abu Rayhan, Naima Akter, Sharmin Akter, Naznin Kabir, Aminul Islam, Syed Mahbubul Alam, Syeda Anonna Rahman.

World No Tobacco Day in Ashod, Israel. A smoker giving up her cigarette (and placing it in a bottle full of cigarettes), and a member of the municipal health unit giving her a bottle of fresh water in return. Photo credit: Miri Ben David.

The Ashdod municipal health unit team and a volunteer, wearing T-shirts announcing ‘Ashdod, a Smoke Free City’, around the display of marked bottles of water. Photo credit: Miri Ben David.

Ashkelon College students in Israel at the launch of the ‘Tobacco Free Campus’. Photo credit: Department of Public Health, Ashkelon College.

Supported by Unfairtobacco, the environmental organisation NABU informed people about the environmental toll of tobacco and mobilised youth to collect cigarette butts from the streets of Greifswald, Germany. Photo credit: Jan Lessmann.

Unfairtobacco joined the environmental organisation NABU for World No Tobacco Day 2018 and cleaned streets of Greifswald, Germany, from cigarette butt waste. Photo credit: Jan Lessmann.

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Footnotes

  • Contributors July TC News Analysis.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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