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Worldwide news and comment
  1. Marita Hefler
  1. Correspondence to Marita Hefler; marita.hefler{at}menzies.edu.au

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World: Philip Morris-funded FSFW fails (again) to end pariah status

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

A screenshot of a tweet from the official WHO Twitter account, reaffirming WHO’s stance against working with the Philip Morris-funded Foundation for a Smoke-Free World, and any other tobacco industry-funded entity. Source: https://twitter.com/WHO/status/1090968768996626435

The Philip Morris-funded Foundation for a Smoke-Free World published an open letter to the Board of the WHO on 24 January 2019, urging it to ‘consider how best to work with the Foundation’. The letter was published to coincide with the WHO January Executive board meeting. The WHO stance since September 2017 has been that it will not partner with FSFW, governments should not partner with FSFW, and the public health community should follow this lead (https://www.who.int/news-room/detail/28-09-2017-who-statement-on-philip-morris-funded-foundation-for-a-smoke-free-world).

In line with FSFW’s usual rhetoric, the letter was replete with hand-wringing about the widespread use of tobacco and the enormous harms wrought by the epidemic, while barely acknowledging the herd of elephants in the room: the fact that its own funders continue to pursue growth in the combustible tobacco market, and actively undermine effective tobacco control.

The letter made much of FSFW’s independence from the tobacco industry, despite the fact that (to date) its website states that it is entirely funded by Philip Morris. Independent examination of its governing documents has found multiple loopholes regarding conflicts of interest, and concluded ‘…it is problematic that the Foundation’s fundamental purpose was decided on and its leader selected following a tobacco company-paid, privately negotiated arrangement with the Foundation’s president. It cannot be regarded as independent’ (available at: https://tobaccocontrol.bmj.com/content/early/2018/09/20/tobaccocontrol-2018-054278).

The audacity of the FSFW letter was particularly striking, given a series of articles published the previous day by The Guardian highlighting the tobacco industry’s funding (including Philip Morris) of thinktanks and free market organisations which help to advance tobacco industry interests. Over 100 organisations which receive tobacco industry funding have argued against tobacco tax increases, smokefree spaces, and plain packaging in countries around the world. Several groups which received donations from Altria also argued for the US Food and Drug Administration to approve Philip Morris’ heated tobacco product, IQOS. The Guardian articles can be accessed https://www.theguardian.com/world/series/tobacco-a-deadly-business). The Guardian article builds on existing evidence (much of it published in this journal) about tobacco industry interference in policy making, tobacco industry responses to the impact of the FCTC and use of third party groups for lobbying and advocacy.

The global public health community responded promptly to the FSFW letter; over 200 organisations and individuals signed an open letter urging WHO to continue to reject any partnership with FSFW. Less than a week after the public health community’s letter, a tweet from the WHO official Twitter account reiterated the WHO position, reaffirming it will not partner with FSFW or any other tobacco industry-funded group, with a link to its 2017 statement.

Japan: effective smokefree laws urgently needed

Despite its outstanding health record in other areas, Japan is a global laggard in tobacco control, and does not meet standards set by the WHO Framework Convention on Tobacco Control (FCTC), particularly for smoke-free public spaces. The widespread public exposure to secondhand smoke in Japan will come into sharp focus during July and August 2020, when the eyes of the world turn to Tokyo as the host city of the next Olympic and Paralympic Games.

In 2010, the International Olympic Committee (IOC) agreed with WHO to promote a smoke-free Olympics and Paralympics (IOC’s standards). From 2008, every Olympic and Paralympic host site has had smoke-free regulations. In anticipation of the 2020 games, there has been a nationwide push in Japan for smoke-free policy. The former Minister for Health, Labour and Welfare of Japan, Yasuhisa Shiozaki, expressed his support for a smoke-free policy by proposing new legislation in 2016 to prohibit indoor smoking in all public spaces, including restaurants and bars. The policy was strongly supported by the general public, patient groups, academia, and practicing health professionals. However, Shiozaki and other smoke-free policy supporters faced fierce opposition from pro-smoking politicians. As a result, the legislation was not submitted to the Diet (Japanese parliament) in 2017.

In March 2018, the Cabinet endorsed an alternative, watered-down smoke-free bill, which was passed in the Upper House on July 2018 and will be implemented in April 2020. This permits small restaurants and bars with floor space up to 100m2 to allow indoor smoking. Nearly 55% of restaurants/bars in Tokyo are below this threshold and will be exempt from being completely smoke-free. The legislation is much less effective than the original plan presented by Shiozaki in 2016. It had a 30m2 threshold, which would have applied to more than 70% of restaurants and bars in Tokyo. The weakened bill also allows restaurants and bars to have special smoking rooms in which customers are allowed to smoke electronic tobacco products while eating and drinking.

In order to ascertain Diet members’ perspectives regarding the smoke-free bill, we conducted a survey of Japanese parliament members. All 707 Diet members were sent questionnaires in February 2018. A total of 125 responded; a response rate of less than 18%. The response rate varied significantly by party: only 7.9% (32 of 407) of the members of the ruling Liberal Democratic Party (LDP) returned the questionnaire, compared with 34% (70 of 206) opposition party members.

Among respondents, there was high awareness about the risks of secondhand smoke. Ninety six percent were aware of the association between secondhand smoke and lung cancer and cardiovascular diseases. Similarly, 97% were aware that segregated smoking and non-smoking areas are ineffective in preventing exposure to secondhand smoke.

Despite this awareness, support for appropriate policies regarding smoke-free areas was sharply divided. About 55% suggested that new policies should make restaurants and bars completely smoke-free, regardless of size. On the other hand, nearly 25% answered that no restriction or smoke segregation policy should be applied, depending on the size. While 73% of opposition parties’ respondents (51 of 70) supported the smoke-free policy, only 31% (10 of 32) of LDP respondents agreed.

The questionnaire also addressed the perspectives of Diet members on what kind of secondhand smoke measures should be applied to meet the IOC’s standards on the premises of public facilities and other places that many people may visit during the Tokyo games. Slightly more than 34% agreed with smoke-free policies either on-site or indoors, but 48% indicated support for an option permitting installation of smoking rooms.

In Japan, Diet members are obligated to vote along party lines. However, this does not apply to certain situations for issues considered sufficiently controversial to vote according to one’s individual conscience. Nearly half (47%) of the respondents supported a conscience vote on the smoke-free bill. Respondents who supported entirely smoke-free policies in restaurants and bars were more likely to support a conscience vote than those supporting smoke segregation policies.

Given the low response rate to the survey, at 17.7% overall, and 7.9% for the ruling LDP, it is unlikely that those who did respond represented the wider population of Diet members. For example, three of the 125 (2.4%) of the respondents are known to receive donations from the tobacco and relevant industries. However, among all Diet members, studies have found that at least 140 of 707 (nearly 20%) of Diet members received tobacco industry donations between 2010 and 2015.

Most respondents from the opposition parties were against the smoke-free bill approved in July 2018 and preferred stronger protections from secondhand smoke, but opinions from LDP members were not unanimous. According to the Japan Society for Tobacco Control, the LDP as a whole has historically stronger ties with the tobacco industry (led by JT) than the other parties, and may have tried to weaken the smoke-free bill because of industry pressure. It is worth noting that tobacco industry contributions to political campaigns are neither prohibited nor transparent in Japan.

Strong protection from secondhand smoke would likely have a significant positive impact on population health in Japan, given that approximately 18 000 deaths were attributable to secondhand smoking in Japan in 2017. As demonstrated by the UK’s recent passage of smoke-free policy, political commitments to legislate smoking control policies based on scientific evidence are a key determinant of improvements in tobacco control and thus of public health success. Diet members, including Prime Minister Abe and the Minister for Health, Labour and Welfare, Takumi Nemoto, are expected to show their leadership and commit to the health of the Japanese people.

Promoting an open debate on the smoke-free bill, and allowing a free vote would be an important step forward. Implementing a comprehensive and effective smoke-free bill would signal a new commitment from the Japanese government to protect its own citizens. It is past time to cast aside Japan’s dismal tobacco control record and fully implement its obligations under the WHO FCTC. Apart from the urgent need to protect Japanese citizens, the forthcoming Olympic and Paralympic Games would be an opportunity to showcase fully smoke-free, impeccable Japanese hospitality as it hosts athletes and visitors from around the world.

This article was originally published on the Tobacco Control website. A full list of contributors, and links to additional information are at https://blogs.bmj.com/tc/2019/01/20/the-2020-tokyo-olympic-paralympic-games-time-for-japan-to-showcase-smokefree-hospitality/.

Shuhei Nomura

Haruka Sakamoto

University of Tokyo, Japan

nom3.shu@gmail.com

A screenshot of the LinkedIn profile of new Turkish vice trade minister, taken in early February – more than 2 weeks after Mr Turagay was appointed by the Turkish government. source: https://www.linkedin.com/in/r%C4%B1za-tuna-turagay-5030823/?originalSubdomain=tr.

A screenshot of Mr Turagay on the Turkish trade ministry website, taken in early February when his LinkedIn profile still listed him as a BAT employee. source: https://www.ticaret.gov.tr/kurumsal/riza-tuna-turagay.

Turkey: revolving door from BAT to trade Ministry

The start of 2019 marked a potentially historic step backwards for tobacco control in Turkey. On 17 January, Mr Riza Tuna Turagay was appointed as the Vice Trade Minister – straight from more than a decade of working in senior roles for British American Tobacco (BAT). Turagay’s name was deleted from BAT’s website shortly after the appointment, and did not appear on the Turkish government website nearly a week. In early February, his LinkedIn profile still showed him as a BAT employee.

Previously a Turkish civil servant, Turagay joined BAT in 2006. His most recent appointment was as BAT Turkey and Northern Cyprus Corporate Relations Director. The appointment was seen as an open declaration of tobacco industry interference by the shocked health and non-government community in Turkey, which published several statements and media releases emphasising the importance of Article 5.3 of the Framework Convention on Tobacco Control (FCTC).

In recent years, Turkey has been known as a global tobacco control leader. It was the first country in the world to put in place all six MPOWER measures at the highest level, an achievement recognised globally when Prime Minister Recep Tayyip Erdoğan was presented with the WHO Director-General’s World No Tobacco Day special recognition certificate in May 2013.

Turkish tobacco control measures include a ban on smoking in all indoor areas, raising cigarette prices, a full advertising ban, antismoking media campaigns, warnings on tobacco packaging, and increased access to cessation products and treatments. Turkey officially introduced plain packaging for tobacco products on 4th December 2018, the next step in its fight against smoking. Starting next year, all cigarettes will be sold in packaging without logos and without prominent display of brands

Despite this impressive record, there has been increasing concern that the government’s commitment to tobacco control and enforcing tobacco laws has been decreasing in recent years. This has been acknowledged in the official announcement of a sharp increase in the country’s smoking prevalence from 27% to 32%. Another ominous development shortly after the appointment of Turagay was the announcement by the Turkish health minister that smoking rooms of up to 30% of floor space would be allowed in restaurants, a dramatically regressive measure.

Turkey has been a party to the FCTC since 2004. The appointment of a tobacco industry executive to a government position would be unacceptable anywhere around the world. It raises serious questions about Turkey’s adherence to FCTC article 5.3 which requires avoiding conflicts of interest between government officials and tobacco company employees and minimizing industry influence on policy. Trade policies directly impact on tobacco consumption and public health.

The hard-won achievements that turned Turkey from a nation synonymous with tobacco to a tobacco control champion must be protected. Tobacco control can only be successful by fighting the pernicious influence of the tobacco industry. Turagay’s previous employer BAT had made public declarations about their plans in Turkey and set a goal to increase tobacco consumption. Turkey is at a crossroads: will it continue to choose public health, or will it put the interests of the tobacco industry first?

Elif Dağli

Health Institute Association, Turkey

elifzdagli@gmail.com

Malaysia: new health Minister a boost for Smokefree Malaysia

The change of government in Malaysia in May 2018 has seen a new tobacco control champion emerge in the form of the new Minister of Health, Datuk Seri Dr Dzulkefley Ahmad. Prior to his political career, Dr Ahmad, who has a PhD in toxicology from Imperial College, was a medical science lecturer at Universiti Sains Malaysia.

Dr Ahmad’s biggest impact to date as Minister of Health has been to enforce a smoking ban on all eateries (all air-conditioned and non-air-conditioned restaurants, coffee shops, as well as open-air hawker centres and street stalls) in Malaysia, commencing with educational enforcement for 6 months from January first 2019 followed by full implementation from June first, 2019. People caught smoking in prohibited areas will be fined RM10,000 (USD2400) and eateries found not enforcing the ban will be fined RM2,500 (USD600).

As expected, there has been resistance. A Smokers Rights Club, formed by seven disgruntled smokers, threatened to sue the government on the grounds that the ban breaches the Federal constitution. Dr Dzulkefley’s reply was ‘see you in court’, a response that has dampened the ardour of other challengers and gained the respect and support of many more in the country of 32 million people where the number of estimated smokers is 5 million, mostly men.

Since the smoking ban started, families with young children can now be seen in many eateries for the first time. Following implementation, attitudes have also changed among some businesses. Pelita, a large local eatery chain and a member of the Malaysian Muslim Restaurant Owners Association (PRESMA), was one of the few non-governmental groups opposed to the implementation in late 2018. It has now pledged to end the sales of cigarettes.

In a recent survey by the International Islamic University, seven out of 10 retailers, including coffee shops and eateries, were found to be recipients of incentives from the tobacco industry aiming to boost cigarette sales.

The policy shift is having a snowball effect on public support for a Smoke Free Malaysia by 2045. Civil society groups are urging the government to expand smoke free legislation from government buildings to all workplaces, laundrettes and hotels in the country; and the State of Perak has included a Quit Smoking logo on the new Perak State Football Club jersey, a first in Malaysian sports.

Amer Siddiq Amer Nordin

Christopher Bullen

University Malaya, Malaysia

amersiddiq@um.edu.my

Netherlands: National Prevention Accord to improve health and reduce smoking

The Netherlands has been criticised for its slow implementation of FCTC measures, with even a short period of reversal of tobacco control progress between 2010 and 2012. More recently, however, the government has taken a much more positive stance towards tobacco control. One year ago, a four-party coalition came to power, comprising two conservative parties (VVD, CDA) and two progressive parties (D66 and CU). The coalition agreement included the promise to allocate €170 million to tackle alcohol abuse, tobacco consumption and obesity. A National Prevention Accord (NPA) was to be drafted in close corporation with civil society, leading to a selection of policy measures that should both be evidence-based and sufficiently supported by civil society.

A lengthy consultation process was set in motion, with a broad selection of societal and public health organisations asked to commit and contribute to reaching a smoke free generation through their own activities. Although the food and alcohol industry were involved when the talks were about obesity and alcohol, tobacco and e-cigarette representatives were not invited, in line with Article 5.3 of the Framework Convention on Tobacco Control (FCTC). Paul Blokhuis, the responsible State-Secretary for Public Health launched his policy intentions as part of the NPA on November 23rd.

With the NPA, the new government aims to achieve a 100% smoke-free generation and reduce adult smoking prevalence to 5% by 2040. To achieve these long-term aims, the NPA contains important measures for the next several years. These include an increased budget for mass media campaigns and smoking cessation support, an end to smoking sections in cafés and bars, extension of smoke-free areas to include use of electronic cigarettes, plain packaging on tobacco products, smoke-free outdoor school areas, a ban on the point-of-sale display of tobacco, starting in supermarkets, and annual price increases in the pack of cigarettes from around €6.50 now to €10 in 2023. The National Institute for Health and Environment will monitor and periodically report on the NPA’s progress towards reaching the goal of 5% smokers in 2040, stimulating future governments’ commitment to the NPA.

Tobacco control advocates in the Netherlands are hopeful and optimistic about the current state of affairs, but also remain alert, since some of the policy measures still need to be approved by the Dutch parliament. The tobacco industry is also known to vehemently lobby against the NPA, for example through a campaign in which it portrays the government as patronising and paternalistic.

This article was first published on the Tobacco Control website at https://blogs.bmj.com/tc/2018/12/11/netherlands-national-prevention-accord-to-improve-health-and-reduce-smoking/.

Dirk Jan A van Mourik

Marc C Willemsen

Maastrich University, The Netherlands

d.vanmourik@maastrichtuniversity.nl

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

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

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