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December 1998 was a busy time for British Columbia’s “Tobacco Industry’s Poster Child”. In Vancouver, preparations were underway for a World Health Organisation (WHO) meeting to forge an international treaty on tobacco control and the poster child poster was prominently displayed. In Vancouver, Dr Douglas Bettcher, coordinator of the WHO’s framework convention on tobacco control team, and a native of Alberta, Canada, discovered the poster child model was one of his cousins. He invited the model, Christine Hemmerling of nearby Maple Ridge, to address the convention delegates.
Creating the “Tobacco Industry’s Poster Child”
The British Columbia Ministry of Health, working with NOW Communications of Vancouver, set out to create an image that conveyed the damage that could actually happen to a young, supposedly invulnerable smoker. It was decided to portray a young girl, about 14, because smoking among girls is increasing more rapidly in BC than among boys. She was to be recognisably pretty, except for the damaging effects of tobacco.
The goal was to have a pre-teenager look at the poster and think “This could happen to me”. There was an additional objective—to link the damage to the tobacco industry itself. The poster’s original headline “Smoke Damage”, didn’t accomplish that goal, so the agency developed a headline—“Tobacco Industry’s Poster Child”—that mocked the poster child imagery of good causes.
The poster child picture was inspired by issue 21 ofColors magazine, published by the Benetton company in the summer of 1997 (< http://www.ashaust.org.au/wsd.html >). Each edition of the magazine deals with a particular social issue, and issue 21 focused on smoking. It included a collage of a human body made up of photographs of damage caused by tobacco: hair loss, cataracts, tooth decay, tumours, and diseased lungs. The effect was shocking, revolting, and riveting. The challenge was to capture all of that in a single image to convince kids that damage from smoking doesn’t just happen after 30 or 40 years.
The poster child picture illustrates several of the principles that are key to BC’s tobacco strategy: taking on the industry itself; presenting carefully tested information to young people in a straightforward, direct yet dramatic manner; and putting the work and experience of others to good use, adapting as necessary for British Columbia.
The same week, a new animated billboard of the poster child was mounted throughout Vancouver. It began with an image of a lovely young girl holding a flower. The image then metamorphosed into the now familiar “Tobacco Industry’s Poster Child” with the diseased lung, cancerous gums, stained teeth, yellowed fingers, and wrinkled skin (figure 1).
The WHO meeting, which took place on 2–4 December 1998, and the billboard, were part of a series of British Columbia’s Tobacco Strategy activities over the past year. These activities included a number of firsts for the province’s tobacco initiatives and positioned the British Columbia government as a leader in tobacco prevention and reduction throughout Canada.
The Honorable Penny Priddy was appointed minister of health and minister responsible for seniors in February 1998 (figure 2). Priddy says the goal of British Columbia’s tobacco strategy is to protect British Columbia’s children from becoming addicted to the tobacco industry’s deadly products. “When I first began as Minister of Health, I heard some disturbing statistics: every day in British Columbia, 20 more children start smoking. That’s almost the average size of a classroom of 11-year-olds,” Priddy said. “Most of those kids will become addicted, and half of those addicted will eventually die of a smoking related illness.”
Soon after taking on her new portfolio, Priddy introduced landmark legislation to increase the penalties for retailers convicted of selling cigarettes to young people under the age of 19. In addition, amendments were passed to the Tobacco Damages and Health Care Costs Recovery Act—legislation passed in 1997 to authorise the Government of British Columbia and assist individuals to launch court action to seek damages for costs incurred as a result of tobacco-related illness.
On 12 November 1998, the province became the first in Canada to launch a lawsuit against tobacco companies to recover health costs. The statement of claim alleges that the tobacco companies knew, or ought to have known, of the addictive nature and dangerous health effects of tobacco use for many years and that they failed to warn consumers of the risks of smoking. Several other Canadian jurisdictions including Manitoba and Newfoundland have expressed serious interest in launching similar action.
British Columbia became the first jurisdiction in the world to bring in regulation requiring detailed reports from tobacco companies on ingredients and additives in cigarettes and chemicals in tobacco smoke. In December the information was published on < www.cctc.ca >, the website of the Canadian Centre for Tobacco Control, which is recognised nationally as a source of information on tobacco. “We took a lot of action last year, and I’m proud of the progress we have made,” Priddy said. “Comparatively, British Columbia is a small jurisdiction, but we proved you can take on big tobacco and hold them to account.”
The tobacco strategy was launched in June 1997. Lillian Bayne, assistant deputy minister in British Columbia’s Ministry of Health, said British Columbia had a long-standing tobacco reduction programme that focused primarily on prevention and cessation. They developed a new, comprehensive strategy that included action aimed at holding the tobacco industry to account, increased funding for programmes, and a mass media public education campaign. “We felt that in order to be successful, we would need to take action at all levels: education, prevention and protection, and regulation,” Bayne said. “It is difficult for anyone, even government, to counter the promotional power of the tobacco industry. The recent court action in the United States produced evidence of the practices of the tobacco industry in targeting kids, failing to disclose information about the harmful chemicals in tobacco smoke, and suppressing research about the addictive nature of tobacco.”
Cynthia Callard, executive director of Physicians for a Smoke-Free Canada, says governments need to legislate to change the industry’s behaviour. “The experience has been that without strong regulation and pressure by governments to force tobacco companies to behave in the public interest, they won’t do it.”
The strategy is starting to make a difference. Smoking rates in British Columbia are the second lowest in the country, and well below the national average. According to the most recent Statistics Canada National Population Health Survey,1 smoking decreased among Canadians aged 15 and over between 1994/1995 and 1996/1997 from 31% to 29%. In comparison, a 1997 British Columbia survey showed that 23% of those aged 15 and over smoke.2
British Columbia has published information it has received from the tobacco companies on cigarette ingredients and additives and smoke chemical content. “Most people don’t know what they’re inhaling when they smoke and many believe that light or mild cigarettes are safer,” Callard said. “British Columbia’s reports show there’s no difference in the amounts of chemicals in light or regular cigarettes, and that there are higher levels of harmful chemicals in second hand smoke than in the smoke inhaled through a cigarette filter. This can be used by governments or researchers to develop further evidence of the health impacts of tobacco.”
In addition to legislation and legal action, British Columbia’s approach includes a C$5 million programme of tobacco prevention, protection, and cessation initiatives. These include tobacco prevention resources for teachers in classrooms and a new youth cessation programme.
One programme that is getting a lot of attention is the Critics’ Choice contest—an innovative way to involve young people in tobacco prevention. In Critics’ Choice, young people of high school age review the best and latest television messages from jurisdictions around the world, including those developed in British Columbia. In previous years, British Columbia has aired hard-hitting messages from the states of California and Arizona, and the commonwealth of Massachusetts.
This year, British Columbia students chose the Australian “Aorta” as the message they felt would have the most impact in preventing young people from starting to smoke. “Aorta”, which was the subject of a previous cover essay in Tobacco Control(1998;7:5–8), shows a physician’s gloved hand squeezing fatty deposits out of a smoker’s aorta the way you would squeeze glue from a tube.
The public education campaign also includes an award-winning website: < www.tobaccofacts.org >; and the popular poster campaign featuring the “Tobacco Industry’s Poster Child” (figure 1), and “Sucked In—Here’s What’s Hiding in Cigarettes” (figure 3). The posters have been distributed around the province, and requests for copies have come in from across Canada and around the world. The images have also been adapted for use on buses and in transit stations.
Shelley Canitz, director of British Columbia’s tobacco strategy, said that the government is facing challenges by the tobacco industry along the way. In September 1998, the Canadian Tobacco Manufacturers’ Council—which represents Canada’s three major tobacco companies—opened an office in Vancouver and began an advertising campaign against the government’s efforts.
Other tobacco industry actions have included a direct mail campaign to British Columbia retailers and constitutional challenges to two of BC’s major pieces of legislation: the Tobacco Damages and Health Care Costs Recovery Act, and the Tobacco Sales Act Tobacco Testing and Disclosure Regulation. Canitz said they expect to meet the tobacco industry in court for the first time in October 1999, to fight the constitutional challenge filed against the Tobacco Damages and Health Care Costs Recovery Act by Canada’s three major tobacco companies: Imperial Tobacco Ltd, RJR-Macdonald Inc., and Rothmans, Benson & Hedges Inc.
Health minister Penny Priddy says that tobacco industry action won’t deter the government from pressing ahead with the tobacco strategy. “Last year we focused on setting the groundwork to launch the major initiatives. This year we’ll expand our tobacco programs, develop new public education messages, and meet the challenges posed by the industry. I have appointed a Teen Tobacco Team to advise me and I am confident they will come up with exciting, new ideas to directly involve young people in creating the messages and programs to protect kids from tobacco.”
It is expected that this will be another busy year for British Columbia’s “Tobacco Industry’s Poster Child”, which has just undergone its second print run. An additional 30 000 posters are now being distributed throughout British Columbia and Canada, and indications are that it will prove just as popular as last year.
Reports on ingredients and additives in cigarettes, and constituents of tobacco smoke are available in English and French at< www.cctc.ca >.
Note to readers
We hereby solicit your ideas and contributions for future covers of Tobacco Control. As with previous covers, we would like future covers to be colourful and creative—with a tobacco control theme. Original artwork, anti-tobacco posters, photographs, and cartoons may all be considered. Material with an international flavour would be particularly desirable. A cover essay will generally appear in each issue to provide appropriate background information and commentary on the cover.
Please send ideas and submissions (original or high-quality, camera-ready photographs) to the editor at the address on the inside front cover.—ed