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The disintegration of the former Soviet Union into separate nation states was accompanied by an unruly stampede by the transnational tobacco companies, falling over themselves to buy up the formerly state owned tobacco factories. Was it just the opportunity to take over going concerns at knock down prices, or more the chance to get into markets that had been denied them up to that time? Or was the most attractive feature the already high smoking rates, resulting from years of negligible health education and the implicit promotion of tobacco as an essential part of human existence, which along with alcohol was used as a regulator of cash in the economy? All these were no doubt obvious attractions at the time, but there is another which, at least to observers in the health professions, is only now beginning to be fully understood.
When companies such as British American Tobacco (BAT) moved into the countries euphemistically known as the new democracies of Europe, they were, in actual fact, moving into cultures little changed from the former Soviet times. They were buying not only the factories, the markets and the labour, but passports to unfettered action as well. For while these nations' economies were quickly transformed from the former “socialist”, centrally planned economic systems into market economies, the culture that accompanied them remained—and continues to remain—remarkably intact. Power controlled by a small, mostly unelected elite, protected from criticism and lionised as economic saviours; an almost total freedom of action, with no real accountability for the consequences; and censorship of the news media: these were among the old, “red” culture's distinctive features. Ironically, if the actors have changed, the basic scenery and script remain largely recognisable, and the very infrastructure that barred the way of the tobacco companies in the past is turning out to be among the most valuable things the new “brown elite” has acquired.
Uzbekistan provides a striking example. It is a large nation, dwarfing several western European countries. It is over three times the size of England, but with only half the population; just the tragically ruined and polluted area of the Aral sea, which lies within it, is one and a half times the size of Denmark. To BAT, no doubt, Uzbekistan is first and foremost a large, ready made market. Of its 25 million inhabitants, many are already smokers, most having picked up their addiction in Soviet times. But there is still scope for more to get hooked, and especially for women to catch up with the men. Perhaps most salivating of all to a tobacco salesman is the fact that over half the population is under 15 years of age. Health organisations are well aware of the burden of disease that already results from past smoking, of course, but feel virtually powerless to do anything about stopping its inexorable rise in the future. It is not only a question of the relative lack of power compared to massive transnational companies which have bought their country lock, stock and ashtray, but an absurd imbalance of resources.
True, the country passed a tobacco control law, but it was never implemented. Admittedly, when tobacco control experts from the World Health Organization were due to arrive in 1997, the health ministry reckoned it had better have a tobacco programmes coordinator, so it appointed one, a busy cardiologist. He did his best, which was better than the nothing the ministry had done before, but in fairness, having no salary for the extra job thrust upon him, and no budget to spend, it was clear from the outset that there was little he could achieve. When he stepped down from the role (though diligently continuing his anti-tobacco efforts in his clinical work), a successor was appointed, but still without salary or budget. When the monthly salary required to fill such a post is probably less than a tobacco company pays to fill the fuel tank of just one of its promotional vehicles—US$15–20 per month—is it really beyond the reach of the government to spend such a sum on starting to tackle the country's tobacco problem?
Contrast this situation with what the WHO delegates found when they arrived at the capital, Tashkent. While they, accredited WHO representatives as they were, had to wait three hours in different lines to be processed by immigration and customs, they saw someone who was able to walk freely through the immigration area to identify the people he was meeting, whom he then simply invited to follow him VIP style through to the waiting transport. The nature of his pass for being able to exercise such privileges? A sign with BAT's name and tobacco leaf logo. Another representative of the brown elite was waiting with a sign bearing RJ Reynolds's name.
The team from WHO noted that BAT had been attempting—and apparently succeeding—to buy goodwill by giving money to health care institutions; for example, it paid for a modern clinic in Samarkand, site of its main plant. Perhaps more remarkable, they found other health institutes which had been offered money by BAT, but whose desperate need for funds was matched only by the integrity of their leaders. Such heroic acts usually go unsung.
The WHO delegates also heard talk of a contract between BAT and the government, limiting the anti-smoking measures the government could take—perhaps it fixed the maximum to be spent at less than $15 per month? They saw a massive amount of tobacco advertising—ubiquitous billboards, whose mild health warnings in small print at the bottom was impossible to read from any distance. According to their report, there were numerous cigarette brand window signs and promotional awnings over shops, as well as a plethora of high quality plastic bags bearing tobacco ads. In a sort of tobacco advertiser's fantasy fulfilment, these bags were not only being used as shopping bags by the general population, but as briefcases by medical students. As in neighbouring countries such as Kazakhstan (see Tobacco Control 2000;9:269), BAT is busy with a much flaunted but worthless youth education programme, which probably enhances the adult allure of cigarettes for the next batch of “starters”.
Is the tobacco industry's exercise of power limited to more or less unfettered advertising and shady guarantees not to impede its sales by health promotion? With the sort of culture described above, which includes some of the secrecy of the former regime, it is hard to be sure, but all too easy to guess. For example, under the new constitution, Uzbekistan is supposedly free from the censorship that was routine in Soviet days, yet in reality, the apparatus of censorship still trudges on and little has changed except those being protected by it. Only this year, senior editors of a newspaper that had accepted a hard hitting story about the country's tobacco problem felt it wise not to publish it before lengthy sessions with the censors, conceding several cuts and changes along the way.
A few years ago, a less overt attack on tobacco in the news media resulted in some responses in kind: the sort where a few paid hacks were cranked up to write pieces with headlines like: “BAT is ours!” (reminiscent of patriotic utterances by the party hacks of the past, the Russian version scans); and advice that it is better not to smoke, but if you do, then at least smoke good quality (code for western) cigarettes. This time, however, Uzbek readers were spared this sort of nonsense, though some observers still fear delayed and perhaps hidden retribution.
In Soviet times, state interference in the press would not only have been perceived by the general population as routine, but journalists whose work was censored might even have seen it as a reassurance of integrity, the inevitable result of criticising the corrupt elite, possibly presaging eventual adoption by INDEX on Censorship. In modern Uzbekistan, it remains to be seen whether the abuse of power to protect the all powerful brown elite will become accepted as equally routine and inevitable.
Mathew Arnold's classic narrative poem Sohrab and Rustum ends by following the course of the Oxus river, beside which Rustum has unwittingly killed his long lost son in a duel of champions from opposing armies. The poem ends as the river struggles through miles of obstructions, “till at last/ The long'd-for dash of waves is heard, and wide/ His luminous home of waters opens, bright/ And tranquil, from whose floor the new-bathed stars/ Emerge, and shine upon the Aral Sea.” The Soviet Union so abused the Aral and diverted its tributaries, and allowed massive amounts of industrial pollution to end up in it, that it is now just a vast, dry, toxic wasteland, whose poison dust blows into neighbouring countries. If anyone questioned what was going on while this scandalous and irreparable environmental disaster was taking place, no doubt they were told the harm was greatly exaggerated, and reminded of the economic benefits of industrial progress. Unless the current government acts fast, and strips the tobacco industry of its extraordinary privileges, a comparable disaster will take place in the human landscape over the next quarter of a century, this one measured in tens of thousands of needless premature deaths.
All articles written by David Simpson unless otherwise attributed. Ideas and items for News Analysis should be sent to David Simpson at the address given on the inside front cover.