From Tobacco Info No. 10 - August 2012
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WHO Director-General Margaret Chan attacks Big Tobacco

The 15^th World Conference celebrates Australia’s plain packaging and explores endgame ideas

By Geoffrey Lansdell

Dr. Margaret Chan, Director-General of the World Health Organization, opened the 2012 World Conference on Tobacco or Health (WCTOH) by blasting the tobacco industry for systematically subverting government policies throughout the world:

“This conference is being held at a time when we are at a crossroads in our efforts to rid the world of a killing addiction,” said Dr. Chan. “Why do we need to control tobacco? Because Big Tobacco — the despicable industry — is using all sorts of tactics to compromise and undermine the efforts of countries that take public health actions to protect the health of their people. This conference is extremely important for us to galvanize in solidarity, in support of the countries that are being taken to court by the industry. Australia, Norway, Uruguay, and Turkey are being intimidated and challenged by the industry for taking actions to protect their people.”

Later in the conference, which was held at the Suntec Singapore Convention Centre in the Republic of Singapore from March 19 to March 24 and attended by 2,600 delegates representing 129 countries, Dr. Chan spoke of the global importance of eradicating tobacco use, especially in a time of financial turmoil.

“In a world undergoing economic upheaval, with populations ageing, chronic diseases on the rise, and medical costs soaring, tackling a huge and entirely preventable cause of disease and death becomes all the more imperative. We have an instrument for doing so — the WHO Framework Convention on Tobacco Control (FCTC).”

The FCTC was developed by the World Health Organization in response to the globalization of the tobacco epidemic, and with 174 signatory countries, it is considered one of the most widely embraced treaties in United Nations history.

The Canadian contingent

Historically, Canada has been a leader in tobacco control. At the 2012 World Conference, however, Canada had no national story to tell and no political representation. Although Canada has introduced updated graphic warnings that now cover 75 per cent of cigarette packs, the biggest tobacco-control story happened shortly after the WCTOH when funding for the Federal Tobacco Control Strategy (FTCS) was cut by 35 per cent.

With the latest round of cuts, the FTCS was reduced by $40 million over the last six years, from $68 million in 2006 to $28 million for the 2012 fiscal year. Despite the funding cuts and the lack of progressive governmental anti-tobacco measures in recent years, Canada was extremely well represented at the WCTOH with 71 delegates, including epidemiologist Prabhat Jha and journalist Stan Shatenstein, who both received Luther L. Terry Awards for their exceptional contributions to the field of tobacco control.

During the conference’s plenaries and panel discussions, Canada was also represented by an array of researchers and advocates. With twelve presenters, only the United States and India had more speakers in Singapore than Canada, but it was Australia that stole the show, having surpassed every other country over the past few years with new developments in packaging, taxation, mass media campaigns, and government funding for tobacco control initiatives.

Australia’s plain packaging bill

Australia’s Tobacco Plain Packaging Act was by far the most celebrated achievement at the WCTOH, in large part because it has elicited genuine fear from the tobacco industry that Australia’s innovative legislation will catch on around the world the way graphic warnings did after Canada introduced them in 2000. With 174 countries having ratified the FCTC which mandates a comprehensive advertising ban including branding on cigarette packs, the pack really is the tobacco industry’s last bastion of advertising.

The Plain Packaging Act, which became law in 2011, enforces uniform packaging for cigarettes with no branding other than the brand name, which appears in a basic font on the drab brown portion of the pack.

In a plenary session on “Australia’s plain packaging experience,” Jane Halton, Australia’s secretary of the Department of Health and Ageing, spoke about the importance of having an integrated national approach to tobacco control.

“It’s a partnership between government, public health, and our bureaucracy. We need to be aligned if we are going to counter the sneaky, underhanded behaviour of Big Tobacco,” said Halton.

In her introduction to the Luther L. Terry awards ceremony, Dr. Chan drew special attention to “the courage of the Australian government in introducing the plain package.”

On the strength of their pioneering legislation, Halton’s Department of Health and Ageing received a Terry medal for Outstanding Leadership by a Government Ministry, while Michael Daube (Distinguished Career) and Melanie Wakefield (Outstanding Research Contribution) also received Terry awards, at least in part for their roles in promoting plain packaging.

Endgame ideas: attacking the vector

Some tobacco-control groups have been advocating for governments to develop a tobacco endgame strategy, and a few governments have taken steps down that road. But is it possible to achieve near-zero smoking prevalence through a calculated plan to either phase out tobacco use or to impose an outright ban on the sale of tobacco?

Ruth E. Malone, editor of  Tobacco Control, defined the tobacco endgame as something that “addresses tobacco as a system issue, not as an individual behaviour issue; it addresses both the health and the political aspects of the tobacco epidemic; and finally, it involves a fundamental de-normalization not just of tobacco use, but of the tobacco industry.”

The idea of a tobacco endgame is a hot topic in the field of tobacco control, and several countries have strategies to end tobacco use, including New Zealand, Finland, Singapore, Bhutan, and the Australian island of Tasmania, but questions remain in all of these countries as to whether their respective plans will be implemented.

One of the most innovative endgame strategies was developed by Heng Nung Koong from Singapore’s National Cancer Centre. The movement is called Towards Tobacco-Free Singapore. Its ambitious goal is to convince politicians in Singapore to ban the sale of tobacco products to anyone born in or after the year 2000.

As Judith Mackay, special advisor to the World Lung Foundation summarized, “The idea is that no child born after January 1, 2000 would ever be able to buy cigarettes in Singapore. I don’t just mean until they’re 18, but never, so that there’ll be a whole smoke-free generation.”

Koong’s proposal has gained a lot of popular support in Singapore and among tobacco-control advocates globally. The Singaporean government is cautiously considering the proposal. Ang Hak Seng, CEO of Singapore’s Health Promotion Board, offered this assessment of the proposed ban: “Banning tobacco is not such a simple thing. There are many stakeholders, and the solution must not polarize the community. It’s an interesting idea that we are studying and assessing for its feasibility, but there are challenges.”

While phasing out tobacco use is one endgame possibility, Cynthia Callard, Executive Director of Physicians for a Smoke-Free Canada, offered a more global perspective on the tobacco industry’s ability to find new smokers and the need  to address the root source of the problem — the tobacco industry itself.

“If you think the tobacco industry is able to adapt its clients in the same way it adapts its products, you’ll see that we have a more intractable problem. Even in countries where we think we’re doing very well, if we stop talking about prevalence and start talking about the absolute number of smokers, we haven’t made much progress at all. There were six million smokers in Canada in 1965, and there are six million smokers in Canada today.”

“If we want to do better, we have to do things differently,” Callard continued. “One of those things is to control the vector of the disease. We focused for the first 25 years of our modern tobacco control on the smoker — educating children not to smoke and trying to convince people to quit. Then we went to the next phase by banning advertising and having smoke-free public spaces. But our efforts on the tobacco companies themselves have been far more modest.”

Robert Proctor, a Stanford historian whose recently-published book Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition received rave reviews for its thorough analysis of tobacco industry documents, picked up on the idea of attacking the vector with an eloquent 10-point critique of the conspiratorial and manipulative nature of the industry, which drew a rousing ovation:

“For those people we hear saying that the industry has come clean, I’d like to point out that I’m not aware of any tobacco company that’s ever admitted that millions of people die every year from cigarettes. There’s never been a tobacco company that’s admitted nicotine addiction causes death. There’s never been a tobacco company to admit having marketed deliberately to children. There’s never been a tobacco company that has admitted lying to the public. There’s never been a tobacco company that has admitted to conspiring to hide the hazards of smoking. There’s never been a tobacco company having admitted to manipulating the chemistry of nicotine to optimize, create, and sustain addiction. No tobacco company has ever admitted that filters are completely fraudulent. No tobacco company has ever admitted that the cigarettes sold today are as deadly as any ever sold. No cigarette company has ever admitted that cigarettes are as addictive as heroin or cocaine. And no cigarette company has ever admitted that cigarettes are among the world’s leading cause of forest fires and death by fire. And finally, no cigarette company has ever apologized for any of the ten things I just mentioned.”

Proctor, who favours an outright ban on the sale and manufacturing of tobacco products, has also submitted a 102-page expert report that has been entered into evidence in the $27 billion class-action lawsuit against Big Tobacco currently taking place in Montreal.

Proctor’s expert report details the sordid history of the Canadian tobacco industry, and like Golden Holocaust, provides a thorough analysis of the industry’s internal documents. Proctor is scheduled to testify in early 2013, and his testimony could help deal a death blow to the Canadian tobacco industry. It is believed that if the plaintiffs are awarded anything close to $27 billion, it would bankrupt Big Tobacco in Canada.

And perhaps a bankrupt industry will prove to be the great Canadian endgame.

FCTC Article 5.3: Preventing tobacco industry interference in government policy

Throughout the conference, one theme kept recurring: it is time to move from monitoring the tobacco industry to attacking the industry in order to prevent transnational tobacco companies (TTCs) from interfering with tobacco-control policy decisions.

The opening sentence of FCTC Article 5.3 states: “The tobacco industry has operated for years with the express intention of subverting the role of governments and of the WHO in implementing public health policies to combat the tobacco epidemic.” The purpose of Article 5.3 is to provide a framework for countries to prevent tobacco industry interference in policy decisions and to protect tobacco control from the tobacco industry’s commercial interests.

Stella Bialous, president of Tobacco Policy International, points out that, “Two ways to move in that direction (away from just monitoring) are social investment funds and government divestment of shares in pension funds. There are only two countries that have divested their entire pension funds of tobacco stocks out of 174 countries that have ratified the FCTC.” New Zealand became the first country to divest their state-controlled pension funds in 2007 by dumping NZ$37.6 million of tobacco stocks. In 2010, Norway followed suit by divesting $2.1 billion in tobacco stocks.

“As far as de-normalizing tobacco companies with other businesses,” Bialous concluded, “we are doing a terrible job.”

In short, until governments and non-tobacco corporations take the tobacco pandemic seriously and stop investing in tobacco stocks and doing business with Big Tobacco, tobacco companies will remain hugely profitable.

Further complicating the situation and contributing to the growing profitability of tobacco companies is that it has become very easy to use corporate social responsibilities (CSRs) to their advantage. CSR policy is meant to act as a self-regulating mechanism in which a business monitors its own activities to ensure compliance with the spirit of the law, ethical standards, and international norms.

By moving factories and tobacco farming from wealthy countries to the developing world, TTCs are able to bring jobs to poor countries while saving on their costs. Tobacco companies have also become savvy at donating to relief agencies that are always looking for aid, making the donations difficult to turn down even though such actions constitute a form of marketing.

According to Gregory N. Connolly, director of the Center for Global Tobacco Control at Harvard’s School of Public Health, “The industry has a strategic plan for engaging developing countries and transforming markets.” The first phase is for TTCs to go into developing markets and “buy the (local) tobacco industry out.”

As the consolidation of TTCs continues, Connolly points out that we can expect to see the continued migration of manufacturing and agriculture out of higher income countries and into lower income countries. Not only is it cheaper to operate in the developing world, but Big Tobacco has a much easier time impacting public policy and runs less risk of facing multi-billion dollar class-action lawsuits and healthcare recovery claims.

As this migration continues, it becomes increasingly difficult to monitor the activities of the tobacco industry, but this is where the Cigarette Citadels Mapping Project comes in.

The Cigarette Citadels Mapping Project

“The FCTC has some great strengths,” according to Matthew Kohrman, associate professor in the Stanford University anthropology department, “But it also has some fundamental weaknesses. One of its greatest weaknesses is that it’s largely a demand-side document that places the responsibility on advocates, governments, smokers, and potential smokers. What does that leave out? It leaves out the industry to an enormous degree.”

In response to this shortcoming, Kohrman developed the Cigarette Citadels Mapping Project, “To provide new optics for thinking about this area of health concern.” The Citadels project uses internet applications — mostly Google Earth and Google Maps — to map cigarette factories throughout the world.

“This project lets anyone observe precisely in what communities around the world cigarettes are being produced,” Kohrman says. “It also leverages satellite technology so you can zoom down and learn next to which neighbourhood schools, hospitals, and other services the industry has embedded their factories.”

Although the implications of this innovative project remain unclear, part of its goal is to provide researchers with a new direction of study. Prior to the launch of the Citadels project in September 2010, there was no single resource that detailed the location and production amounts of cigarette factories around the world. To date, the project has mapped over 450 factories, five of which are in Canada: there is a Philip Morris (parent company of Rothmans, Benson & Hedges) factory in Quebec City and JTI-Macdonald plants in Montreal and Brampton; and there are two smaller factories — one in Ohsweken, Ontario (Grand River Enterprises) and one in Odanak, Quebec (Abenaki Enterprises / Choice Tobacco). This does not include the estimated 50 illegal factories producing and distributing cigarettes.

Conspicuously absent from the Canadian picture is Imperial Tobacco Canada (ITC), which, like most large manufacturers, has moved its factories from high income countries such as Canada to lower income countries. In ITC’s case, its last two large Canadian plants in Montreal and Guelph were closed in 2003 and 2006, respectively. Operations were moved to Monterrey, Mexico, where essentially all of ITC’s products are made and then shipped to Canada.

One of the significant achievements of the Citadels project is to create a mapped database with information on each factory, providing exact locations, phone and fax numbers, number of employees, and a general description of what brands each factory produces and for what markets the tobacco is targeted.

To explore the map, visit https://www.stanford.edu/group/tobaccoprv/cgi-bin/wordpress/

Bloomberg promises additional $220 million to fight tobacco epidemic

In his introductory speech to the Bloomberg Awards for Global Tobacco Control, philanthropist and New York City Mayor Michael Bloomberg announced that Bloomberg Philanthropies will be committing an additional $220 million over the next four years to fund global tobacco-control initiatives.

“We need to focus our efforts where the most smokers live and where the tobacco industry is employing its most destructive tactics. We need to encourage governments to wield their single most effective weapon — the raising of taxes. And we need to continue to work with governments to pass effective tobacco-control policies. That is the fight ahead.”

The most daunting aspect of ‘the fight ahead’ may be the fight against Big Tobacco’s money. As Dr. Chan highlighted on several occasions in Singapore, the tobacco industry has extremely deep pockets and is notoriously ruthless in filing suit against any new public health measure that targets tobacco.

In Australia, four transnational tobacco companies (TTCs) have taken the government to court over its plain packaging legislation. In Canada, the United States, and Uruguay, tobacco companies have challenged new government measures on graphic warnings. In Norway, Philip Morris has challenged the Norwegian government’s display ban.

In all of these cases, and many before them, Big Tobacco’s strategy is to let everyone in the world know that any new tobacco-control law will be challenged in a drawn-out legal battle that will cost the government a lot of money. For a low-income nation, fighting Big Tobacco over several years in court can be financially devastating. This is precisely why TTCs are increasingly moving into developing nations. It is also the reason Bloomberg Philanthropies supports governments and NGOs with a focus, according to Mayor Bloomberg, on “Low- and middle-income countries where 80 per cent of tobacco-related deaths occur”.