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The European Alcohol Policy Alliance
(EUROCARE) is an alliance of non-governemental and public health and well-being
organisations. It advocates the prevention
and reduction of alcohol related harm in
Europe through effective and evidence
based alcohol policy, www.eurocare.org
I
I
I*
EUROCARE
The European Alcohol Policy Alliance
ff Eurocare is an alliance of non-
*•5 governmental and public health
and well-being organisations
with around 50 member organi® sations across 21 European
S
W countries. Eurocare is not affili■» ated and does not receive any
funding from the alcohol indus
try or any of its social aspect or
ganisations.
Member organisations are in
volved in research and advo
cacy, as well as in the provision
of information to the public;
education and training of volun
tary and professional commu
nity care workers; the provision
of workplace and school based
programmes; counselling ser
vices, residential support and
alcohol-free clubs for problem
drinkers; and research and ad
vocacy institutes.
Eurocare's vision is a Europe
where alcohol related harm is
no longer one of the leading risk
factors for ill-health and pre
mature death. A Europe where
innocents no longer suffer from
the drinking of others and
where the European Union and
its Member States recognise
the harm done by alcohol and
apply effective and comprehen
sive policies to tackle it.
I II I II I I—
Eurocare's mission is to prevent
and reduce alcohol
related harm in Europe. To that
end, Eurocare seeks to:
• Monitor all EU policy develop
ments that have an impact on
national alcohol policies
• Promote the development
and implementation of policies
that
are
effective
and
evidence-based
• Engage in dialogue with deci
sion makers to ensure that the
harms caused by alcohol (social,
health and economic burden)
are taken into consideration in
all relevant policy discussions
• Facilitate the collection, colla
tion, analysis, dissemination and
utilization of data on alcohol
consumption and related harm
within the EU and other coun
tries
• Create and nurture alliances
between organisations con
cerned with alcohol related
harm
aiiriMi
Alcohol is no ordinary commodity
- less is better
There is a mass of evidence that the
levels of alcohol related harm in any
population are correlated with the
overall level of alcohol consumption:
higher per capita consumption tends
to be associated with higher levels of
harm, lower consumption with lower
levels of harm .
Eurocare recommends that the
target for the EU should be reduction
of total alcohol consumption in
Europe by 2020, from an average of
12.5 litres to 9 litres per adult per
year.
____
New members are always welcome
to join £urocare. Send us an email to
get more information
;
■
I
i
!
i
II
Contact us:
A Cause for Action 1
Tel.: +32 (0)2 736 05 72
info@eurocare.org
www.eurocare.org
Alcohol is the 3rd leading cause of ill-health and death in the EU
Alcohol harms others
• Europe is the heaviest
drinking region of the world.
• Consumption
levels
in
some European countries
are around 2.5 times higher
than the global average.
• Alcohol is one of the top 4
risk factors for non-communicable diseases (NCDs), and
• The World Economic Fo
rum's 2010 Global Risks
Report identifies NCDs as
the second most severe
threat to the global economy
in terms of likelihood and po
tential economic loss.
• Alcohol is one of the 4
top risk factors for de
veloping NCDs such as
cancer and cardiovascu
lar disease.
• Alcohol is a toxic sub
stance in terms of its
direct and indirect ef
fects on a wide range of
body organs and sys
tems and a cause of
some 60 diseases.
•23 million people in
the EU are dependent
on alcohol.
• Use of alcohol is espe
cially harmful for young
er age groups.
•9 million children . and young
people in the EU living with at least
one parent addicted to alcohol.
• Approximately 30 000 Europeans
are killed -on the roads yearly.
Around one accident in four can be
linked to alcohol consumption, and
at least 10,000 people are killed in
alcohol-related road accidents in the
EU each year.
• Drinking alcohol during pregnancy
can lead to birth defects and devel
opmental disorders. It may cause the
unborn child physical, behavioural
and learning disabilities.
• There is a strong link between alcohol and violence. In some coun
tries, as ' much as 80% of violent
crimes committed by adolescents
are associated with alcohol use.
• Alcohol is the world's
number one risk for illhealth
and
premature
death for the core of the
working age population
(25-59 year).
• A 13% increase in work
absence can be expected
with an increase in con
sumption of 1 liter pure al
cohol.
• NCDs are estimated to
cause a €25 trillion global
economic output loss over
the period 2005-2030.
• The social cost attribut
able to alcohol is 155,8
billion Euro yearly.
Conclusions of the
EU Roundtable
on an Integrated
Approach to
Alcohol Related Harm
Three EU Roundtable meetings on an Integrated Approach to Addressing Alcohol
Related Harm were held in Brussels in November 2011, May 2012 and January
2013, and MEP Nessa Childers (S&D, IE) chaired the third Roundtable. The
concept of the Roundtable was initiated during discussions with the European
Commission and other stakeholders active in this area (including physicians,
patients and families affected by alcohol related harm) with the aim of
bringing together likeminded stakeholders for an exchange of views on alcohol
consumption, alcohol use disorders (AUDs), and the policy measures needed to
reduce alcohol related harm. The EU Roundtables on an Integrated Approach to
Alcohol Related Harm were facilitated by Lundbeck.
SIGNED (IN ALPHABETICAL ORDER)
www.alcoholconcern.org.uk
www.easl.eu
European Liver
Patients Association
ELPA
www.elpa-info.org
www.emna.org
www.eufami.org
eurcbare
www.eurocare.org
www.lundbeck.com
Conclusions of the Ell Roundtable
on an Integrated Approach to Alcohol
Related Harm
ALL THE SIGNATORIES OFTHESE CONCLUSIONS:
Support the renewal of the EU alcohol strategy and believe that it should encompass an
integrated approach to addressing alcohol related harm for Europe, which would entail pro
visions to encourage the prevention, early diagnosis and treatment of alcohol use disorders
(AUDs) and support the individuals and families suffering from the harmful effects of exces
sive alcohol consumption.
Although National Alcohol Strategies and the EU Alcohol Strategy1 have made progress in
addressing alcohol related harm, the problem of excessive alcohol consumption and the
negative effect it has on those suffering from AUDs, on their families and to society as a
whole, remains an overwhelming public health challenge that should be tackled through
targeted, evidence-based policy measures.
In light of:
• The overwhelming social stigma of people suffering from AUDs and related harm, which
results in extremely worrying levels of under recognition, detection and treatment of
AUDs;
• New data published in 2012 on alcohol consumption and the value to society and in
dividuals of reducing alcohol consumption to address the burden caused by alcohol in
Europe";
• Data on prevention'";
• Data on the low diagnosis'7 and treatment rates7 of alcohol dependence in Europe;
• Available data which estimates the social costs attributable to alcohol at €155.8 billion
in Europe in 2010";
• Scientific evidence showing that alcohol is a small molecule that easily penetrates the
brain7' and affects the individuals’ motivational I reward system in a way that can lead
to dependence7" 7""x;
• The Global status report on alcohol and health11 that shows that alcohol is also a major
risk factor for more than 60 major types of diseases and injuries and a component
cause in 200 others, including alcoholic liver disease (ALD), neuropsychiatric disorders
and AUDs such as alcohol dependence, cardiovascular diseases (CVDs), Fetal Alcohol
Spectrum Disorders (FASD), cancer, diabetes;
All signatories agree that an integrated policy approach to addressing alcohol related harm
should include the following components:
DATA COLLECTION ■
An integrated and comprehensive approach to alcohol policy interventions rests on sound
evidence. Data on alcohol consumption, its burden and the related direct and indirect costs
across the EU must therefore be improved. There is a need for standardised condition cod
ing and data collection systems in order to improve the ability to compare, disseminate
and replicate studies across the EUxlx"xi". In addition, effective monitoring systems to as
sess the impact of existing policies are needed.
Conclusions of the EU Roundtable on an Integrated Approach to Alcohol Related Harm
PREVENTION
There is a clear need to increase efforts to prevent excessive alcohol consumption as it
is the second leading risk factor for disease burden in Europe’, and AUDs are the leading
cause of disability in menx,v. Evidence also suggests that the earlier people start drinking
the higherthe risk of developing AUDs™. Policies should therefore aim to delay the drink
ing starting age.
TAXATION AND PRICING: Taxation on alcohol products and other pricing measures, in par
ticular minimum unit pricing (MUP), should be supported and encouraged as they serve to
deterthe consumption of alcohol, and therefore reduce rates of consumption™1.
ADVERTISING: The monitoring of the alcohol industry’s advertising practices (including
displays in private settings such as night clubs, online advertising and in social media)
and compliance with relevant national codes of conduct applying to the alcohol industry
should be closely monitored. A total ban on advertising and sponsorship of alcohol brands
(i.e. sport events and festivals) should be implemented.
SALE RESTRICTIONS: Measures to restrict alcohol sales, such as age limits (i.e. 18 years
old) and controlled opening hours, need to be better implemented and enforced*.
ALCOHOL LABELLING: Warning labels help establish a social understanding that alcohol
is a hazardous commodity. Moreover, they have shown to be effective in raising aware
ness amongst the general public about the health message that they contain™'1, and visual
labelling on products must change regularly to have continuing impact. Alcohol labelling
should therefore be improved and extended as effective means to prevent excessive alco
hol consumption.
AWARENESS RAISING: The Commission has led a number of successful awareness cam
paigns in the area of health in the past. A targeted EU initiative focused on the negative
effects of excessive alcohol consumption for individuals, families and the society should
be considered. Awareness initiatives should aim to:
•
•
•
reduce stigmatisation of people with an AUD and their families;
raise awareness of the risks associated to alcohol consumption;
support services available and how to access them.
Such initiatives also play an important role in supporting national governments’ aware
ness initiatives with adequate expertise and tailored materials, especially those facing
financial constraints in the current economic context. In addition, as civil society organisa
tions working directly with alcohol problems, patient and medical organisations have a key
role in awareness raising efforts. Greater support should be provided to them to develop
consistent and effective media (including social media) strategies.
VULNERABLE GROUPS: Selected interventions for vulnerable groups, such as the children
of people with alcohol related problems and people with mental health disorders should
be researched, implemented and evaluated, with best practice shared across Europe
Conclusions of the EU Roundtable on an Integrated
DIAGNOSIS, TREATMENT AND CONTINUOUS SUPPORT
There is an urgent need to ensure the early diagnosis and improved access to tailored sup
port, counselling services and treatment for AUDs1'. Early detection and access to adequate
support services and treatment could save thousands of lives". Evidence shows that there
is a need for a Europe-wide monitoring system to evaluate the prevalence of AUDs and the
impact of early detection, treatment and counselling services"1.
EDUCATION, TRAINING AND GUIDELINES FOR HEALTHCARE PROFESSIONALS: Healthcare
professional education is crucial to ensure quality diagnosis and management of AUDs.
This should include measures to develop and update relevant guidelines on AUDs, increase
healthcare professionals’ knowledge and implementation of brief interventions and quality
follow up support for people suffering from AUDs and their families.
SCREENING AND EARLY INTERVENTION: Access to reliable screening and diagnostic tools
should be available and consistently used by primary healthcare professionals (General
Practitioners and other healthcare staff), to help them identify people with alcohol related
problems, accordingto adequate protocols and codes of conduct.
Screening and early detection should be part of continuous care and support to patients.
Primary healthcare professionals need to continuously assess alcohol use in patients and
refer to appropriate services as appropriate, such as alcohol treatment services and/or
mutual aid associations.
Family education programmes are essential to ensure early detection of AUDs. Targeted
education programmes should focus on the nature of AUDs, risks, symptoms, and how to
communicate and support people with AUDs.
National governments need to:
strengthen General Practitioners’ incentives schemes to screen people who are at
risk of having an AUD;
ensure and support the establishment of standardised screening including a manda
tory liver enzymes test (GPT (ALT) for patients between 20 - 60 years old, and recol
lection of the patient’s case history;
• support the implementation of brief interventions beyond the healthcare sector (e.g.
education of social services staff, drink-driving interventions by law enforcement
officers, etc).
•
•
COUNSELLING, SUPPORT AND TREATMENT SERVICES: National governments should pri
oritise action and resources to ensure improved access to counselling and treatment ser
vices in orderto successfully address AUDs and meet patients’ needs. These should range
from brief interventions, primary care, to specialised treatment methods and centres1".
There is a need to follow-up and continue to have a support system in place for people liv
ing with AUDs and their families, as well as those who have taken part in treatment. Long
term recovery and relapse prevention support should be consistently provided to people
with alcohol related problems and their families.
INTEGRATED POLICIES
Policy measures in different relevant areas, such as healthcare, employment, justice and
education, should be shaped in a consistent and integrated manner. This should include
the integration of outcomes from relevant research projects as well as targeted measures
for specific settings such as the workplace. Exchange of best practices schemes, including
the establishment of a database, should be further developed and implemented in order
to inform and support effective policy development and implementation.
Conclusions of the ED Roundtable on an Integrated Approach to Alcohol Related Harm
REFERENCES
European Commission (2006) An EU strategy to support Member States In reducing alcohol related harm. Available at: http://
ec.europa.eu/health/ph_determinants/llfe_style/alcohol/documents/alcohol_com_625_en.pdi
Rehm, J., Shield, K. et al (2012) Alcohol consumption, alcohol dependence and attr‘bu.tab,e burd.®"
^valllbleab htto"//31
gains from effective interventions for alcohol dependence. Centre for Addiction and Mental Health
www.camh.ca/en/research/news_and_publicati0ns/rep0rts_and_b00ks/D0cuments/CAMH%20Alc0h0l%20Rep0rt
£2oEurope%2020i2.pdf
Alcohol Public Health Research Alliance (AMPHORA) (2012) Alcohol Policy in Europe: Evidence from AMPHORA. Available at:
http://www. amphoraproJect.net/w2box/data/e-book/AMPHORA%20ebook . pdf
Decision Resources. Spectrum report Nov2oi2. Therapeutic Markets: Opportunities and pipeline analysis.
Kohn R„ Saxena, S., Levav, I., Saraceno, 8. (2004) The treatment gap In mental health care. World Health Organization (WHO) Builetin. Available at: http://www.ncbl.nlm.nih.gov/pmc/articles/PMC2623050/
Gabathuler, R. (2010) Approaches to transport therapeutic drugs across the blood-brain barrier to treat brain diseases. Neurobiol
vii Wrase J. et al. (2007) Different neural systems adjust motor behavior in response to reward and punishment. NeuroImage. 36,
1253-1262. Available at: http://www-psych.stanford.edu/~span/Publlcatlons/jwo7ni2.pdf
viii GrQsser SM. et al. (2004) Cue-induced activation of the striatum and medial prefrontal cortex Is associated with subsequent
relapse in abstinent alcoholics. Psychopharmacology (Berl). 175,296-302.
Braus DF. et al (2001) Alcohol-associated stimuli activate the ventral striatum in abstinent alcoholics. Journal ofNeural Transmis
sion. 108,887-894.
World Health Organization (2011) Global status report on alcohol and health. Available at: http://www.who.int/substance_abuse/
publicatlons/global_alcohol_report/msbgsruprofiles.pdf
World Health Organization, Regional Office for Europe (2012). European action plan to reduce the harmful use of alcohol. Available
at: http://www.euro.who.lnt/ data/assets/pdf_file/ooo6/i47732/RC6i_wdi3E_Alcohol_ni372_ver20i2.pdf
xll World Health Organization, Regional Office for Europe (2012). Alcohol in the European Union: Consumption, harm and policy ap
proaches. Available at: http://www.eur0.wh0.int/__data/assets/pdf_file/0003/160680/e96457.pdf
xiii
European Commission (2006) An EU strategy to support Member States in reducing alcohol related harm. Available at: http://
ec.europa.eu/health/ph_determlnants/life_style/alcohol/documents/alcohol_com_625_en.pdf
xiv
Wlttchen H.U., Jacobi F., Rehm J., Gustavsson A., Svensson M., JOnsson B., Olesen J., Allgulander C., Alonso J., Faravelli C.,
Fratiglioni L., Jennum P., Lieb R., Maercker A., van Os n J., Preisig M„ L. Salvador-Carulla L., Simon R., and Stelnhausen HC (2011)
The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology. 21,
655-679-Available at: http://www.ecnp.eu/~/media/Files/ecnp/communicatlon/reports/ECNP%2oEBC%2oReport.pdf
xv
National Institute for Health and Clinical Excellence (2010) Alcohol use disorders: harmful drinking and alcohol dependence. Avail
able at: http://www.nice.org.uk/nicemedia/live/11875/51786/51786.pdf
xvi
Meng Y., Hill-McManus D., Brennan, A (2012) Model-based appraisal of alcohol minimum pricing and off-licensed trade discount
bans in Scotland using the Sheffield alcohol policy model (v 2):- second update based on newly available data. University of Shef
field. Available at: http://www.shef.ac.Uk/polopoly_fs/1.150021l/file/scotlandupdatejan2012.pdf
xvii
Wllkenson, C., Room, R. (2009) Warnings on alcohol containers and advertisements: International experience and evidence on
effects. Drug and Alcohol Review, 28,4,426-435. Available at: http://www.ncbl.nlm.nih.gov/pubmed719594797
Conclusions of the EU Roundtable on an Integrated Approach to Alco~hol Related n1rm
Pan American Network on
Alcohol and Public Health
(PANNAPH)
First Regional Meeting,
Mexico City, Mexico
August 21-23, 2012
Summary Report and
Recommendations
Background
The Pan American Health Organiza
tion (PAHO) has accelerated its
efforts in recent years to increase
awareness of the harm from alcohol
consumption and support member
countries’ responses to reduce
alcohol related problems. In 2005, it
organized the first Pan American Conference on Alcohol and Public Policies, with the support of the
Government of Brazil; 26 countries participated. PAHO subsequently prepared a technical report
entitled “Alcohol and Public Health in the Americas: A Case for Action,” which summarized the situa
tion in the Region, described which policies are most effective, and proposed ten areas for national
and regional action. PAHO translated, adapted, and/or disseminated several publications into
Spanish to assist countries in implementing effective national response to alcohol problems. PAHO,
also supported research on nonfatal injuries in emergency rooms and alcohol and gender issues,
with a focus on intra-family violence. To that end, it published the book Unhappy Hours: Alcohol and
Partner Aggression in the Americas. Finally, PAHO provided technical cooperation on alcohol policy
issues and brief interventions in primary care to several countries in the Region.
In 2010, the Ministers of Health of the Member States of the World Health Organization (WHO)
approved by consensus a global strategy to reduce alcohol-related problems. In February 2011, the
WHO organized the first meeting between countries in Geneva, Switzerland, to discuss mechanisms
and priorities for implementing the global strategy. Over 100 countries participated in the meeting,
including 23 countries from the region of the Americas. Those 23 participating countries formed the
Pan-American Network on Alcohol and Public Health (PANNAPH), led by Mexico and vice-chaired by
Brazil. In 2011, Member States adopted a regional plan of action at the 51st Directing Council titled “Plan
of Action to Reduce the Harmful Use of Alcohol,” the plan calls for the implementation of the WHOGIobal
Strategy to Reduce Harmful Use of Alcohol and promotes a public health and human rights approach
aimed at lowering the levels of per capita alcohol consumption in the population, as well as reducing al
cohol related harm in the Americas and Caribbean. The plan of action proposed that PAHO’s role be to
coordinate the regional response and to strengthen its technical cooperation for national activities based
on the ten target policy areas proposed by the global strategy, for a period of ten years (2012 - 2021).
The plan of action contains five main objectives and describes both regional and national activities
under each objective. The five main objectives are: (1) to raise awareness and political commitment;
(2) to improve the knowledge base on the magnitude of problems and on effectiveness of interven
tion disaggregated by sex and ethnic group; (3) to increase technical support to Member States;
(4) to strengthen partnerships and; (5) to improve monitoring and surveillance systems and dissemi
nation of information for advocacy, policy development, and evaluation.
In order to facilitate communication with regional partners in the network, PAHO created a listserv, a
logo for the group, a system for exchanging information, and continued to promote research collabo
ration and advocacy. A regional meeting was proposed by Mexico and the country provided logisti
cal technical and financial support. The 1st Meeting of the Pan American Network on Alcohol and
Public Health took place in Mexico City, Mexico, from August 21 to 23, 2012.
Thirty countries participated in the meeting. In addition, thirteen regional and national PAHO advi
sors, three collaborating centers, six non-governmental organizations, a WHO representative, and
Mexican and international experts participated in the meeting.
Objectives
The three main objectives of the meeting were to:
1)
Update all partners on global and regional processes in place, such as the global strategy
adopted in 2010 by the WHO and the regional action plan, the role of the collaborating
centers, NGOs, and civil society, as well as to discuss the contributions of others.
2)
Present scientific evidence regarding the policies that were adopted in the global strategy and
the regional plan, and discuss ways in which regional countries have implemented these
strategies and barriers encountered.
3)
Discuss and agree on the highest priority areas for cooperation, according to needs, with
PAHO and WHO. PAHO understands there are regional, national and subnational needs and
can provide the necessary tools and training, seek resources, promote technical cooperation
between countries, promote multi-country research, and share knowledge.
Topics Discussed
Three plenary conferences opened the meeting, covering the burden of alcohol in Mexico, an
overview of the evidence on the effectiveness of various alcohol policies globally, and a review
of the global developments since the approval of the WHO global strategy for reducing alcohol
problems.
The rest of the meeting was organized through eleven panels of discussion. Each panel topic
began with a lead presenter followed by commentaries by three countries. A question and
answer session followed the presentations. The eleven topic areas are summarized below.
Panel 1: Implementing Policies to Control Availability
Among the policies used to control availability, panelists mentioned restricting alcohol outlet
density, restricting the types of alcohol beverages that can be sold or packaged, especially those
types of products that appeal to youth (i.e. alcopops), and restricting hours and days of sales.
The importance of community groups and youth in advocating and supporting restrictions were
mentioned as key factors in encouraging public officials in implementing and enforcing polices to
control availability.
Panel 2: Implementing Policies on Price and Taxation
Numerous studies have shown that increased alcohol taxes and prices are related to reductions
in alcohol-related problems, including crime, traffic crashes, and mortality rates. Panelists
encouraged network members to consider pricing and/or taxation of alcoholic beverages based
on their alcohol content and to consider dedicating a portion of alcohol tax revenues to the pre
vention and treatment of alcohol-related problems.
Panel 3: Implementing Polices on Traffic Safety and Alcohol
.
a
Statistics show that in the Americas, the majority of alcohol-related traffic deaths are associ
with drivers with medium and low levels of alcohol in their system. Panelists encqT
network members to establish and enforce a low legal maximum-blood alcohol cor
level for drinking and driving (.05 g/dL for many countries in the region). In the reg
that combine a public information campaign in conjunction with enforcement actior
reductions in alcohol-related traffic crashes and deaths.
Panel 4: What Works to Reduce Youth Drinking?
Establishing and enforcing a minimum legal drinking age for the purchase of alcohol is an
important policy in reducing youth drinking. Panelists mentioned the need to combine campaigns
seeking to influence social norms around youth drinking with policies that limit availability, increase
alcohol prices, and encourage health care professionals to discuss alcohol issues with youth.
Panel 5: Alcohol and Violence
Alcohol use is related to intentional and non-intentional injuries, intra-familiar and interpersonal
violence, child abuse, suicide, homicide and traffic crashes. Alcohol use is seen in domestic
violence situations, where women are more likely to be physically and sexually assaulted by
their partners and these issues have been seen in urban, rural and indigenous populations. Pan
elists mentioned the need to link gender equity policies and policies for the primary prevention of
violence with those to reduce harmful use of alcohol at the population level, as well as to improve
and strengthen treatment and care services to all those involved in alcohol-related violence.
Panel 6: Regulation of Alcohol Marketing and Sponsorship
The alcohol industry constantly promotes positive images of alcohol consumption and has
increasingly sponsored community projects, sports teams, and prevention projects. The alcohol
industry relies on self-regulating their own practices but, as has been constantly demonstrated,
the alcohol industry frequently violates its own codes without any consequence. Panelists
stressed the need for statutory regulations to restrict or ban, as appropriate, the marketing of
alcoholic beverages, particularly to youth, and to establish a government agency to be respon
sible for monitoring and enforcing of alcohol marketing regulations. Several countries ex
pressed concern with the pressure the alcohol industry and the International Federation of
Association Football (FIFA for its French acronym) has put on Brazil to change the law prohibiting
alcohol sales in soccer stadiums, as such change would influence policy decisions in their own
countries, which look up to Brazil as a model. Several countries discussed the need for a code
and guidelines on how to interact with the alcohol industry and discussed having PAHO take a
lead role in developing such guidance to countries.
Panel 7: Law Enforcement
Public health should partner with law enforcement agencies to
promote the proactive enforcement of alcohol laws to prevent alco
hol-related harm. Multiple law enforcement strategies that can be
used were described and an emphasis on building public aware
ness and support for law enforcement strategies was encouraged.
Panel 8: Unrecorded Alcohol Consumption
Unrecorded alcohol consumption includes alcoholic beverages
that are produced legally but are not registered (taxes are not paid),
alcohol that is not produced for human consumption, and alcohol that
is produced illegally. Illegally produced alcohol may have increased
risk because there is no standard alcohol level, it’s cheap, and often
contains toxic substances. Strategies to reduce unrecorded alcohol
include abolishing the use of methanol to
denature alcohol, treating certain products
with bittering agents to make alcohol undrinkable (for alcohol that is not produced for
human consumption), controlling medicinal
alcohol sales, and testing illegally produced
but available products. Countries expressed
a need to have a regional laboratory which
could analyze samples in a standardized and
’
%
unbiased way, as currently such efforts are
I
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estados,
only done through studies sponsored by the alcohol industry, which has a vested interest in such
analyses and results.
Panel 9: Implementing Programs for Early Intervention and Treatment
The goal of early intervention programs is to delay the initial use of alcohol. These programs
establish strong networks of community groups and schools to promote prevention programs with
youth but they also establish a system through which screenings, brief interventions, and treatment
referrals can be made. Panelists called for strengthening the capacity of health care systems to
integrate and provide screening, brief interventions and treatment, centered in primary health care
services, as well as in collaboration with schools, community groups, self-help groups and work
places. Furthermore, it is necessary to update both the undergraduate and graduate academic
training of health professionals to facilitate and accelerate the creation and improvement of commu=
nity-based services, instead of psychiatric hospitals, as promoted in the region since the Declara
tion of Caracas.
Panel 10: The Role of Civil Society, Collaborating Centers and Non-Governmental
Organizations
In order for civil society to have a large impact on reducing alcohol-related problems, society
should recognize the autonomy of these associations, these groups should not take funds
from the alcohol industry, and their policies should be evidence-based. Panelists encouraged
network members to not only talk about the problems and solutions but to train and assist civil
society on how to best implement solutions.
Panel 11: The Influence of the Alcohol Industry in Public Policies to Reduce
Harmful Alcohol Consumption: How Can We Manage Conflict of Interest?
The alcohol industry promotes and supports groups and studies that encourage prevention
policies that have little or no effect on reducing alcohol consumption or alcohol-related
problems. They present false evidence to create confusion about the three most effective
strategies (taxes, restrictions on physical availability, and restrictions on alcohol marketing).
In addition to counter-advertising campaigns, panelists recommended
PAHO’s assistance on developing clear guidelines on interactions
with the alcohol industry and conflicts of interest with public health.
■
Where We Are
In addition to the adoption of the “Plan of Action to Reduce the Harmful
Use of Alcohol", network members are collaborating on several new
research projects. Below is a list of current projects and participant
countries:
BELICE
♦ New studies on nonfatal injuries in Emergency Rooms: Costa Rica,
Peru, and Belize.
♦ New general population studies based on the GEN
Alcohol and Culture: An International Study (GEN
Belize and Brazil.
♦ New STEP Survey participants: Colombia and Suriname.
' ««
♦ Grand Challenges in Mental Health Canada: Belize and Guyana.
♦ New proposals under development to International Development Research Ce
Brazil, Peru, St Kitts and Nevis, Argentina and Uruguay.
er,
ionnaire:
Mexico Recommendations
The participants of the 1st Meeting of the Pan
American Network on Alcohol and Public Health (PANNAPH) in Mexico City, Mexico, August 21-23, 2012 rec
ommend that:
As the leading risk for the burden of diseases in the
Americas, alcohol needs to be considered a top
priority in national and regional efforts aimed at
improving public health. Alcohol is a causal factor to
over 60 disease conditions, including intentional and
non-intentional injuries, cancers, heart disease,
neuropsychiatric conditions, in both men and
women and across the life cycle.
Effective policies need to be integrated into a
national alcohol policy which brings the various
sector of the government together with the goal of
protecting and promoting public health.
There are a number of effective alcohol policies which are cost effective and have a population
impact. These include taxes, restrictions on physical availability, and restrictions on alcohol
marketing.
♦ PANNAPH represent the views of over 30 countries in the Region and the network should
continue as a unified group with a unified technical voice.
♦ Brazil acts as Chair and Belize as Vice-Chair of the network from 2012 until the next meeting
of the group.
♦ Actions be coordinated with other sectors of the government and within the Ministries of Health
to ensure that evidence-based policies are promoted.
♦ Adult Per Capita consumption be the only feasible and technically sound indicator for the
Non-Communicable Disease strategy at global and regional levels and should not be replaced
by others indicators such as prevalence of heavy drinking.
♦ Actions of the network should be coordinated with the Global Coordinating Council through the
national counterparts of each country and that they be the same as those participating in the
Global Network.
♦ PAHO assist in the development of clear guidance on interactions with the alcohol industry
and conflicts of interest with public health such as developing procedures and rules of
engagement (who, with whom and how).
♦ PAHO assist in the development of a universal code of principles for the regulation of market
ing of alcohol that is public health-oriented and that can be used by governments, regardless
of self-regulatory codes (where they exist, these have been found to be insufficient).
♦ PAHO provide complete information to Ministers of Health and other relevant stakeholders
about research being undertaken with the support of the alcohol industry in the Region.
♦ PAHO cooperate with collaborating centers, research institutions, and individual researchers
to create and promote a Regional Network of Alcohol Policy Researchers, independent of th
influence of the alcohol industry.
♦ PAHO cooperate with non-governmental organizations for alcohol policy advocacy
the creation of a regional network and linking it with the Global Alcohol Polic" 1
(GAPA) and other relevant networks internationally.
PAHO assist member countries in preparing case studies related to alcohol policy imple
mentation and disseminating these studies at regional and global levels.
PANNAPH write a letter to the government of Brazil, indicating its support for maintaining a
ban on alcohol sales in stadiums during the 2014 FIFA World Cup.
PAHO support a sub-regional meeting on alcohol policy with Caribbean countries.
PAHO assist Member States in developing a definition of a standard alcoholic drink that is
compatible with WHO recommendations and can improve the comparability of information
across the Region.
New members be integrated into the network.
A regional laboratory for analysis of alcohol beverages be established.
PAHO continue to support technical cooperation between countries.
PAHO assist in building the capacity for alcohol policy through virtual courses and dissemina
tion of information in English and Spanish to network members and others interested in
public health.
Participating Countries
Argentina
Antigua and Barbuda
Bahamas
Barbados
Belize
Bolivia
Brazil
Canada
Colombia
Costa Rica
Cuba
Dominica
Dominican Republic
Ecuador
El Salvador
Grenada
Guatemala
Guyana
Honduras
Mexico
Nicaragua
Panama
Paraguay
Peru
St. Kitts and Nevis
St. Lucia
Suriname
Trinidad and Tobago
United States of America
Uruguay
Venezuela
w.paho.org
Area of Sustainable Development and Environmental Health (SDE)
Pan American
Health
Organization
World Health Organization
PROTOCOL
TO ELIMINATE ILLICIT TRADE
IN TOBACCO PRODUCTS
AN INTRODUCTION
WHO FRAMEWORK CONVENTION
ON TOBACCO CONTROL
ABOUT THE PROTOCOL TO ELIMINATE ILLICIT TRADE
IN TOBACCO PRODUCTS
What is the Protocol?
The Protocol to Eliminate Illicit Trade in Tobacco Products is the first protocol to the WHO
Framework Convention on Tobacco Control (WHO FCTC) and a new international treaty in
its own right.
It builds upon and complements Article 15 of the Convention (Illicit trade in tobacco products),
with the objective of eliminating all forms of illicit trade in tobacco products.
The Protocol was adopted on 12 November 2012 by the Conference of the Parties (COP) to
the WHO FCTC at its fifth session in Seoul, Republic of Korea, after four years of negotiations
by the Intergovernmental Negotiating Body that was established by the COP in 2007.
Why is it so important to prevent the illicit trade in tobacco products?
The growing international illicit trade in tobacco products poses a serious threat to public
health globally. Illicit trade increases the accessibility and affordability of tobacco products,
thus fuelling the tobacco epidemic and undermining tobacco control policies. It also causes
substantial losses in government revenues, and at the same time contributes to the funding
of transnational criminal activities.
The World Customs Organization (WCO) reports that a total of 1.9 billion illicit cigarettes
were seized in 2011, across 64 of its Member States. According to recent studies, between
9% and 11% of the global cigarette market is illicit. However, this percentage is significantly
higher in low- and middle-income countries, reaching 50% or more in some cases. Estimates
show that if the illicit trade were eliminated globally, governments would gain at least USS 30
billion annually in tax revenue, and one million premature deaths would be avoided every six
years due to higher average cigarette prices and lower consumption.
What are the key provisions of the Protocol?
•
The Protocol aims to control the supply chain in tobacco products (Articles 6-13): this has
often been referred to as the “heart” of the Protocol. It requires the establishment of a global
tracking and tracing regime within five years of entry into force of the Protocol, comprising
national and/or regional tracking and tracing systems and a global information sharing point
located in the Convention Secretariat. The global tracking and tracing regime will mean
that if tobacco products are found on the illegal market, the authorities would be able to
determine which company produced them, where and when they were produced, and the
intended market of sale, shipment route and the point of diversion
Other provisions to ensure control of the supply chain cover licensing, due diligence, record
keeping and security and preventive measures In particular, strict requirements are imposed
on the licensing of manufacture, import and export of tobacco products and manufacturing
equipment, and on the monitoring of sales to ensure that the quantities are commensurate
with the actual demand. Transactions regarding tobacco products in free zones, international
transit and duty free sales as well as through the Internet and other telecommunication
modes will be subject to the same comprehensive regulations as other sales
The Protocol also covers important matters concerning offences (Articles 14-19), with
provisions on liability, prosecutions and sanctions, seizure payments and special investigative
techniques, as well as the disposal and destruction of confiscated products. The Protocol
contains a catalogue of conduct, which each Party shall include in its national legislation as
unlawful, for example producing or selling cigarettes without a licence, or smuggling cigarettes
Each Party shall also decide which unlawful conduct constitutes a criminal offence.
Another key group of substantive articles addresses international cooperation (Articles
20-31), with measures on information sharing, technical and law-enforcement cooperation,
protection of sovereignty, jurisdiction, mutual legal and administrative assistance and
extradition. For example, Parties have the obligation to exchange information necessary to
d^}t or investigate illicit trade in tobacco products, including records of investigations and
p^ecutions and details of seizures of tobacco products. This enhanced cooperation will have
a deterrent effect. Parties also agreed to afford one another mutual legal assistance and to
cooperate in providing technical assistance in order to achieve the objectives of the Protocol
The Protocol establishes the reporting obligations of the Parties linked to the reporting system
of the WHO FCTC (Article 32), as well as the institutional and financial arrangements (Articles
33-36) necessary for its implementation.
The Protocol will require a multisectoral approach by governments, with cooperation among
health, finance, customs, law enforcement, trade and other relevant sectors.
Governance of the Protocol
The Protocol establishes in its Article 33 the Meeting of the Parties (MOP) as its governing
body. The MOP will comprise all Parties to the Protocol.
Sessions of the MOP shall be convened immediately before or immediately after the sessions
of the COP, including the first session following entry into force of the Protocol. Entry into force
will take place 90 days after the deposit of the 40th instrument of ratification. The Rules of
Procedure and the Financial Rules of the COP apply, mutatis mutandis, to the MOP, unless the
decides otherwise.
15
The Secretariat of the WHO FCTC is also the Secretariat of the Protocol (Article 34).
Protection from the interests of the tobacco industry
Like the WHO FCTC, the Protocol refers to the necessity for Parties to protect their public
health policies with respect to tobacco control from commercial and other vested interests of
the tobacco industry. In addition, the Protocol specifically stipulates that obligations assigned to
a Party shall not be performed by or delegated to the tobacco industry. In Article 8, the Protocol
requires Parties to ensure that their competent authorities, in participating in the tracking and
tracing regime, interact with the tobacco industry and those representing the interests of the
tobacco industry only to the extent strictly necessary in the implementation of that Article.
Where to find the text of the Protocol?
The text of the Protocol is available in all six official languages of the COP at: http://www.who.
'Wfctc/protocol/illicitjrade/
becoming a party to the protocol
Who can become a Party to the Protocol?
According to Article 33 of the WHO FCTC, Parties to the Convention may be parties to a
protocol.
Signature and ratification
The Secretary-General of the United Nations is the Depositary for the Protocol (Article 46).
In accordance with its Article 43, the Protocol was opened for signature at the World Health.
Organization Headquarters in Geneva on 10 and 11 January 2013, and thereafter at tl.
United Nations Headquarters in New York until 9 January 2014.
J
Full powers are required to sign the Protocol (except for Heads of State, Heads of Government
or Ministers for Foreign Affairs who are empowered, by virtue of their functions, to sign the
Protocol on behalf of the State) and should be submitted to the Treaty Section of the United
Nations Secretariat in New York.
A model instrument of full powers is available for download at:
http://www.who.int/fctc/protocol/protocol_sign/en/index.html
Pursuant to its Article 44, the Protocol is subject to ratification, acceptance, approval or
accession by States and to formal confirmation or accession by regional economic integration
organizations that are Party to the WHO FCTC. Ratification, acceptance and approval are
international acts by which States that have already signed the Protocol establish on the
international level their consent to be bound by it. Formal confirmation is the equivalent
of ratification for international organizations, such as regional economic integration
organizations.
A model instrument of ratification of the Protocol is available at:
http://www.who.int/fctc/protocol/protocol_sign/en/index.html
Accession
siQ6 Pro*oco'
be open for accession from the day after the date on which it is closed for
whk-h h'Accession is an international act by which a State or an international organization,
bv if
aS n°* s'9nec* a treaty, establishes on the international level its consent to be bound
RESOURCES AND ASSISTANCE
Preparing the entry into force of the Protocol
The Secretariat will carry out activities to raise awareness of the Protocol and to provide
assistance to Parties, upon request, in the process leading up to entry into force. The
preparatory work will include, in particular, establishing coordination with international
organizations that have expertise in Protocol-related matters; conducting a study of the basic
requirements of the tracking and tracing regime and the global information sharing focal
point, including relevant experiences available in Parties; and developing a self-assessment
Checklist for use by Parties in assessing their legal, regulatory and policy frameworks in view
•the requirements of the Protocol and in order to scope Parties' technical assistance and
capacity building needs.
How will the implementation of the Protocol be funded?
At the national level, each Party shall provide financial support in respect of its national
activities intended to achieve the objective of the Protocol, in accordance with its national
plans, priorities and programmes (Article 36). The Secretariat shall advise lower-resource
Parties, upon request, on available sources of funding.
At the international level, once the Protocol has entered into force, the MOP shall decide on
the scale and mechanism of the voluntary assessed contributions from the Parties to the
Protocol and other possible resources for its implementation (Article 33). The Protocol also
requires Parties to promote the utilization of bilateral and multilateral channels to provide
funding. Prior to entry into force, the Convention Secretariat will raise funds in order to carry
out the activities required for preparing entry into force, in line with the preparatory work
endorsed by the COP
Contact
^r information and assistance, please contact the Convention Secretariat at:
•>tocolfctc@who.int
o
© World Health Or<
Convention Secretariat
WHO Framework Convention on Tobacco Control
World Health Organization
Avenue Appia 20, 1211 Geneva 27 Switzerland
Tel. +41 22 791 50 43 Fax: +41 22 791 58 30
Email: fctcsecretariat@who.int
Web: www.who.int/fctc
eurQ:are
European Alcohol Policy Alliance
□I
■ ISCJOIQ dj
Library of ALCOHOL HEALTH
WARNING LABELS
eur(fcare
European Alcohol Pc
j The European Alcohol Policy Alliance (EUROCARE)
i is an alliance of non- governmental and public health organisations with
around 51 member organisations across 23 European countries advocating
the prevention and reduction of alcohol related harm in Europe. Member
organisations are involved in advocacy and research, as well as in the
provision of information and training on alcohol issues and the service for
I people whose lives are affected by alcohol problems.
The mission of Eurocare is to promote policies to prevent and reduce
alcohol related harm. The message, in regard to alcohol consumption is
"less is better"
' Publication name:
Publication year:
Produced by:
Page - 2
Eurocare library of health warning labels
2012
European Alcohol Policy Alliance
EXAMPLE OF ALCOHOL HEALTH WARNING LABEL
Eurocare proudly presents the second library of alcohol health warning labels. It
is Eurocare's wish that this proposal will serve as a starting point for much needed
discussion around labelling of alcoholic beverages in the European Union (EU).
Over the last years Eurocare has been advocating for introduction of health
warning messages.
The Eurocare report: 'What's not on the bottle? Brief overview of state of ptry in
the alcohol labelling' (December 2011) gives an overview of the different initiatives
taken in this area around the world and summarises the main research findings on
effectiveness of warning labels.
In the long term, it is Eurocare's hope that a library of health warning messages
will be prepared at the EU level by the European Commission. Moreover, it should
be made available to all EU Member States and alcohol producers.
In this document Eurocare would like to present its recommendations and ideas
for such a library. It is hoped that they will be a constructive starting point for
preparation of library of health warning labels at the EU level, similar to that which
has already been developed for tobacco products.
Rationale
Product labels can serve a number of purposes, providing information abo^ the
product to the consumer, enticing the consumer to buy the product and willing
consumers of dangers and health risks from the product.
Promoting consumers rights, prosperity and wellbeing are core values of the
European Union (EU) and this is reflected in its laws. Consequently, the Directive
on General Product Safety obliges producers 'to provide consumers with relevant
information to enable them to assess the risks inherent in a product (...) where
such risks are not immediately obvious without adequate warnings'1'1
[1]
DIRECTIVE 2001/95/EC; http://eur-lex.europa.eu/LexUriServ/LexUriServ.do2uri-OJ:L:2002:011:0004:0004:EN:PDF
Page - 4
France is the only EU Member State which has introduced mandatory health
warning labels which inform about the dangers of drinking alcohol while pregnant.
Eurocare would like this initiative expanded across all Member States and across
other areas of alcohol related harm.
I
I
Alcohol is a cause in some 60 diseases and conditions however public awareness
about the risks associated with alcohol consumption remains relatively low. For
instance, despite the research dating back to 1987 that conclusively points out to
th^Rrcinogenicity of all alcoholic beverages121, the connection between alcohol
and cancer is not well known by the consumers. The 2010 Eurobarometer report
found that 1 in 10 European citizens do not know that there is a connection and
what is especially alarming, is that 1 in 5 do not believe the connection131.
There is a clear public health obligation to inform consumers of the dangers and
health risks associated with the consumption of alcohol and this is backed up with
substantial public support. The Eurobarometer 2010 reports that overwhelming
majority of the European Union population (79%) would agree with putting
warnings on alcohol labels to warn pregnant women and drivers of the dangers
of drinking alcohol.
j
i
I
I
•
|
i
Warning labels can increase knowledge and change in the perception of risks
associated with alcohol consumption. Studies show that warning labels are
noticed by most drinkers, especially by young and high risk drinkers and prompt
target groups to discuss health effects of drinking (especially early after their
introduction)141. Evidence also suggests that the recall of warning labels was
assOated with being less likely to report having engaged in drunk driving151.
[2]
International Agency for Research on Cancer (1987) Monographs on the Evaluation of Carcinogenic
Risks to Humans
Volume 44: Alcohol Drinking. http://monographs.iarc.fr/ENG/Monographs/vol44/volume44.pdf
[3]
Eurobarometer (2010) EU citizens' attitudes towards alcohol http://ec.europa.eu/public_opinion/archives/ebs/ebs_331 _en.pdf
[4]
Babor, T., Caetano, R.( Casswell, S., Edwards, G., Giesbrecht N., Hill L,, Holder H , Homel R., Osterberg E„ Rehm J. .Room R. and Rossow I. (2003) Alcohol: No ordinary commodity - research and public policy.
Oxford: Oxford University Press
Greenfield T. (1997) Warning Labels: Evidence on harm reduction from long-term American surveys. In: Plant M,
Single E. and Stockwell T. (Eds.) Alcohol: Minimizing the harm. London: Free Association Books.
[5]
Greenfield T. (1997) Warning Labels: Evidence on harm reduction from long-term American surveys.
In- Plant M., Single E. and Stockwell T. (Eds.) Alcohol: Minimizing the harm. London: Free Association Books
Page - 5
The studies from the US, note that warning labels have prompted discussions
about the dangers of drinking and there is evidence of increased support fo
alcohol labeling by the US public following its introduction'6'
In addition, a 'dose-response' effect was found showing when people were
frequently exposed to warnings (on adverts at point of-sale, in magazines and or
containers) the more likely they were to have discussed the issue'8'.
In France it has been found that there has been somewhat of a change
social norm surrounding alcohol during pregnancy. This is thought to be relatec
to the introduction of the health warning labels in 2006”'.
Alcohol warning labels have also been found to deter others from driving undei
the influence of alcohol'’01. This further illustrated how health warnings may play a
role in changing social norms and public acceptability.
It could plausibly be argued that where relatively strict warning label regulations
have been used, there has indeed been a shift towards regarding alcohol as more
problematic and heavier drinking as less 'normalised'"".
As a single measure, it is unlikely that warning labels will, result in a substantia
reduction in hazardous alcohol consumption or specific risk behaviours such as
drinking and driving.
Labels need to be regarded as an opportunity for impact overtime and as a part of
a comprehensive strategy, rather than expecting that they will affect behaviours
change immediately.
th I
Greenfie'd (1997) in Stockwell T. (2006) A Review of Research Into The Impacts of Alcohol warning
Labels On Attitudes And Behaviour. University of Victoria, Canada.
hoi warn’ (Kfsl)utas ®nd Greenfield 1992). In Stockwell T. (2006) A Review of Research Into The Impacts of Alcoho! warnmg Labels On Attitudes And Behaviour. University of Victoria, Canada.
loj
Ibid
to the CNAPA
1
Labelling on alcoholic drinks packaging: The French experience. Presentation
j'fejtyle/alcohol/documents/ev^2^^)W^co08f |ennpdftP:^eCeUrOPa eU^ea^arC^'Ve^P'1-C'eter,,'inantS^
experienced^1“
Page - 6
Introduction of health warning messages on alcohol labels throughout the EU
would prove a cost effective measure, to significantly raise public awareness about
the risks associated with alcohol consumption.
______ ____
.
.
_
HEALTH WARNINGS ON ALCOHOLIC BEVERAGES SHOULD:
• Be placed in a standard location on the container
• Be parallel to the base of the container
• Be clearly separate from other information of the label i.e.
be placed in boxes with thick red borders
• Size should be determined by a minimum percentage oWie
size of the container
• Be written in capital letters and bold type
• Appear on a contrasting background (red bold type on
white) warnings printed in red compared to black lead to
improved noticeability
® Be rotating and with sufficient vividness and strength to
attract consumers
9 Use images that are informational in style and taken from
other ongoing education campaigns, this would enhanc^
their effectiveness
• Be in the official language of the country in which the
products is sold
• Be determined by the European Institution/ Agency or
Ministers of Health (public body not private agency;
Page - 8
LIBRARY OF HEALTH WARNING MESSAGES
Health warnings on alcoholic beverages should be clear messages about the
harm to the individual and others. These messages should cover all relevant
health issues like, liver cirrhosis, cancers, mental health as well as risk of injuries
and violence. In addition, specific messages should warn of the dangers of
consuming alcohol during pregnancy, when driving, operating machinery or
taking certain medication.
He'Jjh warning messages should be accompanied by a recommendation for
act".
For example:
'If you are concerned about your alcohol consumption, call [appropriate help
line and phone number] or visit [appropriate website].
This message could be in smaller font than the health message. Pictogram
should be accompanied with a health warning messages corresponding to it.
ALCOHOL MAY HARM THE UNBORN
BABY
Page - 91
ALCOHOL SLOWS YOUR REACTION
TIME - DON'T DRINK AND DRIVE
DON'T SERVE ALCOHOL TO MINORS
Page - 10
DON'T DRINK WHILE OPERATING
MACHINERY
ALCOHOL INCREASES THE RISK OF
ACCIDENTS AND INJURIES
Page -11
ALCOHOL CAN
CAUSE DEPENDENCE
ALCOHOL CAN CAUSE
MENTAL HEALTH PROBLEMS
Page-12
ALCOHOL CAN CAUSE
LIVER CIRRHOSIS
DON'T DRINK
WHEN TAKING MEDICINE
Page - 13
ALCOHOL CAN CAUSE CANCER
Page -14
01
i • :
e
I A Cause for Action
Alcohol is the 3rd leading cause of ill-health and death in the EU
i
I]
lj
•
Europe is the heaviest drinking region of the world
•
Consumption levels in some European countries are around 2.5 times higher
|^)n the global average
•
Alcohol is one of the top 4 risk factors for non-communicable diseases (NCDs)
such as cancer and cardiovascular disease.
•
Alcohol is a toxic substance in terms of its direct and indirect effects on a wide
range of body organs and systems and a cause of some 60 diseases
•
23 million people in the EU are dependent on alcohol
•
•
•
43% among 15-16 year old Europeans student report heavy binge drinking
Alcohol is the biggest cause of death among young men of age 16 to 24
9 million children and young people in the EU live with at least one parent
addicted to alcohol
Alcohol harms the society
fund 1 accident-try 4 can •be fihkpd tp. alcoholCp.nsurnption, and at least
000 people ar.e- killed:i;h .atephpj related .road accidents in the EU each year.
Os tp which alcohol is one of the top.risk factors, are estimated to cause a
ivilligriglobalecb.ri.omic output.loss oyer-the period pf 2005-2030 .
> social cost attributable to alcohol is 155,0 billion EUR yearly
ohol is the world's number 1 risk for ill health and premature death for
59 year 'old agegfoup-core ofthe'working age. population
Page - 15
This publication was made possible by the
operating grant funded by the European Union
in the framework of the Health Programme.
WARNING LABELS X
The European Alcohol Polio
EUROCARE
LABELS ARK NEEDED ALCOHOL
WARNING LABELS ARE NEEDEC
ALCOHOL WARNING LABELS AR
NEEDED ALCOHOL WARNING
LABELS ARE NEEDED ALCOHOL
WARNING LABELS ARE NEEDEC
ALCOHOL WARNING LASUSAS
NEEDED ALCOHOL WARNING
LABELS ARE NEEDED ALCOHOL
WARNING LABELS ARE NBWW
ALCOHOL WARNING LABELS AR
NEEDED ALCOHOL WARNING
labels are needed alcohca
17 Rue Archimede
1000 Brussels
Belgium
T+32(0)2 736 05 72
T+32(0)2 736 67 82
info@eurocare.org
www.eurocare.org
WARNING LABELS ARB NttW
ALCOHOL WARNING
NEEDED ALCOHOL WtfJJNG
labels ARE NEEDED alwj
WARNING LABELS AHN*
ALCOHOL EARNING
NEEDED ALCOHOL WAR"
LABELS ARE NEEDED ALCVp
eurQ:are
European Alcohol Policy Alliance
EUROCARE RECOMMENDATIONS FOR
A FUTURE EU ALCOHOL STRATEGY
■
M I MM MMBfl
____ I
June 2012
17 Rue Archimede 11000 Brussels ! Belgium I Tel +32 (0)2 736 05 72 I Tel +32 (0)2 736 67 82
info@eurocare.org; www.eurocare.org
Eurocare recommendations for a future EU alcohol strategy
The European Alcohol Policy Alliance (EUROCARE)
The European Alcohol Policy Alliance (EUROCARE) is an alliance of non-governemental and public health
and well-being organisations with around 50 member organisations across 21 European countries
advocating the prevention and reduction of alcohol related harm in Europe. Member organisations are
involved in research and advocacy, as well as in the provision of information to the public; education and
training of voluntary and professional community care workers; the provision of workplace and school
based programmes; counselling services, residential support and alcohol-free clubs for problem drinkers;
and research and advocacy institutes.
The mission of Eurocare is to promote policies to prevent and reduce alcohol related harm, through
advocacy in Europe. The message, in regard to alcohol consumption is "less is better".
Foetal Alcohol Syndrome Disorders
Dependence
Brain drain
Health effects
Road Safety
Workplace
Injury and violence
J
Non-communicable diseases
11
Eurocare recommendations for a future EU alcohol strategy
Contents
Foreword by President Tiziana Codenotti........................................................................................... 3
Summary.....................................................................................................................................
4
Introduction............................................................................................................................................... 5
Alcohol - a cause for action.................................................................................................................. 6
Main policy areas.................................................................................................................................... 8
2.1.
Regulation of marketing........................................................................................................8
2.2.
Price and taxation................................................................................................................... 9
2.3.
Consumer protection: provision of comprehensive information...............................10
2.4.
Public safety and harm to others......................................................................................12
2.4.1.
Drink Driving.................................................................................................................. 12
2.4.2.
Safer drinking environments..................................................................................... 12
2.4.3.
Alcohol and pregnancy................................................................................................13
2.4.4.
Family and Children......................................................................................................14
2.5.
Social inclusion and equality in health............................................................................ 14
2.6.
Prevention with special focus on prevention at workplace......................................... 15
2.7.
Treatment and early interventions.............................................................. ................... 16
2.8.
Monitoring of data, developing and maintaining common evidence base.............. 16
Way forward: how to address alcohol related harm?................................................................... 17
3.1.
Enhanced cooperation between Member States.......................................................... 17
3.2.
Alcohol in all policies........................................................................................................... 17
CONCLUSIONS: Let us all think about alcohol differently.............................................................. 19
2|P a ge
Eurocare recommendations for a future EU alcohol strategy
Foreword by President Tiziana Codenotti
At the time when European Commission is evaluating the current European Union strategy to support
Member States in reducing alcohol related harml the European Alcohol Policy Alliance (Eurocare) wishes
to present its view and recommendations for of a comprehensive alcohol policy in the European Union
(EU) 2013 - 2020.
Eurocare was created in 1990, as concerns grew over the impact of the single market on national alcohol
policies. As the recognition of the importance of health issues has moved forward on the European
political agenda, it gradually allowed emphasising issue of alcohol related harm. Eurocare grew over the
last twenty years, from few enthusiasts to a network of around 50 organisations from 21 countries.
Eurocare recognises the progress that has been achieved over the past years, from the first mention in
1986 of a need to tackle the problems related to harmful and hazardous consumption of alcohol in the
Council Resolution, through 2006 EU Alcohol Strategy, to 2010 adoption of WHO Global Alcohol Strategy.
Despite all the progress achieved over last years, our work to tackle alcohol related harm and raise it on
the political agenda is by no means finished. Europe is still the heaviest drinking region in the world and
harm caused by alcohol to the individual and society at large is too high.
In the current context of economic crisis keeping the focus on public health is crucial. Eurocare would
like to take this opportunity to emphasise the need to place the health and social well being of European
citizens above purely economic interests.
As a public health partner of Directorate General for Health and Consumer Protection (DS SANCO),
Eurocare, and its broader civil society network, would like to appeal to all DGs of the European
Commission to commit to prioritising health issues.
Eurocare is dedicated to working together towards reduction of harm caused by alcohol, to the
individual, others and the society. We hope that European Commission and decision makers at both
national and European level will find this document as a valuable source of inspiration.
Tiziana Codenotti, Eurocare President
1
European Commission (2006) Communication from the Commission to the Council, the European Parliament the European
Economic and Social Committee and the Committee of the Regions. An EU strategy to support Member States in reducing alcohol
related harm. Brussels, Commission of the European Communities COM(2006) 625 Retrieved from- http//eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=COM:2006:0625:FIN:EN:PDF
' —
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Eurocare recommendations for a future EU alcohol strategy
Summary
Eurocare strongly supports continuation of efforts at the EU level to address alcohol
related harm; to that end it believes that the European Commission should develop a
comprehensive EU alcohol strategy 2013-2020.
Alcohol is the world's number one risk for ill-health and premature death amongst the 25-
59 year old age group, a core of the working age population. Europe is the heaviest
drinking region of the world. Consumption levels in some countries are around 2.5 times higher than the
global average2.
Due to the size of the problem and the universal impact, alcohol requires focused approach and
commitment for action from policy and decisions makers at the European and national levels.
Eurocare believes that a number of policy tools can be implemented to address crucial areas such as:
Regulation of marketing
Increase in price of alcoholic beverages
Smarter regulation of availability of alcohol
Provision of information to consumers- labelling
Reduction of drink driving
Creation of safer drinking environments
Raised awareness of dangers from drinking during pregnancy
Protection of family and children
Prevention with special focus on prevention in the workplace
Treatment and early interventions
Better monitoring of data, development and maintenance of common evidence base
There is a mass of evidence that the levels of alcohol related harm in any population are correlated with
the overall level of alcohol consumption: higher per capita consumption tends to be associated with
higher levels of harm, lower consumption with lower levels of harm3.
Eurocare recommends that the target for the EU should be reduction of total alcohol
consumption in Europe by 2020, from an average of 12.5 litres to 9 litres per adult per year
2 WHO Europe (2012) Alcohol in the European Union
3 Ibid
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Eurocare recommendations for a future EU alcohol strategy
Introduction
Eurocare's vision is a Europe where alcohol related harm is no longer one of the leading
risk factors for ill-health and pre-mature death, Europe where innocents no longer suffer
from the drinking of others and where the European Union and its Member States
recognize the harm done by alcohol and apply effective and comprehensive policies to
tackle it.
This report is based on "Eurocare Overview and Recommendations for a Sustainable EU alcohol Strategy"
September 2009. At the time Eurocare consulted its member organizations, the Alcohol Policy Network
(APN), the European Public Health Alliance (EPHA) alcohol working group and the AMPHORA research
network regarding their assessment of the progress so far with the EU Alcohol Strategy.
Eurocare members were then as today concerned about the role of the alcohol industry in the
implementation of the Strategy and the opportunities the industry is being given to obstruct and to
divert attention to what the scientific evidence suggests are unproductive areas of activity.
Addressing the issue of alcohol related harm through effective policies will offer measurable health
system savings and enhance the growth and productivity agenda for Europe 2020.
Eurocare recommendations for a future EU alcohol strategy
Alcohol — a cause for action
Alcohol is one of the world's leading health risks; use of alcohol is especially harmful for
younger age groups. Europe is the heaviest drinking region of the world. Consumption
levels in some countries are around 2.5 times higher than the global average45
. Alcohol
harm is disproportionately high among young people (115 000 deaths per year) alarmingly
43% among 15-16 year old European students reported heavy binge drinking during the
past 30 days and alcohol is the single biggest cause of death among young men of age 16
The World Economic Forum's 2010 Global Risks Report identifies non-communicable diseases (NCDs) as
the second most severe threat to the global economy in terms of likelihood and potential economic loss.
NCDs are a global risk equal in cost to the current global financial crisis6. The World Economic Forum and
Harvard School of Public Health estimate that NCDs will cause a €25 trillion global economic output loss
over the period 2005-2030.
Alcohol is one of the 4 risk factors for developing NCDs such as cancer (1 in 3 Europeans will get cancer in
the coming years) and cardiovascular disease7. It is important to address alcohol in this context and give
it the attention needed. By decreasing the level of alcohol consumption, as well as being physically active
and having a healthy diet:
•
75% of deaths from cardiovascular disease could be avoided8
•
30-40 % of cancers could be avoided9
Accurate European wide data on the impact of alcohol at workplace is not sufficiently gathered and not
comprehensive in its scope. However, the figures from individual countries suggest that the problem
might be bigger than expected.
•
UK estimates that approximate loss in productivity amounts to 6.4 bn GBP; this includes alcohol
related absence, reduced employment, and premature death
•
International Labour Organisation estimated that globally up to 5% of average work force is
alcohol dependent and up to 25% drink heavily to the risk of becoming addicted
4 WHO Europe (2012) Alcohol in the European Union
5 ESPAD (2011) ESPAD Report: Substance Use Among Students in 36 European Countries
6 World Economic Forum (2010) Global risks 2010. Geneva, Retrieved from:
http7/www.weforum.orR/en/initiatives/Rlobalrisk/Reports/index.htm
7 WHO (2009) Global Health Risks: Mortality and burden of disease attributable to selected major risks
s O'Flaherty & Capewell S. Recent levelling ofCHD mortality rates among young adults in Scotland may reflect major social
inequalities. BMJ 2009; 339: b2613
’ World Cancer Research Fund (2008) Recommendationsfor Cancer Prevention
6 | Page
Eurocare recommendations for a future EU alcohol strategy
•
A 13% increase in work absence can be expected with an increase in consumption of 1 liter pure
alcohol10
Due to the size of the problem and the universal impact, alcohol requires a comprehensive, coordinated
response from policy and decisions makers at the European and national levels.
Eurocare recognizes the difficulty of reconciling public health and commercial objectives in regard to
alcohol products. However, there are a number of policy areas where the European Commission is
perfectly placed to enhance actions and deliver measureable achievements to form a coherent approach
to reducing alcohol related harm in the EU. Eurocare believes that the goal should be to work towards
setting clear and specific targets for reduction in the harmful consumption of alcohol and in levels of
harm.
This document aims to contribute to a constructive and action oriented discussion on the future Alcohol
Strategy for the EU (2013-2020). It will focus on the main policy areas accompanied with Eurocare
recommendations and followed by suggestions on the methods of implementation.
With this in mind, Eurocare calls on the Ministers of Health and Social Affairs in Europe and the European
Commission to support the development of comprehensive Alcohol Strategy for the European Union
with clear and targeted measures.
Science Group of the Alcohol and Health Forum (2011) Alcohol WnrLof the European Alcohol and Health Forum Retrieved from- http://greu°
^Ctivit^ Scientific Opinion of the Science Group
-------EaigiiZti^bZal£ghol/docs/science 02 en.pdf
Eurocare recommendations for a future EU alcohol strategy
Main policy areas
Eurocare believes that a combination of policy tools and interventions is needed to
reduce alcohol related harm, to the benefit of society. It should be our common goal to
create an environment that supports lower risk drinking.
Population wide approaches are of significance as they facilitate the reduction of
aggregate level of alcohol consumed. Moreover, such approaches might reduce the
numbers of people who start drinking at harmful and hazardous levels.
Alcohol causes harm to the individuals, others and society at large. It is a multilayered issue which
diversified and evolved overtime into a major health threat. This complex problem needs to be solved by
a comprehensive strategy employing a number of policy options, some of which are presented below.
2.1.
Regulation of marketing
Despite being a key health determinant alcohol is still one of the most heavily marketed products and
young people are a very important target group for the alcohol industry11. They are exposed to
sophisticated marketing aimed at creating positive expectations and beliefs not just about the product
itself but how it will make them feel. Alcohol marketing ranges from mass media advertising to
sponsorship of events, product placement, internet, merchandise, usage of other products connected
with alcohol brands, social networks etc. In 2009, the Science Group of the European Alcohol and Health
Forum produced a report11
12 which reviewed a number of studies regarding impact of marketing on the
volume and patterns of drinking alcohol. It concluded that alcohol marketing increases the likelihood
that young people will start to drink alcohol, and that among those who have started to drink, marketing
increases the their drinking levels in terms of both amount and frequency.
Eurocare firmly believes that this is one of the central policy areas that needs to be addressed in the
coming years. A level playing field for commercial communications should be implemented across
Europe, building on existing regulations in Member States, with an incremental long-term development.
11 Eurocare defines marketing as a mix of sophisticated, integrated strategies, grouped around four main elements: the product,
its price, its place (distribution) and its promotion.
12 Science Group of the Alcohol and Health Forum (2009) Does marketing communication impact on the volume and patterns of
consumption of alcoholic beverages, especially by young people? Retrieved from:
http://ec.europa.eu/health/ph determinants/life style/alcohol/Forum/docs/science oOl en.pdf
8 | P age
Eurocare recommendations for a future EU alcohol strategy
Furthermore, Eurocare believes that the existing French <Lo
Evin13* provides a framework to the
regulation of alcohol marketing which could be accepted as the minimum standard across the EU.
Volume and content of marketing, online marketing, sponsorship as well as product placement are vital
to address in a regulatory framework. Crucially, in light of technological advances and the increased role
of social media in society today, particular focus needs to be placed on regulation of the alcohol
marketing in the online environment.
2.2.
Price and taxation
A number of studies have found that increasing the price of alcohol reduces immediate and chronic harm
related to drinking among people of all ages. All consumers, including heavy and problematic drinkers,
respond to changes in alcohol prices16. Moreover, increase in prices of alcoholic beverages would reduce
consumption by young people, and also have more impact on frequent and heavier drinkers than on
lighter drinkers.
The affordability of alcoholic beverages has increased in Europe over the last 12 years. The real value of
excise duty rates for most alcoholic beverages has gone down since 1996 and consequently alcohol has
been much more affordable. There has been a decline in the EU minimum excise duty rate in real terms
13 Included in the French Act of Public Health
“intrusive here defined as behaviour ad that targets your habits and based on your profile using social net, your own emails
cookies, geolocalisation etc, or brings you to change web page by replacing ads by others
sma“ here defined " m0Vab'e adS that aPPearS betWeen tW° Web PageS in 3 Plaln SCreen Or Whe"
'
start apps on your
“ Babor TF et al (2010) Alcohol: no ordinary commodity. Research and public policy, 2"d ed. Oxford, Oxford University Press.
9 | Page
Eurocare recommendations for a future EU alcohol strategy
for alcoholic beverages since 1992 as they have not been adjusted for inflation. There is also a trend
towards more off-trade alcohol consumption, which tends to be cheaper than alcohol sold on-trade17.
Current excise duties vary for different alcoholic products; this means duty does not always relate
directly to the amount of alcohol in the product; in addition an increase in the duty levied does not
necessarily translate into a price increase- retailer or producers may absorb the cost.
Pricing and other economic measures would be an important part of an effective policy mix to tackle
harmful and hazardous alcohol consumption. Several Member States are discussing minimum pricing
policies and the support from the European Commission for these initiatives is crucial.
Moreover, restrictions on sales below cost and on sales promotions such as 'two for one' and 'happy
hour'; would also have a positive impact on addressing excessive alcohol consumption.
Eurocare acknowledges the difficulties in tackling this issue on the European level, however believes that
a European strategy should encourage Members States to introduce policy options like minimum pricing
and increased taxes.
RECOMMENDATIONS
Minimum alcohol tax rates should be at least proportional to the content alcohol for all alcoholic *
beverages
________________________________________________________________
Tax on wine should rise in line with alcoholic strength
Minimum tax rates should be increased in line with inflation
1 Member States should have the flexibility to limit individual cross-border purchases so as not to
diminish the impact of their current tax policies
I
' Member States should retain the flexibility to use taxes to deal with specific problems
2.3.
Consumer protection: provision of comprehensive information
Product labels can serve a number of purposes, providing information about the product to the
consumer, enticing the consumer to buy the product and warning consumers of dangers and health risks
from the product.
Listing the ingredients contained in a particular beverage alerts the consumer to the presence of any
potentially harmful or problematic substances.
Even more importantly, providing the nutritional
information such as calorie content allows consumer to monitor their diets better and makes it easier to
17
RAND (2009) The affordability of alcoholic beverages in the European Union, Understanding the link between alcohol
affordability, consumption and harms. Cambridge
10 | >
Eurocare recommendations for a future EU alcohol strategy
keep a healthy lifestyle. Unfortunately, today sulphite is the only allergen required to be listed
compulsorily although many other allergens can be present.
Allowing the alcohol industry not to provide full information on the labels of their products is yet another
missed opportunity for reducing alcohol related harm. Eurocare believes that alcohol producers should
provide information not only on ingredients, but also about the risks associated with alcohol
consumption: damages to health (liver cirrhosis, cancers) risk of dependence, dangers associated with
drinking alcohol during pregnancy, when driving, operating machinery and when taking certain
medication. These messages would be, at a low cost to public budgets, easy to implement at EU level
important reminder that alcohol is a hazardous product.
European Commission is best positioned to coordinate efforts to protect consumers from side effects of
products which are sold in the internal market of the EU. Eurocare believes labelling should be part of a
comprehensive strategy to provide information and educate consumers about alcohol and should be
part of integrated policies and programmes to reduce the harm done by alcohol.
RECOMMENDATIONS
Introduction of health warning labels on containers of alcoholic beverages determined by state/ i
public bodies.
Containers of alcoholic products should be required to provide the following information about the
product to consumers:
•
their ingredients
•
substances with allergenic effect
•
relevant nutrition information (energy value kcal)
•
alcoholic strength
•
include health warnings
11 | Page
Eurocare recommendations for a future EU alcohol strategy
2.4.
2.4.1.
Public safety and harm to others
Drink Driving
In 2010, nearly 31,000 Europeans were killed on the roads the main causes of fatal accidents in the EU
are speeding, drink driving and non-use of a seat belt18. Progress in reducing the number of deaths on
the road has been decreasing over the period between 2001 and 2007. In 2007, the percentage of
reduction of fatalities was 0% for the EU. Traffic accidents related to alcohol consumption therefore
remain a major cause for concern. Around one accident in four can be linked to alcohol consumption,
and at least 10,000 people are killed in alcohol-related road accidents in the EU each year.
It has been estimated that a Blood Alcohol Concentration (BAC) of 0,8g/l increases the crash risk of a
driver 2,7 times compared to a zero BAC. When a driver has a BAC of l,5g/l the injury crash rate is 22
times that of a sober driver. Not only the crash rate grows rapidly with increasing BAC but the crash also
becomes more severe. With a BAC of l,5g/l the crash rate for fatal crashes is about 200 times that of
sober drivers19.
RECOMMENDATIONS
Zero tolerance for drink driving in all Member States for all drivers20
Adequate enforcement is needed within Member States (e.g.; police checks, random breath ;
testing etc)_________________ ___________________________ _____________________ _______
A harmonised penalty system with license suspension should be implemented across the EU
Information on drink driving, the harm which results from drinking and driving and the ,
penalties should be included in driving lessons, driving tests and in published driving codes
Ban on sale of alcoholic beverages at petrol stations________________________________________
Introduce alcohol interlocks for professional drivers and in a first phase to repeat offenders
Introduce mandatory labelling on alcohol products on drink driving
2.4.2.
Safer drinking environments
Harm done by alcohol to third parties is a significant burden on society. It causes a number of deaths.
Accidents harm individuals' families, communities and society at large. There is a strong link between
alcohol and violence (e.g.80% of violent crimes committed by adolescents in Estonia are associated with
alcohol use). Alcohol is attributable factor in 40% of all homicides throughout the EU21. Effort should be
made to create an environment that supports lower- risk drinking. Drinking settings such as pubs, bars,
nightclubs are key areas for interventions, for improvements in the way alcohol is served and consumed.
18 ETSC (2012) Drink Driving: Towards Zero Tolerance
http://www.etsc.eu/documents/Drink Driving Towards Zero Tolerance.pdf
19 Ibid
20 A technical enforcement tolerance level could be set at 0,1 or 0,2 g/l BAC but the message to drivers should always be clear:
no drink and drive
WHO Europe (2012) Alcohol in the European Union
12 | P j
Eurocare recommendations for a future EU alcohol strategy
Key features of dangerous venues include a permissive atmosphere, crowding, low levels of comfort,
inadequately trained staff, cheap drinks promotions22. Thoroughly implemented interventions can
enhance prevention of risky behaviour, protect the health of individuals and care for broader impact of
hazardous alcohol consumption on communities (i.e. vandalism)
RECOMMENDATIONS
Minimum legal age for purchasing 18 years (while respecting MS with higher minimum age of
purchase and stricter implementation policy)
Stricter opening hours for commerce selling alcohol (with special emphasis on night shops)
Reduced density of alcohol outlets, especially around areas where young people are more likely to be
present e.g. schools, sport centres, cultural centres, stadiums, play grounds etc.
Mandatory and independently evaluated professional training for employees handling alcohol
(serving, selling)
2.4.3.
Alcohol and pregnancy
Drinking alcohol during pregnancy can lead to birth defects and developmental disorders. It may cause
the unborn child physical, behavioural and learning disabilities.
Alcohol can damage the baby
throughout the entire pregnancy. During the first trimester of pregnancy, exposure to alcohol can cause
abnormalities in the physical structure of the foetus. During the third trimester, the baby's length and
weight increase dramatically and exposure to alcohol can impair the growth. The brain develops and is
vulnerable to damage during the entire pregnancy. The damage to the brain, which may result in
behaviour problems and cognitive deficits, is the most debilitating of the effects of prenatal alcohol
exposure. FASD is an umbrella term describing the range of effect that can occur in person whose
mother drank during pregnancy. It affects nearly 5 million people and is 100% preventable. Although
many women give up alcohol when pregnant there are a substantial number of women in all the EU
Member States who continue to drink.
22
Hughes et al (2011) Environmental factors in drinking venues and alcohol-related harm: the evidence base for European
intervention Addiction 106(Sl):36-46
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RECOMMENDATIONS
Containers of alcoholic products should carry a warning message determined by public health bodies
describing the harmful effects of drinking during pregnancy
Introduction of comprehensive and permanent awareness-raising campaigns and educational
programmes for the public at large
Programmes to enhance knowledge of health care professionals
Provision of services for diagnosis and treatment for children with foetal alcohol syndrome
(FAS/FASD)
Implementation of modules promoting health prevention and awareness-rising as compulsory
modules in the curriculum for medical degrees
Inclusion of FASD diagnosis by social and judicial services
2.4.4.
Family and Children
Whilst million of families within the EU are affected by the problem it is difficult to find an accurate
assessment of its size. Perceptions on alcohol problems vary from culture to culture and, among those
affected, it can often take the 'character of a shameful secret'. It is being estimated that 23 million
people in the EU are dependent on alcohol, which consequently results in 9 million children and young
people in the EU living with at least one parent addicted to alcohol23. Many of these children are raised
in families with alcohol addiction and are exposed to risk behaviour of their parents. Two thirds of the
reported victims of domestic violence had been attacked by a person using alcohol, and 16% of cases of
child abuse and neglect involve alcohol24. Children living with families affected by alcohol related harm
tend to have lower school attendance and worse health.
RECOMMENDATIONS
More support for rehabilitation centres for alcohol dependence
Support for educational centres for children of alcohol dependent parents
Awareness raising campaigns on protection of children from alcohol related harm.
2.5.
Social inclusion and equality in health
Social inclusion is important both as prevention and as rehabilitation. In order to keep people in the
workforce and out of treatment, care and social support, programs to socially integrate and rehabilitate
people with alcohol problems are a priority. It would benefit the individual, its family and community and
the economy as well as reducing inequalities in health. This could be achieved by integration of alcohol
harm related dimension in programs aiming at reducing inequalities in health and social exclusion.
Furthermore, effective programs should be supported, such as self- help groups and early intervention
programs as well as effective treatment.
23 Anderson P, Baumberg B (2006) Alcohol in Europe: a public health perspective. London Institute of Alcohol Studies
24 Ibid
14 |
Eurocare recommendations for a future EU alcohol strategy
The adverse effects of alcohol are exacerbated among those from lower socioeconomic groups; this is
especially the case for dependency, which is often accompanied by poor diet and general lack of money.
People in lower socioeconomic groups who drink heavily cannot protect themselves as well as those in
more affluent groups, who can purchase social and spatial buffering of their behaviour.
Low
socioeconomic status renders a pattern of drinking more visible and makes the drinker more vulnerable
to marginalisation and stigma.
RECOMMENDATIONS
Implementation of health objectives in all policies
Impact assessments of other Directorate Generals policies and decisions on alcohol policy.
2.6.
Prevention with special focus on prevention at workplace
Prevention cannot remain a responsibility of the Member States alone, Europe, as a market place, a
cultural space and communication area must address prevention. Equally the local level is where people
conduct their daily lives. Therefore, prevention should therefore span across the European and local
level. Community based prevention must be supported by a European wide program in a comprehensive,
coordinated, long- term manner.
Harmful and hazardous alcohol consumption is one of the main causes of premature death and
avoidable disease and furthermore has a negative impact on working capacity. Alcohol-related
absenteeism or drinking during working hours have a negative impact on work performance,
competitiveness and productivity. Often forgotten is the impact of drinkers on the productivity of people
other than the drinker. Moreover, about 20 to 25% of all accidents at work involve intoxicated people
injuring themselves and other victims, including co-workers25.
RECOMMENDATIONS
Implementation of alcohol policies within the workplace to focus on health promotion and on I
different lifestyles ratherjhan on the disease and punitive sanctions
More comprehensive data collection on impact of alcohol related problems on economy and within
the workplace
Enforcement and where not existent introduction of zero tolerance policies for BAC levels in
industries where alcohol increases the danger of accidents and injuries
Implementation of awareness raising campaigns at work about ajcohol related harm
25 Science Group of the Alcohol and Health Forum (2011) Alcohol, Work and Productivity: Scientific Opinion of the Science Group
of the European Alcohol and Health Forum Retrieved from: http://ec.europa.eu/h ealth/alcohol/docs/science 02 en.pdf
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Eurocare recommendations for a future EU alcohol strategy
2.7.
Treatment and early interventions
Treatment and early interventions is a vital component of the total response to alcohol problems, and
must be included in a comprehensive approach to alcohol policy. As some studies indicate in primary
health care settings, commonly less than 10% of the population at risk of becoming hazardous and
harmful drinkers are identified and less than 5% of those who could benefit are offered brief
interventions26. There is consistent evidence that early interventions reduce alcohol related harm and
are cost effective. Moreover, organisational factors increase the implementation and effectiveness of
these programmes.
RECOMMENDATIONS
Support given to Member States in exchange of information in area of brief interventions (including
interventions designed for non- dependent high drinker, specialised treatment for persons with
alcohol dependence)
____________ ____________________
Recognition and support for informal groups of mutual self help
2.8.
_____
Monitoring of data, developing and maintaining common evidence base
It is crucial to appropriately monitor alcohol policy developments in the EU, with a set of common
indicators and definitions, in order to ensure that comparable data across EU is available. Consequently,
this consistency will provide tools to assess the policy actions undertaken. There is a need for better data
on alcohol in Europe. The European Commission and Member States should regularly obtain comparable
information on alcohol consumption, on drinking patterns, on the social and health effects of alcohol;
and information on the impact of alcohol policy measures and of alcohol consumption on productivity
and economic development.
The European Commission should monitor and follow the developments in Member States to see if
targets are reached.
RECOMMENDATIONS
A European Alcohol Monitoring centre with country based counterparts, should be established and
financed
When new legislation is adopted at regional, national and the European level standardised
evaluation should be performed.
Alcohol related targets should be included in European Commission work on prevention of chronic
disease
European Commission defining and tracking a common set of indicators and policy responses and
interventions in the framework of Open Method ofCoordination^
26
WHO Europe (2012) Alcohol in the European Union
16 | P
e
Eurocare recommendations for a future EU alcohol strategy
W
Way forward: how to address alcohol related harm?
J
Compared to the current EU alcohol strategy there is a strong need for future policies to
have specific and clear targets, whilst also working harder at promoting a coherent
X
W
approach through health in other policies.
3.1.
Enhanced cooperation between Member States
One way forward to provide a more structured approach would be for the new EU alcohol
strategy to include:
•
Fixing guidelines and timetables for achieving short, medium and long-term goals
•
Establishing quantitative and qualitative indicators and benchmarks, tailored to the needs of
•
Translating European guidelines into national and regional policies, by setting specific measures
Member States and sectors involved, as a means of comparing best practices
and targets
•
Periodic monitoring and evaluation of the progress achieved in order to put in place mutual
learning processes between Member States
Eurocare suggests having a 3 step period; 2013 - 2015, 2016- 2018, 2019-2020 that would be expected
to produce the following outcomes:
•
Enhanced mutual learning and peer review
•
Identification of good practices and of their conditions for transferability
•
Development of joint policy initiatives among several Member States and regions
•
Identification of areas where Community initiatives could reinforce actions at Member State
level.
3.2.
Alcohol in all policies
European Union regulations, such as those governing the internal market, trade, competition and
agriculture, have in practice an enormous impact on national and local health policies.
Eurocare is concerned that alcohol related harm does not seem to be taken into account when issues like
cross border trade, taxes and agricultural support are discussed and regulated by Directorates of the
Commission which are not directly working on health. The efforts of the health community and all
stakeholders involved could be counterproductive if the issue is not being addressed.
This has been recognised over the years by the EU legislature and as mentioned in Art. 168(5) TFEU, it
(...) may adopt incentives measure designed to protect and improve human health (...) and measures
17 | P a g e
Eurocare recommendations for a future EU alcohol strategy
which have as their direct objective the protection of public health regarding tobacco and the abuse of
alcohol.
Alcohol is no ordinary commodity and should not be treated as such. Free trade rules and competition
paradigm should not take precedence over the protection of public health and social wellbeing in
Europe. European Commission with other partners should start reflecting on future exemption of alcohol
from free trade agreements as it is a harmful substance with detrimental effect to health and society.
18 |
Eurocare recommendations for a future EU alcohol strategy
CONCLUSIONS: Let us all think about alcohol differently
What's drinking?
A mere pause from thinking!
~George Gordon, Lord Byron
Alcohol is not a neutral substance. Neither to the individual, as it is an addictive and
harmful product, nor to the society, as one person's freedom to drink might hinder other's person
freedom to safety.
As physical borders disappear and trade within and beyond the EU is made easier and faster, we are
faced with new challenges in terms of alcohol policy. Combination of interventions is needed to reduce
alcohol-related harm to the benefit of society as a whole.
Preventing harm in the first place and promoting healthy lifestyles are a cost effective measure for
fighting diseases- it is an investment in the future saving. We should strive to continuously achieve small
milestones towards the final outcome of a healthier society.
As we are faced with new austerity measures and an aggressive drive for increased alcohol sales, the
protection of consumers and citizen's welfare should not be sidetracked. Otherwise, it is almost certain
that our public systems will be faced with tangible consequences of inaction.
Eurocare believes that the European Commission and Member States have much to learn from sharing
experience of national policies in areas of common interest. This can help them to improve the design
and implementation of their own policies, to develop coordinated or joint initiatives on issues of
transnational interest and to identify areas where Community initiatives could reinforce national actions.
Over the last years policies such as awareness rising have become widespread, whereas policies that
would have a greater impact such as increasing alcohol price and regulating marketing tended to be
forgotten. There is thus a great area for improvement to reduce the burden of alcohol on individuals and
societies over the coming years.
19 | P a
Alcohol
What You Don’t Know
Can Harm You
National Institute on Alcohol Abuse and Alcoholism
National Institutes of Health
^J?you are like many Americans, you may drink alcohol
occasionally. Or, like others, you may drink moderate
amounts of alcohol on a more regular basis. If you are a
woman or someone over the age of 65, this means that
you have no more than one drink per day; if you are a man,
this means that you have no more than two drinks per day.
Drinking at these levels usually is not associated with health
risks and can help to prevent certain forms of heart disease.
But did you know that even moderate drinking,
under certain circumstances, is not risk free? And that if
you drink at more than moderate levels, you may be putting
yourself at risk for serious problems with your health and
problems with family, friends, and coworkers? This booklet
explains some of the consequences of drinking that you may
not have considered.
What Is a Drink?
A standard drink is:
>■ One 12-ounce bottle of beer*
or wine cooler
>■ One 5-ounce glass of wine
>■1.5 ounces of 80-proof
distilled spirits.
■Beer ranges considerably in its alcohol content,
with malt liquor being higher In its alcohol content
than most other brewed beverages.
Drinking and Driving
It may surprise you to learn that you dont need to drink
much alcohol before your ability to drive becomes impaired.
For example, certain driving skills—such as steering a car
while, at the same time, responding to changes in traffic
can be impaired by blood alcohol concentrations (BACs) as
low as 0.02 percent. (The BAC refers to the amount of alcohol
in the blood.) A 160-pound man will have a BAC of about
0.04 percent 1 hour after consuming two 12-ounce beers
or two other standard drinks on an empty stomach (see the
box, “What Is a Drink?”). And the more alcohol you con
sume, the more impaired your driving skills will be. Although
most States set the BAC limit for adults who drive after
drinking at 0.08 to 0.10 percent, impairment of driving
skills begins at much lower levels.
Interactions With Medications
Alcohol interacts negatively with more than 150 medications.
For example, if you are taking antihistamines for a cold
or allergy and drink alcohol, the alcohol will increase the
drowsiness that the medication alone can cause, making
driving or operating machinery even more hazardous. And
if you are taking large doses of the painkiller acetaminophen
and drinking alcohol, you are risking serious liver damage.
Check with your doctor or pharmacist before drinking any
amount of alcohol if you are taking any over-the-counter or
prescription medications.
Interpersonal Problems
The more heavily you drink, the greater the potential for
problems at home, at work, with friends, and even with
strangers. These problems may include:
>- Arguments with or estrangement from your
spouse and other family members;
>• Strained relationships with coworkers;
>■ Absence from or lateness to work with
increasing frequency;
>■ Loss of employment due to decreased
productivity: and
>• Committing or being the victim of violence.
Alcohol-Related Birth Defects
If you are a pregpant woman or one who is trying to conceive,
you can prevent alcohol-related birth defects by not drink
ing alcohol during your pregnancy. Alcohol can cause a
range of birth defects, the most serious being fetal alcohol
syndrome (FAS). Children born with alcohol-related birth
defects can have lifelong learning and behavior problems.
Those born with FAS have physical abnormalities, mental
impairment, and behavior problems. Because scientists
do not know exacdy how much alcohol it takes to cause
alcohol-related birth defects, it is best not to drink any
alcohol during this time.
Long-Term Health Problems
Some problems, like those mentioned above, can occur after
drinking over a relatively short period of time. But other
problems—such as liver disease, heart disease, certain forms
of cancer, and pancreatitis—often develop more gradually
and may become evident only after long-term heavy drinking.
Women may develop alcohol-related health problems after
consuming less alcohol than men do over a shorter period of
time. Because alcohol affects many organs in the body, long
term heavy drinking puts you at risk for developing serious
health problems, some of which are described below.
Alcohol-related liver disease. More than 2 million
Americans suffer from alcohol-related liver disease. Some
drinkers develop alcoholic hepatitis, or inflammation of the
liver, as a result of long-term heavy drinking. Its symptoms
include fever, jaundice (abnormal yellowing of the skin,
eyeballs, and urine), and abdominal pain. Alcoholic hepatitis
can cause death if drinking continues. If drinking stops,
this condition often is reversible. About 10 to 20 percent
of heavy drinkers develop alcoholic cirrhosis, or scarring of
the liver. Alcoholic cirrhosis can cause death if drinking
continues. Although cirrhosis is not reversible, if drinking
stops, ones chances of survival improve considerably. Those
with cirrhosis often feel better, and the ftmctioning of their
liver may improve, if they stop drinking. Although liver
transplantation may be needed as a last resort, many people
with cirrhosis who abstain from alcohol may never need
liver transplantation. In addition, treatment for the compli
cations of cirrhosis is available
Heart disease. Moderate drinking can have beneficial
effects on the heart, especially among those at greatest risk
for heart attacks, such as men over the age of 45 and women
after menopause. But long-term heavy drinking increases
the risk for high blood pressure, heart disease, and some
kinds of stroke.
Cancer. Long-term heavy drinking increases the risk of
developing certain forms of cancer, especially cancer of the
esophagus, mouth, throat, and voice box. Women are at
slightly increased risk of developing breast cancer if they
drink two or more drinks per day. Drinking may also increase
the risk for developing cancer of the colon and rectum.
Pancreatitis. The pancreas helps to regulate the body’s
blood sugar levels by producing insulin. The pancreas also
has a role in digesting the food we eat. Long-term heavy
drinking can lead to pancreatitis, or inflammation of the
pancreas. This condition is associated with severe abdominal
pain and weight loss and can be fatal.
Ifyou or someone you know has been drinking heavily, there
is a risk of developing serious health problems. Because some
of these health problems are both reversible and treatable, it
is important to see your doctor for help. Your doctor will be
able to advise you about both your health and your drinking.
The National Institute on Alcohol Abuse and Alcoholism
(NIAAA), National Institutes of Health, supports about 90
percent of the Nations research on alcohol use and related
consequences. Through this research, NIAAA and the
researchers it supports make an implicit promise—that
alcohol research will yield practical applications that will
help those who suffer as a result of alcohol abuse and
alcoholism. Today, alcohol researchers are working on the
cutting edge of medical science to answer questions such as:
>-Who is at risk for alcohol-related problems?
>-How does alcohol affect the body, including
the brain?
>-How is the risk for alcoholism inherited?
>-What are the health benefits and risks of
moderate drinking?
>What therapies, including medications, show
promise for treating alcohol dependence more
effectively?
Each new discovery made by alcohol researchers
provides a piece of the answer to the ages old question of
how to prevent and treat the alcohol-related troubles that
plague individuals, families, and society. We see the future
of alcohol research both as a challenge and as a reward: A
challenge, because with more answers come more questions,
and we still have far to go. A reward, because the answers we
find ultimately will help diminish a public health threat that
has existed for far too long.
If you or someone you know needs help or more
information, contact:
>-Al-Anon Family Group Headquarters
1600 Corporate Landing Parkway
Virginia Beach, VA 23454—5617
Internet address: http://www.al-anon.alateen.org
Makes referrals to localAl-Anon groups, which are
supportgroupsfor spouses and other significant adults in
an alcoholic persons life. Also makes referrals to Alateen
groups, which offer support to children ofalcoholics.
>• Locations of Al-Anon or Alateen meetings
worldwide can be obtained by calling 1-888-4AL-ANON
Monday through Friday, 8 a.m.—6 p.m. (e.s.t.).
>• Free informational materials can be obtained by
calling the toll-free numbers (operating 7 days per week,
24 hours per day):
iWJ.S.: (800) 356-9996
>-Canada: (800) 714-7498
>•Alcoholics Anonymous (AA) World Services
475 Riverside Drive, 11th Floor
NewYork, NY 10115
(212) 870-3400
Internet address: http://www.alcoholics-anonymous.org
Makes rfferrals to localAA groups andprovides informational
materials on the AA program. Many cities and towns
also have a local AA office listed in the telephone book.
>■ National Council on Alcoholism and Drug
Dependence (NCADD)
12 West 21st Street
New York, NY 10010
(800) NCA-CALL
Internet address: http://www.ncadd.org
Provides telephone numbers oflocal NCADD affiliates
(who can provide information on local treatment resources)
and educational materials on alcoholism via the above
toll-free number.
^-National Institute on Alcohol Abuse
and Alcoholism
Scientific Communications Branch
6000 Executive Boulevard, Suite 409
Bethesda, MD 20892-7003
(301) 443-3860
Internet address: http://www.niaaa.nih.gov
Makes available free publications on all aspects ofalcohol
abuse and alcoholism. Many are available in Spanish.
Call, write, or search the World Wide Web sitefor a list of
publications and ordering information.
Provided by:
Center for Student Wellness
College of Physicians & Surgeons
Columbia University, 107 Bard Hall
212.304.5564
NIAAA
National Institute on Alcohol
Abuse and Alcoholism
NIH Publication No. 99-4323
Printed 1999
Let everyone lead a happy life
Treatment and
Rehabilitation Centre
for Alcoholism
and Drug Dependency
TT RANGANATHAN CLINICAL RESEARCH FOUNDATION
TTK HOSPITAL
TTK Hospital
TTK Hospital / TT Ranganathan Clinical Research
Foundation is a voluntary, non-profit organisation
dedicated to the treatment and rehabilitation of persons
60 Bed Premier
Hospital run by a
Team of Committed
Professionals
Established in 1980, the hospital has 60 beds. A team of
addicted to alcohol and drugs.
qualified professionals, deeply committed to the
mission, provide the patients with both medical and
psychological treatment.
The facilities offered at the Hospital include :
— detoxification unit
- emergency ward
- general wards
- special rooms
- family ward
- therapy centre
- counselling units
- family therapy centre
- recreation centre
- canteen
- pharmacy
Addiction is a Disease.
It requires Treatment
Alcoholism or drug dependency is a disease. A chronic
and progressive disease that leads to severe physical,
emotional and social problems.
Our authentic experience in having treated over 11,000
patients during the last 20 years, has strengthened our
belief that addicts, when provided timely treatment and
support, can lead qualitative lives free of alcohol
and drugs.
Treatment aims at
Total Abstinence and
Improved Quality of Life
The objective of the treatment is to achieve the twin
goals of
• Total abstinence from
alcohol and drugs
for life and
• Positive
changes
towards
enhancing the
quality of his
life.
In-patient Treatment
Detox facilities to
mitigate withdrawal
problems
The treatment programme.is a residential, multi
disciplinary therapeutic programme, conducted by a
team of psychiatrists, physicians, psychologists, social
workers, counsellors and nursing staff. The duration of
the treatment programme is 4 to 6 weeks.
Patients are admitted to the detoxification unit where the
required medical treatment is given. Withdrawal
symptoms due to sudden stoppage of drug usage and
health problems
associated with
addiction are dealt
with.
When the physical
condition of the
patient stabilises, he
is transferred to the
psychological
therapy wing.
Psychological Therapy
Psychological therapy comprises individual counselling,
lectures, group therapy and relaxation techniques.
Individual care and attention are given to patients.
e
Free Follow-up
Follow-up forms an important part of the treatment and is
maintained for a period of five years. Patients are
encouraged to meet the Doctor and their Counsel' rs
regularly to seek medical advice and report on their
progress.
Support groups AA and Al-Anon
Patients and family members are encouraged to attend
Alcoholics Anonymous (AA) and Al-Anon meeting .
Meetings are also held at the hospital premises.
Helping the family
towards leading a
qualitative life
Addiction is an illness that affects not only the addicted
individual, but also his family members.
The family is provided with emotional support to
manage the stress caused
by the behaviour of the
addict. Guidelines to help
the patient in his recovery
form part of this two week
programme.
The programme includes
lecture sessions, group
therapy, and participatiQji
in Al-Anon.
The Social Support Programme aims at exploring the
possible support, the recovering patients can receive
from the society in which they live and utilising it
towards their recovery.
The support persons are usually family members - other
than the spouse - or co-workers or friends. Contact with
the support persons helps in stabilising recovery and
ensuring regular follow-up.
After Care Centre
For patients who need extended help, a special after care
programme is available. The programme is for a period of
3 months. This centre has 20 beds.
How do I get admitted
telephone or in person. It may not be possible to ^t
admission without advance reservation.
For additional information contact:
/ ;
-...A
TTK HOSPITAL
IV Main Road, Indira Nagar, Chennai 600 020.
Phone : 4912948 / 4918461 / 416458. E-mail : ttrcrf@md2.vsnl.net.in
Treatment and Rehabilitation Centre for
Drug Dependency
and Alcoholism
T.T. Ranganathan
Clinical Research Foundation
AFTER CARE CENTRE
Let everyone lead a happy life
AFTER CARE CENTRE
20 Bedded half way home run by a
team of committed professionals
After Care Centre - TT Ranganathan Clinical Research Foundation is a
voluntary, non-profit organisation dedicated to the treatment and
rehabilitation of persons addicted to drugs and alcohol.
Established in 1989, the Centre has 20 beds. A team of qualified
professionals, deeply committed to the mission, provide the patients
both medical and psychological treatment.
The facilities offered at the centre include:
•
•
•
•
•
Therapy centre
Counselling units
Family therapy centre
Recreation centre
Yoga
Addiction is a Disease
It requires Treatment
Drug dependency is a disease. A chronic and progressive disease that
leads to severe physical, emotional and social problems.
Our experience in having treated over 700 patients during the last 10
years, has strengthened our belief that addicts, when provided timely
treatment and support, can lead qualitative lives free of drugs / alcohol.
Treatment aims at total abstinence
and improved quality of life
The objective of the treatment is to achievc:
•Total abstinence from drugs for life
•Positive changes towards enhancing the quality of life
AFTER CARE CENTRE
In-patient Treatment
The treatment programme is a residential, multi disciplinary
therapeutic programme, conducted by a team of psychologists, social
workers, counsellors and Doctor. The duration of the treatment
programme is 12 weeks.
Psychological Therapy
Psychological therapy comprises of individual
counselling,
lectures, group therapy and
relaxation techniques. Individual care and ,
attention are givcn.to patients.
Tree Tollow-up
Follow-up forms an important part of the treatment and it is maintained
for a period of five years. Patients arc encouraged to meet the Doctor and
their Counsellors regularly to seek medical advice and report on their
progress.
Support groups NA, AA and Al -Anon
Patients and family members are encouraged to attend Narcotic
Anonymous (NA), Alcoholics Anonymous (AA) and Al-Anon meetings.
Meetings arc also held at the hospital premises.
Helping the family
towards leading a qualitative life
Addiction is an illness that affects not only the addicted individual, but also his family
members.
The family is provided with emotional support to manage the stress caused by the behaviour
of the addict. Guidelines to help the patient in his recovery form a part of this 12 week
programme.
The programme includes lecture sessions individual therapy, group therapy and
participation in Al-Anon.
Social support programme
The Social Support Programme aims at exploring the possible support, the recovering
patients can receive from the society in which they live and utilise it towards their recovery.
The support persons arc usually family members - other than the spouse - or co-worker or friends. Contact with the support persons helps in stabilising recovery and
ensuring regular follow-ups.
How do I get admitted
For admission, contact the Centre either over telephone or in person. It may not be possible
to get admission without prior consultation.
For additional information contact:
AFTER CARE CENTRE
IV Main road, Indira Nagar, Chennai - 600 020. Tel: 4424314.
4912948 / 4918461
T T RANGANATHAN CLINICAL RESEARCH FOUNDATION (Regd)
"TTK HOSPITAL"
17, IV Main Road, Indira Nagar, Chennai 600 020
TREATMENT CHARGES
The facilities offered and charges for the Wards are listed below:
GENERAL WARDS B' WARDS
Detoxification is done in a Common Ward consisting of 12 beds. The patient is
admitted here for about 4 days. He is then shifted to the Therapy Wards for the
remaining period of 21 days.
There are 6 Wards. Each Ward has 7 beds. Toilets are provided outside the
Wards.
Detoxification and Therapy Charges
Bed Charges duri^Detoxification
& Therapy for 25 days at the rate of
Rs. 125.00 per day
Rs.
FAMILY WARD (FOR WOMEN)
Family members accompanying patients staying in'Bv Wards can avail of the
accommodation provided in the Family Ward. The Ward can accommodate 10
people. The charge is Rs. 20/- per day.
You know that alcohol lowers your inhibitions and interferes with
decision-making, which makes for some potentially dangerous sex
ual situations. At best, deciding to sleep with someone while you're
under the influence can put you in an embarrassing predicament
the next morning. At worst, it can cause you to be the victim of
sexual assault or leave you with a deadly disease like AIDS. That's
why you need to have a plan, to prevent yourself from getting into
sexual jeopardy when you drink.
Danaerous
"Karen was the first girl I’d gone
out with since I’d come out [of the
closet], and I was really psyched. On
our second date, we went out for dinner
and somehow managed to drink two
bottles of wine. Then we headed back
to my dorm room, where we started
making out. I wasn’t ready to have
sex yet, because everything was so
new to me and I wanted my first time
with a woman to be really special.
o o
o °o
this brochure, you'll find; |
After all that wine, I guess my
judgement was off, and I had sex
with her anyway. I didn’t even
Real-life stories from students who've been in
sexual situations they've regrettedand that have changed their lives forever
remember most of it. Even though
part of me really liked her, I felt so
embarrassed after that. Since then
It's been really hard for me to get
close to anyone."
ts about how alcohol has different
on men and women
true statistics about the sexual
er that alcohol can put you in
© "At the end of the semester I
'How to respond when you're being pressured
into having sex while under the influence
to get help if you’ve been sexually
ir signals to watch out for when you're
rig with potential romantic partners
you can have sex legally with
who is drunk
Assault prevention including the basic facts
about "date rape drugs" Rohypnol and GHB
A quiz that will help you determine If your
relationship depends too heavily on alcohol
Here,
students
who
learned the hard way that
mixing alcohol and sex
have serious consequences:
"This guy I really liked asked me
to go to a party with him. We were
having fun, and I guess we were
getting pretty drunk. We decided to
go back to my room to be alone. We
were kissing and fooling around, and
I was okay with it. Then he started to
go further than I wanted to go. I told
him that I didn't want to, but I guess
he thought I was into it. I don’t
even think he realizes that he
raped me."
"I was at a party at a friend’s
apartment right before Thanksgiving
break. I got pretty tanked playing
drinking games, and suddenly 1 was
outside on this fire escape with a guy
I’d met an hour earlier. I was doing
something to him I'd rather not talk
about. The next morning I woke up
and couldn't even remember his
name. I felt disgusted. To make
matters worse-either someone saw
us or he bragged to his friends about
what happened, because after I got
back from the break, a friend of mine
told me I had a new nickname. I still
haven't lived it down, and I feel like
I'm this big joke."
was at a party. It was late and every
one was really trashed. We were all
just hanging out when my friend's
girlfriend decided to sit on my lap. I
didn't think It was any big deal, since
we were pals, but suddenly she start
ed kissing me. I was so out of it I did
n't stop her. This was right in front of
everyone we knew. Someone finally
said to us, ‘What do you guys think
you're doing?' and we stopped, but of
course It got back to my buddy.
He flipped. Our friendship was
totally destroyed by this stupid,
drunken incident. I think he felt I'd
broken a code of trust, which, in a
way, I guess I had. We don’t even talk
anymore.”
@
“I’ve been openly gay for two
while longer. We had sex-which I
years, and active in our campus gay
support organization. This fall, after a
meeting, I invited the group over to
my house for a party. I was excited
to be back on campus, and I guess I
celebrated a little bit too much-1 kept
drinking more even though I knew I
was already pretty drunk. As every
one was getting ready to leave, a guy
who I'd been talking to for most of the
night asked if he could hang out for a
would not have done if I had
been sober. I don't believe In sleep
How Alcohol
Discriminates
ing with people on the first date. I
think he regrets it too, because we
haven't spoken since."
Unfortunately, alcohol isn't up with the times when it comes to treating men
and women equally. Check out this chart to see how drinking affects you, based
on whether you're male or female.
"One Thursday night I was out
with my friends, kicking off the
weekend. This girl challenged me to a
drinking contest, so I took her up on It
and we got really drunk. She came
back to my room after last call. We
hung out, drank a few more beers,
and I guess I passed out. I don't know
how much time had passed, but I
woke up to her on top offlp?.
Apparently my body was in the mood
to have sex, even though I wasn't
mentally Interested at all. She had
already gotten going before I
managed to push her off me. There
was no protection involved. I know
It’s hard to believe that a guy
can be raped, but I really felt vio
lated. I did not want to have sex with
her. To make things worse, about a
month later I realized I'd contracted
herpes."
Ability to Dilute
Alcohol
Ability to
Metabolize Alcohol
Average Total Body Water: 52%
Average Total Body Water: 61%
Women have a smaller quantity of
dehydrogenase, an enzyme that
breaks down alcohol.
Men have a larger quantity of
dehydrogenase, which allows them to
break down the alcohol they take in
more quickly.
Hormonal Factors
Premenstrual hormonal changes
cause intoxication to set in faster
during the days right before a
woman gets her period.
Their susceptibility to getting drunk
does not fluctuate dramatically at
certain times of the month.
Alcohol Increases estrogen levels.
Alcohol also increases estrogen levels
in men. Chronic alcoholism has been
associated with loss of body hair and
muscle mass, development of swollen
breasts and shrunken testicles, and
impotence.
Birth control pills or other medicine
with estrogen increase intoxication.
Just
Frightens
Here are some stone-cold sobering statistics about the college
sex-and-alcohol cocktail:
^cts, Ma'am
Dos
Donis
For Defusing a
Sexual Advance
The following tips can be used
whether the person who's crossing
the line is drunk or not. But before
you start drinking, ingrain them in
your memory so you can put them
into action if you need to. Keep in
mind that sometimes, no matter
what you do, you cannot avoid an
assault.
say, "No!” Say it with certainty. Let there be no doubt
in the person's mind that you have
no intention of having sex with him
or her.
BLEH
n
smile or worry about
being friendly or polite.
Your own physical safety is your
main concern, not whether you hurt
this person's feelings. After a!k
obvious that he or she doesn't
about your feelings.
use the word
"rape.” Saying
O
something
like,
"You
if you get your way, don't
you?" may give the drunk
person a sobering wake-up call
and stop them in their tracks.
hesitate to lie to qet out
M of a situation. If you’re in
a room together but you'd like this
person to leave, tell him or her you
have an STD or that your roommate
is going to be home any minute.
act quickly. Assess the
Where toco
for
What to Do if You Are Raped or
Sexually Assaulted
Whether or not you were drunk when
the assault occurred, remember that
It Is not your fault. If the Incident
occurred within the last 24-72 hours:
Help
doctor. You may have contracted a
sexually transmitted disease from
your attacker for which you should
receive immediate treatment.
If the incident occurred recently or
long ago, you can still get help.
Q Ask a school coun
situation:
(IS) Are there people around to help
selor about support
groups on campus for
survivors of sexual
assault.
you? If so, get someone's attention
her know you're in trouble.
If no one is around, but you
think you might be heard If you
screamed, then go ahead and yell,
"Fire!" People are more likely to
respond to this alarm than if you
were to yell for help, because people
don't like to get involved In what
they perceive to be a lover's quarrel.
Jfh If you are In a deserted area, try
to determine an escape route.
Distract your assailant by looking
off in the opposite direction, as
though you hear someone approaching.
Since the person is drunk, this tactic
should buy you a few moments to
Q If you’re not com
fortable seeking help
on campus, look in your
telephone directory to
find other support
groups in your area.
You can also call
RAINN
(Rape and
Incest
National
Network) at 800-6564673 for a victims ser
vices office near you.
Q Call the police and file a report.
You may need to go In to the station
to do this, or you may be directed to
go to the hospital emergency room
for an examination.
Q If possible, do not shower, bathe,
eat or drink before you are examined.
Bring a change of clothes with you to
the hospital because the police will
need to keep the clothes you were
wearing during the assault as
evidence.
Q Ask to speak to rape crisis coun
selor or social worker, who will Inform
you about counseling services that
are available to you.
O Even if you decide not to press
charges, It is still extremely impor
tant that you be examined by a
What to Do If You Are in An
Abusive Relationship
Whether It has to do with your
partner's alcohol abuse or not,
here's where to turn:
Q We know it's easier said than
done, but get out. You don't have to
tolerate abuse of any kind.
O Seek on-campus help by visiting a
school counselor and learning about
support groups.
Q Call the National
Domestic
Violence Hotline at 800-799-SAFE.
Q You
can
also
call
the
Covenant House 9-line for a
crisis intervention services in
your area. 800-999-9999.
Protect
Date =
■ Not listening to you. Interrupting
you, or Ignoring you.
The following is a checklist of
behaviors that should set off alarms
in your head whether you're
drinking or not. Don’t let your
politeness or intoxication put you in
a threatening situation. If a person
you're with at a party or a bar
displays any of these behaviors,
stay alert enough to call a friend
and ask him or her to help you get
home safely.
■ Disregarding your space boundaries
and touching you without your consent.
■ Drinking heavily.
"Consenting Adults?"
Legally speaking, for two people to
have sex, you've both got to agree to
it. That's called consent: a volun
tary, verbal, positive affirmation
that you both want to have sex.
Problem Is, things get hazy If either
you or your partner Is drunk. So
keep these points In mind If you're
drunk and horny, or you may find
yourself sober and Jailed:
Here are some tactics to use
to
getting involved in a
dangerous sexual situation.
c
O Consent is not just the absence
of the word "no." So ask your partner
If he or she wants to have sex. No
answer means "no."
Q Even If you hear the word,
"yes," explicit consent may not be
considered legally established. If
you've been drinking, any sexual
activity will still be considered
assault in some states.
O Remember you or your partner
can change "yes" to "no" at any time.
Q If
someone is
passed out, he or^te
can't give his or
consent. If you have
sex with this person,
you will be committing
sexual assault. Period.
Q Don't think you
can claim you were
drunk and didn't know
what you were doing If
you commit an act of
sexual assault. You
will be held account
able for your conduct.
When going on a date with some
one new, make sure to tell a friend
what your plans are so that someone
knows where you will be.
much.
® Take a self defense class. That
Alcohol impairs your ability to make
smart choices.
way, you will know what to do if
things get too physical.
(S) Avoid
Date
What Does It Mean to Be
91> Don't go back to someone's
room or leave a party with someone
you don’t know well.
!» Trust your gut. If you feel at all
uncomfortable, get out of the situation.
■ Trying to make you feel guilty If
you won't do something sexual or
using red flag words like "uptight,"
"prude," or "tease."
■ Acting possessive, Jealous, or
paranoid and becoming upset if
anyone else looks at or talks to you,
” Talk to your date beforehand to
make sure you are on the same page
about where the night is going.
drinking
too
Drugs: Q
What You Need to Know
You've heard about them on the
news-young women being sexually
assaulted after drugs have been
slipped Into their drinks. What exactly
are "Roofles" and GHB? And how
can you protect yourself?
"
What
are
they?
Rohypnol, VK, ■'
known on the street as
"Roofles," and Gamma hydroxy
butrylc acid, known as GHB or
liquid ecstasy, are depressants
that can cause dizziness, disorientation,
loss of inhibition, memory blackouts,
and loss of consciousness when
mixed with alcohol. Both are odor
less, colorless, and tasteless, so you
may not even realize it if someone
slips one of these substances Into
your drink. Because they may cause
you to pass out, ingesting them may
put you at risk for sexual assault.
How can you protect yourself?
Q Don't put your drink down.
If your drink is out of sight, even for
a few minutes, don't finish it. Get
yourself a new one.
Don't accept an open drink
from anyone. If you order a drink in
a bar, make sure you watch the
bartender open the bottle or mix
your drink.
punch bowls. With
Roofles and GHB in circulation,
you can't be sure what's in the
punch, so think twice before
you partake.
Q Avoid
O Make a pact with
your friends to watch out
for each other, and spread the
word about these "date-rape drugs"
to everyone you know.
If you think you may have been given
Roofies or GHB, immediately go to
the emergency room and ask for a
urine screening test. Though traces
of the drug may still appear up to 72
hours after Ingestion (depending on
dosage, and individual metabolism)
the chances of getting proof are best
when the sample is obtained quickly.
Therefore, in the event that you are
sexually assaulted after you were
unknowingly given one of these
drugs, the results of this test could
provide
incriminating
evidence
against your attacker.
quiz
:u
n»^Hav.Rg|a|j0|1S||jp?
An Alcohol- based
Is beer, wine or liquor the elixir of love that brought you and
your significant other together? Take this quiz to find out.
I
When you met your current love,
which of the following most closely
characterized your state of mind?
a)
Stone-cold sober
b)
Completely intoxicated
c)
Buzzing
2
Have you ever been drinking
together and done something wild
that you know you wouldn't normally
have done on your own?
a)
Yes, this happens often.
b)
Yes, but only once or twice
c)
No, never
4^
When you two hang out together,
When you and your significant
how often is the consumption of alco
hol not involved?
other are feeling romantic, the first
a)
About half of the time-you like to thing you do is:
party, but you spend down time
a) Decide whether you'll go out or
together too.
stay in
b)
Almost always-you're not big
drinkers.
c)
Almost never-you're pretty much
consuming some concoction whenev
er you're together.
3
6
Has there ever been a time when
you've gotten into a fight with your
partner while you were both drunk?
a)
No
b)
Yes, you've gotten Into drunken
spats from time to time.
c)
Yes, you've been known to get into
nasty fights when you've both been
drinking. The next day, you usually
have only sketchy memories of what
the argument was about.
4
Since you met your honey, you’ve
been under alcohol’s Influence:
a)
More often than before you met
b)
Less often than before you met
c)
Equally as often as before you met
°°
Read on to see if your relationship has a solid or a liquid
foundation.
Scoring:
1. a-1, b-3, c-2
6-9 points
Alcohol Dependency Rating: Low
You've got many memories that
haven't involved beer, wine, or liquor,
and that means there's a good chance
your relationship Is built on true
mutual affection. Congratulations,
you've got a solid foundation.
10-14 points
Alcohol Dependency Rating: Medium
You and your partner like to drink
together pretty frequently, but you
throw some non-partylng time into
the mix too. To keep from tipping
the bottle too much, try taking a
vacation from drinking. A full
month on the wagon will tell you
if your relationship is solid, or if
it's been alcohol-dependent all along.
15-18 points
Alcohol Dependency Rating: High
Since you and your significant other
have both got a buzz on whenever
you're together, neither of you
realizes that your relationship may
be on the rocks. If you have a hard
time relating without the help of
cocktails, it means you aren't getting
to know each other. If you really want
to make a go of things, start
spending alcohol-free time
together. But if losing the alcohol
means your love is headed down the
drain, get out of this liquid-based
relationship before it drowns you
both.
24-hour confidential information and how
to get help for yourself or a friend.
When Someone Else's
Drinking Gives You a Headache
Alcohol and Your Body
Alcohol and Student Life
Also part of Facts on Tap,
includes:
- a brochure that talks about parental
substance abuse and its impact on students.
- a detailed handbook for students
from substance abusing families.
- a handy pocket reminder for those
stressful trips home to families affected by
substance abuse.
Made possible by a generous grant from
American Council for Drug Education
An Affiliate of Phoenix House
800-488-DRUG
Provided by:
Center for Student Wellness
College of Physicians & Surgeons
Columbia University, 107 Bard Hall
212.304.5564" *'
Globa! Tobacco Treaty
Action Guide:
Protecting National Health Policies
from international Tobacco Industry
Interference
CORPORATE
ACCOUNTABILITY
INTERNATIONAL
CHALLENGING ABUSE, PROTECTING PEOPLE
formerly ilfflfaCt
NJffTT
September 2005
^ffillvy&sfopccrposAle.^uSe. cr^
Global Tobacco Treaty Action Guide
CORPORATE
ACCOUNTABILITY
INTERNATIONAL
CHALLENGING ABUSE, PROTECTING PEOPLE
formerly
Infact
Corporate Accountability International (formerly Infact) is a membership organization that protects people
by waging and winning campaigns challenging irresponsible and dangerous corporate actions around the
world. For over 25 years, Corporate Accountability International and its members have scored major
victories that protect people and save lives. Corporate Accountability International is an NGO in official
relations with the World Health Organization (WHO) and a founding member of NATT.
N>TT
The Network for Accountability of Tobacco Transnationals (NATT) consists of more than 100 consumer,
human rights, environmental, faith-based and corporate accountability NGOs in 50 countries. NATT was
formed in the spring of 1999 to ensure a strong, unified voice for a Framework Convention on Tobacco
Control (FCTC) that will:
• Institute effective controls over tobacco transnationals that are spreading tobacco addiction, disease and
death; and
• Contribute to the establishment of broad global standards that hold corporations accountable for policies,
practices and products that endanger human health and the environment.
Credits: A special thank-you to the many people around the world who contributed to this Global Tobacco
Treaty Action Guide by sharing their stories and lending their insight. Thank you to all of the FCTC
campaigners, including members of NATT, who are working toward FCTC ratification and implementation
and to expose and challenge tobacco industry interference in health policy.
Thank you in particular to: Tjandra Yoga Aditama, Indonesian Smoking Control Foundation; Issah Ali,
Action for Integrated Development, Ghana; Joaquin Bamoya, InterAmerican Heart Foundation; Rafael
Camacho Solis, Founding Member, Alianza Contra el Tabaco (ATCA); Tania Maria Cavalcante, National
Cancer Institute of Brazil (INCA); Beatriz Marcet Champagne, InterAmerican Heart Foundation; Hatai
Chitanondh, Thailand Health Promotion Institute; Muyunda Ililonga, Zambia Consumers Association; Patricia
Lambert, Head of the South African Delegation to the FCTC; Akinbode Oluwafemi, Environmental Rights
Action, Nigeria
Corporate Accountability International’s campaigning toward the ratification and implementation of
the global tobacco treaty is made possible through the commitment of thousands of our members. We
would like to say a special thank you to: Jamey Aebersold, AHS Foundation, Edie Allen, Martha Alworth,
Christine Andersen, Big Cat Foundation, Mig Boyle, Helen Boyle, Lee Carpenter, Judith Davidson, Delight
and Paul Dodyk, David Dunning, Neva Goodwin, Diane and Don Hewat, Betty Jenney, Chris Lloyd, Robin
Lloyd, Henry Lord, Cindy Marshall and Kathy Pillsbury, Betty Morningstar, Catherene Morton, Ostara Fund,
Pettus Foundation, Deborah Rose, Kathleen Ruff, Sisters of Charity of the Blessed Virgin Mary, Sisters of
Charity of the Incarnate Word, Ted and Jennifer Stanley, Alice Zea, and every member of our Ida Tarbell
Society.
September 2005
Corporate Accountability International
2
Global Tobacco Treaty Action Guide
Table of Contents
HOW TO USE THIS ACTION GUIDE
A Message from Corporate Accountability International’s Executive Director................................ 4
BACKGROUND ON THE PROBLEM
The Tobacco Industry Does Not Have the Right to Participate in the Development
of Public Health Policy......................................................................................................................................5
Tobacco Industry Interference in Public Health Policy............................................................................. 6
Case Studies & Success Stories
Guatemala............................................................................................................................................... 9
Nigeria........................................................................................................................................... .......10
Costa Rica............................................................................................................................................. 11
Corporate Profiles: Philip Morris/Altria, BAT and JTI......................................................................... 12
SOLUTIONS: CHALLENGING INTERFERENCE IN YOUR COUNTRY
Exposing and Defeating Tobacco Industry Interference: Take Action!............................................ 14
Talking Points....................................................................................................................................................15
FCTC Preamble Statement, Articles 5.3, 12 (e) and 20.4 (c)................................................................ 16
Model Legislation to Exclude the Tobacco Industry and Implement the FCTC.............................. 17
Tobacco Industry Interference Reporting Form....................................................................................... 19
Positive Impact of the FCTC: Story and Question Forms...................................................................... 23
APPENDICES
Appendix 1: WHO Regional Information................................................................................................... 25
Appendix 2: NATT FCTC Working Group.............................................................................................. 26
Appendix 3: FCTC and the United States................................................................................................... 27
This document is a complement to the Handbook for FCTC Ratification Campaigns,
published in 2004 by Corporate Accountability International and NATT.
September 2005
Corporate Accountability International
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Global Tobacco Treaty Action Guide
How to Use This Action Guide: A Message from Corporate
Accountability International’s Executive Director
After more than a decade of arduous campaigning by many, we now have a tool that has the
capacity to protect public health in an unprecedented way: the WHO Framework Convention on
Tobacco Control (FCTC), the first global public health treaty. The FCTC, a milestone in the history of
corporate accountability, is considered one of the most rapidly embraced United Nations treaties of all
time. Presently ratified in more than 70 countries, the FCTC is already protecting almost half of the
world’s population. On 27 February 2005, the treaty went into force after the initial 40 countries ratified
it through their domestic processes.
But this significant progress is under threat from interference by
the international tobacco industry. Transnational tobacco
corporations—Philip Morris/Altria, British American Tobacco
(BAT), and Japan Tobacco International (JTI)—often have annual
revenues greater than the Gross Domestic Product (GDP) of the
countries in which they operate. With tremendous wealth and power,
these giant corporations pose the greatest risk to effective,
meaningful tobacco control measures around the world.
While these victories
continue to inspire and
empower more countries
to protect their citizens
from tobacco, this success
has also strengthened the
tobacco industry’s resolve
to interfere.
From the treaty’s initial negotiations to today, the international tobacco industry has attempted persistently
to stop, weaken and delay it. Now that the fight for people’s lives is in the hands of individual countries,
the tobacco industry is working at the country level to undermine the treaty’s progress. The good news
is, you can help stop transnational corporate influence over the national health policies in your country.
As the ratification numbers reflect, the movement challenging the tobacco industry’s interference in
health policy is strong and growing. As part of our commitment to protecting people around the world,
our network wants to share success stories, tips and tactics for challenging the tobacco industry in your
country. We created this action guide to help public health advocates, non-governmental organizations,
government officials and concerned citizens stop the tobacco industry’s attempts to use their money and
influence to manipulate the debate over FCTC ratification.
As you work to protect people by campaigning for your country to ratify and implement the FCTC,
please share news of your activities — and the tobacco industry’s tactics — with allies, including
Corporate Accountability International. If you are a member of the Network for Accountability of
Tobacco Transnationals (NATT), please share your news with that listserve as well.
Together we are challenging some of the most powerful and dangerous corporations in the world and
making incredible progress. Our hope is that this Action Guide will strengthen and advance our
collective work.
For electronic versions of this Global Tobacco Treaty Action Guide, the Handbook for FCTC
Ratification Campaigns and other valuable tools for protecting people from dangerous and irresponsible
corporate actions, visit www.stopcorporateabuse.org .
Onward,
Kathryn Mulvey
\^_^7
Corporate Accountability International Executive Director
September 2005
Corporate Accountability International
Global Tobacco Treaty Action Guide
The Tobacco Industry Does NOT Have the Right
To Participate in the Development of Public Health Policy
Tobacco corporations have an inherent conflict of interest with effective tobacco control
legislation. The World Health Organization (WHO) and governments around the world have
been very clear: Philip Morris/Altria and the rest of the tobacco industry do NOT have a right to
participate in the development of public health policy. The tobacco industry and its allies
continue their attempts to influence tobacco control at both the domestic and international level,
but WHO resolutions and the FCTC exclude industry participation:
World Health Assembly resolution 54.18 finds that “the tobacco
industry has operatedfor years with the expressed intention of
subverting the role ofgovernments and of WHO in implementing
public health policies to combat the tobacco epidemic, ” and urges
governments to ensure the integrity of health policy development.
The Preamble of the FCTC recognizes “the need to be alert to any
efforts by the tobacco industry to undermine or subvert tobacco
control efforts and the need to be informed ofactivities of the tobacco
industry that have a negative impact on tobacco control efforts. ”
In Article 5.3, the FCTC obligates parties to “protect these [public
health] policies from commercial and other vested interests ofthe
tobacco industry. ” The treaty also affirms the importance of civil
society participation in achieving its objectives, while restricting such
involvement, in Article 12(e), to “nongovernmental organizations not
affiliated with the tobacco industry. ”
The FCTC and WHO resolutions on tobacco control provide governments with the support of the
international community to stand up to the tobacco industry and its attempts to influence policy.
In Article 20.4(c), the FCTC also requires parties to collect and disseminate information on
tobacco industry activities that have an impact on the treaty or national policies.
While the tobacco industry may try to pressure governments to include “all stakeholders” in the
discussions around tobacco control legislation, the FCTC clearly excludes the industry from
participating. For this reason, any tobacco industry inclusion in public health policymaking
violates both the spirit and the letter of the FCTC.
September 2005
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Global Tobacco Treaty Action Guide
Tobacco Industry Interference in Public Health Policy
The tobacco industry uses its political influence to weaken, delay and defeat tobacco control
legislation around the world—and tobacco corporations have attempted to derail the FCTC
process from the beginning. According to Tobacco Company Strategies to Undermine Tobacco
Control Activities at the World Health Organization, a July 2000 report by a committee of
experts on tobacco industry documents, the “tobacco companies have operated for many years
with the deliberate purpose of subverting the efforts of the World Health Organization to address
tobacco issues. The attempted subversion has been elaborate, well-financed, sophisticated, and
usually invisible.” In order to ensure that the FCTC protects people around the world from the
tobacco industry, the public health community must be vigilant in identifying, exposing and
ultimately defeating tobacco industry attempts to interfere.
Stories from around the world show that the tobacco industry is taking a country-by-country
approach, but the industry favors four strategies for thwarting FCTC ratification and public
health policy in general. Transnational tobacco corporations Philip Morris/Altria, BAT and
JTI—with combined annual revenues greater than the GDPs of Costa Rica, Kenya, Nicaragua,
Uganda, Honduras and Lebanon combined—set the pace.
Please help us track tobacco industry use of these four strategies
by filling out the form on pages 19-22.
1)
Spreading Misinformation About the Legal Process
The tobacco industry has been misinforming country governments and civil society
organizations about the ratification process—asserting that countries need to pass domestic
tobacco control legislation before they can ratify the FCTC. This is not true. After ratifying the
FCTC, countries will be given a reasonable amount of time, depending on their individual
circumstances and in consultation with the Conference of the Parties, to implement the FCTC.
2)
Asking for a Seat at the Table
The tobacco industry has an inherent conflict of interest and should therefore be disqualified
from having a role in the development of public health policy. Furthermore, the FCTC clearly
excludes the industry from participating. Yet corporations like Philip Morris/Altria and BAT still
attempt to derail ratification and implementation by not always articulating their opposition,
faking “support” for the treaty, and trying to win a seat at the table. While tobacco corporations
like Philip Morris/Altria claim to support the treaty, they oppose its central provisions, such as
the ban on tobacco advertising, promotion and sponsorship.
September 2005
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Global Tobacco Treaty Action Guide
3)
Demanding Voluntary Self-Regulation
The tobacco industry has a long history of proposing voluntary regulation as a strategy to fight
effective and enforceable protections. However, voluntary codes are non-binding, lack
independent oversight and often do not include consequences; in practice they have proven
ineffective at curbing the tobacco industry’s most successful forms of spreading tobacco
addiction.
Through the FCTC process, a majority of the world’s countries came together to reject the
industry’s calls for voluntary regulation and instead set aggressive, binding global limits on how
the industry operates. This hard-fought victory will seriously limit the ability of Philip
Morris/Altria, BAT and JT1 to spread addiction, disease and death with images like the Marlboro
Man and a host of other tactics. Nevertheless, in countries around the world, the tobacco industry
continues to pressure governments to take no direct action and to let the industry regulate itself
through voluntary measures.
Here is an example:
In Mexico, BAT and Philip Morris joined forces to undermine Mexico’s health
policy. According to a 1992 internal memo from Philip Morris International, the
corporation was “evaluating the possibility of developing with BAT an industry
self-regulating advertising and promotional code” in Latin America. The intent
was to “help improve the industry’s image and reduce the chances of government
restrictions.”
Unfortunately, it seems the industry has succeeded with these plans. Just three
weeks after Mexico ratified the FCTC, the government signed a voluntary
agreement with Philip Morris and BAT. Mexico’s voluntary agreement with
Philip Morris and BAT is a clear example of voluntary self-regulation that could
distract the government from implementing effective and meaningful health laws.
This example should alert us to the ever-present danger of industry interference.
4)
Slick PR Campaigns
Corporate Social Responsibility describes the inclusion of social and environmental concerns
into a corporation’s business practices with actions to back up the words. With the tobacco
industry, however, Corporate Social Responsibility is part of a slick PR campaign to try to re
brand its deadly image. British American Tobacco (BAT) and Philip Morris/Altria spend
millions annually in an attempt to brand themselves as “socially responsible” corporations. This
allows them to hide behind glossy image makeovers while continuing to promote tobacco
addiction to children and adults around the world.
While the tobacco industry claims to have changed and evolved, internal documents show their
corporate social responsibility initiatives are merely part of a coordinated attempt to improve
their image and gain access to politicians.
September 2005
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Global Tobacco Treaty Action Guide
Help Us Track Emerging Efforts by the Tobacco
Giants to Interfere in Health Policy!
According to survey data from NGOs and government officials in more than 20 countries, the
tobacco industry attempts to influence public health policy in many ways. No country escapes.
Many countries that have become parties to the FCTC continue to face pressure from the tobacco
industry. In Kenya, which has ratified the FCTC, BAT sponsored a beach holiday for members
of Parliament, just days before they were set to discuss the implementing legislation for the
treaty.
Ongoing monitoring and exposure of tobacco industry tactics are a key component of FCTC
implementation. In addition to the four major strategies described previously, be on alert for the
following:
•
Giving campaign contributions to political parties in order to influence their
decision making;
•
Organizing roundtable discussions on the FCTC’s implementation or other
“social issues”;
•
Providing government officials with recommendations or a sample health
•
Funding government health initiatives like malaria control and HIV/AIDS
policy;
treatment programs;
•
Sponsoring major sporting and cultural events;
•
Conducting purposefully ineffective “youth smoking prevention” programs;
•
Supporting environmental protection and tree-planting programs;
•
Funding “smokers’ rights” groups;
•
Drawing attention to the alleged economic benefits of tobacco addiction;
•
Funding university research on health issues;
•
Providing scholarships to journalism students;
•
Recruiting public relations spies to infiltrate health groups; and,
•
Setting up fake NGOs to gain access to health policy or other meetings.
September 2005
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Global Tobacco Treaty Action Guide
Case Studies & Success Stories:
Three Stories Illustrating Tobacco Industry Interference and
How Activists Are Pushing Back
Guatemala: Ratifying the FCTC Despite Philip Morris’ Slick PR & Lobbying
In response to activist pressure at the Philip Morris/Altria annual shareholders ’ meeting in April
2005, CEO Louis Camilleri declared that the corporation is working with Ministries of Health
and Ministries of Education in countries around the world. This is not only alarming, but
in countries that have ratified, it violates the spirit and letter of Articles 5.3 and 20.4(c) of the
FCTC.
The tactics being used by Tabacalera Centroamerica S.A., the Philip Morris/Altria subsidiary in
Central America, reflect those of its parent company. In the media, the CEO of Tabacalera
Centroamericana in Guatemala publicly declared his support for the FCTC. Months later, the
corporation sent Guatemalan legislators a letter, referencing the FCTC but detailing the
regulations it would support that fell far short of the regulations the FCTC mandate. Not
surprisingly, in its letter to Guatemalan legislators the corporation called for regulations that are
significantly weaker than the FCTC. Philip Morris fought against key FCTC protections, such as
the ban on tobacco advertising, promotion and sponsorship and the promotion of a higher
tobacco tax.
This is an increasingly common tobacco industry tactic: publicly claiming support for the
tobacco treaty then pressing for implementing legislation that is significantly weaker than the
treaty itself. With this approach, tobacco corporations try to cultivate positive public recognition
for supporting the treaty, while working behind closed doors to undermine its most central
provisions.
At the same time in Guatemala, Philip Morris/Altria employed one of the most insidious tobacco
industry tricks: a so-called youth anti-smoking campaign. According to historical internal
industry documents, Philip Morris discussed expanding this type of program to other countries in
Latin America to “strengthen relationships with governments and community.”
As the ratification process progresses in Guatemala and the Senate begins the process of drafting
implementation legislation, activists will remain vigilant and ensure the Senate dismisses the
tobacco industry’s weak recommendations. The progress of public health advocates in the face of
a powerful industry is an inspiring example for activists around the world that it is possible to
protect people from one of the deadliest industries. ■
September 2005
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Global Tobacco Treaty Action Guide
Nigeria: Taking on British American Tobacco’s Bribes and Lies
As Africa’s most populous country, Nigeria is a prime target for the tobacco industry to market
its deadly products. British American Tobacco (BAT), which controls 75 percent of Nigeria’s
cigarette market, is notorious for using its financial resources and government contacts to ensure
steady profits and weak tobacco control legislation. A short list of BAT’s tactics to prevent
positive health policy in Nigeria includes attempting to bribe the media and giving expensive
gifts to regulatory agencies and government officials.
In Nigeria, BAT depends on a misinformed public and easily influenced government, so the
media is a top target. In an orchestrated campaign to buy the media in Nigeria, the corporation
hosts expensive meals for media owners and editors, sponsors journalist association meetings,
syndicates articles favoring the company and tobacco products and leverages its advertising
power to stop the publication of critical articles.
The corporation’s “British American Tobacco Industry Reporter of the Year Award” rewards
reporters who write favorable stories about the company with a new laptop and 100,000 Nigerian
Naira (US$750). Between January 2003 and January 2005, BAT sponsored three meetings
between media executives and BAT executives at the prestigious Lagos Sheraton Hotel and
awarded attending journalists with gifts for participating. The tobacco giant has a track record of
cultivating journalists to write pro-BAT articles that attack the FCTC. Uncovered evidence
showed that a reporter, John Ozeze-Langley—who recently wrote an article in the Daily
Independent titled “BAT: Not the Enemy to Fear” and pleaded to “please let the tobacco
companies be!”—was given the information to write the article by the tobacco company.
Political gifts and lobbying are also a major tactic. Operating from its “Political Liaison Office”
in Nigeria’s capital, BAT’s dirty lobbying activities include expensive holidays and gifts. The
corporation’s lobbying tactics are so extreme that during the tobacco advertising bill debate, a
member of Parliament openly accused the tobacco transnational of employing tactics to stop
passage of the bill.
Specific examples include donating three sport utility vehicles to the Standards Organization of
Nigeria, the government agency charged with ensuring products (like cigarettes) do not endanger
consumers. BAT also donated three SUVs to the enforcement unit of the Nigerian Custom
Service.
These donations to regulatory bodies in Nigeria demonstrate a conflict of interest that puts
people at risk. Unfortunately, BAT’s activities are being replicated around the world in order to
weaken the implementation and enforcement of laws protecting people from the tobacco
industry.
Activists in Nigeria have worked to expose and denounce these instances of dirty politics. By
organizing press conferences and rallies and meeting directly with key government officials,
Environmental Rights Action and a range of organizations in Nigeria are building critical support
for FCTC ratification and strong, effective implementation, even in the face of BAT’s heavyhanded influence. ■
September 2005
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Global Tobacco Treaty Action Guide
Rica: Overcoming the Tobacco Industry’s Influence over Legislators
The FCTC calls for strong, enforceable protections from tobacco products. Considering the
tobacco industry’s dependence on weak regulation for its expansion, it’s no surprise they’re
working against an enforceable treaty that protects people. And since Costa Rica is a political
leader in the region and home to British American Tobacco’s (BAT) Central American
headquarters, the country is a high priority for public health advocates and the tobacco industry.
While Costa Rica signed the FCTC on 3 July 2003, it has not yet ratified the treaty.
In June 2005, an international coalition of public health advocates met in Costa Rica to call on
Costa Rica’s government to ratify the FCTC swiftly. The delegation joined AMBIO-ALERTA, a
NATT member based in Costa Rica, to meet with Representatives of Congress and talk to the
media about why the FCTC needed Costa Rica’s ratification.
In a related event, at a June 2005 forum on national tobacco control policy convened at the
National Assembly by health advocates, BAT used a slick PowerPoint presentation to push its
own regulatory agenda. Presenting itself as a “responsible” tobacco corporation and legitimate
“partner,” BAT advocates for policies that would do more to protect its bottom line than public
health.
This is a tactic that the tobacco industry has used for years to thwart effective regulation. In
response the countries of the world have been clear: the tobacco industry shall play no role in
public health policy making. They unanimously adopted Article 5.3 of the treaty that obligates
parties to “protect these [public health] policies from commercial and other vested interests of
the tobacco industry. ”
AMBIO-ALERTA and IAFA, the leading public health advocates, are resisting. At the June
2005 public forum, they laid out a clear case for why BAT’s proposals won’t work and why a
ratified and implemented FCTC is best for reducing the burden of tobacco-related death and
disease. As the battle in Costa Rica continues, NGOs and the public will continue to pressure the
government to stand up to the tobacco industry and protect people by ratifying and implementing
the global tobacco treaty. ■
September 2005
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Global Tobacco Treaty Action Guide
Profiles of the Biggest Tobacco Transnationals
In many countries Philip Morris/Altria, British American Tobacco and Japan
Tobacco International are more commonly known by a local subsidiary name.
Many times, the local tobacco company is owned by one of these transnational
corporations.
Philip Morris/Altria__________
Chairand CEO: Louis Camilleri
Headquarters Address:
120 Park Ave.
New York, NY 10017
USA
2004
Philip Morris/Altria
Revenues:
$64 billion
Philip Morris International
Revenues: $17.58 billion
International Subsidiary:
Philip Morris International
President and CEO: Andre Calantzopoulos
Philip Morris/Altria
Profits:
$9.4 billion
Address:
Avenue de Cour 107
Casa Postale 1171
1171 Lausanne, CH-1001
Switzerland
Notable Facts:
•
•
•
Largest and most profitable tobacco corporation in the world
Created the Marlboro Man—one of the most effective promotional images
globally—with strong appeal to young people
Claims to support FCTC but opposes central provisions like ban on advertising,
promotion and sponsorship
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Global Tobacco Treaty Action Guide
British American Tobacco (BAT)
2004
CEO: Paul Adams
Headquarters Address:
Globe House, 4 Temple Place
London
WC2R 2PG
United Kingdom
Revenues:
$60.1 billion
Profits:
$2.1 billion
Notable Facts:
•
•
Second-largest tobacco corporation in the world
Maintained highly visible lobbying presence throughout FCTC negotiations,
including representation by BAT’s Director of International Political Affairs,
Manager of International Regulatory Affairs, and Manager of Legal Division
Japan Tobacco Inc. (JT)
2004
President and CEO: Katsuhiko Honda
Headquarters Address:
2-1, Toranomon 2-chome, Minato-ku
Tokyo, 105-8422
Japan
Revenues:
$43.8 billion
Profits:
$72 million
Notable Facts:
•
•
50% owned by Japanese government
Throughout FCTC negotiations, Japan attempted to block progress toward the
comprehensive ban on advertising, promotion and sponsorship. Japan’s
opposition to effective treaty provisions was not surprising, given the heavy
industry representation on its delegation, including the Finance Ministry, which
controls the country’s stake in JT.
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Exposing and Defeating Tobacco Industry Interference:
Take Action!
As you uncover tactics that Philip Morris/Altria, BAT and JTI are employing in your country, there
are several simple things you can do to challenge their dirty tricks. Please share your findings and
stories via email to natt@list.stopcorporateabusenow.org or mrising@stopcorporateabuse.org if you
are not a NATT member.
1.
Involve key allies
❖ Distribute this Global Tobacco Treaty Action Guide to Parliamentarians, Ministry of
Health officials, NGOs and the media.
❖ Encourage allies and members of Parliament to challenge tobacco industry
involvement and interference in FCTC ratification and implementation.
❖ Ask government allies about what the tobacco industry is doing to interfere in policy.
Use the report form in this Global Tobacco Treaty Action Guide to collect their
stories, track and share evidence of industry activity in your country.
2.
Media
❖ Build relationships with reporters and ask them to write stories on the FCTC and to
expose tobacco transnational attempts to interfere.
3.
Challenge the tobacco industry face-to-face
❖ Stand up in a meeting to challenge the tobacco corporations’ presence and rhetoric.
The tobacco industry is working very hard to gain access to government
decisionmakers and you may be in a meeting where a representative from a tobacco
corporation is also present. It is important to identify this person and remind
participants that the FCTC obligates decisionmakers to protect health policy from
tobacco industry interference.
4.
Draw international attention
❖ Let other FCTC campaigners know about this interference. Share what is happening
in your country with domestic and international allies. If you are a NATT member,
use the NATT listserve to draw international attention to the problems.
5.
Promote legislation to keep the tobacco industry out of policy development
❖ Pass legislation for implementing Article 5.3 of the FCTC so that keeping the tobacco
industry out of health policy is included in your national law. Send copies of the
sample legislation found on pages 17-18 of this Global Tobacco Treaty Action Guide
to all legislators urging them to include it as a part of your tobacco control bill.
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Talking Points
Why should the tobacco industry be excluded from public health policymaking?
•
Tobacco is a product that causes addiction, disease and death, and therefore places an
unwarranted financial burden on existing resources for health.
•
The tobacco industry attempted to water down the FCTC from its inception.
•
The tobacco industry’s primary concern is maintaining or increasing its enormous profits
and sharing that wealth with rich shareholders in the North—not protecting public health.
•
After decades of deception and deceit, tobacco corporations should simply never have
been allowed to participate in public health policymaking.
•
Internal corporate documents outline a well-funded, highly coordinated, covert campaign
to thwart protections for public health.
•
While the industry claims to have changed its ways, it continues its attempts to use
sophisticated methods to undermine meaningful tobacco control legislation around the
world.
•
There are many ways that tobacco corporations such as Philip Morris/Altria use their
economic and political muscle to influence public policy—including by hiding behind
subsidiaries like Kraft Foods and public relations campaigns like Corporate Social
Responsibility.
•
The WHO and governments around the world have come together to pass provisions
clearly excluding the industry from participation in the formation of public health
policymaking.
Note-. It is important that limits on political activities include activities by subsidiaries of the
tobacco corporations, such as Philip Morris/Altria’s Kraft Foods. Internal documents and the
Committee of Experts Report, Tobacco Company Strategies to Undermine Tobacco Control
Activities at the World Health Organization, demonstrate how Philip Morris/Altria has tried to
influence national and international policy through Kraft. According to industry analysts, Philip
Morris/Altria is likely to spin-off Kraft by early 2006. This separation will be a major step
toward reducing the wealth, power and influence of the world’s largest tobacco corporation.
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FCTC Preamble Statement, Articles 5.3, 12 (e) and 20.4 (c)
The following sections of the FCTC clearly exclude the tobacco industry from participating in
public health policymaking and call for the collection and dissemination of information on
tobacco industry activities that have an impact on tobacco control.
Preamble
Recognizing the need to be alert to any efforts by the tobacco industry to undermine or
subvert tobacco control efforts and the need to be informed ofactivities of the tobacco
industry that have a negative impact on tobacco control efforts;
Article 5 — General Obligations
3. In setting and implementing their public health policies with respect to tobacco
control, Parties shall act to protect these policies from commercial and other
vested interests ofthe tobacco industry in accordance with national law.
Article 12 — Education, communication, training and public awareness
Each Party shall promote and strengthen public awareness of tobacco control issues,
using all available communication tools, as appropriate. Towards this end, each party
shall adopt and implement effective legislative, executive, administrative or other
measures to promote:
(e)
awareness and participation ofpublic and private agencies and
nongovernmental organizations not affiliated with the tobacco industry in
developing and implementing intersectoral programs and strategies for
tobacco control.
Article 20 — Research, surveillance and exchange of information
4. The Parties shall, subject to national law, promote andfacilitate the exchange of
publicly available scientific, technical, socioeconomic, commercial and legal
information, as well as information regarding practices of the tobacco industry and the
cultivation of tobacco, which is relevant to this Convention, and in so doing shall take
into account and address the special needs of developing country Parties and Parties
with economies in transition. Each Party shall endeavour to:
(c)
cooperate with competent international organizations to progressively
establish and maintain a global system to regularly collect and disseminate
information on tobacco production, manufacture and the activities of the
tobacco industry which have an impact on the Convention or national
tobacco control activities.
The following page suggests model legislation for implementing these sections.
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Model Legislation to Exclude the Tobacco
Industry and Implement the FCTC
The model legislation below suggests ways in which countries can insulate tobacco control
policy, as well as their tobacco control legislation, from the influence of the tobacco industry.
Comprehensive, effective model legislation to implement the FCTC has been created by the
WHO, PAHO and the International Union for Health Education and Promotion. The purpose of
these legislative suggestions below is to provide guidance specifically on industry exclusion.
They should be used in tandem with other existing sources of comprehensive model legislation.
Many existing sources of model legislation provide guidance on implementation of Article
20.4(c).
Principles/Preamble/Purpose
Recognizing the need to safeguard the development, implementation, review and
enforcement oftobacco control policies from interference by commercial and other
vested interests ofthe tobacco industry;
This suggested legislative text would give effect to the concepts contained in the FCTC. While
preambles are not necessarily an essential component of any piece of legislation, if they are used,
they can give expression to aspects of policy that lie behind the legislation. In doing so, they can
educate people about the context for the legislation and also assist the courts in interpreting the
law if it is challenged. Including clear language like that given in our example in a preamble to a
piece of legislation would help indicate that, if questions of tobacco industry involvement ever
arose, the country’s law should be interpreted in such a way that it restricts or prevents any
industry involvement.
Definitions/Interpretations/Preliminaries
“Vested interests of the tobacco industry” means people or groups who stand to benefit,
financially or otherwise, from legislation, policies, or programs that promote or protect
the interests of the tobacco industry. They include, but are not limited to, people or
groups that own shares in a tobacco corporation or any of its subsidiaries, and people or
groups that directly participate in tobacco advertising, promotion, or sponsorship.
Having a definition like the one we have suggested above in a piece of tobacco control
legislation provides a clear indication of the types of people or groups whose interests would be
in direct or indirect conflict with public health interests. This definition is consistent with
existing treaty law, other FCTC provisions and the ordinary meaning and interpretation of the
phrase. Articulating a clear definition of this term will help countries to thwart tobacco industry
attempts to influence legislation and implementation through subsidiaries and affiliates.
Governments should be urged to define this important term in a way that affords maximum
protection for domestic tobacco control policies. A broad definition is critical to target actions
that may not constitute direct interference by the tobacco industry, and this idea is captured in the
phrase “who stand to benefit financially or otherwise.”
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Administration
Prohibition on tobacco industry participation—The Minister of Health [or other
governing authority] shall implement policies and procedures to prohibit commercial
and other vested interests of the tobacco industry, including government agencies and
wholly or partially government-owned tobacco companies, from participating in the
development, implementation, and review ofall policies under this Act. This prohibition
shall include, but not be limited to:
(i)
The use of tobacco industry-funded research in developing,
implementing, and reviewing tobacco control policies;
(ii)
Consultation with or participation by scientists or other individuals who
may have a conflict ofinterest as defined [in previous sections of this legislation];
(Hi) The participation of commercial and other vested interests ofthe tobacco
industry, including government agencies and wholly or partially governmentowned tobacco companies, in any official proceedings conducted under this Act;
and
(iv) The use ofprint, electronic, or other public media by commercial and
other vested interests of the tobacco industry, including government agencies and
wholly or partially government-owned tobacco companies, regarding any topic
covered by this Act.
This suggested legislative text goes to the heart of excluding the tobacco industry from
participation in policymaking. It captures all of the obligations required in FCTC Articles 5.3,
and 12.
The inclusion of these three provisions in any domestic tobacco control legislation will ensure
that policy, legislation and implementation are all insulated from tobacco industry
interference. In addition, they will provide policymakers, legislators, implemented and
enforcers with legally binding tools to uphold tobacco control measures and protect them
from interference by tobacco corporations, their subsidiaries and affiliates.
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Global Tobacco Treaty Action Guide
Tobacco Industry Interference Reporting Form
Please share your country’s stories of activities and interference with allies around the world. Sharing
your stories will help FCTC advocates around the world more effectively counter tobacco industry
interference. For an online version of the survey visit www.stopcorporateabuse.org/reportform , or
► Ifyou are a NATT member, email it to natt@list.stopcorporateabusenow.org .
► If you are not a NATT member, email it to mrising@stopcorporateabuse.org.
NAME:
TITLE:
ORGANIZATION:
____________
ADDRESS:
CITY/ STATE/ PROVINCE: POSTAL CODE:
COUNTRY:
PHONE:
FAX:
EMAIL/WEBSITE:
DIRECTIONS:
On pages 6-7, we detailed four of the main strategies giant tobacco corporations
are using to undermine health policy. Please use the questions below to share
information about the tobacco industry’s tactics in your country.
PLEASE USE DETAIL & PROVIDE SOURCES/EVIDENCE WHEREVER POSSIBLE
1.
Spreading Misinformation About the Legal Process
The tobacco industry has been misinforming country governments and civil society
organizations about the ratification process — asserting that countries need to pass
domestic tobacco control legislation before they can ratify the FCTC. This is not true.
A.
Which transnational tobacco corporations are active in your country? How would you
characterize their presence generally? Do you have specific information on trends, etc.?
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B.
Has the tobacco industry told government officials or civil society organizations in your
country that your government needs to pass domestic tobacco control legislation before
ratifying the FCTC? If so, what were the circumstances of the conversation? Who was
present?
C.
List all companies and organizations (including business groups) currently opposing the
FCTC, tobacco control and/or public health legislation in your country. Note: Tobacco
transnationals often use trade unions, advertising agencies, farmers, business councils
and chambers to lobby on their behalf
2.
Asking for a Seat at the Table
The FCTC clearly excludes the industry from participating in public policy. Yet
corporations like Philip Morris/Altria still attempt to derail ratification and
implementation by not always articulating their opposition, faking “support” for the
treaty, and trying to win a seat at the table. While tobacco corporations like Philip
Morris/Altria claim to support the treaty, they oppose its central provisions, such as the
ban on tobacco advertising, promotion and sponsorship.
A.
Has Philip Morris/Altria, BAT or JTI taken a public position on the FCTC in your
country? If so, what is it? How have they communicated this position?
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3.
B.
Is the government holding consultations with the industry or its affiliates? If so, what do
these consultations look like? What is the industry saying?
C.
Is the tobacco industry organizing meetings of “stakeholders” about tobacco control
policies or other topics on your country? If yes, please describe.
Demanding Voluntary Self-Regulation
The tobacco industry has a long history of proposing voluntary regulation as a strategy to
fight effective and enforceable protections. However, voluntary codes are non-binding, lack
independent oversight and often do not include consequences; in practice they have proven
ineffective at curbing the tobacco industry’s most successful forms of spreading tobacco
addiction.
A. Are you aware of any voluntary self-regulation agreement between a tobacco corporation
and your government? If yes, please describe in detail. What has the tobacco corporation
agreed to do?
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B. Are any major tobacco corporations promoting voluntary self-regulation as an alternative
to legal, binding regulations? If yes, please provide details.
4.
Slick Public Relations
While the tobacco industry claims to have changed and evolved, internal documents show
their corporate social responsibility initiatives are merely part of a coordinated attempt to
improve their image and gain access to politicians.
A. Does Philip Morris/AItria, or any other tobacco transnational, advertise its philanthropy/
charitable giving or social responsibility (on TV, magazines, other)? If yes, please
describe. Do you have print examples? Fax or .pdf and email or mail please!
B. Are any of the tobacco transnationals promoting their so-called corporate responsibility?
If so, how?
C. Are any of the tobacco transnationals running advertisements or campaigns they say are
designed to stop youth smoking, or funding any youth smoking prevention programs in
your country? If yes, please describe.
If you prefer to send by mail, please send to • Corporate Accountability International •
• c/o Megan Rising • 46 Plympton Street Boston, MA 02118 • USA •
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Global Tobacco Treaty Action Guide
Positive Impact of the FCTC: Story Form
With the global tobacco treaty we are on the road to reversing the global tobacco epidemic.
Along the way there are significant victories and milestones that are important to celebrate. From
Bangladesh to Palau and from Thailand to South Africa, we have heard many stories of positive
policy change, growing civil society momentum and
noticeable changes in everyday life because of the FCTC.
In Thailand, for example, Philip Morris worked for years to
undermine tobacco control legislation. But because of the
vigilance of NGOs and officials in the Thai Health Promotion
Institute, Thailand has been able to counter this interference
effectively and is setting a high standard for tobacco control
In September 2005, the
world will celebrate with
Thailand as they implement
an advertising law that raises
the standard for controlling
Big Tobacco’s marketing.
policy. According to an internal industry document from
1994, Philip Morris developed strategies and an action plan
to “mitigate the impact of the Tobacco Control Bill.” Despite Philip Morris’s plans, public health
advocates in Thailand have moved forward with some of the strongest tobacco control legislation
in the world.
In September 2005, the world will celebrate with Thailand as they implement an advertising law
that raises the standard for controlling Big Tobacco’s marketing. It bans all point-of-sale
advertising and promotions—outlawing one of the primary ways that tobacco corporations
market tobacco.
Philip Morris attempted to stop this point-of-sale advertising ban by lobbying and sending letters
to key government decisionmakers, including the Public Health Minister and the Chair of the
Senate Health Committee. When this tactic failed, Philip Morris (Thailand) joined BAT
(Thailand), JTI and the Thailand tobacco monopoly in threatening to sue the Thai Ministry of
Public Health for implementing this law! Public health advocates continue to move forward in
the face of this interference and pressure by meeting with key decisionmakers and holding news
conferences to assert the importance of this order and ensure its implementation. The Public
Health Ministry has declared that all point-of-sale advertising must be removed by 24 September
2005 and retailers are pledging their compliance. Congratulations to all who made this victory
happen in Thailand!
We invite you to take a few minutes to reflect on the impact that the FCTC has had on your
country, its people and health policy. As your country takes steps toward ratification and
implementation, please share this progress with allies around the world, by sending an email to
the NATT list at natt@list.stopcorporateabusenow.org or mrising@stopcorporateabuse.org if you
are not a NATT member. For an online version of the survey visit
www.stopcorporateabuse.org/storyform.
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Impact of the FCTC: Question Form
Have you noticed a change in tobacco control in your country or region since the FCTC
negotiations began in 2000?
If your country has ratified, has the ban on advertising, promotion and sponsorship passed into
law yet? What is the timeline for the ad ban? When will it take effect? Are ads coming down
already? What changes have you seen since the FCTC was adopted in May 2003? Examples may
include: labels, promotional activities, TV, magazines, etc. Please be as detailed as possible and
include specific dates to demonstrate the progress.
What positive impact of the FCTC have you seen in your country? Are there specific practices of
tobacco corporations that have changed? Concrete examples will be most helpful.
How do you think ratifying the FCTC will improve the lives of people in your country? What are
you most hopeful about for the impact of the FCTC in your country?
For NATT members, how has being part of NATT helped you to be a more effective advocate?
For government officials, how have NGOs in NATT supported you in advancing effective
legislation?
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Appendix 1: WHO Regional Information
WHO Headquarters
Tobacco Free Initiative
Avenue Appia 20
1211 Geneva 27
Switzerland
Telephone: (+41 22) 791 21 11
Fax: (41 22)791 3111
Regional Office for Africa
Cite du Djoue, P.O. Box 06
Brazzaville
Congo
Telephone: +242 839 100/+47 241 39100
Fax: +242 839 501/+47 241 395018
Email: regafro@whoafr.org
Regional Director: Dr. L. Sambo
Regional Office for Europe
8, Scherfigsvej
DK-2100 Copenhagen 0
Denmark
Telephone:+45 39 171 717
Fax:+45 39 171 818
Email: postmaster@euro.who.int
Regional Director: Marc Danzon
Regional Office for the Eastern
Mediterranean
Abdul Razzak Al Sanhouri Street,
P.O. Box 7608,
Nasr City, Cairo 11371,
Egypt
Telephone: +202 670 25 35
Fax: +202 670 24 92 or 670 24 94
Email: postmaster@emro.who.int
Regional Director: Dr. Hussein AbdelRazzak Al Gezairy
Regional Office for Southeast Asia
World Health House
Indraprastha Estate
Mahatma Gandhi Marg
New Delhi 110 002
India
Telephone:+91 11 2337 0804
Fax: +91 11 2337 9507
Email: pandevh@whosea.org
Regional Director: Dr. Sam lee
Plianbangchang
Regional Office for the Americas
525,23rd Street N.W.
Regional Office for the Western Pacific
Washington D.C. 20037
P.O. Box 2932
1000 Manila
Philippines
Telephone: +63 2 528 8001
Email: postmaster@,wpro.who.int
USA
Telephone: +1 202 974 3000
Fax: +1 202 974 3663
Email: postmaster@paho.org
Regional Director: Dr. Mirta Roses
Regional Director: Dr. Shigeru Omi
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Appendix 2: NATT FCTC Working Group
Action for Integrated Development (Ghana)
Issah Ali, integratedaid@yahoo.co.uk
Consumer Information Network (Kenya)
Samuel Ochieng, cin@insightkenya.com and cin@swiftkenya.com
Consumers International Regional Office for Latin America and the Caribbean
(CIROLAC, Chile)
Lezak Shallat, lshallat@consint.cl
ConsumerVOICE (India)
Bejon Misra, beionm@hotmail.com; consumeralert@id.eth
Corporate Accountability International (US), NATT Secretariat
Megan Rising, mrising@stopcorporateabuse.org
Corporate Accountability International, Latin America Coordinator
Yul Francisco Dorado, yuldorado@stopcorporateabuse.org
Environmental Rights Action (Nigeria)
Akinbode Oluwafemi, bodufemi@hotmail.com
National Consumers and Environmental Alliance of Togo
Ebeh Kodjo, ebeh@cooperation.net
Zambia Consumers Association
Muyunda Ililonga, zaca@zamnet.zm
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Appendix 3: FCTC and the United States
Decision to Sign
The Bush Administration's decision to sign the Framework Convention on Tobacco Control
(FCTC) with great fanfare in May 2004 appears to have been one in a series of public relations
maneuvers to gain positive recognition while working to undermine the world's first public
health treaty. Throughout the FCTC negotiating process, the US government consistently took
positions that would dilute the treaty at the expense of people's lives in the US and around the
world. For example, the US opposed a comprehensive ban on tobacco advertising, promotion
and sponsorship—even with exceptions based on constitutional constraints; fought to prioritize
trade agreements over public health; and opposed excluding the tobacco industry from public
health policymaking.
Obstructionist Tactics
At the Intergovernmental Working Group meetings in June 2004 and February 2005, the Bush
Administration continued to engage in its obstructionist tactics, especially with regard to treaty
funding. This Administration’s past track record and current inaction on this lifesaving treaty call
into question whether the US government is truly committed to the FCTC and accountable to the
US public or more concerned with splashy PR.
Signatory Inaction
According to the Vienna Convention on the Law of Treaties, once a country signs a treaty it is
bound to uphold the spirit and intent of the agreement. Signature provides a way to maintain
momentum from the negotiations and gives countries the opportunity to demonstrate good faith
in accepting treaty obligations. Unfortunately, the US has abused the process and not followed
this practice with many humanitarian treaties it has signed. There is a clear pattern in recent
history of the US negotiating down to the lowest common denominator, then failing to support
environmental, human rights and other treaties. Since signing the FCTC, the Bush
Administration has made no demonstrable progress—the treaty has not yet been introduced to
the Senate Foreign Relations Committee for approval. Although the US is considered a leader in
tobacco control, continued inaction on this life-saving agreement means it will not have a seat at
the table as countries come together at the first Conference of the Parties.
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CORPORATE
ACCOUNTABILITY
INTERNATIONAL
CHALLENGJNG AR^SE, PROTECTING PEOPLE
formerly
tafact
46 Plympton Street ♦ Boston, MA 02118-2425 USA ♦ T:+1.617.695.2525 F:+1.617.695.2626
www.stopcorporateabuse.org ♦ mrisinq@stopcorporateabuse.org
The Framework Convention on Tobacco Control (FCTC):
Breaking New Ground, Protecting Global Public Health
The adoption of the Framework Convention on Tobacco Control (FCTC) is a milestone in the history
of corporate accountability and public health. This groundbreaking treaty will change the way
tobacco giants like Philip Morris (now Altria), British American Tobacco (BAT), and Japan Tobacco
International (JTI) operate globally. It also establishes important precedents for international
regulation of other industries that profit at the expense of human health and the environment.
The story of the FCTC inspires hope. The developing world, led by a block of all 46 African nations
and supported by dozens of non-governmental organizations (NGOs), united around protecting the
health of their people from the deadly expansion of Big Tobacco. Throughout the process, the US
practiced its now-predictable but increasingly unacceptable “cowboy diplomacy" approach to
international treaties on the environment and human rights. Despite staunch US opposition and
aggressive attempts by Philip Morris/Altria, BAT and JTI to derail the treaty, when implemented the
FCTC will go a long way toward curbing the global spread of tobacco addiction.
History of the FCTC
The World Health Assembly (WHA) called for development of the world's first public health treaty to
control the spread of tobacco addiction in 1996, and set the negotiating process in motion in 1999.1
World Health Organization (WHO) Director-General Gro Harlem Brundtland put the FCTC on a "fast
track," with the goal of adopting the treaty by May 2003. Member States have overcome opposition
from the tobacco transnationals and their allies to successfully meet that challenge.
In October 1999 and March 2000, WHO and its Member States convened working groups to prepare
the draft elements of the FCTC. In October 2000, an Intergovernmental Negotiating Body (INB)
began formal talks on the FCTC. There have been a total of six formal negotiating sessions held
between October 2000 and February 2003 involving 171 countries.2
A total of eight days of working groups and 49 days of formal negotiations were held between
^October 1999 and February 2003. An additional 39 Regional Intersessional Meetings were held
between 2001 and 2003, beginning with the Johannesburg meeting of 21 African countries in March
2001.3 Many of these intersessional meetings were attended by NGOs.
Well over 200 NGOs around the world have been active on the FCTC, including twenty-six public
interest NGOs in official relations with WHO. The Network for Accountability of Tobacco
Transnationals (NATT) was founded by Infact in the summer of 1999, and is comprised of 79
consumer, human rights, environmental, faith-based and corporate accountability organizations in 50
countries. The Framework Convention Alliance (FCA) was initiated in the fall of 1999, and has 187
members including major international tobacco control and public health organizations.
www.infact.org/fctc.htmi
46 Plympton Street ▼ Boston, MA 02118 USA
617-695-2525 v 1:617-695-2626 »info@infact.org
FCTC: Breaking New Ground, Protecting Global Public Health
Throughout the FCTC process, NGOs have provided technical assistance to government delegates,
monitored and exposed tobacco industry abuses such as interference in public health policy,
generated direct pressure on tobacco transnationals through tactics like Infact's Boycott targeting
Philip Morris/Altria's Kraft Foods, increased visibility of tobacco control issues in the media, and
raised public awareness of the FCTC. NGOs will continue to play a vital role in the adoption and
ratification of the treaty.
The INB reached agreement on the final text of the FCTC on 1 March 2003, and forwarded it to the
World Health Assembly for adoption in May 2003.
Development of the FCTC Text
From the beginning of the FCTC process, developing countries have pushed for effective measures
to reverse the global tobacco epidemic and hold tobacco transnationals accountable for their
abuses. India, Iran, Jamaica, Palau, Senegal, South Africa and Thailand are a few countries that
played key leadership roles during the FCTC negotiations. NATT and other NGOs backed these
champions of public health with a global outcry for the FCTC to:
>
Ban all tobacco advertising, promotion and sponsorship;
>
Consistently establish the principle that public health takes precedence over trade in tobacco;
>
Prohibit interference in public health policy by tobacco corporations, their subsidiaries,
>
affiliates and agents;
Ensure that tobacco corporations are held accountable for past, present and future harm
>
caused by their products and practices;
Establish strong mechanisms and institutions to fund and enforce treaty obligations.
However, the negotiating texts produced by the INB Chair with assistance from the WHO
Secretariat repeatedly failed to reflect positions taken by the large majority of countries. At the final
round of negotiations, the countries of Africa, Southeast Asia, the Eastern Mediterranean, Pacific
and Caribbean Islands stood firm to protect their people from the tobacco giants' aggressive
expansion. As a result the final text—while far from the FCTC these countries and NGOs dreamed
of—is a major step forward for public health and corporate accountability.
Tobacco Advertising,
Promotion and
Sponsorship
First Chair's Text of FCTC
January 2001 4
Final FCTC Draft to WHA
March 2003 5
Prohibition of "direct and indirect
+ Article 13 requires parties to
undertake a comprehensive ban on
tobacco advertising, promotion and
sponsorship within five years of
FCTC's entry into force.
Article 13.3 allows exceptions for
constitutional reasons.
Definitions are broad enough to
cover the range of tactics employed
by the tobacco corporations to
promote their products.
€
advertising, promotion, sponsorship
targeted at [emphasis added] persons
under 18" would have forced parties
to debate intent of tobacco
corporations to appeal to youth.
—
Text failed to recognize effectiveness
of comprehensive bans at reducing
+
tobacco consumption.
2
Final FCTC Draft to WHA
March 2003 5
First Chair's Text of FCTC
January 2001 4
Priority of Public
Health vs. Tobacco
Trade
As a Guiding Principle, "tobacco
control measures should not constitute
a means of arbitrary or unjustifiable
discrimination in international trade."
+
First line of Preamble, establishing
that parties to this convention are
"determined to give priority to their
right to protect public health,"
+
provides interpretive guidance if
tobacco control measures based on
the FCTC are attacked under trade
and investment agreements.
Guiding Principle subordinating
tobacco control to trade is removed.
Protection of Public
Health Policy from
Tobacco Industry
bg Interference
■
Surveillance, Research and Exchange
of Information required parties to
promote and cooperate in exchange of
information regarding practices of the
tobacco industry.
Education, Training and Public
Awareness called for parties to
facilitate public access to information
on the tobacco industry.
+
In Preamble, parties recognize "the
+
need to be alert to any efforts by the
tobacco industry to undermine or
subvert tobacco control efforts. . ."
Article 5.3 obligates parties to
+
protect public health policies from
commercial and other vested
interests of the tobacco industry.
Article 20.4(c) calls for exchange of
+
information on "the activities of the
tobacco industry which have an
impact on the Convention or national
tobacco control activities.”
Article 12 excludes agencies and
NGOs affiliated with the tobacco
industry from participation in tobacco
control programs and strategies.
" Liability and
Compensation for
Harms Caused by
Tobacco
■
Treaty Mechanisms
and Institutions
As a Guiding Principle, "the tobacco
industry should be held responsible for
the harm its products cause to public
health and the environment. . ."
No text developed on Liability and
Compensation.
Established voluntary mechanism for
provision of Financial Resources.
Recognized special responsibility of
developed country parties that export
manufactured tobacco products to
provide technical support for tobacco
control.
—
+
Article 4.5 no longer clearly states
the tobacco industry's responsibility
for harms caused by its products.
Inclusion of Article 19 focusing on
liability is a step toward holding
tobacco transnationals accountable
for their deadly practices.
Article 30 allows no reservations to
this Convention, despite tremendous
pressure from the US in this area.
Articles 5.6 and 26 recognize the
importance of dedicated funding for
the FCTC.
3
"Aggressive promotional tactics like the Marlboro Man have driven the global profits of
tobacco transnationals. When adopted and entered into force, this agreement will
significantly reduce Philip Morris, BAT, and Japan Tobacco's ability to spread addiction,
Quite simply, this is a matter of life and death. The final text is a good first step. It falls far
short of what we dreamed, and while we are disappointed, we are also elated. This
document confirms our feet are on the right path.”
disease and death around the world. In the face of enormous pressure, developing
countries have led the way toward meaningful, effective measures."
— Kathryn Mulvey, Executive Director of Infact (US), a founding member of NATT
— Patricia Lambert, Chair of the South African Delegation, INB6 Closing Plenary
FCTC Negotiating Process, 1996-2003
May 1996
May 1999
Summer 1998
August 1997
World Health Assembly (WHA)
initiates development of FCTC
10th World Conference on _World Health Organization
Tobacco or Health urges
(WHO) establishes Tobacco
Free Initiative, driving work on
governments and WHO to
formulate FCTC
FCTC
WHA sets in motion
“ process to begin drafting
August 2000
May 2000
WHA calls for FCTC
negotiations to begin6
FCTC
£
WHO Committee of Experts releases report
condemning efforts by
tobacco
transnationals to derail
public health initiatives7
May 2001
Oct<£er 2000
WHO Public Hearings on FCTC
1st session of Intergovernmental Negotiating Body (INB1): Ambassador Celso
Amorim of Brazil elected Chair
NATT organizes 1st International Week of Resistance to Tobacco Transnationals
(IWR2000), with events in 30 countries showcasing Infact's documentary
film Making a Killing: Philip Morris, Kraft and Global Tobacco Addiction3
INB3
NATT bestows inaugural Marlboro Man Awards,
, for taking positions that benefit the tobacco industry
at the expense of public health, on US, Japan,
Tunisia, Dominican Republic and Costa Rica19
•
1 st Working Group
^Tf
January 2001
1st Chair's text of
FCTC released
March 2000
2nd Working Group
March 2001
21 African countries participate
in 1st intersessional meeting
on FCTC in Johannesburg:
strong regional position
prioritizes public health over
tobacco trade
March 2002
July 2002
IINB4: Ambassador Luiz Felipe de Seixas Correa takes
over as Chair
.IWR2002
I
highlights theme of public health over trade
NATT's
Marlboro Man Awards go to US, Republic of
I
Korea, Pakistan and Dominican Republic
New Chair's Text condemned by leading
governments and NGOs as too weak to
reverse the global tobacco epidemic
and hold tobacco transnationals
accountable for their abuses
November 2001
INB2
IWR2001 includes events in 37 countries
.WHA passes precedent-setting resolution to monitor the
global impact of the tobacco industry's political
activities9
October 1999
Summer 1999
Network for Accountability of
Tobacco Transnationals
(NATT) is formed
OcDber 2002
January 2003
INB5
NATT members and other NGOs release Dirty Dealings: Big Tobacco's Lobbying, Pay-offs and Public Relations to Undermine
National and Global Health Policies
-Africa, Southeast Asia, Eastern Mediterranean, Pacific and Caribbean Islands unite to champion key treaty provisions
Revised Chair's Text fails to
reflect strong positions
taken by great majority of
~ countries at INB5
NATT's Marlboro Man Awards go to US, China, Germany, tSAT and Japan
February 2003
INB6
NATT's Marlboro Man Awards go to Chair—Ambassador Luiz Felipe de Seixas Correa, Japan,
Cuba and twice to the US
Final text forwarded to WHA includes comprehensive ban on tobacco advertising, promotion and
- sponsorship; promotes public health as priority; obligates parties to protect public health policies
from tobacco industry influence; fails to state tobacco industry's responsibility for harms caused
by its products. No reservations allowed.
March 2003
— 'tobacco industry denounces FCTC
May 2003
June 2003
WHA scheduled to adopt FCTC
FCTC open for signature
US threatens to reopen text
4
5
Successful Treaty Ratification Examples
Qn .
..
.n.
The FCTC will open for signature on 16 June 2003, and enter int
,ornmJCo| NPnntiatinn r
country has ratified or accepted the treaty. Since the first FCTC ln erg°
, t
iiir?L<=<=P " th
meeting in October 1999, at least 13 million people have died from tobac^®*at®d '""®® mt
sooner the treaty enters into force, the more lives will potentially be save
p
Some recent human rights and environmental treaties have entered into force rapidly, providing
hopeful models for ratification of the FCTC. Fifty-seven countries from all the major regions ratified
the Convention on the Rights of the Child within the first year. In addition, 43 countries ratified
within two years. Fifty-seven countries ratified the Mine Ban Treaty within one year.
These treaties
are considered to be the fastest humanitarian treaties to enter into force. The Framework
Convention on Climate Change opened for signature in June 1992 and entered into force in March
1994, after the threshold of 50 ratifications was reached.13
Some countries that have played a leading role in the FCTC negotiations also have a good record
of quickly ratifying human rights and environmental conventions—including island nations of the
Pacific and Caribbean and several European and African countries. The Convention on the Rights
of the Child, the Mine Ban Treaty, and the Framework Convention on Climate Change were all
ratified within one year by Guinea, Mauritius, Mexico, Peru, St. Kitts and Nevis, Sweden and
Zimbabwe. An additional 20 countries ratified at least two of these treaties within one year.
Although opposition to ratification of the FCTC is expected from the tobacco industry and its
government allies, the FCTC should have the necessary momentum from governments, backed by
broad-based NGO support, to enter into force within two years. The sooner governments take
action, the more needless addictions and deaths will be prevented.
Who Stands to Gain from a Delay?
The tobacco transnationals—Philip Morris/Altria, JTI and BAT—and their investors in wealthy
countries like the US, Japan and Germany have the most to gain in delaying the FCTC's entry into
force.
Recently released Philip Morris/Altria internal documents indicate a key corporate strategy is to
delay the FCTC, as recommended by the notorious Washington, DC-based firm Mongoven, Biscoe
&
Duchin (MBD). During Infact’s campaign on the infant food industry in the late 1970s and’early
1980s, Jack Mongoven of MBD advised Nestle on how to fight the Nestle Boycott and the WHO
Code of Marketing of Breast-Milk Substitutes. With regard to the FCTC, MBD told Philip Morris that
"the first alternative to an onerous convention is to delay its crafting and adoption ... Any
pressures to delay the finalisation of the convention would require the combined efforts of several
individual or coalitions of countries and various NGOs." MBD suggested to Philip Morris/Altria that
"key intervention points to delay or strongly influence movements in negotiations are the biennial
meetings of the WHA. The firm also recommended focusing on the FCTC by regions and having a
"central corporate-wide" strategy.- The majority of governments have so far stood firm to keep the
FCTC on schedule and to negotiate a strong text.
Governments must continue to be vigilant against industry tactics to delay the treaty's adoption and
entry into force-including arguments in favor of reservations and against a ban on advertising.
^eXXXZo^
the treaty may In the long run have little impact on the treaty's effecdXTstn “veXg "heS'
epidemic spread by tobacco transnationals.
leveling me yiv
6
A World With a Strong FCTC
Within five years of entry into force of the FCTC, the Marlboro Man and other ads for tobacco
products will disappear from billboards, there will be no television or radio commercials promoting
tobacco directly or indirectly, and merchandise with brand names like Marlboro Classics clothing will
be a thing of the past. Sports and other events will no longer be associated with tobacco products,
brands or corporations. Tobacco promotions by Philip Morris/Altria, JTI, BAT and other tobacco
corporations will be far less visible in society and fewer children will become addicted to tobacco as
a result. There has already been a dramatic drop in youth addiction in countries where most
tobacco advertisements are prohibited as part of a comprehensive tobacco control program.
The FCTC will make it easier for governments to pass tobacco control legislation since the FCTC
will make lobbying and other activities of the tobacco transnationals more transparent. Tobacco
giants will be less able to hide and therefore not as able to undermine public policy. International
cooperation in legal matters pertaining to tobacco will make it far more likely that the tobacco
transnationals will begin to pay the true costs of their deadly business.
A shrinking rather than growing market of addicted consumers will result in fewer deaths and lower
^health care costs so governments have more resources to tackle other public health challenges. In
impoverished areas, more money will be available for essentials like food rather than lining the
pockets of giant tobacco corporations and wealthy shareholders.
“This is indeed a milestone in the evolution of public health action and demonstrates the
power of the collective will. But we must be reminded, while we applaud ourselves, that this
is only the beginning. There are many more battles ahead."
— Dr. Eva Lewis-Fuller, Chief Jamaican Delegate, INB6 Closing Plenary
"WHA 49.17, International Framework Convention for Tobacco Control,"
http://tobacco.who.int/printer_content.cfm?tld=37, 25 May 1993.
"Intergovernmental Negotiating Body," www.who.int/gb/fctc/EZE_Frame.html.
"Intersessional Consultations," www.tobacco.who.int/printer_content.cfm?sid=66.
"Chair's Text of a Framework Convention on Tobacco Control," A/FCTC/INB2/2,
www.who.int/gb/fctc/pdf/inb2/e2inb2.pdf, 9 January 2001.
"Draft WHO Framework Convention on Tobacco Control," A/FCTC/INB6/5, www.who.int/gb/fctc/pdf/inb6/einb65.pdf ,
“ 3 March 2002.
'
2
3
4
6
"WHA 53.16, Framework Convention on Tobacco Control," http://tobacco.who.int/printer_content.cfm?tld=54,
20 May 2000.
"Tobacco Company Strategies to Undermine Tobacco Control Activities of the World Health Organization," Report of
the Committee of Experts on Tobacco Industry Documents, Geneva, July 2000.
8
"Milestones of the FCTC Process," http:www.treatycheck.org/milestones%202000.htm .
9
"WHA 54.18, Transparency in Tobacco Control," http:/tobacco.who.int/printer_content.cfm?tld=112, 22 May 2001.
"Report from International Negotiating Body Meetings," http:www.treatycheck.org/INB.htm.
" Based on WHO estimates cited in "WHA 52.18, Towards a framework convention on tobacco control,"
http://tobacco.who.int/printer_content.cfm?tld=134, 24 May 1999.
12
"Status of Ratification of the Principle International and Human Rights Treaties," Office of the United Nations High
Commission of Human Rights, as of 9 December 2002. "1997 Mine Ban Treaty Ratification Update,"
http7Zwww.icbl.org/ratification, as of 1 April 2003.
13
"United Nations Framework Convention on Climate Change, Status of Signatories and Ratification of Convention"
7
14
http://unfccc.int/resource/conv/kp.html .
.
„
Stacy M Carter "Mongoven, Biscoe & Duchin: Destroying Tobacco Control Activism from the Inside, Tobacco
Control 2002 Vol 11 Issue 2' Mongoven, Biscoe & Duchin, Inc., "An Analysis of the International Framework
Convention Process: Executive Summary, The WHO Tobacco Control Convention," November 1997, Philip Morris
document # 2074292078-2082.
Since 1977, Infact has been exposing life-threatening abuses by transnational corporations and
organizing successful grassroots campaigns to hold corporations accountable to consumers and
society at large. From the Nestle Boycott of the 1970s and '80s over infant formula marketing, to
the GE Boycott of the 1980s and '90s to curb nuclear weapons production and promotion, to
today's Boycott of Kraft Macaroni & Cheese—a product of tobacco giant Philip
Morris/Altria—Infact organizes to win! Infact is an NGO in official relations with the World Health
Organization, and a founding member of the Network for Accountability of Tobacco Transnationals.
The Network for Accountability of Tobacco Transnationals (NATT) consists of more
than 75 consumer, human rights, environmental, faith-based and corporate accountability NGOs in 50
countries. NATT was formed in the spring of 1999 to ensure a strong, unified voice for an effective
Framework Convention on Tobacco Control that will:
• Institute effective controls over tobacco transnationals that are spreading tobacco addiction, disease
and death; and
• Contribute to the establishment of broad global standards that hold corporations accountable for
policies, practices and products that endanger human health and the environment.
e
§
www.infact.org/fctc.htmO
46 Plympton Street » Boston, MA 02118 USA
617-695-2525 . f:617-695-2626 rinfo@infact.org
Breaking New Ground, Protecting Global Public
World Health
Organization
REGIONAL OFFICE FOR
Europe
Regional Committee for Europe
Sixty-second session
Malta, 10-13 September 2012
Strategy and action plan
for healthy ageing in Europe,
2012-2020
REGIONAL OFFICE FOR
Regional Committee for Europe
Sixty-second session
Malta, 10-13 September 2012
Provisional agenda item 5(c)
Europe
EUR/RC62/10 Rev.1
+ EUR/RC62/Conf.Doc./4
10 September 2012
122346
ORIGINAL: ENGLISH
Strategy and action plan for healthy ageing in
Europe,2012-2020
The WHO European Region has a rapidly ageing population. The median age is
already the highest in the world, and the proportion of people aged 65 and above is
forecast to almost double between 2010 and 2050. The average age of the
population and the proportion of people above retirement age are also projected to
increase fast, even in countries with life expectancies that are well below the
European average.
Allowing more people to lead active and healthy lives in later age requires investing
in a broad range of policies for healthy ageing, from prevention and control of
noncommunicable diseases (NCDs) over the life-course to strengthening health
systems, in order to increase older people's access to affordable, high-quality health
and social services.
Investing in healthy ageing has become key for the sustainability of health and social
policies in Europe. A closing window of opportunity of relative growth of the labour
force along with unfavourable economic prospects in many countries in Europe have
made the need to step up the implementation of policies for active ageing
particularly urgent.
This document contains a draft strategy and action plan for healthy ageing in
Europe. It focuses on priority action areas and interventions that correspond to the
four priority areas of Health 2020, the new European policy framework for health and
well-being. It is therefore in synergy with the core health policy developments being
undertaken by the WHO Regional Office for Europe in the period 2011-2012,
namely Health 2020, the European action plan for the prevention and control of
noncommunicable diseases, and the European action plan for strengthening public
health capacities and services.
This draft has been developed in consultation with Member States, guided by the
Standing Committee of the WHO Regional Committee for Europe.
A draft resolution is attached, for consideration by the Regional Committee.
WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR EUROPE
Scherfigsvej 8, DK-2100 Copenhagen 0, Denmark Telephone: +45 39 17 17 17 Fax: +45 39 17 18 18
E-mail: govemance@euro.who.int Web: http://www.euro.who.int/en/who-we-are/govemance
Contents
page
Executive summary............................................................ :................................. ...............—....... '
Mandate, context and process............ ...........................................................................................2
Mandate..... ................................ ......................................................................................... 2
Healthy ageing in Europe: challenges and opportunities.................................................... 2
The need and opportunity to act now............. ..................................................................... 4
Guiding principles and scope..................... ........................................................................ 4
Vision, overall goal and objectives.......................................... ........................................... 7
International cooperation: working together........................................................................8
Strategic priority areas for action...................................... ,........................................................... 8
Strategic area 1: Healthy ageing over the life-course..................... .................................... 8
Strategic area 2: Supportive environments.... .................................................................. 10
Strategic area 3: People centred health and long-term care systems fit for ageing
populations.......................... .............................................................................................. 1 •
Strategic area 4: Strengthening the evidence base and research....................................... 13
Priority' interventions......... .................. .............................. ....................... ............................. .....15
Priority intervention 1: Promoting physical activity......................................................... 15
Priority intervention 2: Falls prevention............................................................................ 16
Priority intervention 3: Vaccination of older people and infectious disease prevention
in health care settings............. ............................... .................................. ................... ...... 17
Priority intervention 4: Public support to informal caregiving with a focus on home
care, including self-care..................................................................................................... 18
Priority intervention 5: Geriatric and gerontological capacity-building among the
health and social care workforce........................................................................................ 18
Supporting interventions............... ................................................................................ .............. 19
Supporting intervention 1: Prevention of social isolation and social exclusion.............. 19
Supporting intervention 2: Prevention of elder maltreatment........... ............................... 20
Supporting intervention 3: Quality of care strategies for older people including
dementia care and palliative care for long-term care patients........... ............................... 21
References.................................. ................................................................ ................................ 23
EUR/RC62/10 Rev.1
page 1
Executive summary
This document contains the draft of a strategy and action plan for healthy ageing in Europe,
2012-2020. It proposes strategic action areas and a set of interventions that will be in synergy
with Health 2020, the new European policy framework supporting action across government
and society for health and well-being, to which its strategic areas correspond. It is the first
European strategy to bring together, in a coherent manner, the ageing-related elements of the
WHO Regional Office for Europe’s work programme and to present them in the form of four
strategic action areas and five priority interventions, together with three supporting
interventions. The action plan is intended as a guide for Member States at different income
levels or stages of ageing policy development or demographic transition.
At the core of this proposal is a list of priority interventions for which there is evidence to show
that, if adequately implemented, they can provide “quick wins” (in the sense that they should be
politically feasible), and for which progress is achievable and measurable even within a
relatively short time span. Moreover, preference has been given to interventions with evidence
to support their effectiveness and contribution to the sustainability of health and social policies.
The strategy and action plan is in four main sections. The first sets out the mandate, background
and context. The second proposes four strategic priority areas for action that build on the
Regional Office’s existing tools, instruments and commitments, including tools that have been
developed at the global level. These are (i) healthy ageing over the life-course; (ii) supportive
environments; (iii) health and long-term care systems fit for ageing populations; and (iv)
strengthening the evidence base and research. These priority areas comprise actions that help
people to stay active as long as possible, including in the labour market, and actions to protect
the health and well-being of people with (multiple) chronic conditions or at risk of frailty.
The third section suggests five priority interventions: (i) promoting physical activity, (ii) falls
prevention; ; (iii) vaccination of older people and infectious disease prevention in health care
settings; (iv) public support to informal care-giving, with a focus on home care; and (v)
geriatric and gerontological capacity-building among the health and social care workforce.
Three additional supporting interventions in the final section link healthy ageing to its wider
social context: (i) prevention of social isolation and social exclusion; (ii) prevention of elder
maltreatment; and (iii) quality of care strategies for older people including dementia care and
palliative care for long-term care patients.
This strategy and action plan also outlines synergies and complementarities in cooperation with
partners, in particular with European Commission initiatives. In implementing this strategy and
action plan, the Regional Office will ensure that all countries in the WHO European Region are
adequately covered, as population ageing is spreading fast in the Region, making the need to
prepare health and social care systems for ageing populations particularly urgent.
EUR/RC62/10 Rev.1
page 2
Mandate, context and process
Mandate
l.
At its sixty-first session in September 2011, the WHO Regional Committee for Europe
(RC61) confirmed the Regional Office’s mandate to develop a new European health policy,
Health 2020, which would “focus in particular on policies and interventions that work and
which make the greatest difference to the health and well-being of people in the Region” (1).
2.
Sound policies for healthy ageing are indispensable for reaching the goals of Health 2020
in response to fast demographic ageing in the WHO European Region, as well as to other major
health and social challenges that have been identified in Health 2020, such as the increasing
need for intersectoral action in order to reach public health goals and combat the
noncommunicable disease (NCD) epidemic in the Region. Healthy ageing policies are key to
preventing disease, disability and erosion of well-being, much of which is highly concentrated
in older age groups. The actions under the four priority areas of this strategy and action plan all
correspond to and support the four priority areas of Health 2020, as detailed below.
3.
There is growing evidence that more can be done to create better people-centred health
systems for older people and to improve coverage with and access to public health services for
older age groups. Healthy ageing is indeed vitally important for making current levels of wealth
and social protection sustainable in the future, including the contribution of families and
voluntary action, and for responding to the specific needs of an ageing labour force in Europe.
4.
In addition to proposing detailed actions for implementing the priority areas of Health
2020 through an “ageing lens”, this draft strategy and action plan builds on a number of relevant
resolutions and previous work at both global and European regional level. In 1999, the World
Health Assembly, in its resolution WHA52.7 on active ageing, called upon Member States to
ensure the highest attainable standard of health and well-being for their older citizens (2), and
more recently, in resolution WHA58.16 it focused on developing age-friendly primary health
care (3). In 2012, the World Health Assembly adopted resolution WHA65.3 on “Strengthening
noncommunicable disease policies to promote active ageing” (4). Links to the WHO reform are
promoted at every stage.
5.
Since the 1980s, Member States in the European Region have continuously requested that
the Regional Office focus its work on healthy ageing (5). For example, healthy ageing is one of
the 21 targets of HEALTH21 - the “health for all in the 21st century” update of the European
Health for All Strategy (6).
6.
In several resolutions (e.g. A/RES/58/134 and A/RES/59/150) the United Nations
General Assembly has called on governments, United Nations organizations and others to
incorporate the concerns of older people into their programmes of work. The Second World
Assembly on Ageing that was held in Madrid, Spain in 2002 adopted the Madrid International
Plan of Action on Ageing (MIPAA) (7). As a contribution to this meeting, WHO developed a
document entitled Active ageing: a policy framework (8). In the same year, the United Nations
Economic Commission for Europe (UNECE) Ministerial Conference on Ageing in Berlin
adopted the Regional Implementation Strategy for MIPAA in Europe (9).
Healthy ageing in Europe: challenges and opportunities
7.
The population in the European Region has the highest median age in the world. People
in many European countries enjoy some of the highest life expectancies in the world. As life
expectancy increases, more people live past 65 years of age and into very old age, greatly
EUR/RC62/10 Rev.1
page 3
increasing the numbers of older people. By 2050, more than one quarter (27%) of the population
is expected to be 65 years and older. However, trends in longevity gain are uneven, and gaps
between and within countries of the European Region continue to grow (10).
8.
While many people are living longer and healthier lives, there are important uncertainties
about future trends in the health and functional status of ageing populations. This calls for
strong public health policies to allow more people to stay active and participate fully in society.
Moreover, those with chronic conditions or at risk of frailty require access to adequate support
and protection by health systems and public health actions.
9.
In western European countries, the labour force is rapidly becoming older, a trend which
is spreading eastward and which calls for particular attention to be paid to the health and well
being of persons aged 50 and above or in the last years of their working life. Moreover, in many
countries old-age dependency ratios are projected to grow to unprecedented levels, and the
concern this has caused about the financial sustainability of the current scope of publicly funded
health and social protection has become even more acute in times of fiscal and economic
crises (11).
10. Demographic ageing is also high in eastern European countries and those in the
Commonwealth of Independent States (CIS), where the median age is projected to increase by
10 years within less than two decades (12). Differences between men and women are significant
across the Region, not only in terms of life expectancy (women consistently make up the
majority of the old, and particularly the oldest old) but also in relation to roles and experience of
health and responses from the health system. There are currently 2.5 women for each man
among those aged 85 years or over, and this imbalance is projected to increase by 2050 (10).
11. In response to global trends in ageing, in the late 1990s WHO called for a paradigm shift
towards a positive concept of ageing, defining healthy and active ageing as a process that
“allows people to realize their potential for physical, social, and mental well-being throughout
the life-course and to participate in society, while providing them with adequate protection,
security and care when they require assistance” (8).
12.
Healthy ageing therefore has several dimensions.
•
It responds to the growing needs and expectations of ageing populations for better health
promotion and health and social services, including support for self-help.
•
It recognizes everyone’s fundamental right to the enjoyment of the highest attainable
standard of physical and mental health, irrespective of age.
•
It takes into account growing evidence about inefficiencies shortcomings in terms of
quality and access to services, including prevention (at all levels - primary, secondary
and tertiary).
•
Besides maternal and child health, and the fight against the NCD epidemic, healthy
ageing is a major contributor to closing the gap in health and well-being between
countries in the Region, between socioeconomic groups and between men and women.
•
Healthy ageing interacts with policies of social protection to prevent the risk of poverty
among older people, a risk that is still widespread in Europe.
•
Healthy ageing can contribute to the sustainability of health and welfare systems in
Europe, in particular by allowing people in higher age groups to remain active,
autonomous and fully integrated.
EUR/RC62/10 Rev.1
page 4
The need and opportunity to act now
13.
The closing “window of opportunity”, during which the share of the population of
economically active age was growing, and the negative economic outlook in many countries
have added to the urgent need to step up the implementation of policies for active ageing. Many
countries have already launched healthy ageing initiatives at various levels of government,
including national strategies. WHO is supporting this process with a number of tools that are
relevant for healthy ageing, such as in the areas of NCD prevention and control, public health
services, and health systems strengthening.
14.
Postponing the implementation of healthy ageing policies in a period of economic
austerity may prove more costly in the long term and can be counter-productive to the
sustainability of welfare policies.
15.
On a more positive note, there is a rapidly growing body of knowledge and evidence for
action, as Europe is rich with innovative policy initiatives on population ageing. This strategy
and action plan aims to offer a framework that leads to a better uptake of evidence in the field of
ageing, including findings about interventions with known effectiveness that can contribute to
the sustainability of health systems, such as targeted disease prevention strategies.
16.
This strategy and action plan is being developed at a time when questions of healthy
ageing are high on policy agendas in Europe and globally. The year 2012 sees the tenth
anniversary of the United Nations Madrid International Plan of Action on Ageing and the
thirtieth anniversary of the first International Plan of Action on Ageing (13). The theme of
World Health Day 2012 is “Ageing and health”. At the level of the European Union, 2012 has
been designated as the European Year for Active Ageing and Solidarity between Generations.
This strategy and action plan will be at the core of the WHO Regional Office for Europe’s
response to the European Commission’s call to all partners in the field of active and healthy
ageing to join forces over the years ahead.
Guiding principles and scope
Guiding principles
17.
In line with the principles at the core of Health 2020, this strategy and action plan is
based on everyone’s fundamental right to the enjoyment of the highest attainable standard of
physical and mental health, irrespective of age, as articulated in the WHO Constitution and
committed to by WHO’s European Member States in various international treaties at both
global and regional level (14-17). Moreover, it incorporates the core values and principles set
out in the global and European Regional documents listed above, with a particular emphasis on
the United Nations Principles for Older Persons (18).
18.
Implementing policies for healthy ageing is essential to achieving the two linked strategic
objectives of Health 2020, because many health challenges and inequalities are most
pronounced in higher age groups. Policies on healthy ageing are a prime example of the need
for cross-sectoral action at various levels of government, including:
•
improving health for all and reducing health inequalities; and
•
improving leadership and participatory governance for health.
19.
Furthermore, the implementation of this strategy and action plan requires that a number
of principles of the Health 2020 policy framework be applied.
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•
Participatory approaches: involving older persons in policy-making and evaluation has
proven to be key for the design of successful initiatives and their implementation.
•
Empowerment at the personal and community levels: involving people in community
action, voluntary initiatives and informal care is at the core of successful healthy ageing
strategies.
•
A focus on equity with attention to vulnerable or disadvantaged groups of older
people: inequalities accumulate over the life-course. Healthy ageing policies therefore
can contribute to closing the gaps in health inequalities.
•
Gender perspective: there are important differences between men and women in the
roles and experiences during old age. Women are potentially more affected by living
alone, and by poverty in old age, and they spend on average a larger part of their life with
some form of functional limitations. At the same time, they constitute the vast majority of
both formal and informal care-givers, as well as being clearly over-represented as care
recipients, even when controlled for their higher average age. These and other aspects call
for a gender perspective on healthy ageing policies throughout all strategic areas and
priority interventions.
•
The need for intersectoral action: “whole-of-society”, “whole-of-government” and
“health in all policies” approaches: not only the social determinants of healthy ageing but
also the responsibility for care of older people and for strategy development and
leadership on healthy ageing are usually joint responsibilities between health ministries
and other government departments, and typically belong to different levels of
government. Moreover, they involve other stakeholders, private sector, civil society and
voluntary action at various levels.
•
Sustainability and value for money: fiscal sustainability is a major concern in many
countries that are in the process of reforming health systems and public health services
for ageing populations. Improved quality of care and proven effectiveness of
interventions are important concerns in this respect. This applies to countries at all
income levels.
Scope
20.
The scope of this strategy and action plan has two dimensions. The four suggested
strategic action areas span the policy field of healthy ageing and link to corresponding priority
areas of Health 2020. They follow earlier strategic approaches proposed by WHO, such as
“Active ageing: a policy framework” (8). The five priority interventions and three supporting
interventions have been selected in an attempt to prioritize and select actions using a number of
criteria.
•
They build on existing WHO strategies, tools and expertise.
•
Progress can be achieved in the WHO European Region within a limited timescale.
•
They are relevant for countries at all income levels and stages of development of policies
for healthy ageing.
•
They have a high impact on health and well-being of older people, as identified by the
available evidence base.
•
They address the largest gaps and inequalities in access to good quality and effective
interventions.
•
They correspond to the major concerns that are regularly expressed by patient groups,
families of people in need of care, and other stakeholder groups.
•
There is evidence for their effectiveness and that they can contribute to making health and
social systems more sustainable.
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•
The evidence exists to justify a concerted societal response to this burden, with tools that
are effective and adaptable to countries at all levels of development.
•
There is a mandate in global and regional strategies for the response by Member States.
Linkages
21.
Healthy ageing is a cross-cutting concern, with linkages to a number of other strategic
areas and existing action plans. The health and well-being of older people can be decisively
improved, if the implementation of all actions takes the specific needs, concerns and barriers of
access for older men and women into account. The main linkages are to the areas described
below.
The new European policy framework for health and well-being, Health 2020
22.
Responding to the challenges of ageing populations is one of the public health priorities
in the European Region in the new European policy framework for health and well-being,
Health 2020. This strategy and action plan is in line with the four priority areas of Health 2020,
and thus provides an “ageing lens” through which to view activities undertaken in the context of
Health 2020.
Noncommunicable diseases
23.
There is a large overlap between the NCD agenda and strategies for healthy ageing over
the life-course (4). Shared topics (often found in national strategies) include prevention of
malnutrition and obesity, physical activity and exercise, tobacco and alcohol. The first of the
proposed strategic areas in this strategy and action plan focuses on addressing NCDs among
older persons.
Mental disorders
24.
Mental health is a vital, often neglected aspect of medical and social attention to older
people, including preventive actions. The Regional Office’s draft mental health action plan,
which is currently being revised in consultation with Member States, already addresses these
concerns (19). In 2011, the High-level Meeting of the United Nations General Assembly on
prevention and control of noncommunicable diseases adopted a political declaration which
recognizes that “mental and neurological disorders, including Alzheimer’s disease, are an
important cause of morbidity and contribute to the global noncommunicable disease
burden” (20). A report developed jointly by WHO and Alzheimer’s Disease International calls
for making dementia a public health priority (21). The specific needs of older persons with
dementia and the needs of their carers, are a cross-cutting concern that is supported by a range
of actions and priority interventions in this strategy and action plan.
Violence and injury prevention
25.
Injuries account for a large share of the burden of disease and disability of older people,
in particular in the oldest age groups. Elder maltreatment has received more attention only over
the last decade and has become an emerging field for international exchange of experience, in
which WHO continues to play an important role.
Infectious diseases
26.
There is growing recognition of the benefit for older people of proper vaccination
strategies (such as against influenza), both for themselves and for health and social care staff
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who are in contact with them. A corresponding priority intervention is proposed in this action
plan.
Health systems strengthening
27.
The complex care needs of chronic patients in ageing populations call for wellcoordinated and high-quality services for older people. This includes better access to preventive
services (at all levels - primary, secondary and tertiary) and to rehabilitation. It is a central
concern of reform strategies to support self-management and delivery of care as close to home
as is safe and cost-effective, by both increasing value for money and making the financing of
health care systems sustainable, which are core goals of the Tallinn Charter “Health Systems for
Health and Wealth” (22).
Vision, overall goal and objectives
Vision
28.
The vision of this strategy and action plan is of an age-friendly WHO European Region
where population ageing is seen as an opportunity rather than a burden for society. It is the
vision of a European Region where older people can maintain their health and functional
capacity and enjoy well-being by living with dignity, without discrimination and with adequate
financial means, in environments that support them in feeling secure, being active, empowered
and socially engaged, and having access to appropriate high-quality health and social services
and support. An age-friendly European Region helps people to reach older age in better health
and to continue leading active lives in various roles including in employment and voluntary
action.
Goals
29.
The goals of this strategy and action plan are:
•
to allow more people to live longer in good health, to remain active for longer, and to
counteract growing inequalities in old age;
•
to facilitate access to good quality health and social services for people in need of care
and support, in order to make healthy life expectancy more equitable within and between
Member States;
•
to empower older women and men to remain fully integrated in society and to live in
dignity, independent of their health or dependency status; and
•
to raise awareness and contribute to overcoming age discrimination and ageing
stereotypes of any form.
Objectives
30.
The objectives of this strategy and action plan are:
•
to foster enabling environments and to take health-promoting and disease prevention
action on risk factors for older people in a life-course and gender perspective;
•
to strengthen health systems for healthy ageing and better quality and more equitable
health and social care for older people; and
•
to strengthen the evidence base for health and social care policies for ageing populations
in Europe.
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International cooperation: working together
31.
The implementation of the strategy and action plan calls for strengthening international
cooperation and partnership between initiatives in Europe. There are also synergies and
complementarities with initiatives from the European Commission, United Nations agencies and
other international partner organizations, such as the UNECE, the Organisation for Economic
Co-operation and Development (OECD) and the World Bank.
32.
The implementation of the strategy and action plan has synergies with a number of the
priorities and actions identified in the strategic implementation plan of the European
Commission’s Pilot European Innovation Partnership on Active and Healthy Ageing (EIP
AHA) and shares its positive vision on ageing (23). The strategic framework for action of the
EIP AHA defines three pillars or “life stages” of older people in relation to care processes: (i)
prevention, screening and early diagnosis; (ii) care and cure; and (iii) active ageing and
independent living. The EIP AHA singles out, among others, falls prevention and the prevention
of ftmctional decline and frailty; training programmes for the health workforce; support for
home care; and innovation for improving social inclusion.
33.
The strategic framework for action of the EIP AHA complements this strategy and action
plan by placing stronger emphasis on questions of research, innovation, and technology. Strong
synergy between them is foreseen is under the horizontal topic of age-friendly environments of
the EIP AHA, which also is a strategic priority area of the present strategy and action plan. The
indicators on healthy ageing are another example of cooperation, complementing the interactive
geographical information system of atlases on inequalities in health and their social
determinants, which has been jointly developed with the European Commission’s DirectorateGeneral for Health and Consumers (DG SANCO). The development of other joint global
indicators is under way with Eurostat and the OECD for gathering ageing-related data, such as
for workforce planning.
34.
Collaboration in this field has already started in the context of cooperation between the
WHO Regional Office for Europe and the European Commission.
Strategic priority areas for action
35.
The four strategic action areas described below complement each other and link to other
WHO strategies and action plans that are mutually reinforcing (24). The first three directly
support, through a special “ageing lens”, the four priority areas of Health 2020. Strengthening
the evidence base and research is one of the cross-cutting priorities of Health 2020. Moreover,
they reflect WHO’s specific mandate for the European Region, where countries are at different
stages of population ageing. Finally, they build on earlier WHO frameworks, such as “Healthy
Ageing: A Framework for Action” (8), and initiatives with a good track record of take-up in
Member States. The Healthy Cities movement is a prime example (25). These four strategic
areas also bring together the elements that support the development and implementation of
national healthy ageing policies that are referred to in resolutions WHA52.7 (2), WHA58.16 (3)
and WHA65.3 (4).
Strategic area 1: Healthy ageing over the life-course
Background
36.
Health and activity in older age are the result of the living circumstances and actions of
an individual during his or her whole life span. The life-course approach to healthy ageing helps
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people influence how they age by adopting healthier lifestyles earlier in life and by adapting to
age-associated changes. This strategic area supports priority areas 1 and 2 of Health 2020,
namely “Investing in health through a life-course approach and empowering people” and
“Tackling Europe’s major health challenges in communicable and noncommunicable diseases”.
The link between NCD prevention and healthy ageing over the life-course is also at the core of
the resolution on “Strengthening noncommunicable disease policies to promote active ageing”
endorsed by the Sixty-fifth World Health Assembly in May 2012 (4).
37. In this strategy and action plan, one focus is on interventions targeted on “early old age”,
those aged 50 years or more, and on prevention, including secondary and tertiary prevention in
older age groups. There is growing evidence about the underutilization of health promotion and
disease prevention, including secondary and tertiary prevention that can be efficient and costeffective for older age groups.
38. In national strategies and action frameworks, healthy ageing usually spans interventions
on a broad range of NCDs and their most common risk factors and determinants, with a special
focus on providing guidance that is targeted at older people: malnutrition, physical activity, a
safe environment, smoking cessation, alcohol, obesity, hearing and eyesight, and mental health.
All of these areas are covered in specific WHO strategies and action plans at regional or global
level, and four main NCDs and their risk factors are covered in detail in the recent Action plan
for the implementation of the European strategy for the prevention and control of
noncommunicable diseases (24).
39. This strategy and action plan focuses on a small set of priority interventions, and it
consequently avoids repetitions of core components of existing strategies, such as the
Framework Convention on Tobacco Control, on alcohol or mental health, while keeping in
mind the importance of sufficiently including health aspects of older people in their
implementation, which may not always be the case (examples are the widespread failure of
proper screening, detection and subsequent treatment of tuberculosis, HIV/AIDS or depression
among older persons). In this respect, primary care is important for providing for good quality
general assessment of the health status of older persons, with the goal of early detection of
physical and cognitive decline and for adequate preventive measures and timely treatment.
40. In the framework of the present strategy and action plan, this strategic area therefore has a
clear focus on:
•
mainstreaming of ageing into all relevant health promotion and disease prevention
activities, and
•
increasing coverage with and access to targeted priority interventions for older persons.
Objective
41. The objective in this strategic area is to deliver health promotion and disease prevention
services for healthy ageing with a focus on adults aged 50 years and above.
Action by WHO
42.
WHO will:
•
prepare gender-responsive guidelines for evidence-based recommended “baskets” of
health promotion and prevention services targeted at people aged 50 years and above that
are based on good practice from Member States, with a focus on NCDs, vaccinepreventable diseases, injury and mental health;
•
mainstream healthy ageing into existing regional actions for health promotion and disease
prevention, including intersectoral policies, within the overall framework of Health 2020,
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while ensuring that the special needs of older men and women are taken fully into
account in the implementation of relevant regional action plans ;
•
provide tools to monitor the gender aspects of implementation (for example, the balance
between women’s formal and informal work, their self-care and health protection) and the
concentration of many risk factors affecting persons aged 50 years and above;
•
assist Member States in developing instruments for evaluation and monitoring of the
implementation of policies for healthy ageing by preventive actions and health promotion
services, and foster cross-country learning and comparisons ;
•
report on country progress with implementation of the specific measures covered under
this action area in a regional report by 2016 and 2020; and
•
develop tools to raise awareness among persons aged 50 years and above about the
availability of disease prevention and health promotion (including services) and to foster
their health literacy.
Action by Member States
43.
Implications for Member States:
•
paying particular attention to the needs and special risks of persons aged 50 years and
above during the implementation of commitments under the strategic area “Promoting
health and preventing disease” of the NCD action plan, ensuring that gender aspects are
well addressed;
•
extending the coverage of preventive action to people in older age groups and those in
special settings, by ensuring that those living with functional limitations at home or in
institutions, including those with dementia, are not excluded from or face high barriers of
access to these services, including financial ones;
•
supporting reporting systems and research in order to monitor the uptake, outcomes and
social determinants of successful implementation of these actions.
Strategic area 2: Supportive environments
Background
44.
A supportive environment at community level makes important contributions to the
quality of life, associated with healthy ageing, better living and working conditions and
healthier lifestyles for both urban and rural neighbourhoods. Alongside primary health care
services, supportive environments are an important element of primary prevention. Creating
healthy and supportive environments for health and well-being for all ages corresponds to
priority area 4 of Health 2020 “Creating supportive environments and resilient communities”.
For older people, environmental factors of the built environment; transportation; support for
social participation and social inclusion; security; education; and communication and
information are the most relevant aspects of this priority area of Health 2020.
45.
Important decisions influencing these wider determinants of health and well-being are
often taken at local level. Within national policy frameworks, decisions that directly concern
health and social services for older people are also often taken at local level. It is at community
level that inequalities in healthy ageing can be effectively addressed.
46.
In recent years, impressive “bottom-up” movements have been initiated by cities and
rural communities that seek cooperation among themselves and with WHO on policies and tools
for making their communities more age-friendly. Structured tools and processes of self
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evaluation and follow-up monitoring have been put in place, which ensure that older people and
their representatives have a key role to play in their design and implementation. In the European
Region, this support is organized via the WHO Healthy Cities subnetwork on healthy ageing. A
global network of age-friendly cities has been established by WHO headquarters, and a process
is under way for alignment and cooperation between both initiatives, in order to explore
synergies and “bundle” the resources available at WHO.
Objective
47.
The objective in this strategic area is to engage an increasing number of communities in
the process of developing strategies for becoming more age-friendly, providing supportive
environments for older persons to protect their health and well-being and to foster inclusion in
their communities, and allowing them to play an active role in shaping their social environment
and local policies for healthy ageing.
Action by WHO
48.
WHO will:
•
mobilize existing health-promoting networks, including the International Network of
Health-Promoting Hospitals and Health Services, the Healthy Cities Network, and the
Regions for Health Network, and extend further partnerships with appropriate
international partners for implementing this strategy and action plan;
•
contribute to the further development of evaluation tools and guidelines for supportive
environments at the city/community level, building on existing WHO tools;
•
review the use of “Healthy ageing profiles” for planning at community level, such as
those based on the WHO/Europe guide and policy tool of “Healthy ageing profiles” (26);
based on this review, draft revised and amended guidelines for publication by 2013; and
•
in cooperation with communities that are already part of the movement, strengthen the
WHO governance for age-friendly communities in Europe, in cooperation with the global
network of age-friendly cities.
Action by Member States
49.
Implications for Member States:
•
encouraging and advocating the uptake of age-friendly policy concepts and initiatives
among the WHO European Region’s Healthy Cities movement; and
•
supporting unified approaches to local systems for evaluation and data collection on
“healthy ageing profiles”, in cooperation with WHO.
Strategic area 3: People centred health and long-term care systems
fit for ageing populations
Background
50.
Older people are far too often faced with barriers of access to good-quality health and
long-term care, including lack of information and high private cost-sharing. In many cases,
health systems continue to face challenges in overcoming age discrimination or age-rationing
and putting adequate resources in place to respond to the growing needs of ageing populations,
in terms of both human resources and public funding. A particular concern is to train sufficient
numbers of health care staff with adequate knowledge of geriatrics and gerontology. Emphasis
has been placed on the need to strengthen health systems in Europe: the Tallinn Charter calls for
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strengthening of public health capacities and services (22). Moreover, this strategic area brings
together specific actions that contribute to priority area 3 of Health 2020 “strengthening people
centred health systems, public health capacity and emergency preparedness”, viewed through
the lens of ageing.
51.
Those with functional limitations and in need of long-term care are too often at risk of
preventable further decline of their health status, in particular when faced with multiple
morbidity and onset of frailty. Frail older people who live in institutions can be at heightened
risks in this respect. But there are many ways of improving the quality of care and life in
nursing homes, including by paying more attention to preventive actions, from malnutrition
prevention to falls prevention or more effective use of medication and assistive devices
matching the needs of older people.
52.
There is growing evidence about effective ways of providing care for older people with
multiple chronic conditions, including at the boundary between health and social care systems,
where there is often scope for closer cooperation across sectors and levels of government, such
as concerted action to allow older people to stay in their own homes for longer. This can be
particularly relevant for care of people with dementia and the support needed for their
families (21).
53.
Timely action on potential future shortages of human resources, more efficient health and
social care for older people, including health promotion activities and better access to primary
and secondary prevention, are all vital investments that can contribute to the sustainability of
public funding for health systems in the future. This has become a major concern in times of
economic uncertainty and fiscal constraints.
54.
This strategic action area has important linkages and synergies with the strengthening of
health systems for control of NCDs and chronic disease, and with mechanisms for the
coordination of care, which all should be designed in ways that respect the special needs of
older people, including those in older age groups and who are suffering from a decline in mental
functioning.
Objectives
55.
The objectives in this strategic area are to strengthen the capacity of health systems to
respond to ageing populations and to improve the health and well-being of older people by
facilitating appropriate use of high-quality services and mechanisms of financial and social
protection, in order for older people to remain healthy and capable of living independently as
long as possible, and to prevent health and functional impairment leading to social exclusion.
Action by WHO
56.
WHO will:
•
contribute to research, documentation and dissemination of good practice with regard to
innovative models of coordinated service provision for older people, in particular at the
boundary between health and social service systems, and related to fostering community
based partnerships for older people’s health;
•
contribute to the synthesis and dissemination of good practice with regard to initiatives to
improve the quality of health and social care for older people, including those living in
institutions;
•
document and evaluate innovations in access to information and in service provision for
older people, including eHealth to support the coordination of care, so that people with
functional limitations can live in a community setting as long as possible;
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•
contribute to research, documentation and dissemination of recommended community
preventive services for older persons, and good practice in enhancing the use of these
services;
•
disseminate good practice with regard to “horizontal governance” for healthy ageing, and
particular in the design and implementation of national ageing strategies, with a special
focus on gender aspects and the human rights of older people;
•
ensure that human resource planning and monitoring take adequate account of the
numbers and qualifications of staff needed for ageing populations; and
•
exploit synergies with the strategic priority area of health systems strengthening under the
NCD action plan, in particular on coordination of care for people with chronic conditions.
Action by Member States
57.
Implications for Member States:
•
within overall ageing strategies, ensuring coordinated responses to the health and social
needs of people with chronic conditions and functional limitations, including dementia, as
well as the quality of services, and availability of resources;
•
improving surveys and reporting systems for ageing populations, and fostering the
exchange of innovative modes of delivering care that are responsive to older peoples’
needs;
•
fostering health literacy and empowerment of older people, their relatives and voluntary
support networks;
•
putting in place a basic package of support for home care and informal caregivers, such as
alternative modes of day care (see Priority intervention 4 below);
•
ensuring that targeted disease management programmes adequately cover the oldest old
and groups of vulnerable older persons;
•
improving working conditions and staff retention for those providing services to older
people;
•
adopting staff training curricula that adequately cover geriatrics and gerontology and
improve capacity planning for the future workforce;
•
focussing community- and population-based public health services on the issues of older
people;
•
providing universal access to health and social care (financial protection), with cost
sharing regulations that protect low-income households, including older people; this
includes coverage of affordable medicines and assistive devices; and
•
strengthening cost-effective and evidence-based interventions in prevailing primary care
settings to support healthy ageing, whereby a continuum of care is ensured within a
balanced system of community care, disease prevention, primary care settings, outpatient
care, and second- and third-level hospital care; providing mechanisms and policy
coalitions across government departments and regional levels to ensure coordination of
health and social care for older people with chronic conditions and long-term care needs.
Strategic area 4: Strengthening the evidence base and research
Background
58.
Over the past ten years the WHO European Region has seen much progress in research
and exchange of good practice in the area of health policy for ageing populations. But there
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remain gaps in the evidence, and there is an urgent need to further promote the systematic
review, synthesis and dissemination of information about effective interventions that can benefit
health policy for various target audiences. One focus of attention has to be on spreading
effective policies that contribute to closing the gap in the inequalities in health status and access
to services between and within Member States in the Region.
59.
There are also still important gaps in data systems and consequently in knowledge about
health and social trends of ageing populations, such as basic trends in functional status and
living conditions of older people. Data harmonization across the Region is at various stages,
depending on the statistical domain in question.
60.
There has been good progress in some data domains, such as longitudinal surveys (the
Survey of Health, Ageing and Retirement in Europe - SHARE; the Study on Global Ageing and
Adult Health - SAGE) on long-term care recipients, and on expenditure and workforce, in part
of the Region, and this can serve as a model for a larger number of European countries. This
progress has resulted in major new insights and evidence for policy, illustrating how important
it is to have the relevant data systems in place and to harmonize them internationally.
Objective
61.
The objective in this strategic area is to strengthen the technical capacity of Member
States and of the Regional Office to monitor and evaluate the health and functional status of
older people and their access to health and social services.
Action by WHO
62.
The proposed action by WHO will fit within the overall vision of a joint European health
information system and will support the WHO global health observatory and United Nations
reporting systems, with shared data modules across agencies that are active in international data
collection and cross-country comparisons (in particular the European Commission and OECD).
WHO will:
•
identify and subsequently advocate for closing the most important gaps in statistical
evidence and for carrying out both the qualitative and the quantitative research that is
needed to guide policy;
•
advocate the use of WHO instruments and tools such as the International Classification of
Functioning and SAGE, ensuring links to NCD surveillance (better disaggregation of data
by age and sex in surveillance systems, including for older age groups) and monitor social
determinants and health inequalities among older women and men, ensuring that a gender
analysis of inequalities is done;
•
cooperate with the European Advisory Committee on Health Research to identify gaps in
evidence for policy and priority research for ageing and health;
•
provide guidance on the production of health and ageing indicators for non-European
Union countries by promoting existing tools and emerging statistical standards;
•
intensify cooperation with and input to regional and global data initiatives such as those
undertaken jointly by OECD and Eurostat, in cooperation with WHO headquarters;
•
increase the number of WHO collaborating centres and intensify cooperation with
national and international partners in this policy field;
•
in cooperation with international partners such as UNECE, the European Commission
and OECD, agree on definitions and indicators for healthy ageing.
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Action by Member States
63.
Implications for Member States:
•
improving the capacity of surveys and reporting systems to monitor health and social care
services, in particular preventive services, and their utilization and access by older
persons, disaggregated by (five-year) age groups and sex, as well as evaluating the health
of older people, in particular for monitoring functional status in the population;
•
investing in longitudinal data surveys to monitor trends in the health and functional status
of ageing populations;
•
compiling national reports at regular intervals on the situation of older people and their
health and well-being that are based on latest administrative data and research findings;
•
establishing a centre of excellence for research into healthy ageing policies and strategies
and their implementation, including for monitoring the demographic, social and health
situation of older people, building on available expertise such as the network of nursing
centres of excellence in Europe; and
•
carrying out programmes for the prevention and management of chronic diseases that
meet specific evidence-based requirements suited to the characteristics of older people.
Priority interventions
64.
The proposed priority interventions have been selected keeping in mind the criteria
described above in the introductory section under “scope” (see page 5). Each intervention is
mapped to its corresponding priority area for action under Health 2020.
Priority intervention 1: Promoting physical activity
Goal
65.
The goal of priority intervention I is to promote increased physical activity of older
persons both through community environments and social activities.
Mapping to Health 2020
66.
This intervention supports priority area I of Health 2020: Investing in healthy ageing over
the life-course.
Rationale
67.
The level of physical activity is one of the strongest predictors of healthy ageing, in
particular for older age groups. Physical activity can improve respiratory and muscular fitness,
and bone and functional health, and reduce the risk of NCD, depression and cognitive
decline (27). For older people, physical activity includes recreational or leisure-time physical
activity, transportation (e.g. walking and cycling), occupational physical activity (if still
engaged in work), household chores, play, games, sports or exercise planned in the context of
daily, family, and community activities. The motivations and needs of men and women differ,
and actions should therefore take gender norms, values and access to resources into
consideration.
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Actions
68.
The following actions should be taken:
•
foster cooperation and sharing of experience and good practice on effective measures to
increase physical activity levels among older persons, in order to support their
implementation and evaluation;
•
develop and implement targeted community programmes for physical activity among
older people, including a combination of individual and group-based behaviour change
approaches with support and follow-up;
•
provide advice about physical activity in all health and social care settings for older
people, specifically targeting sedentaiy people, with a focus on promoting moderate
intensity physical activity (particularly walking) and providing ongoing support; and
•
support local governments in creating motivating environments and infrastructure for
physical activity (in particular active transport) for all ages.
Priority intervention 2: Falls prevention
Goal
69.
The goal of priority intervention 2 is to reduce the burden of disease and disability from
accidental falls among older persons.
Mapping to Health 2020
70.
This intervention supports Priority area 1 of Health 2020: Investing in healthy ageing
over the life-course.
Rationale
71.
Falls among older people and the injuries to which they often lead are the underlying
causes of a large share of the burden of disease and disability among older people in Europe and
a major risk factor for developing frailty. The risk of falls increases steeply with age. Injuries
from falls (such as femur fracture) usually require hospitalization and costly interventions,
including rehabilitation. They are the underlying cause of many of the functional limitations that
lead to the need for long-term care, including admission to a nursing home.
72.
Environmental hazards account for between a quarter and a half of falls; other factors
include muscle weakness, gait and balance disturbances, previous history of falls, and
medication. Falls can happen in any setting: 30-40% of nursing home residents have been
reported to fall each year. There is convincing evidence that most falls are preventable (28).
Some preventive measures have been shown to be cost-effective or even cost-saving, and there
are examples of successful implementation of falls prevention strategies in different settings,
when supported by public policies (29).
Actions
73.
The following actions should be taken:
•
make the general population more aware of risk factors and effective falls prevention
measures for older persons that can improve balance and prevent falls;
EUR/RC62/10 Rev.1
page 17
•
in order to reduce falls and the proportion of falls that result in injuries, implement
exercise programmes, physical therapy and balance retraining, and have home safety
assessments and modification carried out by trained professionals;
•
carry out multicomponent interventions incorporating gait and balance training, use of
assistive devices, modification of environmental hazards and medication reviews (these
have proven to be most effective in the community);
•
improve training and access to relevant information for informal caregivers in the
community;
•
increase access to preventive measures for high-risk groups of older persons, such as
wearing hip protectors; and
•
include falls prevention measures in quality frameworks in all health and social care
settings for older people.
Priority intervention 3: Vaccination of older people and infectious
disease prevention in health care settings
Goal
74.
The goal of priority intervention 3 is to reduce the health risks (morbidity and mortality)
for older people that are due to gaps in vaccination against common infectious diseases.
Mapping to Health 2020
75.
This intervention supports priority area 2 of Health 2020: Tackling major disease
challenges (related to ageing).
Rationale
76.
There is increasing evidence about the scope of vaccine-preventable disease that is due to
inadequate immunization coverage of the population, including older people (30). In many
cases, low vaccine coverage rates are also seen among health (and social) care workers. This is
in spite of the fact that there is convincing evidence about the difference that vaccination can
make to morbidity and mortality of older persons in different settings, and not only for high-risk
groups such as nursing home residents.
Actions
77.
The following actions should be taken:
•
implement national immunization schedules, including for higher age groups;
•
continue to provide data on vaccine-preventable diseases and vaccination coverage
among older people in order to obtain a better understanding of disease epidemiology;
and
•
ensure implementation of infectious disease control programmes in institutions, extending
beyond hospitals to take in other facilities, including those for older people.
EUR/RC62/10 Rev.1
page 18
Priority intervention 4: Public support to informal caregiving with a
focus on home care, including self-care
Goal
78.
The goal of priority intervention 4 is to make informal care that is offered by family
members and friends sustainable and to improve health and well-being of those in need of care,
as well as of their caregivers, with special attention to the needs of the growing number of
people with dementia.
Mapping to Health 2020
79.
This intervention supports priority area 3 of Health 2020: Strengthening people centred
health and long-term care systems (fit for ageing populations).
Rationale
80.
In all European countries, the majority of care hours are informal care (mostly by women)
even in countries with the largest publicly supported elderly care sectors. The growing
prevalence of dementia will increase the need for support (31). Public support to informal
caregiving is therefore arguably the single most important public policy measure to contribute to
the future sustainability of health and social care in ageing populations (21,32). In contrast to
their importance, statistical systems and cross-country comparative tools are frequently not up
to the task of monitoring and analysing trends on informal care appropriately (31).
Actions
81.
The following actions should be taken:
•
design strategies for training older adults in self-care and for training informal caregivers,
and adapt self-care training programmes;
•
disseminate good practice and foster international exchanges of information, including on
gender-responsive practices that do not overburden women; and
•
in cooperation with other international organizations, strengthen the evidence base and
advocate for the improvement of international systems for reporting on the family
situation and informal caregiving and carrying out evaluation and trend analysis.
Priority intervention 5: Geriatric and gerontological capacity
building among the health and social care workforce
Goal
82.
The goal of this priority intervention is to ensure that training capacity in geriatrics and
gerontology corresponds to the degree to which health and social care needs become
increasingly concentrated in older people, many of whom suffer from dementia.
Mapping to Health 2020
83.
This intervention supports priority area 3 of Health 2020: Strengthening people centred
health and long-term care systems (fit for ageing populations).
EUR/RC62/10 Rev.1
page 19
Rationale
84.
National and subnational capacity for training in geriatrics and gerontology is insufficient
in many instances (33). This concerns both gaps in the geriatric knowledge of general
practitioners and other health care practitioners, as well as insufficient specialist training and
specialists in geriatrics itself (34). There is ample evidence of the problems with regard to
access to training and shortcomings in the quality of care that are due to these shortages.
Although these shortages have in many cases been identified for many years, insufficient
progress has been made in many cases, increasing the urgency of action under this priority
intervention. This intervention is therefore crucial for priority area 3 of Health 2020
“strengthening people centred health systems, public health capacity and emergency
preparedness".
Actions
85.
The following actions should be taken:
•
draw up national guidelines on geriatric education and define standards for geriatric
training;
•
engage in geriatric and gerontological capacity planning as part of overall health and
social workforce planning for ageing populations;
•
contribute to closing the gap in capacity and training of health and social care staff
between and within countries, and promote international networks in the Region; and
•
foster international exchanges of information on good practice in the evaluation and
promotion of continuous training in competencies for the health and social care of older
people.
Supporting interventions
86.
These supporting interventions underline the need for intersectoral action and linkages in
three areas of national and community-level policies for healthy ageing. Two of the proposed
supporting interventions aim at the broader social determinants of health and well-being of older
men and women: the prevention of social isolation and social exclusion, and the prevention of
elder maltreatment. The third supporting intervention addresses the need to step up national
development, implementation and international exchange of strategies for ensuring the quality
of care for older persons, in particular at the boundary of health and social services.
Supporting intervention 1: Prevention of social isolation and social
exclusion
Goal
87.
The goal of supporting intervention I is to reduce loneliness, social isolation and social
exclusion, which are important risk factors affecting the health and well-being of older people.
Mapping to Health 2020
88.
This intervention supports priority area 4 of Health 2020: Supportive environments and
resilient communities.
EUR/RC62/10 Rev.1
page 20
Rationale
89.
Loneliness, social isolation and social exclusion are important risk factors of ill health
among older people, in particular in the absence of family networks or insufficient support for
families. This affects all aspects of health and well-being, from mental health and dementia to
the risk of emergency admissions to the hospital due to avoidable conditions such as severe
dehydration or malnutrition (8). Poverty among older people can greatly increase their risk of
social exclusion. Innovative ways to combat social isolation are currently underused in many
cases and deserve more international exchange and cooperation. Tackling this issue calls for
strong intersectoral and gender approaches that tackle the impact of gender and other social
determinants of health. For instance, in all countries older women are more at risk of social
isolation than older men (31). Most interventions combine public action with volunteering,
activating the own potential of older people and their families or communities (25). This takes
into consideration important differences in Europe in the traditional family roles and in the
number of older people who live with their extended family.
Actions
90.
The following actions should be taken:
•
promote the civil engagement of older people and strengthen the role of volunteering;
•
foster intergenerational relations through positive media reporting and public image
campaigns; and
•
increase access to innovative models of support for older people to combat social
isolation, including tele-links to social service providers and access to and training in the
use of technology, to foster intergenerational exchange and bridge geographical distances
within families.
Supporting intervention 2: Prevention of elder maltreatment
Goal
91.
The goal of supporting intervention 2 is to prevent elder maltreatment.
Mapping to Health 2020
92.
This intervention supports priority area 4 of Health 2020: Supportive environments and
resilient communities.
Rationale
93.
Elder maltreatment, which can take the form of physical, sexual, mental or financial
abuse or neglect, is a significant cause of injuries, illness and despair. Older people may be
maltreated in the home by family members and caregivers, or in institutions by professional
staff or visitors. In the WHO European Region, at least 4 million elderly people were recently
estimated to experience maltreatment in any one year. With the ageing population in the Region,
the challenges are likely to increase (35).
94.
The violence or neglect involved are gross violations of human rights. It is only in the last
two decades that the scope of the problem has been recognized, systematically studied and
addressed in the various settings where older people live. Not only the scope of the problem but
also the range of initiatives to address it that have emerged at all levels of government, among
international organizations and other stakeholders call for improved international cooperation to
provide guidance and facilitate exchanges of best practice. The gender dimension of elder
EUR/RC62/10 Rev.1
page 21
maltreatment needs further research. In addition pejorative attitudes towards old age and
prejudices have to be taken into account. Among others, these factors cause disrespectful
behaviour, humiliation and assaults.
Actions
95.
The following actions should be taken:
•
draw up national policies and plans for preventing elder maltreatment as part of
intersectoral ageing strategies, building on the latest evidence from national good practice
and regional and international guidance;
•
improve the evidence base for elder maltreatment and strengthen capacity for research on
effective interventions;
•
build capacity and exchange good practices across sectors for protection and prevention;
•
raise awareness and target investments on preventing elder maltreatment; and
•
improve the quality of services in the community and in institutions, to adapt them better
to the special needs of older people with functional limitations, and to ensure that quality
guidelines are in place for preventing elder maltreatment.
Supporting intervention 3: Quality of care strategies for older people
including dementia care and palliative care for long-term care
patients
Goal
96.
The goal of supporting intervention 3 is to improve the quality of care for older people, in
particular for those with severe chronic disease and functional limitations, with a special focus
on dementia care and palliative care for long-term care patients.
Mapping to Health 2020
97.
This intervention supports priority area 3 of Health 2020: Strengthening people centred
health and long-term care systems (fit for ageing populations).
Rationale
98.
People of all ages who suffer from severe chronic conditions and functional limitations
often need a complex package of care, including primary care, specialized care, access to
affordable medication, assistive devices and social care (33). There is growing evidence about
shortcomings in the quality of care and lack of care coordination (36). Moreover, for those
living in institutions or needing long-term care at home, adequate nutrition, personal security
and access to good-quality mainstream services can be an issue, in particular in resourceconstrained situations (32). Quality of care processes, guidelines and implementation in long
term care settings and chronic care are still only emerging in many countries; to remedy this
calls for international exchanges of good practice and experience with quality improvement
strategies. Persons with dementia deserve special attention in this respect (37). More attention
should be paid to the effective use of medicines as older persons with multiple chronic
conditions may have a higher risk of either under-treatment or over-treatment.
Actions
99.
The following actions should be taken:
EUR/RC62/10 Rev.1
page 22
foster international cooperation on quality of care measurement and exchanges of best
practices with implementing quality of care initiatives at various levels of governance;
and
provide training and transfer of knowledge and guidance for initiatives to improve the
quality of care provided in resource-constrained settings and health care systems in
transition.
EUR/RC62/10 Rev.1
page 23
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A Quarterly Newsletter of National Institute of Health and Family Welfare
Vol. XI, No. 2, April-June, 2009
Use of Tobacco in India Challenges and Interventions
Burden
Globally approximately 5.4 million people die each year as
a result of diseases resulting from tobacco consumption.
More than 80% of these deaths occur in the developing
Jpuntries. Tobacco is a risk factor for 6 of the 8 leading
causes of death and also is the most common preventable
cause ofdeath in the world.
More than 0.8 million people die due to tobacco
consumption in India every year. Nearly 2200 Indians die
each day due to tobacco related diseases. As per estimates,
10 million persons will die in India from smoking by 2010,
and 70% of these will be in the age group of 30-69
years (This does not include the estimated
deaths from consuming smokeless forms).
India is the second largest consumer of
tobacco in the world. Tobacco is
consumed in many forms, both
smoking and smokeless, e.g. bidi,
gutka, khaini, paan masala, hukka,
Cigarettes, cigars, chillum, chutta,
gul, mawa, misri and others.
As per estimates from the latest round of
National Family Health Survey (3rd
Round), 2005-06, there is an increase in the
prevalence of tobacco consumption in India, with
57% males and 10.8% females reportedly consuming
tobacco in some form. The Global Youth Tobacco Survey
(GYTS), 2006 for India also indicates that approximately
14.1% of children in the age group of 13-15 years are
consuming tobacco in some form.
There are studies to indicate that approximately 40% of
the disease burden in the country is related to diseases
caused by tobacco. Approximately 50% ofall cancer deaths
in the country are due to tobacco consumption e.g. cancer
of the oral cavity, lung, throat, esophagus, stomach and
urinary bladder. India has the highest burden oforal cancer
in the world and 90% of cases of oral cancer are tobacco
related. As per recent evidence tobacco use is related to
cancer of cervix in women, which is the most common
cancer among Indian women and is a major killer.
The majority of the cardio-vascular diseases and lung
disorders are directly attributable to tobacco consumption.
Other diseases which are associated with tobacco
consumption are stroke, cataract, peripheral vascular
diseases and others. Moreover, studies have indicated that
incidence of impotence is 85% higher among smokers.
Tobacco use by pregnant women leads to low birth weight
babies and birth defects.
Recent scientific evidence has proved the health
hazards resulting from exposure to second
hand smoke (SHS) or environmental
tobacco smoke (ETS). SHS is known
to contain more than 4000 chemicals,
many of these are carcinogens.
Inhalation of SHS results in cancer
and heart diseases in adults, Sudden
Infant Death Syndrome (SIDS),
acute respiratory diseases,
exacerbation of asthma and middle ear
diseases in children.
In addition to die disease and death burden
resulting from tobacco use, tobacco has other
implications also in the form of social, economic and
ecological or environmental effects.
Approximately 0.27% of irrigated land is under tobacco
crop. More than 10 million farmers, farm workers, tendu
leaf pluckers, bidi rollers, middlemen, agents, retailers
constitute tobacco workforce. (ILO 2002 estimates- 5.5
million bidi hand rollers, 85% of whom are women and
children). Bidi rollers face exploitation in the form of low
wages paid by the middlemen and are trapped in a vicious
cycle ofpoverty.
Tobacco contributes to deforestation in three ways: forests
cleared for cultivation of tobacco, fuel wood stripped from
forests for curing of tobacco and forest resources used for
packaging of tobacco, tobacco leaves, cigarettes, etc.
Tobacco growing depletes soil nutrients at a much faster
rate than many other crops, thus rapidly decreasing the
fertility of the soil. Tobacco is a sensitive plant and
therefore, requires huge chemical inputs and fertilizers.
Such chemicals may run off into water bodies,
contaminating local water supplies, causing excessive
leeching and other problems. Frequent contact with and
spraying of chemicals, and storage of tobacco in the
residential premises offarmers have adverse health effects.
A Health Cost Study conducted in 1998-99 showed that
cost of treatment of diseases caused by tobacco use far
exceeded the revenue collected by taxing tobacco products.
Total economic cost of the three major diseases due to
tobacco use (cancer, cardiovascular diseases, lung diseases)
in India was Rs. 30,833 crores (extrapblated to rates of
2002-03), while the revenue collected was approximately
Rs. 27,000 crores for the same year.
Tobacco control initiatives
To control the menace of tobacco,
Government of India enacted “Cigarette
and other Tobacco Products Act in 2003
(Prohibition of Advertisement and
Regulation of Trade and Commerce,
Production, Supply and Distribution).
The specific provisions under the Act are
as follows:
1.
2.
3.
4.
5.
Ban on smoking in public places — To protect the
people from harm effects of Second Hand Smoke
(SHS), the smoking is banned in all public places,
including auditoria, public conveyances, railway
stations, railway waiting rooms, bus stops, airport
lounges, libraries, all public and private offices, all
work places, court buildings, hospital buildings, open
auditoria, shopping malls, cinema theaters,
amusement centres, hotels, restaurants including
refreshment rooms, coffee houses/homes, canteens,
banquet halls, discotheques, pubs, clubs, bars and
many other places.
Ban on direct/indirect advertisement and sponsorship
oftobacco products.
Ban on sale of tobacco products to minors (below 18
years ofage) and ban on sale by minors.
Ban on sale of tobacco products within 100 yards of
the educational institutions.
Specified health warnings on tobacco products.
India has also ratified the WHO-Framework Convention
on Tobacco Control (FCTC) in 2005. This is the first
global health treaty, ratified by more than 160 countries all
over the world and provides a key set of recommendations
to reduce the demand as well as to reduce the supply of
tobacco products.
The Government of India launched pilot phase ofNational
Tobacco Control Programme (NTCP) in 2007-08, in 9
States (18 districts) i.e. Assam, West Bengal, Madhya
Pradesh, Tamil Nadu, Karnataka, Gujarat, Rajasthan,
Delhi, and Uttar Pradesh to implement Anti Tobacco Laws
and bring about greater awareness regarding harmful
effects of tobacco and take ‘Tobacco Control Initiatives’ to
the community level. The NTCP has now being expanded
to 12 new states (24 districts). At present the programme is
under implementation in 42 districts in the country.
The main components of the programme are:
Mass media awareness campaign.
Setting up of tobacco products testing labs.
3.
Capacity building at the state/district
level to create infrastructure under
the overall umbrella of National
Rural Health Mission for
implementation of provisions under
the law and undertake tobacco
control initiatives e.g. school
programmes, trainings, cessation
facilities etc.
4.
GATS — A Global Adult Tobacco
Survey (GATS-India) is being
undertaken in the country to build a
statewise baseline database regarding prevalence of
tobacco products use, related behaviour, practices and
other issues. The same will serve as a useful tool fo^
policy formulation and monitoring tobacco control
initiatives.
5.
Collaborate with concerned departments for projects
on alternate crops and alternate livelihoods for tobacco
farmers and bidi workers.
1.
2.
Other initiatives
I•
To report the violations of prohibition of smoking in
public places as defined under the law, a Toll Free
National Helpline (24x7) (1800 - 110 - 456) has been
established.
2.
A series of advocacy workshops (at national, regional
and state level) were carried out to generate awareness
regarding harm effects of tobacco and set-up
mechanism for effective implementation of tobacco
control act.
Main challenges facing tobacco control:
1.
Low level of awareness regarding harm effects of
tobacco consumption, second hand smoke (SHS) and
2.
provisions under the law.
Availability of a large number of tobacco products in
the country.
3.
4.
Low age of initiation into tobacco use.
Limited capacity of states to implement tobacco
5.
control initiatives and tobacco control law.
Limited availability of cessation facilities in the
country.
6.
Low priority to tobacco control in view of emphasis on
maternal and child health problems and
communicable diseases.
7.
•
Providing alternate livelihoods to large workforce
involved in tobacco farming and tobacco products
manufacturing.
Lack of coordination among other stakeholder
departments e.g. commerce, welfare, industry, HRD,
environment, rural development and others.
Suggested measures for effective implementation of
NTCP and Tobacco Control Act
I. Integration of components of tobacco control in
NRHM and on-going National Health Programmes
e.g. National Cancer Control Programme, RNTCP,
National Mental Health Programme, NCD
Programme for School Health Programme.
2.' Inclusion of tobacco control component in UG and
PG medical/dental/nursing curriculum.
3.
Starting new courses on tobacco control.
4.
Smoke free environments — taking steps for smoke free
institutions/hospitals/workplaces and “Tobacco Free
Schools”.
5.
Expansion of cessation facilities to all medical/dental
colleges and health care institutions. Setting up
QUITLINES to increase accessibility to cessation
help.
6.
Development of training materials on tobacco control.
7.
Building up of capacity of states for initiating tobacco
control measures.
Z>r. Jagdish Kaur, ChiefMedical Officer, Directorate General of
Health Services, Nirman Bhavan, New Delhi.
Celebration of Birth Anniversary of Bharat Ratna Dr. Bhimrao Ambedkar
The 118lh Birth Anniversary of Bharat Ratna Dr. Bhimrao Ambedkar was celebrated on April 5, at the Institute. On this
occasion Prof. Deoki Nandan, Director, NIHFW delivered an oration on the life and achievements of Dr. Ambedkar. In
addition to the oration, some remarks about Dr. Amabedkar's life were made by Dr. V.K.Tiwari, Reader and Acting Deputy
Director (Admn.), Mr. Salek Chand, Senior Documentation Officer and Mr. Jagmer Singh, Senior Technical Assistant at this
event. A small metal statue of Dr. Ambedkar was presented to the Director for his oration by Prof. K.Kalaivani, Head,
Department ofRBM on behalf of the coordinating team of the event.
Research Brief - completed study of the quarter
Globalization as a Social Determinant of Health: Influences on Pattern of Food
and Health Information among Young People (University Students)
Prof. A.M. Khan
General Objective
□
To identify how the globalized and internationalized
food and eating institution influence the young
people s eating behaviour.
Major Findings
Globalization has brought a lot of changes in the food
habits of the children.
Over concern of parents and an atmosphere for fast
and junk food at home seems to be important forces in
triggering habits of constant munching and bingeing
in children.
□ In trying to cajole and pacify the children and
compensate the loss/grief, the parents shower a lot of
affection in the form of eatables for the child; to the
extent that the children develop a habit of munching
snacks and a liking for fast food
(noodles) and junk food like chips
and soft drinks.
□ Sufficient physical activity reduces
the chances of fat getting
assimilated in the body . But on
shifting from school to the
university, life becomes a lot more
sedentary. This, associated with
constant munching habits and
drinking soft drinks, leads to
weight gain.
□ There seems to be a direct relation
between increased availability and
accessibility of the food, triggering
the liking for the food. Fast food
and junk food is available and accessible almost
everywhere.
□ There is a generalized opinion of growing craze of
westernization among the youth, shaping their
behaviour, emotions, lifestyle, and their outlook to
culture, food and other practices. Today, the youth
prefer fast food and junk food in lieu of traditional
food and quench their thirst with soft drinks in lieu of
water.
□ Too much of pressure on the students in the university
and the growing competitive atmosphere has brought
in changes in the lifestyle, particularly affecting the
bio-rhythmic changes, sleeping late, getting up late,
skipping breakfast, preferring brunch over lunch,
having a heavy dinner, leading a more sedentary
lifestyle, working more on computers and many such
practices. All these have effected the food behaviour,
riming of food and the frequency of food intake.
□
□
Taste of food is a compelling factor to decide the food
behaviour of the people. Food institutions like Me
Donald, KFC and Pizza Hut have capitalized on this
and have probably added some components which
create an addiction to food on the basis of taste.
□ Globalization becomes a catalyst by increasing the
availability and affordability of commercial food as
that it brings the friends together. Commercial food
rich in the undesirable fats, preservatives, taste
enhancers and varied chemicals, has kept the global
food industry moving ar a rapid and profitable speed.
This is where globalization rears its ugly side and
sabotages all honest attempts to combat obesity. The
commercial glamour leads to increased intake of jun^j
□
food and often proves too much to resist.
Media has been grossly responsible for the growing
publicity or promotional advertisements of fast/junk
food. It has not shown any resolve in addressing the
issue of hazards of fast/junk food to the health of the
youth/children.
The fast food and junk food is on
fast track, has captured the nerves
of the people at large and is fully
assimilated by the people from all
sections of the society.
□ The food habit of the people is
more geared to the taste than the
nutritional value. The
understanding of balanced diet is
miserably poor.
□ The educational institutions are
unmindful to the implications
junk food and fast food and lack
food policy.
Policy Implications
"Worldwide scientific evidences have strongly proved the
adverse effects of fast food and junk food, particularly the
problem of obesity which is closely linked with it, which
results in to series of chronic diseases. The study has
revealed important information, which is vital for
visualization of the health of the people. The country needs
a widespread awareness programmes about the
implications of fast food and junk food. Food industry and
media promoting the culture of fast food and junk food
need a national policy and regulations. Educational
institutions need clear cut food policy to detract the
growing culture of fast food. Country needs food industry
which can promote traditional food with similar glamour
as that of fast food.
Extra-mural Training Course
A Training Course for 'Senior and Middle Level Managers on Improving Quality of Care in Health Sector' was held from
22nd—26d' June at Srinagar, Kashmir. The course was conducted in collaboration with the World Bank Institute and the GTZ.
Forty two (42) Senior and Middle Level Managers from eight (8) different states (Chhattisgarh, Jammu and Kashmir,
Rajasthan, Uttar Pradesh, Uttarakhand, West Bengal, Orissa and Delhi) participated in the course. The course was inaugurated
by Dr. R.K. Srivastava, Director General Health Services, Government of India, New Delhi. Mr. R.K. Meena, Principal
Secretary, Health and Family Welfare, Government of Rajasthan delivered the presidential address and Dr. Dinesh Baswal,
Assistant Commissioner (Trg.), MOHFW gave special comments on the course. Dr. S.D. Gupta, Director, IIHMR, Jaipur
and Chairperson of the 'Programme Advisory Committee' of the NIHFW put forth the special remarks about the course and
jProf. Deoki Nandan, Director, National Institute of Health and Family Welfare introduced the course. The course included the
’senior level esteemed participants like Dr. S.KJain, Dr. B.S. Sharma, Dr. N.A. OanoogoandDr. R.K. Panth.
Lectures by Guest Speakers
Mr. Anil Chand Punetha,
Commissioner Family Welfare,
Government of Andhra Pradesh
delivered a lecture on “ Innovation in
NRHM” on 6'h April.
Mr. Samir Thapar, Avalon Health
Group delivered a lecture on "DevInfo” on 5‘h May.
Dr. Afaf Tawfik, Global Core Trainer
delivered a lecture on “New Initiative
of WHO Global Standard” on 16th
June.
Meetings
□
Meeting on “Standardization for Professional Development Course in Management,
Public Health and Health Sector Reforms for District Medical Officers was held at
NIHFWon 15th and 16th May.
□
Meeting of experts for “Making Undergraduates
PSM Teaching Interesting and Interactive” was
held from 13th-14th May at the Institute.
□ A meeting was held with the World Bank Institute team on 29th and 30th June,
comprising of Ms. Shiela Jagannathan and Ms. Sheeja Nair to initiate ‘Post-graduate
Certificate Course in Hospital Administration’
through e-learning mode.
□
An Expert Group Meeting for “Establishing Quality Monitoring Unit for Emergency
Obstetric Care and Life Saving Anaesthetic Skill Training” was held on 1st May at the
Institute.
□
Three meetings on “Task force on Restructuring
and Reform of National Institute of Health &
Family Welfare” were held on 13th-14th April, 18th May and 13th June. The
meetings were chaired by Prof. L.M. Nath, former Dean and Director, All India
Institute ofMedical Sciences, New Delhi.
Visitors to the Institute
□
Dr. John O. Odondi, Ministry of Public Health, Kenya and Dr. Sanjiv Kumar,
Chief Health Section, United Nations Children's Fund (UNICEF), Kenya, visited
the Institute on 29th June..
A distinguished team of external resource
persons including the learned international
faculty from the GTZ and the World Bank
Institute, namely Ms. Sylvia Jeanette Sax,
International Public Health Consultant, Dr.
Kai Stietenroth, Consultant, GTZ, Dr. Preeti
Kudesia, Senior Public Health Specialist, Ms.
Sheeja Nair, Research Analyst, World Bank,
Mr. Bejon Kumar Misra, Consumer Expert
and Mr. S. Malikarjuna, Consultant, EPOS. At
the National Level, Resource Persons included
Mr. R.K. Meena, Principal Secretary, Health and Family Welfare, Rajasthan, Dr. S.D. Gupta, Director, IIHMR, Jaipur, Dr.
M.L. Jain, Director Medical Health (RCH), Rajasthan, Dr. Sanjay Aggarwal, OSD (PPP), Department of Health and Family
Welfare, Government of NCT, Delhi, Dr. B.S. Garg, Director, Professor & Head, Department of Community Medicine,
MGIMS, Wardha, Maharashtra, Dr. Aniruddha Mukherjee, Technical Officer, SPSRC, West Bengal, Dr. Imtiyaz Ali, Dean,
Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Dr. Dinesh Baswal, Assistant Commissioner (Trg.), MOHFW, Dr.
S.K. Sikdar, Assistant Commissioner (Family Planning), MOHFW, Prof. Deoki Nandan, Director, NIHFW, Dr. J.K. Das,
Professor, NIHFW, Dr. Vivek Adhish, Reader, NIHFW and Dr. Neera Dhar, Reader, NIHFW.
The course was coordinated by Prof. J.K. Das and Dr. Neera Dhar under the able guidance ofProf. Deoki Nandan.
Training Courses/Workshops Conducted by the Institute:
Intra-mural
National Workshop for ‘Training of Trainers of
Medical Officer in Immunization’ (Two Courses)
Course Coordinator: Prof. M. Bhattacharya
Objective: To familiarize the trainers from the states with
the contents and methods for immunization training of
medical officers to enable them to effectively conduct
divisional/district level trainings ofmedical officers.
Dates: (i) 20th-22nd April, (ii) 18th-20thMay
No. Trained: Course I -Gujarat-11, Uttarakhand-10,
Delhi-6, UNICEF-2 and WHO-NPSP-1
Course II: Jharkhand-8, Delhi-10, Haryana-3 and
Chandigarh-3
Total: Course 1:30, Course II: 24
□
□
Course Coordinators: Dr. Poonam Khattar and Dr. Neera
Dhar
Dates: 11 th-15 th May
Objective: To enhance the knowledge and skills of trainers
in the area of training technology and management of|
training.
No. Trained: Assam 2, Haryana 4, Himachal Pradesh 1,
Gujarat 3, Chhattisgarh 2, Punjab 2, West Bengal 1
Total: 15
Refresher Training for ‘Rapid Response Teams from
Northern States in Avian Influenza and Pandemic
Preparedness’
General Objective : To enable the Rapid Response Team
Members to manage the human cases ofAvian Influenza.
Course Coordinators: Dr. S.V. Adhish and Dr. Gyan
Singh
Dates: 22nd-25th April
No. Trained: U.P.( 3), Haryana (3), Punjab(2), Delhi (3),
Jammu (5), Uttarakhand (3), Himachal Pradesh (3),
Chandigarh (3)
Total = 25
□
Training Course on ‘Training Technology for Health
Professionals’
Regional Workshop on ‘Determinants of Under
Nutrition in Children and Assessment of
Management at Different Levels of Health Care’
Workshop Coordinators: Mr. J.P. Shivdasani and Mrs.
Vandana Bhattacharya
Dates: 10th-13 th May
□
Capacity Building of Faculty of Medical Colleges in
RCH-II/NRHM
Coordinators: Dr. U. Datta and Dr. Poonam Khattar
Date: 18 th June
Objective: To finalize the sessions and materials for the
□
training programme for the faculty of medical colleges
regarding NRHM/RCH-II.
No. Trained: Delhi 17, Maharashtra 1
Total: 18
Activities of the Director
□
□
□
□
□
□
□
.
'□
□
□
Attended the Core Group Meeting on 'Institutional
Maternal Care' organized by the Ministry of Women
and Child Development at MMPCCP on April 22.
Attended the 'Executive Committee Meeting' of the
Chhatrapati Shahuji Maharaj University, Lucknow
on April 25.
Attended the 'Executive Committee Meeting' of
National Health Systems Resource Centre at
MOHFW on May 1.
Attended the 'Technical Advisory Panel Meeting' of
PATH held inNew Delhi on May 12.
Delivered a lecture on 'Supportive Supervision' in
the Training Course on Immunization held at
NIHFWonMay 19.
Attended the 'Joint Review Mission Meeting' of
National Rural Health Mission, in the MOHFW on
May 20.
Attended the Workshop on 'Maternal Death Review'
at Post-graduate Institute of Medical Education and
Research, Chandigarh on May 21 and May 22.
Visited Muzaffamagar and Lucknow during May
25-29, in connection with 'Joint Review Mission'
(RCH).
Attended 'National Core Trainers Training on Child
Growth Assessment - WHO Child Growth
Standards' organized by the Ministry of Women and
Child Development with support from the NIHFW,
NIPCCD, NIN and WHO/UNICEF at Hyderabad on
June 8.
Attended a meeting on 'Conditional Maternity
Prof. Deoki Nandan delivering a lecture on Supportive Supervision in
the Training Course on Immunization
□
□
□
Benefits Scheme at NIPCCD' organized by the
Ministry of Women and Child Development on June
15.
Attended a meeting on 'National Level Review of
States under 6lh Joint Review Mission' at MOHFW
during June 15-18.
Attended a workshop on 'National Consultation on
Public Health Workforce in India' organized jointly
by the MOHFW and WHO at New Delhi on June 2425.
Attended a meeting of the 'High Level Committee
set-up by NCT of Delhi on Costing of Services in the
Health Sector' at Delhi Institute of Pharmaceutical
Sciences and Research on June 26.
Activities of the Faculty: Outside Institute and Country
Apart from their routine academic and administrative responsibilities, the faculty of the Institute participated in the activities
quoted below:
INTERNATIONALACTIVITIES
Prof. (Mrs.) M. Bhattacharya
□ Attended the Expert meeting on “HIV/AIDS Estimation and Projections” at Bangkok, Thailand on 27 &
□
29'h April.
h
Attended a workshop on “Crafting Effective Responses to the HIV Epidemics on Asia in the 40' Summer
on Population” at the East West Centre in Honolulu, Hawaii from 2nd June to 2nd July.
w
Dr. S. V. Adhish and Dr. Geetanjali
□ Attended a workshop on “National Training on Youth Friendly Health Services” at New
Delhi from 18'1' to 30lh May and at Malno, Sweden on 1“ to 6* June.
Dr. Meerambika Mahapatra and Mrs. Vinod Joon
□
Attended a four week “WHO Training Programme on Community Health Care and
Research” organised by Department of Community Medicine, Khon Kaen University, Khon
Kaen, Thailand from 3d to 30,h May.
CONSULTANCY OFFERED
Prof. T. Matliiyazhagan
□
Served as an expert member in a meeting organized by
NACO, New Delhi regarding ‘Condom Promotion
Impact Survey on 18* May.
Dr. M.M. Misro
□
Nominated as a member in the ‘National Advisory
Committee for the Symposium on Comparative
Endocrinology and Reproductive Physiology: Current
Advances’.
Acted as Guide
Dr. M.M. Misro
□
Guided summer training students from Amity
Dr. Rajesh Kumar
□
Guided a dissertation on “ A Study of Functioning of
Delivery Huts Scheme of Haryana in Sample Block of
University, NOIDA during the quarter.
District Rohtak” for the Post Graduate Diploma in
f Dr.K.S.Nair
Public Health Management.
-if
□
Guided a summer trainee on “A Review of
Dr. Ankur Yadav
Performance ofJSY in the EAG States” from 6‘1' April 5th June.
□
Guided a dissertation on “An Overview of the
Biological Control Measures against Malaria in CHC,
Badkhalsa, Sonepat, Haryana” for the Post Graduate
Diploma in Public Health Management.
GUEST LECTURES DELIVERED BY THE FACULTY
Prof. M. Bhattacharya
□
Delivered a lecture on “Cold Chain and Logistics
Dr. Y.L. Tekhre
□
Management in Training of Trainers for Medical
Delivered a lecture on “Understanding more about
HIV/AIDS in the Refresher Training for Community
Officer in Immunization” from Gujarat, Delhi and
Leader on Reproductive Child Health and Life Skill
Uttarakhand on 20* April at the NIHFW.
Education Issues” at Swabhiman Smile Foundation,
New Delhi.
Prof. T. Mathiyazhagan
Dr. Poonam Khattar
□
Delivered a lecture on “Impact Evaluation of Radio
Programme for Behavoiur Change” at the workshop
□
Delivered a lecture on 'Enforcement of Section-5 in
the National Workshop on Tobacco held at Nagaland
held at NACO, New Delhi on 23rd April.
on 27' June.
Prof. J.K. Das
□
□
Delivered a lecture on “Disaster Management” at
Haryana Institute of Public Administration, Gurgaon
on 30* April.
Acted as a resource person in the workshop
“Development of Teachers Guide in Health and
Physical Education” from Class 1 to 10 at Laxmibai
National Institute of Physical Education, Gwalior,
organized by NCERT.
PAPERS REVIEWED/PUBLISHED
Prof. (Mrs.) M. Bhattacharya
□
Reviewed a research paper on “Water handling and
sanitation practices in rural community of Madhya
Pradesh: A Knowledge, Attitude and Practice Study”.
□
Published a paper on “Making a difference - Better
health care through GIS”, Geospatial Today, May
2009, p. 44-46.
Dr. T. G. Shrivastav
□
Published a paper on “Development of ELISA for
Measurement of Progesterone Employing 17 a-OHPHRP as Enzyme Label”. Sabana Khatoon, Shail K.
Chaube, Kiran Rangari, Kiran P. Kariya, Tulsidas G.
Shrivastav. Journal of Immunoassay and
Immunochemistry, 2009,30:186-196.
□
Reviewed die papers for the “International Journal of
Microscopy and International Journal of Integrative
Dr. M.M. Misro
Biology”.
□
As an Editorial Board Member “Reviewed two papers”
for the International Journal - CWHRon 18,h April,
Dr. UtsukDatta
2009.
□
□
□
Reviewed the progress of the final report of the ad hoc
1CMR project “Sperm DNA damage in male
infertility and its influence on reproductive outcome”.
Three papers accepted for publication in International
Journals on “Fertility and Sterility, Andrologia and
Molecular Reproduction and Development”.
Published a paper on “Vitamin A First Dose
Supplement Coverage Evaluation amongst Children
Aged, 12-23 Months Residing in Slums of Delhi” in
Indianjournal ofOphthalmology, 57(4):299-304.
W
Mrs. Manisha
□
Published a paper on “Population Boom in India”, in
the monthly English journal, Kurukshetra, April
2009, p. 30-31.
.
□
Adjudicated the Ph.D. thesis entitled “Morphological,
biochemical and molecular (VDAC-2 in sperm
ODFs) indicators in the semen of infertile/sub-fertile
patients attending an infertility clinic” submitted to
Bharathidashan University Tiruchirapalli, Tamil^
Nadu.
ACTED AS EXAMINERS
Prof. (Mrs.) M. Bhattacharya
□
□
Invited as an external examiner for “Practical
Examination in MD Community Medicine” at
M.L.N Medical College, Allahabad on 4* & 5*
May.
Invited as an external examiner at Chhatrapati Shahuji
Maharaj Medical University, Lucknow, Uttar Pradesh
for “Practical Examination of MD(SPM)” on 17* &
18* April.
Mr. J.P. Shivdasani
□
Dr. T. G. Shrivastav
□
Doctoral committee member for “Special centre for
molecular medicine, Jawaharlal Nehru University”,
New Delhi for the research topics entitled
“Modulation of intracellular dynamics and function
of Pregnane and Xenobiotic Receptor (PXR) by
endogenous and exogenous factors” and “Molecular
characterization of Pregnane and Xenobiotic Receptor
(PXR) and its potential isoforms in normal and
pathological states”.
Attended the Selection Committee for Selection of
Monitoring and Evaluation Officers at National AIDS
Control Organization under NACP-III in New Delhi
on 22.4.2009.
Mr. Salek Chand
□
Acted as an examiner for “B. Lib. Science Paper II”
from 27* to 29* April at Patna University, Patna.
□
Acted as an examiner for “PGDLAN practical
examination of IGNOU” in the course of MLIL-004,
New Delhi on 19* June.
Special Activities
Rapid Appraisal of Health Interventions (RAHI-II)
Under the RAHI-II, twelve research studies were
conducted with the financial assistance from UNFPA. The
studies were undertaken by twelve medical colleges from
six low performing States i.e. Uttar Pradesh, Madhya
Pradesh, Rajasthan, Bihar, Jharkhand and Uttarakhand.
Research papers based on these reports have been prepared
and sent to Indian Journal of Public Health for publication
in its forthcoming issue.
end-line evaluation of MNGO's scheme in the district of
Pauri and Dehradun, Uttarakhand state, data collection
has been completed.
Evaluation of Training in Routine Immunization
Dr. Utsuk Datta along with his team conducted an
evaluation of “Health Workers' Training in Routine
Immunization” (First Phase) for Uttar Pradesh, Bihar and
Uttarakhand from 8* to IS*June.
An Inclen-NIHFW Collaborative Study
Pulse Polio Immunization
Determinants of Under Nutrition in Children: An
Assessment of Management at Different Levels of
Health Care
The Pulse Polio Immunization
rounds were conducted in the
Institute on 5* April, 24* April and
28* June;
Prof. Deoki Nandan, Director, NIHFW and Principal
^(^Investigator, Mr. J.P. Shivdasani, Senior Investigator and
research team members, Dr. B.S. Dewan, Ex-MD Student;
Mrs. Reeta Dhinga, Research Officer; Mrs. Vandana
Bhattacharya, RO; Mr. Ramesh Gandotra, ARO and Mr.
Ghanshyam Karol, ARO visited district Mathura for data
collection during the quarter.
Annual Sentinel Surveillance Activities
Prof. M. Bhattacharya, Prof. J.K. Das, Dr. Utsuk Datta,
Dr. Gyan Singh and Dr. Sanjay Gupta went for monitoring
and supervision of High Risk Group (HRG) sites at
Assam, West Bengal and Tamil Nadu during the quarter.
Joint Review Mission (JRM)
Prof. Deoki Nandan, Prof. J.K. Das, Dr. T. Bir and Dr.
kSanjay Gupta
visited Khagaria (Bihar), Lucknow,
Muzaffarnagar and Lakhimpur Khiri (UP) under the Sixth
Joint Review Mission during the month ofJune.
Mother NGO Evaluation Study
Dr. T. Bir along with his team completed external
evaluation of “Mother Non-government Organizations
(MNGOs) in four districts of Delhi state. For the external
Trainers Course on Basic Newborn
Care and Resuscitation
A trainers course on “Basic Newborn Care and
Resuscitation” was conducted from 29* to 30* June by the
Ministry of Health and Family Welfare, Government of
India in collaboration with the NIHFW. The inaugural
function was held at the NIHFW auditorium at 9:30 a.m.
on 29* June. The function was attended by various
distinguished delegates from national and international
organizations, Ministry of Health and Family Welfare and
the National Institute of Health and Family Welfare. At the
outset a welcome address was given by Dr. B.Kishore,
Assistant Commissioner Child Health-I, Ministry of
Health and Family Welfare, Government of India. Shri
Amarjeet Sinha, IAS, Joint Secretary (NRHM), Ministry
of Health and Family Welfare, Government of India, Shri.
Amit Mohan Prasad, IAS, Joint Secretary (RCH), Ministry
of Health and Family Welfare, Government of India, and
Professor Deoki Nandan, Director, NIHFW addressed the
gathering. A vote of thanks was proposed by Dr. Sangeeta
Saxena, Assisstant Commissioner, Child Health-11,
Ministry of Health and Family Welfare, Government of
India. The function was anchored by Dr. Neera Dhar,
Reader, NIHFW.
Contact Programmes under Distance Learning Courses
Health and Family Welfare Management
Place
Kolkata
Bangalore
Mumbai
Delhi
Date
20th-241*1 April, 2009
18th-24th May, 2009
4'" -8th May, 2009
I8‘h -22nd May, 2009
NIHFW Coordinators No. of Candidates Attended
18
Prof. J.K. Das
18
Prof. J.K.Das
11
Dr. Vivek Adhish
03
Dr. Poonam Khattar ;
News from Administration
New Appointments
★
★
*
*
Sh. Vinay Kumar, Assistant on 1.5.2009 (Group B)
Sh. Dinesh Kumar,TA (Lab.) on 15.5.2009 (Group B)
Sh. Vikas Sharma, TA (Press) on 19.6.2009 (Group B)
Sh. Pawan Kumar Sharma, Projectionist on 9.6.2009 (Group C) •
Fresh recruitments have been made under NRHM/RCH Project.
Promotions
*
*
*
*
*
★
★
Smt. Prem Lata, Assistant on 23.4.2009 (Group B)
Smt. Gurdeep Rawal, Steno. II on 23.4.2009 (Group B)
Smt. Paramjeet Arora, Steno. II on 23.4.2009 (Group B)
Smt. Savita Nandwani, Steno. II on 23.4.2009 (Group B)
Sh. Sherin Raj T.P., ARO (adhoc) on 24.6.2009 (Group B)
Sh. Prem Pal, U.D.C. on 23.4.2009 (Group C)
Smt. Shashi Bala Jain, U.D.C. on 24.4.2009 (Group C)
Renovations: Expanding and Modernizing Infrastructure
e
Other Highlights
Forthcoming Training Courses/Workshops
Dates
Name of Course(s)_____________ ______ _ _________ _______ _______
July 6-24,2009
Training Course on Hospital Management for Senior Hospital
SI. No.
1.
Administrators
__________ ___ _________________________
July 13-14, 2009
National Consultation on India Adaptation of Training Package on
WHO Child Growth Standard (Integrating Mother Child Protection) in
Collaboration with Ministry of Women and Child Development,
NIPCCD, UNICEF, WHO and NIHFW __________
Training Course for State and District Level Programme management
July 13-17, 2009 - Course I
unit of Jammu and Kashmir
August 3-7, 2009 - Course II
Aug 31-Sept 4, 2009 - Course III
4.
Professional Development Course in Management, Public Health and
July 20- September, 26, 2009
5.
6.
Training Course on Monitoring under NRHM
Training Course on Logistic and Supply Management in Health and
August 24-28, 2009
Family Welfare
Training Course on Health and Human Rights
August 24-28, 2009
Training Course on Increasing Human Capacity to Address Gender
September 7-11, 2009
3.
September 14-18, 2009 - Course IV
Health Sector Reforms for District Medical Officers
7.
8.
August 3-7,2009
~1|
Equity in Health and Development
9.
10.
Training Course on the Role of NGOs in NRHM in India
September 7-18, 2009
Flagship Course on Health System Policy and Management (NIHFWWBI Collaboration)
September 14-18,2009
11.
Capacity Building for Health Officers in Communication Skills
September 14-19, 2009
Corrigendum
Editorial Board
Editor-in-Chief
Prof. Deoki Nandan
Editor
Dr. Neera Dhar
Advisors
Prof. M. Bhattacharya
Dr. Rajni Bagga delivered a lecture on “Motivation,
Satisfaction and Job Preference in Nursing
Leadership Course” at IIM, Ahmedabad on 8*
January.
Prof. J.K. Das
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The
Smok
Truth
"Along with the pleasures of ciga
rette smoking come real risks of
serious diseases such as lung can
cer, respiratory disease and heart
disease. We also recognize that for
many people, smoking is difficult
to quit," confesses the Pakistan
Tobacco Company in its Annual
Report and Accounts for 1999.
Tobacco Free Initiative-Pakistan
Tobacco
The global killer
An economic drain
More than 70,000 scientific articles
have established tobacco as the leading
cause of premature death and dis
abling disease, yet tobacco products,
especially cigarettes, remain the
world's most accessible commodity.
Available in posh malls of elite neigh
borhoods and ragged kiosks in the
poorest of slums, cigarette consump
tion worldwide is rising sharply,
increasing the incidence of preventable
morbidity and mortality.
The economic costs of tobacco use are
equally mind-boggling. The World
Bank says the cost to the international
community in terms of death and dis
ability is much greater than the eco
nomic gain from the production and
sale of tobacco products.
According
to
World
Health
Organization (WHO), the world's 1.15
billion smokers consume an average of
14 cigarettes every day. Of these smok
ers, 82% live in developing countries a result of inadequate tobacco controls.
The latest global statistics on tobacco's
toll on health are shocking. Worldwide
11,000 people die from tobacco-related
diseases every day. Worldwide mortali
ty from tobacco is likely to rise from
about four million deaths a year in 1999
to about 10 million a year in 2030 - more
than the combined deaths from malaria,
maternal and major childhood condi
tions, tuberculosis and AIDS. And 7
million of these deaths will be in lowincome and middle-income countries.
A lifelong smoker is as likely to die as
a direct result of tobacco use than from
all other potential causes of death com
bined. Half of all long-tern smokers
will eventually be killed by tobacco,
and of these, half will die during pro
ductive middle age, losing 20 to 25
years of life.
The Voluntary Health Association of
India estimates that tobacco-related ill
ness cost the country (population 1 bil
lion) $11 billion a year in public health
costs. In the small country of Costa Rica
(population 3 million), smoking-related
illness cost the social security system an
estimated $534 million per year.
Besides being a drain on the cashstrapped economies of developing
countries, tobacco use forms an avoid
able burden on household budgets.
Money saved could be spent on basic
needs like shelter, food, clothing, edu
cation, etc. In Bangladesh an average
laborer must toil approximately half a
day to purchase a pack of 20 cigarettes.
In 1990, the cost of 20 cigarettes in
China was estimated as being 25% of
the average daily income.
In Pakistan, where more than 48 million
people live in absolute poverty, the cost
of cigarettes is strikingly high compared
with average incomes. A daily pack of 20
cigarettes bought at Rs 10 totals Rs 3,650
a year - nearly 16% of the per capita
income. Low-income earning men in
rural areas, are more likely to smoke,
found the National Health Survey 199094 conducted by the Pakistan Medical
Research Council (PMRC).
Broad categories of smoking costs
Scientific evidence establishes that in
populations where smoking has been
common for several decades, about
90% of lung cancer, 15-20% of other
cancers, 75% of chronic bronchitis and
emphysema and 25% of deaths from
cardiovascular disease between 35 and
69 years of age are attributable to
tobacco.
1.
Healthcare
Medical - services, Prescription drugs,
Hospital and other institutional services
2.
Production losses resulting from:
Death, Sickness, Reduced productivity
3.
Welfare provision
4.
Fires and accidents
5.
Pollution, litter and environmental
degradation
6.
Research and education
he government of Pakistan iden
tified smoking as among coun
try's leading causes of morbidity
and mortality in its December 1997
health policy. This admission came
against the backdrop of a rising inci
dence of tobacco-related diseases.
T
A recent World Bank report said car
diovascular diseases account for 10%,
malignant neoplasm (cancers) 4.3%,
and non-communicable respiratory
diseases 3.2% of the total burden of dis
ease in Pakistan. Another study profil
ing heart diseases in South Asia in 1983
found that up to 83% of heart disease
patients in Pakistan are smokers.
The 1990-94 National Health Survey
dtes tobacco use as a major risk facto’
for heart trouble, chronic bronchitis and
emphysema, cancers of lung, larynx,
pharynx, oral cavity, esophagus, pan
creas and bladder, and respiratory infec
tions and stomach ulcers.
Smoking prevalence
in Pakistan
Despite numerous health and economic
costs, the consumption of cigarettes
continues to rise in Pakistan, making it
a high cigarette consumption country.
According to the Pakistan Pediatric
Association, 1,000 to 1,200 children
between the ages of 6 and 16 years take
up smoking every day. Twenty-nine
percent of men and 3.4% of women
smoke cigarettes regularly, concluded
the National Health Survey, while the’
Pakistan Society for Cancer Prevention
says 37% of men and 4% of women over
15 years of age are smokers.
1. Smoking is most common and most
likely to be heavy (20 or more cigarettes
per day) among men 25-44 years of age
in Pakistan.
2. Approximately 90% of lung cancer
cases in men and 79% in women are
attributable to cigarette smoking.
3. Twenty-four percent of illiterate rural
young men smoke as compared to 19%
of illiterate urban young men.
4. Among rural smokers (15-64 years of
age), 26% smoke heavily compared to
37% in urban areas.
Who brought tobacco
to Sub-Continent?
Tobacco was first grown by the original
inhabitants of what is now North
America. 'Tobacco' was their word for
the Y-shaped tube they used to inhale
smoke. The word 'nicotine', however, is
of French origin, named after French
Ambassador to Portugal Jean Nicot
who was honored by the Queen of
France when she was presented with a
jeweled box containing snuff.
The Portuguese sailors brought this
'magic substance' to the Indian SubContinent in the early 17th century dur
ing Mughal King Akbar's reign.
Although tobacco fascinated Akbar, he
'did not adopt it after a court debate
between the physicians, clergy and
nobles resulted in the rejection of tobac
co use. His successor Jehangir also for
bade tobacco use, as did his contempo
rary rulers in Persia.
The production of fine-cured Virginia
tobacco was first initiated in lower
Sindh in the 1950s and later extended
northwards to the plains of Punjab.
Subsequently, as its suitability for the
higher altitude was established, it came
to be grown exclusively in NVVFP. Some
accounts, however, say that Flue Cured
Virginia tobacco was first grown on a
limited scale in NWFP in 1948, a year
after Partition.
^Tobacco farming
not that lucrative
It is popularly believed that tobacco is a
lucrative crop, but that's not true.
According to WHO, farmers do not ben
efit from tobacco cultivation as the lion's
share of profits go to cigarette compa
nies. In Malaysia, for example, the prof
it margin for farmers is only 2% as com
pared to 79% for the manufacturers.
Tobacco occupies 0.2 per cent of the
total irrigated land in Pakistan and is
grown in all four provinces. In 1995-96,
tobacco was cultivated on an area of
46,100 hectares with the total produc
tion standing at 79,900 tonnes.
According to the Economics Wing of
the Ministry of Food, Agriculture and
Livestock, tobacco production from
1980-81 to 1995-96 has not been
steady. During these years, the highest
recorded yield was 101,600 tonnes in
1992-93 when the crop was grown on
582,000 hectares. The highest per
hectare yield was 1,807 kilograms, in
1991-92.
The country registered an annual
growth rate of 6% from 1981 to 1988.
Moreover, Pakistan was ranked below
only Japan and Korea in terms of per
hectare yields.
As many as 80,000 people are engaged
in tobacco production and marketing.
The province-wise breakup of this fig
ure is not available. However, NWFP
has the highest number of people
engaged in the tobacco production on a
full-time basis.
The number of people turning to
tobacco cultivation in NWFP is rising
where the crop is considered economi
cally beneficial and
risk-free.
Moreover, the government's drive to
eradicate poppy cultivation and substi
tute it with tobacco is also luring peo
ple in various areas to replace one vice
with the other.
"... the major beneficiaries are cigarette
manufacturing companies who are loot
ing all the labour, hard work and ener
gy of the tobacco growers," said
Ikramullah Khan, a prominent
Pakistani tobacco grower, in a press
statement published by The News on
May 24, 2000.
Modes of tobacco intake
Tobacco use in Pakistan is not limited
to cigarette smoking. Chilum, huqqah,
chewing tobacco in pan, snuff and
niswar are some other common ways
of intake. Experts divide tobacco use
into two broad categories - smoking
and smokeless tobacco. Both uses of
tobacco are very common in Pakistan
as established by a survey conducted
by the PMRC in 1994.
Smokeless tobacco includes primarily
moist dry snuff and chewing tobacco.
All forms of smokeless tobacco contain
nicotine and their use can lead to nico
tine dependence and cigarette use.
Smoking tobacco is used as cigarettes,
huqqah and chilum, the latter two being
the oldest means of tobacco intake in
this region. Presently, cigarettes are
most common, for they are ready to use
and backed by aggressive promotion by
manufacturers.
The tobacco industry
in Pakistan
In Pakistan, two transnational compa
nies British American Tobacco (BAT)
and Philip Morris Industries (PMI) hold
78% of the cigarette market. BAT holds
67% shares in the Pakistan Tobacco
Company (PTC), while PMI has a 30%
share in Lakson Tobacco Company
(LTC). PTC holds 38% of the market,
while LTC has a market share of slight
ly over 40%. The rest of the market is
held by local companies such as Sarhad
Cigarette Industries, Khyber Tobacco
Company, Souvenir Tobacco Company
Limited and Saleem Cigarette
Industries.
According to the Tobacco Statistical
Bulletin 1994, there were 32 tobacco
companies having 38 cigarette manu
facturing factories with an installed
capacity of over 87 billion sticks per
annum.
However, unofficial reports put the
number of factories much higher.
According to one report, 75 unlicensed
factories are in operation in the tobacco
rich Mardan Division and Lala Musa
alone, which are manufacturing coun
terfeit major international brands and
tax-evaded cigarettes.
The Frontier province has 25 factories
with installed annual capacity of more
than 35 billion sticks. The nine facto
ries in Sindh and four in Punjab have
annual capacities of nearly 22 billion
sticks and nearly 30 billion sticks
respectively.
Promotion
ordecention
The worst form of government patron
age to the tobacco business is its reluc
tance to slap strict controls on the pro
motion and sale of cigarettes. The World
Health Assembly in 1986 recommended
the adoption of comprehensive tobacco
control measures to eliminate the pro
motion of cigarettes in its member
states. The Assembly reiterated its call in
1990 and urged member states to con
sider eliminating all direct and indirect
tobacco advertising, promotion and
sponsorship. These recommendations
were aimed at protecting the young
people from taking up smoking, assist
ing smokers to quit and challenging the
social acceptability of smoking.
Ten years later the situation in Pakistan
remains the same. Though the country
is signatory to both resolutions, the
tobacco companies continue to indulge
in aggressive promotional activities.
Indeed, advertising is the industry's
frontline in its ambitions to increase
sales. Manipulative advertising and dis
information campaigns associate smok
ing with dreamlike promises of prestige,
power, freedom and luxury. This pro
motes not only individual products but
also tobacco use as a 'lifestyle'. Young
people are especially susceptible to
these messages and also more likely to
develop nicotine addiction than people
who take up the habit later in life.
Tobacco companies admit that adver
tisement campaigns result in increased
sales. When PTC in March 2000 halved
the price of its Gold Flake brand, in the
words of the company, the campaign
yielded positive results. "The response
from the market was immediate, and
demand for the brand escalated tremen
dously in some markets," read the
February-March 2000 issue of PTC s in
house newsletter Pak Tobacco.
To advertise the Gold Flake price reduc
tion, PTC ran an aggressive campaign
Who benefits from the tobacco business
obacco companies sell 50 billion sticks (out of their
87 billion stick installed capacity) every year in
Pakistan. Around 10 billion smuggled, counterfeit
or tax-evaded cigarettes are also consumed locally. The
tobacco companies are continuously increasing their mar
ket size. The cigarette production rose from 29.9 billion
sticks in 1990-91 to 48.21 billion sticks in 1997-98, an
increase of more than 70% over seven years. Both com
panies rake in huge profits every year that run into mil
lions of rupees.
T
But the beneficiaries in this deadly business are not the
tobacco companies alone. As elsewhere in the world, the
government of Pakistan patronizes the tobacco business at the expense of public health. The reason for this
patronage is simple: the tobacco business generates
much-needed taxes for the cash-strapped government.
According to "Tobacco Control in the Third World: A
Resource Atlas", the Pakistani government collected Rs
15.86 billion ($311 million) as tobacco tax in 1990, making
up 10.5% of the total tax revenue. Tobacco taxes are con
tinually rising since then. In 1999, only two companies,
PTC and LTC, paid Rs 18.7 billion in government levies.
In fact, the revenues collected by the government from
the tobacco industry each year exceed the profits posted
by the companies. According to the Pakistan Tobacco
Company's 1999 Annual Report and Accounts, the com
pany paid Rs 10.03 billion in government levies, while it
posted an after-tax-profit of only Rs 136 million.
Similarly, Lakson Tobacco Company deposited Rs 8.66
billion in the government kitty during the fiscal year
on PTV during the Sharjah Cricket Cup
and Triangular Series in the West Indies
and bought three-day programming
ownership on PTV World with Gold
Flake Eid Hangama. A double-page
advert also appeared in the Urdu-language newspaper Din.
Countrywide, 800,000 posters and
buntings and 150,000 leaflets plastered
market walls. Three thematic Gold
Flake Floats operated in some cities for
10 days. They featured live music, male
and female models and comedians and
also sold the brand at the reduced price.
The company sponsored a Gold Flake
Canal Mela in Lahore featuring Gold
Flake streamers on both sides of the
1998-1999 and it recorded a net profit of 180.7 million. It
is estimated that ars^d 70% of ra«nues generated by
the tobacco compani^Rire paid as cWe duties and other
government levies.
How government patronizes tobac
co industry
Addicted to tobacco revenues, the government patron
izes the tobacco business in a number of ways:
1. The Pakistan Tobacco Board (PTB) was established in
1968 with headquarters in Peshawar after the govern
ment recognized 'tobacco potential'. Attached to the
Ministry of Commerce, the Board is to promote tobacco
cultivation on scientific lines for domestic use and
export. It regulates, controls, grades and exports tobacco
products; undertakes research and training for the tobac
co industry; renders assistance for the development of
existing and new growing areas and establishment of
model farms.
busy Canal Road and 35 banners
throughout the dty. All this only to
advertise a single price cut!
According to
the
prestigious
Advertising Age magazine, LTC was
the third largest advertiser in Pakistan
in 1998, spending an astounding Rs 328
million (US $6.42 million). It was
followed by BAT, which spent a stag
gering Rs 295 million (US $5.77 million)
during the same year. The marketing
expenses of the two companies neared
Rs 1.5 billion in 1999, with LTC spend
ing Rs 804.75 million and BAT Rs
680.643 - all in the name of hooking
new users, the lifeline of the tobacco
industry.
2. The government ensures that the tobacco industry
makes prompt payments to tobacco farmers, which is not
the case for other crops like sugarcane, cotton and fruits.
Under the Deferred Payment Leaf Voucher Scheme, intro
duced in 1975, the government constituted a consortium
of nationalized commercial banks for providing addition
al loans to tobacco companies during the marketing sea
son of tobacco. The scheme is aimed at ensuring that
tobacco growers are promptly paid for purchases made
by the industry. In 1994, Rs 434.14 million were handed
out to tobacco companies under this scheme.
3. The Pakistan Sports Board and all sports associations
under its aegis accept tobacco sponsorships. The mone
tary value of these sponsorships runs into millions of
rupees.
4. The government gives tobacco companies a freehand
to advertise their products
on electronic and print
Gold Leaf,
media. While the total
a brand marketed
magnitude of tobacco
advertisement in the print
by the Pakistan
media is unknown, the
Tobacco Company,
state-owned
Pakistan
is sold at a retail
Television Corporation
(PTV) earns almost 33% of price of Rs 33 for a
its advertising income
pack of 20. The
from the tobacco industry.
According
to
press
government gets
reports, PTV generated
Rs 24.96 while the
around Rs 280 million
through tobacco advercompany keeps
tisements during the
RS 8.04 Only.
Cricket World Cup 1999.
chronology of
official anti-tobacco
measures
1979: The government, through the
Cigarettes (Printing of Warning)
Ordinance, makes it mandatory for
tobacco companies to print "Smoking is
Injurious to Health" on all cigarettes
packs.
Mid 1980s: The health ministry initiates
its anti-tobacco campaign on electronic
media through a meager allocation.
1988: State-owned Pakistan Television
prohibits tobacco advertising before
10:00 p.m. and exaggeration of the
pleasures of smoking. Ban is not
enforced.
1992:
State-owned
Pakistan
International Airlines declares all
domestic flights 'smoke-free'.
1993: Government reduces import duty
on cigarettes from 90% to 80% in an
attempt to make smuggling less attrac
tive and to recover evaded taxes and
excise duties.
1994: Pakistan's lone private television
station, Network Television Marketing
(NTM), bans all forms of tobacco adver
tisements including program sponsor
ships by cigarette manufacturers.
1997: Government bans, through a noti
fication, smoking in all government
offices and public transport. Ban is not
enforced.
The landmark case:
an unfortunate
decision
The Pakistan Chest Foundation and
Pakistan Anti-Tuberculosis Association
in 1996 moved the Lahore High Court
against the aggressive tobacco promo
tion on PTV and radio. After an
exhaustive hearing that spanned more
than a year, the court on March 21,1997
banned any cigarette commercials or
programs on television and radio that
might induce people to smoke. Exempt
for three years were advertisements
during the live telecast of tobaccosponsored sports events, which were
not to show anyone smoking and were
to be followed by a warning against
smoking. The court ordered that only a
statement naming the sponsoring com
pany could be relayed during radio
sports commentaries.
PTC and LTC along with other manu
facturers promptly challenged the ban,
filing an appeal a few days after the ban,
and were able to get a favorable verdict.
On September 18 1997, the Lahore High
Court's divisional bench set aside the
ban on "technical grounds".
Islam and smoking
"Smoking, in whichever form and by
whichever means, causes extensive
health and financial damage to smok
ers. It is also the cause of a variety of
diseases. Consequently, and on this
evidence alone, smoking would be
forbidden and should in no way be
practised by Muslims," says Grand
Imam of Al-Azhar, Cairo, Egypt,
Sheikh Gadul Haq Ali Gadul Haq.
Chairman of the Permanent
Committee of Academic Research
and Fatwa, Saudi Arabia, Abdul-Aziz
bin Baz, along with the Vice-President
of the Committee, Abdul-Razzaq
Afifi and members Abdullah bin
Ghadian and Abdullah bn Qa'oud
also adjudged smoking as 'haram' in
Islam.
As high-income countries increasingly tighten the noose
around cigarette companies and introduce meas
ures to bring down the number of smokers,
the multibillion transnational compa
nies are now creating new markets
in developing countries, where
controls are non-existent and
governments in dire need of
revenues. While the con
sumption of cigarettes
declines in the United
States by 1.5% every year,
it increases annually by mhm
1.7% in developing coun
tries as a result of the
increasing presence of
these companies.
The three big tobacco transna
tional companies - Philip Morris
Industries (PMI), British American
Tobacco (BAT) and RJ Reynolds (RJR)
- bear substantial responsibility for rising
smoking rates and projected increases.
The American PMI, which manufacturers Marlboro and
holds 16% of the world tobacco market, has gained only a
4.7% increase in the US market since 1990, but its interna
tional sales during the same period have increased by 80%.
In 1997 the company sold 235 billion cigarettes in the US,
compared with 711 billion in international markets for a
profit of Rs 239.7 billion (US $4.6 billion). Shockingly, PMI
Several countries have effectively
reduced the smoking rates through a
mix of price and non-price measures.
c A good example is Thailand, which
adopted a comprehensive control
c has
program. Smoking in cinemas and
e buses
was banned in Bangkok in the
s 1970s. National advertising bans and
other anti-smoking measures fol
s lowed, and in 1993 the government
raised the cigarette tax on health
grounds. In 1997, Thailand became the
S second
country (after Canada) to
t require tobacco companies to .reveal
o the ingredients of their cigarettes.
smoking prevalence has
r Overall
dropped as a result.
i
United Kingdom has reduced
e The
smoking substantially, through both
s price and non-price measures:
revenues in 1996 far exceeded the Gross Domestic Products
of Malaysia, Kuwait, Guatemala, Pakistan and
Croatia. The company generated 35% of its
Rs 2805 billion (US $55 billion) rev
enues in the international market.
Similarly, BAT, which holds
15% of the global cigarette
market and has subsidiaries
in 65 countries, made a prof
it of Rs 102 billion (US $2
billion) on sales worth Rs
1209 billion (US $23.7) bil
lion in the international
market during 1997.
The American RJR, which
controls around 4% of the.
international market, has seen"
a 75% rise in its international
sales since 1990, reaching Rs 173.4
billion (US $3.4 billion) in 1997.
International sales, particularly in Eastern
Europe and Central Asian Republics, now account for
almost 41% of the company's total tobacco sales.
While these transnational companies are having a field
day in the markets of developing countries, it becomes all
the more important for governments and people to put in
place effective checks on tobacco consumption and to save
future generations from falling prey to a deadly addiction.
♦ From 1965 to 1995 annual UK ciga
rette sales fell from 150 billion to 80
billion.
♦ Annual UK tobacco deaths in the
35-69 year age group decreased
from 80,000 to 40,000.
♦ In December 1998, the UK govern
ment announced a major campaign
to help 1.5 million people stop
smoking by the year 2010; it said
taxes on tobacco products would
continue to be increased. Its targets
include reducing smoking among
children from 13% to 9%, reducing
adult smoking from 28% to 24% or
less, and reducing the number of
women who smoke during preg
nancy from 23% to 15%.
♦ Tobacco taxes were increased to
reduce cigarette consumption and
. increase the government's tobacco
revenues.
France has had a comprehensive tobac
co control law in force since 1993. The
law bans tobacco advertising and
requires strong health warnings cm
both the front and the back of packag"
ing. It also controls smoking in trans
port, public places and workplaces by
either banning it altogether or limiting
it to smoking areas. Between 1991
(when the law was adopted) and 1995,
tobacco consumption - measured in
weight of tobacco products sold - had
fallen by 7.3%.
Among Latin American countries,
advertising controls apply in Chile,
Colombia, Costa Rica, Mexico and
Panama. Smoking is banned in domes
tic and international flights throughout
the Americas. National tobacco control
plans have been drafted in Brazil and
Mexico.
W’
WHO's Tobacco
Free Initiative
The deadly impact of tobacco on health
now and in the future is the primary
reason for WHO's strong and explicit
support to tobacco control on a world
wide basis. WHO established the
Tobacco Free Initiative in July 1998 to
coordinate an improved global strategic
response.
The long-term mission of global tobac
co control is to reduce smoking preva
lence and tobacco consumption in all
countries and among all groups, and
thereby reduce the burden of disease
caused by tobacco. In support of this
mission, the goals of the Tobacco Free
Initiative are to:
® Contribute in galvanizing national
support for evidence-based tobacco
control policies and actions;
® Build new partnerships for action at
national and local levels and strengthen
existing ones in the country;
® Heighten awareness of the need to
address tobacco issues at all levels of
society;
® Commission policy research to sup
port rapid, sustained and innovative
actions;
® Mobilize resources to support
required actions at the national and
local levels;
® To muster government support for
the Framework Convention for Tobacco
Control being finalized under the aus
pices of the WHO.
The Framework
Convention on Tobacco
Control (FCTC)
On 24 May 1999, the World Health
Assembly (WHA), the WHO governing
body paved the way for multilateral
negotiations to begin on a set of rules
and regulations that will govern the
global rise and spread of tobacco and
tobacco products in the next century.
The 191-member WHA unanimously
backed a resolution calling for work to
begin on the Framework Convention on
Tobacco Control (FCTC) - a new legal
instrument that could address issues as
diverse as tobacco advertising and pro
motion, agricultural diversification,
smuggling, taxes and subsidies.
A record 50 nations took the floor to
pledge financial and political support
for the Convention. The list included
the five permanent members of the
United Nations Security Council, major
tobacco growers and exporters as well
as several countries in the developing
and developed world which face the
brunt of the tobacco industry's market
ing and promotion pitch. The European
Union and 5 NGOs also made state
ments in support of the Convention and
the Director-General's leadership in
global tobacco control.
The Tobacco Free
Initiative-Pakistan
TheNetwork for Consumer Protection,
which has been working to protect and
promote consumer rights in the area o'
pharmaceutical products and baby
milks and foods, has launched the
Tobacco Free Initiative-Pakistan (TFIPak) with initial support from the
WHO. The primary goal of TFI-Pakistan
is to mount resistance to the onslaught
by the tobacco industry, to educate the
people about the hazards of tobacco use
and to pressure the government to
introduce adequate controls on tobacco
sale and promotion.
TFI-Pak, in collaboration with WHO,
tlie international anti-tobacco move
ment and domestic health groups, will
mount a countrywide tobacco cam
paign to reduce smoking prevalence
and tobacco consumption, thereby
reducing the related burden of disease.
TFI-Pak's objectives include:
® Effective advocacy by mustering
national support for evidence-based
tobacco control measures e.g. ban on all
kinds of tobacco promotion.
® Contribution towards development
of comprehensive anti-tobacco legisla
tion.
® Building a national awareness cam
paign about the hazards of tobacco
through partnerships at all levels.
® Undertaking policy and operational
research to fill knowledge gaps for
effective anti-tobacco action.
® To lobby for and contribute towards
the development of the Framework
Convention for Tobacco Control at
national and international levels.
TFI-Pak believes that the tobacco issue
should be tackled in a holistic manner
through a mix of price and non-price
measures such as progressive taxation
and bans on promotion. TFI-Pak consid
ers a total ban on the direct and indirect
promotion of tobacco products on print
and electronic media the first and fore
most step, but this ban should accompa
ny pricing measures that have proved
very effective in many countries.
According to the World Bank, evidence
shows that price increases on cigarettes
are highly effective in reducing
demand. Higher taxes induce some
smokers to quit and prevent other indi
viduals from starting.
A recent World Bank report (Curbing
the Epidemic) on the economics of
tobacco control recommends a multi
pronged approach to curbing tobacco.
Tailored to individual country needs,
the strategy would include raising
taxes to between 2/3 and 4/5 of the
retail price of cigarettes, adopting
comprehensive bans on advertising
and promotion of tobacco, publishing
and disseminating research results on
the health effects of tobacco and
increasing access to nicotine replace
ment and other cessation therapies.
Although Pakistan already has high
tobacco taxes, customers have not felt
the brunt of tobacco taxation as various
brands of cigarettes remain within the
financial accessibility of different
income groups. In such a situation, the
government could set a minimum
price for the sale of tobacco to prevent
the tobacco industry undercutting
price controls introduced by higher
taxation.
TFI-Pak's Anti-Tobacco Charter*
1.
Promotion
i. Ban on direct and indirect promotion
of tobacco products on electronic and
print media.
b. Ban on tobacco sponsorship of
sports, musical or cultural events.
c. Ban on product placement by tobac
co companies in all types of media,
movies, sports, musical or cultural
events.
undercutting the price controls intro
duced by higher taxation.
4.
Health warnings
a. Implement a public education pro
gram on the risks of tobacco use and
second-hand smoke through money
generated by tobacco taxes.
b. Industry should be bound to print
clear and categorical health warnings
d. Ban on images of smokers on print mentioning instances of specific dis
eases. These messages should be highly
media as well as on TV and movies.
visible on tobacco packs and use words
c. Ban on tobacco-sponsored advertise
and symbols that communicate effec
ments of other products and services.
tively. These messages should also
f. Ban on use of tobacco brand names
include specific health warnings for
for promotion of other products and
tobacco and its affects on children and
services
in pregnant women. Hazards of passive
smoking should be included in the
2. Restrictions to access
a. Ban on juvenile smoking envisaging purview of these messages.
punishment for sellers.
b. Restricted availability of tobacco 5.
Quit Smoking
products through licensed outlets.
Programs
•- Ban on sale of cigarettes by sticks.
d. Packing requirement of 25 sticks per
a. Medical students should be required
to attain special courses on smoking ces
pack should be made compulsory for
sation counseling.
all cigarettes brands.
b. Smoking cessation programs in all
public and private hospitals should be
3. Fiscal Measures
a. A progressive tax should be imposed established and the Health Fund could
be used for the purpose.
on all tobacco products at the existing
retail price. The proceeds thus collected
should go to a National Health Fund.
6. Nicotine standards
b. A portion of excise duty collected a. Maximum nicotine and tar level per
from sale of tobacco should be spent on
stick standards should be adopted and
the strengthening of the public health
enforced.
delivery system.
b. The tobacco companies should be
c. Set a minimum price for the sale of required to display the nicotine and tar
content per stick on every pack.
tobacco to avoid the tobacco industry
Let's join hands
TFI-Pakistan will strengthen with the support
and cooperation of smokers and non-smokers,
health workers, teachers and parents, politicians
and opinion leaders, trade unions, commercial
and industrial organizations, media, schools
and other educational institutions, consumer
groups, health services and medical associa
tions, religious groups and researchers.
Anybody and everybody can have a role to play
in saving ourselves and future generations from
death and disease. So, don't wait, join hands
with TFI-Pakistan now!
7.
Social acceptability
a. Establish smoke-free environment in S
all enclosed public places, particularly
workplaces, health care facilities,
schools, public transport, hotels and
restaurants, etc.
b. Schools curriculum should include
materials that could link tobacco with ’.
death and disease with a view to dis
couraging children from taking up
smoking or any other tobacco use.
8. Phase
crop
of tobacco
a. Funds should be made available into
research for alternative crops that
could be grown in tobacco growin;
areas.
b. Tobacco farmers should be encour
aged through interest-free loans and
subsidies to switch to other crops.
9. Elimination of
government patronage
a. Immediate abolition of the Deferred
Leaf Payment Voucher Scheme.
b. Abolition of all forms of subsidies to
tobacco growers.
c.
Role of the Pakistan Tobacco Board
should gradually be minimized and
eventually be abolished.
*The charter also provide elements for 3-^\
comprehensive an ti-tobacco legisIatioiK >
in Pakistan.
For more information about TFI-Pakistan and
other consumer protection’work, please contact:
Coordinator,
Tobacco Free Initiative-Pakistan
The Network for Consumer Protection
40-A, Ramzan Plaza, G-9 Markaz,
P.O. Box 2563
Islamabad, Pakistan
Phone: +92-51-2261085
e-mail: tfi-pak@best.net.pk
This paper has been researched and written by TheNetwork team and volumes
Year of Publication April 2001
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U
TOBACCO
IN
KILLING
THE
SPIRIT
TFI-PAK
TOBACCO FREE INITIATIVE PAKISTAN
A PROJECT OF THENETWORK FOR CONSUMER PROTECTION IN PAKISTAN
TOBACCO IN
Introduction
port; a recreational and competitive activity, has been an aspect of all
~“ cultures since the dawn of time. Men and women have always run, jumped,
X
climbed, lifted, thrown and wrestled but no one can say when sports
actually began, as the transition of a physical activity into competitive
contest involving intellect has led to the emergence of term 'sports’ as we
Sports sponsorships
in Pakistan
Currently there are 39 National Sports Federations in Pakistan
operating independently, governed by their own constitutions and
know it today.
Sport has come a long way from pre-historic times to the modern period in history
and has been affected in more ways than one. Economic analysis demonstrates that
the boom in sports participation and in sports spectatorship has been due to the
realization of the sports as a marketable commodity. This transformation started from
recipient of the tobacco money. The sponsoring of cricket matches
universities and schools where sports was recognized as a means of building a
and airing of advertisements on match days to the extent of one after
future through sponsorships for further studies and also as professional career. The
every over bowled meant that in a single day covering a one-day
people associated with business and industry also became involved. Modern football
supplemented by five provincial bodies and four provincial Olympic
international match PTV received Rs. 36 lakh from tobacco industry
was invented in the elite boys’ schools in Victorian England and is now the most
committees. With minimum of funds available from official quarters
alone. In a series of five matches this amount reached more than Rs.
widely watched sport in the world primarily due to the interest of the media which
these federations depend upon sponsorship from the private sector.
1.8 crore (18 million).
to stage sports events like the 'World Cup Football' which are open to all age groups,
The tobacco industry has used these sports structures in Pakistan for
Pakistan Cricket Board (PCB) and Pakistan television while allowing
provided extensive coverage. The commercial motives have encouraged promoters
and especially the youth. The sponsors' messages is not restricted to those who have
the promotion of their products. Notable amongst these are cricket,
cricket to be used as a medium for the sponsorship of tobacco
the ability to pay for witnessing the event and are able to carry the it back home but
golf, snooker, volleyball and baseball. The tobacco industry has
are also available to those who see it in the comfort of their lounges and receive the
approached these games differently. While the intention in cricket was
products has given the tobacco industry a chance to reach all age
groups, especially the youth. These tactics are reflected in one of the
sponsors' messages directly. Now that the world's sporting events are open to men
and women who may earn millions of dollars by their athletic prowess, it is quite
to attach tobacco to an already established game in Pakistan, the
other games were either introduced through the power of media and
improbable that the promoters I sponsors of such sports persons would let this
advertising for the increase in sales of their particular brand or were
launched by British American Tobacco (BAT) to develop an insight on
the perceived benefits of smoking and to establish the situations in
opportunity of promoting their product sneak away.
used to present a responsible face to the people who matter.
which a person is more likely to smoke. The sponsorship of sports can
Along with bringing in the professionalism in sport and extending other benefits to the
Cricket and Tobacco
projects of the tobacco industry called 'Project Virgo'. The project was
also be linked to these insights. The results of this project indicated
players and sports bodies, the sponsorship has also lured in industries with an
To be a giant
which has used sports to reach people with their messages and has linked a healthy
This has forever been our passion
activity to one that kills millions worldwide.
W
_
Though these maybe fortunate things
PCB disassociated itself from 'WILLS' in the season of 1997 and 1998
cigarette business. We use sports as an avenue for advertising our products....We
Pakistan Tobacco Company Ltd. termed Board of Cricket Control in
under international pressure as other cricket playing nations had
can go into an area where we are marketing an event, measure sales during the
Pakistan (BCCP) as 'friends of Wills' and indeed they are as the
relationship was also highlighted by Mr. Justice Nasim Hassan Shah,
the former president of BCCP, who wrote, 'Our deals with WILLS and
event and measure sales after the event, and see an increase in sales."
Giants step over barriers that seem never ending
In Pakistan sports are widely sponsored by the tobacco industry, which either directly
links a particular sport with a cigarette brand like Red & White Snooker, Wills Cup
Giants rise above fear
a 'tobacco free event' on the state run television. The absence of anti-tobacco
Triumph over pain
legislation in Pakistan allows the tobacco industry to operate freely in all sporting
Push themselves and inspire others
events which ensures their presence in the field and the media while introducing their
Cricket, Royals Volley ball etc. or ensure their presence by buying televising rights of
product to millions of people at home. Sponsorship of sports is the worst kind of
Pepsi are illustrations of faith and commitment that allow both to
achieve a better image ...'
Pakistan's state owned television channel (PTV) has also been a
'The modern sporting world is very different from the days of
the 'game' where players acted like knights and gentlemen.
promotional gimmick used by the tobacco industry to lure the young towards
True it is still a revealer of character, but it is now more a case
smoking. By presenting a 'socially acceptable face' the tobacco industry has always
of survival, both for the game and the participants. The range
tried to divert the attention from the need to ban all kinds of tobacco promotion.
of alternatives include 'outside' incentives, like sponsorship
To move the world forward
Experiences from across the globe suggest that a complete ban on all kinds of direct
and cash'. Mr. Justice Nasim Hassan Shah, the former
Winter Olympics
and indirect promotion of tobacco products is one of the basic measures required to
president of BCCP, & former chief justice of Pakistan
Salt Lake City 2002
decrease the overall consumption of tobacco products and to save millions of lives
To take giant steps
better way to do it then at the time of watching your team win.
the domestic setup called, 'Wills cricket'. Malcom Bannister, Chairman
They conquer mountains that appear
insurmountable
To do giant things
to smoke after doing something heroic along with friends and what
According to an executive of the tobacco industry (RJ Reynolds), 'We're in the
But to be one
To be a giant
Cricket in Pakistan is very popular sport and is now an established
professional sport. Sponsorship in cricket has been lucrative with the
tobacco industry pouring Rs. 145 lakh (14.5 million) every season in
This desire to be a giant
Not to stand on one's shoulder or to have one for
a friend
that people smoke while relaxing and also as a reward after
completion of a task. If the campaigns of tobacco industry are looked
into carefully, these also reflect situations in which people are shown
inherent motive of exploiting the public. One such example is the tobacco industry,
from the disabling diseases and premature deaths caused by it.
g KILLING THE SPIRIT
moved away from tobacco sponsorships. The Pakistan Tobacco
Sports sponsorships
in Pakistan
Company in its financial report of first half of 1999, just after removing
itself from the cricketing scene registered a decrease in sales volume
of over 7% over the same period the year before. By its own
admission they saw a drop in sales of Wills, Gold Flake and Embassy
Currently there are 39 National Sports Federations in Pakistan
brands. These brands were linked to cricket. The game of cricket
operating independently, governed by their own constitutions and
survived in Pakistan and has flourished after disassociating itself from
the tobacco industry. So it is not a matter of survival of the game but
of the tobacco industry, which needs sports to survive.
Sportsmen who have won laurels for the country like Imran Khan
captain of the successful 1992 Pakistan's world cup cricket squad,
have felt the exploitation of sports by the tobacco industry. In the
recipient of the tobacco money. The sponsoring of cricket matches
words of Imran Khan, 'Having played international cricket and having
and airing of advertisements on match days to the extent of one after
established the largest cancer hospital in Pakistan.... I have
witnessed the power and pervasiveness of tobacco promotion through
every over bowled meant that in a single day covering a one-day
supplemented by five provincial bodies and four provincial Olympic
international match PTV received Rs. 36 lakh from tobacco industry
sports and its disastrous health consequences in the form of cancer
committees. With minimum of funds available from official quarters
alone. In a series of five matches this amount reached more than Rs.
these federations depend upon sponsorship from the private sector.
1.8 crore (18 million).
and death. I want to urge all the sport persons including sports
organizers and their respective governments to make sport across the
globe free from tobacco by not accepting sponsorships from the
The tobacco industry has used these sports structures in Pakistan for
the promotion of their products. Notable amongst these are cricket,
golf, snooker, volleyball and baseball. The tobacco industry has
approached these games differently. While the intention in cricket was
to attach tobacco to an already established game in Pakistan, the
other games were either introduced through the power of media and
advertising for the increase in sales of their particular brand or were
used to present a responsible face to the people who matter.
Cricket and Tobacco
Cricket in Pakistan is very popular sport and is now an established
professional sport. Sponsorship in cricket has been lucrative with the
Pakistan Cricket Board (PCB) and Pakistan television while allowing
groups, especially the youth. These tactics are reflected in one of the
projects of the tobacco industry called 'Project Virgo'. The project was
Pakistan Tobacco Company Ltd. termed Board of Cricket Control in
Pakistan (BCCP) as friends of Wills' and indeed they are as the
relationship was also highlighted by Mr. Justice Nasim Hassan Shah,
To maneuver in the official quarters and to appear responsible the
The case of Snooker
tobacco industry's corporate and regulatory affairs body (CORA)
the perceived benefits of smoking and to establish the situations in
which a person is more likely to smoke. The sponsorship of sports can
founder Quaid-e-Azam Mohammad Ali Jinnah enjoyed snooker and
organizes friendly golf tournaments in Pakistan regularly. In a similar
his image has been used by the tobacco industry to promote the
one day tournament in November 1999, The Federal Minister of
also be linked to these insights. The results of this project indicated
that people smoke while relaxing and also as a reward after
game, it has however been restricted to the elite clubs of the country.
Despite hosting the 2nd World Snooker Championship in 1966 the
completion of a task. If the campaigns of tobacco industry are looked
into carefully, these also reflect situations in which people are shown
game had remained virtually unknown in Pakistan. The Pakistan
Tobacco Industry (PTI) took up the sponsorship of the game in 1989
to smoke after doing something heroic along with friends and what
better way to do it then at the time of watching your team win.
and attached its brand 'Red and White' with it. Simultaneously PTI
also launched a promotional campaign using the popular image of
Finance, Mr. Shoukat Aziz, The Federal Minister for Petroleum Usman
Aminuddin and the British High Commissioner were some of the
players who played for a brand new Corolla car and other cash prizes.
Spouses were also present at the tournament and at the dinner
hosted at the end by the tobacco industry.
'James Bond' playing snooker. The campaign used all kinds of media
PCB disassociated itself from WILLS' in the season of 1997 and 1998
including the state run Pakistan television. The effect of this could be
The participants and guests were given golf shirts, sun visors and golf
under international pressure as other cricket playing nations had
seen on the ground as snooker clubs opened in all kinds of places
including the rural areas. According to an official of Pakistan Billiard
that everyone went home with a present and a message from the
and Snooker Association (PBSA), the game had become synonymous
with Red and White. These snooker clubs became a haven for
Pepsi are illustrations of faith and commitment that allow both to
achieve a better image ...'
children where they could smoke easily and freely.
Pakistan's state owned television channel (PTV) has also been a
PTI paid Rs. 1.5 crore (15 million) to the PBSA for holding the 20th
World Snooker Championship in 1993 while the Eighth Red & White
Asian snooker championship received Rs. 20 Lakh (2 million). In the
The modern sporting world is very different from the days of
1991 National snooker championship PTI spent Rs.40 lakh (4 million)
the 'game' where players acted like knights and gentlemen.
True it is still a revealer of character, but it is now more a case
on the event. The amount spent on a game which was not even
recognized at that stage helped the Tobacco industry to further its
of survival, both for the game and the participants. The range
intentions of recruiting young smokers as sales of RED & White went
of alternatives include 'outside' incentives, like sponsorship
up during these years.
Ironically Latif Amir Bukhsh, the first National Snooker Champion and
president of BCCP, & former chief justice of Pakistan
Pakistan remains a game of the elite class. Golf clubs have restricted
memberships and usually have policy makers as their members. The
Pakistan is traditionally not a snooker playing nation. Although our
the former president of BCCP, who wrote, 'Our deals with WILLS and
and cash'. Mr. Justice Nasim Hassan Shah, the former
tobacco industry has used golf to reach people who matter. Golf in
launched by British American Tobacco (BAT) to develop an insight on
tobacco industry pouring Rs. 145 lakh (14.5 million) every season in
the domestic setup called, Wills cricket'. Malcom Bannister, Chairman
tobacco industry'.
cricket to be used as a medium for the sponsorship of tobacco
products has given the tobacco industry a chance to reach all age
Golf - Gaining
official recognition.
holder of record three consecutive national titles died at the age of 40
with cancer of the lungs and stomach. In his memory Latif memorial
snooker is aiso held every year
balls and the spouses won prizes through a lucky draw thus ensuring
tobacco industry.
has parted ways as we were not serving their purposes' admitted one of the
officials associated with volleyball on condition of anonymity.
Success stories
The First Tobacco Free World
Cup Football
The Federation of International Football Associations (FIFA), the largest
sports body in the world has not accepted any tobacco sponsorship for the
last 16 years. According to FIFA spokesman Keith Cooper, 'Tobacco has no
place in football or in any other sport, and any involvement of any tobacco
company is entirely unwanted and actively rejected'
FIFA has signed an agreement with the World Health Organization for a
smoke-free World Cup 2002 to end cigarette promotion and smoking at the
games. To circumvent the situation the Korea Tobacco and Ginseng Corp.
announced that it planned to begin marketing tobacco packaged to promote
this summer's tournament, which South Koreans will cohost with Japan.
These cigarette packs showed players in action. Reacting to this indirect use (
of sports FIFA commented, 'It is the latest example of how the tobacco
industry sets out to mislead the public as it has been doing for so many years
now. FIFA remains very conscious of the need to make the public—and
especially young people-aware of the dangers of smoking and also wishes to
ensure that the nonsmoking majority can enjoy the games without having to
sit in somebody else's tobacco smoke'.
Football World cup is the most widely watched extravaganza in the history of
sports and making it 'Smoke free' has helped in keeping the youngsters away
from smoking.
South Asian
Federation Games
Pakistan March 2003.
The 9th South Asian Federation Games to be held in Islamabad in March
2003 were declared "tobacco-free” by the organizers of the game taking a
j
"
lead from the initiatives of FIFA and World Health Organization and effective
lobbying from the Tobacco Free Initiative-Pakistan and Pakistan Anti Tobacco
Volleyball - a game for
the masses.
Coalition.
SAF Games secretariat admitted that tobacco and sports do not go together
as sports is a healthy activity which should not be linked with tobacco. No
tobacco brand or product was included in the list of official sponsors where the
Royal cigarettes, a brand popular with the low socio-economic strata has been
audience of the games would include children and people under 18.
involved in sponsoring volleyball at the local as well as national level. The
contract between the tobacco industry and the controlling body for volleyball in
The Tobacco Industry managed to manipulate the situation and ensured its
Pakistan lasted for 5 years i.e from 1997 to 2001. The tobacco industry paid
presence in the media by sponsoring the events related to SAF games.
Rs. 4 lakh (0.4 million) for holding a tournament and had the rights for
Though the tobacco industry is not an official sponsor, Pakistan Television
television and media coverage for that event. After 5 years of promotion of
allowed the tobacco industry to air its advertisements during programs related
their product through the game the tobacco industry has not renewed its
to SAF Games.
contract citing international pressures as one of the reasons for abstaining
from further sponsorships. To many, and especially those associated with the
Participating in the 9th SAF Games are powerful contingents from India,
game of volleyball, this is not a valid argument as the tobacco industry
Bangladesh, Sri Lanka, Nepal, Bhutan, Maldives and Pakistan. All these
continues to sponsor other sporting events where it sees an opportunity to
countries except hosts Pakistan have strict anti-tobacco laws which inhibit
increase its sales. 'If the sales of Royals had improved the company would
tobacco promotion in their countries.
have stayed with us but as we did not get the coverage on media the company
KILLING THE SPIRIT
TOBACCO IN
What do sportsmen
say?
What needs to be done?
The need to ban all kinds of direct and indirect promotion
Imran Khan
of tobacco products is highlighted by the tobacco
Former Captain - Pakistan Cricket Team
industries ruthless approach to target young adults and its
blatant refusal of the same. Tobacco industry has long
exploited the official quarters hiding behind the garb of
Tobacco companies direct their advertisements and promotion towards young
people. Internal tobacco industry documents disclosed in 1998 made clear
that for decades the industry has systematically targeted children as an
sports like, motor racing, cricket and football are among the most common
being a 'responsible company' and adopting 'voluntary
codes of marketing of tobacco products' and using sports
as a medium to enhance their sales. Anti-tobacco activists
examples. By sponsoring individual sports persons, sporting events and
across the world have gathered enough evidence to firmly
teams the companies establish a link at subliminal between their products and
believe that 'voluntary codes' do not work and to decrease
the consumption of tobacco across the world, a complete
ban on all kinds of direct and indirect marketing of tobacco
important market, carefully studying their smoking habits and developing
products and marketing campaigns aimed at them. Sponsorships of popular
health and athletic prowess'.
Abdur Razzak
Smoking drains this energy. If young people want to succeed as
products is required. Only such a comprehensive ban can
save the youth from premature deaths and disabling
diseases caused by tobacco consumption especially in the
sportspersons they must choose between smoking and health. It is only
developing countries like Pakistan.
Ail rounder Pakistan Cricket Team.
^The sportsmen have an internal energy on which they build their careers.
physical fitness, hard work and dedication to the game which can make you
an all rounder'
TFI-Pakistan
InzamamulHaq
Batsman, Pakistan Cricket Team
There are lots of ways of relaxing and I do enjoy relaxing but what needs to
Tobacco Free Initiative-Pakistan is a project of TheNetwork for Consumer
be highlighted is that smoking cannot be included in that list. For a
Protection. TFI-Pak is an informed and organized response from civil society
sportsperson fitness is very important and smoking can easily destroy your
chances of reaching your maximum potential. We as sport persons should
also recognize our responsibility as public figures and as idols of our fans who
want to copy our every style and smoking should not be one of these'.
Muffy Davis
to promote and contribute towards effective tobacco control in the country.
TFI-Pakistan approaches the tobacco issue in a holistic way and its strategies
address problems on both the demand and supply sides.
In collaboration with the World Health Organization's Tobacco Free Initiative,
U. S. Disabled Ski Team and 1998 Paralympic Bronze Medallist 2000, Giant
alom World Champion and 2001 World Cup Overall Champion
K
ports have kept me away from smoking and drugs. I grew up competing in
Department for International Development United Kingdom, the international
anti-tobacco movement and active national and local groups, TFI-Pakistan has
launched a national anti-tobacco campaign.
sports and I knew I could never by my personal best if I was smoking or using
drugs. After I broke my back and began competing in Disable Skiing, I was so
thankful I never got into smoking because I now have diminished lung
capacity due to my disability. Smoking affects the lungs and would have made
The aim is to curb the tobacco epidemic in the country in order to minimize
the related burden of disease by effective advocacy and by mustering national
it worse. I could never willingly mess up the limited lung capacity I have by
support for evidence-based tobacco control measures e.g. ban on all kinds of
smoking. I find it strange that so many kids start smoking because they think
tobacco promotion. TFI-Pak coordinates all the activities of Pakistan Anti
its cool. As an athlete, it’s just the opposite, smoking is definitely not cool'.
Tobacco Coalition.
;o Free Inititative-
For more information about TFI-Pa
TheNetwc
for Consumer Protection
40-A Ramzan Plaza,G-9 Markaz, Islamabad. Tel: +92-51-2261085 Fax: +92-51-2262495
________ Website: www.thenetwork.org.pk
Email: tfi-pak@thenetwork.org.pk_________
Why Tobacco Promotion
n overwhelming majority of inde
offer a means to create a positive image of tobacco
Tire tobacco industry in Pakistan indulges in aggres
pendent and peer reviewed studies
products and link them to desirable personal traits.
sive promotional activities. Indeed, advertising is the
have established tobacco promotion
Their objective is to stimulate and increase demand
industry's frontline in its ambition to increase con
as a cause of increased tobacco con
for the product and broaden the base of people using
sumption of tobacco products. If Pakistan is to
\
umption. Tobacco industry despite recognizing tire
ame continues to indulge in its unethical marketing
adult smokers have been the critical fac
in the growth and decline of every major
and and the company in the last 50 years.
achieve a reduction in tobacco products consumption,
.. .Younger adult smokers are the only source of
for the health of our people, a ban on all direct and
replacement smokers..... If younger adults turn
radices promoting its products to all sections of the
The tobacco industry pours billions of dollars into its
indirect advertisements of tobacco products is imper
away from smoking, the industry must decline,
ociety. The concept of civil society empowers indi-
media campaigns mainly those focusing on cigarettes,
ative.
just as a population which does not give birth wili
^Countries like Australia, Finland, France, Italy, New
j 'Young adult smokers: strategies and Opportunities; Intenul memorandum
' fmmR.J fayiwMs. M February 19S4
eventually dwindle.
iduals with a general-
the world over.
zed responsibility to
Advertisements form a
ct with regard to the
central part of these cam
iterests and collective
paigns and are carefully
designed and based on the
ife of the community.
z-
Zealand, Portugal, Singapore, Thailand and Turkey
recognized the increasing threat of tobacco consump
|
tion and imposed bans on all kinds of promotion of
bbacco promotion not
habits, tastes and desires
the tobacco products. The European Union aims to
>nly undermines these
of targeted potential cus
phase out all types of tobacco promotion by year
nterests but also dis-
tomers. These campaigns
2006. But countries like Pakistan dependant on the
upts the collective life
also take into considera
perceived economic gains from tobacco industry, are
idding to the problem
tion social and cultural
still deliberating on how to tackle the issue focusing
>f increasing tobacco
aspects and include slo
on the economic argument rather than its health
gans that are specific and
impact.
onsumption.
Luring the young and innocent
Tobacco advertise
illy be killed by it. More than half of these are now
Tobacco kills a smoker every 8 seconds and the tobac
hildren and teenagers. By 2030, tobacco is expected to
co industry needs to replace this smoker to maintain
>e the single biggest cause of premature deaths,
its market. The overwhelming growth of the tobacco
recounting for about 10 million deaths per year.
tobacco consumption.
or intended age group.
ind about 500 million people alive today will eventu-
ments increase
'tobacco consumption
industry in the past decade indicates that not only has
it been able to replace its dying customer but has also
With trade barriers being curtailed to liberalize global
been able to increase its customer base by the second.
rade, tobacco industry has found markets of develop-
The media campaigns for tobacco products are
ng countries an open haven primarily due to lack of
focused mainly on young adults, categorized by the
■elevant laws to monitor their activities. There is also
tobacco industry as a potential source of replacement
an enhanced competition amongst the makers of
smokers.
sumption
Countries which have banned all kinds of promotion
have witnessed a decrease in the overall drop in
appealing to each society
Tobacco kills 1.1 million people worldwide, every year
Bans on advertising
lead to reduced con
Researchers have concluded from evidence gathered
According to a World Bank report entitled 'Curbing
the epidemic'
"Bans on advertising and promotion prove effective,
but only if they are comprehensive, covering all
media and all uses of brand names and logos."
around the world, including United States, New
Zealand, United Kingdom, Australia and Germany,
that there is a causal link between tobacco advertising
and its subsequent consumption.
U.S. General's report of 1989 identifies four direct
mechanisms by which tobacco advertising leads to an
tobacco products to capture these emerging markets,
resulting in lower prices, greater advertising and pro
"They [young adults] represent tomorrow's cigarette
motion, and other similar activities that stimulate
business. As this 14 - 24 age group matures, they will
demand for their product.
account for a key share of the total cigarette volume
for at least the next 25 years” writes one of the indus
The tobacco industry, like all other profit making
tries executives, J.W.Hind of R.J Reynolds Tobacco,
industries, depends upon consumers for its growth,
now owned by the Japan Tobacco in an internal mem- ■ yB
who it views as potential customers. Advertisements
orandum, dated 23rd January, 1975.
increase in tobacco consumption:
♦ Encouraging children or young adults to experi
ment with tobacco products and initiating regular
use.
♦ Increased daily consumption.
♦ Reducing motivation to quit smoking.
♦ Encouraging former smokers to take up smoking
again.
Addiction of government to easy revenues and sponsorships
be banned in P
[Environmental Tobacco Smoke] the time had come
Country
Date of Ban
Norway
1 July 1975
Inland
1 March 1978
I Percentage drop in consumption
for the companies to be considerably more proac
since year of ban on advertising!
-26%
-37%
New Zealand
17 December 1990 -21%
:rance
1 January 1993
-14%
Source: Luk Joosens, ’Questions and Answers: Why Ban Tobacco
dvcrtisihg in the European Union,” International Union Against Cancer,
djyrary 1998. Quoted in Tobacco Advertising & Promotion: The Need fo
Coordinated Global Response, Ross Hammond.)
Some of the slogans used by the industry are:
amount the tobac
co industry
Brand name
Slogan
tive. This reflects the attitude that is currently pre
Benson and Hedges
Be gold (one & only)
stands to lose if
vailing in almost every country in the region to one
Capstan
degree or another...An industry code will be written
Diplomat
Men demand Capstan the world over
Enhances the taste*
claim is taken
Embassy
This is the friendship*
Gold Flake
Together in success*
Gold Leaf
For the taste alone, A taste apart
According
oping a minor's program that would show that
Gold Street
K-2
Share the golden moments
Always together*
culations,
industry to be willing to work cooperatively with
Morven Gold
Bked & White
Share the taste of adventure
... so that it can be used as both a lobbying lever
and an argument against not introducing formal
legislation...it was proposed that we look at devel
the authorities in at least one area in which we have
a mutual objective."
Wills Kings
Come for the style and stay for the taste
The same great taste*
’. Translated from URDU
the above
seriously.
to these cal
for every
smoker it
attracted as
a new cus
The Deceptive face of
the Tobacco Industry
The truth behind voluntary market
ing codes.
The tobacco industry in Pakistan has adopted a 'vol
untary and self regulatory code for the marketing of
cigarettes'. The Purpose of the code is to "establish a
The tobacco industry's voluntary code adopted by it
tomer the
for marketing of tobacco products claims not to use
company
models who appear to be under 25 years of age. They
promotion of cigarettes, [which] are directed solely at
adults in the domestic market of Pakistan. This Code
establishes uniform standards for the advertising and
promotion of cigarette brands in Pakistan and pro
vides a mechanism whereby compliance with this
Code can be ascertained promptly, fairly and on a
is calculated by.
Tobacco Advertising
sexual attraction, nor shall it picture a person inhaling
One of the worlds largest multinational cigarette com
multiplying the
average number of’
or exhaling cigarette smoke and cigarette advertising
pany, Philip Morris, (PM) with global sales of over
arettes smoked per day by 365 days of the year and
should not suggest that as a result of smoking a per
$36 billion, spends $3.1 billion on its advertising cam-
the average whole sale price of the company's brand.
son appears attractive or healthy.
paigns, making it the world's ninth largest advertiser.
The companies spend almost $1180 per smoker who
British American Tobacco (BAT) with sales of over $26
wants to change brands, again calculated by consider
An analysis of the tobacco advertisements undertak
billion spends almost $459 million on advertising on
ing the amount spent on advertising campaigns and
en by TFI-Pak indicated that models in all advertise
ments were portrayed as sophisticated, professional
^rbacco products. The tobacco industry has increased
"s expenditures on media campaigns by 2000% since
Considering these figures, the companies stand to
ly successful, sexually attractive, athletic and brave,
1965 with a significant rise in the early 90s. The tobac
lose $644 for every smoker who switches to their
friends in need. In short, the characters portrayed in
co industry still maintains that it focuses on brand
brands. For each smoker who didn't change brands,
these ads are emblems of adulthood that are idolized
loyalty or creating brand switches and does not aim
the entire investment would be
by children trying to find a place in the adult world.
to increase tobacco consumption.
lost.
Every brand carries a slogan around which the
consistent basis".
The hidden agenda of the tobacco industry is illumi
nated by a Phillip Morris memo from Colin Goddard,
"Pakistan - Meeting in London," 9 July 1994. (meeting
between Philip Morris, BAT and Rothmans)
"Since the industry in Pakistan is facing unprecedent
ed opposition, not only on the advertising front but
on most other issues too, including ETS
gains $535.
gest that smoking is essential to social prominence, or
form of self -regulation, with uniform standards for
the marketing of cigarettes, including advertising and
The Economics of
further claim that cigarette advertising shall not sug
media campaign is built. These slogans are in local
Ross Hammond in his paper, "Tobacco
language and are developed after a meticulous
Advertising and Promotion: The
research on the cultural and social aspects of the
Need for a coordinated
society. They are structured to appeal young adults
response" has cal
psychologically as friendship, adventure and free
culated the
dom are some of the traits one aspires to have at this
age. Popular singers and their compositions are used
to further enhance the appeal. These slogans are
_ incorporated into media themes depicting the slogan
and the activity of smoking as one.
the percentage of people switching brands.
If the companies are true in their stance of promoting
society, thus creating an impression that the act of
brand loyalty and brand switching, economic sense
smoking is a part of the norm. The added attractions
prevailing, they should stop promotion of tobacco
of prizes, lotteries, gift schemes and the use of celebri
products altogether.
ties is all a part of luring the younger generation
Some examples of
advertising cam
paigns in Pakistan:
towards smoking. The tobacco industry admits as
much saying, "The adolescent seeks to display his
Experiences with
new urge for independence with a symbol, And ciga
old Flake' a
rettes are such a symbol since they are associated with
Health Programs
he Council of Islamic Ideology,
Many countries have undertaken health promotion
them to the young" (Kwechansky Marketing Research
T
and education programs to inform people of the haz
Inc, Report for Imperial Tobacco Limited, Subject:
ban on smoking and has described the Act
ards of tobacco. However, these efforts are continually
"Project 16")
adulthood and at the same time adults seek to deny
as 'Makroh'. The members of the CH have
undermined by the tobacco industry. Over 40 years of
experience with health education and health promo
The tobacco industry's advertisements appearing in
tion measures show that these measures alone are
the local press, soon after their adoption of the 'self
Pakistan (CD) has recommended a
also urged the Muslims not to indulge in
this habit as it is a sheer waste of money that
is strictly forbidden in Islam.
insufficient to combat the tobacco problem. If smok
regulatory code’ in early 2001 claiming that cigarettes
ing is still perceived as socially acceptable, education
are not sold to minors, generate the idea of making
al campaigns focused on the health hazards of tobac
cigarettes an adult commodity, thus enticing the
co use will have but modest results in getting large
young to join the adult group and also portrays a hid
numbers of smokers to stop smoking or in preventing
den agenda of appearing responsible in the eyes of
non-smokers especially teenagers from starting. The
the public by promoting ineffective youth access
tronic media and has demanded the same
net effect will be a well-informed population of con
measures. According to a Philip Morris executive, "If
from the government.
tinuing smokers. For better results, education and
we don't do something fast to project the industry
health promotion must be accompanied by other
responsibility regarding the youth access issue, we are
actions, particularly legislation and tobacco tax meas
going to be looking at severe market restrictions in a
ures that will reduce the social acceptability of tobac
very short time. Those restrictions will pave the way
co use.
for equally severe legislation or regulation on where
I
draft of a speech, JJM to PM Invitational, Importance
of youth issue. 10 Feb 1995, http://www.pmdocs.com)
campaigns in
Pakistan:
In Pakistan the tobacco companies pour millions of
rupees into their advertising campaigns. According
to, 'Advertising Age' a magazine which monitors the
spending of different companies, Lakson Tobacco
spent Rs. 328 million (32.8 crore) in 1998, making it
the third largest advertiser in Pakistan. It was fol
lowed by British American Tobacco, which spent
Rs.295 million (29.5 crore) on advertising.
Psychologists and researchers believe that the tobacco
industry's media campaigns are carefully designed
and aim to familiarize the younger generation with
the act of smoking. The use of cultural events creates
an aura which depicts smoking as an inherent part of
brand popu
lar with the low
income group, is
manufactured by
Pakistan Tobacco
Company, (PTC).
British American
Tobacco holds 67%
shares in PTC. In one
of the media cam
The CH also supports the call for a complete
ban on advertisements of cigarettes on elec
paigns eight million
posters and 350 ban
ners advertised this
product at a cultural
children
event 'Canal Mela' in
Lahore. Double page advertisements sponsoring the event
were placed in the local newspapers and 1.5 million
Who stands
to lose if
adults are allowed to smoke" (Philip Morris, Third
Tobacco advertising
G
leaflets were also distributed. 'Eid Hungama' a celebrities stage show
was also sponsored by the same brand.
tobacco
PTC, manufacturers of 'Embassy' offered a 'Toyota Hilux' as a prize
advertise-
packs. The company received one million entries, which translates in
through a draw. Contestants entered by sending Embassy empty
to 20 million cigarettes sold.
fments are
f- Fritz Gahagan, once a marketing consultant
. for five tobacco companies offered insight
into this business:
"The problem-is how do you sell death?
j How do you sell a poison that kills 350,000
people per year, a 1,000 people a day? You
do it with the great open spaces ... the
mountains, the open places, the lakes com
ing up to the shore. They do it with healthy
young people. They do it with athletes. Hot
could a whiff of a cigarette be of any harm
in a situation like that? It couldn't be there’s too much fresh air, too much health ■
' too much absolute exuding of youth and
vitality - that’s the way they do it." (1988)
Quoted in World in Action, Secrets of Safer
R
Gold leaf's media campaign 'Voyage of Discovery' offered lucrative
banned?
prizes including Rs. 150,000 in cash.
Capstan a local brand offered a free ride on an exclusive jet liner to
he economic fears that
any destination in the world in its "Jet Set Go campaign"
have deterred policy
makers from taking action are largely unfounded. Policies that reduce the demand for tobacco, such as bans
on advertising increase in tobacco taxes would not cause long term loses in the vast majority of countries. The
effects, if any, would appear gradually and the growth in population in these countries would tend to com
pensate for these. The tobacco industry recognizes the need to advertise and according to a Philip Morris
executive: "Advertising is critical to our ability to expand the geographical presence of our brands
their premiqm image" tiWWebb, 1933 Board presentation Closing 19
No. 2500157095)
l-n; ,
. ...
sustain
’ >
TFI-Pakistan
Tobacco Free Initiative-Pakistan is a project of
TheNetwork for Consumer Protection. TFI-Pak is an
informed and organized response from civil society to
promote and contribute towards effective tobacco con
trol in the country. TFI-Pakistan approaches the tobacco
issue in a holistic way and its strategies address prob
lems on both the demand and supply sides.
In collaboration with the World Health Organization's
Tobacco Free Initiative, Department for International
Development United Kingdom, the international anti
tobacco movement and active national and local groups,
TFI-Pakistan has launched a national anti-tobacco cam
paign. The aim is to curb the tobacco epidemic in the coun
try in order to minimize the related burden of disease.
sumer groups, health services and medical associations,
religious groups and researchers
We need to present a collaborative front on the issue and
protect our rights as consumers.
If we do not act now the future of our generations would
be at the whims of the tobacco giants, whose sole interest
is the 'profit'.
□bjectives of the TFIPakistan
♦
♦
The need to work
together
♦
TFI-Pakistan will strengthen with the support and coop
eration of smokers and non-smokers, health workers,
teachers and parents, politicians and opinion leaders,
trade unions, commercial and industrial organizations,
media, schools and other educational institutions, con-
♦
♦
♦
♦
♦
♦
♦
Do not allow the tobacco industry to put up pro
motional materials in your locality.
Avoid buying goods from the stores that sell
tobacco products.
Ask people around you not to smoke. Do not feel
shy, as this is your right.
Ensure that you and your children are protected
from tobacco by declaring your home a 'Tobacco
Free Home', (for further details on this campaign,
please contact us)
Try and make your working place tobacco free.
Talk to your children's school administration and
discuss it in Parent teacher meetings. Ask schools
♦
Effective advocacy by mustering national support
for evidence-based tobacco control measures e.g.
ban on all kinds of tobacco promotion.
Contribution towards development of comprehen
sive anti-tobacco legislation.
Building a national awareness campaign about the
hazards of tobacco through partnerships at all levels.
Undertaking policy and operational research to fill
knowledge gaps for effective anti-tobacco action.
To lobby for and contribute towards the develop
ment of the Framework Convention for tobacco con
trol atjiational and international levels.
to take up this issue and declare schools tobacco
free. It is important to provide information to children in a manner, which does not portray ciga-
♦
rettes as an adult commodity as most children
view this habit to be a part of growing ,up.
Write letters in newspapers and taik to your local
people telling them about the hazards of tobacco s v
use.
♦
Discourage people from advertising tobacco pro
ucts in your area. Do not allow the tobacco ind
try to use the space of your residential area fdj
posters and other exhibits.
For more information about TFI-Pakistan and other consumer protection work, please contact: Coordinator, Tobacco Free Initiative-Paklsta
TheNetwork
for Consumer Protection
40-A, Ramzan Plaza, G-9 Markaz, Islamabad. Ph: 051-2261085 e-mail: tfi-pak@ thenetwork.org .pk
website: www.thenetwork.org.pk
■'
U.S.A
Alcohol-related problems cost American society nearly $200 billion per year
and cause as many as 100,000 deaths annually. The alcoholic-beverage
industry's relentless marketing and powerful political influence, coupled with
ineffective government alcohol policies, contribute to this ongoing public health
and safety epidemic. In addressing alcohol problems, policy makers routinely
have promoted a variety of education, law enforcement and rehabilitation
programs that zero in on a few highly visible alcohol issues that concern
individual drinking behavior. They have devoted little attention to public
health policy measures that promise to help reduce alcohol problems across the
board. These measures include implementing reforms of alcohol marketing
and advertising to reduce the pressure on young people and heavy drinkers to
drink, increasing excise taxes to reduce overall consumption - particularly
among price-sensitive young consumers - and expanding requirements for the
labeling of alcoholic beverages to provide consumers with a better balance of
information about the drug they are consuming.
Alcohol Policies In USA
Taxation
Beer Taxes : This policy topic covers laws specifying the two major types of
taxes levied on beer - “specific excise taxes” (taxes levied per gallon at the
wholesale or
retail level) and “ad valorem excise taxes” (taxes levied as a percentage of the
beverage’s retail price).
General Information
This policy addresses beer taxes, one of three types of beverage taxes included in
APIS (in addition to wine and distilled spirits taxes). Although some States have
separate tax rates for other types of alcoholic beverages (e.g., sparkling wine),
these beverages constitute a small segment of the market and their tax rates are not
addressed by APIS.
State alcohol taxes fall into four main categories. The names applied to these
categories may vary by jurisdiction, but the following terms are commonly used:
Specific Excise (SE) Taxes - Taxes levied per gallon at the wholesale or
retail level.
Ad Valorem Excise (A VE) Taxes - Taxes levied as a percentage of the
beverage’s retail price (which may also be referred to as the percentage of gross
receipts, gross proceeds, retail receipts or retail proceeds). Different ad valorem
excise tax rates may apply to on- and off-premises sales.
Sales Tax - A tax on goods in general rather than a tax that specifically
applies to alcoholic beverages. APIS provides the sales tax rate only for those
States in which: (1) a sales tax does not apply to an alcoholic beverage; and (2) an
ad valorem excise tax does apply to that beverage.
Sales Tax Adjusted Retail Ad Valorem Tax - In some States, AVE taxes are
levied in lieu of sales tax. In these cases, an accurate index of the actual tax
reflected in the retail price requires that the retail ad valorem excise tax be adjusted
to reflect the fact that sales taxes are not levied.
Wine Taxes : This policy topic covers laws specifying the two major types of
taxes levied on wine - “specific excise taxes” (taxes levied per gallon at the
wholesale or retail level) and “ad valorem excise taxes” (taxes levied as a
percentage of the beverage’s retail price).
General Information
This policy addresses wine taxes, one of three types of beverage taxes included in
APIS (in addition to beer and distilled spirits taxes). Although some States have
separate tax rates for other types of alcoholic beverages (e.g., sparkling wine),
these beverages constitute a small segment of the market and their tax rates are not
addressed by APIS.
State alcohol taxes fall into four main categories. The names applied to these
categories may vary by jurisdiction, but the following terms are commonly used:
Specific Excise (SE) Taxes - Taxes levied per gallon at the wholesale or
retail level.
Ad Valorem Excise (A VE) Taxes - Taxes levied as a percentage of the
beverage’s retail price (which may also be referred to as the percentage of gross
receipts, gross proceeds, retail receipts or retail proceeds). Different ad valorem
excise tax rates may apply to on- and off-premises sales.
Sales Tax - A tax on goods in general rather than a tax that specifically
applies to alcoholic beverages. APIS provides the sales tax rate only for those
States in which: (1) a sales tax does not apply to an alcoholic beverage; and (2) an
ad valorem excise tax does apply to that beverage.
Sales Tax Adjusted Retail Ad Valorem Tax - In some States, AVE taxes are
levied in lieu of sales tax. In these cases, an accurate index of the actual tax
reflected in the retail price requires that the retail ad valorem excise tax be adjusted
to reflect the fact that sales taxes are not levied.
Underage Drinking
Possession/ Consumption/ Internal Posession : All States prohibit possession of
alcoholic beverages (with certain exceptions) by those under age 21. In addition,
most but not all States have statutes that specifically prohibit consumption of
alcoholic beverages by those under the age of 21. Many States that prohibit
possession and/or consumption apply various statutory exceptions to these
provisions (see below).
States that prohibit underage consumption may allow different exceptions for
consumption than those that apply to underage possession.
In recent years, a number of States have passed laws prohibiting the "internal
possession" of alcohol by persons under 21 years of age. These provisions
typically require evidence of alcohol in the minor's body, but do not require any
specific evidence of possession or consumption. Internal possession laws are
especially useful to law enforcement in making arrests or issuing citations when
breaking up underage drinking parties. Internal possession laws allow officers to
bring charges against underage persons who are neither holding nor drinking
alcoholic beverages in the presence of law enforcement officers. As with laws
prohibiting underage possession and consumption, States that prohibit internal
possession may apply various statutory exceptions to these provisions (see below).
APIS codes a State as having an internal possession law if its statutes or
regulations prohibit a person under the age of 21 from having alcohol in her or his
system as determined by a blood, breath or urine test. Laws that punish persons
under the age of 21 for displaying "indicators of consumption," or for "exhibiting
the effects" of having consumed alcohol, are not considered to be internal
possession laws for the purpose of APIS coding.
Although all States prohibit possession of alcohol by minors, some States do not
specifically prohibit underage alcohol consumption. In addition, States that
prohibit underage possession and/or consumption may or may not address the issue
of internal possession.
Exceptions
Some States allow an exception to possession, consumption, or internal possession
prohibitions when a family member consents and/or is present. States vary widely
in terms of which relatives may consent or must be present for this exception to
apply and in what circumstances the exception applies. Sometimes a reference is
made simply to "family" or "family member" without further elaboration.
APIS codes two types of family member exceptions. The first is an exception for
either the consent or presence of a parent or guardian. The second is an exception
for either the consent or presence of the spouse of a married minor.
When a statute or regulation is unclear as to which family members must be
present and/or consent, APIS assumes that parents, guardians, and spouses are all
included. Further detail and explanations for such statutes and regulations are
provided in Row and/or Jurisdiction Notes in the comparison tables. Some
jurisdictions limit family member exceptions to specific locations. For example,
minors might be allowed to possess or consume alcohol with parental consent in
their parents' residence, but not elsewhere.
Some States allow exceptions to possession, consumption, or internal possession
prohibitions on private property. States vary in the extent of the private property
exception, which may extend to all private locations, private residences only, or in
the home of a parent or guardian only. In some jurisdictions, a location exception
is conditional on the presence and/or consent of a parent, legal guardian, or spouse.
With respect specifically to consumption laws, some States prohibit underage
consumption only on licensed premises. Because the number of underage persons
who drink on licensed premises is small, APIS codes such States as having no law
prohibiting consumption.
Purchase : This policy topic covers laws prohibiting minors from purchasing or
attempting to purchase alcoholic beverages and laws allowing persons under age
21 to purchase alcoholic beverages for law enforcement purposes.
Most States, but not all, prohibit minors from purchasing or attempting to
purchase alcoholic beverages. Note that a minor purchasing alcoholic beverages
can be prosecuted for possession since, arguably, a sale cannot be completed until
there is possession on the part of the purchaser. Purchase and possession are
nevertheless separate offenses. A minor who purchases alcoholic beverages is
potentially liable for two offenses in States that have both prohibitions.
In some States, a person under age 21 is allowed to purchase alcoholic beverages
as part of a law enforcement action. These actions are checks on merchant
compliance to identify merchants who illegally sell alcoholic beverages to minors.
This allowance for purchase in the law enforcement context may exist even though
a State does not have a law specifically prohibiting underage purchase.
Hosting Underage Drinking Parties : This policy topic covers laws that impose
liability against individuals (social hosts) responsible for underage drinking events
on property they own, lease, or otherwise control.
Prohibitions Against Hosting Underage Drinking Parties addresses laws that
establish State-imposed liability against individuals (social hosts) responsible for
underage drinking events on property they own, lease, or otherwise control. These
laws often are closely linked to laws prohibiting furnishing alcohol to minors,
although laws establishing State-imposed liability for hosting underage drinking
parties may apply without regard to who furnishes the alcohol. Hosts who allow
underage drinking on their property as well as supply the alcohol consumed or
possessed by the minors may be in violation of two distinct laws: furnishing
alcohol to a minor and allowing underage drinking to occur on property they
control. APIS provides additional information on laws pertaining to furnishing
alcohol to minors in the Furnishing Alcohol to Minors policy topic.
The primary purpose of laws that establish State-imposed liability for hosting
underage drinking parties is to deter underage drinking parties. Although research
on the topic is limited, what is available suggests that parties are high risk settings
for binge drinking and associated alcohol problems. Very young drinkers are often
introduced to heavy drinking behaviors at these events (National Research Council
Institute of Medicine, 2003). Law enforcement officials report that, in many cases,
underage drinking parties occur on private property, but the adult responsible for
the property is not present or cannot be shown to have furnished the alcohol.
Statutes that establish State-imposed liability for social hosts address this issue by
providing a legal basis for holding adults responsible for parties that occur on their
property whether or not they provided the alcohol to minors.
Two general types of liability may apply to hosting underage drinking parties:
State-imposed liability and private party civil liability. State-imposed liability
involves a statutory prohibition that is enforced by the State, generally through
criminal proceedings that can lead to sanctions such as fines or imprisonment.
Private party civil liability involves an action by a private party seeking monetary
damages for injuries that result from permitting underage drinking on the host's
premises. Although related, these two forms of liability are quite distinct. For
example, a social host may allow a minor to drink alcohol after which the minor
causes a motor vehicle crash that injures an innocent third party. In this situation,
the social host may be prosecuted by the State under a criminal statute and face a
fine or imprisonment for the criminal violation. In a State that provides for private
party civil liability, the injured third party could also sue the host for monetary
damages associated with die motor vehicle crash. State-imposed liability is
established by statute. Private party civil liability can be imposed either by statute
or by a court using common law negligence principles. This policy topic addresses
State-imposed liability for hosting underage drinking parties.
False Identification :This policy topic covers laws prohibiting the use of false
identification by minors to obtain alcohol.
Retailers are responsible for insuring that sales of alcoholic beverages are made
only to persons who are legally permitted to purchase alcohol. Inspecting
government-issued identification (driver's license, non-driver identification card,
passport, military identification) is one major mechanism for insuring that buyers
meet minimum age requirements. In attempting to circumvent these safeguards,
minors may obtain and use apparently valid identification that falsely states their
age as 21 or over. Age may be falsified by altering the birthdate on a valid
identification, obtaining an invalid identification card that appears to be valid, or
using someone else's identification.
Compliance check studies suggest that underage drinkers may have little need to
use false identification because retailers often make sales without any inspection of
identification [1], However, concerns about false identification remain high among
educators, law enforcement officials, retailers, and government officials. Current
technology, including high quality color copiers and printers, has made false
identification easier to fabricate, and the Internet provides ready access to a large
number of false identification vendors.
All States prohibit use of false identification by minors to obtain alcohol. In
addition to the basic prohibitions, States have adopted a variety of legal provisions
pertaining to false identification for obtaining alcohol. These provisions can be
divided into three basic categories:
Provisions that target minors who possess and use false identification to obtain
alcohol
Provisions that target those who supply minors with false identification, either
through lending of a valid ID or the production of invalid ("fake") IDs
Provisions that assist retailers in avoiding sales to potential buyers who present
false identification
Government-issued IDs are used for a number of age-related purposes other than
the purchase of alcohol: registering to vote, enlisting in the military, entering
certain entertainment venues, etc. APIS confines its analysis to statutes and
regulations relating to the use of false identification for the purpose of obtaining
alcohol.
EUROPE
Every country in the European Union (EU) has a number of laws and other
policies that set alcohol apart from other goods traded in its territory, often for
reasons of public health. These policies take place in a specific cultural setting
and are also adopted and enforced in the context of people’s views on alcohol
policy. These currently seem to be most in favour of controls on advertising and
young people’s drinking, although evidence is scarce in this area. Where a
thorough European investigation has been done, most European drivers have
been found to support a complete ban on alcohol use by new drivers, and many
are in favour of a ban for all drivers.
Despite the ubiquity of alcohol policies, just under half the EU countries still do
not have an action plan or coordinating body for alcohol. Even so, most
countries have programmes for one aspect of alcohol policy, of which school
based education programmes are the most common throughout Europe. All
countries also have some form of drink-driving restrictions, with everywhere
except the UK, Ireland and Luxembourg having a maximum blood alcohol limit
for drivers at the level recommended by the European Commission (0.5g/L).
However, many European drivers believe that there is only a slim chance of
being detected - a third overall believe they will never be breathalysed, although
this is lower in countries with Random Breath Testing.
Sales of alcohol are generally subject to restrictions in most EU countries, in a
few cases through retail monopolies but more often through licences, while the
places that alcohol can be sold are frequently restricted. Over one-third of
countries (and some regions) also limit the hours of sale, while restrictions on
the days of sale or the density of off-premise retailers exist in a small number of
countries. All countries prohibit the sale of alcohol to young people beneath a
certain age in bars and pubs, although four countries have no policy on the sale
of alcohol to children in shops. The cut-off point for allowing sales to young
people also varies across Europe, tending to be 18 years in northern Europe and
16 years in southern Europe.
Alcohol marketing is controlled to different degrees depending on the type of
marketing activity. Television beer adverts are subject to legal restrictions
(beyond content restrictions) in over half of Europe, including complete bans in
five countries; this rises to 14 countries for bans on spirits adverts. Billboards
and print media are subject to less regulation though, with one in three countries
having no controls. Sports sponsorship is subject to the weakest restrictions,
with only seven countries having any legal restrictions at all.
The taxation of alcoholic beverages is another consistent feature of European
countries, although the rates themselves vary considerably between countries.
This can be seen clearly for wine, where nearly half the countries have no tax at
all, but one in five countries has a tax rate above €1,000, adjusted for
purchasing power. In general, the average effective tax rate is highest in
northern Europe, and weakest in southern and parts of central and eastern
Europe. Four countries have also introduced a targeted tax on alcopops since
2004, which appears to have reduced alcopops consumption since.
When the different policy areas are combined into a single scale, the overall
strictness of alcohol policy ranges from 5.5 (Greece) to 17.7 (Norway) out of a
possible maximum of 20, with an average of 10.8. The least strict policies are in
southern and parts of central and eastern Europe, and the highest in northern
Europe - but the scores do not all decrease from north to south, as seen in the
high score in France. Most countries with high policy scores also have high
taxation levels, but there are some exceptions such as France (high policy score,
low tax), Ireland, and the UK (both low policy score, high tax).
This picture of alcohol policy is very different from the one visible fifty years
ago, with the overall levels of policy much closer together, partly due to a
weakening of the availability restrictions in the northern European countries.
However, the main factor in the policy harmonization is the increased level of
policy in many countries, particularly in the area of drink-driving where all
countries now have a legal limit. Marketing controls, minimum ages to buy
alcohol, and public policy structures to deliver alcohol policy are also much
more common in 2005 than in 1950. While European countries are, therefore,
ahead of the world in print advertising restrictions and drink-driving limits, they
are less likely to have high taxes or controls on availability such as limits on the
days and hours of sales, or licences for the retail sale of alcohol.
Alcohol Policies In The Countries Of Europe
In a different way, the policies adopted by a country are also a barometer of the
response to alcohol, and it is fortunate that much better data on this are available
than for opinion polls. This enables a policy-by-policy comparison in a number
of key areas, as well as several comparisons of the ‘overall level’ of alcohol
policy in the countries and Europe as a whole.
The data for this come from the Global Status Report on Alcohol Policy (WHO
2004), updated by the Alcohol Policy Network which is co-financed by the
European Commission. However, for some countries these policies are decided
on a regional rather than country level, meaning that there is no single
‘minimum age to buy alcohol in Spain’, for example. In these countries
(Austria, Spain and Switzerland in particular), the least strict of the regional
policies is used to represent the national situation, as this was felt to reflect
better the country response than the most strict region.
Framework For The Policy
The starting point for dealing with alcohol on a country level is to decide what
an alcoholic beverage is. Although there are internationally agreed definitions
of alcohol for the purposes of classifying trade, most countries go further for the
purposes of their own alcohol laws. In general, the countries of Europe fall into
the World Health Organization’s (WHO) ‘low’ definition band, which defines
the maximum level of alcohol for a ‘non- alcoholic’ drink at 2% alcohol
concentration or less. However, several countries (all in Northern Europe) have
slightly higher definitions of 2-3%, while Romania and Slovakia do not define
alcohol in this way at all. Clearly anomalous in this context is Hungary, whose
definition of 5% alcohol concentration - above the level of most beers - is only
significantly exceeded by two other countries in the world. In comparison, the
EU’s definition of alcohol for tax purposes is at least 0.5% (for beer) or 1.2%
alcohol concentration (for all other drinks).
Framework for the policies
♦Most countries define alcohol as less than 2% absolute
volume
♦Just under 1/2 of countries do not have an action plan or
coordinating body
♦Nearly all countries have 'moderately developed’ school
programmes
Risky environments
♦Drink-driving: blood alcohol
♦limits and enforcement
♦Workplace restrictions
♦Restrictions on drinking in parks and street
COMPARING ALCOHOL POLICIES
Global - How the EU compares to the rest of the world Policy
score - How countries overall levels of alcohol policy compare,
using the ECAS policy scale
Trends - Comparing the Europe of 1950 with the Europe of today
Market restrictions
♦ Monopolies and licences for production and retail
♦ Off-licence sales restrictions - days, hours, places,
density
Tax and price
♦ Alcohol tax rates for beer, wine & spirits
♦ Taxes on alcopops
♦ Link of tax to the price of alcohol
Marketing controls
♦ Restrictions on TV, print or billboard adverts
Sports sponsorship restrictions
Young people
♦Minimum legal age to buy alcohol in bars
♦Minimum age in shops
The structure of alcohol policy further provides a useful background to the
specific laws covered below. In just over half the EU countries this structure
involves an action plan and/or a coordinating body, but this still leaves a
number of other countries scattered across Europe who leave alcohol policy to
the intersection of more general departments. The Global Status Report also
provides the country source’s opinion of the status of alcohol awareness
programmes in their country - this is a useful indication of how active the
government has been, but is only a subjective measure. Bearing this in mind, it
seems that EU15 states were more likely to have better developed workplace
and drink-driving campaigns than EU10 states. On the other hand, only two
countries - Greece and Portugal - do not have ‘moderately developed’
school-based alcohol programmes, suggesting that the EU10 has
well-developed awareness campaigns in some areas despite lagging behind in
others.
Risky environments: driving and working
One of the most common forms of alcohol policy is restricting drinking in
inappropriate situations, often instigated by organisations with a remit that is
broader than alcohol. The most common example of this is for drink-driving,
where insurers and road safety organisations have seen alcohol as a major risk
factor for driving- related damage and loss of life. Most of the EU countries
have a maximum Blood Alcohol Concentration (BAC) of no more than 0.5g/L,
although the UK, Ireland and Luxembourg continue to have a higher limit.
Limits tend to be even lower, with three countries (Czech Republic, Hungary
and Slovak Republic, as well as Romania) prohibiting any alcohol in drivers
and tliree more having levels lower than the majority. Outside of the EU, the
international community is more likely to have a limit of 0 - yet they are
substantially more likely to have BACs above the EU Recommendation as well,
with fewer countries lying between the two extremes. Some European countries
also have different BACs for different groups, such as the 0.3g/L limit for
novice and professional drivers in Spain.
An essential component of an effective drink-driving policy is enforcement,
particularly using random breath testing. Data on the perceived chances of being
breathalysed are available from the SARTRE project, which has been
part-funded by the European Commission (Christ 1998; Sardi and Evers 2004).
Across 21 EU countries (and Switzerland), nearly 30% of drivers believe they
will never be breathalysed, with a further 45% believing they will only be
breathalysed rarely. This correlates moderately strongly with drivers’ own
experiences of being breathalysed, with over 70% of drivers saying they have
not been checked for alcohol in the last three years.
Although the perceived chances and experience of checks are lower in some
countries than others, there appears to be no consistent geographical pattern to
this - for example, drivers from Italy, Spain and Greece perceive low chances
but so do those from the UK, Poland and Sweden, while those from France,
Portugal and Slovenia see the chances as much higher. In contrast to the WHO’s
analysis of its country informant ratings, there is also no correlation in Europe
between the BAC and perceived levels of enforcement. However, a policy of
Random Breath Testing made a significant difference to drivers’ experiences
and perceptions of alcohol checks. In the six SARTRE countries where RBT
was not allowed (Germany, Ireland, Italy, Poland, the UK and Switzerland^),
86% of drivers had not been checked in the past three years compared to only
65% elsewhere. The effect was even stronger for drivers’ perceptions - in the
countries with RBT only 22% of drivers thought they would never be checked,
compared to more than double this figure (46%) in the six countries without
RBT.
Another frequently restricted environment is the workplace, probably due to
both reduced productivity and a greater risk of workplace accidents with those
who have drunk alcohol. In the certain EU countries these restrictions are nearly
always in the form of a complete ban on alcohol use in the workplace, while the
preference in some other countries is for voluntary or local action. Despite the
absence of any controls in Greece (as well as Switzerland), the EU is much
more likely to have at least a voluntary control on workplace drinking compared
to the rest of the world, although as with drink-driving this is substantially less
likely to be a complete ban. Similarly, bans on alcohol consumption in
educational, healthcare and government establishments are often forbidden, and
these follow a near-identical pattern in Europe.
A final area where drinking is often restricted is public spaces such as parks and
streets. This tends to be less motivated by preventing harmful alcohol use and
more focused on public disorder, nuisance, and anti-social behaviour. As such,
it more often has a legal base in countries where there is strong public concern
over anti- social behaviour, primarily in eastern and northern Europe (e.g.
Belgium, Latvia). Elsewhere there is a roughly equal tendency to either have no
restrictions, or to devolve these decisions onto a local level where they can be
adapted to the particular situation in a locality. As for workplace restrictions, the
EU overall is more likely than the rest of the world to have a policy but less
likely to have a complete ban on public drinking (a policy pursued in Europe by
Latvia alone).
Market restrictions
Retail monopolies are relatively uncommon within the EU, particularly given
the EU- level cases over the past 15 years (Osterberg and Karlsson 2002) which has sometimes even induced countries to privatize in anticipation of EU
membership talks, as in the case of Turkey in 2003. Only the four northern
European countries maintain a retail monopoly adapted to the needs of
EU/European Free Trade Association (EFTA) membership, with the majority of
countries instead requiring special licences to sell alcohol. A minority of
countries do not even require licences for any alcoholic drink, and these are
generally situated in a geographically continuous area of central and eastern
Europe (Austria, Belgium, Czech Republic, Germany, Slovak Republic,
Slovenia, Switzerland; and also Spain).
A similar pattern is visible for off-licence sales restrictions (unfortunately no
comparable data are available for on-licences). The most common policy here is
to restrict the places at which alcohol can be sold (for example, not within 500m
of a school), which is practised in most countries. Eleven of the study countries
restrict the hours of sale (for Latvia excluding beer), while six restrict the days
of sale and five regulate the density of alcohol retailers (the EU figures are nine,
three, and four countries respectively).
Again, a cluster of central and eastern European countries have none of these
restrictions (Austria, the Czech Republic, Germany, Luxembourg and Slovakia)
together with several southern European countries (Portugal, Italy and Greece;
also Spain on a country basis). In contrast, Sweden, Finland and Norway have
all types of restrictions (if not for all beverages). Nevertheless, this should not
be understood as a simple cultural or geographical divide - for example, France
has density and place restrictions that are absent in Denmark and Iceland, while
some regions of Spain also strictly control off-licence sales.
Of the 14 countries with information on how these restrictions are enforced,
only two (Hungary and Romania) describe rare or nonexistent enforcement.
While these country-based opinions should be treated with some caution, they
do suggest that enforcement is better in Europe than in the rest of the world with
the exception of North America.
Controlling sales to young people
Besides the general restrictions on availability, all of the study countries have
decided that only people above a certain age (16- 20) should be able to buy
alcohol. This policy splits Europe cleanly into two - the Nordic countries,
Denmark, UK, Ireland have a minimum age of 18 to purchase beer in a bar,
while the rest opt for a lower age of 16 (the only partial exceptions are Malta (at
16), Greece (17), 34 of the Spanish regions (18) and Iceland (20)). The gap is
even more striking for shop sales, with some southem/central countries
sometimes not even having a minimum age, compared to the northern countries
that put the limit at 18-20 years as before. This picture changes slightly when
buying spirits rather than beer or wine (both on- and off-premise), as this is
treated more severely by some of the central European countries leaving only
those in the south of Europe with lower ages.
It is also evident that different countries view the different types and places of
alcohol differently when it comes to young people. Strikingly, most countries
Table 9.1 The legal purchase age for alcohol in Europe.
B = Beer
Min. Legal Age
W = Wine
On-premise
Min. Legal Age
Off-premise
S = Spirits
B&W
s
B&W
S
Austria
16
16-18
16
16-18
Belgium
16
18
None
18
18
On-premise
Lithuania
Off-premise
B&W
s
B&W
s
18
18
18
18
18
Luxembourg
16
16
None
None
18
Malta
16
16
None
None
Bulgaria
18
Czech Rep.
18
18
18
18
Netherlands
16
18
16
18
Denmark
18
18
16
16
Norway
18
20
18
20
Estonia
18
18
18
18
Poland
18
18
18
18
Finland
18
18
18
20
Portugal
16
16
16
16
France
16
18
16
16
Romania
18
18
18
18
Germany
16
18
16
18
Slovak Rep.
18
18
18
18
Greece
17
17
None
None
Hungary
18
18
18
18
Iceland
20
20
20
20
Sweden
Ireland
18
18
18
18
Switzerland
Italy
16
16
16
16
Turkey
Latvia
18
18
18
18
UK
Slovenia
Spain
18
18
18
18
16-18*
16-18*
16-18*
16-18*
18
18
20
20
16
18
16
18
18
18
18
18
18
18
18
18
* Minimum legal age in Spain is 18 in all but 4 regions. Source: Global Status Report on Alcohol Policy
(WHO 2004) and updates from the Alcohol Policy Network co-financed by the European Commission.
treat spirits more severely than beer or wine, with the exception of a few where
the beverages are treated consistently. Equally, a number of countries have a
more relaxed policy for off-premise sales than for on-premise, either by
reducing the age to buy in shops (Denmark) or simply abandoning the age
restriction altogether (Belgium, Greece, Luxembourg, Malta) - although in
contrast the minimum age in Sweden is raised from 18 to 20 years for shop
sales. Compared to the rest of the world (for beer only, both on- and
off-premise), EU states are much more likely to have a minimum age to buy
alcohol. However, countries that do have a policy choose an older age than the
EL on average; in particular, a legal purchase age of 16 years is virtually unique
to the EU.
While the legal purchase age has been shown to be an effective policy (see
Chapter 7), levels of enforcement seem to be highly variable within Europe
given the very,weak relationship between perceived availability and the
statutory minimum age.7 Beer is seen as the most available type of drink, and is
seen as easily available by over 90% of students in central and eastern Europe
(as well as Italy, Greece and Bulgaria) and over 80% of students elsewhere
(except France and Turkey). Students feel spirits are much less available, yet
over 80% of students still thought they were easy to get hold of in some
countries (e.g. Italy, the Czech Republic) - only in the Nordic and Baltic
countries (and Turkey) did the figures drop significantly.
Volume of alcohol marketing
Given the range of media containing alcohol marketing, it was decided to
restrict the analysis to three of the more prominent types - national television,
print media and billboards - as well as restrictions on sponsoring sports events.
For each of these, country informants said whether there were:
• Voluntary agreements (also including delegated powers to regions)
• Partial legislation (by hours, type of programme/magazine, saturation limits,
or place of advertisement, but not including content restrictions such as those in
the EU-wide Television Without Frontiers Directive (TVWF); see Chapter 8).
• A complete ban on that form of alcohol advertising.
Given that the definition used for ‘partial legislation’ does not include content
restrictions, and that all EU member states are legally obliged to have content
restrictions in line with the TVWF Directive, it should be remembered that the
discussion here concentrates on restrictions on the volume/placement of
marketing rather than its’ content.
Controls on the volume of marketing
TV adverts are controlled by law in over ’A of Europe, including complete bans
in five countries. One in three countries have no controls on print or billboard
ads. Only seven countries have legal restrictions on sports sponsorship.
Television adverts for alcohol are subject to legal control in just over half of
Europe,although this in the form of a complete ban in only five countries (of
which only France and Sweden are in the EU).8 Voluntary agreements are
relatively common, but these are not present where many countries have no
controls at all. As with the legal purchase age, EU states - especially those in
the domr countries control spirits advertising more tightly than wine or beer, to
the extent that EU states are more likely to have complete bans on spirits than
any of partial restrictions, voluntary agreements or no restrictions individually
(although not combined). This change between drinks types is also much
stronger than the rest of the world, meaning non-EU countries are more likely to
have complete bans on beer TV advertising than EU states but less likely to
have bans for spirits.
Controlling alcohol advertising in print or on billboards is noticeably less
common than for television, with 1 in 3 European states not having any policy
on them at all. Most of the uncontrolled advertising environments are found in
eastern Europe (Bulgaria and Romania); as before, EU15 states often have
voluntary agreements with only Greece, Luxembourg and Portugal lacking even
these. Internationally the levels of voluntary agreements are only a third of the
EU level, although both complete bans and complete deregulation are more
frequently used. Raised restrictions for spirits are less common than for TV but
are still used in five countries for print advertising and four for billboards most strikingly, while only Norway has a complete ban on print adverts for
alcohol, a further three countries have bans specific to spirits (Finland, Poland
and Slovenia).
Sponsorship represents another way for alcohol producers and retailers to link
brands to attractive lifestyles (see Chapter 7). However, sponsorship controls
have tended to be slightly less widespread than those for television advertising,
with only seven countries having any legal restrictions on sports sponsorship
together with voluntary restrictions in a further five. Legal controls over youth
event sponsorship are even less likely, being adopted only in six countries
(Finland, France, Norway, Poland, Latvia, and Switzerland). In both cases, the
EU is more likely to have some policy than the rest of the world but less likely
to have legal restrictions, particularly complete bans.
TAX AND PRICE
Tax is a particularly hard policy to compare across countries due to the
complexity in how it is calculated, as well as the difficulties in comparing
monetary values across different contexts. To get around this, three methods
have been used:
1.
The rates in Euros (€) were calculated for a ‘standard’ strength of each
drink
type. 9 The tax levels shown are for a given amount of alcohol
rather than for the original beverage (i.e. for one hectolitre of pure alcohol hlpa - rather than for a bottle of wine) - which enables the tax on alcohol
itself to be compared.
2.
These figures were converted to ‘purchasing power parity (PPP)’ to take
into account the different costs in different countries, thereby giving a truer
comparison of the impact of the tax on each country’s citizens.
3.
Finally, the WHO report asked country representatives around the world for
the alcohol-specific tax expressed as a percentage of the shop retail price.
These data are less reliable and only cover 14-19 EU countries (depending
on the beverage), but allow an analysis of how the EU relates to the rest of
the world.
CONCLUSION
Alcohol policy in Europe shows some striking similarities between countries but also a number of continuing differences. For example, while all European
countries have a set of policies relating to alcohol, sometimes these are
uncoordinated and lacking an overarching strategy. Areas where the countries
are relatively similar include blood alcohol limits for drivers, licences for
alcohol sales, the existence of a minimum age at which alcohol can be
purchased in bars, and some form of alcohol education in schools. In contrast,
wide differences can be seen in the enforcement of drink-driving regulations
(where large numbers in several countries believe they will never be
breathalysed), the exact age at which young people can buy alcohol (particularly
in shops), limits on availability, and advertising restrictions. Most of all, the tax
rates in different European countries show an enormous variation, with the
lowest rates found in southern and parts of central and eastern Europe. Despite
this, it should be noted that there is not a simple north-south gradient in the
strictness of alcohol policy, as seen by the high score in France and relatively
low policy scores in Ireland and the UK. Controls on the availability of alcohol
have declined over the second half of the 20th century, which some have argued
is associated with the growth of consumerism (Lund, Alavaikko, and Osterberg)
Tax levels compared to alcohol prices are also lower in Europe than the rest of
the world, a finding that must also be put in the context of the internal market
policies. And while many effective policies to reduce harm are widespread in
the EU today, there remain many situations where alcohol-related harm could
be clearly reduced through the widespread implementation of policies that are
adopted in the majority of the EU Member States.
However, it is equally important to highlight the positive trend of alcohol
policy in Europe overall. Drink-driving controls in particular are now
commonplace, in contrast to their relative rarity 50 years ago. To a lesser extent,
a number of other policies have also diffused widely within Europe including
marketing controls, minimum ages to buy alcohol, and public policy structures
to deliver alcohol policy - all of which are possibly partially related to public
attitudes to alcohol policy, although more research is needed in this area. And
on a collective level, EU Member States are considerably closer in their alcohol
policies than they were half a century ago, paralleling the harmonization in
drinking levels discussed in Chapter 4. It is within this trend of improvement
that the gaps should be seen, and worked upon in a positive light.
INDIA
Alcohol consumption has been steadily increasing in developing countries like
India and decreasing in developed countries since the 1980s. The pattern of
drinking to intoxication is more prevalent in developing countries indicating higher
levels of risk due to drinking. 62.5 million alcohol users estimated in India
Per capita consumption of alcohol increased by 106.7% over the 15-year period
from 1970 to 1996.Due to its large population, India has been identified as the
potentially third largest market for alcoholic beverages in the world which has
attracted the attention of multi national liquor companies.
Sale of alcohol has been growing steadily at 6% and is estimated to grow at the
rate of 8% per year. About 80% of alcohol consumption is in the form of hard
liquor or distilled spirits showing that the majority drink beverages with a high
concentration of alcoholBranded liquor accounts for about 40% of alcohol
consumption while the rest is in the form of country liquor.
People drink at an earlier age than previously . The mean age of initiation of
alcohol use has decreased from 23.36 years in 1950 to 1960 to 19.45 years in 1980
to 199O.India has a large proportion of lifetime abstainers (89.6%). The female
population is largely abstinent with 98.4% as lifetime abstainers. This makes India
an attractive business proposition for the liquor industry.
Changing social norms, urbanization, increased availability, high intensity mass
marketing and relaxation of overseas trade rules along with poor level of
awareness related to alcohol has contributed to increased alcohol use.
Taxes generated from alcohol production and sale is the major source of revenue in
most states (Rs.25,000 crores) and has been cited as a reason for permitting alcohol
sale. Four states - Gujarat, Mizoram, Manipur and Nagaland - have enforced
prohibition.Profile of clients in addiction treatment centers in 23 states (including
states with prohibition) showed that alcohol was the first or second major drug of
abuse in all except one state.
Revenue generated by alcohol
Large amount of revenue is generated from sale of alcohol. Yet, the hidden,
cumulative costs of health care, absenteeism and reduced income levels related to
heavy alcohol use are higher. These costs were estimated to be 60% more than the
revenue generated in a study from Karnataka.
Work place:
■ Twenty percent of absenteeism and 40% of accidents at work place are related to
alcohol.
• Annual loss due to alcohol was estimated to be Rs.70 000 to 80 000 million .hr a
public enterprise, number of workplace accidents reduced to lesser then one fourth
of the previous levels after alcoholism treatment.
Family:
■ Eighty five percent of men who were violent towards their wives were frequent
or daily users of alcohol. More than half of the abusive incidents were under the
influence of alcohol. An assessment showed that domestic violence reduced to one
tenth of previous levels after alcoholism treatment.
• 3 to 45 % of household expenditure is spent on alcohol. Use of alcohol increases
indebtedness and reduces the ability to pay for food and education.
• Alcohol abuse leads to separations and divorces and causes emotional hardship to
the family. The emotional trauma cannot be translated in terms of money but the
impact it has on quality of lives is significant.
Alcohol Laws in India
The alcohol law in India is well -defined regarding sale and consumption of
alcohol. It is believed that the laws vary from state to state and it is prohibited in
states of Mizoram, Nagaland, Manipur and Gujarat, and also, in Union Territories
of Lakshadweep.
Legal Drinking Age
The legal drinking ages in India vary between 18-25 years. In India, people are
considered mature enough to drive and vote when they turn 18, but the legal
drinking age largely varies from state to state. In western state of Maharashtra, a
person is legally considered as eligible for having hard core drinks like vodka, rum,
and whisky until he turns 25, whereas he can start with beer at 18. However, the
minimum drinking age in Indian states of Haryana and Meghalaya are also the
same. In West Bengal, Andhra Pradesh and Tamil Nadu, you can are eligible to
buy a drink at the age of 21. In Goa, Kerala, Uttar Pradesh and Karnataka, you are
eligible to buy a drink at 18 years. This diversity in alcohol laws are largely based
on the cultural landscape of the land. Legal experts debate that the effects of age
prohibitions are never judged in many of the Indian states, which has contributed
to rise in young alcohol drinkers.
Drink Driving Law in India
The BAC limits are fixed at 0.03 %. Any person whose BAC values are detected
more than this limit is booked under the first offense. A person may have to shell
out about Rs. 2000, or he or she may have to spend at the most 6 months in jail. If
a second offense is committed within 3 years of the first then a person may have to
face a jail imprisonment of about 2 years or he or she may have to shell out three
thousand rupees. Sometimes they have to face the both. Despite such stricter drink
driving law, authorities acknowledge that many times they find it difficult to
restrict and make the offenders to follow the law. The offenders tend to slip out by
finding loop holes in the law.
Alcoholic Advertisements
The alcohol based advertisements are banned in India as per the Cable Television
Network (Regulation) Amendment Bill, which was legalized on September 8,
2000. The government is very particular against broadcasting such advertisements
in its channel Doordarshan, whereas some of the satellite channels still broadcast
the alcohol advertisements.
Over the last few years Ministry of Social Justice and Empowerment have done
their bit to counteract the alcohol consumption. The Ministry has combined with
various other likeminded government and non-govemment organizations to spread
awareness about dangers of alcohol amongst youngsters and other adults indulged
in it.
Dry Days
Dry Days are specific days when the sale of alcohol is banned. Most of the Indian
states observe dry days on major religious festivals/occasions depending on the
popularity of the festival in that region. Dry days may also depend on the
establishment selling alcohol. For example, generally 5-star hotels do not have to
observe all the dry days that smaller bars may have to. Dry Days are fixed by the
respective state government. These dry days are observed to maintain peace and
order during the festival days. Dry days are also observed on and around voting
days.
On dry days, sale and supply of liquor will be suspended meaning thereby all
wholesalers will not make the supply of liquor and all the retail vendors will
remain closed. However, service of liquor in licensed bars, hotels, clubs and
restaurants is permissible even on dry days except on three national holidays. On
the national holidays, even L-20 / L-49A licenses are not granted. These are special
temporary licenses granted for service of liquor in parties/functions. These licenses
may however, be granted on other dry days. Even on the three national holidays,
liquor can be served by the hotels provided they have obtained L-3 license. L-3
licence allows hotels to serve liquor to the residents of their rooms.
There is no ban for service of liquor by anyone at his residence provided the liquor
served is authorized and is within the permissible limits.
Conclusion
Drinking and driving is already a serious public health problem, which is likely to
emerge as one of the most significant problems in the near future. Some database
& research evidence in India is available already, which along with the
international evidence be adequate for “preventive action”, while the research &
documentation is encouraged, specifically action research.
Strategies for prevention require to be inter-sectoral and multidisciplinary action
plan-based. The various strategies for preventive action are seen as a “cascade of
strategies”, starting with implementation, through development of consensus,
amendments to enactment of new laws.
Singapore
Alcohol law in Singapore is very strict and the country exercises stricter laws in
terms of public conduct. According to recent statistics, Singapore tops the list of
countries with low crime rates and it is partly due to strict alcohol and drug abuse
law. Consumption or mere purchase of alcohol is not permitted to anyone below
the age of 18. People who are found creating pandemonium in the public places
under the influence of alcohol are subjected to heavy imprisonment of about three
months and hefty fines are imposed too. Read through the blog to get familiar with
the alcohol law in Singapore.
There are also strict laws regarding importing alcohol into the country. Only the
alcohol which is meant for personal consumption is allowed to be imported into the
country. A person has to pay hefty tax of $9.00 per liter of alcohol with 15% of
alcohol.
Legalized Drinking Age and Related Problems
As indicated before, the legalized drinking age in Singapore is 18 years and anyone
found violating the laws is punished severely. Despite all this the government is
worried about the cases of drink abuses reported amongst the minors. According to
some private blogs and articles every year hundreds of minors are admitted to
hospital due to heavy drinking. Authorities believe that heavy restrictions related to
drinking alcohol are driving the teenagers to go wayward. Experts believe that
desensitizing alcohol will help to reduce underage drinking tendencies in
teenagers. There are many organizations in Singapore like MADD, Mother Against
Drink Driving, which forces the youngsters to seek parental permission before
drinking. But instances have been reported when such youngsters who often seek
parental permission show tendencies for heavy drinking.
Some reports suggest that binge drinking tendencies have increased among
women. Frequent drinking incidents have been reported amongst women below the
age of 18 and between the ages of 30-49. Also, reports suggest that due to stricter
laws regarding alcohol consumption and due to various other reasons the
tendencies for binge drinking has escalated amongst Singaporean population.
Also, the cases of unrecorded alcohol consumption in Singapore have been traced
to 1 .0 liter pure alcohol for a population above the age of 15 years since 1995.
BAC Limits
In Singapore the BAC limits are 0.08%. The drunk driving is considered a noncompoundable offense in Singapore. Also, the law applies same for everyone, no
matter who you are but punishment will be the same and harsher too. If you are
caught driving under the influence of alcohol at the first instance then you may
have to cough up $5000 or languish for 6 months in prison along with the
humiliation of surrendering your license.
If you are a second time offender then you might be fined upto $10,000 with the
imprisonment which lasts for a year and for the same time period your license will
also be revoked. Subsequently the punishments will get harsher. If you are
committing the offense for the third time then there are chances that you have to
cough up $30,000 and 3 years of imprisonment. Also, the offenders involved in
drunken driving accidents leading to death and serious accidents can be caned up
to 6 strokes.
Hong Kong
Alcohol laws of Hong Kong are consistent with most common law jurisdictions, but sale of alcohol is
more liberal than other countries like Canada. It is strict when compared to China (prior to 2006) and
Macau where there is no legal drinking age.
Alcohol sales
Alcohol is available at licensed restaurants (any size), bars, clubs and many food
retailers (mostly supermarkets). The Liquor Licensing Board of Hong Kong is
responsible for licensing of alcohol serving establishments.
For consumption on-premises
The sale of liquor on a premises for consumption on that premises is not subject to
any restriction on sale hours unless a special condition limiting hours is imposed
by the Liquor Licensing Board on the liquor licence Cap 109 B laws of Hong Kong
reg 17.
There are further restrictions if the premises are employing persons under the
drinking age therein as to when they can work. —There is no age restriction on
drinking at at private residence or on drinking age at locations that are not the
subject ofliquor licenses. No licensee shall permit any person under the age of 18
years to drink any intoxicating liquor on any licensed premises - under Regulation
28.
Drinking age
No licensee shall permit any person under the age of 18 years to drink any
intoxicating liquor on any licensed premises, this is the primary legislation in Hong
Kong under the DUTIABLE COMMODITIES (LIQUOR) REGULATIONS that
speaks to the age at which a person may consume liquor in a premises that is the
subject of a liquor licence: there are no other age restrictions on liquor
consumption in Hong Kong however some retailers do limit sale of liquor at shops
by age; others do not. There is no obligation on retailers to refuse to sell liquor to a
person on the grounds of age.
Drunk driving
The law against what is.known as drink driving, impaired driving in Hong Kong is
strictly enforced. Hong Kong's maximum blood alcohol level (BAL) is 55 mg of
alcohol per 100 ml of blood, or 0.22 mg alcohol per litre breath alcohol content
(BrAC)
With effectfrom 9 February 2009, police officers in uniform can require a person
who is driving or attempting to drive a vehicle on a road to conduct a breath test
without the needfor reasonable suspicion. In the new random breath test
operations, the Police will use pre-screening devices to conduct the test to reduce
delay and inconvenience to drivers.
Fines for drivers found impaired:
• Maximum fine of HK$25,000 and imprisonment for 3 years
• Disqualification from driving for not less than 3 months on first conviction
and not less than 2 years on second or subsequent conviction
• Mandated to attend a driving improvement course
• Incur 10 driving offence points
(The same penalty applies for failing to provide specimens for breath, blood or
urine tests without reasonable excuse).
- Media
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