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Tobacco and the developing world
Published In Prof'()l<
Bernard Lown, MD
The opium wars of the 21st century: Tobacco and the developing world
The opium wars of the 21st ceritry: Tobacco and the developing worldSince the 1964 report
of the Surgeon General's Advisory Committee on Smoking and Health 38 million adults in
the United States have quit smoking. (1) During the 1990's, the retreat of cigarette
companies has become a near rout in some industrialized countries. The tobacco industry,
quite to the contrary, is not on its knees nor about to surrender. Its long range global strategy
is to maintain sales roughly constant in industrialized countries, while investing mammoth
resources to increase market share in the Third World, in the former Soviet Union and in
Eastern Europe. The struggle against tobacco is not being won, it is being relocated. In the
past decade United States tobacco consumption dropped 17 percent while exports have
skyrocketed 259 percent. At present, the two American giants, Philip Morris and R.J.
Reynolds sell more than two thirds of their cigarettes overseas and half their profits come
from foreign sales. (2)
The tobacco wars of the next century will increasingly be waged among vulnerable
populations ill equipped to cope with the slick marketing techniques and the dirty tricks
perfected by the tobacco industry. Most developing countries have no advertising controls,
lack adequate health warning requirements, and have a dearth of pressure groups
campaigning for stricter tobacco controls. They have set no age limits, nor imposed
restrictions on smoking in public places. Their populations are poorly educated on the
health hazards nor is information being provided to the burgeoning numbers of teen-agers
who are most susceptible to advertising hype.
Tobacco already exacts an inordinate toll in the developing world. In Mexico, according to
the Center for Disease Control (CDC), death rate for all smoking related disease has
increased substantially, ranging in mortality increases of 60% for cerebrovascular disease to
220% for lung cancer. (3) In Brazil cigarette-related disease now leads infectious diseases as
the principal cause of death.(4) In Bangladesh, as a result of increased smoking, cancer of
the lung has become the third most common cancer among men and perinatal mortality is 270
per 1000 /children of smoking mothers-more than twice the rate for children of nonsmokers.
(4) In India, a six-fold increase in mortality from bronchitis and emphysema has been noted,
coincident with that country's skyrocketing cigarette consumption.(4,5 ) In developing
countries, not only is the use of tobacco surging, but the cigarettes are more addictive and
more lethal because of higher tar and nicotine content.
In Asia smoking is growing at the fastest rate in the world accounting for half of global
cigarette use . The largest number of recruits are among the young and women. (6) The
tobacco industry Ends the Asian market particularly inviting because of its size and the love
for smoking. In China 61 percent of men and 10% of women over 15 now smoke. These
320 million smokers consume 1.7 trillion cigarettes annually. While the Chinese account
for a third of all smokers world wide, as yet this lucrative market has not reached its potential
limit. The staggering health costs is a reckoning for the future. The Chinese Academy of
Preventive Medicine forecasts 3.2 million deaths annually by the year 2030. (7, 8)
The United States has played a key role in promoting the global consumption of tobacco.
More than a century ago the American tobacco magnate James B. Duke entered China. (9)
Until his arrival very few Chinese smoked, mostly older men using a bitter native tobacco.
usually in pipes. Duke hired "teachers", who traveled from village to village in Shantung
province, marketing a milder North Carolina tobacco leaf and instructing curious onlookers
how to light up and hold cigarettes. Duke installed the first mechanical cigarette-rolling
machine in China and unleashed a panoply of promotional materials, including cigarette
packs displaying nude American actresses. He set the precedent of having the United States
government pressure the Chinese to permit the import of American cigarettes.
Pushing deadly merchandise abroad if anything it has intensified in recent years. In 19S5
when US began its campaign to open Asian markets to tobacco exports, it shipped IS billion
cigarettes; by 1992 the figure had risen to 87 billion or nearly five-fold. The US government.
while discouraging smoking at home, successfully pressured Japan, Taiwan, South Korea and
Thailand into breaking their domestic tobacco monopolies to allow the sale of American
cigarettes.(6) These national monopolies did not advertise and sold cigarettes largely to
male adults. After US companies penetrated their markets smoking soared among young
people. Two years after the entry of American cigarettes in Japan, their import increased by
75 percent with 10-fold increase in the number of television advertisements to encourage
smoking. The US broke a healthy taboo against smoking by Japanese women. In but a few
years the number of women smokers more than doubled. (6, 10)
In a single year after the ban against American tobacco was lifted, smoking among Korean
teenagers rose from 18.4 to 29.8 percent and more than quintupled among female teens, from
1.6 to 8.7 per cent. (2) A poll among two thousand high school students in Taipei, Taiwan
indicated that 26% boys and 1% of girls smoked a cigarette. After American tobacco
companies entered their market in a survey of eleven hundred high school students, the
figures shot up to 48 percent of boys and 20 percent of girls. (6) Words like Marlboro.
Winston, Salem, and Kent have entered the vocabulary of every' Asian nation.
The American government engaged in activities that would have provoked outrage if carried
out in its own country. The US Trade representative refused the Taiwanese proposal not to
allow advertisement in magazines read primarily by teen-agers. (6) Tire Taiwanese were not
permitted to move the health warnings from the side to the front of the package nor increase
the type size, nor were they allowed to prohibit wending machine sales. An unconscionable
American trade imperialism fuels the rise in smoking. This prompted the former U.S.
Surgeon General, Dr. C. Everett Koop to say about his country, "People will look back on
this era of the health of the world, as imperialistic as anything since the British Empire-but
worse." (10).
Even without the exercise of government muscle on their behalf, the tobacco titans present a
formidable challenge to an unwary public. Tobacco promotion is pursued aggressively in less
developed countries, with advertising budgets for many countries surpassing national funds
appropriated for health research. The tobacco companies invest prodigious resources in
targeting women and children. According to a recent editorial in the New York Times, .
"Hong Kong is one of the battlefronts of the modem-day Opium War. While Britain went to
war last century to keep its Indian-grown opium streaming into Chinese pons, today
American tobacco companies win profits and build addiction throughout Asia." (11)
In Hong Kong, where American tobacco blends make up 94 percent of the market, hip
clothing stores pass out cigarettes free to their customers. Advertising is geared to the young
in Asia by sponsoring sporting events and pop concerts with free disco passes given out in
return for empty cigarette packs. The Marlboro bicycle tour is the biggest national summer
sport in the. Philippines. (5) Salem cigarettes sponsor a "virtual reality" dome, where
teenagers attack each other with laser guns. (12) Empty packs of American cigarettes can be
redeemed for tickets to movies, discos and concerts. In Kenya, cigarettes with brand names
such as Life and Sportsman are promoted as the passport to success, health, and a Western
lifestyle( 13). In Taiwan, most smokers prefer Long Life, Prosperin' Island, or New
Paradise.! 14)
The financial stakes are enormous. The international trade in tobacco is dominated by six
multinational conglomerates, three of which are based in the United States (Philip Morris. RJ.
Reynolds, and American Brands). Together, these six companies account for 40 percent of
the world cigarette production and almost 85 percent of the tobacco leaf sold on the world
tnarket.( 15) Since 1970, as American domestic smoking rates began to decline, intensive
marketing campaigns supported by vast governmental resources tripled America's export of
tobacco. Sales of Philip Morris in Africa is growing at 20% per year. It is projected that
international sales of Philip Morris will jump 16% in 1997 to 764 billion cigarettes with a
projection of 1 trillion by the year 2000. Foreign smoking is the major reason for the
profitability of Philip Morris with earnings of $6.3 billions in 1996. This company now ranks
third in profitability in the US behind Exxon and General Electric. By virtue of their great
wealth the tobacco conglomerates are a world power having more political clout than a
majority of developing nations.
From a public health perspective what is happening in the developing world is an
unprecedented calamity. We know but little of the full impact of smoking on malnourished
disease-ridden people. There is evidence that tobacco may interact synergistically with
infectious diseases and with environmental hazards to cause increases in certain cancers. For
example, tuberculosis which is widespread in developing countries, may enhance the risk of
lung cancer and is further amplified by smoking. (16)) In Egypt, Schistosoma haematobium
has been associated with an increased prevalence of bladder carcinoma among smokers (17)
In less-developed countries, poorly controlled occupational hazards, such as organic dusts.
uranium, or asbestos, may act as synergistic co-carcinogens in workers. (5) In addition, the
health costs of fires resulting from cigarette smoking in countries where dwellings are often
constructed of highly flammable materials is part of the tragic impact of tobacco.
The burden of disease due to tobacco is incalculable. Richard Peto and colleagues, (18)
suggest that by the year 2025 mortality ascribable to global tobacco use will exceed 10
million annually and about 70% of the deaths will be in the developing countries. Such
colossal mayhem is unprecedented in the annals of human barbarism. Cigarettes can not be
permitted as a trade weapon that wastes the lives of unwitting victims to enrich the coffers of
corporate America. The world has outlawed chemical weapons but tobacco is far more
deadly. United States health professionals have an awesome moral burden to speak out and
unrelentingly combat this global scourge, op
Bibliography
1.
The Surgeon General's 1990 report on the health benefits of smoking cessaction: executive
summan’ MMWR 1990;39(RR-12):l-10.
2.
Weissman R. Tobacco's global reach. The Nation. 1997; July 7, p 5.
3.
Death rate from leading causes of smoking related deaths have tripled since 1970 in
Mexico JAMA July 19, 1995 vol 274 p 208) During 1970-1990.
4.
Nath UR. Smoking in the Third World. World Health. June 1986:6-7.
5.
Yach D. The impact of smoking in developing countries with special reference to Africa.
Int J Health Sen 1986; 16:279-92.)
6.
Sesser S. Opium war redux. New Yorker Magazine. 1993;September 13, p 78-89.
7.
Faison S. China next in the war to depose cigarettes. New York Times August 27, 1997.
8.
Tomlinson B. China bans smoking on trains and buses. BMJ. 1997;314:772.
9.
Grayson R. Big tobacco has eyed china for a century. New York Times. Letters to Editor.
September 14. 1997
10.Jackson D.Z. US shouldn't help big tobacco sell its deadly wares abroad . Boston
Globe 199". May 16
11 .Editorial. New York Times . "Selling Cigarettes in Asia" 1997; Sept 10.
12.Barry M. The influence of the U.S. tobacco industry on the health, economy, and
environment of developing countries . Sounding Board NEJM 1991: 324:917-919.
13.Yach D. The impact of smoking in developing countries with special reference to Africa.
Int J Health Serv 1986; 16:279-92.
14.Jones D. Spotlight on Taiwan: foreign brands grab a big share. Tobacco Reporter. January
1989:324.
15.Connolly G. The intemationd marketing of tobacco. In: Tobacco Use in America
Conference. Houston, Texas, January 27-28, 1989. Chicago: American Medical Association.
1989:49-66.
16.
Willcox PA, Benatar SR. Potgieter PD. Use of the flexible fibreoptic bronchoscope in
diagnosis of sputum-negative pulmonary tuberculosis. Thorax 1982: 37:598-601.
Makhyoun
17.
NA. Smoking and bladder cancer in Egypt. Br J Cancer 1974; 30:577-8
18.
PetoR. Lopez AD, Boreham J, Thun M, Heath C Jr Mortality from tobacco in developed
countries: indirect estimation from national vital statisitics. Lancet 1992: 239:1268-78
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Dr. Armando Packer
Steering Committee
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fac a fi.uner.cdu.ar
Dr. Emilio Kuschnir
President
Scientific Committee
polofrizta arnet.com.ar
concafa unc.edu.ar
Worldwide trends in tobacco consumption and mortality
World Health Organization
TOBACCO: THE TWENTIETH CENTURY’S EPIDEMIC
Every ten seconds, somewhere in the world, tobacco kills another victim. If current
smoking trends continue, this toll will increase up to one tobacco-caused death every three
seconds over the next thirty to forty years.
Recent data have confirmed that the risks of smoking are substantially higher than previouslv
thought. With prolonged smoking, smokers have a death rate about three times higher than
nonsmokers at all ages from young adulthood. Tobacco products are known or probable
causes of over two dozen diseases or groups of diseases. If, as is likely, much of the excess
mortality from these diseases is directly attributable to tobacco use, then this implies that the
lifetime risk of a smoker being killed by the use of tobacco products is at least 50%.
Therefore, a lifelong smoker is as likely to die as a direct result of tobacco use as from all
other potential causes of death combined!
Other problems ensue because the negative health consequences of tobacco are not as
immediate as with other hazardous substances. The health risks of tobacco are vastly
underestimated by the public, and even by many of those who are responsible for protecting
and promoting public health. Yet the risks of smoking are very high when compared to other
risks faced in everyday life (See Table 1). Widespread underestimation of risks associated
with tobacco use. is a major reason why tobacco products are still widely available, and why
lenient tobacco policies have been allowed to occur. But nothing can alter the fact that
tobacco use is one of the major public health challenges facing the world as it enters the
twenty-first century.
TOBACCO USE IS A KNOWN OR PROBABLE CAUSE OF DEATH FROM:
Cancers of the:
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Lip, oral cavity and pharynx
Oesophagus
Pancreas
Larynx
Lung, trachea and bronchus
Urinary bladder
Kidney and other urinary organs
Cardiovascular diseases:
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Rheumatic heart disease
Hypertension
Ischaemic heart disease
Pulmonary heart disease
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Other heart diseases
Cerebrovascular diseases
Atherosclerosis
Aortic aneurysm
Other arterial diseases
Respiratory diseases:
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Tuberculosis
Pneumonia and influenza
Bronchitis and emphysema
Asthma
Chronic airway obstruction
Paediatric diseases:
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Low birth weight
Respiratory distress syndrome
Newborn respiratory conditions
Sudden infant death syndrome
Tobacco products have no safe level of consumption, and arc the only legal consumer
products that kill when used exactly as the manufacturer intends. Researchers have rated
nicotine as even more addictive than heroin, cocaine, marijuana or alcohol. The Tenth
Revision of the International Classification of Diseases reserves classification El7.2 for
"tobacco dependence syndrome". Yet tobacco products continue to be aggressively marketed
by tobacco companies. The result is that global tobacco consumption has doubled since
medical science conclusively proved, 30 years ago, that these products were unrivalled
killers. And consumption is still increasing in many areas of the world.
An analysis of trends in cigarette consumption for WHO regions indicates that the two
regions with the highest average per capita (adult) consumption in 1990-1992 were Europe
(2290 cigarettes per adult per year) and the Western Pacific (2000). The lowest consumption
was observed in the African Region (540). For the developed countries as a whole, per capita
adult consumption is currently about 2400 cigarettes, which is still significantly greater than
the average consumption in the developing world (1370 cigarettes).
The gap is rapidly narrowing, however. In 1970-1972, consumption per adult in the
developed countries was 3.25 times higher than in the developing world (see Figure 1). By
1980-1982, this ratio had narrowed to 2.38, and by 1990-1992, to 1.75. During the last
decade, per capita consumption has declined by an average of 1.4% per year in developed
countries, but has risen by 1.7% annually in developing countries. If these trends were to
continue, consumption of cigarettes per adult in the developing world will exceed levels in
the developed world some time between the years 2005 and 2010, i.e., within two decades.
There have been very noticeable differences in trends among WHO regions. Over the last
decade, the fastest decline in per capita consumption occurred in the Americas. Nor was this
entirely due to declines in consumption in Canada and the United States of America;
excluding those two countries, per capita consumption in the Region still declined by an
annual average of 1.7%. On the other hand, the increasing consumption in the Western
Pacific (2.2%) and South-East Asia (1.8%) is primarily due to the trends in China and India
respectively. From 1983, per capita (adult) consumption in China rose by 3.9% per year to
reach 1990 cigarettes in 1990-1992. In India, where about 90% of cigarettes are consumed in
the form of bidis (traditional hand-foiled cigarettes), adult consumption has risen by about
2% per year over the last decade and now exceeds 1200 cigarettes (including bidis).
WHO estimates that there are about 1100 million regular smokers in the world today. About
300 million (200 million males and 100 million females) are in the developed countries, and
nearly three times as many (800 million: 700 million males and 100 million females), in
developing countries. In developed countries, 41% of men are regular smokers, as are 21% of
women (see Figure 2). Half the men living in developing countries are smokers, compared
with about 8% of women.
The health consequences of the smoking epidemic in developed countries have been
quantified by WHO, in close collaboration with the Imperial Cancer Research Fund's Cancer
Studies Unit at the University of Oxford, UK. A major report giving detailed estimates of the
numbers and rates of smoking-attributed deaths for over 50 countries or groups of countries.
has been published. Between 1950 and 2000, it is estimated that smoking will have caused
about 62 million deaths in the developed countries (12.5 % of all deaths: 20% of male deaths
and 4% of female deaths). More than half of these deaths (38 million) will have occurred at
ages 35-69 years. Currently, smoking is the cause of more than one in three (36%) male
deaths in middle age, and about one in eight (13%) of female deaths. Each smoker who dies
in this age-group loses, on average. 22 years of life compared with average life expectancy.
During the 1990s, the report estimates that almost 2 million people a year will die from
smoking in developed countries (1.44 million men and 0.48 million women).
As regards cigarettes the health consequences of tobacco use are much more difficult to
estimate in developing countries owing to lack of data. Currently, it is estimated that tobacco
causes about 1 million deaths a year in developing countries, but there is substantial
uncertainty about this figure. If current trends continue, and if the risks of death from tobacco
use are similar in developing countries to those that have been observed in the industrialized
world, then the annual toll of mortality from tobacco will rise dramatically to around 7
million deaths per year in the 2020s or early 2030s (see Table 2). The chief uncertainty is not
whether, but rather when, these deaths will occur if current trends in tobacco use persist.
Table 2. Estimated number of Deaths caused every year by Tobacco
Developed countries
Developing countries
Total
Decade
1990s
Decades
2020s/early 2030s
2 million
1 million
3 million
3 million
7 million
10 million
pH-liUICC GLOBALink
The International Tobacco-Control Network Selected documents: The
Death Toll form Tobacco - A Crime Against Humanity
September 1998
Deaths caused by smoking
There are between 1.1 -1.4 billion smokers in the world out of a total population of around 5.8
billion. It has been estimated that 50% of smokers will die prematurely from tobacco related
illness, half in middle age (defined as 35 - 69 years of age) with an average loss of life expectancy
of 20 - 25 years (8 years over all ages).
This means that over half a billion people (in excess of 500 million) or about 10% of the existing
population will die from smoking. Of these. 27% will die from lung cancer, 24% will die from
heart disease, 23% will die from chronic obstructive lung disease, emphysema or bronchitis and
the remaining 26% will die from other diseases including other circulatory disease (18%) and
other cancers (8%).
Currently, 3 million people worldwide die every year from smoking related disease. This repre
sents about 1 person every ten seconds. One third of all people aged fifteen years and over smoke
and this proportion is increasing in Asia, Eastern Europe and the former Soviet States.
Consumption trends indicate that smoking prevalence is reducing in developed countries (DCs)
(down 1.5% per annum in the United States) whilst increasing in lesser-developed countries
(LDCs)(up 1.7% per annum on average).
The World Health Organisation (WHO) has estimated that, based on current trends, the death toll
from smoking will rise to 10 million peopleper year by the year 2025. Currently two million
deaths occur each year in developed countries and 1 million deaths occur each year in lesserdeveloped countries. By 2025 this proportion will alter to 3 million deaths per year in developed
countries and 7 million deaths per year in lesser-developed countries. No other consumer product
in the history of the world had come even close to inflicting this degree of harm on the world
community. If anything else posed a threat to life of this magnitude whether human induced or
naturally occurring - be it world war, genocide, ethnic cleansing, natural disaster or disease - it
would demand immediate international action. The response to HIV, the prosecution of war crimes
(both current and dating back to World War H), germ warfare, nuclear weapons or even climate
change are but a few examples.
The history of the smoking pandemic of the 20* century can be traced back to the invention of the
mechanical cigarette machine in the late 1 SOO’s. Until that time cigarettes were rolled by hand.
production was low and smoking was not overly prevalent. The cigarette machine meant that
millions of cigarettes could be produced each day at a lower cost and distributed more widely.
The result was that cigarette smoking increased such that by the late 1940’s smoking rates in
developing countries were up to 70% in aduh males and up to 25% in adult females. Smoking
rates in LDCs were significantly less.
From the discovery of the link between increased smoking and disease in the early 1950’s, and
major reports publicising the need for public health action, smoking rates among adult males in
developed countries has declined although prevalence in adult females increased to some degree
but now the levels are roughly equal at about 25% in many developed countries. Meanwhile,
smoking rates in lesser-developed countries has increased in both the adult male and adult female
population.
Due to the latency in the development of disease from smoking, the effects were first detected
among adult males in developed countries. The effect of increased smoking among adult females is
now being reflected in disease rates with similar observations in lesser-developed countries.
Hence the WHO estimates by the year 2025.
Transnational tobacco companies
Tobacco consumed by the world’s 1.1 -1.4 billion smokers is produced by a handful of
transnational tobacco companies and a number of state owned manufacturers. China’s state owned
production accounts for 31% of all tobacco sales with Italy, Russia, Japan, Taiwan, Indonesia and
Thailand, amongst other countries, having substantial government owned factories as well.
However, transnational tobacco companies account for 40% of the global market and control 70%
of world production, and this is increasing. In many cases, the state owned producer was a state
monopoly but. increasingly, this has been broken down through free trade agreements to a point
where transnational tobacco companies are not only marketing in countries previously the subject
of a state monopoly but there are reports of expressions of interest by transnational tobacco com
panies in obtaining an interest in formerly state owned monopolies now being privatised.
Whilst all tobacco consumption contributes to the overall death toll, state owned production is
arguably an internal matter to the nation - state in question. The activities of privately owned.
transnational tobacco companies is a matter on international concern. The major transnational
tobacco companies, in order of sales, are: US based Philip Morris Inc., followed by British based
BAT Industries p.l.c., United States based RJR Nabisco and Rothmans. Under agreements appar
ently reached among these transnational tobacco companies, Rothmans does not market in the
United States and BAT does not market in Britain. There are reports that Philip Morris and BAT
have entered into collusive agreements that fix cigarette prices and divide markets in South
.America (apparently such anti competitive arrangements are not illegal in those countries). It is a
mark of the power of the major transnational tobacco companies that they can reach such agree
ments dividing up markets in sovereign nations consequently inflicting the harm identified above.
In 1996. Philip Morris had annual revenues ofS55 billion, just over half from tobacco with the
rest coming from domestic and international food and alcohol sales. Only 18% was from domestic
tobacco sales (20% in 1992) compared with 35% from international sales (21% in 1992). Total
tobacco sales comprised 53% in 1996 (41% in 1992) or about 23 billion. BAT revenue in 1996
was S23 billion. RJR Nabisco had total revenues of SI 7 billion in 1996 of which 48% or about 8
billion was from tobacco sales. These massive levels of turnover and the economic, political and
social influence of the transnational tobacco companies has led to the industry being described
collectively as "Big Tobacco”. A comparison is made that these revenues exceed the gross domes
tic product of many countries. For example, Philip Morris has a turnover larger than the GDP of
Ecuador, Guatemala, Kenya, Kuwait, Malaysia and Peru. It is roughly the equi vent of Ireland.
Singapore or Hungary. RJR Nabisco’s turnover is roughly the equivalent of the GDP of Costa
Rica, Croatia, Cuba, El Salvador, Lebanon or Jamaica. Whilst these companies undoubtedly.have
significant economic, political and social influence, the fact remains (with all due respect to the
countries with which comparison is made), these transnational tobacco companies, either indi
vidually or collectively, are not an overwhelmingly dominant force on a world scale.
Deceit and duplicity of the tobacco industry
The current status of the tobacco industry is anomalous insofar as cigarette consumption clearly
inflicts a degree of mortality totally at odds with fundamental human rights and human values. At
the same time the tobacco industry defends itself on the basis that tobacco is a “legal product".
This occurred because the tobacco industry had already acquired a substantial degree of eco
nomic. political and social influence by the time the link between smoking and disease was estab
lished. Since that time the tobacco industry worldwide has engaged in a deliberate campaign of
deceit and duplicity to protect and even expand its influence through a process of denial and
disputation of the now proven link between smoking and disease, the addictive properties of
nicotine and their marketing strategies directed at youth.
This deceit and duplicity is currently being exposed by litigation in the United States which is
spreading worldwide. The position has now been reached where continued disputation and distor
tion is untenable, particularly in the face of the projected increase in tobacco deaths by the year
2025 if current trends are continued. This is all the more so given the disparity in the projected
increase between developed and less developed countries, reflecting an exploitation of lesser
developed countries which will only increase to offset liabilities the tobacco industry is incurring
in the United States. This is a circumstance calling for international action. It must not be allowed
to happen. Were it to occur it would be, without doubt, a crime against humanity.
Crimes against humanity in the International Criminal Court
On 17 July 1998 the United Nations Rome Statute of The International Criminal Court established
a permanent Court having power to exercise jurisdiction over persons for the most serious crimes
of international concern. Article 5 confersjurisdiction on the International Criminal Court with
respect to the following crimes:
1.
The crime of genocide;
2.
Crimes against humanity;
3.
War crimes;
4.
The crime of aggression.
5.
For the purposes of the Statute, Article 7 defines a “crime against humanity" to mean any of the
following acts when committed as part of a widespread or systematic attack directly against any
civilian population, with knowledge of the attack;
1.
Murder;
2.
Extermination;
3.
Enslavement;
4.
Deportation or forcible transfer of population;
5.
Imprisonment or other severe deprivation of physical liberty in violation of fundamental
rules of international law;
6.
Torture;
7.
Rape, sexual slavery, enforced prostitution, forced pregnancy, enforced sterilisation, or any
other form of sexual violence of comparable gravity;
8.
Persecution against any identifiable group or collectively on political, racial, national
ethnic, cultural, religious, gender as defined in paragraph 3, or other grounds that are
universally recognized as impermissible under international law, in connection with any
act referred to in this paragraph or any crime within the jurisdiction of the Court;
9.
10.
11.
Enforced disappearance of persons:
The crime of apartheid;
Other inhumane acts of a similar character intentionally causing great suffering, or serious
injury to body or to mental or physical health.
Given what is known about smoking and disease and the deceit and duplicity of the tobacco
industry, were the death toll from tobacco to increase from 3 million a year to 10 million a year by
the year 2025, especially with the dramatic increase in lesser developed countries from 1 million
a year to 7 million a year, it is impossible to describe that consequence as anything other than the
result of an inhumane act of a character similar to murder, causing great suffering, or serious injury
to body or to mental or physical health committed as part of a widespread or systematic attack
directed against the civilian population of the world.
Given that the directors and executives of the major transnational tobacco companies must now
have knowledge of the consequences of their activities, if those activities continue then each and
every one of them must face the prospect ofbeing charged with committing a crime against human
ity in the International Criminal Court. Article 11 of the Statute provides that the Court has juris
diction only with respect to crimes committed after the entry and the force of the Statute. This
means that the opportunity exists for these directors and executives to escape liability under the
provisions of the Statute providing there is no increase in mortality from tobacco use. Arguably
they should be responsible for a reduction. Given the likely increase in mortality from past smok
ing. because of the latency of tobacco related disease, every effort would need to be made to
reduce consumption in order to avoid a significant increase in the current death toll. Certainly
expansion in lesser-developed countries should not occur. As a means of securing this outcome.
each of the major transnational tobacco companies, and each of their directors and executives.
should formally be put on notice of the consequences of their activities such that charges of a crime
against humanity can be laid and successfully prosecuted if radical action is not taken to reverse
current trends.
NEIL FRANCEY
Barrister at Law
Wentworth Chambers
180 Philip Street
Sydney 2000
AUSTRALIA
Globalization and Increasing Trend of Alcoholism *
I.
Introduction
Although alcohol consumption has existed in India for many centuries, the quantity
patterns of use, and resultant problems have undergone substantial changes over
the past two decades. Alcohol consumption produces individual health and social
problems. The global burden of disease from alcohol exceeds that of tobacco and is
on a par with the burden attributable to unsafe sex world wide (Global Status
Report on alcohol, WHO, 1999). Although recorded alcohol consumption per
capita has fallen since 1980 in most developed countries, it has risen steadily in
developing countries and alarmingly so in India. The per capita consumption of
alcohol by adults of 15 years and above in India increased by 106.67 percent
between 1970-72 and 1994-96!
2.
Alcohol industry
Based on beverage type the Indian alcohol industry has three prominent sectors:
The IMFL (Indian Made Foreign Liquor) and beer sector, the country liquor sector,
and the illicit liquor sector. The IMFL and beer sector is the most visible part of the
alcohol Industry, with a few large companies with multiple production units and
nation wide marketing networks. These companies control much of the market.
They have been present in India for several decades and have established several
brand names regionally or nationally. These companies aggressively advertise and
promote their brands and their corporate identities, and constantly monitor and
protect their products'and market shares. They are also cash rich, since profit
margins are high in this industry.
Beginning in 1992 under liberalized industrial laws, some Indian alcohol
companies developed collaborative ties with international corporations. Joint
ventures have been established to use local production capacity to manufacture
international brands under a technology transfer and licensing system. These joint
ventures have served a dual purpose: they have brought international alcohol
brands to India, and they have utilized the existing production and marketing
strengths of Indian Industry. Hence they have been mutually supportive. Nearly all
of the major transnational alcohol companies now have a presence in India and
many internationally popular brands of whisky and beer have become available.
The upper middle and higher socioeconomic classes now purchase these ‘famous’
brands locally rather than having to cany these back from trips to other countries
or to buy them from illegal importers. The price of these products remains high,
but since they carry high social prestige value, there is good demand in this
premium range.
With liberalization and globalization, foreign liquor has become freely available.
The IMFL and beer industry spends much effort and money to promote and
advertise their brands. Since direct advertisement of liquor was
not permitted in the print and electronic media, the industry has found methods to
advertise indirectly (Saxena, 1994). Alcohol brands arc advertised in the form of
same or similarly named other products (e.g. mineral water, soda, and playing
cards) made by the same company. The advertisements
"Compiled by Mr. S D Rajendran, Community Health Cell for the Asia Social Forum, 2'“' - 1"' January 21)1)3,
Hyderabad. India.
display the alcohol product prominently. In addition, beverage ads have become
common on satellite cable television beamed to India from neighboring countries.
IMFL and beer producers also financially sponsor major sporting events that attract
sustained media attention, including live television coverage of the event. With its
new international linkages, the Indian alcohol industry has also got into the
entertainment and fashion world. It is now common for a liquor company to
sponsor a fashion show or musical event. Hence the Indian IMFL and beer industry
has initiated a high level of sustained marketing and promotional activities and
these have become especially aggressive in the 1990s.
The Indian alcohol industry produces a large amount of revenue for the
government. It has been estimated that direct collections of excise and sales tax,are
approximately USS 5 billion per year for the country as a whole. In Karnataka, it is
approximately Rs. 2400.00 crores per year. States derive as much as 25% of
money from alcohol sales for their annual budget. Besides the generation of legal
revenues for the government, the alcohol industry is thought to create an
approximately equal sum in “black money” that takes the form of bribes,
protection payments and profits from illicit alcohol. This gives the alcohol industry
enormous political power and clout, which may be used to help influence and
maintain government policies ‘beneficial’ to the industry but harmful to the people.
Studies indicate that the losses borne by household, states and the nation out weigh
financial gains.
Table 1: Annual Distilled Spirits Production in India, by Year (April to March)
Year
1982-83
1983-84
1984—85
1985-86
1986-87
1987-88
1988-89
1989-90
1990-9 r
1991-92
1992-93
1993-94
1994-95
1995-96
AMOUNT
OF
ABSOLUTE
ALCOHOL
PRODUCED (IN THOUSANDS HECTOLIRES)
2862.55
3104.75
______________________ 3310.64______________________
______________________ 3407.49______________________
______________________ 3204,80_____________
3432.48
_______________________ 4190.45______________________
No dala available
No data available
4895.00
3467.00
3626.00
_________ 6056,00_______
7888.04
1
Source: Alcohol and Public Health in 8 developing countries, WHO, Geneva, 1999.
3.
Alcohol - Related Problems
It is probable, given equal amounts of drinking, that developing countries like
India experience more problems than developed countries (Saxena, 1997). Among
the reasons for this may be such things as a highly skewed distribution of drinkers
in the society, the prevalence of nutritional and infectious diseases, economic
deprivation, more hazardous and accident-prone physical environments, and lack
of any organised support system. Although conclusive scientific evidence for
alcohol related health and social problems is lacking for India, there are enough
2
indications in the available literature to infer that these are substantial. Women’s
sanghas participating in a women health empowerment training in several districts
in Karnataka have consistently said that (he biggest problem they face relate to
alcohol abuse. Community health groups in different parts of the country also
recognize the importance of the problem. The rapid rise in alcohol consumption in
recent years has increased the likelihood of further growth of the following health
problems in the years to come.
3.1
3.2
Health problems include
o
Cirrhosis of the liver and premature death
•
Cardiomyopathy
•
•
°
•
•
•
o
Cancer of the upper gastrointestinal tract
Pancreatitis
Cognitive impairment or neuropsychiatric disorders
Road traffic accidents and injuries
Nutritional deficiencies and infections
HIV infections and STD
Hypertension
SOCIAL PROBLEMS
Excessive drinking produces a variety of closely inter related social problems in
India. For ease of description these have been divided into the following broad
categories.
3.2.1 Violence and Crime
Violence within and outside the home is frequent in India and a substantial
proportion of it is alcohol - related. Wife beating and child abuse under the
influence of alcohol are common, and street brawls and group violence happen
often after drinking
3.2.2
/Yorkpla ce effects
Heavy drinking affects work performance in a number of negative ways. When
compared to their sober counterparts, drinkers are more frequently absent, are less
efficient, have more accidents at work, and also show maladjustment with other
workers which leads to over all decreased performance.
3.2.3
Economic Effects
While alcoholic beverages are less expensive in India, their purchase may still
require a substantial portion of a poor persons meager income. With one in three
people in India falling below the poverty line, the economic consequences of
expenditures on alcohol attain special significance. Besides money spent on
alcohol, a heavy drinker also suffers other adverse economic effects. These include
reduced wages (because of missed work and lowered efficiency on the job),
increased medical expanses for illness and accidents, legal cost of drink-related
offences, and decreased eligibility of loans. Most individuals with severe alcohol
dependence find it difficult to reduce their expenditure on drink, and hence their
families often must do without essential necessities. Although the overall economic
effect of alcohol use at the national level has not been estimated, it is likely that it
represents a substantial proportion of India’s national income.
Family Effects
3.2.4
Excessive drinking by one or more family member results in several negative
consequences for others in the family, especially for the wife and children of a
male drinker. These effects are particularly serious for poor families. As has been
mentioned above, much of the family income may be used to buy alcohol, wages
may decline, and the drinker may eventually lose his job. In such situation the wife
and children arc forced into work, often in low paid, hazardous jobs. Children may
be unable to continue their schooling and may also suffer from nutritional
deficiencies because there is not enough to eat at home. Wife and child battering
are common, which lead to physical and mental trauma. Failure of the man to use
contraceptive methods often leads to unwanted pregnancies, further increasing
family size. These factors contribute towards greater poverty, often Io the point of
destitution.
Strong family tics and social disapproval of divorce save many of these families
from a formal breakdown, but the prevalence of intermittent or prolonged iniirihil
separation, as well as suicide, in heavy drinking families is high. Problems faced
by wives of alcoholic men have been studied scientifically by Gamhat cl al. (1983),
but the many descriptive accounts by the lay press offer more vocal testimony of
these phenomena. Wives of alcoholic men show a high degree of depression
(Devaret al., 1983) and of suicide (Ponnudurai & Jayakar, 1980)
4.
Govt, of India Response
Govt, qf India should seriously think about the alarmingly increasing alcohol
related problems and work towards developing a clear-cut and comprehensive
Alcohol Policy.
The Indian Charter on Alcohol should be adopted with the following principles.
which would be agreed upon by all the health ministries of the States:
1.
All people have the right to a family, community and working life
protected from accidents, violence and other negative consequences of
alcohol consumption.
2.
All people have the right to valid impartial information and education,
starting early in life, on the consequences of alcohol consumption on
health, the family and society.
3.
All the children and adolescents have the right to grow up in an
environment protected from the negative consequences of alcohol
consumption and, to the extent possible, from the promotion of alcoholic
beverages.
4.
All people with hazardous or harmful alcohol consumption and members
of their families have the right to accessible treatment and care.
5.
All people who do not wish to consume alcohol, or who cannot do so for
health or other reasons, have the right to be safeguarded from pressures to
drink and be supported in their non - drinking behavior.
National Master Plan
5.
The government of India formed an expert committee in 1986 to develop a
comprehensive strategy for reduction of both supply and demand of all substances
of abuse, including alcohol. The details of the master plan and its position on
alcohol - related issues are not yet available. Again Govt, of India should review
(he National Master Plan and revise it for up to date condition. This plan should be
implemented through Primary Health Centres and through health workers. Il
should contain the following broad areas:
Training to PHC doctors and Health Workers
Raise awareness of the effects of alcohol in rural areas
Arrange community based dc-addiction treatment involving family members
and the community
4.
Proper after care should be provided with the family and community support
5.
Introduce Life Skills programme in high schools to increase the ability of
young people to meet the needs and challenges of every day life and avoid high
risk behaviors
6.
Provide and / or expand meaningful alternatives to alcohol and drug use and
increase education, training and networking among community development
workers ad organisations.
1.
2.
3.
In monitoring and implementing the above plan, the local NGOs and community
action groups should be encouraged to participate fully.
6.
Conclusion
Globalisation is based on commercial interests, which want to increase the
consumption of alcohol. They promote the expansion of drinking into new social
context and situations. Their central perspective is that of the market, seeing
developing countries as ‘emerging markets’. Drinking is shown as a symbol of
‘cosmopolitan outlook’. European and North American life styles are presented
glamorously and attractively. We have to counter them. Globalisation has brought
in global methods of manufacture, distribution, advertisements and promotion of
alcohol consumption. We have to adopt or adopt global strategics to reduce alcohol
consumption and its ill effects on the health and social life of our people. While
interventions for primary prevention and community health based approaches arc
required along side medical deaddiction approaches, it is imperative that socitil
movements also address the broader policy aspects and economic underpinnings of
the problem.
Towards Tobacco Control in a Globalised Economy
The 21st century witnessed the world markets being thrown open to free trade rules, raising alarming
consequences especially to the developing world. Nevertheless, it worked to the benefit of certain interest
groups in the market, one of the prominent among them being the tobacco industry.
The form, nature and the magnitude of the tobacco industry varies from country to country. But globalisation,
has primarily given them all access to the global market, thereby expanding their business territories and areas
of operation.
The Multinational Tobacco Industry
Tobacco industry today spans across seas, with companies like Philip Morris (PM), British American Tobacco
(BAT) and Japan Tobacco expanding its horizons way beyond their countries of origin. These cigarette majors
have managed to take their brands to remote comers of the world either through large buyouts of domestic
tobacco companies or by opening up subsidiaries and branches. For example, in India, Philip Morris holds 41%
shares in Godfrey Philips (popular for their Four Square brand) and BAT holds 31.4% shares in Indian Tobacco
Company (ITC). Thailand stands out for its resistance in 1995 to the US Trade Representative trying to force
open its market to the US tobacco companies.
The political links of tobacco companies are no secret. Philip Morris has been the largest contributor of
unregulated political donations in the last two federal elections in the US1. Considering the leading role-played
by the US in the global economy, it is but strategic for tobacco corporations to maintain political influence in the
US. In 1995, the company capitalising its dose assodation with high political offices drafted a law on growing,
manufacturing and advertising of tobacco which was later approved by the Lithuanian government2. Thus,
tobacco trade has moved on from being a token of goodwill between kings to that which dictates the world
order. What is wrong about building a billion-dollar business that boosts the world economy?
The true color of the industry
Tobacco is the only consumer product, which if consumed as per the manufacturer's instructions kills
half of its life-long users;
Tobacco industry has known about the harmful effects of tobacco for more than 30 years but
intentionally opted to keep its consumers in the dark about it
c)
Besides inflicting 44-odd illnesses in human beings, tobacco poses serious threat to the environment;
d)
Tobacco depletes national reserves by way of high medical costs for treating tobacco-related diseases
e)
Tobacco is more addictive than cocaine or marijuana thereby robbing its user of the freedom to decide
to continue or discontinue its use.
a)
b)
Magnitude of the Tobacco Menace
According to World Health Organisation (WHO), 4 million people die globally from tobacco-related illnesses
every year. This is more than the combined global death toll from HIV, Tuberculosis, maternal mortality,
homicide, alcohol, suicide and automobile accidents put together 3. WHO projects that by 2030, the global
tobacco death toll would rise to 10 million and 70 % of these deaths would occur in poor developing countries.
In India, tobacco kills more than 8 lakh persons every year. If current trends continue, 250 million children alive
today will be killed by tobacco4.
1 From research conducted by the Center for Responsive Politics, Washington, D.C. www.opensecrets.org
2 INFACT survey by Tomas Stanikas, Kaunas Medical Academy, Lithuania, presented at the 10tb World Conference on
Tobacco or Health, Beijing, August 1997.
3 Hoard, Barnum. “The Economic Burden ofthe Global Trade in Tobacco," Paper presented at the 9lh World Conference
on Tobacco or Health. October 1994.
4 C.J. Murray and A.D. Lopez, Eds. The Global Burden of Disease: A Comprehensive Assessment of Mortality and
Disabilityfrom Disease, Injuries and Risk Factors in 1990 and Projected to 2020 (Cambridge MA: Harvard School of
Public Health, 1996).
Youth are favorite target of the tobacco industry. Tobacco companies use aggressive advertising geared
towards getting the children addicted at an early age so that they remain tobacco users for a lifetime. This is in
dear violation of the commitments the countries from the region have made under the UN Convention on the
Rights of the Child, which guarantees right to life, survival and development of a child.
Scientific studies have shown that Tobacco has been proven to cause cancer of the lungs, mouth and throat,
breast, urinary bladder and cervix. Smoking is a leading cause for Peripheral Vascular Disease, which could
eventually lead to amputation of limbs and even early death. A cigarette smoker has two to three times the risk
of having a heart attack or a stroke compared to a non-smoker. Smokeless tobacco users are more likely to
develop cancers of the lip, tongue, and floor of the mouth, cheek and gum than non-users.
Non-smokers who are exposed to tobacco smoke at home, have a 25 per cent increased risk of heart diseases
and lung cancer. WHO estimates that 700 million, or almost half of the world's children, breath air polluted by
tobacco smoke, particularly at home. Children of smoking parents are more prone to respiratory tract infections
such as bronchitis, pneumonia, cot death, middle ear diseases and asthma attacks5.
Tobacco production costs the environment dearly. In 66 tobacco-growing countries of the world, 4.6% of
national deforestation is due to cutting of trees for curing tobacco and for building curing bams. Around 6-8
kilograms of wood are required to cure 1 kilogram of tobacco. Trees are also cut to produce paper for wrappiric^k
cigarettes and for packaging of tobacco products. In Thane district in Maharashtra (India), vast acres of forest^
land is deared to procure "katha", an ingredient of the indigenous tobacco products Gutkha and pan masala
from the bark of Khaire trees6. Smoking causes an estimated 10 % of the global deaths from fire. Disposal of
the butts, packs, and cartons of tobacco products produces much trash that workers in the US complain that
sweeping up cigarette butts causes them hours of extra work each month7.
Challenges Posed by Tobacco
Factors Influencing Demand For Tobacco And Feasible Solutions
Entrapping Advertising: Tobacco industry is the largest advertiser in the world. Obviously, they have to try
hard to sell their product against all its proven dangers to public health. In 1996, Philip Morris the world's
largest multinational cigarette company spent $3.1 billon advertising its tobacco and food products 8. In India,
approximately Rupees 400 crore is spent on tobacco ads every year. In Bangladesh, British American Tobacco
which owns controlling share of Bangladesh's former tobacco monopoly, spent $ 3.4 million on brand
promotions and development in 1998.
With the growing restrictions on direct advertising of tobacco products world wide, the industry is evolving
dubious and unscrupulous marketing strategies to circumvent law. A quick look at these promos exposes thei^
tactic to hook young and fresh consumers to their products through indirect means (ike brand stretching and
sponsoring youth programmes such as sports and cultural meets. The industry has always opposed ad bans and
ingeniously suggests voluntary restrictions, which have proven to be ineffective in other countries. In a recent
study involving 22 high-income countries it was revealed that where most comprehensive advertising
restrictions were in place, tobacco consumption had fallen by 6 %9.
Package Advertising: Tobacco companies for decades have been effectively using the tobacco package space
as an excellent advertising media. Countries like Canada, Brazil and European Union have realised the power of
package advertising and have made it mandatory to display pictorial health messages on tobacco packs. The
5 Report of the Scientific Committee on Tobacco and Health. Department of Health, UK, 1998.
6 “Dawood is diversifying into Gutkha", Bombay Times, 04/12/2000.
’Novotny &Zhao 1999.
8 R. Hammond. Tobacco Advertising and Promotion: The Needfor a Co-ordinated Global Response. Geneva: World
Health Organisation. 2000
9 P. Jha & FJ. Chaloupka. Curbing the Epidemic,Govemments and the Economics ofTobacco Control. Washington. 1999.
2
Canadian experience as revealed in a recent survey has been that 44 % of smokers said that the new warning
increased their motivation to quit and among those attempted to quit in 2001, 38% cited the warnings as a
motivating factor. 35 percent of smokers and 34 percent of nonsmokers said they know more about the health
effects of smoking than they did before the new warnings 10.
Tobacco & Poverty: Researchers from Bangladesh and India report that tobacco use further impoverishes
poor-income households. In a recent survey conducted among 400 pavement dwelling families in Mumbai,
India, the poor spend more on purchasing tobacco than on nutritious food like meat, milk, fruits or egg11.
Similarly, among the poor income households in Bangladesh a typical male smoker spends 5 times as much on
cigarettes as the per capita expenditure on housing, 18 times as much as for health and 20 times as much as
for education12. Obviously, tobacco reduces the purchasing capacity of the poor to procure basic life needs.
Affordability : Increasing tax is a feasible strategy to reduce accessibility and affordability especially among
income-sensitive groups. This should be a popular strategy among the Governments as it brings additional
revenue to the Government exchequer..
Increasing taxes, increases smuggling" is the typical industry line of argument. However, it has been found that
increase in contraband and smuggling arises out of poor low enforcement and customs regulations rather than
from tax increases.
Sale of loose tobacco products also accentuates the tobacco consumption especially among the price-sensitive
groups.
Rights and Awareness: Addictive as tobacco is, it robs its user of the power to choose to continue or
discontinue its use. In doing so, it deprives the consumer of the basic right to choose. Tobacco companies hide
information about the harmful effects of their products thereby denying the consumers the right to information
based on which they could otherwise make an "informed choice". Children's rights to life, survival and
development are jeopardized in terms of reduced access to health and education from increasing tobacco
expenses incurred by adults in the family. They are choked from passive smoking, which the adults in their
environment are unmindful of.
Issues related to the Supply of Tobacco
The tobacco industry perpetually whips up farmers' associations and unions creating fear that tobacco control
would lead to massive unemployment in the tobacco production sectors. However, economists Jha & Chaloupka
(1999) who have done extensive macro analysis of tobacco producing economies allay these fears13.
They opine that the negative effects of tobacco control on employments have been grossly overstated. While
there would be no net loss of jobs, there might even be job gains if global tobacco consumption fell. This is
because money spent on tobacco would be spend on other goods and services thereby generating more jobs.
Even in economies heavily dependent on tobacco, aid adjustment, crop diversification, rural training and other
safety net systems would take care of the problem.
Even in countries with comprehensive tobacco control policies, tobacco consumption reduces at best by 1 %.
With increasing population in most of the developing countries it would be a while before there would be any
considerable impact on tobacco production, giving farmers sufficient time to diversify into alternate avenues.
10 Research by Canadian Cancer Society on the Effectiveness of Pictorial Health Warnings. 2001.
11 S. John, S. Vaite & D. Efroymson. Tobacco and Poverty: Observationsfrom India and Bangladesh. PATH Canada.
October 2002.
12 D. Eforymson & S. Ahmed. Hungry for Tobacco. Work for a Better Bangladesh. 2001.
13 P. Jha & F.J. Chaloupka. Curbing the Epidemic, Governments and the Economics ofTobacco Control. Washington.
1999.
3
A recent study conducted among tobacco farmers in Karnataka, one of the leading tobacco producing States in
India, reveals that diversification to alternate livelihood is a feasible option for those engaged In various tobacco
production avenues. Tobacco farmers have been found to suffer from several occupational health hazards and
complain of perpetual state of poverty and debts14.
Envisaging future decline in bidi smoking, Kerala Dinesh Bidi, the largest co-operative society in Asia launched
its diversification efforts into food processing and other consumer products. In the first three years of
diversification, 15 out of the 30 products have been reported to be breaking even15.
Another major argument leveled against diversification is that with these efforts countries would cease to
receive the tax they are currently getting from tobacco taxes. This is a fallacy. In India, for instance, the
Government revenue from tobacco is way below what it spends on treating tobacco-related illnesses.
Also, with tobacco users reducing its consumption in response to tobacco control measures, it is likely that they
would invest in other consumer products. This would lead to development of other sectors of the economy and
thus contribute to overall national growth.
Framework Convention on Tobacco Control (FCTC)
In 1998, the World Health Organisation invoked its prerogative to propose an international tobacco contra^
treaty named Framework Convention on Tobacco Control to contain the global tobacco epidemic. This firs^
global public health treaty addresses transnational issues pertaining to tobacco advertising, smuggling,
packaging, testing and reporting of toxic constituents, environmental tobacco smoke and resource sharing.
The treaty is currently moving towards the final stages of its negotiation by 190 odd Member Nations of WHO in
the last and sixth round of negotiation scheduled for Mid February 2003. It is slated to be adopted by World
Health Assembly in May 2003.
The treaty is significant for the Asian countries, primarily in resisting the tobacco industry which considers us
the prime target in this decade. It serves as a booster to build national tobacco control policies and
programmes. The negotiations for the first time in the history of tobacco control movement, has brought
together people, Governments, NGOs, energy and resources from all over the world to address the tobacco
pandemic
Tobacco Control in Asia
In the last decade, several organisations in the region have initiated awareness programmes among children,
youth, women and workers as a prevention strategy. Some of them advocate strong tobacco control policies
home and abroad. In India, research and surveillance have been carried out on different population groups
their tobacco control patterns.
Thailand has advanced tobacco control programmes and policies. India has of late proposed the Tobacco
Products Bill, banning tobacco advertising, promotions and smoking in public places among others. Bangladesh
and Nepal are also drafting national policies to contain the tobacco epidemic.
In the recent years, tobacco control activists have realised the power of collective strength and have formed
networks and coalitions at local and national levels. The Consortium for Tobacco Free Karnataka, Indian
Coalition for Tobacco Control, Bangladesh Anti Tobacco A' snce, South Asia Tobacco Control Forum and South
East Asia Tobacco Control Alliance, Framework Convention Alliance are a few of the active alliances in the
region.
I4S. John, S. Vaite & D. Efroymson. Tobacco and Poverty: Observations from India and Bangladesh. PATH Canada.
October 2002.
15 Ibid. Interview with Kerala Dinesh Bidi Office Bearers.
4
In 1998, World Health Assembly launched the drafting of an international treaty to address trans-national
tobacco control issues. The treaty, Framework Convention on Tobacco Control is currently is in the last stages
of its development, with over 150 world countries concluding its negotiations soon in Geneva. Countries and
organisations from the region play a vital role in demanding stringent tobacco control measures in this treaty.
Emerging Needs of Tobacco Control in Asia
Industry documents and operations reveal that they are now training their guns on Asia and Africa. Lack of
adequate tobacco control policies and failure in implementing the existing policies make all of us more
vulnerable to the attacks of these companies as also to tobacco epidemic. Illiterate masses and cultural
practices also seem to be hurdles in tobacco control in Asia. The emerging needs therefore for the region are:
a) Building awareness among the Asian people about the health and sodo-economic consequences of
tobacco use and trade
b) Exposing myths and cultural practices that promotes the habit
c) Training development workers and organization on tobacco control issues
d) Building networks and coalitions that would serve as pressure groups in policy advocacy
e) Engaging in active advocacy for tobacco control policies at national and regional level
f) Advocacy for effective implementation of FCTC commitments in the region
Possibilities for Collaboration
The issues involved in tobacco control demands a matching o-ordinated response from different sectors of the
dvil sodety. World Health Organisation responded to this global epidemic by setting up the Tobacco Free
Initiative in 1998, which in turn supports various global campaigns and programmes in tobacco control. It calls
upon the dvil sodety each year to observe 31st of May as the World No Tobacco Day.
Besides, there are various networks, coalitions and organizations already engaged in active tobacco control. If
you are further interested in learning or engaging in tobacco control issues, feel free to contact any of the
organisers of the event listed below:
Thelma Narayan, Community Health Cell
Consortium for Tobacco Free Karnataka
International Secretariat
People's Health Assembly
Email: sochara@vsnl.com.
Shoba John, PATH Canada
South East Asia Focal Point,
Framework Convention on Tobacco Control.
Member, Indian Coalition for Tobacco Control
Email: sjohn_pathcan@vsnl.net
Dr. Srinath Reddy
Professor of Cardiology, AIIMS.
Secretary,SHAN & HRIDAY, New Delhi
Email:info@hriday-shan.org
Naveen Thomas
Fellow, Oxfam India Trust
Email:navthom@vsnl.net
Paper prepared by:
Shoba John
PATH Canada, India.
January 2003
for Asia Social Forum
Workshop on "Working Towards Tobacco Control"
5
ACTION TOWARDS A TOBACCO FREE WORLD
A Workshop on Tobacco Control, Asia Social Forum, Hyderabad
Date: 3rd January, 2003
Time: 2:15 to 6:30 P.M.
Venue: Taj Mahal Hotel,
Abids Road,
Hyderabad - 01
Ph: 24758221
Facilitated by:
Community Health Cell, Bangalore on behalf of Jan Swasthya Abhiyan / People’s Health Movement
Partner Organizations
Indian Coalition for Tobacco Control
LIFE HRG
Consortium For Tobacco Free Karnataka
PATH-Canada
Introduction
This workshop will present a canvas of the entire range of activities and effects related to
tobacco production, supply, distribution, consumption, health, socio-economic spheres and the
environment. It would also include an overview of the tobacco control initiatives al the local,
Asian and global levels. Discussion will be held on working together and evolving strategies at
various levels for tobacco control.
Proposed Format of Workshop
2:15 to 2: 30 p.in.: Street Play on the Tobacco industry and its effects
Duration of the workshop: 4 hours
1 SI.
1 No.
*•
1
EVENT
Presentation on the following issues: An Introductory Overview
Chairperson: Dr. Ramesh Bilimaga
Welcome Note: Profile of Tobacco related issues in Asia/ India Dr.Thelma Narayan, CHC - An introduction to the Workshop.
DURATION
1 hr 10 mins
(2.30 - 3.40pm)
10 mins
Objective: To highlight the various aspects of the problem and to update participants on
the current situation
Magic show & Talking Doll Show on the ill effects of tobacco
• Tobacco control initiatives at various levels - Global, National :
- Mr. Sonam, Ministry of Health & Education, Bhutan
- Mr. Ratan Deb, BATA, Bangladesh,
- Dr. Prakash C Gupta, India)
State [ IMA, Karnataka Task Force, CFTFK - Mr Chander (CHC) ]
Objective: To inform participants about the ongoing initiatives in tobacco control and to
record our recognition of important innovative initiatives
45 mins
•
Clarifications / responses
15 mins
i 2.
People’s Health Celebration
Chairperson: Ms. Devaki Jain
• Felicitation of people/ groups who have made efforts for tobacco control in the
Asian region
• Cultural event (Song, Testimonies- Mr.Jaggaiah(Patient), Ms. Lalithamma (Ex
Tobacco Cultivator and Patient)
25 mins
(3.40-4.05pm)
Objective: To honour people who have made concerted efforts in tobacco control in their
local areas and to celebrate the spirit of working together.
TEA BREAK / EXHIBITION OF POSTERS
3.
Panel Discussion
Chairperson : Ms. Devaki Jain
• Panel Discussion
1. Epidemiological / Public Health Issues posed by Tobacco - Dr. Prakash C Gupte
2. FCTC* Update- Dr. Srinath Reddy
3. Socio-Economic Concerns Tobacco Raises and Exposing the Tobacco IndustryMs. Shoba John, PATH, Canada (India).
4. The Environment, Gender and Child Rights Issues around Tobacco Production Ms. Suvarna, Shimoga, Karnataka
15 mins
(4.05 -4.20pm)
1 hr 10 mins
(4.20 - 5.30pm)
50 mins
Objective: Analysis of the Social, Economic, Environmental & Health effects of tobacco;
Introduction to * Framework Convention for Tobacco Control (FCTC) and to introduce
the Challenges and Initiatives for action towards a tobacco control in Asia.
• Open House
4.
Objective: To provide an opportunity for the participants to seek clarifications and
participate in the discussion.
Group Work
Chairperson: Dr. Srinath Reddy
• Presentation of tentative ‘Workshop Statement’.
• Group discussion tentatively on:
a) What strategies to be adopted to work with Government and civil society at local.
national and international levels to advance tobacco control policy efforts?
b) How do we work with the media and various pressure groups (including
international groups) to advance tobacco control?
c) How do we mobilise community support towards advocating for policy changes as
well as to inititate and implement tobacco control programmes.
d) Discussion on the ‘Statement’ and possible modifications
Objective: To identify issues, evolve strategies and devise mechanisms for working
together in the future.
20 mins
30 mins
(5.30 - 6.00pm) |
30 mins
5.
I Concluding Session
30 mins
I Chairperson: Dr. Thelma Narayan (6.00 • 6.30pm)
• Presentations by the group , declaration of'Workshop Statement' and vote of
thanks.
30 mins
| Objective: To share the discussions of the group and discuss concrete follow-up plans.
Rapporteurs:
Mr. Naveen Thomas. Fellow, Oxfam GB
Dr. Prakash Vinjamuri. LIFE HRG
Dr.Anant Bhan, Fellow, CHC
There will be a poster exhibition; background papers, books and pamphlets from various regions in Asia will
be available at the venue. Nine banana carts from LIFE, a Hyderabad organisation involved in Health and
Nutrition Education will carry posters, flags and handbills celebrating tobacco control in different parts of
Hyderabad city, at the ASF and Youth Forum venue.
UICC GLOBALink
The International Tobacco-Control Network Selected documents: The
Death Toll form Tobacco - A Crime Against Humanity
September 1998
Deaths caused by smoking
There are between 1.1 -1.4 billion smokers in the world out of a total population of around 5.8
billion. It has been estimated that 50% of smokers will die prematurely from tobacco related
illness, half in middle age (defined as 35 - 69 years of age) with an average loss of life expectancy
of 20 - 25 years (8 years over all ages).
This means that over half a billion people (in excess of 500 million) or about 10% of the existing
population will die from smoking. Of these, 27% will die from lung cancer, 24% will die from
heart disease, 23% will die from chronic obstructive lung disease, emphysema or bronchitis and
the remaining 26% will die from other diseases including other circulatory disease (18%) and
other cancers (8%).
Currently, 3 million people worldwide die every year from smoking related disease. This repre
sents about 1 person every ten seconds. One third of all people aged fifteen years and over smoke
and this proportion is increasing in Asia, Eastern Europe and the former Soviet States.
Consumption trends indicate that smoking prevalence is reducing in developed countries (DCs)
(down 1.5% per annum in the United States) whilst increasing in lesser-developed countries
(LDCs)(up 1.7% per annum on average).
The World Health Organisation (WHO) has estimated that, based on current trends, the death toll
from smoking will rise to 10 million people per year by the year 2025. Currently two million
deaths occur each year in developed countries and 1 million deaths occur each year in lesserdeveloped countries. By 2025 this proportion will alter to 3 million deaths per year in developed
countries and 7 million deaths per year in lesser-developed countries. No other consumer product
in the history of the world had come even close to inflicting this degree of harm on the world
community. If anything else posed a threat to life of this magnitude whether human induced or
naturally occurring - be it world war, genocide, ethnic cleansing, natural disaster or disease - it
would demand immediate international action. The response to HIV, the prosecution of war crimes
(both current and dating back to World War II), germ warfare, nuclear weapons or even climate
change are but a few examples.
The history of the smoking pandemic of the 20'" century can be traced back to the invention of the
mechanical cigarette machine in the late 1 SOO’s. Until that time cigarettes were rolled by hand,
production was low and smoking was not overly prevalent. The cigarette machine meant that
millions of cigarettes could be produced each day at a lower cost and distributed more widely.
The result was that cigarette smoking increased such that by the late I940’s smoking rates in
developing countries were up to 70% in adult males and up to 25% in adult females. Smoking
rates in LDCs were significantly less.
From the discovery of the link between increased smoking and disease in the early 1950’s, and
major reports publicising the need for public health action, smoking rates among adult males in
developed countries has declined although prevalence in adult females increased to some degree
but now the levels are roughly equal at about 25% in many developed countries. Meanwhile,
smoking rates in lesser-developed countries has increased in both the adult male and adult female
population.
Due to the latency in the development of disease from smoking, the effects were first detected
among adult males in developed countries. The effect of increased smoking among adult females is
now being reflected in disease rates with similar observations in lesser-developed countries.
Hence the WHO estimates by the year 2025.
Transnational tobacco companies
Tobacco consumed by the world’s 1.1 -1.4 billion smokers is produced by a handful of
transnational tobacco companies and a number of state owned manufacturers. China's state owned
production accounts for 31% of all tobacco sales with Italy, Russia, Japan, Taiwan. Indonesia and
Thailand, amongst other countries, having substantial government owned factories as well.
However, transnational tobacco companies account for 40% of the global market and control 70%
of world production, and this is increasing. In many cases, the state owned producer was a state
monopoly but, increasingly, this has been broken down through free trade agreements to a point
where transnational tobacco companies are not only marketing in countries previously the subject
of a state monopoly but there are reports of expressions of interest by transnational tobacco com
panies in obtaining an interest in fonnerly state owned monopolies now being privatised.
Whilst all tobacco consumption contributes to the overall death toll, state owned production is
arguably an internal matter to the nation - state in question. The activities of privately owned.
transnational tobacco companies is a matter on international concern. The major transnational
tobacco companies, in order of sales, are: US based Philip Morris Inc., followed by British based
BAT Industries p.l.c., United States based RJR Nabisco and Rothmans. Under agreements appar
ently reached among these transnational tobacco companies, Rothmans does not market in the
United Stales and BAT does not market in Britain. There are reports that Philip Morris and BAT
have entered into collusive agreements that fix cigarette prices and divide markets in South
America (apparently such anti competitive arrangements are not illegal in those countries). It is a
mark of the power of the major transnational tobacco companies that they can reach such agree
ments dividing up markets in sovereign nations consequently inflicting the hann identified above.
In 1996. Philip Morris had annual revenues ofS55 billion, just over half from tobacco with the
rest coming from domestic and international food and alcohol sales. Only 18% was from domestic
tobacco sales (20% in 1992) compared with 35% from international sales (21% in 1992). Total
tobacco sales comprised 53% in 1996 (41% in 1992) or about 23 billion. BAT revenue in 1996
was S23 billion. RJR Nabisco had total revenues of SI 7 billion in 1996 of which 48% or about S
billion was from tobacco sales. These massive levels of turnover and the economic, political and
social influence of the transnational tobacco companies has led to the industry being described
collectively as “Big Tobacco”. A comparison is made that these revenues exceed the gross domes
tic product of many countries. For example, Philip Morris has a turnover larger than the GDP of
Ecuador, Guatemala, Kenya, Kuwait, Malaysia and Peru. It is roughly the equivent of Ireland,
Singapore or Hungary. RJR Nabisco’s turnover is roughly the equivalent of the GDP of Costa
Rica. Croatia, Cuba, El Salvador, Lebanon or Jamaica. Whilst these companies undoubtedly have
significant economic, political and social influence, the fact remains (with all due respect to the
countries with which comparison is made), these transnational tobacco companies, either individually or collectively, are not an overwhelmingly dominant force on a world scale.
Deceit and duplicity of the tobacco industry
The current status ofthe tobacco industry is anomalous insofar as cigarette consumption clearly
inflicts a degree of mortality totally at odds with fundamental human rights and human values. At
the same time the tobacco industry defends itself on the basis that tobacco is a “legal product".
This occurred because the tobacco industry had already acquired a substantial degree of eco
nomic. political and social influence by the time the link between smoking and disease was estab
lished. Since that time the tobacco industry worldwide has engaged in a deliberate campaign of
deceit and duplicity to protect and even expand its influence through a process of denial and
disputation of the now proven link between smoking and disease, the addictive properties of
nicotine and their marketing strategies directed at youth.
This deceit and duplicity is currently being exposed by litigation in the United States which is
spreading worldwide. The position has now been reached where continued disputation and distor
tion is untenable, particularly in the face of the projected increase in tobacco deaths by the year
2025 if current trends are continued. This is all the more so given the disparity in the projected
increase between developed and less developed countries, reflecting an exploitation of lesser
developed countries which will only increase to offset liabilities the tobacco industry is incurring
in the United States. This is a circumstance calling for international action. It must not be allowed
to happen. Were it to occur it would be, without doubt, a crime against humanity.
Crimes against humanity in the International Criminal Court
On 17 July 1998 the United Nations Rome Statute of The International Criminal Court established
a permanent Court having power to exercise jurisdiction over persons for the most serious crimes
of international concern. Article 5 confers jurisdiction on the International Criminal Court with
respect to the following crimes:
1.
The crime of genocide;
2.
Crimes against humanity;
3.
War crimes:
4.
The crime ofaggression.
5.
For the purposes ofthe Statute, Article 7 defines a “crime against humanity” to mean any of the
following acts when committed as part of a widespread or systematic attack directly against any
civilian population, with knowledge of the attack;
1.
Murder;
2.
Extermination;
3.
Enslavement;
4.
Deportation or forcible transfer of population;
5.
Imprisonment or other severe deprivation of physical liberty in violation of fundamental
rules of international law;
6.
Torture;
7.
Rape, sexual slavery, enforced prostitution, forced pregnancy; enforced sterilisation, or any
other form of sexual violence of comparable gravity;
8.
Persecution against any identifiable group or collectively on political, racial, national
ethnic, cultural, religious, gender as defined in paragraph 3, or other grounds that are
universally recognized as impermissible under international law, in connection with any
act referred to in this paragraph or any crime within the jurisdiction of the Court;
9.
10.
11.
Enforced disappearance of persons;
The crime of apartheid;
Other inhumane acts of a similar character intentionally causing great suffering, or serious
injury to body or to mental or physical health.
Given what is known about smoking and disease and the deceit and duplicity of the tobacco
industry, were the death toll from tobacco to increase from 3 million a year to 10 million a year by
the year 2025. especially with the dramatic increase in lesser developed countries from 1 million
a year to 7 million a year, it is impossible to describe that consequence as anything other than the
result.of an inhumane act of a character similar to murder, causing great suffering, or serious injury
to body or to mental or physical health committed as part <jf a widespread or systematic attack
directed against the civilian population of the world.
Given that the directors and executives of the major transnational tobacco companies must now
have knowledge of the consequences of their activities, if those activities continue then each and
every one of them must face the prospect ofbeing charged with committing a crime against human
ity in the International Criminal Court. Article 11 ofthe Statute provides that the Court has juris
diction only with respect to crimes committed after the entry and the force of the Statute. This
means that the opportunity exists for these directors and executives to escape liability under the
provisions of the Statute providing there is no increase in mortality from tobacco use. Arguably
they should be responsible for a reduction. Given the likely increase in mortality from past smok
ing. because of the latency of tobacco related disease, every effort would need to be made to
reduce consumption in order to avoid a significant increase in the current death toll. Certainly
expansion in lesser-developed countries should not occur. As a means of securing this outcome.
each of the major transnational tobacco companies, and each of their directors and executives,
should formally be put on notice of the consequences of their activities such that charges of a crime
against humanity can be laid and successfully prosecuted if radical action is not taken to reverse
current trends.
NEIL FRANCEY
Barrister at Law
Wentworth Chambers
180 Philip Street
Sydney 2000
AUSTRALIA
Worldwide trends in tobacco consumption and mortality
World Health Organization
TOBACCO: THE TWENTIETH CENTURY'S EPIDEMIC
Every ten seconds, somewhere in the world, tobacco kills another victim. If current
smoking trends continue, this toll will increase up to one tobacco-caused death every three
seconds over the next thirty to forty years.
Recent data have confirmed that the risks of smoking are substantially higher than previously
thought. With prolonged smoking, smokers have a death rate about three times higher than
nonsmokers at all ages from young adulthood. Tobacco products are known or probable
causes of over two dozen diseases or groups of diseases. If, as is likely, much of the excess
mortality' from these diseases is directly attributable to tobacco use, then this implies that the
lifetime risk of a smoker being killed by the use of tobacco products is at least 50"u.
Therefore, a lifelong smoker is as likely to die as a direct result of tobacco use as from all
other potential causes of death combined!
Other problems ensue because the negative health consequences of tobacco are not as
immediate as with other hazardous substances. The health risks of tobacco are vastly
underestimated by the public, and even by many of those who are responsible for protecting
and promoting public health. Yet the risks of smoking are very high when compared to other
risks faced in everyday life (See Table 1). Widespread underestimation of risks associated
with tobacco use. is a major reason why tobacco products are still widely available, and whylenient tobacco policies have been allowed to occur. But nothing can alter the fact that
tobacco use is one of the major public health challenges facing the world as it enters the
twenty-first century.
TOBACCO USE IS A KNOWN OR PROBABLE CAUSE OF DEATH FROM:
Cancers of the:
•
•
•
•
•
•
•
Lip, oral cavity and pharynx
Oesophagus
Pancreas
Larynx
Lung, trachea and bronchus
Urinary' bladder
Kidney and other urinary organs
Cardiovascular diseases:
•
•
•
•
Rheumatic heart disease
Hypertension
Ischaemic heart disease
Pulmonary heart disease
•
•
•
•
•
Other heart diseases
Cerebrovascular diseases
Atherosclerosis
Aortic aneurysm
Other arterial diseases
Respiratory diseases:
•
•
•
•
•
Tuberculosis
Pneumonia and influenza
Bronchitis and emphysema
Asthma
Chronic airway obstruction
Paediatric diseases:
•
•
•
•
Low birth weight
Respiratory distress syndrome
Newborn respiratory conditions
Sudden infant death syndrome
Tobacco products have no safe level of consumption, and are the only legal consumer
products that kill when used exactly as the manufacturer intends. Researchers have rated
nicotine as even more addictive than heroin, cocaine, marijuana or alcohol. The Tenth
Revision of the International Classification of Diseases reserves classification Fl 7.2 for
"tobacco dependence syndrome". Yet tobacco products continue to be aggressively marketed
by tobacco companies. The result is that global tobacco consumption has doubled since
medical science conclusively proved, 30 years ago, that these products were unrivalled
killers. And consumption is still increasing in many areas of the world.
An analysis of trends in cigarette consumption for WHO regions indicates that the two
regions with the highest average per capita (adult) consumption in 1990-1992 were Europe
(2290 cigarettes per adult per year) and the Western Pacific (2000). The lowest consumption
was observed in the African Region (540). For the developed countries as a whole, per capita
adult consumption is currently about 2400 cigarettes, which is still significantly greater than
the average consumption in the developing world (1370 cigarettes).
The gap is rapidly narrowing, however. In 1970-1972, consumption per adult in the
developed countries was 3.25 times higher than in the developing world (see Figure 1). By
1980-1982, this ratio had narrowed to 2.38, and by 1990-1992, to 1.75. During the last
decade, per capita consumption has declined by an average of 1.4% per year in developed
countries, but has risen by 1.7% annually in developing countries. If these trends were to
continue, consumption of cigarettes per adult in the developing world will exceed levels in
the developed world some time between die years 2005 and 2010, i.e., within two decades.
There have been very noticeable differences in trends among WHO regions. Over the last
decade, the fastest decline in per capita consumption occurred in the Americas. Nor was this
entirely due to declines in consumption in Canada and the United States of America;
excluding those two countries, per capita consumption in the Region still declined by an
annual average of 1.7%. On the other hand, the increasing consumption in the Western
Pacific (2.2%) and South-East Asia (1.8%) is primarily due to the trends in China and India
respectively. From 1983, per capita (adult) consumption in China rose by 3.9% per year to
reach 1990 cigarettes in 1990-1992. In India, where about 90% of cigarettes are consumed in
the form of bidis (traditional hand-rolled cigarettes), adult consumption has risen by about
2% per year over the last decade and now exceeds 1200 cigarettes (including bidis).
WHO estimates that there are about 1100 million regular smokers in the world today. About
300 million (200 million males and 100 million females) are in the developed countries, and
nearly three times as many (800 million: 700 million males and 100 million females), in
developing countries. In developed countries, 41% of men are regular smokers, as are 21% of
women (see Figure 2). Half the men living in developing countries are smokers, compared
with about 8% of women.
The health consequences of the smoking epidemic in developed countries have been
quantified by WHO, in close collaboration with the Imperial Cancer Research Fund's Cancer
Studies Unit at the University of Oxford, UK. A major report giving detailed estimates of the
numbers and rates of smoking-attributed deaths for over 50 countries or groups of countries.
has been published. Between 1950 and 2000, it is estimated that smoking will have caused
about 62 million deaths in the developed countries (12.5 % of all deaths: 20% of male deaths
and 4% of female deaths). More than half of these deaths (38 million) will have occurred at
ages 35-69 years. Currently, smoking is the cause of more than one in three (36%) male
deaths in middle age, and about one in eight (13%) of female deaths. Each smoker who dies
in this age-group loses, on average, 22 years of life compared with average life expectancy.
During the 1990s, the report estimates that almost 2 million people a year will die from
smoking in developed countries (1.44 million men and 0.48 million women).
As regards cigarettes the health consequences of tobacco use are much more difficult to
estimate in developing countries owing to lack of data. Currently, it is estimated that tobacco
causes about 1 million deaths a year in developing countries, but there is substantial
uncertainty about this figure. If current trends continue, and if the risks of death from tobacco
use are similar in developing countries to those that have been observed in the industrialized
world, then the annual toll of mortality from tobacco will rise dramatically to around 7
million deaths per year in the 2020s or early 2030s (see Table 2). The chief uncertainty is not
whether, but rather when, these deaths will occur if current trends in tobacco use persist.
Table 2. Estimated number of Deaths caused every year by Tobacco
Developed countries
Developing countries
Total
Decade
1990s
Decades
2020s/early 2030s
2 million
1 million
3 million
3 million
7 million
10 million
Tobacco and the developing world
■■iililhhi'il In l-mt I III
Bernard Lown, MD
The opium wars of the 21st century: Tobacco and the developing world
The opium wars of the 21st centry: Tobacco and the developing worldSincc the 1964 report
of the Surgeon General's Advisory Committee on Smoking and Health 38. million adults in
the United States have quit smoking. (1) During the 1990's, the retreat of cigarette
companies has become a near rout in some industrialized countries. The tobacco industry,
quite to the contrary, is not on its knees nor about to surrender. Ils long range global strategy
is to maintain sales roughly constant in industrialized countries, while investing mammoth
resources to increase market share in the Third World, in the former Soviet Union and in
Eastern Europe. The struggle against tobacco is not being won, it is being relocated. In the
past decade United States tobacco consumption dropped 17 percent while exports have
skyrocketed 259 percent. At present, the two American giants, Philip Morris and R..I.
Reynolds sell more than two thirds of their cigarettes overseas and half their profits come
from foreign sales. (2)
The tobacco wars of the next century will increasingly be waged among vulnerable
poptdations ill equipped to cope with the slick marketing techniques and the dirty tricks
perfected by the tobacco industry. Most developing countries have no advertising controls,
lack adequate health warning requirements, and have a dearth of pressure groups
campaigning for stricter tobacco controls. They have set no age limits, nor imposed
restrictions on smoking in public places. Their populations are poorly educated on the
health hazards nor is information being provided to the burgeoning numbers of teen-agers
who are most susceptible to advertising hype.
Tobacco already exacts an inordinate toll in the developing world. In Mexico, according to
the Center for Disease Control (CDC), death rate for all smoking related disease has
increased substantially, ranging in mortality increases of 60% for cerebrovascular disease to
220% for lung cancer. (.3) In Brazil cigarette-related disease now leads infectious diseases as
the principal cause of death.(4) In Bangladesh, as a result of increased smoking, cancer of
the lung has become the third most common cancer among men and perinatal mortality is 270
per 1000 /children of smoking molhcrs-more than twice the rate for children of nonsmokers.
(4) In India, a six-fold increase in mortality from bronchitis and emphysema has been noted,
coincident with that country's skyrocketing cigarette consumption.(4,5 ) In developing
countries, not only is the use of tobacco surging, but the cigarettes are more addictive and
more lethal because of higher tar and nicotine content.
In Asia smoking is growing at the fastest rate in the world accounting for half of global
cigarette use . The largest number of recruits are among the young and women. (6) The
tobacco industry finds the Asian market particularly inviting because of its size and the love
for smoking. In China 61 percent of men and 10% of women over 15 now smoke. These
320 million smokers consume 1.7 trillion cigarettes annually. While the Chinese account
for a third of all smokers world wide, as yet this lucrative market has not reached its potential
limit. The staggering health costs is a reckoning for the future. The Chinese Academy of
Preventive Medicine forecasts 3.2 million deaths annually by the year 2030. (7, 8)
The United States has played a key role in promoting the global consumption of tobacco.
More than a century ago the American tobacco magnate James B. Duke entered China. (9)
Until his arrival very few Chinese smoked, mostly older men using a bitter native tobacco.
usually in pipes. Duke hired "teachers", who traveled from village to village in Shantung
province, marketing a milder North Carolina tobacco leaf and instructing curious onlookers
how to light up and hold cigarettes. Duke installed the first mechanical cigarette-rolling
machine in China and unleashed a panoply of promotional materials, including cigarette
packs displaying nude American actresses. He set the precedent of having the United States
government pressure the Chinese to permit the import of American cigarettes.
Pushing deadly merchandise abroad if anything it has intensified in recent years. In 1985
when US began its campaign to open Asian markets to tobacco exports, it shipped 18 billion
cigarettes; by 1992 the figure had risen to 87 billion or nearly five-fold. The US government.
while discouraging smoking at home, successfully pressured Japan, Taiwan. South Korea and
Thailand into breaking their domestic tobacco monopolies to allow the sale of American
cigarettes.(6) These national monopolies did not advertise and sold cigarettes largely to
male adults. After US companies penetrated their markets smoking soared among young
people. Two years after the entry of American cigarettes in Japan, their import increased by
75 percent with 10-fold increase in the number of television advertisements to encourage
smoking. The US broke a healthy taboo against smoking by Japanese women. In but a few
years the number of women smokers more than doubled. (6, 10)
In a single year after the ban against .American tobacco was lifted, smoking among Korean
teenagers rose from 18.4 to 29.8 percent and more than quintupled among female teens, from
1.6 to 8.7 per cent. (2) A poll among two thousand high school students in Taipei, Taiwan
indicated that 26% boys and 1% of girls smoked a cigarette. After American tobacco
companies entered their market in a survey of eleven hundred high school students, the
figures shot up to 48 percent of boys and 20 percent of girls, (6) Words like Marlboro.
Winston, Salem, and Kent have entered the vocabulary' of every Asian nation.
The American government engaged in activities that would have provoked outrage if carried
out in its own country. The US Trade representative refused the Taiwanese proposal not to
allow advertisement in magazines read primarily by teen-agers. (6) The Taiwanese were not
permitted to move the health warnings from the side to the front of the package nor increase
the type size, nor were they allowed to prohibit wending machine sales. An unconscionable
American trade imperialism fuels the rise in smoking. This prompted the former U.S.
Surgeon General, Dr. C. Everett Koop to say about his country, "People will look back on
this era of the health of the world, as imperialistic as anything since the British Empire-but
worse." (10).
Even without the exercise of government muscle on their behalf, the tobacco titans present a
formidable challenge to an unwary public. Tobacco promotion is pursued aggressively in less
developed countries, with advertising budgets for many countries surpassing national funds
appropriated for health research. The tcbacco companies invest prodigious resources in
targeting women and children. According to a recent editorial in the New York Times,
"Hong Kong is one of the baltlefronts of the modern-day Opium War. While Britain went to
war last century' to keep its Indian-grown opium streaming into Chinese ports, today
American tobacco companies win profits Sd build addiction throughout Asia." (11)
In Hong Kong, where American tobacco blends make up 94 percent of the market, hip
clothing stores pass out cigarettes free to their customers. Advertising is geared to the young
in Asia by sponsoring sporting events and pop concerts with free disco passes given out in
return for empty cigarette packs. The Marlboro bicycle tour is the biggest national summer
sport in the Philippines. (5) Salem cigarettes sponsor a "virtual reality" dome, where
teenagers attack each other with laser guns. (12) Empty packs of American cigarettes can be
redeemed for tickets to movies, discos and concerts. In Kenya, cigarettes with brand names
such as Life and Sportsman are promoted as the passport to success, health, and a Western
lifestylef 13). In Taiwan, most smokers prefer Long Life. Prosperity Island, or New
Paradise.(14)
The financial stakes are enormous. The international trade in tobacco is dominated by six
multinational conglomerates, three of which are based in the United States (Philip Morris, RJ.
Reynolds, and American Brands). Together, these six companies account for 40 percent of
the world cigarette production and almost 85 percent of the tobacco leaf sold on the world
market.(15) Since 1970, as American domestic smoking rates began to decline, intensive
marketing campaigns supported by vast governmental resources tripled America's export of
tobacco. Sales of Philip Morris in Africa is growing at 20% per year. It is projected that
international sales of Philip Morris will jump 16% in 1997 to 764 billion cigarettes with a
projection of 1 trillion by the year 2000. Foreign smoking is the major reason for the
profitability of Philip Morris with earnings of S6.3 billions in 1996. This company now ranks
third in profitability in the US behind Exxon and General Electric. By virtue of their great
wealth the tobacco conglomerates are a world power having more political clout than a
majority of developing nations.
From a public health perspective what is happening in the developing world is an
unprecedented calamity. We know but little of the full impact of smoking on malnourished
disease-ridden people. There is evidence that tobacco may interact synergistically with
infectious diseases and with environmental hazards to cause increases in certain cancers. For
example, tuberculosis which is widespread in developing countries, may enhance the risk of
lung cancer and is further amplified by smoking. (16)) In Egypt, Schistosoma haematobium
has been associated with an increased prevalence of bladder carcinoma among smokers (17)
In less-developed countries, poorly controlled occupational hazards, such as organic dusts.
uranium, or asbestos, may act as synergistic co-carcinogens in workers. (5) In addition, the
health costs of fires resulting from cigarette smoking in countries where dwellings are often
constructed of highly flammable materials is part of the tragic impact of tobacco.
The burden of disease due to tobacco is incalculable. Richard Peto and colleagues, (18)
suggest that by the year 2025 mortality ascribable to global tobacco use will exceed 10
million annually and about 70% of the deaths will be in the developing countries. Such
colossal mayhem is unprecedented in the annals of human barbarism. Cigarettes can not be
permitted as a trade weapon that wastes the lives of unwitting victims to enrich the coffers of
corporate America. The world has outlawed chemical weapons but tobacco is far more
deadly. United States health professionals have an awesome moral burden to speak out and
unrelentingly combat this global scourge, op
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17.
Makhyoun NA. Smoking and bladder cancer in Egypt. Br J Cancer 1974; 30:577-8
IS.PetoR. Lopez AD, Boreham J, Thun M, Heath C Jr Mortality from tobacco in developed
countries: indirect estimation from national vital statistics. Lancet 1992: 239:1268-78
Dr. Armando Pacher
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Tobacco and the developing world
I’liblhlicd In
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Bernard Lown, MD
The opium wars of the 21st century: Tobacco and the developing world
The opium wars of the 21st centry: Tobacco and the developing WOrldSince the 1964 report
of the Surgeon General's Advisory Committee on Smoking and Health 38 million adults in
the United States have quit smoking. (1) During the 1990's, the retreat of cigarette
companies has become a near rout in some industrialized countries. The tobacco industry,
quite to the contrary, is not on its knees nor about to surrender. Its long range global strategy
is to maintain sales roughly constant in industrialized countries, while investing mammoth
resources to increase market share in the Third World, in the former Soviet Union and in
liastem Europe. The struggle against tobacco is not being won, it is being relocated. In the
past decade United States tobacco consumption dropped 17 percent while exports have
skyrocketed 259 percent. At present, the two American giants, Philip Morris and R..J.
Reynolds sell more than two thirds of their cigarettes overseas and half their profits come
from foreign sales. (2)
The tobacco wars of the next century will increasingly be waged among vulnerable
populations ill equipped to cope with the slick marketing techniques and the dirty tricks
perfected by the tobacco industry. Most developing countries have no advertising controls,
lack adequate health warning requirements, and have a dearth of pressure groups
campaigning for stricter tobacco controls. They have set no age limits, nor imposed
restrictions on smoking in public places. Their populations are poorly educated on the
health hazards nor is information being provided to the burgeoning numbers of teen-agers
who are most susceptible to advertising hype.
Tobacco already exacts an inordinate toll in the developing world. In Mexico, according to
the Center for Disease Control (CDC), death rale for all smoking related disease has
increased substantially, ranging in mortality increases of 60% for cerebrovascular disease to
220% for lung cancer. (3) In Brazil cigarette-related disease now leads infectious diseases as
the principal cause of death.(4) In Bangladesh, as a result of increased smoking, cancer of
the lung has become the third most common cancer among men and perinatal mortality is 270
per 100(1 /children of smoking mothcrs-morc than twice the rate for children of nonsmokers.
(4) In India, a six-fold increase in mortality from bronchitis and emphysema has been noted,
coincident with that country's skyrocketing cigarette consumption.(4,5 ) In developing
countries, not only is the use of tobacco surging, but the cigarettes are more addictive and
more lethal because of higher tar and nicotine content.
In Asia smoking is growing at the fastest rate in the world accounting for half of global
cigarette use . The largest number of recruits are among the young and women. (6) The
tobacco industry finds the Asian market particularly inviting because of its size and the love
for smoking. In China 61 percent of men and 10% of women over 15 now smoke. These
320 million smokers consume 1.7 trillion cigarettes annually. While the Chinese account
for a third of all smokers world wide, as yet this lucrative market has not reached its potential
limit. The staggering health costs is a reckoning for the future. The Chinese Academy of
Preventive Medicine forecasts 3.2 million deaths annually by the year 2030. (7, 8)
The United States has played a key role in promoting the global consumption of tobacco.
More than a century ago the American tobacco magnate James B. Duke entered China. (9)
Until his arrival very few Chinese smoked, mostly older men using a bitter native tobacco.
usually in pipes. Duke hired "teachers", who traveled from village to village in Shantung
province, marketing a milder North Carolina tobacco leaf and instructing curious onlookers
how to light up and hold cigarettes. Duke installed the first mechanical cigarette-rolling
machine in China and unleashed a panoply of promotional materials, including cigarette
packs displaying nude American actresses. He set the precedent of having the United States
government pressure the Chinese to permit the import of American cigarettes.
Pushing deadly merchandise abroad if anything it has intensified in recent years. In 19S5
when US began its campaign to open Asian markets to tobacco exports, it shipped IS billion
cigarettes; by 1992 the figure had risen to S7 billion or nearly five-fold. The US government.
while discouraging smoking at home, successfully pressured Japan, Taiwan, South Korea and
Thailand into breaking their domestic tobacco monopolies to allow the sale of American
cigarettes.(6) These national monopolies did not advertise and sold cigarettes largely to
male adults. After US companies penetrated their markets smoking soared among young
people. Two years after the entry of American cigarettes in Japan, their import increased by
75 percent with 10-fold increase in the number of television advertisements to encourage
smoking. The US broke a healthy taboo against smoking by Japanese women. In but a few
years the number of women smokers more than doubled. (6, 10)
In a single year after the ban against American tobacco was lifted, smoking among Korean
teenagers rose from 18.4 to 29.8 percent and more than quintupled among female teens, from
1.6 to 8.7 per cent. (2) A poll among two thousand high school students in Taipei, Taiwan
indicated that 26% boys and 1% of girls smoked a cigarette. After American tobacco
companies entered their market in a survey of eleven hundred high school students, the
figures shot up to 48 percent of boys and 20 percent of girls. (6) Words like Marlboro.
Winston. Salem, and Kent have entered the vocabulary' of every Asian nation.
The American government engaged in activities that would have provoked outrage if carried
out in its own country. The US Trade representative refused the Taiwanese proposal not to
allow advertisement in magazines read primarily by teen-agers. (6) The Taiwanese were not
permitted to move the health warnings from the side to the front of the package nor increase
the type size, nor were they allowed to prohibit wending machine sales. An unconscionable
American trade imperialism fuels the rise in smoking. This prompted the former U.S.
Surgeon General, Dr. C. Everett Koop to say about his country, "People will look back on
this era of the health of the world, as imperialistic as anything since the British Empire-but
worse." (10).
Even without the exercise of government muscle on their behalf, the tobacco titans present a
formidable challenge to an unwary public. Tobacco promotion is pursued aggressively in less
developed countries, with advertising budgets for many countries surpassing national funds
appropriated for health research. The tobacco companies invest prodigious resources in
targeting women and children. According to a recent editorial in the New York Times.
"Hong Kong is one of the batliefronts of rite modern-day Opium War. While Britain went to
war last century to keep its Indian-grown opium streaming into Chinese ports, today
American tobacco companies win profits nd build addiction throughout Asia." (11)
In Hong Kong, where American tobacco blends make up 94 percent of the market, hip
clothing stores pass out cigarettes free to their customers. Advertising is geared to the young
in Asia by sponsoring sporting events and pop concerts with free disco passes given out in
return for empty cigarette packs. The Marlboro bicycle tour is the biggest national summer
sport in the Philippines. (5) Salem cigarettes sponsor -a "virtual reality" dome, where
teenagers attack each other with laser guns. (12) Empty packs of American cigarettes can be
redeemed for tickets to movies, discos and concerts. In Kenya, cigarettes with brand names
such as Life and Sportsman are promoted as the passport to success, health, and a Western
lifestyle( 13). In Taiwan, most smokers prefer Long Life, Prosperity Island, or New
Paradise.(14)
The financial stakes are enormous. The international trade in tobacco is dominated by six
multinational conglomerates, three of which are based in the United States (Philip Morris. RJ.
Reynolds, and American Brands). Together, these six companies account for 40 percent of
the world cigarette production and almost 85 percent of the tobacco leaf sold on the world
market.(15) Since 1970, as American domestic smoking rates began to decline, intensive
marketing campaigns supported by vast governmental resources tripled America's export of
tobacco. Sales of Philip Morris in Africa is growing at 20% per year. It is projected that
international sales of Philip Morris will jump 16% in 1997 to 764 billion cigarettes with a
projection of 1 trillion by the year 2000. Foreign smoking is the major reason for the
profitability of Philip Morris with eamings of S6.3 billions in 1996. This company now ranks
third in profitability in the US behind Exxon and General Electric. By virtue of their great
wealth the tobacco conglomerates are a world power having more political clout than a
majority of developing nations.
From a public health perspective what is happening in the developing world is an
unprecedented calamity. We know but little of the frill impact of smoking on malnourished
disease-ridden people. There is evidence that tobacco may interact synergistically with
infectious diseases and with environmental hazards to cause increases in certain cancers. For
example, tuberculosis which is widespread in developing countries, may enhance the risk of
lung cancer and is further amplified by smoking. (16)) In Egypt, Schistosoma haematobium
has been associated with an increased prevalence of bladder carcinoma among smokers (17)
In less-developed countries, poorly controlled occupational hazards, such as organic dusts,
uranium, or asbestos, may act as synergistic co-carcinogens in workers. (5) In addition, the
health costs of fires resulting from cigarette smoking in countries where dwellings are often
constructed of highly flammable materials is part of the tragic impact of tobacco.
The burden of disease due to tobacco is incalculable. Richard Peto and colleagues, (18)
suggest that by the year 2025 mortality ascribable to global tobacco use will exceed 10
million annually and about 70% of the deaths will be in the developing countries. Such
colossal mayhem is unprecedented in the annals of human barbarism. Cigarettes can not be
permitted as a trade weapon that wastes ie lives of unwitting victims to enrich the coffers of
corporate America. The world has outlawed chemical weapons but tobacco is far more
deadly. United States health professionals have an awesome moral burden to speak out and
unrelentingly combat this global scourge, op
Bibliography
1.
The Surgeon General's 1990 report on the health benefits of smoking cessaction: executive
summary- MMWR 1990;39(RR-12): 1-10.
2. Weissman R. Tobacco's global reach. The Nation. 1997; July 7, p 5.
3. Death rate from leading causes of smoking related deaths have tripled since 1970 in
Mexico JAMA July 19, 1995 vol 274 p 208) During 1970-1990.
4. Nath UR. Smoking in the Third World. World Health. June 1986:6-7.
5. Yach D. The impact of smoking in developing countries with special reference to Africa.
Int J Health Serv 1986; 16:279-92.)
6. Sesser S. Opium war redux. New Yorker Magazine. 1993;September 13, p 78-89.
7. Faison S. China next in the war to depose cigarettes. New York Times August 27, 1997.
8. Tomlinson B. China bans smoking on trains and buses. BMJ. 1997;314:772.
9. Grayson R. Big tobacco has eyed china for a century. New York Times. Letters to Editor.
September 14, 1997
lO.Jackson D.Z. US shouldn't help big tobacco sell its deadly wares abroad . Boston
Globe 1997. May 16
11.Editorial. New York Times . "Selling Cigarettes in Asia" 1997; Sept 10.
12.Barry M. The influence of the U.S. tobacco industry on the health, economy, and
environment of developing countries . Sounding Board NEJM 1991; 324:917-919.
13.
Yach D. The impact of smoking in developing countries with special reference to Africa.
Int J Health Serv 1986; 16:279-92.
Jones
14.
D. Spotlight on Taiwan: foreign brands grab a big share. Tobacco Reporter. January
1989:324.
15.Connolly G. The intemationd marketing of tobacco. In: Tobacco Use in America
Conference. Houston, Texas, January 27-28, 1989. Chicago: American Medical Association.
1989:49-66.
16.
Willcox PA, Benatar SR, Potgieter PD. Use of the flexible fibreoptic bronchoscope in
diagnosis of sputum-negative pulmonary tuberculosis. Thorax 1982; 37:598-601.
Makhyoun
17.
NA. Smoking and bladder cancer in Egypt. Br J Cancer 1974; 30:577-8
PetoR.
18.
Lopez AD, Boreham J, Thun M, Heath C Jr Mortality from tobacco in developed
countries: indirect estimation from national vital statistics. Lancet 1992; 239:1268-78
Dr. \rniaiido Pilcher
President
Steering Committee
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Worldwide trends in tobacco consumption and mortality
World Health Organization
TOBACCO: THE TWENTIETH CENTURY'S EPIDEMIC
Every ten seconds, somewhere in the world, tobacco kills another victim. If current
smoking trends continue, this toll will increase up to one tobacco-caused death every three
seconds over the next thirty to forty years.
Recent data have confirmed that the risks of smoking are substantially higher than previously
thought. With prolonged smoking, smokers have a death rate about three times higher than
nonsmokers at all ages from young adulthood. Tobacco products are known or probable
causes of over two dozen diseases or groups of diseases. If, as is likely, much of the excess
mortality from these diseases is directly attributable to tobacco use, then this implies (hat the
lifetime risk of a smoker being killed by the use of tobacco products is at least 5()%i
Therefore, a lifelong smoker is ns likely to die ns a diivel ivsull of lobiiceo use ns lioiii nil
other potential causes of death combined!
Other problems ensue because the negative health consequences of tobacco are not as
immediate as with other hazardous substances. The health risks of tobacco are vastly
underestimated by the public, and even by many of those who are responsible for protecting
and promoting public health. Yet the risks of smoking are very high when compared to other
risks faced in everyday life (See Table 1). Widespread underestimation of risks associated
with tobacco use, is a major reason why tobacco products are still widely available, and why
lenient tobacco policies have been allowed to occur. But nothing can alter the fact that
tobacco use is one of the major public health challenges facing the world as it enters the
twenty-first century.
TOBACCO USE IS A KNOWN OR PROBABLE CAUSE OF DEATH FROM:
Cancers of the:
•
•
•
•
•
•
•
Lip, oral cavity and pharynx
Oesophagus
Pancreas
Larynx
Lung, trachea and bronchus
Urinary bladder
Kidney and other urinary organs
Cardiovascular diseases:
•
•
•
•
Rheumatic heart disease
Hypertension
Ischaemic heart disease
Pulmonary heart disease
•
•
•
•
•
Other heart diseases
Cerebrovascular diseases
Atherosclerosis
Aortic aneurysm
Other arterial diseases
Respiratory diseases:
•
•
•
•
•
Tuberculosis
Pneumonia and influenza
Bronchitis and emphysema
Asthma
Chronic airway obstruction
Paediatric diseases:
•
•
•
•
Low birth weight
Respiratory distress syndrome
Newborn respiratory conditions
Sudden infant death syndrome
Tobacco products have no safe level of consumption, and arc the only legal consumer
products that kill when used exactly as the manufacturer intends. Researchers have rated
nicotine as even more addictive than heroin, cocaine, marijuana or alcohol. The Tenth
Revision of the International Classification of Diseases reserves classification Fl 7.2 for
"tobacco dependence syndrome". Yet tobacco products continue to be aggressively marketed
by tobacco companies. The result is that global tobacco consumption has doubled since
medical science conclusively proved, 30 years ago, that these products were unrivalled
killers. And consumption is still increasing in many areas of the world.
' An analysis of trends in cigarette consumption for WHO regions indicates that the two
regions with the highest average per capita (adult) consumption in 1990-1992 were Europe
(2290 cigarettes per adult per year) and the Western Pacific (2000). The lowest consumption
was observed in the African Region (540). For the developed countries as a whole, per capita
adult consumption is currently about 2400 cigarettes, which is still significantly greater than
the average consumption in the developing world (1370 cigarettes).
The gap is rapidly narrowing, however. In 1970-1972, consumption per adult in the
developed countries was 3.25 times higher than in the developing world (see Figure 1). By
1980-1982, this ratio had narrowed to 2.38, and by 1990-1992, to 1.75. During the last
decade, per capita consumption has declined by an average of 1.4% per year in developed
countries, but has risen by 1.7% annually in developing countries. If these trends were to
continue, consumption of cigarettes per adult in the developing world will exceed levels in
I the developed world some time between the years 2005 and 2010, i.e., within two decades.
There have been very noticeable differences in trends among WHO regions. Over the last
decade, the fastest decline in per capita consumption occurred in the Americas. Nor was this
entirely due to declines in consumption ih Canada and the United States of America;
excluding those two countries, per capita consumption in the Region still declined by an
annual average of 1.7%. On the other hand, the increasing consumption in the Western
Pacific (2.2%) and South-East Asia (1.8%) is primarily due to the trends in China and India
respectively. From 1983, per capita (adult) consumption in China rose by 3.9% per year to
reach 1990 cigarettes in 1990-1992. In India, where about 90% of cigarettes are consumed in
the form of bidis (traditional hand-rolled cigarettes), adult consumption has risen by about
2% per year over the last decade and now exceeds 1200 cigarettes (including bidis).
WHO estimates that there are about 1100 million regular smokers in the world today. About
300 million (200 million males and 100 million females) are in the developed countries, and
nearly three times as many (800 million: 700 million males and 100 million females), in
developing countries. In developed countries, 41% of men are regular smokers, as are 21% of
women (see Figure 2). Half the men living in developing countries are smokers, compared
with about 8% of women.
The health consequences of the smoking epidemic in developed countries have been
quantified by WHO, in close collaboration with the Imperial Cancer Research Fund's Cancer
Studies Unit at the University of Oxford. UK. A major report giving detailed estimates of the
numbers and rates of smoking-attributed deaths for over 50 countries or groups of countries,
has been published. Between 1950 and 2000, it is estimated that smoking will have caused
about 62 million deaths in the developed countries (12.5 % of all deaths: 20% of male deaths
and 4% of female deaths). More than half of these deaths (38 million) will have occurred at
ages 35-69 years. Currently, smoking is the cause of more than one in three (36%) male
deaths in middle age, and about one in eight (13%) of female deaths. Each smoker who dies
in this age-group loses, on average, 22 years of life compared with average life expectancy.
During the 1990s, the report estimates that almost 2 million people a year will die from
smoking in developed countries (1.44 million men and 0.48 million women).
As regards cigarettes the health consequences of tobacco use are much more difficult to
estimate in developing countries owing, to lack of data. Currently, it is estimated that tobacco
causes about 1 million deaths a year in developing countries, but there is substantial
uncertainty about this figure. If current trends continue, and if the risks of death from tobacco
use are similar in developing countries to those that have been observed in the industrialized
world, then the annual toll of mortality from tobacco will rise dramatically to around 7
million deaths per year in the 2020s or early 2030s (see Table 2). The chief uncertainty is not
whether, but rather when, these deaths will occur if current trends in tobacco use persist.
Table 2. Estimated number of Deaths caused every year by Tobacco
Developed countries
Developing countries
Total
Decade
1990s
Decades
2020s/early 2030s
2 million
1 million
3 million
3 million
7 million
10 million
Towards Tobacco Control in a Globalise4 Economy
The 21st century witnessed the world markets being thrown open to free trade rules, raising alarming
consequences especially to the developing world. Nevertheless, it worked to the benefit of certain interest
groups in the market, one of the prominent among them being the tobacco industry.
The form, nature and the magnitude of the tobacco industry varies from country to country. But globalisation,
has primarily given them all access to the global market, thereby expanding their business territories and areas
of operation.
The Multinational Tobacco Industry
Tobacco industry today spans across seas, with companies like PJiilip Morris (PM), British American Tobacco
(BAT) and Japan Tobacco expanding its horizons way beyond their countries of origin. These cigarette majors
have managed to take their brands to remote comers of the world either through large buyouts of domestic
tobacco companies or by opening up subsidiaries and branches. For example, in India, Philip Morris holds 41%
shares in Godfrey Philips (popular for their Four Square brand) and BAT holds 31.4% shares in Indian Tobacco
Company (ITC). Thailand stands out for its resistance in 1995 to the US Trade Representative trying to force
open its market to the US tobacco companies.
The political links of tobacco companies are no secret. Philip Morris has been the largest contributor of
unregulated political donations in the last two federal elections in the US1. Considering the leading role-played
by the US in the global economy, it is but strategic for tobacco corporations to maintain political influence in the
US. In 1995, the company capitalising its dose assodation with high political offices drafted a law on growing,
manufacturing and advertising of tobacco which was later approved by the Lithuanian government2. Thus,
tobacco trade has moved on from being a token of goodwill between kings to that which dictates the world
order. What is wrong about building a billion-dollar business that boosts the world economy?
The true color of the industry
Tobacco is the only consumer product, which if consumed as per the manufacturer's instructions kills
half of its life-long users;
Tobacco industry has known about the harmful effects of tobacco for more than 30 years but
intentionally opted to keep its consumers in the dark about it
c)
Besides inflicting 44-odd illnesses in human beings, tobacco poses serious threat to the environment;
d)
Tobacco depletes national reserves by way of high medical costs for treating tobacco-related diseases
e)
Tobacco is more addictive than cocaine or marijuana thereby robbing its user of the freedom to decide
to continue or discontinue its use.
a)
b)
Magnitude of the Tobacco Menace
According to World Health Organisation (WHO), 4 million people die globally from tobacco-related illnesses
every year. This is more than the combined global death toll from HIV, Tuberculosis, maternal mortality,
homicide, alcohol, suidde and automobile aoddents put together3. WHO projects that by 2030, the global
tobacco death toll would rise to 10 million and 70 % of these deaths would occur in poor developing countries.
In India, tobacco kills more than 8 lakh persons every year. If current trends continue, 250 million children alive
today will be killed by tobacco4.
1 From research conducted by the Center for Responsive Politics, Washington, D.C. www.opensecrets.org
2 INFACT survey by Tomas Stanikas, Kaunas Medical Academy, Lithuania, presented at the 10dl World Conference on
Tobacco or Health, Beijing, August 1997.
3 Hoard, Barnum. “The Economic Burden ofthe Global Trade in Tobacco,” Paper presented at the 9lh World Conference
on Tobacco or Health, October 1994.
4 C.J. Murray and A.D. Lopez, Eds. The Global Burden of Disease: A Comprehensive Assessment of Mortality and
Disability from Disease, Injuries and Risk Factors in 1990 and Projected to 2020 (Cambridge MA: Harvard School of
Public Health, 1996).
Youth are favorite target of the tobacco industry. Tobacco companies use aggressive advertising geared
towards getting the children addicted at an early age so that they remain tobacco users for a lifetime. This is in
dear violation of the commitments the countries from the region have made under the UN Convention on the
Rights of the Child, which guarantees right to life, survival and development of a child.
Scientific studies have shown that Tobacco has been proven to cause cancer of the lungs, mouth and throat,
breast, urinary bladder and cervix. Smoking is a leading cause for Peripheral Vascular Disease, which could
eventually lead to amputation of limbs and even early death. A cigarette smoker has two to three times the risk
of having a heart attack or a stroke compared to a non-smoker. Smokeless tobacco users are more likely to
develop cancers of the lip, tongue, and floor of the mouth, cheek and gum than non-users.
Non-smokers who are exposed to tobacco smoke at home, have a 25 per cent increased risk of heart diseases
and lung cancer. WHO estimates that 700 million, or almost half of the world's children, breath air polluted by
tobacco smoke, particularly at home. Children of smoking parents are more prone to respiratory tract infections
such as bronchitis, pneumonia, cot death, middle ear diseases and asthma attacks5.
Tobacco production costs the environment dearly. In 66 tobacco-growing countries of the world, 4.6% of
national deforestation is due to cutting of trees for curing tobacco and for building curing bams. Around 6-8
kilograms of wood are required to cure 1 kilogram of tobacco. Trees are also cut to produce paper for wrapping £
cigarettes and for packaging of tobacco products. In Thane district in Maharashtra (India), vast acres of forest
land is cleared to procure "katha", an ingredient of the indigenous tobacco products Gutkha and pan masala
from the bark of Khaire trees6. Smoking causes an estimated 10 % of the global deaths from fire. Disposal of
the butts, packs, and cartons of tobacco products produces much trash that workers in the US complain that
sweeping up cigarette butts causes them hours of extra work each month 7.
Challenges Posed by Tobacco
Factors Influencing Demand For Tobacco And Feasible Solutions
Entrapping Advertising: Tobacco industry is the largest advertiser in the world. Obviously, they have to tty
hard to sell their product against all its proven dangers to public health. In 1996, Philip Morris the world's
largest multinational cigarette company spent $3.1 billon advertising its tobacco and food products 8. In Indian
approximately Rupees 400 crore is spent on tobacco ads every year. In Bangladesh, British American Tobacco
which owns controlling share of Bangladesh's former tobacco monopoly, spent $ 3.4 million on brand
promotions and development in 1998.
With the growing restrictions on direct advertising of tobacco products world wide, the industry is evolving—
dubious and unscrupulous marketing strategies to circumvent law. A quick look at these promos exposes theiiW
tactic to hook young and fresh consumers to their products through indirect means like brand stretching and
sponsoring youth programmes such as sports and cultural meets. The industry has always opposed ad bans and
ingeniously suggests voluntary restrictions, which have proven to be ineffective in other countries. In a recent
study involving 22 high-income countries it was revealed that where most comprehensive advertising
restrictions were in place, tobacco consumption had fallen by 6 %9.
Package Advertising: Tobacco companies for decades have been effectively using the tobacco package space
as an excellent advertising media. Countries like Canada, Brazil and European Union have realised the powerof
package advertising and have made it mandatory to display pictorial health mes' ages on tobacco packs. The
5 Report of the Scientific Committee on Tobacco and Health. Department of Health, UK, 1998.
6 "Dawood is diversifying into Gutkha", Bombay Times, 04/12/2000.
7 Novotny & Zhao 1999.
8 R. Hammond. Tobacco Advertising and Promotion: The Needfor a Co-ordinated Global Response. Geneva: World
Health Organisation. 2000
9 P. Jha & F.J. Chaloupka. Curbing the Epidem ic.Govemments and the Economics of Tobacco Control. Washington. 1999.
2
Canadian experience as revealed in a recent survey has been that 44 % of smokers said that the new warning
increased their motivation to quit and among those attempted to quit in 2001, 38% dted the warnings as a
motivating factor. 35 percent of smokers and 34 percent of nonsmokers said they know more about the health
effects of smoking than they did before the new warnings 10.
Tobacco & Poverty: Researchers from Bangladesh and India report that tobacco use further impoverishes
poor-income households. In a recent survey conducted among 400 pavement dwelling families in Mumbai,
India, the poor spend more on purchasing tobacco than on nutritious food like meat, milk, fruits or egg11.
Similarly, among the poor income households in Bangladesh a typical male smoker spends 5 times as much on
cigarettes as the per capita expenditure on housing, 18 times as much as for health and 20 times as much as
for education12. Obviously, tobacco reduces the purchasing capacity of the poor to procure basic life needs.
Affordability : Increasing tax is a feasible strategy to reduce accessibility and affordability especially among
income-sensitive groups. This should be a popular strategy among the Governments as it brings additional
revenue to the Government exchequer..
Increasing taxes, increases smuggling" is the typical industry line of argument. However, it has been found that
increase in contraband and smuggling arises out of poor low enforcement and customs regulations rather than
from tax increases.
Sale of loose tobacco products also accentuates the tobacco consumption especially among the price-sensitive
groups.
Rights and Awareness: Addictive as tobacco is, it robs its user of the power to choose to continue or
discontinue its use. In doing so, it deprives the consumer of the basic right to choose. Tobacco companies hide
information about the harmful effects of their products thereby denying the consumers the right to information
based on which they could otherwise make an "informed choice". Children's rights to life, survival and
development are jeopardized in terms of reduced access to health and education from increasing tobacco
expenses incurred by adults in the family. They are choked from passive smoking, which the adults in their
environment are unmindful of.
Issues related to the Supply of Tobacco
The tobacco industry perpetually whips up farmers' associations and unions creating fear that tobacco control
would lead to massive unemployment in the tobacco production sectors. However, economists Jha & Chaloupka
(1999) who have done extensive macro analysis of tobacco producing economies allay these fears13.
They opine that the negative effects of tobacco control on employments have been grossly overstated. While
there would be no net loss of jobs, there might even be job gains if global tobacco consumption fell. This is
because" money spent on tobacco would be spend on other goods and services thereby generating more jobs.
Even in economies heavily dependent on tobacco, aid adjustment, crop diversification, rural training and other
safety net systems would take care of the problem.
Even in countries with comprehensive tobacco control policies, tobacco consumption reduces at best by 1 %.
With increasing population in most of the developing countries it would be a while before there would be any
considerable impact on tobacco production, giving farmers sufficient time to diversify into alternate avenues.
10 Research by Canadian Cancer Society on the Effectiveness of Pictorial Health Warnings. 2001.
" S. John, S. Vaite & D. Efroymson. Tobacco and Poverty: Observationsfrom India and Bangladesh. PATH Canada.
October 2002.
12 D. Eforymson & S. Ahmed. Hungry for Tobacco. Work for a Better Bangladesh. 2001.
11 P. Jha & F.J. Chaloupka. Curbing the Epidemic, Governments and the Economics of Tobacco Control. Washington.
1999.
3
A recent study conducted among tobacco farmers in Karnataka, one of the leading tobacco producing States in
India, reveals that diversification to alternate livelihood is a feasible option for those engaged in various tobacco
production avenues. Tobacco farmers have been found to suffer from several occupational health hazards and
complain of perpetual state of poverty and debts14.
Envisaging future decline in bidi smoking, Kerala Dinesh Bidi, the largest co-operative society in Asia launched
its diversification efforts into food processing and other consumer products. In the first three years of
diversification, 15 out of the 30 products have been reported to be breaking even15.
Another major argument leveled against diversification is that with these efforts countries would cease to
receive the tax they are currently getting from tobacco taxes. This is a fallacy. In India, for instance, the
Government revenue from tobacco is way below what it spends on treating tobacco-related illnesses.
Also, with tobacco users reducing its consumption in response to tobacco control measures, it is likely that they
would invest in other consumer products. This would lead to development of other sectors of the economy and
thus contribute to overall national growth.
Framework Convention on Tobacco Control (FCTC)
In 1998, the World Health Organisation invoked its prerogative to propose an international tobacco contra^
treaty named Framework Convention on Tobacco Control to contain the global tobacco epidemic. This first
global public health treaty addresses transnational issues pertaining to tobacco advertising, smuggling,
packaging, testing and reporting of toxic constituents, environmental tobacco smoke and resource sharing.
The treaty is currently moving towards the final stages of its negotiation by 190 odd Member Nations of WHO in
the last and sixth round of negotiation scheduled for Mid February 2003. It is slated to be adopted by World
Health Assembly in May 2003.
The treaty is significant for the Asian countries, primarily in resisting the tobacco industry which considers us
the prime target in this decade. It serves as a booster to build national tobacco control policies and
programmes. The negotiations for the first time in the history of tobacco control movement, has brought
together people, Governments, NGOs, energy and resources from all over the world to address the tobacco
pandemic.
Tobacco Control in Asia
In the last decade, several organisations in the region have initiated awareness programmes among children,
youth, women and workers as a prevention strategy. Some of them advocate strong tobacco control policies
home and abroad. In India, research and surveillance have been carried out on different population groups
their tobacco control patterns.
Thailand has advanced tobacco control programmes and policies. India has of late proposed the Tobacco
Products Bill, banning tobacco advertising, promotions and smoking in public places among others. Bangladesh
and Nepal are also drafting national policies to contain the tobacco epidemic.
In the recent years, tobacco control activists have realised the power of collective strength and have formed
networks and coalitions at local and national levels. The Consortium for Tobacco Free Karnataka, Indian
Coalition for Tobacco Control, Bangladesh Anti Tobacco Alliance, South Asia T bacco Control Forum and South
East Asia Tobacco Control Alliance, Framework Convention Alliance are a few of the active alliances in the
region.
I4S. John, S. Vaite & D. Efroymson. Tobacco and Poverty: Observations from India and Bangladesh. PATH Canada.
October 2002.
15 Ibid. Interview with Kerala Dinesh Bidi Office Bearers.
4
In 1998, World Health Assembly launched the drafting of an international treaty to address trans-national
tobacco control issues. The treaty, Framework Convention on Tobacco Control is currently is in the last stages
of its development, with over 150 world countries concluding its negotiations soon in Geneva. Countries and
organisations from the region play a vital role in demanding stringent tobacco control measures in this treaty.
Emerging Needs of Tobacco Control in Asia
Industry documents and operations reveal that they are now training their guns on Asia and Africa. Lack of
adequate tobacco control policies and failure in implementing the existing policies make all of us more
vulnerable to the attacks of these companies as also to tobacco epidemic. Illiterate masses and cultural
practices also seem to be hurdles in tobacco control in Asia. The emerging needs therefore for the region are:
a) Building awareness among the Asian people about the health and socio-economic consequences of
tobacco use and trade
b) Exposing myths and cultural practices that promotes the habit
c) Training development workers and organization on tobacco control issues
d) Building networks and coalitions that would serve as pressure groups in policy advocacy
e) Engaging in active advocacy for tobacco control policies at national and regional level
f) Advocacy for effective implementation of FCTC commitments in the region
Possibilities for Collaboration
The issues involved in tobacco control demands a matching o-ordinated response from different sectors of the
civil society. World Health Organisation responded to this global epidemic by setting up the Tobacco Free
Initiative in 1998, which in turn supports various global campaigns and programmes in tobacco control. It calls
upon the civil society each year to observe 31st of May as the World No Tobacco Day.
Besides, there are various networks, coalitions and organizations already engaged in active tobacco control. If
you are further interested in learning or engaging in tobacco control issues, feel free to contact any of the
organisors of the event listed below:
Thelma Narayan, Community Health Cell
Consortium for Tobacco Free Karnataka
International Secretariat
People's Health Assembly
Email: sochara@vsnl.com.
Shoba John, PATH Canada
South East Asia Focal Point,
Framework Convention on Tobacco Control.
Member, Indian Coalition for Tobacco Control
Email: sjohnjDathcan@vsnl.net
Dr. Srinath Reddy
Professor of Cardiology, AIIMS.
Secretary,SHAN & HRIDAY, New Delhi
Email:info@hriday-shan.org
Naveen Thomas
Fellow, Oxfam India Trust
Email:navthom@vsnl.net
Paper prepared by:
January 2003
Shoba John
PATH Canada, India.
for Asia Social Forum
Workshop on "Working Towards Tobacco Control"
5
pH- I 2UICC GLOBALink
The International Tobacco-Control Network Selected documents: The
Death Toll form Tobacco - A Crime Against Humanity
September 1998
Deaths caused by smoking
There are between 1.1 -1.4 billion smokers in the world out of a total population of around 5.8
billion. It has been estimated that 50% of smokers will die prematurely from tobacco related
illness, half in middle age (defined as 35 - 69 years of age) with an average loss of life expectancy
of 20 - 25 years (8 years over all ages).
This means that over half a billion people (in excess of 500 million) or about 10% of the existing
population will die from smoking. Of these, 27% will die from lung cancer, 24% will die from
heart disease, 23% will die from chronic obstructive lung disease, emphysema or bronchitis and
the remaining 26% will die from other diseases including other circulatory disease (18%) and
other cancers (8%).
Currently, 3 million people worldwide die every year from smoking related disease. This repre
sents about 1 person every ten seconds. One third of all people aged fifteen years and over smoke
and this proportion is increasing in Asia, Eastern Europe and the former Soviet States.
Consumption trends indicate that smoking prevalence is reducing in developed countries (DCs)
(down 1.5% per annum in the United States) whilst increasing in lesser-developed countries
(LDCs)(up 1.7% per annum on average).
The World Health Organisation (WHO) has estimated that, based on current trends, the death toll
from smoking will rise to 10 million people per year by the year 2025. Currently two million
deaths occur each year in developed countries and 1 million deaths occur each year in lesserdeveloped countries. By 2025 this proportion will alter to 3 million deaths per year in developed
countries and 7 million deaths per year in lesser-developed countries. No other consumer product
in the history of the world had come even close to inflicting this degree of hann on the world
community. If anything else posed a threat to life of this magnitude whether human induced or
naturally occurring - be it world war, genocide, ethnic cleansing, natural disaster or disease - it
would demand immediate international action. The response to HIV, the prosecution of war crimes
(both current and dating back to World War II), germ warfare, nuclear weapons or even climate
change are but a few examples.
The history of the smoking pandemic of the 20lh century can be traced back to the invention of the
mechanical cigarette machine in the late 1 SCO’s. Until that time cigarettes were rolled by hand,
production was low and smoking was not overly prevalent. The cigarette machine meant that
millions of cigarettes could be produced each day at a lower cost and distributed more widely.
The result was that cigarette smoking increased such that by the late 1940’s smoking rates in
developing countries were up to 70% in adult males and up to 25% in adult females. Smoking
rates in LDCs were significantly less.
From the discovery of the link between increased smoking and disease in the early 1950’s, and
major reports publicising the need for public health action, smoking rates among adult males in
developed countries has declined although prevalence in adult females increased to some degree
but now the levels are roughly equal at about 25% in many developed countries. Meanwhile,
smoking rates in lesser-developed countries has increased in both the adult male and adult female
population.
Due to the latency in the development of disease from smoking, the effects were first detected
among adult males in developed countries. The effect of increased smoking among adult females is
now being reflected in disease rates with similar observations in lesser-developed countries.
Hence the WHO estimates by the year 2025.
Transnational tobacco companies
Tobacco consumed by the world’s 1.1 - 1.4 billion smokers is produced by a handful of
transnational tobacco companies and a number of state owned manufacturers. China’s state owned
production accounts for 31% of all tobacco sales with Italy, Russia, Japan, Taiwan, Indonesia and
Thailand, amongst other countries, having substantial government owned factories as well.
However, transnational tobacco companies account for 40% of the global market and control 70%
of world production, and this is increasing. In many cases, the state owned producer was a state
monopoly but. increasingly, this has been broken down through free trade agreements to a point
where transnational tobacco companies are not only marketing in countries previously the subject
of a state monopoly but there are reports of expressions of interest by transnational tobacco com
panies in obtaining an interest in formerly state owned monopolies now being privatised.
Whilst all tobacco consumption contributes to the overall death toll, state owned production is
arguably an internal matter to the nation - state in question. The activities of privately owned.
transnational tobacco companies is a matter on international concern. The major transnational
tobacco companies, in order of sales, are: US based Philip Morris Inc., followed by British based
BAT Industries p.l.c., United States based RJR Nabisco and Rothmans. Under agreements appar
ently reached among these transnational tobacco companies, Rothmans does not market in the
United States and BAT does not market in Britain. There are reports that Philip Morris and BAT
have entered into collusive agreements that fix cigarette prices and divide markets in South
America (apparently such anti competitive arrangements are not illegal in those countries). It is a
mark of the power of the major transnational tobacco companies that they can reach such agree
ments dividing up markets in sovereign nations consequently inflicting the harm identified above.
In 1996. Philip Morris had annual revenues ofS55 billion, just over half from tobacco with the
rest coming from domestic and international food and alcohol sales. Only 18% was from domestic
tobacco sales (20% in 1992) compared with 35% from international sales (21% in 1992). Total
tobacco sales comprised 53% in 1996 (41% in 1992) or about 23 billion. BAT revenue in 1996
was S23 billion. RJR Nabisco had total revenues of SI 7 billion in 1996 of which 48% or about 8
billion was from tobacco sales. These massive levels of turnover and the economic, political and
social influence of the transnational tobacco companies has led to the industry being described
collectively as "Big Tobacco”. A comparison is made that these revenues exceed the gross domes
tic product of many countries. For example, Philip Morris has a turnover larger than the GDP of
Ecuador, Guatemala, Kenya, Kuwait, Malaysia and Peru. It is roughly the equivent of Ireland.
Singapore or Hungary. RJR Nabisco’s turnover is roughly the equivalent of the GDP of Costa
Rica, Croatia, Cuba, El Salvador, Lebanon or Jamaica. Whilst these companies undoubtedly have
significant economic, political and social influence, the fact remains (with all due respect to the
countries with which comparison is made), these transnational tobacco companies, either indi
vidually or collectively, are not an overwhelmingly dominant force on a world scale.
Deceit and duplicity of the tobacco industry
The current status of the tobacco industry is anomalous insofar as cigarette consumption clearly
inflicts a degree of mortality totally at odds with fundamental human rights and human values. Al
the same time the tobacco industry defends itself on the basis that tobacco is a “legal product".
This occurred because the tobacco industry had already acquired a substantial degree of eco
nomic, political and social influence by the time the link between smoking and disease was estab
lished. Since that lime the tobacco industry worldwide has engaged in a deliberate campaign of
deceit and duplicity to protect and even expand its influence through a process of denial and
disputation of the now proven link between smoking and disease, the addictive properties of
nicotine and their marketing strategies directed at youth.
This deceit and duplicity is currently being exposed by litigation in the United States which is
spreading worldwide. The position has now been reached where continued disputation and distor
tion is untenable, particularly in the face of the projected increase in tobacco deaths by the year
2025 if current trends are continued. This is all the more so given the disparity in the projected
increase between developed and less developed countries, reflecting an exploitation of lesser
developed countries which will only increase to offset liabilities the tobacco industry is incurring
in the United States. This is a circumstance calling for international action. It must not be allowed
to happen. Were it to occur it would be, without doubt, a crime against humanity.
Crimes against humanity in the International Criminal Court
On 17 July 1998 the United Nations Rome Statute of The International Criminal Court established
a permanent Court having power to exercise jurisdiction over persons for the most serious crimes
of international concern. Article 5 confersjurisdiction on the International Criminal Court with
respect to the following crimes:
1.
The crime of genocide;
2.
Crimes against humanity;
3.
War crimes:
4.
The crime of aggression.
5.
For the purposes of the Statute, Article 7 defines a “crime against humanity" to mean any of the
following acts when committed as part of a widespread or systematic attack directly against any
civilian population, with knowledge of the attack;
1.
Murder;
2.
Extermination;
3.
Enslavement;
4.
Deportation or forcible transfer of population;
5.
Imprisonment or other severe deprivation of physical liberty in violation of fundamental
rules of international law;
6.
Torture;
7.
Rape, sexual slavery, enforced prostitution, forced pregnancy, enforced sterilisation, or any
other form of sexual violence of comparable gravity;
8.
Persecution against any identifiable group or collectively on political, racial, national
ethnic, cultural, religious, gender as defined in paragraph 3, or other grounds that are
universally recognized as impermissible under international law, in connection with any
act referred to in this paragraph or any crime within the jurisdiction of the Court;
9.
10.
11.
Enforced disappearance of persons;
The crime of apartheid;
Other inhumane acts of a similar character intentionally causing great suffering, or serious
injury to body or to mental or physical health.
Given what is known about smoking and disease and the deceit and duplicity of the tobacco
industry, were the death toll from tobacco to increase from 3 million a year to 10 million a year by
the year 2025, especially with the dramatic increase in lesser developed countries from 1 mil’iicn
a year to 7 million a year, it is impossible to describe that consequence as anything other than the
result of an inhumane act of a character similar to murder, causing great suffering, or serious injury
to body or to mental or physical health committed as part of a widespread or systematic attack
directed against the civilian population of the world.
Given that the directors and executives of the major transnational tobacco companies must now
have knowledge of the consequences of their activities, if those activities continue then each and
every one of them must face the prospect of being charged with committing a crime against huma::ity in the International Criminal Court. Article 11 of the Statute provides that the Court has juris
diction only with respect to crimes committed after the entry and the force of the Statute. This
means that the opportunity exists for these directors and executives to escape liability under the
provisions of the Statute providing there is no increase in mortality from tobacco use. Arguabh
they should be responsible for a reduction. Given the likely increase in mortality from past smok
ing. because of the latency of tobacco related disease, every effort would need to be made to
reduce consumption in order to avoid a significant increase in the current death toll. Certainly
expansion in lesser-developed countries should not occur. As a means of securing this outcome.
each of the major transnational tobacco companies, and each of their directors and executives.
should formally be put on notice of the consequences of their activities such that charges of a crime
against humanity can be laid and successfully prosecuted if radical action is not taken to reverse
current trends.
NEIL FRANCEY
Barrister at Law
Wentworth Chambers
180 Philip Street
Sydney 2000
AUSTRALIA
There are a number of complex and inter-relating factors that predispose young people to
smoke, and these vary among individuals and among populations. However, years of
research have identified certain factors that commonly play a role in smoking initiation.
These include high levels of social acceptability for tobacco products, exposure and
vulnerability to tobacco marketing efforts, availability and ease of access, role modelling
by parents and other adults, and peer group use.
Minimizing of risk
Adolescents frequently experiment with new behaviours, but don't often take into serious
consideration the long-term consequences. Some youths who are exposed to tobacco
messages from an early age come to accept the notion that tobacco provides certain
psychological benefits which will help them through adolescence. For them, the risks of
tobacco use, which are perceived to be remote, are outweighed by the immediate
psychological benefits. Young people tend to underestimate the addictiveness of nicotine
and the difficulties associated with quitting, tending to believe that it is easier for young
people to quit than adults. However, they soon find that the addiction to nicotine remains
long after any psychological benefits are gone. Studies in some countries show that fourfifths of everyone who has smoked as many as 100 cigarettes will be smoking two years
later, and half will still be smoking in 20 years. This means that, at least in the countries
studied and possibly elsewhere, about half of those who became addicted as adolescents
will still be smoking at age 35.
Exposure to tobacco advertising and promotion
The role of advertising is critical to the adolescent's conditioning process. In
advertisements, tobacco users are portrayed as glamourous, popular, independent,
adventurous, and macho. By selecting brands that present these images, young people
may feel that they are internalizing these characteristics. A study in the United States
found that among teens who smoke, 85% chose the three most heavily advertised brands
of cigarettes, compared to only 35% of adults. Data suggest that children are more
responsive than adults to the messages and images contained in tobacco advertisements.
And young people who are more aware of tobacco promotions are more susceptible to
become users of tobacco products.
Children's attitudes and behaviour regarding tobacco are influenced by advertising. Thus,
tobacco advertising subverts the understanding and ability of young people to make a
free, informed choice whether or not to smoke. Advertising also leads teens to believe
that smoking is more common than may actually be the case, particularly among their
peers. (See In search of new customers: Advertising plays cm important role.)
Modelling of adults
"The (tobacco) industry knew that as long as young adults....provided role modelsfor
children, it didn't matter how much you tried to educate children not to smoke, they
would not take any notice." Sir Richard Doll, 1991
Children perceive smoking to be an adult behaviour, and children may often appear more
grown-up. Studies show that young children are influenced by parents who smoke,
forming more positive attitudes towards smoking than those living with non-smoking
parents. This association was found in children as young as three years old. In one study,
twice as many children of smokers say that they want to smoke compared to children of
non-smokers. Adolescent children of parents who successfully quit smoking are also
much less likely to smoke compared to those of parents who do smoke.
Adults should be made aware of the impact of their own smoking behaviour on the future
smoking behaviour of children. It is essential for adult smoking to be reduced and
marginalized as part of a comprehensive strategy to decrease smoking among young
people.
Candy or chocolate cigarettes may be one of the first experiences a child has of imitating
adult smoking behaviour, and these kinds of cigarettes deliver a very inappropriate
message. The encouragement to imitate smoking as a desirable adult behaviour through
the use of these confectionary products aimed specifically at children should be
discouraged. Some countries already have a ban on such products.
Susceptibility to starting to smoke
There are many environmental influences that help determine the likelihood that an
adolescent will become susceptible and experiment with cigarettes. An adolescent is
labelled as cognitively susceptible to smoke if she or he is not absolutely sure that she or
he will not smoke a cigarette in a given situation. Those who develop a cognitive
susceptibility are twice as likely to experiment with smoking than other adolescents. In
the USA, susceptibility to start smoking starts around age 10 years and peaks by age 14
years in close to 60% of the population. Once adolescents have experimented,
approximately half continue to smoke and become addicted. An adolescent who thinks
that the health problems of smoking can be alleviated, provided that you stop smoking
before the age of 35, appears to be at much greater risk of experimentation.
Peer pressure
Exposure to peers who smoke increases the risk of adolescents stalling to smoke.
However, it appears that this influence is particularly important after the adolescent has
already become susceptible to smoking. Indeed, the effect of peers is most noticeable in
the transition from experimental smoking to addiction.
pHH
COMPREHENSIVE POLICIES AND PROGRAMMES ARE NECESSARY
Children do not simply "choose" to smoke. They are greatly influenced by their
environment, which is greatly influenced by public policies. Children are much more
likely to smoke if they are surrounded by attractive tobacco advertising and promotion; if
their favourite sport is sponsored by a tobacco company; if their film idols smoke in the
movies; if they see people smoking all around them; and if tobacco products are cheap
and readily available to them.
Educational programmes serve a purpose, particularly in countries where the harms of
tobacco use are not widely known. However, without sound public policies, the billions
of dollars tobacco companies spend promoting their products and creating a "pro
tobacco" environment for children can overwhelm the healthy messages children receive
from parents and in the schools. Strong public policies help level the playing field and
give children a real chance to grow up tobacco-free.
Which Youth-Oriented Policies Work?
Policy experts agree that a combination of the policies described below should
significantly reduce tobacco use by youth, provided they are sustained over time, and
strictly enforced, and adequately funded. For real progress to be made, it is also
important that all.of the recommended policies be implemented. Although benefits will
be realized through the implementation of even one of these policies, a comprehensive
approach works best. Tobacco companies denied one approach to marketing or selling
tobacco products to children will redouble efforts using any other methods that are not
prohibited.
All of these policies are included within WHO's Ten-Point Programme for Successful
Tobacco Control. The following points, derived from World Health Assembly
resolutions, along with recommendations from other international and intergovernmental
bodies lists some key elements that should be included in comprehensive national
tobacco control programmes.
1.
2.
Protection for children from becoming addicted to tobacco.
Use of fiscal policies to discourage the use of tobacco, such as tobacco
taxes that increase faster than the growth in prices and income.
3.
Use of a portion of the money raised from tobacco taxes to finance other
tobacco control and health promotion measures.
4.
Health promotion, health education and smoking cessation programmes.
Health workers and institutions set an example by being smoke-free.
5.
Protection from involuntary exposure to environmental tobacco smoke
(ETS).
6.
Elimination of socio-economic, behavioural and other incentives which
maintain and promote use of tobacco.
7.
Elimination of direct and indirect tobacco advertising, promotion and
sponsorship.
8.
Controls on tobacco products, including prominent health warnings on
tobacco products and any remaining advertisements; limits on and
mandatory reporting of toxic constituents in tobacco products and
tobacco smoke.
9.
Promotion of economic alternatives to tobacco growing and
manufacturing.
10.
Effective management, monitoring and evaluation of tobacco issues.
Higher tobacco taxation
Studies consistently show that children are more sensitive to price increases than adults.
In the United States, for example, youth are about three times more likely than adults to
quit smoking, or not to start smoking, in response to a tobacco price increase. Increasing
the price puts a higher barrier between youths and easy access. Thus, tobacco tax
increases are good health policy and good fiscal policy. Cheap cigarettes are not a social
benefit, because they encourage more smoking, causing higher health care costs and more
death and disease. One other way to make cheap cigarettes less accessible to young
people would be to legislate against single sales of cigarettes as well as half-size cigarette
packages, known in some countries as "kiddie packs".
In many countries, governments earn substantial tax revenue from illegal sales of tobacco
products to minors, but often are putting only a small percentage of it back into
prevention programmes for young people. It is uniquely appropriate that a portion of
funds raised by tobacco taxes be used to fund programs to protect children and reduce
tobacco use. This funding approach has been used in Australia, the United States, Canada
and other countries, and has proven to be effective and politically popular.
Multisectoral collaboration
The Jakarta Declaration On Leading Promotion into the 21st Century (Jakarta, July 1997)
identifies international trade in tobacco as having a major negative impact on public
health, and consequently the health of children. It calls for the creation of new
partnerships for health, between governmental and nongovernmental organizations,
between public and private sectors at all levels of governance in society and for the
formation of a global health promotion alliance. Such concerted intersectoral and
transnational efforts are urgently required to counteract the efforts of the multinational
tobacco companies.
Marketing restrictions
Advertising affects young people's perceptions of the pervasiveness, image, and functions
of smoking. Studies have shown that in some countries, tobacco advertising is twice as
influential as peer pressure in encouraging children to smoke. Children are often more
likely to buy the most heavily advertised brands of cigarettes. Because tobacco
advertising is inherently misleading, public policies should prohibit all tobacco
advertising and promotions, including free samples and other giveaways, sale of non
tobacco products that carry a tobacco brand name, point of sale advertising and tobacco
company sponsorship of sporting and cultural events. Those countries which have
adopted bans on tobacco advertising as part of a comprehensive tobacco control
programme have seen significant declines in tobacco consumption.
Prohibition of sales to minors
In many countries, tobacco products are routinely sold to children, while selling other
addictive, lethal drugs to children is not tolerated. A minimum age of 18 or older should
be established for tobacco sales. All tobacco retailers should be licensed and their license
should be contingent on obeying the law. A graduated schedule of civil penalties ranging
from a warning to license revocation should be established. Enforcement is critically
important! If these laws are not enforced, they will not be obeyed. Enforcement fund's
may be raised from licensing fees and penalties, so these measures can be selfsupporting. To eliminate possibilities of unsupervised sales of tobacco products, vending
machine sales should be prohibited.
In recent years, tobacco control programmes in a number of countries have
attempted to limit the possibility that cigarettes will be sold to minors. However,
even where these programmes are effective in limiting actual sales, the majority
of young people still think that obtaining cigarettes is easy. Studies found that
many regular adolescent smokers do not buy their own cigarettes. Older siblings '
and acquaintances are clearly prepared to purchase for underage minors.
Therefore, while strategies to reduce the availability of tobacco products to
young people are important, they will be of only limited value unless
accompanied by comprehensive tobacco control programmes.
Countermarketing and education programmes
Many governments have established successful programmes using the mass media to
provide strong messages designed to counter the image promoted by cigarette companies
of tobacco use as sexy, glamorous and normal. Equally important are school-based and
community-based programmes to teach children about the dangers of tobacco use and to
teach them the skills they need to resist tobacco marketing efforts and peer pressure.
Research shows that coordinated mass media programmes and education programmes
produce much better results than either approach by itself.
Protection from environmental tobacco smoke
It is important that smoking be legally prohibited in public places, especially where
children may be present. First, environmental tobacco smoke has been established
beyond question to be harmful to all people, and especially to children. Second, if public
places become smoke-free, then young people will have far fewer places to light up, and
this could go a long way in reducing smoking. Finally, children who grow up seeing
smoking permitted all around them will wrongly conclude that smoking must not be very
harmful, and that it is socially acceptable to smoke. Incidently, tobacco companies work
very hard to make smoking appear socially acceptable. The 1988 mission statement of
one tobacco company in Canada included the following intention: "support to continued
social acceptability of smoking through industry and/or corporate actions."
HOW TO PROMOTE TOBACCO CONTROL POLICIES
Although tobacco is much more than a youth issue, emphasising the harms to young
people may be useful in generating support for tobacco control among politicians and the
general public. Even smokers are more likely to support tobacco control legislation if
they believe it will help prevent children from starting to smoke. The rationale that
children may not be in a position to make informed and rational decisions about whether
or not to become tobacco users can also help further policies which will help protect
children from the pressures to use tobacco.
Policies to protect children from tobacco can be passed in many forms and at many
different levels of government (e.g., local, provincial, national and international). Policies
may be passed most easily as regulations in some places and as legislation in others. In
most countries, however, nongovernmental organizations (NGOs) play a critical role in
promoting passage of tobacco prevention laws.
Successful campaigns generally follow three stages:
Advance research and planning
It is important to gather as much information as possible at the outset about the issue,
define feasible objectives and strategies, and determine who are likely allies and
opponents, what the public thinks, whether a strong coalition can be formed, and how a
campaign can be funded. Research and planning will be necessary throughout, but it is
never more important than at the beginning.
Launching the campaign
If the advance research and planning suggests that a full-scale campaign is warranted, the
next step is to bring the issue into focus for the media and politicians and get it onto the
public agenda. Events such as release of a study supporting new policies, a press
conference, introduction of legislation, expressions of support by leading politicians, etc.,
can be planned to keep public attention on the issue. Positive media exposure is often the
key to success.
Lobbying for passage
If the proposal is a good one, opposition from the tobacco industry will be fierce and the
campaign will be hard-fought. There will be many challenges; clever tactics by the
opposition will have to be anticipated and defeated. A successful campaign must be
tireless, strategic and aggressive. Help from experienced lobbyists who know the
politicians involved can be extremely helpful. International support for the measures can
also prove very useful.
It will be important to broaden the base of support for the proposal at every stage, and to
maintain a positive, reasonable approach. Politicians and the media alike will shun
organizations and individuals they believe are too extreme.
Of course, many campaigns do not succeed at first, and so the issue must be fought again
and again until a proposal passes. Even after the proposal becomes law, the job is not
done. The gain must be protected from future attacks. For example, will the law be
strictly enforced? Is adequate funding appropriated? After every victory or defeat, it is
important to thank allies, learn from successes and failures, and regroup for the next
campaign.
Tobacco kills nearly 10.000 people every day
The facts speak for themselves. Tobacco use worldwide has reached the proportion of a
global epidemic with little sign of abatement. Each year, tobacco causes about three and a
half million deaths throughout the world. This translates to nearly ten thousand deaths per
day. Based on current trends, this will increase to ten million annual deaths during the
2020s or 2030s, with seven million of these deaths occurring in developing countries.
Based on current patterns of consumption, it is predicted that over 500 million people
currently alive will be killed by tobacco.
In developed countries, where smoking became widespread during the 1940s and 1950s.
the catastrophic effect of past smoking trends can now be seen. About 20% of all deaths
occurring at present in'developed countries are due to tobacco. By 2020, it is predicted
that tobacco use will cause over 12% of all deaths globally. By 2020, it is predicted that
tobacco will cause more deaths worldwide than HIV, tuberculosis, maternal mortality.
motor vehicle accidents, suicide and homicide combined.
HOW TOBACCO AFFECTS YOUNG PEOPLE
Tobacco affects young people in an extraordinary number of ways. Due to environmental
tobacco smoke (ETS) and maternal smoking, children's health may even be compromised
from before the time they are bom. In many countries, children may grow up in a haze of
tobacco smoke, wreaking further havoc with-their health. Household money that is spent
on tobacco reduces the amount available for food, education and medical care. Children
may also suffer the emotional pain and financial insecurity, that comes from the loss of a
parent or caretaker who dies an untimely death due to tobacco.
On another level are the pervasive pressures for young people to use tobacco. People
everywhere seem to be smoking. Attractive advertisements and exciting tobacco
promotions are difficult to resist. Especially when the price is affordable, and it's no
problem for minors to buy tobacco.
Even if tlie health risks are understood, the message that tobacco kills is not very relevant
to young smokers, who believe themselves to be immortal. By the time they are ready to
quit smoking, addiction has taken hold. These factors all contribute to the grim statistics.
Based on current trends, about 250 million children alive in the world today will
eventually be killed by tobacco.
WHO believes that every child has the right to grow up without tobacco. This means
without the rampant pressures to use tobacco, which in many countries emanates from all
icomers. There is a need to change the environment to one where non-smoking is
considered normal social behviour and where the choice not to smoke is the easier
choice. ■
Tobacco is fast becoming a greater cause of death and disability than any
single disease
Research shows that the risks from smoking are substantially higher than previously
thought. With prolonged smoking, smokers have a death rate about three times higher
than non-smokers at all ages starting from young adulthood. On average, smokers who
begin smoking in adolescence and continue to smoke regularly have a 50% chance of
dying from tobacco. And half of these will die in middle age. before age seventy, losing
around 22 years of normal life expectancy. Therefore, a lifelong smoker is as likely to die
as a direct result of tobacco use as from all other potential causes of death combined.
Tobacco is a known or probable cause of about 25 diseases, and the sheer scale of its
impact on global disease burden is still not fully appreciated. For example, it is well
know that tobacco is the most important cause of lung cancer. Less known is the fact that
tobacco kills more people through many other diseases, including cancers in other parts
of the body, heart disease, stroke, emphysema and other chronic diseases. Studies in the
United Kingdom have shown that smokers in their 30s and 40s are five times more likely
to have a heart attack than non-smokers.
TOBACCO USE IS A KNOWN
OR PROBABLE CAUSE OF DEATH FROM:
Respiratory diseases:
Cancers of the:
•
•
•
•
•
•
•
Lip, oral cavity and pharynx
Oesophagus
Pancreas
Larynx
Lung, trachea and bronchus
Urinary bladder
Kidney and other urinary organs
Cardiovascular diseases:
•
•
•
•
•
•
•
•
•
Rheumatic heart disease
Hypertension
Ischaemic heart disease
Pulmonary heart disease
Other heart diseases
Cerebrovascular diseases
Atherosclerosis
Aortic aneurysm
Other arterial diseases
•
•
•
•
•
Tuberculosis
Pneumonia and
influenza
Bronchitis and
emphysema
Asthma
Chronic airway
obstruction
Paediatric diseases:
•
•
•
•
Low birth weight
Respiratory distress
syndrome
Newborn respiratory
conditions
Sudden infant death
syndrome
Lung cancer and other
diseases caused by passive
smoking
Fires caused by smoking
materials
According to WHO estimates, there are around 1.1 billion smokers in the world—about
one-third of the global population aged 15 years and over. Of these, 800 million are in
developing countries. Data suggest that, globally, approximately 47% of men and 12% of
women smoke. In developing countries, 48% of men and 7% of women smoke, while in
developed countries, 42% of men smoke as do 24% of women. By the mid 2020s, the
transfer of the tobacco epidemic from rich to poor countries will be well advanced, with
only about 15% of the world's smokers living in rich countries. Health care facilities in
poorer countries will be hopelessly inadequate to cope with this epidemic.
In certain regions, the health consequences of tobacco use are particularly devastating. In
the Former Socialist Economies, around 17% of all deaths in 1995 were due to tobacco
use. This figure is expected to increase so that in 2020, more than 22% of all deaths in
this region will be due to tobacco. In 1995. it was estimated that 41% of all deaths among
men aged 35-69 years in this region were caused by tobacco.
There has occured a shifting of the tobacco epidemic. The apparent success in tobacco
control in some countries has been negated by growth in tobacco use in less developed
countries. So, globally there has been no net progress in reducing tobacco consumption.
In absolute figures, the biggest and sharpest increases in disease burden are expected in
India and China, where the use of tobacco has grown most steeply. In China alone, where
there are about 300 million smokers, new data show there are already about threequarters of a million deaths a year caused by tobacco. Based on current trends, of all the
children and young people under the age of 20 years alive today in China, at least 50
million of these will eventually die prematurely because of tobacco use.
Although life expectancy for both sexes is predicted to rise, in many countries, the gap
between them is growing significantly due to the large number of men who smoke and
die of tobacco-related diseases. However, the number of women and girls who smoke is
also rising, and so too will the number of tobacco-related deaths among women.
HEALTH BENEFITS OF QUITTING SMOKING
One year after quitting, the risk of coronary heart disease (CHD) decreases by
50%, and within 15 years, the relative risk of dying from CHD for an ex-smoker
approaches that of a long-time non-smoker.
The relative risk of developing lung cancer, chronic obstructive lung diseases, and
stroke also decreases, but more slowly.
Ten to fourteen years after smoking cessation, the risk of mortality from cancer
decreases to nearly that of those who have never
smoked.
Quitting smoking benefits health, no matter at what age one quits.
ENVIRONMENTAL TOBACCO SMOKE SERIOUSLY DAMAGES HEAI.TH OE
NON-SMOKERS
l-.nv ironmental tobacco smoke (ETS) contains basically all of the same carcinogens and
toxic agents that are inhaled directly by smokers. Evidence is quickly mounting as to the
serious health consequences of ETS, both for adults and for children. These findings
make a strong case for swift and tough policies to limit smoking in public places.
Exposure to ETS is a cause of disease, including lung cancer and possibly coronary heart
disease in healthy non-smokers. Prolonged exposure to environmental tobacco smoke
increases the risks of lung cancer and heart disease in healthy adults, possibly by as much
as 20-30%.
ETS can also result in aggravated asthmatic conditions, impaired blood circulation,
bronchitis and pneumonia. It also is a frequent cause of eye and nasal irritation.
Health consequences of ETS particular to young people:
Children exposed to ETS
•
•
•
•
•
get more coughs and colds and are more likely to suffer acute upper and lower
respiratory tract infections. One study showed that children exposed to ETS
during the first 18 months of life have a 60% increase in the risk of developing
lower respiratory illnesses such as croup, bronchitis, bronchiolitis and pneumonia.
have an increased chance of developing asthma. If they already have asthma.
second-hand smoke can bring on asthma attacks and make them worse.
are at risk of impaired lung function, and may have breathing problems in the
future.
have an increased frequency of middle-ear infections, which can lead to reduced
hearing.
Babies born to women who smoke during pregnancy, as well as those infants
exposed to ETS have a significantly greater risk of dying of sudden infant death
syndrome (SIDS).
Smokeless tobacco use - A growing addiction
Smokeless tobacco is used in many forms around the world. In the United States and
parts of Europe, it is marketed as chewing tobacco and as oral snuff. In south and south
■east Asia, it is most commonly consumed in a 'betel quid' or 'pan' consisting of tobacco
flakes, mixed with powdered or chopped areca nut, slaked lime and catechu, wrapped in a
ibetel leaf. This practice is a part of culture and tradition. Smokeless tobacco use has also
been reported in parts of Africa and the former Soviet Union. In India, the more'recent
trend of chewing prepacked powdered areca nut with tobacco, lime and catechu (termed
'pan masala') has started to replace the habit of betel quid chewing. In Sudan, "toombak"
is used orally, while "nass" is widely used in Central Asian republics.
Although the term "smokeless tobacco" is commonly used for tobacco products used
■orally, this is a term promoted by the tobacco industry that suggests that the product is
harmless. To avoid that innocuous connotation, the term "spit tobacco" is increasingly
. used in countries such as the United States.
In the United States, recent surveys have shown alarming increases in use of spit tobacco
among children and younger adults . This increase is primarily due to the growing
popularity of oral snuff use among teenage and young adolescent males. It is estimated
that in one million adolescent boys in the USA use spit tobacco. Spit tobacco is also used
by many athletes, particularly baseball players, who are often role models for these boys.
Other populations with notable patterns of spit tobacco consumption are south and
southeast Asian immigrant communities in the United States and the United Kingdom.
These groups continue to use spit tobacco products manufactured and imported from the
Indian subcontinent.
Use of smokeless tobacco, including snuff and chewing tobacco varieties, has been
established to cause oral cancer (one of the ten leading cancers worldwide), irreversible
gingival recession, other oral pathologies, nicotine addiction and cardiovascular diseases.
Smokeless tobacco and betel quid chewing, particularly with tobacco, is the most
common cause of oral cancer in high incidence regions, and ranks globally as the greatest
single risk factor for oral cancer. There have been cases of six year old children in India
with submucous fibrosis, a precancerous condition . In south and southeast Asia, more
than 100,000 new cases of oral cancer are diagnosed annually. Some 1,700 and 30,000
cases of oral cancer are diagnosed in the UK and the USA respectively, each year. It is
believed that as many as 75% of oral cancers diagnosed in the United States are attributed
to regular use of smokeless tobacco products and alcohol combined.
Beyond prevention helping teens quit smoking
There is often a hick ofsmoking cessation resources designed for young people
As countries strive towards tobacco-free societies, prevention of smoking among youth is
of key importance. However, around the world, high rates of smoking among teens
provides a strong argument for effective youth-oriented smoking cessation programmes.
Available information suggests that physical and psychological dependence on smoking
can develop quickly in young people. By the time teens have been smoking on a daily
basis for a number of years, the smoking habit and addiction levels may well have
become entrenched, and they are faced with the same difficulties in quilling as adult
smokers. Although intentions to quit and quit attempts are common among teenagers.
only small numbers of teenagers actually quit. One of the problems may well be the lack
of smoking cessation resources tailored to young people.
Recent studies have found that students would welcome smoking cessation assistance if
provided in acceptable-ways. It appears that some groups of students prefer more
independent quilting strategies, such as self-help programmes or "quit and win" style
incentives. However, this will vary among populations, and will need to be determined
before interventions are planned.
Tobacco addiction and kids
The younger people start smoking cigarettes, the more likely they are to become strongly
addicted to nicotine.
Tobacco products contain substantial amounts of nicotine, which is absorbed easily from
tobacco smoke in the lungs and from smokeless tobacco in the mouth or nose. Nicotine
has been clearly recognized as a drug of addiction, and tobacco dependence has been
classified as a mental and behavioural disorder according to the WHO International
Classification of Diseases, ICD-10 (Classification F17.2). Experts in the field of
substance abuse consider tobacco dependency to be as strong or stronger than
dependence on such substances as heroin or cocaine. Moreover, because the typical
tobacco user receives daily and repeated doses of nicotine, addiction is more common
among all tobacco users than among other drug users. In many countries, about 90% of
smokers smoke every day, and approximately that proportion or perhaps even more are
dependent on tobacco. Among addictive behaviours, cigarette smoking is the one most
likely to take hold during adolescence. A study found that 42% of young people who
smoke as few as three cigarettes go on to become regular smokers. What often starts out
as an act of independence may rapidly become an addictive dependence on tobacco.
Studies by health scientists in the United States have found that about three-fourths of
under-age smokers consider themselves addicted, while a majority of adolescent smokers
in Australia had tried to quit and found it very difficult. About two-thirds of adolescent
smokers in another USA study indicated that they wanted to quit smoking, and 70% said
that they would not have started if they could choose again. These responses are
remarkably similar to the conclusions of studies conducted years earlier for a Canadian
tobacco company:
"However intriguing smoking tvas at 11, 12 or 13, by the age of 16 or 17 many
regretted their use of cigarettes for health reasons, and because they feel unable to stop
smoking when they want to. "
Danger!
PR in the playground
Tobacco industry initiatives on Youth smoking
"We believe in our right io provide adult smokers with brand choice and information.
alongside our responsibility to ensure that our marketing does not undermine efforts to
prevent children from smoking. [Martin Broughton. Chairman of BAT. 2000][ 1 ]
"In all my years at Philip Moms. I’ve never heard anyone talk about marketing to youth."
[Geoffrey Bible. CEO of Philip Morris, 1998][2]
If younger adults turn away from smoking, the industry will decline, just as a population
which does
not give birth will eventually dwindle.'
[Diane Burrows, RJ Reynolds, 1984][3]
“... We refined the objective of a juvenile initiative program as follows: "Maintain
and proactively protect our ability to advertise, promote and market our products via a
juvenile initiative*".
* Juvenile Initiative = a series of programs and events to discourage juvenile smoking
because smoking is an adult decision.”
[Cathy Leiber, Philip Morris International, 1995][4]
"As we discussed, the ultimate means for determining the success of this program will
be: 1) A reduction in legislation introduced and passed restricting or banning our sales
and marketing activities; 2) Passage of legislation favorable to the industry; 3) greater
support from business, parent, and teacher groups.”
[Joshua Slavitt. Philip Morris, “Tobacco Industry Youth Initiative,” 1991] [5]
A cigarette for the beginner is a symbolic act. 1 am no longer my mother's child. I'm
tough. I am an adventurer, I'm not square ... As the force from the psychological
symbolism subsides, the pharmacological effect takes over to sustain the habit."
[Philip Morris, 1969][(5]
naaressea lores seminars.
TOBACCO CULTIVATION RUINS HEALTH OF WORKERS
That moving .out from
tobacco cultivation is a feasible
alternative is the message that
has
emanated from the
workshop on “Action Towards a
Tobacco:Free World” at the
Asian Social Forum. The
workshop brought together
development
workers,
researchers, medical and
economic experts besides the
labourers who were previously
engaged in tobacco related
work.
Latha, a labourer from
Shimoga, Karnataka, narrated
her experiences. “ We used to
get a paltry wage of Rs.30/- a
day for 20 hours of back
breaking work in the tobacco
farms. Tobacco dust infected
several parts inside by body
and I spent more than
Rs.30,000/- for treatment”. She
has since become a crusader
persuading her co-workers to
give up toiling on tobacco
farms at the cost of their health.
“I will never go back to those
fields, even if they offer me one
hundred rupees a day”,
reaffirms a decided Latha.
Tobacco
Board
officials from the region admit
that 80% of the forest in some
of these villages has been
depleted due to massive felling
of trees to cure tobacco. Their
records confirm that many
tobacco farmers are leaving
tobacco cultivation. Some of
these farmers have found safer
havens in growing maize and
groundnut and tobacco
labourers in Shimoga and other
parts of Karnataka have shifted
to income-generating activities
like rearing cattle.
Suvarna,
a
development worker, who
works with women in tobacco
farming, says, “Tobacco work
drains them of their energy and
health and often strains family
relationships to the point of
breaking them due to the long
hours of work during the
farming season. It leaves them
no time to attend to household
chores and children”. Many of
these children eventually drop
out of school and are taken to
—----------- - <=
r*
MF
work on tobacco farms.
Several of the workers
at the workshop who despise
working on tobacco farms
pointed out that government
policies in this regard are anti
poor. Government promotes
tobacco farming, research and
marketing through support
institutions
and
these
essentially benefit the rich
farmers who own land and
resources. They opine that
unless these are reversed and
alternatives explored and
developed, this exploitative
industry would continue to
thrive undeterred at the cost of
the health of the workers and
smokers.
ASF Sidelights
The venue of Asia Social Forum, Nizam College grounds,
thundered with the resounding rythms of dappu(drums).
Marxist intellectuals to Gandhians were seated on the dias.
From revolutionary groups to anti tobacco groups
participated in the programme.
Nora Cartinos an octagenarian from Argentina seized the
attention with her active approach and inspirative speech.
Budhist monks from Sri Lanka not withstanding the
scorching sun sheltered under unmbrellas.
Medha Patkar and the leaders of the Left parties squatted in
the masses before the Plenary.
Worldwide trends in tobacco consumption and mortality
World Health Organization
TOBACCO: THE TWENTIETH CENTURY'S EPIDEMIC
Every ten seconds, somewhere in the world, tobacco kills another victim. If current
smoking trends continue, this toll will increase up to one tobacco-caused death every three
seconds over the next thirty to forty years.
Recent data have confirmed that the risks of smoking are substantially higher than previously
thought. With prolonged smoking, smokers have a death rate about three times higher than
nonsmokers at all ages from young adulthood. Tobacco products are known or probable
causes of over two dozen diseases or groups of diseases. If, as is likely, much of the excess
mortality from these diseases is directly attributable to tobacco use, then this implies that the
lifetime risk of a smoker being killed by the use of tobacco products is at least 50%.
Therefore, a lifelong smoker is as likely to die'as a direct result of tobacco use as from all
other potential causes of death combined!
Other problems ensue because the negative health consequences of tobacco are not as
immediate as with other hazardous substances.' The health risks of tobacco arc vastly
underestimated by the public, and even by many of those who are responsible for protecting
and promoting public health. Yet the risks of smoking are very high when compared to other
risks faced in everyday life (See Table 1). Widespread underestimation of risks associated
with tobacco use, is a major reason why tobacco products are still widely available, and why
lenient tobacco policies have been allowed to occur. But nothing can alter the fact that
tobacco use is one of the major public health challenges facing the world as it enters the
twenty-first century.
TOBACCO USE IS A KNOWN OR PROBABLE CAUSE OF DEATH FROM:
Cancers of the:
•
•
•
•
•
•
•
Lip, oral cavity and pharynx
Oesophagus
Pancreas
Larynx
Lung, trachea and bronchus
Urinaiy bladder
Kidney and other urinary organs
Cardiovascular diseases:
•
•
•
•
Rheumatic heart disease
Hypertension
Ischaemic heart disease
Pulmonary heart disease
•
•
•
•
•
Other heart diseases
Cerebrovascular diseases
Atherosclerosis
Aortic aneurysm
Other arterial diseases
Respiratory diseases:
•
•
•
•
•
Tuberculosis
Pneumonia and influenza
Bronchitis and emphysema
Asthma
Chronic airway obstruction
Paediatric diseases:
•
•
•
•
Low birth weight
Respiratory distress syndrome .
Newborn respiratory conditions
Sudden infant death syndrome
Tobacco products have no safe level of consumption, and are the only legal consumer
products that kill when used exactly as the manufacturer intends. Researchers have rated
nicotine as even more addictive than heroin, cocaine, marijuana or alcohol. The Tenth
Revision of the International Classification of Diseases reserves classification Fl7.2 for
"tobacco dependence syndrome". Yet tobacco products continue to be aggressively marketed
by tobacco companies. The result is that global tobacco consumption Jias doubled since
medical science conclusively proved, 30 years ago, that these products were unrivalled
killers. And consumption is still increasing in many areas of the world.
An analysis of trends in cigarette consumption for WHO regions indicates that the two
regions with the highest average per capita (adult) consumption in 1990-1992 were Europe
(2290 cigarettes per adult per year) and the Western Pacific (2000). The lowest consumption
was observed in the African Region (540). For the developed countries as a whole, per capita
adult consumption is currently about 2400 cigarettes, which is still significantly greater than
the average consumption in the developing world (1370 cigarettes).
The gap is rapidly narrowing, however. In 1970-1972, consumption per adult in the
developed countries was 3.25 times higher than in the developing world (see Figure 1). By
1980-1982, this ratio had narrowed to 2.38, and by 1990-1992, to 1.75. During the last
decade, per capita consumption has declined by an average of 1.4% per year in developed
countries, but has risen by 1.7% annually in developing countries. If these trends were to
continue, consumption of cigarettes per adult in the developing world'will exceed levels in
the developed world some time between the years 2005 and 2010, i.e., within two decades.
There have been very noticeable differences in trends among WHO regions. Over the last
decade, the fastest decline in per capita consumption occurred in the Americas. Nor was this
entirely due to declines in consumption in Canada and the United Stales of America;
excluding those two countries, per capita consumption in the Region still declined by an
annual average of 1.7%. On the other hand, the increasing consumption in the Western
Pacific (2.2%) and South-East Asia (1.8%) is primarily due to the trends in China and India
respectively. From 1983, per capita (adult) consumption in China rose by 3.9% per year to
reach 1990 cigarettes in 1990-1992. In India, where about 90% of cigarettes are consumed in
the form of bidis (traditional hand-rolled cigarettes), adult consumption has risen by about
2% per year over the last decade and now exceeds 1200 cigarettes (including bidis).
WHO estimates that there are about 1100 million regular smokers in the world today. About
300 million (200 million males and 100 million females) are in the developed countries, and
nearly three times as many (800 million: 700 million males and 100 million females), in
developing countries. In developed countries, 41% of men are regular smokers, as are 21% of
women (see Figure 2). Half the men living in developing countries are smokers, compared
with about 8% of women.
The health consequences of the smoking epidemic in developed countries have been
quantified by WHO, in close collaboration with the Imperial Cancer Research Fund's Cancer
Studies Unit at the University of Oxford, UK. A major report giving detailed estimates of the
numbers and rates of smoking-attributed deaths for over 50 countries or groups of countries.
has been published. Between 1950 and 2000, it is estimated that smoking will have caused
about 62 million deaths in the developed countries (12.5 % of all deaths: 20% of male deaths
and 4% of female deaths). More than half of these deaths (38 million) will have occurred at
ages 35-69 years. Currently, smoking is the cause of more than one in three (36%) male
deaths in middle age, and about one in eight (13%) of female deaths. Each smoker who dies
in this age-group loses, on average, 22 years of life compared with average life expectancy.
During the 1990s, the report estimates that almost 2 million people a year will die from
smoking in developed countries (1.44 million men and 0.48 million women).
As regards cigarettes the health consequences of tobacco use are much more difficult to
estimate in developing countries owing to lack of data. Currently, it is estimated that tobacco
causes about 1 million deaths a year in developing countries, but there is substantial
uncertainty about this figure. If current trends continue, and if the risks of death from tobacco
use are similar in developing countries to those that have been observed in the industrialized
world, then the annual toll of mortality from tobacco will rise dramatically to around 7
million deaths per year in the 2020s or early 2030s (see Table 2). The chief uncertainty is not
whether, but rather when, these deaths will occur if current trends in tobacco use persist.
Table 2. Estimated number of Deaths caused every year by Tobacco
Developed countries
Developing countries
Total
Decade
1990s
Decades
2020s/early 2030s
2 million
1 million
3 million
3 million
7 million
10 million
UICC GLOBALink
The International Tobacco-Control Network Selected documents: The
Death Toll form Tobacco - A Crime Against Humanity
September 1998
Deaths caused by smoking
There are between 1.1 -1.4 billion smokers in the world out of a total population of around 5.8
billion. It has been estimated that 50% of smokers will die prematurely from tobacco related
illness, half in middle age (defined as 35 - 69 years of age) with an average loss of life expectancy
of 20 - 25 years (8 years over all ages).
This means that over half a billion people (in excess of 500 million) or about 10% of the existing
population will die from smoking. Of these, 27% will die from lung cancer, 24% will die from
heart disease, 23% will die from chronic obstructive lung disease, emphysema or bronchitis and
the remaining 26% will die from other diseases including other circulatory disease (18%) and
other cancers (8%).
Currently, 3 million people worldwide die every year from smoking related disease. This repre
sents about 1 person every ten seconds. One third of all people aged fifteen years and over smoke
and this proportion is increasing in Asia, Eastern Europe and the former Soviet States.
Consumption trends indicate that smoking prevalence is reducing in developed countries (DCs)
(down 1.5% per annum in the United States) whilst increasing in lesser-developed countries
(LDCs)(up 1.7% per annum on average).
The World Health Organisation (WHO) has estimated that, based on current trends, the death loll
from smoking will rise to 10 million people per year by the year 2025. Currently two million
deaths occur each year in developed countries and 1 million deaths occur each year in lesserdeveloped countries. By 2025 this proportion will alter to 3 million deaths per year in developed
countries and 7 million deaths per year in lesser-developed countries. No other consumer product
in the history of the world had come even close to inflicting this degree of harm onyhe world
community. If anything else posed a threat to Life of this magnitude whether human induced or
naturally occurring - be it world war, genocide, ethnic cleansing, natural disaster or disease - it
would demand immediate international action. The response to HIV, the prosecution of war crimes
(both current and dating back to World War H), germ warfare, nuclear weapons or even climate
change are but a few examples.
The history of the smoking pandemic of the 20th century can be traced back to the invention of the
mechanical cigarette machine in the late 1809’s. Until that time cigarettes were rolled by hand,
production was low and smoking was not overly prevalent. The cigarette machine meant that
millions of cigarettes could be produced each day at a lower cost and distributed more widely.
The result was that cigarette smoking increased such that by the late 1940’s smoking rates in
developing countries were up to 70% in adult males and up to 25% in adult females. Smoking
rates in LDCs were significantly less.
From the discovery of the link between increased smoking and disease in the early 1950’s, and
major reports publicising the need for public health action, smoking rates among adult males in
developed countries has declined although prevalence in adult females increased to some degree
but now the levels are roughly equal at about 25% in many developed countries. Meanwhile,
smoking rates in lesser-developed countries has increased in both the adult mal .? and adult female
population.
Due to the latency in the development of disease from smoking, the effects were first detected
among adult males in developed countries. The effect of increased smoking among adult females is
now being reflected in disease rates with similar observations in lesser-developed countries.
Hence the WHO estimates by the year 2025.
Transnational tobacco companies
Tobacco consumed by the world’s 1.1 -1.4 billion smokers is produced by a handful of
transnational tobacco companies and a number of state owned manufacturers. China’s state owned
production accounts for 31% of all tobacco sales with Italy, Russia, Japan, Taiwan. Indonesia and
Thailand, amongst other countries, having substantial government owned factories as well.
_
9
However, transnational tobacco companies account for 40% of the global market and control 70%
of world production, and this is increasing. In many cases, the state owned producer was a state
monopoly but. increasingly, this has been broken down through free trade agreements to a point
where transnational tobacco companies are not only marketing in countries previously the subject
of a state monopoly but there are reports of expressions of interest by transnational tobacco com
panies in obtaining an interest in formerly state owned monopolies now being privatised.
A
Whilst all tobacco consumption contributes to the overall death toll, state owned production is
arguably an internal matter to the nation - state in question. The activities of privately owned.
transnational tobacco companies is a matter on international concern. The major transnational
tobacco companies, in order of sales, are: US based Philip Morris Inc., followed by British based
BAT Industries p.l.c., United States based RJR Nabisco and Rothmans. Under agreements appar
ently reached among these transnational tobacco companies, Rothmans does not market in the
United States and BAT does not market in Britain. There are reports that Philip Morris and BAT
have entered into collusive agreements that fix cigarette prices and divide markets in South
America (apparently such anti competitive arrangements are not illegal in those countries). It is a
mark of the power of the major transnational tobacco companies that they can reach such agree
ments dividing up markets in sovereign nations consequently inflicting the harm identified above.
In 1996, Philip Morris had annual revenues ofS55 billion, just over half from tobacco with the
rest coming from domestic and international food and alcohol sales. Only 18% was from domestic
tobacco sales (20% in 1992) compared with 35% from international sales (21% in 1992). Total
tobacco sales comprised 53% in 1996 (41% in 1992) or about 23 billion. BAT revenue in 1996
was S23 billion. RJR Nabisco had total revenues of SI 7 billion in 1996 of which 48% or about 8
billion was from tobacco sales. These massive levels of turnover and the economic, political and
social influence of the transnational tobacco companies has led to the industry being described
collectively as “Big Tobacco”. A comparison is made that these revenues exceed the gross domes
tic product of many countries. For example, Philip Morris has a turnover larger than the GDP of
Ecuador, Guatemala, Kenya, Kuwait, Malaysia and Peru. It is roughly the equi vent of Ireland.
Singapore or Hungary. RJR Nabisco’s turnover is roughly the equivalent of the GDP of Costa
Rica, Croatia. Cuba, El Salvador, Lebanon or Jamaica. Whilst these companies undoubtedly have
significant economic, political and social influence, the fact remains (with all due respect to the
countries with which comparison is made), these transnational tobacco companies, either indi
vidually or collectively, are not an overwhelmingly dominant force on a world scale.
Deceit and duplicity of the tobacco industry'
The current status of the tobacco industry is anomalous insofar as cigarette consumption clearly
inflicts a degree of mortality totally at odds with fundamental human rights and human values. At
the same time the tobacco industry defends itself on the basis that tobacco is a "legal product".
This occurred because the tobacco industry had already acquired a substantial degree of eco
nomic. political and social influence by the time the link between smoking and disease was estab
lished. Since that time the tobacco industry worldwide has engaged in a deliberate campaign of
deceit and duplicity to protect and even expand its influence through a process of denial and
disputation of the now proven link between smoking and disease, the addictive properties of
nicotine and their marketing strategies directed at youth.
This deceit and duplicity is currently being exposed by litigation in the United States which is
spreading worldwide. The position has now been reached where continued disputation and distor
tion is untenable, particularly in the face of the projected increase in tobacco deaths by the year
2025 if current trends are continued. This is all the more so given the disparity in the projected
increase between developed and less developed countries, reflecting an exploitation of lesser
developed countries which will only increase to offset liabilities the tobacco industry is incurring
in the United States. This is a circumstance calling for international action. It must not be allowed
to happen. Were it to occur it would be, without doubt, a crime against humanity.
Crimes against humanity in the International Criminal Court
On 17 July 1998 the United Nations Rome Statute of The International Criminal Court established
a permanent Court having power to exercise jurisdiction over persons for the most serious crimes
of international concern. Article 5 confers jurisdiction on the International Criminal Court with
respect to the following crimes:
I.
The crime of genocide;
2.
Crimes against humanity;
3.
War crimes;
4.
The crime of aggression.
5.
For the purposes of the Statute, Article 7 defines a “crime against humanity" to mean any of the
following acts when committed as part of a widespread or systematic attack directly against any
civilian population, with knowledge of the anack;
1.
Murder;
2.
Extermination;
3.
Enslavement;
4.
Deportation or forcible transfer of population;
5.
Imprisonment or othersevere deprivation of physical liberty in violation of fundamental
rules of international law;
6.
Torture;
7.
Rape, sexual slavery, enforced prostitution, forced pregnancy, enforced sterilisation, or any
other form of sexual violence of comparable gravity;
8.
Persecution against any identifiable group or collectively on political, racial, national
ethnic, cultural, religious, gender as defined in paragraph 3, or other grounds that are
universally recognized as impermissible under international law, in connection with any
act referred to in this paragraph or any crime within the jurisdiction of the Court;
9.
10.
11.
Enforced disappearance of persons;
The crime of apartheid;
Other inhumane acts of a simi lar character intentionally causing great su ffering, or serious
injury to body or to mental or physical health.
Given what is known about smoking and disease and the deceit and duplicity of the tobacco
industry, were the death toll from tobacco to increase from 3 million a year to 10 million a year by
the year 2025. especially with the dramatic increase in lesser developed countries from 1 million
a year to 7 million a year, it is impossible to describe that consequence as anything other than the
result of an inhumane act of a character similar to murder, causing great suffering, or serious injury
to body or to menial or physical health committed as part of a widespread or systematic attack
directed against the civilian population of the world.
Given that the directors and executives of the major transnational tobacco companies must now
have knowledge ofthe consequences of their activities, ifthose activities continue then each and
every one of them must face the prospect of being charged with committing a crime against human
ity in the International Criminal Court. Article 11 of the-Statute provides that the Court has juris
diction only with respect to crimes committed after the entry and the force of the Statute. This
means that the opportunity exists for these directors and executives to escape liability under the
provisions of the Statute providing there is no increase in mortality from tobacco use. Arguably
they should be responsible for a reduction. Given the likely increase in mortality from past smok
ing. because of the latency of tobacco related disease, every effort would need to be made.to
reduce consumption in order to avoid a significant increase in the current death toll. Certainly
expansion in lesser-developed countries should not occur. As a means of securing this outcome.
each of the major transnational tobacco companies, and each of their directors and executives.
should formally be put on notice of the consequences of their activities such that charges of a crime
against humanity can be laid and successfully prosecuted if radical action is not taken to reverse
current trends.
NEIL FRANCEY
Barrister at Law
Wentworth Chambers
180 Philip Street
Sydney 2000
AUSTRALIA
4lh January 2003
For Immediate Release
Asian Tobacco Control Activists
Suggest Alternatives to Tobacco-Related Work
Hyderabad: Moving out from tobacco cultivation is a feasible alternative, was the
message that emanated from the workshop on “Action Towards a Tobacco Free World
at the Asia Social Forum in the citadel of tobacco farming. The workshop held yesterday
brought together development workers, researchers, medical and economic experts
besides the labourers who were previously engaged in tobacco related work.
Latha, a labourer from Shimoga, Karnataka narrated her experiences working in the
tobacco fields, “ We used to get a paltry wage of Rs. 30/-a day for 20 hours of back
breaking work in the tobacco farms. Tobacco dust infested my insides and I spent more
than Rs. 30,000/- in treatment”. She has since become a crusader persuading her co
workers to give up toiling on tobacco farms at the cost of their health. “ I will never go
back to those fields, even if they offer me Hundred rupees a day”, reaffirms a decided
Latha.
Tobacco Board officials from the region admit that 80 % of the forest in some of these
villages have been depleted due to massive felling of trees to cure tobacco. Their records
confirm that many tobacco farmers are therefore leaving tobacco cultivation. Some of
these farmers have found safer havens in growing maize and groundnut and tobacco
laborers in Shimoga and other parts of Karnataka have shifted to income generation
activities like rearing cattle.
Suvarna, a development worker who works with women in tobacco farming relates,
Tobacco work drains them of their energy and health and often strains family
relationships to the point of breaking them due to the long hours of work during the
farming season. It leaves them with hardly any time to attend to household chores and
children”. Many of these children eventually drop out of school and are taken to work on
tobacco farms.
Several of the workers at the workshop who despise working on tobacco farms pointed
out that Government policies in this regard are anti-poor. Government promotes tobacco
farming, research and marketing through support institutions and these essentially benefit
the rich farmers who own land and resources. They opine that unless these are reversed
and alternatives are explored and developed, this exploitative industry would continue to
thrive undeterred.
For Further details, contact:
Thelma Narayan, Co-ordinator, Community Health Cell, Bangalore.
Email: sochara@vsnl.net
Statement issued by the participants of the
“WORKSHOP ON ACTION TOWARDS A TOBACCO FREE WORLD”
On 3rd January 2003
_______________ ASIAN SOCIAL FORUM, HYDERABAD, INDIA_______________
FIGHT TOBACCO THE KILLER !!!
Realizing that tobacco and its products
including cigarettes, bidis, guthka, and chewed
tobacco...
•
Is one of the biggest killers worldwide and
particularly among the poor killing 4.9 million
people every year and reducing life by 15-20
years. Tobacco causes cancer of the various
organs, diseases of heart, blood vessels, lungs
and other organs leading to suffering disability
and death.
We the participants of the workshop on Action
Towards a Tobacco Free World in the Asia
Social Forum issues this statement and call
upon Government, civil society, media and the
people to take up urgent action......
®
On public policies In the context of right to food,
right to health and right to work and poverty
reduction.
e
Work through local government and local
bodies, focussing on women and dalits.
•
Hold the tobacco companies responsible for the
losses incurred and the adverse consequences
on individuals and families of tobacco use.
•
Ban all direct and indirect advertisement of
tobacco and its products including sponsorship
of sports and cultural event by the tobacco
companies and affiliated bodies.
•
Is highly addictive with nicotine being more
addictive than cocaine or heroin.
•
Is the only freely available consumer product
that kills.
•
Has an adverse environmental impact, using of
millions of tonnes of wood for curing tobacco, •
excessive use of pesticides and chemicals,
depleting soil fertility.
•
•
The tobacco industry results in an overall fiscal
loss, with loss of productivity and cost of
treating tobacco related illnesses being more
than the revenue gainded.
The tobacco industry indulges in misinformation
through aggressive advertisement and
sponsorship targeting children, youth and
women.
•
Affects millions of non-smokers and particularly
pregnant women, retarding the growth of the
unborn children and causing abortion through
passive smoking.
•
Tobacco use perpetuates poverty at household
and larger levels.
Ban the manufacture and sale of chewed
tobacco in any form, since minors are especially
vulnerable.
•
Progressively reduce the area of cultivation of
tobacco utilizing the area thus freed for other
beneficial crops.
•
Prevent the cutting down of trees and
denudation of forests for curing and packaging
tobacco.
•
Increase progressively the tax on tobacco and
its products and utilize the revenue thus
received for health promotion.
•
Introduce legislation and effectively implement
laws for prohibition of smoking in public places.
•
Use all means to increase public awareness
e
Reduce glamorization of tobacco products
through films and media.
‘WORKING TOGETHER FOR TOABCCO CONTROL”" TOGETHER WE CAN DO IT!
Action Towards a Tobacco Free World
A workshop at Asia Social Forum, Hyderabad
Date: 3rd January 2003
Time: 2:15 to 6:30 P.M.
Venue: Taj Mahal Hotel, Abids Road, Hyderabad
Facilitated by:
Community Health Cell, Bangalore on behalf of Jan Swasthya Abhiyan / People’s Health
Movement)
Partner Organizations
Consortium For Tobacco Free Karnataka
PATH-Canada, LIFE
A Report by Dr. Anant Bhan, Community Health Cell
The workshop began with registration of all participants. They were given files with
background material about the purpose of the workshop. Around 40 people participated in the
workshop.
The workshop began with an introduction to the purpose of conducting the workshop by Mr.
S.J. Grander from the Community Health Cell who spoke about the global problem that
Tobacco had become and the targeting of Asia and developing countries by Tobacco MNCs
and hence the importance of a concerted effort to network for freedom from tobacco.
Dr. Ramesh S. Bilimagga, Radiation Oncologist and member, CFTFK (Consortium For
Tobacco Free Karnataka, Bangalore, chaired the first session. He welcomed all the
participants to the workshop and reiterated that tobacco was a major problem not just in India
but also across the world. He stressed that a small step by everybody in the direction of a
tobacco free world would make a big difference. He then invited Dr. Thelma Narayan from
CHC to give an overview of the problem.
Dr. Thelma explained that the workshop was being held under the platform of Jan Swasthya
Abhiyan (PHM) which was active in more than 92 countries ands was working towards
making the govts, and WHO and international bodies accountable to their commitment for
Health For All. She stressed that many coordinating and facilitating agencies had helped in
organizing the workshop and also enumerated the other events at ASF being facilitated by
CHC/JSA/PHM. She said that the workshop would help us understand the tobacco issue
especially in regards to dealing with the tobacco industry. It was needed to share our
solidarity in the ASF platform and to strategize and reflect. The effect of globalization on
public health needed to be studied in depth. Opium had been used in the past by Britain to
subjugate China and now the western powers through the tobacco MNCs were using tobacco
to subjugate the Asian countries. The US was promoting the global consumption of tobacco
and there had been a sharp increase in tobacco usage in many areas; the issue of tobacco
advertising was also an important issue. While tobacco use was reducing in the North
America and Western Europe, the tobacco market was being relocated with increasing use in
Asia and developing countries. Data from different Asian Countries was presented. The
dynamics and intricacies influencing the negotiations of the Frame Work Convention For
Tobacco Control (FCTC) led by the WHO (World Health Organization) needs to be more
transparent in order to evolve a useful instrument.
A Magic Show and a talking doll show followed this. The magician stressed on the ill effects
of tobacco and requested people to not let their lives go up in smoke and to avoid the bad
habits. It was well appreciated by the audience. He also wished everybody present a very
happy and tobacco free New Year.
Dr.Ramesh then invited Dr. Prakash C. Gupta, an epidemiologist and a public health
consultant from Mumbai having 36 years of research experience in the field of tobacco.
Dr.Prakash began by saying that tobacco is a public health problem even at the grassroots
level. Understanding the problem was not enough and something needed to be done about the
problem. There were various organizations working in the field of tobacco control in India-a
loose coalition oTwhich was the ICTC (the Indian Coalition for Tobacco Control). Each of
the organizations was free to pursue their own agenda but it was an interactive forum for all
participating organizations to pool their resources. He expressed hope that more organizations
would join the fold. He also mentioned that a death clock had been installed in Delhi that
would register the deaths being caused by tobacco usage in India.
After thanking Dr. Prakash, Dr. Ramesh introduced Mr. Sonam, a bureaucrat form the
Ministry of Health and Education in Bhutan. Mr. Sonam said that Bhutan had initialed
tobacco control regulations as early as 1729; the state religion (Buddhism) did not permit the
usage of tobacco. He cautioned that in their experience regulation alone was not enough and
there was he need to take undertake aggressive information dissemination and work for anti
tobacco legislation. The Hon’ble Minister of Health had ensured that the sale and
consumption of tobacco had been banned in public places. The effort had come through a
decentralized approach wherein 18 out of the 20 districts in the country had themselves taken
up the initiative to work for local tobacco control. He said that a dilemma that faced the govt.
was the continuing sale of tobacco in the duty free shops in the capital city, which could not
be stopped because of diplomatic problems- he invited suggestions from the participants on
how to deal with the problem. He said that one of the queens in Bhutan was committed to the
cause of tobacco control and had been appointed as a goodwill ambassador by the UNFPA
and she advocated the tobacco and health issues in various districts that she regularly visited.
Appreciating the people of Bhutan, Dr. Ramesh said that it was important to remember that
perseverance was the key.
Dr. Ramesh then called upon two members of the Bangladesh Anti Tobacco Alliance to
speak about efforts al tobacco control in their country. One of them Mr. Ratan Deb said that
sometime ago though there were many groups working in the field not many were working
together ;only school level programs were being organized to raise awareness about the
harmful effects of tobacco and these also not very effective as they were leading to rebellion
in many cases. He felt that what would work is strict enforcement, high taxes, controlling of
advertising, more elaborate warning in the packs. He said that BATA has little resources
compared to other groups and tobacco companies. BATA had filed a case in the Bangladeshi
courts and had managed to achieve a significant legal victory which led to decrease in the
rampant advertisement of tobacco companies and had also proved that British American
Tobacco Company’s antismoking campaign was a sham. BATA has been closely working
with the Bangladeshi govt, and have been attempting to spread the message of harmful
effects of tobacco even in the regional languages. A law for stricter tobacco control is now
pending in the parliament. A second writ petition is now pending in the courts under the
Right to Life campaign against the Imperial Tobacco company; the court has given a stay
order on all relevant advertisements for two months. Many organizations and facilities in
Bangladesh are now tobacco free due to the efforts of BATA. He ended stressing that
working together was very important for tobacco control. Mr. Naveen Thomas expressed the
view here that one major factor for the success of the campaign in Bhutan was the fact that
the political, religious and local leadership had come together to fight (he problem and were
very much involved.
Dr. Ramesh appreciated the efforts of BATA and raised the fact that the various govts, had a
dichotomous attitude towards tobacco wherein e.g. the Karnataka govt, had an anti tobacco
cell in the Kidwai Memorial Institute of Oncology, it also had a research wing in the Tobacco
Board to try to improve productivity and quality of tobacco crops. He said that in K’taka
• There were 8 million tobacco addicts.
• 6000 children under the age of 15 yrs of age and as many between the ages of 1524 enter the pool of tobacco users.
There was a need to publicize the tobacco issue among the lay public as they had the right to
information.
Mr. Jaggaiah, a security guard from Hyderabad who used to smoke around 48-50 beedis a
day for over 40 years presented his medical problems directly related to his tobacco
addiction. He used to get cough, dyspnoea and chest pain; he had to undergo surgery
(pneumonectomy) for pathology arising from his tobacco usage; he said that he had now
stopped smoking and was proud to be free from tobacco.
Ms. Lalitamma from Karnataka, an ex-cultivator then shared her experience .She said that she
had been working in the tobacco fields for over 15 years; most of the workers used to be
employed as daily wage workers by the rich cultivators and had work for only 3-4 months/yr.
The workers had very hectic work in the fields everyday and at the end of each day they were
so tired that they could not adopt any hygienic methods before consuming food or have a bath
before sleeping. They also used to use a lot of pesticides in the tobacco nurseries in their
homes and because of all this problems she felt that they used to inadvertently consume a lol
of pesticides. During the course of her work, she developed health problems and approached
a medical practitioner who advised admission - her treatment bills were in the range of about
Rs 30,000. She said that she had resolved to never do that kind of work again and was hoping
that other people also left that hazardous work.
Dr, Ramesh thanked all the speakers for giving an insight into the various issues related to
tobacco that were affecting their lives and work. He then thanked the organizers for having
given him the opportunity to chair the session and handed over the stage to the next
chairperson, Ms. Devaki Jain.
Ms. Devaki then chaired the next session, which was distribution of certificates and
mementoes of appreciation to
•
•
•
The people of Bhutan for having shown great collective resolve for the fight against
tobacco. This was received by Mr.Sonam Thunsho, secretary, government of Bhutan
in charge of health education.
The members of BATA for their work for tobacco control in their country and for
dragging the guilty tobacco companies to court and make them accountable for their
unlawful practices. This was received by Mr.Ratan and Mr. Biplob^ .
Dr. Prakash C. Gupta for his extensive work in research in the field of tobacco.
A short tea break was then announced which gave the opportunity for the audience to interact
with the speakers and also for them to view the exhibition of anti tobacco posters that had
been put up by Community Health Cell in the hall.
The tea break was followed by a panel discussion on various facets of the tobacco issue. The
discussion was chaired by Ms. Devaki Jain. She said that the amount of money the govt.
spent on treating diseases arising from the usage of tobacco was more than the money it
received through excise. Tobacco related deaths were more than the number of deaths caused
due to HIV, Malaria, and T.B. combined. There was a need for campaign mode activists, as
knowledge about the ill effects of tobacco did not deter people from harmful habits. Death
was a close phenomenon in India especially among the poor and hence morbidity and
mortality due to tobacco could not be used as an effective deterrent in that sector. There was a
need to work to change attitudes; also important was to fight the tobacco industry, which was
targeting the young by using unfair advertising means. There was a need to talk about it in the
background of globalization and macro-economic program. The relation between poverty in
India and the addiction to tobacco, alcohol and the susceptibility to HIV in poor communities
was well known and proven in studies such as one done by NIMHANS. Also, interestingly,
the govt, had included Tobacco in the Foods and Beverages list.
Dr. Devaki then invited Dr. Prakash Gupta to give his presentation. Dr. Prakash’s
presentation had the following salient points:1.
There were only two causes of death that were increasing worldwide- HIV and
Tobacco.
2.
Death was an objectively measured event; Tobacco usage was the single most
preventable cause of death in the world.
3.
Current WHO estimates of tobacco attributable premature deaths are in the range
of4.9 million/yr. This is expected to rise to 10 million / yr by the year 2030; already
in the 20,h century approx. 100 million people had died due to health problems related
to tobacco usage.
4.
India was the second largest producer and consumer of tobacco in the world; ICMR
estimate for the annual attributable mortality from tobacco was 8,00,000.
5.
Tobacco causes a lot of medical problems and addiction is a key issue because of the
nicotine content
6.
Children are the mot severely affected and unfortunately they are powerless to fight
against this evil.
7.
There were many misconceptions related to tobacco e.g. that it was not a high-risk
product and that tobacco users do not have any choice, once addicted.
8.
The truth was that more than half of chronic tobacco users would die of health
problems arising from that habit.
9.
Tobacco smoke had a lot of toxic chemicals and carcinogens and had an effect even
on passive smokers; hence there was a need for concerned people to fight for their
right for clean air.
10.
Tobacco and social justice was also an important issue- as its usage was more among
the lower SE strata and the relative risks were also higher in this group; beedis,
commonly used by this group were more harmful than cigarettes; also unfortunately.
most of the interventions were aimed at the higher SE strata.
11.
The rising usage of tobacco among the women was alarming- one study had shown
that as many as 10% of college going women in Mumbai were using tobacco.
Dr. Devaki then invited Dr. Srinath Reddy to present his views and experience as the
Indian govt, nominee and as a NGO health activist at the FCTC deliberations. FCTC was
an attempt by WHO to exercise its treaty making power for tobacco control. The critical
issues included stronger action required on the demand and supply sides. There were the
issues of trade and public health involved; most country representatives participating in
the deliberations were advocating a total ban on all forms of advtg.- direct and indirect.
But there had been pressures from some quarters and in the ongoing round the talk was
around restriction of advtg; unfortunately the issue of surrogate advtg had not been
addressed. The WB and developed countries were of the view that there was a continued
increasing demand for tobacco irrespective of control measures (more in the developing
countries and lesser in the developed ones). Global resources were lacking for
implementation unless a global fund was set up. Also, cross border advertising continued
to be an issue and trade v/s public health was a battle that was still being fought out in the
FCTC. The recent draft of the FCTC was disappointing. It has been prepared for the
next round of negotiation in February 2003.
Ms. Devaki thanked Dr. Reddy and mentioned that the UN precincts and most eateries in
the developed countries are smoke free. She then invited Ms. Shobha John of PATFI
Canada (Programme For Appropriate Technology for Health) based al Mumbai to make
a presentation. Shobha spoke about the poor being affected the most by tobacco usage
and she presented some data from her PATH studies which showed that the tobacco
consumption among the pavement dwellers was 82% and among the street children was
76% - these people were spending less amount of money on food than tobacco. She also
raised the issue of misplaced targeting by activists who were not addressing the tobacco
problem that was afflicting the poor SE strata and the need to reach out to that group. In
Bangladesh, a study had proven that many households were spending 18 times more on
tobacco than health. The tobacco issue was causing a loss to the country as the estimated
health costs were in the range of Rs 6.5 billion while the excise returns were only Rs.4.5
billion; hence the economic loss to the nation was immense. Also the tobacco industries
were themselves promoting smuggling of their products and were using a lot of front
groups for surrogate advertisements. The industry’s argument that a lot of workers would
lose their job had to be viewed with scepticism because the companies as they were
getting mechanized were laying off a lot of workers; also experience had shown that the
industry was actually quite exploitative; Ms. Devaki mentioned that some traders in
B’lore had been subletting the space outside their shops which was actually govt.
property to vendors; she then invited Ms. Suvarna to share the findings of her study in
Shimoga in Karnataka.
Suvarna mentioned that she had been working in the area for the last 12 yeras and she had
noticed that tobacco cultivation had decreased by more than 50% - this had sparked an
interest to initiate the study. They had discovered that the cultivators were actually the
large fanners as the govt. Tobacco board regulations were that all tobacco cultivators
should a possess a minimum of at least 3-4 acres of land .Tobacco cultivation was labour
intensive. It also required a lot of wood for curing which had led the farmers to steal wood
from the forests. Almost 80% of the forests had been depleted and now the local populace
had sometimes to walk a distance of 10 kms to collect firewood. Good quality wood was
required for curing wherein temperatures were maintained at 90-120 degrees Fahrenheit
for 4 days. The alternative crops that some families had shifted to in the state were maize
etc.; they had noticed that the land became more fertile if tobacco cultivation was
decreased. As tobacco was a very labour intensive work, the people used to be busy from
morning to evening in their work, which had affected families, as there was nobody to
look after children and the elderly. This has been shown in falling attendance in school for
the children of cultivators and agricultural laborers. The Sanghas and self-help groups
discussed this and decided to utilize the govt, programs. Supporting each other, they
cultivation, women were the most affected - they had occupational problems, were made
to work hard and do menial jobs; there was gender insensitivity and the women were made
to do the most difficult and strenuous work. This had affected the lives of many women
and children adversely. Ms. Devaki appreciated the presentation and mentioned the need
for linked narratives to help with advocacy issues.
This was followed by a group discussion involving all participants that was chaired by
Dr. Srinath Reddy. The main points that were highlighted in the discussion by various
participants were: •
Coronary Artery Disease (CAD) caused by tobacco usage needs to be studied and
publicized.
•
FCTC needs to advocate strong regulations- local and national.
•
Need to sensitize the politicians about the issue.
•
Need for effective political lobbying and policy level interventions.
•
Need to safeguard the interests of the involved people and to try to bring the larger
forces to come together.
•
Lesser emphasis to be laid on health and more on the fiscal and the environmental
aspects.
•
To try to attempt a linkage with the right to food campaign and the environmental
issues.
•
Promote the usage of the 73rd and the 74lb amendments that promote local
governance.
•
Need for economists to study the long term effects of tobacco usage.
•
Promote the ban of tobacco consumption in public places as it gives the right to
people to protest tobacco usage.
•
Alternate employment strategies to be promoted.
•
Need to understand that there was no direct subsidy by the Govt, of India to the
tobacco industry but indirect subsidy.
•
Legislation against tobacco would be ineffective if people were not informed and
convinced about the reasons for legislation.
•
Need to approach and convince even the local and vernacular media to cover tobacco
related issues.
•
Need to convince the film producers and artists to not promote the usage of tobacco
in the movies/serials; this was especially relevant as the theme of the World No
Tobacco Day this year was 'Free Films from the influence of Tobacco
•
The information about tobacco to be integrated into existing health programs and
through the educational system in school and colleges.
Mr. Niranjan from the People’s Health Movement in Sri Lanka shared that the cost of
one cigarette in Sri Lanka was 7-8 rupees and that was an effective deterrent also; it was
discussed that Prof. Panchamukhi’s study on Karnataka had proven that tobacco farmers
were ready to diversify into vegetable cultivation but the market support was not in
place. Whereas the tobacco industry was picking up its produce and taking it to the
market, this support was not available for the farmers involved in vegetable farming to
transport their produce to the distant markets.
The group then discussed the statement to be issued by the workshop participants- certain
changes were suggested for incorporation in the statement before finalization and
distribution to the ASF organizers and the media. The modified statement and the press
release are attached.
Dr. Srinath thanked the participants fortheir active participation in the group discussion.
A formal vote of thanks was proposed and the workshop ended.
ACTION TOWARDS A TOBACCO FREE WORLD
1 Workshop on Tobacco Control, Asia Social Forum, Hyderabad
Venue: Taj Mahal Hotel,
Abids Road,
Hyderabad - 01
Ph: 24758221 .
Date: 3rd January, 2003
Time: 2:15 to 6:30 P.M.
Facilitated by:
Community Health Cell, Bangalore on behalf of Jan Swasthya Abhiyan / People’s Health Movement
Partner Organizations
Consortium For Tobacco Free Karnataka
PATH-Canada
Indian Coalition for Tobacco Control
LIFE HRG
Introduction
This workshop will present a canvas of the entire range of activities and effects related to
tobacco production, supply, distribution, consumption, health, socio-economic spheres and the
environment. It would also include an overview of the tobacco control initiatives at the local,
Asian and global levels. Discussion will be held on working together and evolving strategies at
various levels for tobacco control.
Proposed Format of Workshop
2:15 to 2: 30 p.m.: Street Play on the Tobacco industry and its effects
Duration of the workshop: 4 hours
SI.
No.
EVENT
'T~ Presentation on the following issues: An Introductory Overview
Chairperson: Dr. Ramesh Bilimaga
Welcome Note: Profile of Tobacco related issues in Asia/ India
Dr.Thelma Narayan, CHC - An introduction to the Workshop.
DURATION
1 hr 10 mins
(2.30 -3.40pm)
10 mins
Objective: To highlight the various aspects of the problem and to update participants on
the current situation
'
Magic show & Talking Doll Show on the ill effects of tobacco
• Tobacco control initiatives at various levels - Globa), National :
- Mr. Sonam, Ministry of Health & Education, Bhutan
- Mr. Ratan Deb, BATA, Bangladesh,
- Dr. Prakash C Gupta, India)
Slate | IMA, Karnataka Task Force, CFTFK - Mr Chander (C’II( ') |
Objective: To inform participants about the ongoing initiatives in tobacco control, and to
record our recognition of important innovative initiatives
45 mins
i
1
i
•
< ‘liiriHeiitioiis / responses
15 mins
2.
People’s Health Celebration
Chairperson: Ms. Devaki .Jain______________________ _____________
• Felicitation of people/ groups who have made efforts for tobacco control in the
Asian region
• Cultural event (Song, Testimonies- MrJaggaiah(Patienl). Ms. Lalit'hamma (Ex
Tobacco Cultivator and Patient)
25 mins
(3_-IO_4.O5pm) j
Objective: To honour people who have made concerted efforts tn tobacco control in their
local areas and to celebrate the spirit of working together.
TEA BREAK / EXHIBITION OF POSTERS
3.
15 mins
(4.05 4.20pm)
1 hr 10 mins
(4.20 5.30pm)
Panel Discussion
Chairperson : Ms. Devaki Jain
• Panel Discussion
1. Epidemiological / Public Health Issues posed by Tobacco - Dr. Prakash C Ciupte
2. FCTC* Update- Dr. Srinath Reddy
3. Socio-Economic Concerns Tobacco Raises and Exposing the Tobacco IndustryMs. Shoba John, PATH, Canada (India).
4. The Environment, Gender and Child Rights Issues around Tobacco Production Ms. Suvarna, Shimoga, Karnataka
50 mins
>'
Objective: Analysis of the Social, Economic, Environmental & Health effects of tobacco;
Introduction to * Framework Convention for Tobacco Control (FCTC) and to introduce
the Challenges and Initiatives for action towards a tobacco control in Asia.
• Open House
Objective: To provide an opportunity for the participants to seek clarifications and
participate in the discussion._________________ -___________________________
4.~ Group Work
< hub-person: Dr. .Srinath Reddy______ _
• Presentation of tentative ‘Workshop Statement’.
• Group discussion tentatively on:
a) What strategies to be adopted to work with Government and civil society at local,
national and international levels to advance tobacco control policy efforts?
b) How do we work with the media and various pressure groups (including
international groups) to advance tobacco control?
c) How do we mobilise community support towards advocating for policy changes as
well as to inititate and implement tobacco control programmes.
d) Discussion on the ‘Statement’ and possible modifications
Objective: To identify issues, evolve strategies and devise mechanisms for working
together in the future.
20 mins
30 mins
(5.30 - 6.00pm)
30 mins
5. Concluding Session
____ Chairperson: Dr. Thelma Narayan
• Presentations by the group . declaration of‘Workshop Statement' and vote of
thanks.
30 mins
(6.00 -6.30pm)
30 mins
Objective: To share the discussions of the group and discuss concrete follow-up plans.
Rapporteurs:
Mr. Naveen Thomas. Fellow, Oxfam GB
Dr. Prakash Vinjamuri. LIFE HRG
Dr.Anant Bhan. Fellow. CIIC
There will be a poster exhibition; background papers, books and pamphlets from various regions in Asia will
be available at the venue. Nine banana carts from LIFE, a Hyderabad organisation involved in Health and
Nutrition Education will carry posters, flags and handbills celebrating tobacco control in different parts of
Hyderabad city, at the ASF and Youth Forum venue.
WHO/NMH/TFI/02.03
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World No Tobacco Day activities are coordinated
every year by the Tobacco Free Initiative of the
World Health Organization.
© World Health Organization, 2002.
All rights reserved.
Requests for permission to reproduce or translate
WHO publications - whether for sale or for non
commercial distribution - should be addressed to
Publications, at:
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The World Health Organization does not warrant
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is complete and correct and shall not be liable for
any damages incurred as a result of its use.
World No ibbacc® Day
Free Sp
Enter The
' Sports and tobacco do not mix... FIFA's
decision to back our public health cause
is a significant step towards achieving
this goal. The world's biggest sporting
May 31, 2002.
World's largest sporting event, the FIFA
2002 World Cup games, to begin in Seoul,
Republic of Korea.
Knowledge, provoking a new understanding of an issue. Knowledge, setting people
free. Knowledge, spurring some to act, others to legislate, and yet others to agitate.
May 31, 2002.
The World Health Organization's 191
Member States celebrate World No
Tobacco Day (WNTD).
In the beginning, people did not know
that tobacco was a killer. Most people still
do not know that a cigarette is a highly
engineered product designed to bring on
early addiction and sure death in one in
event is now tobacco free.
Dr Gro Harlem Brundtland,
Director-General, World Health
Organization commending FIFA
for declaring the 2002 World Cup
Tobacco Free
If our sport could once be used to pro
mote tobacco when we did not know
better, we have an obligation to use it to
discourage tobacco now that we do.This
is an obligation towards all those who,
in the past, have suffered as a conse
quence of having been duped into
thinking tobacco and football have
something in common...That's why FIFA
has been very ready to work with the
Two mandates. Two dreams. A shared
vision and a global event. The world of
health and the world of sport came
together on May 31, 2002 to write a piece
of public health history. The World Cup
games were declared tobacco free for the
first time ever. Billions of viewers watched
the kick-off game beginning with tobacco
free messages flashing around the world as
well as in the stadium.
World Health Organization and the US
Centers for Disease Control to see how
we can use the World Cup... to reflect
modem knowledge and modern aware
ness of the dangers of tobacco use.
Keith Cooper, Director of
Communications FedPra tion
Internationale de Football
Association (FIFA) November 2000
s
The journey to rid sports of the influence
of tobacco, however, began much earlier
and it was routed through knowledge,
outrage, decision, and action on the one
hand and science, policy, and implementa
tion on the other. In his remarks quoted
above, the former FIFA official says it all.
|IUII
sports, from playgrounds to national and
international stadia as well as sports gooc
as marketing and recruit
' ' '
tims while
attract new and ypungei
keeping the old ones ad
World Health Organizati
.
in 1998 to begin work on a set of global
rules to curb the marketing and promotion
of tobacco and its products, its focus
turned to the sports arena. The reasons
were obvious. Tobacco companies pump
hundreds of millions of dollars every year
into sponsoring sports events worldwide.
Until recently, they were everywhere. From
your humble sports field around the corner
to the grand stadia of the world, not to
mention clothing and equipment used by
athletes and fans, tobacco beckoned from
every corner.
The glare of boisterous publicity around
tobacco products was deliberately
designed to keep the gore of deaths
caused by them away from the public eye.
The deception was for the public. The prof
its were for the companies and the death
and disease burden were for countries to
cope with.
Sports is a celebration of life. It inspires
healthy living, fair competition and above
all, fun and camaraderie. Associating
tobacco with sports helped hide the grim
truth about the death-causing ingredients
these products contain. All this was done in
the name of freedom. All this was done in
the name of choice. It took half a century
of knowledge generation, outrage and
court action to expose the inherent deceit
behind the way tobacco companies
designed, manufactured, sold, promoted
and protected their products.
Something started to change in 1998 when
191 countries set about working on the pro
posed Framework Convention on Tobacco
Control (FCTC). As WHO readied the ground
for a tobacco treaty, first about tobacco
related diseases, and later about the product
that was allowed to cause 4.2 million deaths
annually now and an estimated 10.4 million
deaths in 2025. The first barrage of ques
tions led to more questions until suddenly
the floodgates were opened for truth to
pour out. The story was ugly. It was a tale
of deception and deceit with tobacco
industry's own documents showing that
they were enticing children as young as
nine to smoke or chew tobacco. Sports sta
dia where unsuspecting children and youth
go to kick a ball or ride a bicycle were
prime settings for tobacco promotion. WHO
focused on the eye of the needle when it
told the world that tobacco was a commu
nicated disease, communicated through
advertising, marketing and promotion.
WHO's call for rules around tobacco has
met with success in many areas. Some
countries have seized their courts for
redress, others have worked through their
peopte
parliaments to strengthen existing rules or
write in new ones. One area where the call
has been strong and unanimous has been
sports. Country after country has called for
abolishing any links between tobacco and
sports. The WHO launched its own Tobacco
Free Sports in 1999 joining forces with the
US Centers for Disease Control (CDC). From
sports clubs, to stadia around the world,
from sports goods manufacturers to sports
television broadcasters to governments
negotiating the FCTC, the verdict was
unequivocal and unrelenting: tobacco and
sport do not mix.
Declaring sport an important link in the
communication of tobacco-related diseases,
WHO has called for global bans on tobacco
marketing, advertising and sponsorship of
sport. It has called for an end to pernicious
association between the life-affirming
activity that is sports and a life-taking prod
uct. This movement into centre court has
become a metaphor for the FCTC, whose
principal aim is to reclaim ground, includ
ing policy ground, from vested interests.
3
.
3
Athletes, sports organizations,
national and local sports
authorities, schools and uni
versity teams, sports media
and everyone interested in
physical activity are invited to
join this campaign for Tobacco
Free Sports. WHO urges peo
ple everywhere to take back
their right to health and
&& In relation to the theme Tobacco Free Sports for World No Tobacco Day, 2002,1 want
healthy living and to protect
to urge all the sportspersons including sports organizers and their respective gov
future generations from the
ernments to make sports across the globe free from tobacco by not accepting spon
preventable death and disease
sorships from the tobacco companies.
caused by tobacco.
Dr Gro Harlem
Brundtland, DirectorGeneral, World Health
Organization
November 2001
Having played international cricket for twenty-one years and having estab
lished the largest cancer hospital in Pakistan, Shoukat Khanum Memorial Hospital,
which is providing free medical services to the poor suffering from cancers, I have
witnessed from close the power and pervasiveness of tobacco promotion through
sports and its disastrous health consequences in the form of cancers and deaths.
Approximately 90% of the lung cancer in Pakistan is attributable to cigarette smok
ing. The fact that sports people are used as promoters of this killer and that disease
and death caused by smoking is absolutely avoidable saddens me.
Wherever and whatever you are playing, as sportsman or woman, let's make a
personal resolution on this World No Tobacco Day that we will not acc
co sponsorships either personally or as teams. We will not play in
which directly or indirectly promote tobacco - the killer, and hence we wi
tribute to millions of avoidable deaths every year in the world
Imran Khan
Former Captain of Pakistan Cricket Team
Haiti Maras Marr MM
Italy jamaica japan jordan
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isnar malawi malavsia mak
Tobacco Free Sports, launched as part of
the global advocacy project "Tobacco Kills
- Don't be Duped", was designed to cap
ture and channel the outrage over tobac
co-related deaths into the policy domain.
The ploughing of the policy arena with
science and economics sought to reframe
tobacco deaths and bring to it new under
standing. From that of a nasty individual
dependence, tobacco is now seen as a
public health disaster, exacerbated by the
rapacious marketing of tobacco companies
to an unsuspecting public. The Tobacco
Free Sports campaign's contribution to this
global debate has been significant.
Federation in 2001 going tobacco free, the
stage was set for the initiative moving ahead
in leaps and bounds. In November 2001,
WHO, CDC, IOC and FIFA, joined by inter
national athletes, officially launched the
Tobacco Free Sports initiative and ushered
in the topic as the official theme for the
2002 World No Tobacco Day celebrations.
In 2002, Tobacco Free Sports came of age
and started reclaiming ground in ways
unprecedented in WHO's history. The 2002
Salt Lake City Winter Olympics and the
2002 Paralympic Winter Games kicked off
the year's tobacco free sports activities, fol
lowed by numerous national and interna
tional events. Working jointly with FIFA, the
WHO was able to ensure that the 2002 FIFA
World Cup soccer games were tobacco free.
in 1998, the IOC and WHO, in cooperation
with the Organizing Committee of the
Games, prohibited smoking in all Olympic
sports venues. In 1999, the concept of a
global Tobacco Free Sports initiative was
included as a part of the Tobacco Kills,
Don't be Duped media advocacy initiative.
An early partner was the CDC.
Building on the momentum created by
tobacco free Olympics, the idea was carried
to other sports. With the US Women's Soccer
team in 2000 and the South African Football
fairness
o
Sports is about health. We firmly believe that the Olympics
should not be associated with unhealthy behaviours, that's
why we work so hard to promote policies such as the
tobacco-free Olympics. We can promote many such healthy
lifestyles and are actively working with WHO in drafting
similar policies.
Juan Antonio Samaranch
Former president, International Olympic Committee
Ml Good athletes do not smoke
because they know sport and
physical activity are deeply
incompatible with tobacco use.
We will continue to support the
campaign for tobacco control
and healthy lifestyles in the
future.
Dr Jacques Rogge,
President, International
Olympic Committee
I am looking forward to being able to live and compete in fresh air during the 2002
Games. Tobacco use and sports just don't mix. Its not just smoking that can harm
you, but breathing in other people's smoke can also hurt an athlete's performance.
Jean Racine
US women's bobsled team
sport is about
The 2002 FIFA World Cup
May 2002 was a time for reckoning. In
addition to the games themselves being
tobacco free. WHO achieved a major
breakthrough with the development of a
Memorandum of Cooperation with FIFA
for the World Cup in Korea and Japan in
2002. It contained very specific measures
that would be taken to protect the players,
spectators, staff, volunteers, media as well
as television viewers from the harmful
effects of tobacco exposure, consumption,
advertising, marketing and promotion dur
ing the World Cup and future FIFA events.
This policy and its development will have
long term impact in ensuring smoke-free
stadiums in the seated areas for future
events as well, and was achieved through
the collaboration with the WHO Western
Pacific Regional Office and WHO Country
Office in Korea.
games; vending machines were disactivated
or removed. Signs and audio messages in
many languages notified the public of the
tobacco-free policy. These policies applied
to players' and coaches' zones, and areas
for media and VIPs as well. There was no
tobacco advertising or promotion material
at the venues. In addition, health informa
tion on the dangers of tobacco use, the
false premises of the association of tobacco
and sports in advertising and promotion,
and FIFA's decision to go tobacco free, was
distributed at the stadium.
Tobacco use, in any form, was restricted to
specifically designated areas, clearly indi
cated and well apart from the main seat
ing areas of the venues. No tobacco prod
ucts were sold or distributed freely at the
There was more. Before the start of the
games and during the interval, a Public
Service Announcement (PSA) on Tobacco
Free Sports ran on the stadium's screens
and around the world on television. The
Tobacco Free Sports logo appeared around
the side by side with the corporate spon
sors of the games. The logo appeared dur
ing the entire opening match, watched by
millions of television viewers around the
world and continues to appear in the
countless photos that were taken during
the match. The PSA was also beamed to
national broadcasters in over 80 countries
for broadcast in association with the games
as part of FIFA's basic feed. The official site
of the World Cup, www.fifawprldcup.com,
hosted by Yahoo!, broke all records, as the
most frequently visited site in World Cup
and indeed international sport history. The
Tobacco Free Sports logo, poster and links
to more information about the tobacco
epidemic and the work of WHO figured
prominently on the site and were viewed
by billions of people.
Together, FIFA and WHO wrote a piece of
public health history.
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Puerto rics te w at
Talking about tobacco-free
sports is the first step toward
Tobacco and sport simply do not mix. Sport supports health
generating broad public sup
and well-being. Tobacco takes health away.
port to reclaim sports for
health. By talking about
tobacco-free sports we pave
Dr Marc Danzon, Director
Regional Office for Europe
World Health Organization
the way for a complete ban
on advertising of tobacco
products consistent with the
draft international
Framework Convention on
Tobacco Control, the first
international public health
tt Thanks to the unstinting effort of WHO and its partners the rate of sponsor
ship by the tobacco industry in the world is declining, but in this, the Eastern
Mediterranean Region, it is on the rise. People think that tobacco money is
treaty that seeks to regulate
essential for certain sports events to survive. This is untrue. The real truth is
tobacco.
that tobacco products needed sports to survive not the opposite. In the coun
Let us talk about tobacco-free
tries of this Region, the tobacco industry sponsors many sports events, such as
sports.
car rallies and football matches. I hope that decision-makers in the Region will
Dr Shigeru Omi, Director
Regional Office for
the Western Pacific
World Health Organization
address this challenge so that we may see our sports totally free of tobacco.
We have a commitment and obligation to ourselves and to our children to
help them achieve the best possible life in terms of health and opportunities
and also to support them in choosing a healthy lifestyle, as well as healthy
habits based on solid scientific information. Let us all work to make our
favourite sports tobacco-free and help in creating a tobacco-free generation.
Dr Hussein A. Gezairy, Director
Regional Office for the Eastern Mediterranean
World Health Organization
p
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sportjsa||o| t
"There are many difficult choices that public health has to make.
This choice is not a difficult one: we can sell cigarettes, or we can
protect our children.The cost of the first is unacceptably high,
while the while the benefit of the second has no price. PAHO
urges sports events to refuse tobacco sponsorship and to make
1 Africa has one of the fastest
growing prevalence rates of
their venues smoke-free. We also urge governments to prohibit
the use of sports - or any other event sponsorship - to promote
tobacco use among young
tobacco products. There has never been a better opportunity
people. The tobacco epidemic
than now."
is spread through tobacco
Dr George A.O. Alleyne, Director,
Regional Office for the Americas
World Health Organization
advertising, sports sponsor
ship, marketing and promo
tion. This is a reality in every
country of our Region. All
countries should prohibit
tobacco marketing, promotion
and advertising as well as the
distribution of free samples of
tobacco products...I call on all
heads of government, sports
directors, teams and organiz
ers, the community, political
leaders and young people to
create and maintain Tobacco
Free Sports environments in
our communities, towns, cities,
and nations.
Dr E. M. Samba, Director
Regional Office for Africa
World Health Organization
.
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WHO Director-General’s World No Tobacco Day 2002 Award
The Director General’s World No Tobacco Day
award is given to people and organizations
who have shown exceptional courage and
vision in tobacco control. In 2002, it seemed
only fit to grant this honour to an organi
zation which, in addition to representing
the sport of all sports, football, had shown
exemplary leadership in the field of tobacco
control. "Sports and tobacco do not mix.
We have a common goal - that all sports
are free from tobacco. FIFA's decision to
back our public health cause is a significant
step towards this goal. The world’s biggest
sporting event is now tobacco free," she
added when the award was announced.
FIFA received the award at the opening
congress of the games in a glittering event
where WHO was the only non-sporting
organisation to be represented.
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Media coverage
International media interest in this initiative
was very lively and sustained, peaking in
particular during high profile events such as
the November 2001 official launch, the Salt
Lake City Olympics in February 2002, the
FIFA World Cup kick-off in May 2002 and
the World No Tobacco Day celebrations on
May 31, 2002. Individual events in countries
received wide local and regional coverage,
peaking around the activities connected to
World No Tobacco Day celebrations but
also around announcements by local sport
federations or athletes pledging to go
tobacco free. In Egypt, former Egyptian
footballer Mahmoud El-Khatib joined the
campaign, and Public Service Announcements
featuring the athlete was aired repeatedly
on both national and satellite channels.
Imran Khan, former Pakistani cricketer,
generated both public and media interest
with Tobacco Free Sports messages aired
on Pakistan TV and radio.
Global media coverage of the WHO-FIFA
initiative as well as Tobacco Free Sports set
a new threshold exploding around the world
in languages and mediums. In addition to
health
reporting on the event, they served as
watchdogs worldwide, reporting on viola
tions of the agreement with sports organi
zations or the use of deceptive advertising
methods adopted by tobacco companies in
the run-up to the games.
The Tobacco Free Sports initiative expand
ed WHO's coverage beyond its regular con
stituency of health reporters and enabled
public health to be reflected in entirely new
areas such as the sport pages, business and
financial pages, society pages and even by
leading advertising industry information
services such as Advertising Age and Brand
Republic. The pick-up of what is essentially
a public health story by such a wide array
of media points to the popularity and
appeal of this initiative among all sections
of the public.
The tone and content of the coverage was
very positive. Every print article included
either one or more of the main messages
that the initiative aimed to convey:
- Tobacco kills.
- Tobacco companies promote, encourage
and initiate the use of tobacco by associ
ating it with the positive imagery of
sports. This makes tobacco appear more
glamorous, appealing, fun and even
healthy.
- The young are a particular target of this
kind of marketing, and are particularly
susceptible.
- WHO is calling for global bans on adver
tising, marketing and sponsorship of
sports by tobacco companies.
WHO is calling for global bans on smoking
in public areas such as stadiums and play
areas to protect people from second-hand
smoke.
The call for global bans received by far the
most media attention as every story covered
this particular angle. As bans were the core
policy issue involved in the campaign, the
media communication goal of this initiative
was fully realised.
WBD calls ter tougher tobacco cantroi
laws in Asia
Clearing the haze: why we must make the national
games in Hyderabad smoke tree
The Indian Express
UH Health agency awards anti tobacco
prize to FIFA tor smoke free
Deutsche Presse- Agentur
Associated Press Worldstream
»ts of cigarette to he tailed in
World Cuu stadiums m Japan
Xinhua News Agency
World Cup football to be tobacco free
The Press Trust of India
World No Tobacco Day to be observed
by road race
Africa News
UEFA, EU to launch anti tobacco campaign
in Europe when the World Cup starts.
Associated Press Worldstream
Tobacco Free Sports drive tauHChed by
WHO. DoN
Manila Bulletin
Tobacco targets children
Jakarta Post
Advertising an addiction to Asia’s youth
FIFA gets no tobacco award for Korea and
Japan World Cud
80 SffiSfai
The Korea Herald
Financial Times
Agence France Presse
Athletes urged to butt out
w«8 presents highesi ietacco
control award is F»a
Canada Newswire
Associated Press Worldstream ■.
Xinhua News Agency
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World Health Organisation launches
regional campaign in India to get snorts
to kick its tobacco habit
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Worts Ho Tobaccs Sav cornetites with the
WS Cub kick off
Health and Sports officials join in World fight
against smoking
The New York Times
Agence France Presse
Poland marks World no Tobacco Dav
PAP news wire
Volleyball joins Tobacco Free Sports initiative
BAT angers footballers over image rights
Xinhua News Agency
sportbusiness.com
A smoke free vision: The next step is for
government to ban smoking in public places
The Guardian
Tobacco giant sidesteps ban on
Worm Clip ads
TWo Chinese sports figures win WHO Health
award
The Guardian
Xinhua News Agency
World Cup fever sparks public bans in
smoking on ho Tobacco Day
Agence France Presse
Smoking urges to bun out of sports
Anti Tobacco Campaign to target M sports
events
China Daily
PR week
New Straits Times ( Malaysia)
FIFA must strictly enforce no tobacco rule
Thai Health Institute
Agence France Presse
Call tor tobacco free sport
Financial Times
Policy implications and Challenges
The core goals of Tobacco Free Sports have
caught the imagination of the public at
large in ways that have surpassed all expec
tations. These include calls
- To deglamourise tobacco use among the
public and particularly young people.
- To expose the truth about the tobacco
industry's decades-long cynical manipula
tion of sport for profit.
- To build support among the public and
governments for public bans on smoking
within sport settings to protect people
from second-hand smoke; and a ban on
advertising, marketing and promotion of
sport by tobacco companies.
The rush for Tobacco Free Sports posters,
brochures, pins, stickers and advocacy
material has equalled interest in WHO's
landmark "Bob, I've got Cancer" campaign
that depicts two cowboys riding horses
talking about cancer.
Global agencies such as the International
Volleyball Federation (FIVB) have gone
tobacco free and regional sport events such
as the XXI Central American and Caribbean
Games for November 2002 and the 14,h
Asian Games in Busan, Korea, have pledged
to go tobacco free. Nationally, announce
ments to go tobacco free by 33 sport feder
ations in El Salvador and over 17 national
sport organizations in Switzerland are
being joined by their counterparts all over
the world on a monthly basis. The Tobacco
Free Sports initiative has truly become a
movement that spans across global, region
al and national interests.
The actual implementation of the tobacco
free policy in stadiums and during games
has shown that people really appreciate
watching their games without having to
cope with smoke in their eyes. Sports organ
izations and settings are now under scrutiny
from a public whose knowledge about
tobacco the issue grows along with the rag
ing global debate on it. Tobacco companies
are on notice and their attempts to link to
sports is no longer an unquestioned right.
That is already a significant step forward,
made possible at least in part by the
Tobacco Free Sports initiative.
and challenges. For Tobacco Free Sports,
they made common cause with the media
an exposed how tobacco companies contin
ued to thwart public opinion and violate
public health measures by associating their
products with the popularity of the World
Cup. Violations were reported in Korea,
Malaysia, Pakistan, and Niger.
TOBACCO
. J VOLLEYBALL
The FIVB 2002 Women’s
World Championship
will be tobacco free
Non-governmental organizations (NGOs)
have played a key role in the FCTC process
and sustained the debate with information
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Public response to these violations was very
encouraging and several NGOs petitioned
their local broadcasters and other sports
organizations to be alert to these moves.
Focus on these violations served to highlight
the simple fact that the tobacco industry
never gives up and will circumvent any rule
that comes in the way of its marketing and
sales pitch. Hemmed in on one side, tobacco
companies are now parading their new
"social responsibility" mantra informing
governments that they do not market to
youth and are responsible enough to regu
late themselves accordingly.
The jury on self regulation has been out
for a while as it has been on restrictions on
marketing to only young people. The ver
dict is that both do not work. When you
market a product as an "adult choice," the
young are doubly enticed. Working on
developing a treaty governments are in the
throes of legaiese calling for regulation of
the tobacco industry and a phase out of
tobacco advertising beginning with sports
stadiums. At the same time, an high profile
event like the tobacco-free world cup has
shown them the real benefits of the work,
giving their legal work a real-life dimen
sion. For government, it's no longer read
ing and analysing some documents at the
negotiations in Geneva, it also means tak
ing a position, it also means relating to a
tangible global event like the World Cup.
This synergy has worked to the benefit of
public health and while they wait for the
FCTC to be adopted, governments around
the world are looking at litigation and leg
islation as a viable tool with which to sever
all links between tobacco and sports.
At the FCTC negotiations governments that
fall on both sides of the global ban on
advertising bans have expressed interest in
banning the association of tobacco with
sport. The FCTC is being negotiated by 191
Member States of WHO, and represents
the first time WHO's treaty-making clause
has been invoked to address a public
health issue. The latest text being negotiat
ed by governments, called the New Chair's
text on the FCTC, contains language that
requires the phasing out of tobacco spon
sorship of sporting and cultural events.
Once negotiated and signed, the FCTC will
be the world's first legally enforceable
international treaty on tobacco control. It
is expected to be ready by 2003 and
address issues such as tobacco advertising
and marketing, cessation, taxation, smug
gling, education and other tobacco control
measures.
Policy change often begins before it is
recognized as such. WHO's gambit with
Tobacco Free Sports when the organization
entered the stadium, is beginning to pay off.
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For more information about
World No Tobacco Dav. contact:
Tobacco Free Initiative
World Health Organisation
Avenue Appia 20
1211 Geneva 27
tel: 41 22 791 2126
fax: 41 22 791 4832
tfi@who.int
www.who.int/tobacco
inforHalw
Torfurther information, please contact:
Tobacco Free Initiative
World Health Organization
Avenue Appia 20
1211 Geneva 27
Switzerland
Tel: +41 22 791 21 26
Fax: +41 22 791 48 32
Email: tfi@who.int
Web site: http://tobacco.who.int
T
HE TOBACCO EPIDEMIC IS A GLOBAL CHALLENGE
.
demanding concerted global and national action. Recognizing that globaliza
tion is accelerating the epidemic’s spread and perceiving the limits of national action
to contain a public health problem with transnational dimensions, Member States
of the World Health Organization (WHO) negotiated and adopted a unique pub
lic health treaty for tobacco control. Today, the WHO Framework Convention on
Tobacco Control (WHO FCTC) contains the blueprint for coordinated global action
to address one of the most significant risks to health.
However, national action is critical in order to attain the vision embodied in
the WHO FCTC. Building national capacity to carry out effective and sustainable
national tobacco control programmes is an urgent priority, and one of the most sig
nificant measures required to combat the tobacco epidemic.
The idea for this Handbook arose from the awareness that while various official
WHO documents called for developing national capacity for tobacco control, there
was no comprehensive publication for the development of such capacity. Conceived
as a “How to” manual, the approach is intentionally pragmatic, addressing ‘real world’
issues and providing practical advice for setting up viable national tobacco control
programmes.
OVERVIEW
The Handbook contains three main sections. The Introduction presents the evolving
definition of “national capacity”, identifies the types of capacities needed for effective
tobacco control and outlines the key features of building capacity. Section 1 provides
a descriptive overview of the tobacco epidemic, and is further subdivided into four
chapters. These chapters address tobacco as a risk factor, with attendant health and
economic costs; the global strategies of the tobacco industry; the scientific evidence
for effective tobacco control interventions; and the WHO Framework Convention
on Tobacco Control (WHO FCTC) as a global solution to a health epidemic with
prominent politico-legal and sociocultural attributes. Section 2 focuses on the fun
damental capacities necessary to empower countries to take on the tobacco epidemic
successfully. The chapters in this section build on early successes in various areas of
tobacco control within developed and developing countries that have pioneered the
fight against the tobacco epidemic. These chapters apply the lessons learned from
the experiences of these countries and offer advice and suggestions to enable Mem
ber States to put the theories of tobacco control into practice. This section begins
with the development of a national plan of action as the foundation for successful
tobacco control at the country level. It addresses the other important elements in
national capacity-building, including establishing an effective infrastructure for a
national tobacco control programme, training and education, raising public aware
ness through effective communications and media advocacy, programming specific
tobacco control activities, legislating measures for tobacco control and exploring
economic interventions and funding initiatives. Chapters on countermg the tobac
co industry, forming effective partnerships, monitoring and evaluating progress, and
exchanging information and research provide valuable insights to augment tobacco
control capacity.
SUMMARIES OF THE CHAPTERS
Part I. Setting the Theoretical Foundation for Tobacco Control
Chapter 1. Tobacco as a riskfactor: health, social and economic costs
This chapter reviews the global data on the tobacco epidemic. Tobacco is now a major
preventable cause of death in developed and developing countries. Every day over
13 000 people worldwide die from tobacco. Assuming current patterns of tobacco
use and intervention efforts, WHO projects that from 2000 to 2030 the number of
smokers will rise from 1.2 billion to 1.6 billion and the annual number of deaths will
increase from 4.9 million to 10 million. Aggressive promotion by the tobacco indus
try, and permissive environments that make tobacco products readily available and
affordable play a major role in inducing young people to take up tobacco use. The
addictive nature of nicotine ensures that majority of tobacco users remain hooked
for life. The health and economic costs of tobacco use, however, are borne not only
by tobacco users, but by society in general. The chapter examines tobacco consump
tion trends among adults and youth, presenting cross-country data where available.
It illustrates how the costs of tobacco consumption affect tobacco users, non-users,
families and communities, businesses, governments and society, making the tobacco
epidemic a concern for everyone.
Chapter 2. The tobacco industry: global strategies
This chapter offers insights into the nature of the tobacco industry, and the global
strategies it uses to maintain the profitability and widespread use of its deadly prod
uct. The tobacco industry documents database, made available publicly as a result
of the Master Settlement Agreement (MSA) between the tobacco companies and 46
United States territories and states, is a rich source of information on the industry’s
formerly secret tactics and plans to deter effective measures to control tobacco use.
Actual examples in several countries are cited to illustrate how the industry’s strate
gies have been used to impede progress in tobacco control.
Chapters. Tobacco control interventions: the scientific basis
The tremendous adverse impact of tobacco use on health and economic indicators
worldwide makes tobacco control a public health imperative. This chapter discusses
the evidence for effective interventions to reduce tobacco consumption. Both sup
ply- and demand-side interventions are examined. The impact of these strategies on
smoking initiation and cessation, and their cost-effectiveness, are discussed. Bene
fits of tobacco control to individuals, families, communities and governments are
enumerated. For tobacco control to succeed, a comprehensive mix of policies and
strategies is needed. The chapter concludes by urging governments to act quickly,
supporting international efforts through the WHO FCTC and establishing solid
national programmes to stem the devastating effects of the tobacco epidemic on cur
rent and future generations.
Chapter 4. The WHO Framework Convention on Tobacco Control (WHO FCTC): the
political soltition
Public health protection has traditionally been viewed mainly as a national concern.
With globalization, however, many issues related to health no longer respect the
geographical confines of sovereign states, and can no longer be resolved by national
policies alone. The WHO FCTC was developed in response to the current globali
zation of the tobacco epidemic. This effort represented the first time that WHO
Member States had exercised their treaty-making powers under Article 19 of the
WHO Constitution. The idea behind the WHO FCTC and its future related proto
cols, is that it will act as a global complement to, not a replacement for, national and
local tobacco control actions. The chapter reviews the history of the WHO FCTC,
the legal approach selected, utilizing a framework convention and related protocols,
and the process for the WHO FCTC to come into force. The various core tobacco
control interventions contained in the WHO FCTC are introduced, and the features
that are unique to the WHO FCTC are highlighted. Finally, the post-adoption proc
ess is reviewed.
Part II. Putting Theory into Practice
•
Chapter 5- Developing a nationalplan ofaction
Creating a national plan of action for tobacco control and establishing the infrastruc
ture and capacity to implement the plan of action are key to the successful mitigation
of the tobacco epidemic. This chapter provides an overview of the process of devel
oping a national plan of action, starting with building a national coordinating mech
anism for developing a plan of action and doing a situational analysis to determine
needs and resources. The steps for setting a strategic direction and drafting a plan of
action are discussed, and the elements of a national action plan are identified. The
chapter also highlights the importance of ensuring legitimacy by securing official
approval of the plan, and lists some of the critical issues that national programme offic
ers must address to ensure that the plan of action is sustained and implemented.
Chapter 6. Establishing effective infrastructurefor national tobacco controlprogramme
f\s the process of national action plan development unfolds, it is necessary to begin
establishing a national infrastructure to carry out die implementation of the nation
al plan of action. This chapter outlines a model for setting up a national network
and infrastructure for tobacco control. It discusses the human, logistic and financial
resources required to establish a viable national tobacco control programme, and the
process of creating and sustaining national networks to support the implementation
of tobacco control interventions country-wide.
Chapter 7- Training and education
Successful tobacco control depends largely upon having the human resources to
develop and implement a range of activities at different levels. This chapter presents
an overview of the issues related to training and education of the different groups
involved in tobacco control. “Training” refers to the transfer of skills to build capac
ity to undertake effective tobacco control. “Education” means gaining knowledge
and understanding about 1) methods of effective tobacco control and 2) dangers of
tobacco and methods of cessation. Determining training and education needs of var
ious groups requires an assessment of the current situation. Results of the situational
analysis carried out in preparation for developing a national action plan can provide
the critical information for this decision. The selection and development of appropri
ate materials and effective training methods, and the process of conducting effective
training workshops are addressed. The chapter also provides examples of curricula
from various types of training workshops, taken from actual sessions carried out in
several countries.
Chapter 8. Communicating and raisingpublic awareness
The social marketing of tobacco control requires strategic communication. Commu
nication strategies play a key role, not only in ensuring that accurate information is
accessible to rhe population, but also because well-designed communications cam
paigns can lead to changes in behaviour that are essential for reducing the prevalence
of tobacco use. This chapter presents some key strategies and approaches to design
ing a social marketing and communications campaign for tobacco control. It draws
from the experience of several countries, like Australia, Canada, Thailand, and the
United States of America, where effective social marketing and communications cam
paigns have curtailed tobacco use.
Chapter 9. Working with the media
The media is a key player in any tobacco control campaign. Mass media is often
the most practical means to disseminate information and tobacco control messages
rapidly to a large population. Media is the vehicle that shapes public opinion, and
influences policy leaders. Often, repeated news coverage of an issue can guide the
policy agenda of a government. Thus, developing good working relationships with
media professionals is essential. This chapter presents practical advice on cultivating
good media relationships and obtaining media coverage for tobacco control, even
when resources are limited. Characteristics that make an event newsworthy, and that
are required of an effective spokesperson, are identified. Practical tips are provided
on how to develop several key pieces for media communication, including letters to
the editor, opinion editorials and press releases, with actual examples. The chapter
ends with a reminder that media can also become an effective advocate for tobacco
control, if properly guided and encouraged.
BUILDING BLOCKS FOR TOBACCO CONTROL: A HANDBOOK
Chapter 10. Programming selected tobacco control activities
This chapter offers a broad overview of the various programme options that are most
often included as part of a comprehensive, integrated tobacco control action plan. It
examines the roles of prevention through school-based programmes, cessation and
protection of non-smokers through the creation of smoke-free environments with
in a national action plan for tobacco control, and identifies the key elements that
determine the effectiveness of these components in reducing tobacco consumption.
A crucial element for success in tobacco control is the engagement of communities in
the process of understanding the tobacco epidemic more clearly and responding in an
appropriate way to control tobacco use. Pointers on effective community mobilization
and tobacco control educational resources for communities are outlined. The need to
consider strategies targeting key high-risk population sub-groups is discussed.
Chapter 11. Legislating measuresfor tobacco control
Comprehensive tobacco control legislation is a crucial component of a success
ful tobacco control programme. The aim of this chapter is to build on previous
WHO publications on tobacco control legislation—Tobacco control legislation:
an introductory guide, and Developing legislation for tobacco control: template
and guidelines—offering practical advice relevant to countries seeking to develop
and implement tobacco control legislation. The legislative tobacco control measures
that WHO recommends as part of a comprehensive tobacco control programme are
summarized, and steps necessary to persuade national decision-makers to support
these measures are identified. Legislation should be designed to be self-enforcing
and should be supported by a commitment to resource adequately an information,
implementation, monitoring and enforcement programme. To this end, tools and
strategies to implement and enforce legislation are elucidated. The importance of har
nessing the international legislative experience is reinforced, and online databases of
tobacco control legislation are provided.
Chapter 12. Exploring economic measures andfinding initiatives
The economic aspects of tobacco production and consumption play a critical role in
developing strategies for reducing tobacco use. This chapter presents basic informa
tion on the key economic issues in tobacco control. It highlights the evidence on price
and tobacco consumption, key steps to introduce or increase tobacco taxes and pric
es, which countries may adapt according to their specific socioeconomic and political
situation, and funding initiatives for tobacco control, with examples of successful
funding initiatives from Australia, New Zealand and Thailand. Key references from
the World Bank, which address these issues in greater detail, are cited.
Chapter 13. Countering the tobacco industry
Tobacco is unique among the risks to health in that it has an entire industry devot
ed to the promotion of its use, despite the known adverse health impact of tobacco
consumption. Predictably, the tobacco industry aggressively blocks any attempt to
effectively reduce tobacco use. This chapter focuses on strategies to counter the tobac
co industry. Building capacity to face the greatest opponent of successful tobacco
control must be a priority for national and local tobacco control officers. In many cas
es tobacco control advocates and nongovernmental organizations (NGOs) are more
experienced in this area, and much can be learned from them. Hie chapter stresses the
importance of recognizing the true nature of the tobacco industry and offers guidance
in searching the tobacco industry database to learn more about the industry s tactics
in a specific country. It also discusses strategies to monitor the tobacco industry and
neutralize its efforts to impede or delay tobacco control interventions as a necessary
element of building national capacity to curb the tobacco epidemic.
Chapter 14. Forming effective partnerships
In every country with successful tobacco control legislation, NGOs have played a
major role in promoting change. This chapter focuses on the contribution citizen
groupings can make to tobacco control efforts in the legislative field. In particular, it
highlights the role and responsibilities of civil society; focuses on how to build and
strengthen national tobacco control movements; and provides suggestions for work
ing with the private sector.
Chapter 15. Monitoring, stirveillance, evaluation and reporting
Once a tobacco control policy or programme has been launched on the basis of
a thorough assessment of the situation, the evaluation process will consist mainly
of assessing its relevance and adequacy, reviewing progress in implementation, and
assessing impact and effectiveness for the reorientation and formulation of relevant
policies and activities. Surveillance and evaluation play a major role in document
ing tobacco control policy accountability for policy-makers, health managers and
professionals, and for the general public. Therefore, a comprehensive surveillance
and evaluation system should be an integral and a major element of all tobacco con
trol policies and programmes. This chapter introduces the key concepts and issues
in tobacco control programme monitoring, surveillance, evaluation and reporting.
Selected indicators, methodologies and tools are discussed. Because the topic is a
comprehensive one, the reader is provided with a list of earlier WHO publications
that examine this topic in greater detail.
Chapter 16. Exchanging information and research
The WHO FCTC provides guidance on surveillance, research and exchange of infor
mation on tobacco control. Translating research into public information is essential to
assist individuals, communities and governments to take action to reduce tobacco con
sumption. A mechanism to communicate the evidence for tobacco control is necessary
to support a national tobacco control programme. This chapter considers the various
challenges to research in tobacco control, and offers practical steps to overcome these
challenges. The importance of linking research to policy change is emphasized, and
the need to communicate information derived from research effectively to target audi
ences is highlighted. Establishing a mechanism for information exchange is explored,
and as an example, an existing web-based information clearinghouse is presented.
FRAMEWORK CONVENTION ON TOBACCO CONTROL (FCTC)
Introduction - International Treaties and Conventions
There is no dearth of international conventions and laws. There are a lot of them around and
everyone is directly affected by at least some of them. To give a few examples, there is a
Convention on the Rights of the Child, Convention on Climatic Change, Convention for
Protection of Ozone Layer, etc.
Such international conventions are first negotiated by government representatives within the
United Nations System. The negotiated international convention does not become a law
automatically - it has to be ratified by the competent legislative body of the country. In India,
for example, international conventions and treaties need to be ratified by the Indian Parliament.
The proposal for starting the process of an international treaty or convention can be initiated
by any of the permanent organs of the United Nations System. Until 1998, the World Health
Organization (WHO) had not used its constitutional mandate to propose an international treaty
or convention. It had no problem in getting its policies and recommendations in the interest
of public health accepted by everyone.
Why a Convention on Tobacco?
Smoking has been recognized as a major cause of lung cancer, other cancers, heart diseases
and lung diseases for over 40 years. It has been identified as a major global public health
problem. Until about 1990, each year tobacco-related deaths numbered 3 million globally of
which 2 million occured in developed countries. But since then it has been affecting developing
countries far more than industrialized countries. As per current estimates, by the year 2030,
tobacco will cqpse 10 million deaths globally of which 70% will be in developing countries.
Despite these well-established scientific facts the recommendations made by WHO and other
scientific bodies for the control of tobacco in the interest of public health have not been readily
accepted or applied in all countries. As a result, smoking and tobacco use is increasing
globally every year.
The reasons are not difficult to identify. Unlike other disease causing agents, tobacco use
and smoking are promoted globally by a powerful multinational industry that is a big business
in every country in the world. This industry opposes almost every meaningful recommendation
for tobacco control even though the validity of such recommendations in reducing tobacco
use and improving public health has been well established scientifically. The recommended
policies include a ban on advertisement of tobacco products, increase in taxes, no smoking
in public places, detailed consumer information, appropriate trade practices and others.
Several of these (e.g. advertising, smuggling) are transnational in character necessitating
an international approach.
FCTC - Current Status
For these and other reasons, the World Health Organization used its prerogative to propose
the Framework Convention on Tobacco Control (FCTC). In response to an invitation from
national leaders to rethink priorities as they respond to an ongoing international process;
and, engaging powerful ministries, such as finance and foreign affairs, more deeply in
tobacco control;
•
Raise public awareness internationally about the unscrupulous strategies and tactics
employed by the multinational tobacco companies;
•
Mobilize technical and financial support for tobacco control at national and international
levels;
•
Make it politically easier for developing countries to resist the tobacco industry; and
•
Mobilize non-governmental organizations (NGOs) and other members of civil society in
support of stronger tobacco control policies.
FCTC and Non-Governmental Organizations (NGOs)
Non-governmental organizations must play a key role in the development and negotiation
of the convention to ensure its success. There are several ways in which NGOs can support
the FCTC. They can:
•
Join some group of NGOs working on FCTC. The largest such group is the Framework
Convention Alliance;
•
Educate themselves and their constituencies about global tobacco issues and the FCTC;
•
Keep the media informed about the FCTC and get their support;
•
Provide the media with regular stories on the tobacco problem, suggesting the FCTC as
part of the solution;
•
Find out what the country’s delegates to the FCTC have said so far and meet with them
in order to influence their future positions;
•
Contact the FCA Regional Contact to find out what regional action is occurring in the
region;
•
Get resolutions passed in support of the WHO FCTC by the boards of respective NGOs;
•
Adopt a declaration modeled after the Kobe Declaration; and
•
Meet with and send copies of resolutions or declarations to representatives involved in
the WHO FCTC negotiations in respective countries.
More resources and information on FCTC is available at www.fctc.org
Prepared By: Dr. P. C. Gupta, ACT-India
p’H ~ \
HEALTH HAZARDS OF TOBACCO USE
Tobacco use is a serious and growing problem in India. It is estimated that 65% of all men
use some form of tobacco- about 35% smoking, 22% smokeless and 8% both. Prevalence
rates for women differ widely, from 15% in Bhavnagar to 67% in Andhra Pradesh. Overall,
however, the prevalence of bidi and cigarette smoking amongst women is about 3% and the
use ofchewing tobacco is similar to that of men at 22%.’ Since the 1980s use of pan masala
and gutka has increased at a phenomenal rate.1
2
This extraordinarily high use of tobacco products is having a devastating impact on the health
of the people. The World Health Organization estimates that 8 lakh persons die from tobacco
related diseases each year in India alone.3 Currently, approximately 50% of cancers among
males and 20% of cancers among females are caused by tobacco. In a World Bank collaborative
research project conducted in Chennai on 50,000 subjects the following key findings were
made: 50% of smokers died due to smoking, 25% of deaths among males aged 25-69 years
were attributable to tobacco use and the risk of dying among smokers with tuberculosis is
about 4-fold higher than the nonsmokers with tuberculosis. Another study showed that smokers
have a 3-fold risk of developing tuberculosis compared to non-smokers. This shows that at
least 65% of tuberculosis seen among smokers is attributable to the habit of smoking.4
Chronic Obstructive Lung Disease (COLD)
Chronic obstructive lung disease (including chronic bronchitis and emphysema) is a progressively
disabling disease that is rarely reversible. It can cause prolonged suffering due to difficulty
in breathing because of the obstruction or narrowing of the small airways in the lungs and
the destruction of the air sacs in the lungs due to smoking.
Smoking is the main cause of chronic obstructive lung disease: it is very rare in non-smokers
and at least 80% of the deaths from this disease can be attributed to cigarette smoking.5The
risk of death due to the disease increases with the number of cigarettes smoked.
Pneumonia
Pneumonia is not only more common amongst smokers, but is also much more likely to be
fatal.6
Lung Cancer
Lung cancer kills more people than any other type of cancer and at least 80% of these deaths
are caused by smoking. The risk of lung cancer increases directly with the number of cigarettes
smoked. In 1999, 22% of all cancer deaths related to lung cancer, making it the most common
1.
2.
3.
4.
5.
6.
Chatterjea, A., 'Role of the Media and Global Responsibility: A Review of how the tobacco’ industry has used advertising and
media in India to promote tobacco products', Unpublished paper, World Health Organization International Conference on Global
Tobacco Control Law, September 1999.
ibid
WHO. Tobacco or Health Country Profile: India, A Global f talus Report WHO Geneva, 1997. Country presentations at various
regional meetings on tobacco 1997-98. Regional Health Siti: uions in South-East Asia, 1994-97.
Pers. Corres. Gajalakshmi Vendhan, Cancer Registry, Cher tai.,
Tire UK Smoking Epidemic - Deaths in 1995. Health Education Authority, 1998.
Tire UK Smoking Epidemic: Deaths in 1995. Health Education Authority, 1998.
-1-
Peripheral Vascular Disease (PVD)
Smokers have a 16 times greater risk of developing peripheral vascular disease (PVD)
(blocked blood vessels in the legs or feet) than people who have never smoked.16 Smokers
who ignore the warning of early symptoms and continue to smoke are more likely to develop
gangrene of a leg. Cigarette smoking combines with other factors to multiply the risks of
arteriosclerosis. Patients who continue to smoke after surgery for PVD are more likely to
relapse, leading to amputation, and are more likely to die earlier.17
Stroke
Smokers are more likely to develop a cerebral thrombosis (stroke) than non-smokers. About
11% of all stroke deaths are estimated to be smoking related, with the overall relative risk
of stroke in smokers being about 1.5 times that of non-smokers.18 Heavy smokers (consuming
20 or more cigarettes a day) have a 2-4 times greater risk of stroke than non-smokers.19 A
recent study showed that passive smoking as well as active smoking significantly increased
the risk of stroke in men and women.20
Reduced Fertility
Women who smoke may have reduced fertility. One study found that 38% of non-smokers
conceived in their first cycle compared with 28% of smokers. Smokers were 3.4 times more
likely than non-smokers to have taken more than one year to conceive.21 A recent British
study found that both active and passive smoking was associated with delayed conception.22
Cigarette smoking may also affect male fertility: spermatozoa from smokers has been found
to be decreased in density and motility compared with that of non-smokers.23
Male Sexual Impotence
Impotence, or penile erectile dysfuntion, is the repeated inability to have or maintain an
erection. One study of men between the ages of 31 and 49, showed a 50% increase in the
risk of impotence among smokers compared with men who had never smoked.24 Another
US study, of patients attending an impotence clinic, found that the number of current and ex
smokers (81%) was significantly higher than would be expected in the general population
(58%).25
16. Cole, CW et a! Cigarette smoking and peripheral arterial occlusive disease. Surgery 1993; 114:753-757
17. Myers, K A et al. Br J Surg 1978; Faulkner, K Wei al. Med J Austr 1983; 1:217-219
18. Shinton R and Bcevers G. Meta-analysis of relation between cigarette smoking and stroke. Br Med J. 1989; 298:789-94.
19. Smith, PEM. Smoking and stroke: a causative role. (Editorial) Br Med J 1998; 317:962-3
20. Bonita R et al. Passive smoking as well as active smoking increases the risk of acute stroke. Tobacco Control 1999; 8:156-160
View abstract
21 Baird, D.D. and Wilcox, A.J. JAMA 1985; 253:297972983.
22. Hull, MGR et al. Delayed conception and active and passive smoking. Fertility and Sterility, 2000; 74:725-733
23. Makler, A. et al. Fertility & Sterility 1993; 59:645-51.
24. Mannino, D et al. Cigarette Smoking: An Independent Risk Factor for Impotence, American Journal of Epidemiology. 1994; 140:
1003-1008.
25. Condra, M. et al. Prevalence and Significance of Tobacco Smoking in Impotence. Urology; 1986; xxvii: 495-98.
-3-
Peripheral Vascular Disease (PVD)
Smokers have a 16 times greater risk of developing peripheral vascular disease (PVD)
(blocked blood vessels in the legs or feet) than people who have never smoked.'6 Smokers
who ignore the warning of early symptoms and continue to smoke are more likely to develop
gangrene of a leg. Cigarette smoking combines with other factors to multiply the risks of
arteriosclerosis. Patients who continue to smoke after surgery for PVD are more likely to
relapse, leading to amputation, and are more likely to die earlier.17
Stroke
Smokers are more likely to develop a cerebral thrombosis (stroke) than non-smokers. About
11% of all stroke deaths are estimated to be smoking related, with the overall relative risk
of stroke in smoker.s being about 1.5 times that of non-smokers.18 Heavy smokers (consuming
20 or more cigarettes a day) have a 2-4 times greater risk of stroke than non-smokers.19 A
recent study showed that passive smoking as well as active smoking significantly increased
the risk of stroke in men and women.20
Reduced Fertility
Women who smoke may have reduced fertility. One study found that 38% of non-smokers
conceived in their first cycle compared with 28% of smokers. Smokers were 3.4 times more
likely than non-smokers to have taken more than one year to conceive.21 A recent British
study found that both active and passive smoking was associated with delayed conception.22
Cigarette smoking may also affect male fertility: spermatozoa from smokers has been found
to be decreased in density and motility compared with that of non-smokers.23
Male Sexual Impotence
Impotence, or penile erectile dysfuntion, is the repeated inability to have or maintain an
erection. One study of men between the ages of 31 and 49, showed a 50% increase in the
risk of impotence among smokers compared with men who had never smoked.24 Another
US study, of patients attending an impotence clinic, found that the number of current and ex
smokers (81%) was significantly higher than would be expected in the general population
(58%).25
16. Cole, CW et al Cigarette smoking and peripheral arterial occlusive disease. Surgery 1993; 114:753-757
17. Myers, K A et al. Br J Surg 1978; Faulkner, K W et al. Med J Austr 1983; 1:217-219
18. Shinton R and Beevers G. Meta-analysis of relation between cigarette smoking and stroke. Br Med J. 1989; 298:789-94.
19. Smith, PEM. Smoking and stroke: a causative role. (Editorial) Br Med J 1998; 317:962-3
20. Bonita R et al. Passive smoking as well as active smoking increases the risk of acute stroke. Tobacco Control 1999; 8:156-160
View abstract
21 Baird, D.D. and Wilcox, AJ. JAMA 1985; 253:297972983.
22. Hull, MGR et al. Delayed conception and active and passive smoking. Fertility and Sterility, 2000; 74:725-733
23. Maklcr, A. et al. Fertility & Sterility 1993; 59:645-51.
24. Mannino, D et al. Cigarette Smoking: An Independent Risk Factor for Impotence, American Journal of Epidemiology. 1994; 140:
1003-1008.
25. Condra, M. et al. Prevalence and Significance of Tobacco Smoking in Impotence. Urology; 1986; xxvii: 495-98.
Foetal Growth and Birth Weight
Babies born to women who smoke are on average 200 grams (8 ozs) lighter than babies
born to comparable non-smoking mothers. Furthermore, the more cigarettes a woman smokes
during pregnancy, the greater the probable reduction in birth weight. Low birth weight i.s
associated with higher risks of death and disease in infancy and early childhood.26
Spontaneous Abortion and Pregnancy Complications
The rate of spontaneous abortion (miscarriage) is substantially higher in women who smoke.
This is the case even when other factors have been taken into account.6 On an average,
smokers have more complications of pregnancy and labour which can include bleeding during
pregnancy, premature detachment of the placenta and premature rupture of the membranes.27
Some studies have also revealed a link between smoking and ectopic pregnancy10 and
congenital defects in the offspring of smokers.28
The Hazards of Passive Smoking
Non-smokers who are exposed to passive smoking in the home, have a 25 per cent increased
risk of heart disease and lung cancer.29 A major review by the Government-appointed Scientific
Committee on Tobacco and Health (SCOTH) in the UK concluded that passive smoking is
a cause of lung cancer and ischaemic heart disease in adult non-smokers, and a cause of
respiratory tract infections such as bronchitis, pneumonia and bronchiolitis, cot death, middle
ear disease and asthmatic attacks in children.30 More than one-quarter of the risk of death
due to Sudden Infant Death Syndrome (cot death) is attributable to maternal smoking
(equivalent to 365 deaths per year in England and Wales.31 While the relative health risks
from passive smoking are small in comparison with those from active smoking, because the
diseases are common, the overall health impact is large.
Benefits of Quitting Smoking
When smokers give up, their risk of getting lung cancer starts decreasing so that after 10
years an ex-smoker's risk is about a third to half that of continuing smokers.32
Prepared by: Dr. Gajalakshmi Vendhan-and Ms. Shoba John
with assistance from Ms. Belinda Hughes
Royal College of Physicians. Smoking and the Young London, 1992
Poswillo, D and Alberman, Effects of smoking on the foetus, neonate, and child. OUP1992.
Haddow, J.E. et al. Teratology 1993; 47:225-228.
Law MR et al. Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence. BMJ1997;
315:973-80. (View abstract] Hackshaw AK et al. The accumulated evidence on lung cancer and environmental tobacco smoke.
BMJ 1997; 315:980-88. (View abstract]
30 Report of the Scientific Committee on Tobacco and Health. Department of Health, 1998. (View document]
31 Royal College of Physicians. Smoking and the Young London, 1992.
32 The Health Benefits of Smoking Cessation - A Report of the Surgeon General. US DHHS, 1990
26.
27.
28.
29.
ORAL TOBACCO USE - ITS IMPLICATIONS
FOR INDIA AND THE WORLD
MEASURES TO PREVENT ITS USE,
SALE AND MARKETING
Tobacco-related diseases are now a global epidemic. Each year, about 4 million people die
due to tobacco consumption throughout the world. Today, India is the second largest producer
of tobacco and also the second leading seller in the world. Most of the tobacco produced in
India is used within the country. The percentage of tobacco exported to other countries is
very low. However, approximately 2,200 people die of tobacco use every day in India. Yet,
the tobacco companies are persisting with their aggressive marketing. They are targeting
adolescents as future customers.
Presently, there are 60 cigarette-manufacturing factories, about 1000 gutkha and pan masala
manufacturing units and over 1 million women engaged in the hand rolling of bidis. Approximately
600 children between the age group of 10 to 18 are recruited every day by the tobacco industry
to keep their business growing.
Smokeless tobacco products are easily available and at a price that even children can buy
it from any tobacco or pan shop. Children do not simply choose to consume tobacco but are
influenced by their environment with the glamorous advertisements endorsing their acceptance.
They are influenced by the sports personalities, movie stars and people around them consuming
tobacco and because tobacco products are easily available.
What is Smokeless Tobacco?
Smokeless tobacco consists of dried leaves and stems of the plant Nicotinia Tabacum,
containing the drug, nicotine. Nicotine is toxic and has been classified as the most addictive
drug in existence. In India industrially manufactured chewing tobacco, Gutkha, is easily
available in sachets and most popular among youth all over the country. Chewing tobacco
is the major cause of oral cancer.
There are mainly two forms of smokeless tobacco used in different parts of the world.
1.
Oral snuff - also commonly known as dip available in moist, dry and sachet forms.
2.
Chewing tobacco - available in loose leaf, twist and plug forms.
Any form of tobacco used in the world has been established to cause oral cancer, which is
the commonest cancers in India among men.
Contents of Smokeless Tobacco
Smokeless tobacco contains dangerous chemicals, which result in addiction leading to death.
Nicotine is the main deadly substance in smokeless tobacco. It is directly absorbed in the
blood stream and leads to addiction. Smokeless tobacco has similar or higher levels of nicotine
than smoking tobacco.
-1-
Smokeless Tobacco Causes Cancer
Smokeless tobacco use may increase the risk of oral cancer four times. Smokeless tobacco
users, specially those consuming snuff for a long time can develop cancer of the lip, tongue,
floor of the mouth, cheek and gum. The chances of oral cancer are higher in users than in
the non-users of smokeless tobacco.
Warning Signs:
.
•
A mouth sore that bleeds easily or fails to heal, often appears where the tobacco product
is placed.
A painless lump, thickening or soreness in the mouth, throat or tongue.
•
Soreness or swelling that persists.
•
A white or red patch in the mouth that persists.
•
Difficulty in chewing, swallowing or moving tongue or jaw.
Preventive Measures
There are a number of organizations working for tobacco control worldwide as well as in
India. Many preventive measures have been taken and are being planned targeting users
as well as non-users. Many preventive campaigns have been carried out to make the general
public aware of the dangerous and harmful effects of tobacco use. There is a long way to
reach the goal of tobacco control but we must keep making efforts.
1. Control over Glamorous Advertisements and Marketing of Tobacco Products:
Advertisements through the media are one of the effective ways of spreading messages
across to the public and tobacco industries have chosen it for the promotion of their
products and its sale. It immediately affects the adolescent group as this is a very inquisitive
age group and can easily be influenced. Studies have shown that in some countries,
tobacco advertising is twice as influential as peer pressure in encouraging children to use
tobacco. However, the advertisements are misleading and must be stopped as well as
marketing of tobacco to the youth to protect them from becoming future consumers.
2. Protect Children from Becoming Addictive to Tobacco:
The two main smokeless tobacco products, gutkha and pan masala (containing tobacco),
are very easily available in India. Children are always interested to try out new products
seen in the advertisements. Often, the small and cheap sachets are given free to children
in cinema halls, outside schools and colleges and even during some events. There should
be an age limit at which tobacco products can be sold legally to children. If someone
breaches the law, a heavy penalty should be imposed.
3.
Increase in Taxes on Tobacco Products:
The government has to make efforts to increase taxes on tobacco products, to make them
unaffordable to children. This will not only reduce sales but also increase revenue generation
to be used for other tobacco control activities in the country.
-2-
4.
Generating Awareness Regarding the Ill-effects of Tobacco Use:
Designing of strong and very clear messages is necessary. Many organizations have done
similar work in other health awareness areas very successfully. Equally important is to
generate awareness about the dangers and harmful effects of tobacco use specially
focusing on adolescents and children. It has been proved that mass media programmes
and educational programmes produce better results and a quick impact.
5.
Declaring Public Institutions, Specially Schools and Colleges as Tobacco Free:
It is necessary to develop school and college health programmes in order to completely
stop the sale and consumption of tobacco within and outside educational institutions.
6.
Involvement of Health Personnel in Awareness Campaigns:
Health personnel like doctors, nurses, health volunteers and so on can be of great help
in tobacco control activities. They should be appropriately trained as they directly interact
with patients and the community.
7.
Eliminate Sponsorship by Tobacco Companies of any Public Events:
Tobacco companies sponsor major events like sports, awards, festivals and so on. These
sponsorships should be discouraged in order to control the advertisement of tobacco
products.
8.
Showing Prominent Warning on Tobacco Products:
The statutory warning mentioned on tobacco packets and even on cigarette packets is not
prominent. It is necessary that the warnings are prominently depicted on the packets so
that they leave some impact on the mind of the user. For example, a picture of a new born
with disability, pregnant women, oral cancer pictures and so on.
Conclusion:
Smokeless tobacco is a growing addiction especially amongst the youth of India (as high as
55%). If not effectively controlled, it will soon become an epidemic and also a major cause
of deaths in India. It is important to invest in the future - on youth and children. They are being
targeted by the tobacco industries for giving employment as well as the future customers.
Many organizations are working in the area of tobacco control and legislative measures have
also been adopted. Tobacco Products (Prohibition of Advertising and Regulation of
Trade, Commerce and Supply) Bill, 2001 has already been introduced in Parliament and
efforts are required to pass the bill. In order to control the tobacco epidemic, effective smoking
cessation programmes are required to be implemented along with awareness programmes.
Only when this is done will significant progress be made in combating what has become a
truly global epidemic.
Prepared by: Ginashri Datta, ACT-India.
-3-
Voluntary Health Association of India
SUBMISSION
INTRODUCTION
Presently tobacco contributes to 4 million deaths per year globally. According to the
World Health Organization (WHO), tobacco kills more people annually than AIDS and
accidents put together. This figure is expected to rise to 10 million tobacco attributable
deaths per year by 20 25.
INDIAN SCENARIO
In India, deaths attributable to tobacco are expected rise from 1.4% of all deaths of 1990
to 13.3% in 2020. India, according to the projections of WHO, will have the highest rate
of rise in tobacco related deaths during this period, compared to all other
reasons/countries.
Tobacco kills between 8-9 lakh people each year in India. This will multiply many folds
in the next 20 years. Of the 1000 teenagers smoking today, 500 will eventually die of
tobacco related diseases-250 in their middle age and 250 in their old age. Those who die
. earlier loose on an average 22 to 26 years of productive life compared to non-smokers.
Epidemiological data from developed countries demonstrate an approximate 30-40 year
lag time between the onset of regular smoking and smoking-related mortality. Among
men aged 35-69 years in developed countries, 30 per cent of all deaths are estimated to be
cause by smoking. Specifically, smoking causes:
>
>
>
>
>
90-95% of lung cancer deaths
75% of chronic lung disease deaths
40-50% of all cancer deaths
35% of cardiovascular disease deaths
over 20% of vascular disease deaths
As smoking rates in developing countries begin t/o catch up with those in developed
countries, their death and disease rates will also catch up.
FACTS AND REALITIES THE TOBACCO INDUSTRY MUST ACCEPT
> That smoking causes many kinds of cancer, heart diseases and respiratory
illnesses which are fatal for many sufferers.
> The annual global death toll caused by smoking is 4 million. By 2030, that figure
will rise to ICmillion with 70% of those deaths occurring in developing countries.
Tong Swasthya Bhawan, 40 Institutional Areo, South o( I.I.T., New Delhi-110 016, INDIA.
Phone: 6518071-72. 6965871.6962953 Fax: 011 -6853708 Grams: VOLHEALTH N.D.-16 E-mail: VHAI@del2.vsnl.net.in
Donations exempted from IT under Sec lion 80-G of IT Act 1961. Also exempted U/S 10(23C) IV as applicable Io institutions of importance throughout
> That nicotine is a most important active ingredient in tobacco; that the tobacco
companies arc in the drug business; the drug is nicotine and that the cigeratlc is a
drug delivery device.
> That nicotine is physiologically and psychologically addictive, in a similar way to
heroin and cocaine-rather than shopping, chocolate or the internet. The
overwhelming majority of smokers are strongly dependent on nicotine and that
this is a substantial block to smokers quitting if they choose to.
> That teenagers (13-18) and children (<13) are in inherently important to the
tobacco market and the companies are competing for market share in these
groups.
> That advertisement increases total consumption as ;well as promoting brand
shares.
> That advertising is one (of several) important and interlocking ingredients that
nurture smoking behavior among teenagers and children.
> That current formulation of low-tar cigarettes creates false health reassurance and
offers little or no health benefit.
> That second-hand smoke is a real public health hazards including causing
childhood diseases such as asthma, bronchitis, cot-death and glue ear, and is a
cause of lung cancer and heart disease in elders.
NICOTINE ADDICTIONS
> A UK government scientific committee set in March 1998: "over the past decade
there has been increasing recognition that underline smoking behaviour and its
remarkable intractability to change is addiction to the drug nicotine. Nicotine has
been shown to have affects on brain dopamine systems similar to those of drugs
such as heroin and cocaine (SCOTI I, 1998).
> "Dependence on nicotine is established early in teenager's smoking carriers, and
there is a compelling evidence that much adult smoking behavior is motivated by
a need to maintain a preferred level of nicotine intake
” (SCOTH, 1998, Ibid).
> Smokers are compelled to smoke by addiction to nicotine but the harm is largely
done by the 4000+ other chemicals in the tar and the gases produced by burning
tobacco. It is this combination that makes tobacco so deadly.
MARKETING TO CHILDREN
Publicly the tobacco companies have always maintain that they do not target youth, but
the market logic of selling to teenagers is overpowering-teenagers are the key battle
ground for the tobacco companies and for the industry as a whole. Internal industrial
documents show that they set out to aggressively advertise to youth, and even manipulate
peer pressure to make people smoke their brand.
The industry knows that veiy few people start smoking after their teenage years, and if
you can “hook” a youngster early on they could well smoke your brand for life.
Independent surveys have shown that approximately 60% of smokers start by the age of
13 and fully 90% before the age of 20. It is both socially and locally unacceptable to
advertise tobacco to under-age teenagers and children-yet it is to this precise .ago group
that the industry advertises in order to survive: Studies have shown that teenagers
consume the cigarette that most dominate sports sponsorships.
KEY FACTS ON ADVERTISING AND SMOKING
> Chief Economic Adviser to the Department of Health, Dr. Clive Smee, published
the most comprehensive study of the link between advertising and tobacco
consumption in 1993. After reviewing 212 ‘time scries’ correlating advertising
spending and total tobacco consumption, Smce concluded, “The balance of
evidence thus supports the conclusion that advertising does have a positive effect
on consumption. ” Smee also examined in detail the effects of tobacco advertising
bans in four countries and found that banning advertising resulted in reductions in
consumption of 4%-9% in the countries surveyed. He concluded: "In each case
the banning of advertising was followed by a fall in smoking on a scale which
cannot be reasonably attributed to otherfactors. "
> A meta-analysis of econometric findings from time series research found a
positive association between advertising expenditure and cigarette consumption.
The study showed that a 10% increase in advertising expenditure would lead to a
0.6% increase in consumption.
> The US Surgeon General in his 1989 report highlighted the difficulties in
designing studies that prove the point definitively, but concluded: "the collective
empirical, experiential and logical evidence makes it more likely that not that
advertising and promotional activities do stimulate cigarette consumption. ” The
Surgeon General suggests seven ways in which tobacco advertising operates to
encourage smoking:
US SURGEON GENERAL - HOW ADVERTISING AFFECTS CONSUMPTION
By encouraging children or young adults to experiment with tobacco and thereby
slip into regular use.
By encouraging smokers to increase consumption
By reducing smokers’ motivation to quit
By encouraging former smokers to resume
By discouraging full and open discussion of the hazards of smoking as a result of
media dependence on advertising revenues
6.
By muting opposition to controls on tobacco as a result of the dependence of
organizations receiving sponsorship from tobacco companies
7.
By creating though the ubiquity of advertising, sponsorship, etc. and environment
in which tobacco use is seen as familiar and acceptable and the warnings about its
health are undermined.
1.
2.
3.
4.
5.
TOBACCO AND THE RIGHTS OF THE CHILD
The UN Convention on the Rights of the Child was adopted by the UN General
Assembly on 20 November 1989 and came into force in September 1990. Interpretation
of the articles of the Convention by the Committee on the Rights of the Child and the
practice of States demonstrates that tobacco is indeed a human rights issue. As a legally
binding international Convention, ratified States are legally bound to ensure that children
can enjoy all of the rights guaranteed under the Convention, including protection from
tobacco.
WHO estimates that nearly 700 million, or almost half of the world’s children, breathe air
polluted by tobacco smoke, particularly at home. Most have no choice in this matter, and
as a consequence of their exposure in homes and public places, suffers serious long-term
health affects.
Because of the enormous potential harm to children from tobacco use and exposure,
States have a duty to take all necessary legislative and regulatory measures to protect
children from tobacco and ensure that the interests of children take precedence over
those of the tobacco industry, (liven the overwhelming scientific evidence attesting to
the harmful impact of tobacco use and ETS (Environmental Tobacco Smoke) on child
health, implementing comprehensive tobacco control is not only a valid concern falling
within the legislative competence ofgovernments, but is a binding obligation under the
Con vention.
For policy makers, the Convention on the Rights of the Child provides an existing legal
framework for implementing and enhancing comprehensive tobacco control policies.
Utilising the Convention, human rights and tobacco control advocates have a unique
opportunity to identify the problems related to tobacco use and develop in tandem
solutions which can be implemented coherently and universal.
Comprehensive, multi-level strategies will be required, including strong public policies.
Without such policies, the rights of children will continue to be violated, particularly
those relating to guarantees of basic health and welfare, and protection from child labour.
States therefore, both individually and collectively, must live up to their obligations under
the Convention and protect children from tobacco.
The Cigarettes and other Tobacco Products (Prohibition of Advertisement and
Regulation of Trade and Commerce, Production, Supply and Distribution), Bill, ‘
2001 is a social legislation bill that endeavors to protect the health of non-smokers,
tobacco users especially children taking to the tobacco habit.
The Bill, is a non-controvcrsial Bill which merely seeks to:
• >
>
>
>
Ban smoking in public places
Ban on advertising
Adequate warning to users
Ban on sale to minors
The prime beneficiary of this Bill will be the women and children who are the most
vulnerable to tobacco usage. Public health measures protecting people from harmful
effects of tobacco should not be shelved. Simultaneously there has to be a time frame
where a shift has to take place from tobacco crops to other alternative cash crops and
alternative employment opportunities. In India, we are already burdened with diseases of
poverty with a meager health budget and now, we are faced with the additional burden of
tobacco related diseases. ,A developing country like India can not afford the luxury of
tobacco related diseases.
It is therefore, the humble submission of the Voluntary Health Association of India that
the “The Cigarettes and other Tobacco Products (Prohibition of Advertisement and
Regulation of Trade and Commerce, Production, Supply and Distribution), Bill, 2001”
be considered by the Standing Committee to be recommended to the Parliament of India
for its passage. This will go a long way in protecting the health and lives of millions of
people in India and set an example for other developing countries to emulate.
Thanking you,
Yours sincerely,
Alok Mukhopadhyay
ChiefExecutive
New Delhi
3rd July, 2001
pH - | 2--
International Week of Resistance to
Tobacco Transnationals (IWR2004)
17-21 May 2004
On. 21 May 2003, the World Health Assembly unanimously adopted the
Framework Convention on Tobacco Control (FCTC). This groundbreaking trealy
will save millions of lives and change the way the tobacco industry operates
globally Throughout FCTC negotiations, Infact and the Network for
Accountability of Tobacco Transnationals (NATT) organized five successful
International Weeks of Resistance to Tobacco Transnationals that involved
thousands of people in events in more than 40 countries. These events helped
build global support for the creation of a strong FCTC and counter the aggressive
attempts by Philip Morris/Altria, British American Tobacco and Japan Tobacco
International to derail it.
The week of 17 May 2004 marks the one-year anniversary of the FCTCs
adoption. NGOs around the world are using this critical milestone to build global
momentum behind the treaty’s swift implementation. In every region of the world,
civil society is calling on governments to ratify and implement the FCTC with
press conferences, marches, rallies and nationally televised screenings of the film
Overcoming the Odds: A Story of the First Global Health and Corporate Accountability
Treaty.
There is a growing movement calling for swift FCTC
RATIFICATION AND IMPLEMENTATION!
IWR2004 ACTIONS WILL SPAN THE GLOBE. PEOPLE ARE PARTICIPATING IN COUNTRIES SUCH AS:
Bangladesh, Belgium, Botswana, Burundi, Chile, Colombia, El Salvador, Georgia, Ghana, Hungary,
India, Indonesia, Latvia, Lithuania, Malawi, Malaysia, Mauritius, Moldova, Nepal, Nigeria, Pakistan,
Palau, Panama, Peru, the Philippines, Poland, Qatar, Romania, Senegal, South Africa, Spain,
Sri Lanka, Thailand, Togo, Trinidad, Uganda, Uruguay, Vietnam, and Zambia.
SO
\y
fc fact
Challenging corporate abuse
Building grassroots poser
46 Plympton Street ▼ Boston, MA 02118 ▼ USA
+1-617-695-2525 ▼ +1-617-695-2626 - fax
www.infact.org ▼ info@lnfact.org
IHE student charter
TOBACCO : TOWARDS A TOBACCO FREE SOCIETY
Since
•
Tobacco is a major cause of death and disability globally and in India.
•
Tobacco related death and disability are expected, as per WHO estimates to rise
sharply over the next 20 years in India at a rate higher than anywhere else in the
world.
•
Tobacco injures health in many ways, from childhood onwards, through active as
well as passive consumption.
•
Tobacco products contain nicotine which is strongly addictive.
We need
•
Tobacco control policies which will progressively eliminate the production, sale and
use of all tobacco products intended for human consumption.
•
A ban on all forms of advertisement (direct and indirect) of tobacco products
•
A ban on smoking in all public places
•
A ban on sale of tobacco products, in any form, to minors
•
Taxation of tobacco at progressively higher levels, to discourage consumption
through price-linked disincentives and utilisation of the additional tax revenue for
community health education.
•
Agricultural policies which will progressively phase out tobacco cultivation in
favour of alternate crops.
•
Industrial policies which will encourage the switchover of tobacco related industrial
capacity to alternate uses
WHO
Why is tobacco a public health priority?
Tobacco is the second major cause of death in the world. If is currently responsible for the death
of one in fen adults worldwide (about 5 million deaths each year). If current smoking patterns
continue, it will couse some 10 million deaths eoch year by 2025. Holf the people that smoke
today - that is about 650 million people - will eventually be killed by tobacco.
Tobacco is the fourth most common risk factor for disease worldwide. The economic costs of
tobacco use are equoliy devastating. In addition to the high public health costs of treating
tobacco-coused diseases, tobacco kills people at the height of their productivity, depriving
families of breadwinners and nations of a heolthy workforce. Tobacco users are also less
productive while they are alive due to increased sickness. A 1994 study estimated that the use
of tobacco resulted in on annual global net loss of USS 200 thousand million, a third of this loss
being in developing countries.
Tobacco and poverty are inextricably linked. Many studies have shown that in the poorest
households in some low-income countries as much os 10% of total household expenditure is on
tobacco. This means thof these families have less money to spend on basic items such as food,
education ond health core. In addition to its direct health effects, tobacco leads to molnufrifion,
increased health care costs and premature death. It also contributes to a higher illiteracy rate,
since money ihot could have been used for education is spent on tobacco instead. Tobacco's role
in exacerbating poverty hos been largely ignored by researchers in both fields.
Experience hos shown that there ore many cost-effective tobacco control measures that can be
used in different settings and that can have a significant impact on tobacco consumption. The
most cost-effective strategies are population-wide public policies, like bans on direct and indirect
tobacco advertising, tobacco fax and price increases, smoke-free environments in all public ond
workplaces, and large dear graphic health messages on tobacco packaging. All these measures
are included in the provisions of the WHO Framework Convention on Tobacco Control.
The World Health
Organization’s response to the
tobacco epidemic
offices for Africa,
the Americas, the
Eastern Mediterranean, Europe, South-East
Asia and the Western Pacific. TFI-HQ
works closely with its regional advisers to
Its
The Tobacco Free Initiative (TF1) was estab
plan and implement all activities.
lished in July 1998 to focus international
regional advisers, in turn, collaborate with
attention, resources and action on the
WHO's
country
representatives
and
liaison officers to facilitate tobacco control
global tobacco epidemic.
activities at regional and country levels.
Most of TFI's major activities are coordi
jTFI’s objective
nated by its regional offices and decen
TFI's objective is to reduce the global
tralized to country level.
burden of disease and death caused by
tobacco, thereby protecting present and
future generations from the devastating
TFI's activities
health, social, environmental and econom
WHO
ic consequences of tobacco consumption
Tobacco
Control
secretariat;1''
accomplish its mission, TFI:
Since
the
Framework
adoption
(FCTC)
of
Convention
on
interim
the WHO
on
Tobacco
□ provides global policy leadership;,
Control (see box), the interim secretariat of
□ encourages mobilization at all levels of
the WHO. FCTC has been concentrating
its effortaw ensuring that as many coun
society; and
□ promotes
I
Convention
Framework
and exposure Io tobacco smoke. To
the
WHO
Framework
tries as [possible sign and ratify the Treaty.
Convention on Tobacco Control |WI IO
Awareness-raising
FCTC), encourages countries to adhere
policySmcakers, health professionals and
among
politicians,
to its principles, and supports them in
society at large is essential to this process.
their efforts to implement tobacco con
TFI is also providing technical support Io
trol measures based on its provisions.
countries to assist them in their efforts to
strengthen their infrastructure and take the
necessary steps towards the signature,
TFI's global structure
ratification and implementation of the
TFI is part of the Noncommunicable
wVHO FCTC.
Diseases and Mental Health (NMH) clus
ter at WHO headquarters
(HQ)
in
Research and policy development
Geneva. Regional advisers for tobacco
TFI collaborates with an international
control are based in WHO's regional
network of scientists and health experts to
promote research on various aspects of
this reality, WHO's Member Stales unani
a -'resolution
tobacco production and consumption and
mously
their impact on health and economics.
54.18) calling for transparency in tobac
Policy recommendations are developed
co control. TFI monitors tobacco industry
based on this research and in accordance
adopted
(WHA
activities so as to provide essential infor
with the provisions of the WHO FCTC.
mation to countries as they work to devel
These recommendations cover different
op national tobacco control strategies.
aspects of tobacco control, including regu
lation and legislation in relation Io cessa
Training and capacity-.building
tion, second-hand tobacco smoke, smok
In order to encourage and help countries
ing and children, smoking and gender,
to sign, ratify and implement the WHO*
FCTC, TFI is working on projects that aim
economics and trade
to strengthen national capacity in tobacco
Surveillance and monitoring
;£
TFI monitors and evaluates international
control by building on existing national
public health systems. With that objective
reviewing
in mind, TFI is organizing a series of
structural elements (existence of task forces,
regional, sub-regional and national work
commissions, nongovernmental organiza
shops using evidence-based training mate
tobacco-related
issues
by
tions (NGOs)); process developments (laws
and regulations, economics,
rials to help countries develop and imple
behaviour,
ment tobacco control measures tailored to
exposure, advocacy) and epidemiological
their local needs. A series of case studies
data (prevalence, morbidity, mortality).
from different countries on successful tobac
co control interventions is in production.
Current surveillance projects include the
creation of a Global Database, based on
Communication and media
a common standard, to maintain tobacco
Public awareness of tobacco's harmful
control data worldwide, and the joint
effects is essential to lay the foundations for (
WHO/CDC (US Centers for Disease
acceptable tobacco control policies and
Control and Prevention) Global Youth
regulations. TFI works to ensure that tobac
Tobacco Survey (GYTS), which aims to
co remains in the public consciousness by
trends
funding anti-tobacco media campaigns
among 13 to 15-year-olds and evaluate
and workshops undertaken by local,
youth tobacco control programmes.
national and international groups. World
monitor
tobacco
consumption
No Tobacco Day, celebrated around the
Understanding
the tobacco
industry's
practices is crucial for the success of
tobacco control policies. In recognition of
world on 31 May each year, is the culmi
nation of TFI's advocacy activities.
TFI’s global network
TFI
is
expanding
network
its
WHO Collaborating Centres.
of
WHO
TFI collaborates closely with other WHO
Collaborating Centres are a network of
departments at all levels in cross-duster
national institutions designated by WHO
initiatives Io facilitate the integration of
that carry out activities in support of
tobacco control into other health
pro
its
international
work.
health
TFI's
grammes (e.g. child and maternal health
Collaborating Centres work on research,
and tuberculosis). Outside WHO, TFI
training and advocacy. Working with
works with Member States, other interna
national institutions is an effective way of
tional organizations and civil society
increasing national capacity and paving
through
the way for self-sustainable programmes at
NGOs
working on
tobacco
control.
country level.
The United Nations Ad Hoc Inter-Agency
Tobacco- is one of the few openly
Task Force on Tobacco Control was estab
available commercial products that are vir
lished by the Secretary-General of the
tually unregulated. At the same time, it is
United Nations in 1998 to\ 'coordinate
the only legally available product that kills
the tobacco control work being carried out
one half of its regular users when con
by different United Nations agencies.
sumed as recommended by its manufac
It is chaired by WHO and comprises
turer. To address this issue, the Director-
17 agencies of the United Nations system
General of WHO has established a Study
and two organizations outside the UN
Group on Tobacco Product Regulation.
system.
The group, which includes leading scien-
lists in the field, carries
out
regional economic
integration
organizations
Intemalianal agencies
WHU-HQ, Geneve
NMH. TFI
Other WHO-HQ
departments
research
and
drafts
recommenda
tions
for
Member
WHO's
States
on
how to establish regu
latory frameworks for
(Fl regional advisers at
WHO regional offices
Other departments
in regional offices
Gvil society, NGOs
the design and manu
facture
producls
Collaborating Centres
WHO country representatives
and liaison officers
Study Group on Tobacco
Product Regulation
TFI's work is only possible thanks to the collaboration with other
institutions ana the financial support from several donors.
of
tobacco
WHO Framework Convention on Tobacco Control
The WHO FCTC was unanimously adopted by WHO's 192 Member States in May 2003. It is the
first public health treaty negotiated under the auspices of WHO. It represents a turning point in
addressing a major global killer and signals a new era in national and international tobacco
control. The WHO FCTC reaffirms the right of all people Io the highest standard of health. In
contrast to previous drug control treaties, it asserts the importance of demand reduction
strategies, as well os supply issues.
The Convention has provisions that set standards and guidelines for tobacco control in the
following areas:
□ tobacco advertising, promotion and sponsorship;
□ packaging and labelling;
□ regulation and disclosure of contents of tobacco products and smoke;
□ illicit trade;
□ price and fax measures;
□ soles to and by minors;
□ government support for tobacco manufacturing and agriculture;
□ treatment of tobacco dependence;
□ passive smoking and smoke-free environments;
□ surveillance, research and exchange of information; and
□ scientific, technical and legal cooperation.
The WHO FCTC is deposited in the United Nations Headquarters in New York and is open for
signature from 16 June 2003 to 29 June 2004. Member Stales that sign the Convention indicate
that they will strive in good faith to ratify it, and show a political commitment not to undermine
the objectives set out in if. The ratification of the WHO FCTC binds a Member State to implement
its provisions.
Countries wishing to become a party to the Convention after 29 June 2004 may do so by means
of accession, which is a one-step process equivalent to ratification. The WHO FCTC will come into
force of law 90 days offer it has been ratified by 40 Member Stales.
Headquarters
tfi/nmh/who-hq
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© WHO, 2004. All rights reserved.
c
pw
Action Towards a Tobacco Free World
A workshop at Asia Social Forum, Hyderabad
Date: 3rd January 2003
Time: 2:15 to 6:30 P.M.
Venue: Taj Mahal Hotel, Abids Road, Hyderabad
Facilitated by:
Community Health Cell, Bangalore on behalf of Jan Swasthya Abhiyan / People's Health
Movement)
Partner Organizations
Consortium For Tobacco Free Karnataka
PATH-Canada, LIFE
A Report bv Dr. Anant Bhan, Community Health Cell
The workshop began with registration of all participants. They were given files with
background material about the purpose of the workshop. Around 40 people participated in the
workshop.
The workshop began with an introduction to the purpose of conducting the workshop by Mr.
SJ. Chander from the Community Health Cell who spoke about the global problem that
Tobacco had become and the targeting of Asia and developing countries by Tobacco MNCs
and hence the importance of a concerted effort to network for freedom from tobacco.
Dr. Ramesh S. Bilimagga, Radiation Oncologist and member, CFTFK (Consortium For
Tobacco Free Karnataka, Bangalore, chaired the first session. He welcomed all the
participants to the workshop and reiterated that tobacco was a major problem not just in India
but also across the world. He stressed that a small step by everybody in the direction of a
tobacco free world would make a big difference. He then invited Dr. Thelma Narayan from
CHC to give an overview of the problem.
Dr. Thelma explained that the workshop was being held under the platform of Jan Swasthya
Abhiyan (PHM) which was active in more than 92 countries ands was working towards
making the govts, and WHO and international bodies accountable to their commitment for
Health For All. She stressed that many coordinating and facilitating agencies had helped in
organizing the workshop and also enumerated the other events at ASF being facilitated by
CHC/JSA/PHM. She said that the workshop would help us understand the tobacco issue
especially in regards to dealing with the tobacco industry. It was needed to share our
solidarity in the ASF platform and to strategize and reflect. The-effect of globalization on
public health needed to be studied in depth. Opium had been used in the past by Britain to
subjugate China and now the western powers through the tobacco MNCs were using tobacco
to subjugate the Asian countries. The US was promoting the global consumption of tobacco
and there had been a sharp increase in tobacco usage in many areas; the issue of tobacco
advertising was also an important issue. While tobacco use was reducing in the North
America and Western Europe, the tobacco market was being relocated with increasing use in
Asia and developing countries. Data from different Asian Countries was presented. The
dynamics and intricacies influencing the negotiations of the Frame Work Convention For
Tobacco Control (FCTC) led by the WHO (World Health Organization) needs to be more
transparent in order to evolve a useful instrument.
A Magic Show and a talking doll show followed this. The magician stressed on the ill effects
of tobacco and requested people to not let their lives go up in smoke and to avoid the bad
habits. It was well appreciated by the audience. He also wished everybody present a very
happy and tobacco free New Year.
Dr.Ramesh then invited Dr. Prakash C. Gupta, an epidemiologist and a public health
consultant from Mumbai having 36 years of research experience in the field of tobacco.
Dr.Prakash began by saying that tobacco is a public health problem even at the grassroots
level. Understanding the problem was not enough and something needed to be done about the
problem. There were various organizations working in the field of tobacco control in India-a
loose coalition of which was the ICTC.(the Indian Coalition for Tobacco Control). Each of
the organizations was free to pursue their own agenda but it was an interactive forum for all
participating organizations to pool their resources. He expressed hope that more organizations
would join the fold. He also mentioned that a death clock had been installed in Delhi that
would register the deaths being caused by tobacco usage in India.
After thanking Dr. Prakash, Dr. Ramesh introduced Mr. Sonant, a bureaucrat form the
Ministry of Health and Education in Bhutan. Mr. Soham said that Bhutan had initialed
tobacco control regulations as early as 1729; the state religion (Buddhism) did not permit the
usage of tobacco. He cautioned that in their experience regulation alone was not enough and
there was he neqtfto take undertake aggressive information dissemination and work for anti
tobacco legislation. The Hon’ble Minister of Health had ensured that the sale and
consumption of tobacco had been banned in public places. The effort had come through a
decentralized approach wherein 18 out of the 20 districts in the country had themselves taken
up the initiative to work for local tobacco control. He said that a dilemma that faced the govt.
was the continuing sale of tobacco in the duty free shops in the capital city, which could not
be stopped because of diplomatic problems- he invited suggestions from (he participants on
how to deal with the problem. He said that one of the queens in Bhutan was committed to the
cause of tobacco control and had been appointed as a goodwill ambassador by the UNFPA
and she advocated the tobacco and health issues in various districts (hat she regularly visited.
Appreciating the people of Bhutan, Dr. Ramesh said that it was important to remember that
perseverance was the key.
Dr. Ramesh then called upon two members of the Bangladesh Anti Tobacco Alliance to
speak about efforts at tobacco control in their country. One of them Mr. Ratan Deb said that
sometime ago though (here were many groups working in the field not many were working
together ;only school level programs were being organized to raise awareness about the
harmful effects of tobacco and these also not very effective as they were leading to rebellion
in many cases. He felt that what would work is strict enforcement, high taxes, controlling of
advertising, more elaborate wanting in the packs. He said that BATA has little resources
compared to other groups and tobacco companies. BATA had filed a case in the Bangladeshi
courts and had managed to achieve a significant legal victory which led to decrease in the
rampant advertisement of tobacco companies and had also proved that British American
Tobacco Company’s antismoking campaign was a sham. BATA has been closely working
with the Bangladeshi govt, and have been attempting to spread the message of harmful
effects of tobacco even in the regional languages. A law for stricter tobacco control is now
pending in the parliament. A second writ petition is now pending in the courts under the
Right to Life campaign against the Imperial Tobacco company; the court has given a stay
order on all relevant advertisements for two months. Many organizations and facilities in
Bangladesh arc now tobacco free due to (he efforts of BATA. I le ended stressing that
working together was very important for tobacco control. Mr. Naveen Thomas expressed the
view here that one major factor for the success of the campaign in Bhutan was the fact that
the political, religious and local leadership had come together to fight the problem and were
very much involved.
Dr. Ramesh appreciated the efforts of BATA and raised the fact that the various govts, had a
dichotomous attitude towards tobacco wherein e.g. the Karnataka govt-, had an anti tobacco
cell in the Kidwai Memorial Institute of Oncology, it also had a research wing in the Tobacco
Board to try to improve productivity and quality of tobacco crops. He said that in K’taka
• There were 8 million tobacco addicts.
• 6000 children under the age of 15 yrs of age and as many between the ages of 1524 enter the pool of tobacco users.
There was a need to publicize the tobacco issue among the lay public as they had the right to
information.
Mr. Jaggaiah. a security guard from Hyderabad who used to smoke around 48-50 beedis a
day for over 40 years presented his medical problems directly related to his tobacco
addiction. He used to get cough, dyspnoea and chest pain; he had to undergo surgery
(pneumonectomy) for pathology arising from his tobacco usage; he said that he had now
stopped smoking and was proud to be free from tobacco.
Ms. Lalitamma from Karnataka, an ex-cultivator then shared her experience .She said that she
had been working in the tobacco fields for over 15 years; most of the workers used to be
employed as daily wage workers by the rich cultivators and had work for only 3-4 months yr.
The workers had very hectic work in the fields everyday and at the end of each day they were
so tired that they could not adopt any hygienic methods before consuming food or have a bath
before sleeping. They also used to use a lot of pesticides in the tobacco nurseries in their
homes and because of all this problems she felt that they used to inadvertently consume a lot
of pesticides. During the course of her work, she developed health problems and approached
a medical practitioner who advised admission - her treatment bills were in the range of about
Rs-30.000. She said that she had resolved to never do that kind of work again and was hoping
that other people also left that hazardous work.
Dr. Ramesh thanked all the speakers for giving an insight into the various issues related to
tobacco that were affecting their lives and work. He then thanked the organizers for having
given him the opportunity to chair the session and handed over the stage to the next
chairperson. Ms. Devaki Jain.
Ms. Devaki then chaired the next session, which was distribution of certificates and
mementoes of appreciation to
•
•
•
The people of Bhutan for having shown great collective resolve for the fight against
tobacco. This was received by Mr.Sonam Thunsho, secretary, government of Bhutan
in charge of health education.
The members of BATA for their work for tobacco control in their country and for
dragging the guilty tobacco companies to court and make them accountable for their
unlawful practices. This was received by Mr.Ratan and Mr. Biplob
Dr. Prakash C. Gupta for his extensive work in research in the field of tobacco.
A short tea break was then announced which gave the opportunity for the audience to interact
with the speakers and also for them to view the exhibition of anti tobacco posters that had
been put up by Community Health Cell in the hall.
The tea break was followed by a panel discussion on various facets of the tobacco issue. The
discussion was chaired by Ms. Devaki Jain. She said that the amount of money the govt.
spent on treating diseases arising from the usage of tobacco was more than the money it
received through excise. Tobacco related deaths were more than the number of deaths caused
due to HIV, Malaria, and T.B. combined. There was a need for campaign mode activists, as
knowledge about the ill effects of tobacco did not deter people from harmful habits. Death
was a close phenomenon in India especially among the poor and hence morbidity and
mortality due to tobacco could not be used as an effective deterrent in that sector. There was a
need to work to change attitudes: also important was to fight the tobacco industry', which was
targeting the young by using unfair advertising means, There was a need to talk about it in the
background of globalization and macro-economic program. The relation between poverty in
India and the addiction to tobacco, alcohol and the susceptibility to HIV in poor communities
was well known and proven in studies such as one done by NIMH ANS. Also, interestingly.
the govt, had included Tobacco in the Foods and Beverages list.
Dr. Devaki then invited Dr. Prakash Gupta to give his presentation. Dr. Prakash’s
presentation had the following salient points:1.
There were only two causes of death that were increasing worldwide- HIX' and
Tobacco.
2.
Death was an objectively measured event; Tobacco usage was the single most
preventable cause of death in the world.
3.
Current WHO estimates of tobacco attributable premature deaths are in the range
of4.9 million/yr. This is expected to rise to 10 million I yr by the year 2030; already
in the 20lh century approx. 100 million people had died due to health problems related
to tobacco usage.
4.
India was the second largest producer and consumer of tobacco in the world; ICMR
estimate for the annual annbutable mortality from tobacco was 8.00.000.
5.
Tobacco causes a lot of medical problems and addiction is a key issue because of the
nicotine content
6.
Children are the mot severely affected and unfortunately they are powerless to fight
against this evil.
7.
There were many misconceptions related to tobacco e.g. that it was not a high-risk
product and that tobacco users do not have any choice, once addicted.
8.
The truth was that more than half of chronic tobacco users would die of health
problems arising from that habit.
9.
Tobacco smoke had a lot of toxic chemicals and carcinogens and had an effect even
on passive smokers; hence there was a need for concerned people to fight for their
right for clean air.
10.
Tobacco and social justice was also an important issue- as its usage was more among
the lower SE strata and the relative risks were also higher in this group; beedis,
commonly used by this group were more harmful than cigarettes; also unfortunately.
most of the interventions were aimed at the higher SE strata.
11.
The rising usage of tobacco among the women was alarming- one study had shown
that as many as 10% of college going women in Mumbai were using tobacco.
Dr. Devaki then invited Dr. Srinath Reddy to present his views and experience as the
Indian govt, nominee and as a NGO health activist at the FCTC deliberations. FCTC was
an attempt by WHO to exercise its treaty making power for tobacco control. The cmical
issues included stronger action required on the demand and supply sides. There were the
issues of trade and public health involved; most country representatives participating in
the deliberations were advocating a total ban on all forms of advtg.- direct and indirect.
But there had been pressures from some quarters and in the ongoing round the talk was
around restriction of advtg; unfortunately the issue of surrogate advtg had not been
addressed. The WB and developed countries were of the view that there was a continued
increasing demand for tobacco irrespective of control measures (more in the developing
countries and lesser in the developed ones). Global resources were lacking for
implementation unless a global fund was set up. Also, cross border advertising continued
to be an issue and trade y/s public health was a battle that was still being fought out m the
FCTC. The recent draft of the FCTC was disappointing. It has been prepared for the
next round of negotiation in February 2003.
Ms. Devaki thanked Dr. Reddy and mentioned that the UN precincts and most eater.es in
the developed countries are smoke free. She then invited Ms. Shobha John of PATE
Canada (Programme For Appropriate Technology for Health) based at Mumbai to make
a presentation. Shobha spoke about the poor being affected the most by tobacco usage
and she presented some data from her PATH studies which showed that the tobacco
consumption among the pavement dwellers was 82% and among the street children was
76% - these people were spending less amount of money on food than tobacco. She also
raised the issue of misplaced targeting by activists who were not addressing the iqb-eco
problem that was afflicting the poor SE strata and the need to reach out to that group In
Bangladesh, a study had proven that many households were spending 18 times mor. on
tobacco than health. The tobacco issue was causing a loss to the country as the estimated
health costs were in the range of Rs 6.5 billion while the excise returns were only Rs.4.5'
billion: hence the economic loss to the nation was immense. Also the tobacco industries
were themselves promoting smuggling of their products and were using a lot of from
groups for surrogate advertisements. The industry’s argument that a lot of workers would
lose their job had to be viewed with scepticism because the companies as they were
getting mechanized were laying off a lot of workers; also experience had shown that the
industry was actually quite exploitative: Ms. Devaki mentioned that some traders ir.
B’lore had been subletting the space outside their shops which was actually govt.
property to vendors; she then invited Ms. Suvama to share the findings of her stud;, n
Shimoga in Karnataka.
Suvama mentioned that she had been working in the area for the last 12 yeras and she had
noticed that tobacco cultivation had decreased by more than 50% - this had sparked m
interest to initiate the study. They had discovered that the cultivators were actually the
large farmers as the govt. Tobacco board regulations were that all tobacco cultivator:
should a possess a minimum of at least 3-4 acres of land .Tobacco cultivation was larour
intensive. It also required a lot of wood for curing which had led the fanners to steal wood
from the forests. Almost 80% of the forests had been depleted and now' the local populace
had sometimes to walk a distance of 10 kms to collect firewood. Good quality wood was
required for curing wherein temperatures were maintained at 90-120 degrees Fahrenheit
for 4 days. The alternative crops that some families had shifted to in the state were maize
etc.; they had noticed that the land became more fertile if tobacco cultivation was .
decreased. As tobacco was a very labour intensive work, the people used to be busy from
morning to evening in their work, which had affected families, as there was nobody to
look after children and the elderly. This has been shown in falling attendance in school for
the children of cultivators and agricultural laborers. The Sanghas and self-help groups
discussed this and decided to utilize the govt, programs. Supporting each other, the}
cultivation, women were the most affected - they had occupational problems, were made
to work hard and do menial jobs; there was gender insensitivity and the women were made
to do the most difficult and strenuous work. This had affected the lives of many women
and children adversely. Ms. Devaki appreciated the presentation and mentioned the need
for linked narratives to help with advocacy issues.
This was followed by a group discussion involving all participants that was chaired by
Dr. Srinath Reddy. The main points that were highlighted in the discussion by various
participants were: -
•
Coronary Artery Disease (CAD) caused by tobacco usage needs to be studied and
publicized.
•
FCTC needs to advocate strong regulations- local and national.
•
Need to sensitize the politicians about the issue.
•
Need for effective political lobbying and policy level interventions.
•
Need to safeguard the interests of the involved people and to try to bring the larger
forces to come together.
•
Lesser emphasis to be laid on health and more on the fiscal and the environmental
aspects.
•
To try to attempt a linkage with the right to food campaign and the environmental
issues.
•
Promote the usage of the 73ld and the 74lh amendments that promote local
governance.
•
Need for economists to study the long term effects of tobacco usage.. .
•
Promote the ban of tobacco consumption in public places as it gives the right to
people to protest tobacco usage.
•
Alternate employment strategies to be promoted.
•
Need to understand that there was no direct subsidy by the Govt, of India to the
tobacco industry but indirect subsidy.
•
Legislation against tobacco would be ineffective if people were not informed and
convinced about the reasons for legislation.
•
Need to approach and convince ex en the local and vernacular media to cover tobacco
related issues.
•
Need to convince the film producers and artists to not promote the usage of tobacco
in the movies/serials; this was especially relevant as the theme of the World No
Tobacco Day this year was "Free Films from the influence of Tobacco
•
The information about tobacco to be integrated into existing health programs and
through the educational system in school and colleges.
Mr. Niranjan from the People’s Health Movement in Sri Lanka shared that the cost of
one cigarette in Sri Lanka was 7-8 rupees and that was an effective deterrent also: it was
discussed that Prof. Par.chamukhi’s study on Karnataka had proven that tobacco farmers
were ready to diversify' into vegetable cultivation but the market support was not in
place. Whereas the tobacco industry was picking up its produce and taking itto the
market, this support was not available for the farmers involved in vegetable fanning to
transport their produce to the distant markets.
The group then discussed the statement to be issued by the workshop participants- certain
changes were suggested for incorporation in the statement before finalization and
distribution to the ASF organizers and the media. The modified statement and the press
release are attached.
Dr. Srinath thanked the participants for their active participation in the group discussion.
A formal vole of thanks was proposed and the workshop ended.
4lh January 2003
For Immediate Release
Asian Tobacco Control Activists
Suggest Alternatives to Tobacco-Related Work
Hyderabad: Moving out from tobacco cultivation is a feasible alternative, was the
message that emanated from the workshop on “Action Towards a Tobacco Free World
at the Asia Social Forum in the citadel of tobacco farming. The workshop held yesterday
brought together development workers, researchers, medical, and economic expens
besides the labourers who were previously engaged in tobacco related work.
Latha. a labourer from Shimoga, Karnataka narrated her experiences wo'rking in the
tobacco fields, “ We used to get a paltry wage of Rs. 30/-a day for 20 hours of back
breaking work in the tobacco farms. Tobacco dust infested my insides and 1 spent more
than Rs. 30,000/- in treatment”. She has since become a crusader persuading her co7
workers to give up toiling on tobacco farms at the cost of their health. " I will never go
back to those fields, even if they offer me Hundred rupees a day”, reaffirms a decided
Latha.
Tobacco Board officials from the region admit that 80 % of the forest in some of these
villages have been depleted due to massive felling of trees to cure tobacco. Their records
confirm that many tobacco farmers are therefore leaving tobacco cultivation. Some -of
these farmers have found safer havens in growing maize and groundnut and tobacco
laborers in Shimoga and other parts of Karnataka have shilled to income generation
activities like rearing cattle.
Suvarna, a development worker who works with women in tobacco farming relates.
Tobacco work drains them of their energy and health and Often strains family
relationships to the point of breaking them due to the long hours of work during the
farming season. It leaves them with hardly any time to attend to household chores and
children”. Many of these children eventually drop out of school and are taken to work on
tobacco farms.
Several of the workers at the workshop who despise working on tobacco farms pointed
out that Government policies in this regard are anti-poor. Government promotes tobacco
farming, research and marketing through stsport institutions and these essentially benefit
the rich farmers who own land and resources. They opine that unless these are reversed
and alternatives are explored and developed, this exploitative industry would continue to
thrive undeterred.
For Further details, contact-.
Thelma Narayan, Co-ordinator, Community Health Cell, Bangalore.
Email: sochara@vsnl.net
Statement issued by the participants of the
“WORKSHOP ON ACTION TOWARDS A TOBACCO FREE WORLD”
On 3rd January 2003
ASIAN SOCIAL FORUM, HYDERABAD, INDIA
FIGHT TOBACCO THE KILLER !!!
Realizing that tobacco and its products
including cigarettes, bidis, guthka, and chewed
tobacco...
•
Is one of the biggest killers worldwide and
particularly among the poor killing 4.9 million
people every year and reducing life by 15-20
years. Tobacco causes cancer of the various
organs, diseases of heart, blood vessels, lungs
and other organs leading to suffering disability
and death.
•
Is highly addictive with nicotine being more
addictive than cocaine or heroin.
•
Is the only freely available consumer product
that kills.
•
Has an adverse environmental impact, using of
millions of tonnes of wood for curing tobacco,
excessive use of pesticides and chemicals,
depleting soil fertility.
•
•
The tobacco industry results in an overall fiscal
loss, with loss of productivity and cost of
treating tobacco related illnesses being more
than the revenue gainded.
The tobacco industry indulges in misinformation
through
aggressive
advertisement
and
sponsorship targeting children, youth and
women.
•
Affects millions of non-smokers and particusaiy
pregnant women, retarding the growth of the
unborn children and causing abortion through
passive smoking.
•
Tobacco use perpetuates poverty at household
and larger levels.
We the participants of the workshop on Action
Towards a Tobacco Free World in the Asia
Social Forum issues this statement and call
upon Government, civil society, media and the
people to take up urgent action......
•
On public policies In the context of right to food,
right to health and right to work and poverty
reduction.
•
Work through local government and local
bodies, focussing on women and dalits.
•
Hold the tobacco companies responsible for the
losses incurred and the adverse consequences
on individuals and families of tobacco use.
•
Ban all direct and indirect advertisement of
tobacco and its products including sponsorship
of sports and cultural event by the tobacco
companies and affiliated bodies.
•
Ban the manufacture and sale of chewed
tobacco in any form, since minors are especially
vulnerable.
•
Progressively reduce the area of cultivation of
tobacco utilizing the area thus freed for other
beneficial crops.
•
Prevent the cutting down of trees and
denudation of forests for curing and packaging
tobacco.
•
Increase progressively the tax on tobacco and
its products and utilize the revenue thus
received for health promotion.
•
Introduce legislation and effectively implement
laws for prohibition of smoking in public places.
•
Use all means to increase public awareness
•
Reduce glamorization of tobacco
through films and media.
products
‘WORKING TOGETHER FOR TOABCCO CONTROL”" TOGETHER WE CAN DO IT!
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