Smoke out

As an international intergovernmental body, the World Health Organization is usually quite cautious and conservative in its statements, but this year, for their World No-Tobacco Day (May 31), they’ve designed a poster with “Intimidation” in large red letters followed by “Stop Tobacco Industry Interference.” The foreground of the poster is a man in a coat trying to dismantle a No Smoking graphic symbol.

Yesterday the Inquirer ran an article from Dr. Shin Young-soo, regional director of the Western Pacific office of the WHO, with a strong, no-nonsense title “Hands Off!”—a warning repeated several times throughout the article, and directed against the tobacco industry. Shin notes that people are forgetting that these tobacco products “cause addiction, suffering and nearly 6 million deaths per year.” He calls on people to “denounce tobacco industry interference with public health laws whenever and wherever you see it.”

The treaty obligates governments to ensure that laws are passed on prices and tax measures to discourage the demand for tobacco, protection from exposure to tobacco smoke, regulation of the contents of the products, as well as packaging and labeling, and regulation of advertising, promotion and sponsorship. Sales to minors should also be regulated and finally, support for alternatives to tobacco farming should be provided through laws. Passage, as well as implementation of these laws, has been problematic, though, as the tobacco industry tries to find ways around the rules and regulations.

Several articles on the WHO No-Tobacco site explain why the international body is now calling on government, and civil society, to become more vigilant in guarding against the tobacco industry. Included in the website is a full report, first published in 2009, detailing how the industry has tried to block the regulation of tobacco use. The strategies are mind-boggling, including setting up “allied and third-party industries” to oppose tobacco control. These third-party industries include those in transport, advertising, even gambling and gaming, who come out saying that tobacco regulation will mean adverse effects on their industries.

Scientific research

The most disturbing form of interference comes from the industry’s support of “scientific research.” The WHO report says Philip Morris set up an Advancement for Sound Science Coalition which challenged findings that second-hand smoke is harmful. Philip Morris used the coalition “to promote ‘good epidemiology practices’ … to shape the standards of scientific proof in the effort to make it impossible to ‘prove’ that second-hand smoke among many other environmental toxins is dangerous.”

The studies on second-hand smoke came out of the International Agency for Research on Cancer but was then challenged by industry front groups such as the Center for Indoor Air Research (106), the European Science and Environment Forum, as well as media groups to reshape public opinion.

To counteract proposals to limit exposure to second-hand smoke, the tobacco industry also hired consultants to state that ventilation could accommodate both smokers and nonsmokers in some public spaces.

The cases of industry manipulation and intimidation seemed endless, even to the extent of using corporate social responsibility to sponsor activities that allow promotion of tobacco products. One particularly devious practice was support for youth smoking prevention programs. The twist here is that while the tobacco companies come out looking good for discouraging young people from smoking, their goal is to say, ultimately, that if some of the people still pick up the habit, they do so as an adult choice! Waiting, too, for the adults, are smokers’ rights groups, who argue that tobacco regulations violate their human rights.

The WHO choice of the word “intimidation” seems strong but it is a response to lawsuits brought by some companies against government agencies, to block tobacco regulations.  Even more devious is the use of smuggling to get around taxes on cigarettes.

The WHO calls for stricter monitoring of the tobacco companies, including more requirements on disclosures around their expenditures in “marketing, advertising and promotion, lobbying, corporate social responsibility programmes, prevention and cessation programmes, political donations, philanthropy, research funding…” It also wants to require the tobacco companies to report information on their manufacturing, including ingredients of cigarettes, toxic constituents and toxic emissions.

Philippines

While the Philippines signed the international framework on tobacco control in 2005, basic reforms have been slow. It’s not surprising that there are still many Filipinos who will offer cigarettes to visitors and friends, or teach young people, males in particular, to smoke. Even at the University of the Philippines, young students still pick up the habit, smoking away, together with faculty and nonacademic staff, sometimes under a “No Smoking” sign. Others are more discreet, looking for more isolated areas to smoke, but don’t realize that there is a Civil Service Commission regulation that prohibits smoking throughout government institutions.

Put more bluntly, there is no such thing as a smoking area for government premises.

Last year we read about the Metro Manila Commission cracking down on people who smoke in public places.

Predictably, the campaign seems to have died down.

Prices of tobacco products are still among the cheapest in the region, with companies riding on the “tingi” (small amounts) sales behavior of Filipinos. You can buy packs of 10 cigarettes instead of the regular 20, and of course, vendors still sell one or two cigarettes at a time. Anyone of any age can buy the cigarettes; sometimes the vendors are even minors.

Attempts to get graphic warnings on cigarette packs have also floundered. I’m personally pessimistic about the graphic warnings getting smokers to stop, but these could have a deterrent effect for those who haven’t started yet. In recent weeks there have been debates over proposals to increase taxes on tobacco and alcohol, so-called “sin taxes.” The argument is that tobacco farmers in northern Luzon will suffer.

The WHO report concludes that “the tobacco industry is not and cannot be a partner in effective tobacco control,” which seems commonsensical; yet attempts have been made, repeatedly, by the tobacco companies to project themselves as stakeholders and responsible partners. It’s a lesson we might want to learn for other public health initiatives. For example, I wonder if junk food and soft drink manufacturers should be allowed to launch good nutrition campaigns in schools, as they are doing now in the Philippines.

It’s time these Trojan horses—the disguised enemy—are smoked out!