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India: steep decline in tobacco consumption in India reported in second Global Adult Tobacco Survey (GATS 2017)

23 Jun, 17 | by Becky Freeman, Web Editor

Authors: Chaturvedi Pankaj , Sarin Ashima, Seth Sanjay, Gupta PC

On 8th June 2017, results from the second Global Adult Tobacco Survey (GATS 2) of India were released. GATS is a global standard for systematically monitoring adult tobacco use and tracking key tobacco control indicators. India is the world’s largest democracy, and the second largest consumer and third largest producer, of tobacco. Tobacco control results from India take on a global significance in terms of impact on total mortality and disease burden.

For a large and diverse country like India, effective tobacco control has always been a daunting task. In the last five years, the country has witnessed a number of legal battles between the government and the tobacco industry. At one point, a parliamentary committee supported the tobacco industry and sought dilution of certain tobacco control measures. The powerful tobacco lobby tries to delay or derail attempts to reduce tobacco use prevalence. According to media reports, the Health secretary and Health ministers were removed from their posts in part because of their support of tobacco control measures. GATS 2 is can be viewed as a report card of the Government’s action on tobacco control.

GATS 2 was a household survey of 74,037 persons, aged 15 or more, conducted in all 30 states of India and two union territories in 2016-17. The first GATS was conducted in 2009-10. GATS 2 results found a 6% decline in tobacco use prevalence, from 34.6% in GATS 1 to 28.6% in GATS 2. The decline in prevalence was equivalent to a 17% relative decrease, and the number of tobacco users has reduced by about 8.1 million. The GATS 1 data released in October 2010 reported an estimated absolute number of 275 million tobacco users in India. The 2017 National Health Policy of the Government of India had set a target of relative reduction in current tobacco use by 15% by 2020; a target which has now been exceeded. The next target is a 30% reduction by 2025.

This period also witnessed the emergence of new contributors outside the Ministry of Health providing additional powerful tools for tobacco control. The Ministry of Women and Child Development amended the Juvenile Justice Act to make the sale of tobacco to minors as a non bailable offence punishable by 7 years of rigorous imprisonment and a fine of up to 100,000 Indian Rupees (US1550). The Department of Consumer Affairs amended the Legal Metrology Act to prohibit sale of loose cigarettes, which currently accounts for over 70% of the country’s total cigarette sales.

Meanwhile, a regulation under the Food Safety Act (2011) prohibited addition of tobacco and nicotine to any food substance. Through public interest litigation, this regulation enabled the Supreme Court to order a nationwide ban on gutka (a combination of flavored smokeless tobacco and areca nut). In addition, more than a dozen states have independently prohibited flavored smokeless tobacco products – an important step given gutka is a risk factor for oral cancers.

Voice of Tobacco Victims (VoTV), a campaign led by doctors and tobacco victims, played a pivotal role in the getting gutka/smokeless tobacco banned and taxes hiked on various tobacco products in India. The campaign has won awards and recognition from several organizations such as the World Health Organization, British Medical Journal, and the Campaign for Tobacco Free Kid. While most believed that prohibition would not work, VoTV was convinced that it would lead to decreased accessibility and affordability translating into reduced youth initiation. The 360-degree campaign involved advocacy, a legal battle, media, and research. The VoTV network also reached several medical societies and hundreds of individual doctors to increase engagement in tobacco control advocacy.

Despite tremendous resistance and litigation from the tobacco industry, the Ministry of Health imposed an 85% pictorial warning on tobacco packets from 1st April 2016. A significantly higher proportion of adults considered quitting because of the warnings on tobacco products (61.9% current cigarette smokers thinking about quitting smoking GATS 2 versus 38% in GATS 1). The tobacco tax hikes also contributed to reduction in prevalence, with individual expenditure on cigarettes and bidis having tripled since GATS 1.

GATS 2 reported a reduction in smokeless tobacco users from 25.9% to 21.4%. It also affirmed that a smokeless tobacco ban would not lead to switching to smoking. Smoking prevalence between the two GATS survey declined from 14% to 10.7 %, despite the ban on gutka/smokeless tobacco.

Summary of GATS 2 tobacco use

Pattern of tobacco

  • 6% of adults aged 15 and above (267 millions) used tobacco in any form
  • 199 million use smokeless tobacco, 100 million smoke tobacco and 32 million smoke as well as chew tobacco.
  • The most commonly used tobacco products are khaini (a type of smokeless tobacco) 85 million users and bidi (hand rolled cigarette) 67 million users.
  • 199 million users live in rural area and 68 million in urban

Significant changes compared to GATS 1

  • 17% relative decrease in tobacco prevalence
  • Tobacco use among 15-24 year olds showed relative reduction of 33% and for 15-17 year olds there was a 54% reduction.
  • The age of initiation of tobacco use increased by 1 year ( 17.9 to 18.9).
  • While there was a decrease in second-hand smoke exposure in public places (6%) and at home (13%), there was no decrease in workplaces.
  • 9% (83 % to 92%) more believed that second-hand smoke is harmful
  • 7% (89% to 96%) more believed that smokeless tobacco is harmful

Areas of concern

  • 68% of smokers, 17% of bidi smokers, and 50% of smokeless tobacco users purchase loose tobacco.
  • 30% of those who work indoors are exposed to second-hand smoke
  • 23% adults are still exposed to SHS at public places.
  • Nearly 10% of people still notice some form of tobacco advertisement.
  • Despite the gutka ban, 51 million people were still able to buy gutka

We must commend Government of India for their commitment to Tobacco Control. We also recognize the efforts of several national/international NGOs, academic institutions and civil society activists who have contributed to this impressive result. GATS 2 demonstrates that the tobacco control strategies in India are going in the right direction. For continuing improvement, the country needs further strengthening of policies, particularly enforcement of tobacco control laws.

World No Tobacco Day 2017: how different countries are celebrating

31 May, 17 | by Marita Hefler, News Editor

This page brings together coverage from around the world of World No Tobacco Day. It will be updated regularly with tweets, photos and links to news coverage.

The theme of World No Tobacco Day 2017 is Tobacco – a threat to development. 

New Zealand started with a world first by announcing that its military will become completely smoke free by 2020. Read the story here. There is still much to be done in New Zealand to achieve the government’s goal of being smoke-free by 2025.I

In Australia, there is strong action being taken by Aboriginal and Torres Strait Islander health services to reduce the high smoking prevalence among Indigenous people.

In Indonesia, the National Commission on Tobacco Control is urging the government to sign the WHO Framework Convention on Tobacco Control. Read the story here.

Nigeria is a country in the sights of the tobacco industry. Smoke Free Nigeria is saying #NoTobacco.

In Austria, a new study released to mark WNTD has found that increasing the price of tobacco by 5%, it will result in a drop in consumption of 3.5%. Read the study here. 

In the USA, ASH has released a new report highlighting how the country is falling behind other countries – and it is the most vulnerable who are paying the price.

https://twitter.com/AshOrg/status/869559802283917314

New Zealand to have world’s first smoke-free military by 2020

31 May, 17 | by Marita Hefler, News Editor

New Zealand has kicked off World No Tobacco Day by announcing a plan for its defence force to become the world’s first smoke-free military by 2020.

Initiatives to achieve the goal include banning the sale of cigarettes on camps and bases and making NZ defence force housing smokefree. It will also evolve camps and bases into smokefree environments, and continue to promote and support smoking cessation and the benefits of a smokefree NZ defence force.

The plan was announced at an event hosted by ASH New Zealand in Parliament to mark World No Tobacco Day. ASH Chair, Emeritus Professor Robert Beaglehole welcomed the plan. “This is a huge milestone, the New Zealand Defence Force is one of the largest employers in New Zealand with over 14,000 personnel, and the biggest Government department to go smokefree.”

The 2020 target date is five years ahead of the New Zealand government’s Smoke Free 2025 goal, which aims to reduce adult daily smoking prevalence to below 5%.

“ASH applauds the NZDF, not just for their commitment to the 2025 goal, but for showing the leadership to beat the goal by five years. We hope this decisive action can be an example to other government agencies and major employers of the type of leadership needed to reach Smokefree 2025” Beaglehole added.

While the 2020 goal is a welcome step forward, Beaglehole noted “Progress towards the Government’s smoke free 2025 goal is far too slow, especially for Maori and Pacifica, and poor people generally. There are also simple measures the government can introduce, such as increasing targeted mass and social media campaigns. ASH is committing our resources to supporting all policymakers to set a strong, evidence based roadmap to get us to Smokefree 2025”.

Fashion and smoking: Celebrities “rebel” at the MET Gala

4 May, 17 | by Becky Freeman, Web Editor

Fashion and the tobacco industry have a long and intertwined history. Dated images of fashion models smoking while looking impossibly glamorous seem clichéd and old fashioned. Now, smoking is more a symbol of addiction, death, and corporate manipulation – no longer is smoking shorthand for rebellion, coolness and aspiration.

But, that didn’t stop celebrities attending the biggest and most celebrated fashion event of the year, the MET gala, from trying to resurrect smoking’s tarnished image. The event, held in New York as a fundraiser for the Metropolitan Museum of Art’s Costume Institute, receives global media coverage with lead stories in the news, gossip, fashion, and lifestyle pages. It also spawns thousands of social media posts highlighting both the celebrities in attendance and their avant-garde fashion choices.

For example, the American fashion designer, Marc Jacobs, posted an image of himself smoking during the event in the “girls room” with celebrities Courtney Love (herself a paid spokesperson for NJOY e-cigarettes) and her daughter Frances Bean. The Marlboro cigarette packet can be clearly seen in Mr Jacobs’ hand. Associating the Marlboro brand with exclusivity, celebrity, fashion, and rebellion – smoking is illegal inside public buildings in New York.

No doubt Philip Morris is pleased to see its brand being held up as a fashion accessory. It sure beats being known for killing 2 out 3 of your best customers.

Smoking in the girls room #metgala @chardefrancesco @courtneylove @space_witch666

A post shared by Marc Jacobs (@themarcjacobs) on

Smoking in the girls room #metgala @chardefrancesco @courtneylove @space_witch666

A post shared by Marc Jacobs (@themarcjacobs) on May 1, 2017 at 6:31pm PDT

A Tobacco Endgame for Scotland?

25 Apr, 17 | by Marita Hefler, News Editor

A Tobacco Endgame for Scotland?

Katherine Smith and Jasper Been

An editorial in the November 2016 edition of Tobacco Control argued that talk about ‘tobacco endgames’ and policies that go ‘beyond ‘business as usual’ is becoming mainstream in a small number of countries, of which Scotland is one (others include New Zealand, Canada, Finland and Ireland). The race is now on to see which of these countries will be first to cross the finishing line. Attendees at a recent meeting on developing Scotland’s tobacco ‘endgame’ strategy identified three key policy priorities for a Scottish ‘tobacco endgame’: restricting availability of tobacco; pursuing a ‘polluter pays’ approach with tobacco industry profits; and introducing incentives for disadvantaged smokers to quit.

Tobacco Control in Scotland

Scotland is one of many countries that have taken major steps to reduce tobacco use, and related health harms, in recent decades. Having been a leader in the establishment of smokefree public places, Scotland’s current tobacco control strategy, launched in 2013, was bold in its commitment to Scotland becoming ‘smokefree’ (defined as adult smoking rates of 5% or less) by 2034. If this ambitious aim is to be achieved, it will require radical policy initiatives, consistent with recent proposals for tobacco ‘endgame’ scenarios. To date, however, there has been limited discussion of what specific policies ought to be pursued in Scotland to achieve the 2034 ‘smokefree’ goal.

In order to start addressing this gap, on 24th October 2016, an Usher Institute of Population Health Sciences and Informatics/ESRC supported seminar took place in Edinburgh in which researchers, advocates, policymakers and practitioners came together to discuss what a tobacco ‘endgame’ for Scotland might look like. The session involved multiple presentations and ‘pitches’ for policy proposals from a range of experts. Everyone present then had the opportunity to put forward potential policy proposals before collectively voting to identify those with greatest support.

What is a ‘tobacco endgame’?

The concept of ‘tobacco endgames’ is an analogy taken from the game of chess, the idea being that when you’ve got fewer pieces on the board (towards the end of the game), you need to change tactics to win. In public health terms, talking about tobacco endgames marks an important shift in focus towards ‘seeking to end the tobacco epidemic, rather than control it’. Since ‘the essence of the endgame requires thinking outside the box’ the kinds of proposals that are put forward as potential tobacco endgame strategies are often rather more radical than those that we have seen implemented to date.

A recent review of tobacco endgame proposals identified a four broad potential strategies. Some focused on the product itself, others on restrictions for users, while others focused on the market and structural issues:

  • Product– make cigarettes less addictive or appealing, or implement strategies to displace combustible cigarettes with the less harmful alternative of e-cigarettes.
  • Users – restrict access through smokers’ licences or prescriptions for purchasing tobacco, as well as incrementally increase the legal age of purchase to gradually phase out tobacco.
  • Market mechanisms – reduce retail availability, ban combustible tobacco products, make non-combustible nicotine products easier to purchase than combustibles, restrict manufacture and importation of products, price caps.
  • Structural – create a new tobacco control agency, create a regulated market, state takeover of tobacco companies, introduce a performance-based regulation system.

Does Scotland need a ‘tobacco endgame’?

Devolution afforded Scotland a ‘window of opportunity’ in addressing public health challenges. The Scottish Government has implemented a range of tobacco control policies including banning smoking in enclosed public spaces, outlawing vending machines and point-of-sale displays, and, most recently, banning smoking in cars carrying children. While most of these policies have now been implemented in other parts of the UK, Scotland has demonstrated clear public health leadership in this area and its commitment to becoming ‘smokefree’ (i.e. adult smoking prevalence of 5% or less) by 2034 indicates a desire to continue leading on tobacco control.

Reflecting these developments, smoking rates are coming down and we now have the lowest rates of smoking among young people and adults that Scotland has seen in decades. There has also been a significant decrease in the proportion of children exposed to second-hand smoke (from 11% in 2014 to 6% in 2015), following a successful government campaign on this topic. However, the latest data suggest around 21% of Scotland’s population smoke, a figure that is still higher than other parts of the UK. Also, while smoking prevalence is decreasing across all social groups in Scotland, a marked social gradient in smoking rates still exists. Moreover, to achieve the endgame targets we will need a much more rapid decline in smoking amongst the most disadvantaged compared to more affluent groups.

All of this poses some significant challenges. Most pressing is how to reduce smoking in Scotland’s poorest and most disadvantaged communities (including, for example, those experiencing mental ill-health) while avoiding the stigmatisation of those who find it most difficult to quit smoking (and evidence here is limited). Increasing the price of tobacco is the only specific intervention consistently shown to have a positive equity effect in terms of smoking prevalence. Yet, while traditional tobacco taxes are progressive in health terms by promoting cessation, they are regressive in economic terms for those who don’t quit, and such taxes can exacerbate the stresses and material impacts of life on a low income. These broader effects have only recently begun to be studied and have not yet been explored in a Scottish context.

What kinds of approaches were suggested for Scotland?

Having had an overview of the ‘endgame’ options outlined above, four broad policy pitches for Scottish approaches were put forward at the event, before participants went on to suggest four broad and interlinked policy proposals:

  1. Re-orientating tobacco control to take a broader social determinants approach, focusing on addressing the underlying drivers of tobacco use, especially in poorer communities. This involves thinking about some of the upstream drivers of tobacco use, including the efforts of the tobacco industry. Evidence indicates that tobacco control in Scotland, as in many other contexts, is now overwhelmingly an inequalities issue and should therefore be addressed as such.
  2. Framing tobacco control as a human rights issue (especially for children) on the basis of the right to health and associated rights. Scotland is (usually via the UK) party to a range of international and regional human rights treaties, including the International Covenant on Economic, Social, and Cultural Rights and the Convention on the Rights of the Child, which means that the Scottish government can use obligations set out in these legal documents to help make the case for further tobacco control measures, especially where these protect children from tobacco use and exposure.
  3. Measures to reduce the local provision of tobacco retailing, which is currently ubiquitous across Scotland. Strong research evidence demonstrates the links between neighbourhood density of availability and smoking prevalence. Availability is also part of the inequalities story since the density of tobacco outlets in Scotland varies geographically, with deprived neighbourhoods having about 77% more places to buy tobacco than more affluent areas. So environments are currently heavily loaded against poorer communities and this needs to be addressed. Scenario modelling in New Zealand looked at the impacts of reducing density around schools, removing licenses and an overall availability reduction of 95%. This work suggests positive impacts in terms of raising prices of tobacco products and reducing smoking prevalence. We need to do similar work in Scotland.
  4. Strengthening and extending regulation of tobacco as an industrial epidemic. While measures have been taken to prevent the tobacco industry influencing health policy, its expanding interest in new technologies such as e-cigarettes potentially re-opens the policy door to tobacco industry interests. For some, this might be seen as offering tobacco industry interests a ‘way out’ through harm reduction, a route Philip Morris International has presented itself as considering. In contrast, this pitch suggested a need to continue to focus on the role of the tobacco industry, and for regulation to be increasingly shaped by the ‘polluter pays’ principle. This could form part of a wider approach to regulating producers of unhealthy commodities, including alcohol, as modifiable structural determinants of health.

Running across several of the pitches, there was also a plea to work collaboratively with those communities most negatively affected by tobacco use and associated health inequalities. This could help inform policy debates about what approaches are publicly supported and reduce the risk of stigmatising poorer communities.

What specific policies were suggested and which were most popular?

After hearing the pitches, the 37 participants formed small groups to consider specific proposals for a tobacco endgame in Scotland. Each group’s proposals were collated and similar suggestions combined. This resulted in 14 distinct policy proposals that were voted on anonymously by the participants (each participant had three votes). The bar chart below demonstrates that the three most popular strategies involve: restricting availability of tobacco around schools, pursuing a ‘polluter pays’ approach with tobacco industry profits (and investing revenue raised for health) and introducing incentives for disadvantaged smokers to quit (a policy that has already been successfully trialled for pregnant women in the West of Scotland but which is currently not in place).

 

 

 

 

 

What next?

Overall, participants at the seminar seemed broadly supportive of the idea that Scotland now needs to develop a clearer conception of a tobacco endgame. Admittedly this only reflects the views of an invited group of health professionals (researchers, practitioners, policymakers and advocates) whose concerns focus on improving public health and reducing health inequalities. For others, the idea of a tobacco endgame might seem at odds with a liberal policy environment, or else simply feel impractical. Nonetheless, if the Scottish Government is serious about achieving a smokefree Scotland by 2034 then we need to advance discussion about potential ways forward. This becomes pressing given that Scotland’s current tobacco control strategy ends in 2018, with endgame thinking having an opportunity to shape development of a new strategy. The suggestions emerging from this event represent a further contribution, as do those from bigger events such as the 2016 Scottish Smoking Cessation Conference, but discussions also need to become far broader, public, and inclusive. Given the risks of stigmatising smokers, particularly those living in more deprived communities, it will be particularly important to engage these groups in such discussions and this is a topic that researchers in GRIT (the Group for Research on Inequalities and Tobacco) will be pursuing.

Katherine Smith is a Reader in the Global Public Health Unit and member of GRIT (Group for Research on Inequities and Tobacco at the University of Edinburgh. Jasper Been is a member of the Usher Institute of Population Health Sciences and Informatics at the University of Edinburgh and Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands.

Acknowledgements:

Thanks are due to everyone who participated in the 24th October 2016 seminar and to Ash Scotland and GRIT (the Group for Research on Inequalities and Tobacco), the Chief Scientist Office of the Scottish Government, the Farr Institute and the Usher Institute at the University of Edinburgh, for supporting this event. We also acknowledge ESRC funding for this event via a seminar series grant (‘Tobacco and Alcohol: Policy challenges for public and global health’, Grant No. ES/L001284/1). Finally, we would like to thank Lynn Morrice and Rebecca Campbell for organising practical aspects of the event.

 

France: breaking new ground in tobacco control

2 Mar, 17 | by Marita Hefler, News Editor

The start of 2017 has seen tobacco control in France boosted with a series of ground-breaking tobacco control measures, as detailed in a recent article by Physicians for a Smoke-Free Canada.

After a phase-in period, cigarette plain packaging is fully in force as of 1 January 2017. As in other countries that have already introduced plain packaging, or are planning to do so, the tobacco industry and its mouthpieces fought strongly against the new law.

In a move which extends the impact of plain packaging, the French government has also applied Directive 2014/40 of the European Union, which directs member states to restrict tobacco presentation. On February 1, 2017 a regulation was issued that identifies product names judged to be contrary to the European Union Directive. The identified names will only be authorised for sale for one more year in France. Among the brand names and descriptors that will disappear from 2018 under the regulation are Vogue, Virginia Slims, Anis (licorice), Menthol and Biodegradable.

France has also introduced a new tax on tobacco company revenue. Expected to raise about 130 million Euros per year, the new funds will be used to finance further tobacco control initiatives. The measure is particularly significant because it closes a  loophole used by tobacco companies to avoid France’s high-tax regime.

To read the full details on the Physicians for a Smoke-Free Canada website click here.

Is Philip Morris’ claim it wants to phase out conventional cigarettes credible?

1 Dec, 16 | by Marita Hefler, News Editor

In recent months, Philip Morris International has been claiming it wants to lead the push to a smoke free world and  wants to work with governments towards the phase out of conventional cigarettes. The claims have been met with scepticism, but do they stand up to scrutiny?

At an investor day held in late September 2016, PMI chief executive officer Andre Calantzopolous outlined the company’s strategic priorities, which include “to continue leading the combustible product category and deliver against our current growth algorithm” and for “Reduced risk products (RRPs) to ultimately replace cigarettes to the benefit of all stakeholders”. Calantzopoulos described the ‘excellent combustible fundamentals’ which include: improving cigarette industry volume/trend mix, and broad and balanced geographic footprint with expansion opportunities. While these are not exactly the words of a leader who wants to get out of the cigarette business, he also states that the company is committed to achieving widespread conversion to RRPs, and that PMI “welcome all alternatives to achieve a combustion-free world as quickly as possible.” Together these contradictory priorities sound very much like a bet each way.

At first glance, the latter rhetoric sounds like the company has finally – after more than 50 years of denial and deceit about the harms of tobacco – realised that not only is the tobacco business ethically and morally bankrupt, but it is also the wrong profit-making horse to back. However, a closer look suggests that reduced risk products may be yet another cynical tactic for the company to position itself as a socially responsible entity that deserves to be treated as part of the solution, rather than the problem.

The glaring omission in the rhetoric is the most obvious alternative for PMI to meaningfully contribute to achieving a combustion-free world: announce a date by which the company will phase out combustible products entirely. Calantzopoulos is on record as stating the iQOS (I Quit Ordinary Smoking) technology which appears to be the platform it is pinning most hope on, put the industry “on the cusp of a revolution”. At the September meeting, he told investors that almost one million smokers have already converted to RRPs and it had captured nearly 3% of the Japanese cigarette market. Wells Fargo Securities tobacco analyst Bonnie Herzog estimates that iQOS could displace 30% of the global combustible market by 2025.

At the September 2016 investor day, Calantzopoulos was not shy about framing RRPs as a public health solution with enormous potential, claiming “…if we can encourage a meaningful portion of adult smokers to rapidly switch to RRPs that meet this standard, it is likely to create a significant additional population health benefit relative to current regulatory efforts.” He called on the public health community to embrace this approach, and noted “we are very much encouraged by the growing number of pre-eminent public health advocates that already support the principle of tobacco harm reduction through products and science.”

The public health community has seen similar promises before: the promise of reduced risk products is nothing new, and the safety of iQOS is largely untested. If these products fail, as their predecessors have done, PMI will have benefited from iQOS and other reduced risk products being branded consistently with its combustible tobacco products.

Presumably anticipating such objections, Calantzopoulos noted, “I fully recognise there is scepticism and a deficit of trust in our determination to lead the effort to achieve a combustion-free world as soon as possible. Although we cannot change the past, we can certainly change the future and transform our company.”

Indeed, PMI can certainly change the future and transform the company. Nothing will accelerate the transition to a smoke free world more effectively than PMI withdrawing completely from the combustibles market, supported by the intensive consumer engagement strategies it is already using to promote uptake of iQOS.

Public health advocates who are willing to work with the tobacco industry on joint harm reduction approaches would do well to remember the fable of the scorpion and the frog, in which the frog agrees to carry the scorpion across a stream. Halfway across, the scorpion stings the frog. As they both start to drown, the frog asks ‘why?’, to which the scorpion replies ‘it’s my nature’.

This is an edited version of an article which was published in the Worldwide News & Comment section of the November edition of Tobacco Control. 

Additional links:

Both Sides of the Argument? JTI-MacDonald’s Anti-Plain Packaging Spin in Canada

1 Nov, 16 | by Marita Hefler, News Editor

 

Julia Smith

Faculty of Health Sciences, Simon Fraser University

JTI-MacDonald recently launched a multimedia campaign, Both Sides of the Argument, to sway public opinion against proposed plain packaging legislation in Canada. The campaign includes advertisements on popular radio stations, a website, posters in restaurant and bar bathrooms, advertisements in national newspapers and sponsored posts on Facebook. The advertisements and website state that they are “A JTI-Macdonald Corporation Initiative”, however JTI-Macdonald is not a household name in Canada. It is therefore unlikely the viewers/listeners will recognize that the campaign is funded by a tobacco company.

The arguments, presentation and even name of the campaign is remarkably similar to one implemented by British American Tobacco New Zealand, titled ‘Agree–Disagree’, which coincided with the NZ government’s standardized packaging consultations. Analysis of the New Zealand campaign found that messaging misrepresented the intent of the proposed legislation, claimed standardized packaging would harm all brands, and used vague premises as a basis for claiming negative outcomes. The commonalities between the campaigns suggest similar strategies might be used elsewhere, and also creates opportunities for public health advocates to counter industry opposition to plain packaging.

While the Canadian campaign purports to present ‘Both Sides of the Argument’, it quite clearly represents only one perspective. A section of the website, subtitled Has Plain Packaging worked in Australia?, first presents “The evidence for why plain packaging worked in Australia”, appearing to represent the pro-plain packaging camp. However, the text underneath states that there is no evidence plain packaging contributed to declines in smoking, linking to an Australian government site that documents smoking prevalence, but does not mention plain packaging. Underneath this “the evidence for why plain packaging did not work in Australia” is presented. The claim that plain packaging is ineffective is repeated, this time supported by links to JTI-funded research and press releases. ‘Both sides of the argument’ conveniently supports the same conclusion by linking only to JTI funded  ‘research’ and spin.Campaign messages are continually buttressed by weak evidence from organizations with known links to the tobacco industry. For example the site refers to an Institute of Economic Affairs (IEA) report that “demonstrates plain packaging policy is destined to fail.” Not only does the IEA have a long and well documented history of producing research to counter tobacco control initiatives while receiving funding from the industry, the “report” is in fact a brief blog, which in turn links to an even shorter news report that cites statistics without reference or explanation.

JTI-MacDonald did commission an independent firm, Forum Research, to poll 2000 Canadians on their views about plain packaging. A quick scan of the research report reveals numerous weaknesses. Many of the questions are clearly leading. Take, for example, the following: “Some people say that a change to ‘plain’ packaging from multiple different brand designs will make it easier to produce fake cigarette packaging and increase the amount of illegal cigarettes sold in Canada. Do you think this is unlikely or likely?” In response to a question asking if respondents could explain plain packaging to someone else only 17% answered positively. Considering these results, the survey essentially documents the opinions of uninformed individuals. The sampling method in general is unclear, with the only details provided being that 2301 regionally and demographically representative Canadians completed an online survey during a week in August. How the participants were selected to ensure the sample was ‘demographically representative’ is not stated.

Encouragingly, for tobacco control advocates, comments on the campaigns Facebook posts reveal that not everyone is falling for the spin. Of the 50 most recent comments (as of 24 October 2016) under a Both Sides of the Argument post from 4 October 2016, 19 point out the weaknesses in the campaign, identify it as astroturfing, and call out the tobacco industry for promoting junk science.

 

Big Tobacco’s dirty tricks in opposing plain packaging

24 Oct, 16 | by Marita Hefler, News Editor

Jenny Hatchard, University of Bath

Tobacco companies want to sell you cigarettes – today, tomorrow and for the foreseeable future. Whether you’re at the tobacco counter or out with friends, glitzy cigarette packaging is a really important part of their sales pitch. Tobacco companies are aware of this. It’s why they are so opposed to their cigarettes being put in plain packaging.

But it isn’t just tobacco companies that are against plain packaging. In the UK, where plain packaging was introduced in 2016, business associations, think tanks and civil society groups publicly campaigned against the policy and academics, research consultants and public relations and law firms variously wrote lengthy reports and lobbied the government.

But why would these organisations lobby against plain packaging? On looking into these opposition groups, our recent research gives a clear answer. Opponents of plain packaging tend to have links to the tobacco industry. So much so that three-quarters of organisations identified in our study had financial links to tobacco companies.

Perhaps we shouldn’t be surprised. Decades of research into political activity by the tobacco industry has shown that “third parties” are used to campaign against tobacco-control policies. Health advocates are aware of this. In 2005, the World Health Organisation’s Framework Convention on Tobacco Control committed the countries that signed the convention to protect tobacco policy from interference by the tobacco industry and, crucially, groups linked to them. In response, in 2011, the UK government committed to publishing details of any policy meetings with tobacco companies and the Department of Health routinely requests disclosure of tobacco industry links. So far so good. In doing so, the UK sets a strong example.

Third party interference

But our research shows how “third party” opposition to tobacco control policies extends tobacco industry interference beyond this realm of government. In a three-year period which included the 2012 government consultation on plain packaging, 88% of research and 78% of public communications opposing plain packaging were carried out by organisations with financial links to tobacco companies (see figure 1). And public and retailer campaigns funded by tobacco companies to mobilise opposition to plain packaging generated 98% of the more than 420,000 negative postcard and petition submissions to the consultation.

Figure 1
Author provided

In this way, ideas and arguments that come from tobacco companies and their research spill into public spaces. Once there, they can influence the public and political mood on life-saving tobacco control policies and create a misleading impression of diverse and widespread opposition. This is known in the world of political science as “conflict expansion”. And the potential effects are significant. When widespread, these “third party” activities can work to delay and even prevent policies: it took four years to get from consultation to implementation in the UK.

This wouldn’t be so serious if organisations and tobacco companies were open about their relationships. But, in many cases, links were not easy for the research team to detect. Of 150 examples of public communications, less than 20% explicitly acknowledged tobacco industry connections. And, while academics and research consultants tended to clearly report funding sources, “third parties” promoting their research in press releases, news stories and letters to government, frequently did not.

If they were open about their financial relationships with tobacco firms, business and civil society organisations would give the public, politicians and officials the opportunity to scrutinise their arguments and evidence in context. In the case of plain packaging, a lack of openness masked these links and lent credibility to claims that the policy lacked evidence and would increase the trade in illicit cigarettes – claims which have been shown to be unfounded by both peer-reviewed research and by the High Court in Britain. Now, as more countries move to introduce plain packaging, “third party” transparency remains an issue.

In order to help countries guard against tobacco industry interference, awareness can be raised of the effects of their activities on public and political debates. And steps could be taken to make their relationships with tobacco companies clearer. A compulsory register of tobacco companies’ memberships, political activities and associated spending would be a strong first move.

There is strong global commitment to addressing the problem of tobacco industry interference. Parties to the framework convention meet in India in November amid concerns about this issue, and the message to the tobacco industry from the WHO is clear: “The world understands who you are and what you do, and is determined to stamp out the global plague which you do so much to spread.”

The Conversation

Jenny Hatchard, Political Scientist, University of Bath

This article was originally published on The Conversation. Read the original article.

Attacking the source of a 6 million deaths per year epidemic: tobacco industry divestment

20 Oct, 16 | by Marita Hefler, News Editor

Dr. Bronwyn King

CEO, Tobacco Free Portfolios

I never would have imagined my work as a doctor would take me to corporate boardrooms across the globe, from Melbourne to London, Paris, New York and more. But then I never would have imagined I would be invested in the tobacco industry either.

In my early time as a doctor, I did a placement on the lung cancer ward of the Peter MacCallum Cancer Centre in Melbourne. Despite being able to offer the very best medicine available, the majority of my patients died, many of them in their 50’s and 60’s, some as young as 40. It was shocking to bear witness to the true impact of tobacco. Whilst the treatment and care of patients is paramount, we must deal with the source of the problem – tobacco and the companies that manufacturer it.

Once I discovered that through my compulsory pension fund, I was invested in and actually owned a part of a several tobacco companies, I couldn’t just do nothing – I had to take action.

In my quest to disentangle the Australian pension sector from tobacco I’ve become well informed about tobacco and the extent of the ‘tobacco epidemic’, as it is referred to by the World Health Organisation. The numbers astound me. Six million deaths per year are attributed to tobacco and we are on track for one billion tobacco related deaths this century.

Many, including investors (both individual mums and dads as well as big financial institutions), aren’t actually aware of the extent of their tobacco exposure. Tobacco stocks are generally picked up in standard products. Often, tobacco companies have not been selected specifically for investment, but they are wrapped up within default investment products, so they still find a way into your portfolio.

I founded Tobacco Free Portfolios to collaboratively engage with leaders of the finance sector to encourage tobacco free investment. Finance executives have been alarmed also, at the scale of the tobacco problem and have deeply considered the role they can play in addressing this pressing global issue. One by one, they have acted and are now proud to lead organisations that are tobacco free. There are now 35 tobacco free pension funds in Australia – just over 40% of all funds. Each tobacco free announcement is met with resounding public support.

Tobacco Free Portfolios recently took a global step and we were delighted to work with the global insurance giant AXA who announced a tobacco free decision in May 2016, divesting $1.8B Euro of tobacco assets. More organisations are soon to follow suit. That is the way of the future. Affiliations with the tobacco industry are no longer wanted. There are very few individuals or organisations that actively seek to be a part of the tobacco industry. The associations are often so deep and longstanding that it can seem overwhelming – but they must be addressed and they must be undone.

Momentum for tobacco-free investment continues to grow steadily and I can confidently say that the conversation in Australian has largely moved from ‘should we go tobacco-free?’ to ‘how can we go tobacco-free?’ This is a pleasing development and a terrific case study, however, there is still much to do to accelerate action across the globe. The good news is that conversations I have in Paris, Singapore, London and New York are received with exactly the same concern as the conversations I have in Melbourne, Sydney and Canberra. The devastating impact of tobacco is felt everywhere on Earth. Tobacco is everyone’s problem, not just the doctors that provide the care and treatment. We should all feel obliged to do something about it and all those with investments, including those through compulsory pension schemes have a role to play.

It’s up to us to keep tobacco control on the agenda and in public dialogue. A tobacco free future that will allow our children and the generations to come to enjoy long and healthy lives should be our shared hope.

Further details available at www.tobaccofreeportfolios.org

This article will also be published as part of the conference materials for the 17th World Conference on Lung Cancer, to be held in Vienna, 4-7 December 2016. 

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