Karen A Evans-Reeves, Anna B Gilmore and Andy Rowell
Tobacco Control Research Group, University of Bath,
The tobacco industry is under attack. In just two weeks, in May 2016, its tactic of challenging any law that threatens its profits, took a big hit. The arbitration panel, that tobacco giant Philip Morris International (PMI) had hoped would overturn standardised packaging legislation in Australia, published its full ruling that the company’s self-serving claims were inadmissible. Just days later, all four major tobacco companies lost their challenges against both the European Union’s Tobacco Products Directive and standardised packaging legislation in the UK.
This means that from 20 May 2017 EU member states must ensure that health warnings cover 65% of the tobacco pack and are free to introduce standardised packaging for tobacco products. The UK, France and Ireland, which have already enacted standardised packaging legislation, will now go ahead with this brand removal. Further afield Canada, New Zealand, Hungary and Norway are due to follow suit and other countries which have expressed an interest will be buoyed by the way the industry’s legal and trade challenges to plain packs are being soundly rejected. The World Health Organization’s (WHO) slogan for World No Tobacco Day 2016 was “Get Ready for Plain Packaging” recognising that the removal of branded tobacco packaging is “going global.”
Each jurisdiction to consider standardised packaging legislation has received sustained attacks from tobacco companies, using both their own voices and those of third parties which they fund. By commissioning and publicising research reports and opinions from seemingly independent experts, tobacco companies have created not only the impression of a large network of opposition but of an illusory body of evidence, particularly in relation to the industry argument that standardised packaging will increase the illicit tobacco trade.
Key to the industry’s use of third parties is its attempt to shift the paradigm by presenting third parties as ‘independent experts’ and their research as ‘trustworthy and rigorous’ while simultaneously positioning public health academics as ‘advocates’ and ‘zealots’ and their research as ‘advocacy’. This presentation of corporate pawns as informed moderates producing quality work and public health researchers as misguided fundamentalists producing poor quality work is a public relations tactic employed for decades by corporations in relation to environmental and health issues.
Over the last few weeks this tactic has been adopted by the tobacco industry third party, ITIC, in a series of letters sent to Non-Governmental Organisations (South East Asia Tobacco Control Alliance (SEATCA), ASH (UK), EU SmokeFree Partnership), the University of Bath in the UK, and the Editors of Tobacco Control, all of whom had criticised ITIC’s activities, some in letters, reports and webpages. ITIC’s letters made three inter-related claims, each of which we explore in the paragraphs below.
First, that public health research should be seen as advocacy while, by contrast, ITIC’s research (none of which appears to be peer-reviewed) should be seen as high quality. For example, in his letter to the University of Bath the President of ITIC, Daniel Witt, claimed:
“We have become increasingly concerned about how the integrity of reputable institutions and individuals is maligned by overzealous advocacy ….. and ….by what passes for academic research when it is clearly constructed to fulfil an advocacy agenda”.
This denigration of public health research has been strongly criticised by independent experts. In her 2006 verdict in an extortion case against the tobacco industry in the United States Judge Gladys Kessler noted:
“Much of the Defendants’ [i.e. the tobacco industry’s] criticisms of Government witnesses focused on the fact that these witnesses had been long-time, devoted members of “the public health community.” To suggest that they were presenting inaccurate, untruthful, or unreliable testimony because they had spent their professional lives trying to improve the public health of this country is patently absurd”.
The recent high court ruling on the challenges made by British American Tobacco, PMI, Japan Tobacco International and Imperial Tobacco to UK standardised packaging legislation made a similar point, citing Sir Cyril Chantler’s 2015 review of the evidence:
“Chantler … rejected the criticism made by the tobacco companies that those that advised the Government were biased against the industry. Conversely, he articulated scepticism about the methodological efficacy of research results generated by the tobacco companies. He also criticised the tobacco companies for adopting unrealistic criticisms of the output of existing researchers…”
ITIC’s second claim is that it is not a lobby group. Yet based on widely accepted definitions of lobbying, ITIC’s own descriptions of its activities, and the global health communities’ observations of its behaviour, ITIC clearly acts as a lobbying organisation. Indeed, it has persistently boasted of its lobbying success. in 1995, ITIC produced a document which outlined how “ITIC has developed trusted, advisory relationships with key, senior-level policy makers…..[which]…provide channels for private sector expertise to reach the Government before, during and after the official policy-making process. This combination…… provides ITIC and its sponsors a ‘seat at the policy-making table’”. And in 2004, Daniel Witt, ITIC’s President noted: “ITIC is a public policy organization actively working to change public policy in a pro-investment direction.” Although ITIC claims to be an “independent, non-profit research and educational organization” it receives tobacco company funding and has industry representatives on its Board of Directors. Outputs such as the Asia-11 and Asia-14 illicit trade indicator studies, commissioned by PMI and published by ITIC along with global advisory firm Oxford Economics, have been critiqued by Dr Hana Ross (on behalf of SEATCA) for opaque methodology and “unverifiable” results that were “inconsistent with results from other studies” in the region (for more on this issue, read here). In 2014, ITIC was blasted by the WHO for its underhand attempt to destabilise the proposed guidelines on tobacco tax and price policy by convening a meeting with Parties and Observers to the Framework Convention on Tobacco Control (FCTC) immediately prior to the sixth Conference of the Parties (COP6).
Finally, in each letter, ITIC’s President, Daniel Witt argues that public health organisations ought to engage with ITIC given its tax expertise. This position displays a fundamental misunderstanding of the FCTC’s Article 5.3 which aims to protect policy making from the vested interests of the tobacco industry. It also displays a fundamental lack of understanding of public attitudes to ITIC. For example, the World Bank withdrew from an ITIC event in India, following a letter from the Institute of Public Health in the country, similarly, following a letter from ASH (UK), the UK Department for International Development (DfiD) asked ITIC to remove its name, from its list of sponsors on ITIC’s website as DfiD has never been a sponsor, and the WHO has urged all governments not to engage with ITIC.
SEATCA and the University of Bath have respectively published and sent to ITIC detailed rebuttals of ITIC’s letters to them. These rebuttals and the aforementioned high court rulings are unlikely to deter ITIC from trying to influence tobacco control policies such as standardised packaging across the globe and undermining Article 5.3 of the FCTC. But the more people who reject engagement with ITIC, the harder it will be for ITIC to boast that it can get its tobacco industry clients a “seat at the policy making table”.
Across forty years I’ve come to recognise many factoid-driven myths about smoking that just won’t die. If I asked for a dollar each time I had to refute these statements, I’d have accumulated a small fortune.
Their persistence owes much to their being a vehicle for those who utter them to express unvoiced but clear sub-texts that reflect deeply held beliefs about women, the disadvantaged, mental illness, government health campaigns and the “natural”.
Let’s drive a stake through the heart of ten of the most common myths.
1. Women and girls smoke more than men and boys
Women have never smoked more than men. Occasionally, a survey will show one age band where it’s the other way around, but from the earliest mass uptake of smoking in the first decades of last century, men streaked out way ahead of women.
In 1945 in Australia, 72% of men and 26% of women smoked. By 1976, men had fallen to 43% and women had risen to 33%.
As a result, men’s tobacco-caused death rates have always been much higher than those of women. Women’s lung cancer rates, for example, seem unlikely to reach even half the peak rates that we saw among men in the 1970s.
But what about all the “young girls” you can see smoking, I’m always being told. In 2014, 13% of 17-year-old male high school students and 11% of females smoked. In two younger age bands, girls smoked more (by a single percentage point).
Those who keep on insisting girls smoke more are probably just letting their sexist outrage show about noticing girls’ smoking than their ignorance about the data.
2. Quit campaigns don’t work on low socioeconomic smokers
In Australia, 11% of those in the highest quintile of economic advantage smoke, compared with 27.6% in the lowest quintile. More than double.
So does this mean that our quit campaigns “don’t work” on the least well-off?
Smoking prevalence data reflect two things: the proportion of people who ever smoked, and the proportion who quit.
If we look at the most disadvantaged group, we find that a far higher proportion take up smoking than in their more well-to-do counterparts. Only 39.5% have never smoked compared with 50.4% of the most advantaged – see table 9.2.6).
When it comes to quitting, 46% of the most disadvantaged have quit compared to 66% of the least disadvantaged (see table 9.2.9).
There is a higher percentage of the disadvantaged who smoke mainly because more take it up, not because disadvantaged smokers can’t or won’t quit. With 27.6% of the most disadvantaged smoking today, the good news is that nearly three-quarters don’t. Smoking and disadvantage are hardly inseparable.
3. Scare campaigns ‘don’t work’
Countless studies have asked ex-smokers why they stopped and current smokers about why they are trying to stop. I have never seen such a study when there was not daylight between the first reason cited (worry about health consequences) and the second most nominated reason (usually cost).
For example, this national US study covering 13 years showed “concern for your own current or future health” was nominated by 91.6% of ex-smokers as the main reason they quit, compared with 58.7% naming expense and 55.7% being concerned about the impact of their smoking on others.
If information and warnings about the dire consequences of smoking “don’t work”, then from where do all these ex-smokers ever get these top-of-mind concerns? They don’t pop into their heads by magic. They encounter them via anti-smoking campaigns, pack warnings, news stories about research and personal experiences with dying family and friends. The scare campaigns work.
4. Roll-your-own tobacco is more ‘natural’ than factory made
People who smoke rollies often look you in the eye and tell you that factory made cigarettes are full of chemical additives, while roll-your-own tobacco is “natural” – it’s just tobacco. The reasoning here that we are supposed to understand is that it’s these chemicals that are the problem, while the tobacco, being “natural”, is somehow OK.
This myth was first turned very unceremoniously on its head when New Zealand authorities ordered the tobacco companies to provide them with data on the total weight of additives in factory made cigarettes, roll-your-own and pipe tobacco.
For example, data from 1991 supplied by WD & HO Wills showed that in 879,219kg of cigarettes, there was 1,803kg of additives (0.2%). While in 366,036kg of roll-your-own tobacco, there was 82,456kg of additives (22.5%)!
Roll-your-own tobacco is pickled in flavouring and humectant chemicals, the latter being used to keep the tobacco from drying out when smokers expose the tobacco to the air 20 or more times a day when they remove tobacco to roll up a cigarette.
5. Nearly all people with schizophrenia smoke
It’s true that people with mental health problems are much more likely to smoke than those without diagnosed mental health conditions. A meta-analysis of 42 studies on tobacco smoking by those with schizophrenia found an average 62% smoking prevalence (range 14%-88%). But guess which study in these 42 gets cited and quoted far more than any of the others?
If you said the one reporting 88% smoking prevalence you’d be correct. This small 1986 US study of just 277 outpatients with schizophrenia has today been cited a remarkable 1,135 times. With colleagues, I investigated this flagrant example of citation bias (where startling but atypical results stand out in literature searches and get high citations – “wow! This one’s got a high number, let’s quote that one!”).
By googling “How many schizophrenics smoke”, we showed how this percolates into the community via media reports where figures are rounded up in statements such as, “As many as 90% of schizophrenic patients smoke.”
Endlessly repeating that “90%” of those with schizophrenia smoke does these people a real disservice. We would not tolerate such inaccuracy about any other group.
6. Everyone knows the risks of smoking
Knowledge about the risks of smoking can exist at four levels:
Level 1: having heard that smoking increases health risks.
Level 2: being aware that specific diseases are caused by smoking.
Level 3: accurately appreciating the meaning, severity, and probabilities of developing tobacco related diseases.
Level 4: personally accepting that the risks inherent in levels 1–3 apply to one’s own risk of contracting such diseases.
Level 1 knowledge is very high, but as you move up the levels, knowledge and understanding greatly diminish. Very few people, for example, are likely to know that two in three long term smokers will die of a smoking caused disease, nor the average number of years that smokers lose off normal life expectancy.
7. You can reduce the health risks of smoking by just cutting down
It’s true that if you smoke five cigarettes a day rather than 20, your lifetime risk of early death is less (although check the risks for one to four cigarettes a day here).
But trying to “reverse engineer” the risk by just cutting down rather than quitting has been shown in at least four large cohort studies such as this one to confer no harm reduction.
If you want to reduce risk, quitting altogether should be your goal.
8. Air pollution is the real cause of lung cancer
Air pollution is unequivocally a major health risk. By “pollution”, those who make this argument don’t mean natural particulate matter such as pollen and soil dusts, they mean nasty industrial and vehicle pollution.
The most polluted areas of Australia are cities where pollution from industry and motor vehicle emissions are most concentrated. Remote regions of the country are the least polluted, so if we wanted to consider the relative contributions of air pollution and smoking to smoking-caused diseases, an obvious question to ask would be “does the incidence of lung cancer differ between heavily polluted cities and very unpolluted remote areas?”
Yes it does. Lung cancer incidence is highest in Australia in (wait for this …) in the least polluted very remote regions of the country, where smoking prevalence happens also to be highest.
9. Smokers should not try to quit without professional help or drugs
If you ask 100 ex-smokers how they quit, between two-thirds and three-quarters will tell you they quit unaided: on their final successful quit attempt, they did not use nicotine replacement therapy, prescribed drugs, or go to some dedicated smoking cessation clinic or experience the laying on of hands from some alternative medicine therapist. They quit unaided.
So if you ask the question: “What method is used by most successful quitters when they quit?” The answer is cold turkey.
Fine print on this English National Health Service poster states a bald-faced lie by saying that “There are some people who can go cold turkey and stop. But there aren’t many of them.” In the years before nicotine-replacement threapy and other drugs were available, many millions – including heavy smokers – quit smoking without any assistance. That’s a message that the pharmaceutical industry was rather not megaphoned.
Not true. NHS poster.
10. Many smokers live into very old age: so it can’t be that harmful
In just the way that five out of six participants in a round of deadly Russian roulette might proclaim that putting a loaded gun to their head and pulling the trigger caused no harm, those who use this argument are just ignorant of risks and probability.
Many probably buy lottery tickets with the same deep knowing that they have a good chance of winning.
Ten more myths about smoking that will not die
There’s plainly a big appetite for smoking myth busting, so here are 10 more.
1. Today’s smokers are all hard core, addicted smokers who can’t or won’t give up
This claim is the essence of what is known as the “hardening hypothesis”: the idea that decades of effort to motivate smokers to quit has seen all the low-hanging fruit fall from the tree, leaving only deeply addicted, heavy smokers today.
The key index of addicted smoking is the number of cigarettes smoked per day. This creates a small problem for the hardening hypothesis: in nations and states where smoking has reduced most, the average number of cigarettes smoked daily by continuing smokers has gone down, not up. This is exactly the opposite of what the hardening hypothesis would predict if remaining smokers were mostly hard core.
2. Smoking is pleasurable
Repeated studies have found that around 90% of smokers regret having started, and some 40% make an attempt to quit each year. There’s no other product with even a fraction of such customer disloyalty.
But I’m always amused at some die-hard smokers’ efforts explain that they smoke for pleasure and so efforts to persuade them to stop are essentially just anti-hedonistic tirades. Many studies have documented that the “pleasure” of smoking centres around the relief smokers get when they have not smoked for a while. The next nicotine hit takes away the discomfort and craving they have been experiencing.
This argument is a bit like saying that being beaten up every day is something you want to continue with, because hey, it feels so good when the beating stops for a while.
3. Light and mild cigarettes deliver far less tar and nicotine to the smoker than standard varieties
Several nations have outlawed cigarette descriptors such as “light” and “mild” because of evidence that such products do not deliver lower amounts of tar and nicotine to smokers, and so are deceptive.
The allegedly lower yields from cigarettes labelled this way resulted from a massive consumer fraud.
Cigarette manufacturers obtained these low readings by laboratory smoking machine protocols which took a standardized number of puffs, at a standardized puff velocity. The smoke inhaled by the machine was then collected in glass “lungs” behind the machine and the tar and nicotine weighed to give the readings per cigarette.
But the companies didn’t tell smokers two things. So-called light or mild cigarettes had tiny, near-invisible pin-prick perforations just on the filter (see picture). These holes are not covered by the “lips” or “fingers” of the laboratory smoking machine, allowing extra air to be inhaled and thus diluting the dose of tar and nicotine being collected.
But when smokers use these products, two things happen. Their lips and fingers partially occlude the tiny ventilation holes, thus allowing more smoke to be inhaled. Smokers unconsciously “titrate” their smoking to obtain the dose of nicotine that their brain’s addiction centres demand: they can take more puffs, inhale more deeply, leave shorter butt lengths or smoke more cigarettes.
Today, where use of these descriptors has been stopped, the consumer deception continues with the companies using pack colours to loudly hint to smokers about which varieties are “safer”.
Magnification and location of filter ventilation holes. Author collection
4. Filters on cigarettes remove most of the nasty stuff from cigarettes
We’ve all seen the brown stain in a discarded cigarette butt. But what few have seen is how much of that same muck enters the lungs and how much stays there.
This utterly compelling video demonstration shows how ineffective filters are in removing this deadly sludge. A smoker demonstrates holding the smoke in his mouth and then exhales it through a tissue paper, leaving a tell-tale brown stain. He then inhales a drag deep into his lungs, and exhales it into a tissue. The residue is still there, but in a much reduced amount. So where has the remainder gone? It’s still in the lungs!
5. Governments don’t want smoking to fall because they are addicted to tobacco tax and don’t want to kill a goose that lays golden eggs
This is perhaps the silliest and most fiscally illiterate argument we hear about smoking. If governments really want to maximise smoking and tax receipts, they are doing a shockingly bad job of it. Smoking in Australia has fallen almost continuously since the early 1960s. In five of the 11 years to 2011, the Australian government received less tobacco tax receipts than it did the year before (see Table 13.6.6).
Plainly, as smoking continues to decline, diminishing tax returns will occur, although this will be cushioned by the rising population which will include some smokers.
In the meantime, tobacco tax is a win-win for governments and the community. It reduces smoking like nothing else, and it provides substantial transfer of funds from smokers to government for public expenditure.
Those of us who don’t smoke do not squirrel away what we would have otherwise spent on smoking in a jam jar under the bed. We spend it on other goods and services, benefiting the economy too.
6. Most smokers die from smoking caused diseases late in life, and we’ve all got to die from something
Smoking increases the risk of many different diseases, and collectively these take about ten years off normal life expectancy from those who get them.
Smoking is by far the greatest risk factor for lung cancer. In Australia, the average age of death for people with lung cancer is 71.4 (see Table 4.2), while life expectancy is currently 80.1 for men and 84.3 for women.
This means that, on average, men diagnosed with lung cancer lose 8.7 years and women 12.9 years (mean 10.8 years). Of course, some lose many more (Beatle George Harrison died at just 58, Nat King Cole at 45).
If a 20-a-day smoker starts at 17 and dies at 71, 54 years of smoking would see 394,470 cigarettes smoked. At ten puffs per cigarette, that’s some 3.94 million point-blank lung bastings.
It takes about six minutes to smoke a cigarette. So at 20 a day, smokers smoke for two hours each day. Across 54 years, that’s a cumulative 1,644 days of smoking (4.5 years of continual smoking if you put it all together).
So by losing ten years off life expectancy, each cigarette smoked takes about 2.2 times the time it takes to smoke it off the life expectancy that might otherwise have been enjoyed.
7. Smokers cost the health system far more than the government receives from tobacco tax
In June 2015, a senior staff member of Australian libertarian Senator David Leyonhjelm, Helen Dale tweeted:
In Australia, a now old report looking at 2004/05 data estimated the gross health care costs attributable to smoking “before adjustment for savings due to premature death” were $A1.836 billion. In that financial year, the government received $A7,816.35 billion in customs and excise duty and GST on tobacco.
Someone who thought that the fiscal ledger was all that mattered in good government might conclude from this that smokers easily pay their way and perhaps we should even encourage smoking as a citizen’s patriotic duty.
With smokers being considerate enough to die early, these noble citizens lay down their lives early and thus contribute “savings due to premature death” like failing to draw a state pension or needing aged care services late in life. Philip Morris notoriously gave this advice to the new Czech government in 1999.
Other assessments, though, might well point to the values inherent in such assessments. History’s worst regimes have often seen economically non-productive people as human detritus deserving death. Primo Levi’s unforgettable witnessing of this mentality in Auschwitz comes to mind.
8. Big Tobacco is starting to invade low-income nations, now that smoking is on the wane in the wealthiest nations
Sorry, but US and British manufacturers have been aggressively marketing cigarettes in places such as China since the early years of last century. These collectable posters show many featuring Chinese women.
The large populations, the often lax tobacco-control policies and the higher corruption indexes of many low- and middle-income nations makes many of these nirvanas for Big Tobacco.
There are fewer more nauseating experiences than reading the corporate social responsibility reports of tobacco transnationals and then seeing how they operate in smokers’ paradises such as Indonesia. This documentary says it all.
9. Millions of cigarette butts on the world’s beaches leach lots of toxic chemicals into oceans
Cigarette butts are the most discarded items in all litter. Every year uncounted millions if not billions are washed down gutters in storm water and find their way into rivers, harbours and oceans. Cigarette filters and butts contain toxic residue and experiments have shown that placing laboratory fish in containers for 48 hours with leachate extracted from used cigarette butts, 50% of the fish die. From this, we sometimes hear people exclaim that cigarette butts are not just unsightly, but they “poison the oceans”.
But a confined laboratory container does not remotely mirror real life exposures in oceans or rivers. There are some 1,338,000,000 cubic kilometers of water in the world oceans, so the contribution of cigarette butts to the toxification of all this could only excite a homeopath.
If we want to reduce tobacco litter, we need not wander into such dubious justifications. The best way by far is to keep reducing smoking. Industry attempts at portraying themselves as corporately responsible by running dinky little clean-up campaigns or distributing personal butt disposal canisters avoids their efforts to keep as many smoking as possible.
10. Tobacco companies care deeply about their best customers dying early
Naturally, all businesses would rather their customers lived as long as possible so that the cash registers can keep ringing out long and loud. Tobacco companies wish their products didn’t kill so many, but worship the god nicotine for its iron grip on so many.
Visit any tobacco transnational’s website and you will find lots of earnest and caring talk about the companies’ dedication to doing all they can to reduce the terrible harm caused by their products. All the major companies have now invested heavily in electronic cigarettes, so isn’t this a sign that they taking harm reduction seriously?
It might be if the same companies were showing any sign of taking their feet off the turbo-drive accelerator of opposing effective tobacco control policies. But they are doing nothing of the sort. All continue to aggressively attack and delay any policy like tax hikes, graphic health warnings, plain packaging and advertising bans wherever in the world these are planned for introduction.
For all their unctuous hand-wringing about their mission to reduce harm, they are all utterly determined to keep as many smoking as possible. Big Tobacco’s business plan is not smoking or ecigarettes. It’s smoking and ecigarettes. Smoke when you are able to, vape when you can’t. It’s called dual use and some 70% of vapers are doing just that. The tragedy now playing out in some nations is that too many gormless tobacco control experts are blind to this big picture.
Last November, the Board of Health for Westminster, a town in central Massachusetts, proposed prohibiting all tobacco sales – even e-cigarettes – in the town.
Westminster’s three-person Board of Health said that the proposal was meant to protect the next generation from tobacco and nicotine products. The board expressed frustration at its inability to keep up with the seemingly endless barrage of new tobacco products that appealed to minors. Ending all tobacco sales seemed like a clean and quick fix.
But in the face of intense opposition, Westminster’s Board of Health voted to drop the proposal. While banning tobacco sales might have protected children, many felt the proposal infringed on the “rights” and “freedoms” of adults. Some also suggested that people would simply go to other towns to buy tobacco products.
In proposing to ban all tobacco sales at once, Westminster’s Board of Health got ahead of itself. But there are plenty of other strategies that cities and towns can use to effectively reduce tobacco use – especially in young people – that don’t go as far as a total sales ban.
These measures, while aggressive, might help diffuse complaints of “prohibition” and instead keep the focus on dramatically reducing the 480,000 deaths caused each year by tobacco products. And, critically, these policies avoid the pitfalls that doomed the Westminster proposal.
There are two policy options that would make it a whole lot harder for kids to start smoking, while not preventing adults from buying tobacco products: raise the legal buying age to 21 and restrict cigarette sales to adult-only retailers.
Raising the age to 21 works because high school students get tobacco primarily from friends who can legally purchase tobacco. Ninety percent of those who supply cigarettes to minors are under 21. Raising the minimum sales age to 21 puts legal purchasers outside the social circle of most high school students.
A recent study found that raising the tobacco-buying age to 21 in the Boston suburb of Needham led to a nearly 50% decline in youth smoking, a much steeper decline than was seen in surrounding communities.
Obviously this helps prevent sales to minors. But raising the tobacco buying age doesn’t shield minors from tobacco advertising. Since other avenues of tobacco advertising (TV, billboards, sports sponsorships) have been sharply limited or prohibited, tobacco companies have focused nearly all of their advertising dollars on retail stores where tobacco is sold.
Limiting tobacco sales to retail locations that only adults are permitted to enter would remove this barrage of tobacco advertising from the convenience stores where teens spend a significant amount of time. It would also make it easier to prevent minors from purchasing cigarettes.
This is not a radical strategy; it’s similar to how liquor sales are currently regulated in most states. Ideally, limiting cigarette sales to adult-only retail outlets would be done in conjunction with raising the minimum buying age for tobacco from 18 to 21.
These policies wouldn’t prevent adults from purchasing tobacco, but they would help keep youth from taking up smoking (while also making it easier for current smokers to quit).
E-cigarettes. Neil Hall/Reuters
Focus on the most dangerous tobacco products
Westminster’s Board of Health proposal to ban the sale of all tobacco products also included e-cigarettes, which contain nicotine derived from tobacco. This struck many as radical and unwarranted.
The vast majority of all tobacco related deaths result from the use of only one particular product: the cigarette.
People use tobacco products primarily because nicotine is addictive. Nicotine itself is not benign, but on its own it’s much less harmful than the smoke and tar produced by burning tobacco. E-cigarettes and other vaporized nicotine products are almost certainly less toxic and less harmful when used instead of conventional cigarettes.
A bold yet more incremental step would be to allow the sale of potentially less harmful products, like e-cigarettes, while sharply limiting sales of conventional cigarettes and other combusted products. This might take the form of exempting e-cigarettes from the adult-only retailer policies described. Or, potentially, a community might consider prohibiting all cigarette sales, while allowing sales of non-combustible products.
The impact of noncombustible [e-cigarettes] on population health is much more likely to be beneficial in an environment where the appeal, accessibility, promotion, and use of cigarettes and other combusted tobacco products are being rapidly reduced, especially among youth and young adults.
But the evidence to date indicates that e-cigarettes are primarily being used along with cigarettes, rather than instead of them. In addition, use of e-cigarettes by youth, which is rapidly expanding, puts these youth in danger of “graduating” to cigarette use.
A recently published study found that adolescents who had used e-cigarettes were more than twice as likely as their peers to subsequently start smoking. Making it harder for adolescents to obtain cigarettes would help reduce the likelihood that minors using e-cigarettes move on to smoking.
Get community support before acting
The most important lesson of Westminster’s experience may be that policymakers cannot get too far ahead of their communities. As public health law scholar Wendy Parmet recently wrote:
Public health laws that are strongly rooted in, and indeed arise from, the public, may face a quite different fate than those that derive from the good intentions of public health policymakers alone.
Rather than announce a plan to ban the sale of all tobacco products, the Westminster board of health could have instead started a series of community discussions about the problem of tobacco use – and youth tobacco use in particular.
It is likely that such discussions would have quickly produced broad consensus about the need to better protect youth from tobacco, which could have then led to a discussion about potential policy solutions (such as those discussed above).
It is also notable that some of the loudest critics of the proposed Westminster law were proponents (and users of) e-cigarettes, many of whom struggled for years to quit cigarettes. Including this community in early discussions could have led to a shared vision about how to minimize the dangers of e-cigarettes while focusing on the much more significant harms caused by cigarettes.
Making sustainable public health policy requires the slow but important processes of community engagement, education, compromise, and consensus building. With deliberate and incremental steps to reduce the prevalence of tobacco in our communities, we can save countless lives.
Tobacco industry corporate philanthropy and social responsibility has been under the international spotlight recently with the revelation that the American Red Cross continues to accept tobacco industry donations, despite concerns of the International Red Cross that US Red Cross risks damaging the global reputation of the network. Accepting tobacco industry donations is particularly problematic for charitable organisations that work to improve public health, given tobacco industry profitability is only possible at the expense of the health – and lives – of the industry’s best customers.
Barbara McGaw of the Jamaica Coalition for Tobacco Control and Deborah Chen of the Heart Foundation of Jamaica report of a charitable organisation accepting tobacco industry funds, causing a split in the charity sector in Jamaica:
United Way of Jamaica (UWJ) is a key charitable organisation in Jamaica. Through its umbrella group, the Council of Voluntary Social Services (CVSS), it has membership of all of the Non-Government Organisations (NGOs) in the country, including health-related NGOs such as the Heart Foundation of Jamaica, the Jamaica Cancer Society and the Diabetes Association of Jamaica. UWJ and CVSS are sister organisations; their offices, secretariat and CEO are shared, and they have 4 board members in common. United Way Jamaica provides funding for a range of CVSS member organisation projects.
At a function to celebrate the 29th National Builders Awards Ceremony of UWJ in September 2014, Carreras Limited (a subsidiary of BAT) was lauded as UWJ highest corporate donor for 2013. Jamaica’s Minister of Industry, Investment and Commerce, who was a guest speaker at the function, presented the award. The Minister’s involvement contravenes Article 5.3 of the WHO Framework Convention on Tobacco Control, the guidelines of which state that Parties “should not endorse, support, form partnerships with or participate in activities of the tobacco industry described as socially responsible”. The Jamaica Coalition for Tobacco Control (JCTC) wrote to the Minister about the issue; according to his response, the event invitation did not indicate that he would be presenting awards. However, he acknowledged that his role in presenting to Carreras would not be in keeping with the spirit of Article 5.3 of the FCTC.
Against this background, in September 2014, the JCTC wrote to the Chairman of UWJ and suggested that the organisation cease accepting funds from the tobacco industry. Despite further correspondence from the JCTC and the Heart Foundation of Jamaica, the only response received was “We acknowledge receipt of your letter dated September 24, 2014 in which you have raised concerns regarding United Way accepting funds from the tobacco industry. The matter has been brought to the attention of our Board and your concerns have been noted.”
The Heart Foundation also wrote to the Chair of CVSS. Although a more positive response was received stating that consideration could be given to reviewing the criteria for accepting funds at UWJ, to date there has been no change in policy. It is noteworthy that at a celebratory function held in January 2015 by Carreras Ltd (BAT) to honour its CEO for being awarded “Top CEO for 2014” by Business Suite magazine , the Chairman of UWJ was present and gave the vote of thanks at the function.
The UWJ’s mission on its website is “to improve lives by mobilizing the caring power of communities to advance the common good”. The website further states that “The United Way of Jamaica envisions a society where individuals and families achieve their human potential through education, financial stability and healthy living”. Accepting funds from the tobacco industry is not in keeping with United Way’s vision. Despite this, the United Way has accepted funding from the tobacco industry in other countries. It seems that there is no policy against accepting donations from this source. Altria’s 2012 reporting of Recipients of Charitable Contributions from Altria Family of Companies (USA), listed 11 United Way individual organizations that benefitted from donations. Total donations to charitable institutions reported were US$40.8 million.
The Heart Foundation of Jamaica has been a member of CVSS for over 40 years. It has previously written about the problem of United Way accepting donations (see here, here and here). In view of the current situation, the Heart Foundation of Jamaica has suspended its membership as of April 30, 2015. The Heart Foundation of Jamaica hopes that one day there will be a review in the UWJ/CVSS policy such that the HFJ can reinstate its membership. The matter of United Way accepting funds from the tobacco industry globally is an issue which deserves further investigation and exposure.
Since 2007 Austria has received the poorest score on the Tobacco Control Scale. While smoking prevalence and tobacco consumption decreased on average in the European Union, an opposite trend has occurred in Austria. Child smoking has increased dramatically since the 1990s. Cigarettes are available around the clock in thousands of vending machines, circumventing advertising bans and enabling easy access by children.
Legally, cigarettes can be bought at age 16, but half of 13-15 year olds smokers reported having bought cigarettes in tobacco shops. At age 15 already 18% of boys and 21% of girls are smoking daily. Tobacco shops are permitted to sell goods aimed at children and both indoor smoking and tobacco advertising is permitted. Tobacconists also distribute newspapers and are a powerful lobby group. Annual state revenues from cigarette consumption by minors in Austria exceeded 60 million €, but none of this revenue was budgeted for tobacco use prevention. With minor exceptions much of this work is left to unpaid volunteers (e.g. www.aerzteinitiative.at).
Children are permitted to enter smoking rooms and public smoking is visible to children as a normal adult behavior in most hospitality venues. While Austria ratified the WHO FCTC in 2005, it has had limited impact until now. Partial smoking bans were introduced in 2001 in workplaces and in public places in 2009 (with sanctions for violations), but this law is not well enforced. A further summary of the law and the associated problems can be read here.
Legally, cigarettes can be bought at age 16, but half of 13-15 year olds smokers reported having bought cigarettes in tobacco shopsPiulet/flikrCC BY-NC-ND 2.0
The smoking ban in hospitality venues larger than 50m² provided the possibility of smoking rooms and the provisions that smoke should not leak into the nonsmoking areas was infringed regularly. Other violations of the partial smoking ban in the hospitality industry had to be reported by customers and were treated with long delays by local municipalities, a time-consuming method to enforce the law and frequently unsuccessful, even if taken to court.
Because partial smoking bans have failed, amendments to the tobacco law were prepared by the government, foreseeing a total ban in all schools (up to now in compulsory schools only), in the hospitality industry (including clubs, tents, multipurpose rooms), in hotels (except for smoking rooms, which must not serve for eating, drinking or sleeping), in all commercial transportation, and in tobacco shops used for mailing and other purposes, which still need to be specified. Use of water pipes or electronic cigarettes will also be banned where smoking is forbidden.
Crucial elements still missing from the legislation are: technical specifications for smoking rooms, such as a clear definition of their use for smoking only, clarification that the smoking ban applies to all rooms of hospitality venues (including kitchen, corridors, etc.), a ban on smoking and tobacco advertising in all shops and rooms accessible to minors, and a smoking ban in hospitals, on children’s playgrounds and in private cars carrying children.
The EU Tobacco Product Directive still needs to be included in the draft Austrian legislation and necessitates that the law enters into force in May 2016. The present plan to postpone this date until May 2018 is irresponsible and demonstrates the weakness of the government against the chamber of commerce.
The worst omission of the new Austrian draft is the lack of improvement in implementation and enforcement of the law. The present system of reporting violations by customers has failed, especially in small communities with only one inn where filing a complaint would be too personally risky. For example, some people who reported local innkeepers were pictured on a “wanted poster” at the entrance of the inn and were then forbidden to reenter.
Officials who were sent to venues for inspections only after customer complaint, could downplay the offence or postpone the decision by up to 28 months. During this time no other complaint about the same venue would be investigated.
It appears that this ineffective enforcement system will be continued. The draft law only names work inspection and food inspection as additional possibilities for control, but only during routine visits done for other purposes, and in the case of serious offences. Additionally, the draft law states that these controls must not incur extra costs. It is doubtful that rare and announced controls by such inspectors will improve the already poor compliance. Improving compliance for the better may require police assistance, as they could make unannounced controls during busy periods, such as at night in discotheques and other venues where young people meet.
Comments on the draft legislation are accepted until May 8th, 2015 at the ministry of health <email@example.com>, the ministry of finance <firstname.lastname@example.org> and the parliament <email@example.com>
In late 2014, the tobacco industry was confronted with the revelation of child labour on US tobacco farms, detailed in a well-researched 139 page report published by Human Rights Watch (HRW). The USA is not alone; most major tobacco producing countries use child labour in tobacco growing. In other words, almost no cigarette can be guaranteed to be free from child labour
Despite the known scale of the problem, every time a new report is published tobacco companies react with apparent surprise, and depict the problem as an isolated local rather than global issue, detached from the structural power relations within which the industry operates. In the wake of the HRW report on Kazakhstan, Philip Morris said it was ‘grateful’ that the NGO raised the issue, despite the fact that it sent officers to its contract farms on a regular basis.
The child labour issue is nothing new for the tobacco industry, as can be easily researched with the internal documents database. In 1999, British American Tobacco (BAT) for example showed its awareness of the problem when one of its representatives discussed how it could best ‘get value for [its] cash and time contribution’ to the International Tobacco Growers’ Association (ITGA). “I would in particular very much like them to delve more into the child labour and WHO issues…Otherwise what is the point of having the membership and paying the money?” wrote Shabanji Opukah, BAT’s corporate social responsibility manager. Sixteen years later, little appears to have been done to find and implement sustainable solutions to improve tobacco workers’ lives.
On December 10th, 2014, tobacco companies through their Eliminating Child Labour in Tobacco Growing (ECLT) foundation announced a pledge to end child labour in their supply chains. In particular, they announced a commitment to adhere to international labour laws and children’s rights’ conventions that prohibit hazardous work for children under 18 – commitments that have already been signed by most countries.
Reuters published an article that boils down to HRW praise of the pledge as a ‘first time’ thing, lending legitimacy to the move and tobacco industry as a whole, although it noted that significant gaps remain and some key players such as China National Tobacco Corporation and Reynolds Tobacco are not ECLT members. At the end of December, a New York Times editorial also discussed the issue. While putting an emphasis on the need for the US government to pass a law that prohibits the work of children under 18 in tobacco, it praises the tobacco industry. Among others, the article says: “Given Big Tobacco’s shameful history of marketing cigarettes to children, it is noteworthy that the industry is willing to do the right thing in the case of child workers.”
While any move to improve its business practices is welcome, given its history, it seems the tobacco industry is more focused on doing the right thing for its public image than safeguarding the rights of child workers. The industry is particularly keen to embrace voluntary agreements which provide good public relations, while being unenforceable. With articles like the New York Times editorial, big tobacco succeeds in being seen as part of the solution rather than the problem. This obscures the fact that tobacco industry is extremely monopolised, has a record of collusion and suppression of leaf prices, interferes with policy development and invests in NGOs such as ITGA, ECLT and many others in tobacco growing countries, in order to be seen as a good corporate citizen.
For many farming households in developing countries, tobacco production is a precarious livelihood, overshadowed by debt and the threat of poverty. If smallholder farmers – who produce much of the world’s tobacco leaf – do not receive enough money in exchange for their tobacco, they have little choice but to enlist their children to work. Human Rights Watch, in its otherwise well-researched report, fails to analyse the structures and power relations of the global leaf market, and the role of tobacco industry financing in encouraging the expansion of tobacco cultivation.
Lay people, and unfortunately also development professionals, may believe that voluntary industry pledges are a shortcut to improving human rights and reducing poverty. Companies seem to react quickly while governments take longer to develop, debate, pass and implement laws. However, examining the history of tobacco industry pledges regarding child labour, little has changed in the past 16 years. To achieve sustainable human rights improvements, properly-enforced laws that make corporations accountable and change power relations between workers and companies are needed, rather than voluntary industry codes.
It is noteworthy that the industry found it necessary to pledge to abide by national and international laws. Do they really deserve congratulations for trying not to break the law?
Pankaj Chaturvedi, Prakash C Gupta, Sanjay Seth, Ashima Sarin
Voice of Tobacco Victims
Voice of Tobacco Victims Campaign (VOTV) was launched on 31st May 2009 by a dozen cancer survivors of Tata Memorial Hospital, Mumbai under the leadership of Dr Pankaj Chaturvedi. The campaign aims to make Tobacco Victims (cancer survivors and their relatives) the public face of the anti-tobacco campaign and get them justice. There are more than 300 patients and their relatives who are engaged in battling a powerful industry that sold them cancer and suffering. Most are cancer patients who were treated by Dr Chaturvedi in Tata Memorial Hospital, Mumbai. They are supported by 168 motivated oncologists all over India who are performing exemplary voluntary advocacy with highest policy makers.
Led by cancer survivors, VoTV conducted a sensitization programs for the Chief Ministers, Members of Parliament, State legislators, Police Departments, Education Departments, Food inspectors and other government officials. We took up the matter in several High Courts and the Supreme Court, where Dr Chaturvedi made a deposition in front of Justice Singhvi in Ankur Gutka matter.
The Campaign played a pivotal role in the Gutka ban introduced throughout India, ban on all forms of flavoured, scented, packaged chewing tobacco in 9 states and the ban of flavoured supari (pan masala without tobacco) in Maharashtra. They were also instrumental in tax increases in several states. Prior to the recent budget, 300 doctors wrote to the Honorable Prime Minister to raise taxes on tobacco.
VoTV team is also working with state governments for better implementation of tobacco control laws. VoTV has been instrumental in India’s most graphic campaign for awareness in society. The clip is shown in all cinema halls and TV channels.
Some patients filed compensation cases in the consumer court, actions that have rocked the tobacco industry.
VoTV has been recognised by the World Health Organization as an outstanding campaign. Dr Chaturvedi was nominated as a Global Cancer Ambassador by the American Cancer Society, invited as a speaker in special United Nations Summit, and served on various committees for the Ministry of Health. The campaign also received the Judy Wilkenfield Award by Campaign for Tobacco Free Kids, Washington. Most recently, on September 22, 2014, Dr Chaturvedi and VoTV won the British Medical Journal Awards in the Health Advocacy category.
According to several studies and Euromonitor, the campaign has contributed to a 26% reduction in volumes of chewing tobacco and 3% in cigarette volume. I am sure it will translate into reduction in prevalence of tobacco usage and eventually reduce the tobacco related mortality.
A Ugandan MP who has put forward a private members bill to reduce smoking in Uganda has accused British American Tobacco (BAT) of blackmail. Dr Chris Baryomunsi revealed he has received a letter from BAT advising that the company will stop doing business with farmers in his constituency because his bill has meant existing arrangements are ‘increasingly less economically viable’, the Guardian newspaper reported on 13 July.
Dr Baryomunsi is defiant in the face of such pressure: “They thought that the farmers would rise against me and disorganise me politically, but I told them I was not moved. I actually assured them that what mattered to me was not the number of years I spend in parliament but what I do when in parliament. I assured them that no amount of blackmail and intimidation would shake me.”
On January 10, Pascal Diethelm, President of Swiss NGO OxyRomandie, joined nearly 18 international health organisations and German politicians in sending an open letter to the mayor of Dortmund, the Honourable Ullrich Sierau, urging the cancellation of Inter-tabac Asia 2014. On 23 January, he received a reply from Dr Andreas Weber, from the Marketing and Corporate Communications Department at Messe Westfalenhallen Dortmund GmbH. In it, Dr Weber advises that the trade fair is directed at professional visitiors, and that children and young people are not permitted. He goes on to state: “Tobacco is a legal product in Indonesia, as it is in Germany. Economic stakeholders therefore have a right to a trading platform of this kind, as in any other industry. Messe Westfalenhallen Dortmund GmbH respects all political laws and regulations in countries where it organises trade fairs and will of course continue to do so in the future.”
Mr Diethelm’s response, reproduced in full below, outlines how Messe Westfalenhallen Dortmund Gmbh’s organisation of Inter-tabac likely breaches Germany’s legal obligations under the WHO Framework Convention on Tobacco or Health, as well as the moral and ethical implications of its involvement:
Dear Mr Dr Weber,
Thank you for communicating to us the position of Messe Westfalenhallen Dortmund GmbH concerning the organization of Inter-tabac ASIA 2014 by the city of Dortmund.
Unfortunately, I have to say that your company’s statement misses our point entirely.
The official implication of the municipality of Dortmund in such an event, even indirectly through your company, of which the city of Dortmund is the sole shareholder, clearly violates Germany’s legal obligations emanating from article 5.3 of the Framework Convention on Tobacco Control (FCTC), an international treaty ratified by your country on 16 December 2004. The treaty was also ratified by the European Union on 30 June 2005 and all EU Member States are now Parties to the treaty, which could therefore be also considered as providing a European legal framework for tobacco control.
The Guidelines on Article 5.3 of the treaty (see attached German translation) indicate to parties how to fulfill their obligations emanating from the Convention. The city of Dortmund breaches several key dispositions of these Guidelines:
– It violates point 2.1 which states that “Parties should interact with the tobacco industry only when and to the extent strictly necessary to enable them to effectively regulate the tobacco industry and tobacco products.” The organization of Inter-tabac ASIA by the city of Dortmund can hardly be described as “strictly necessary.”
– It violates point 3.1, which states that “Parties should not accept, support or endorse partnerships and non-binding or non-enforceable agreements as well as any voluntary arrangement with the tobacco industry or any entity or person working to further its interests.” The organization of Inter-tabac ASIA will inevitably lead the city of Dortmund, via Messe Westfalenhallen Dortmund GmbH, to conclude multiples agreements with the tobacco companies who are exhibitors in the tobacco trade fair.
– It violates point 4.7, which states that “Government institutions and their bodies should not have any financial interest in the tobacco industry.” By organizing Inter-tabac ASIA, the city of Dortmund has a vested interest in the tobacco industry. The return on its investment is directly linked to the commercial success of its exhibitors, the tobacco companies.
– It violates point 7.1, which states that “Parties should not grant incentives, privileges or benefits to the tobacco industry to establish or run their businesses.” By facilitating their business in Asia, the city of Dortmund grants privilege and benefits to the tobacco industry.
Your company’s statement misses the point in even a more worrying way. You company does not seem to understand, or even have minimal appreciation, of the ethical and moral implications of the decision of the city of Dortmund to organize a trade fair in Bali aimed at promoting tobacco in Indonesia and Asia.
Currently, tobacco kills 6 million people per year and this toll continues to rise while it is at the same time shifting from the highly developed world to lower income countries. In the 20th Century, tobacco was responsible for 100 million deaths. If nothing is done to change the course of the tobacco epidemic, the World Health Organization and all public health authorities predict that the number of tobacco deaths will reach 1 billion in the 21th Century.
In Indonesia, where over two-thirds of the men smoke and where the age of initiation of smoking is commonly below 10, the toll caused by tobacco is taking genocidal proportions. Tobacco kills 260’000 Indonesians each year and this number is rising rapidly. Nowhere in the world can we witness a more striking manifestation of what professor Robert Proctor, historian of science at the University of Stanford, calls the Golden Holocaust.(1)
In such a context, we were stupefied when we read that your company, Messe Westfalenhallen Dortmund GmbH, and therefore the city of Dortmund, feel comfortable with having contributed to this Golden Holocaust for 30 years, as it claims to have done it “with integrity”. This line of defense evokes some of the darkest memories, having connotations of what Hannah Arendt calls “the banality of evil.”
Fortunately, there are people in this world with a conscience, a high sense of morality and who are prepared to act in conformance with their values. This is the case of our tobacco control colleagues in Indonesia, who, with insignificant means compared to the financial power of the tobacco industry, are fighting with courage and determination to reduce the tobacco epidemic in their country and eliminate the grip tobacco multinationals have on it. Over the recent days, they scored a major victory by rallying the support of the Governor of Mali, Made Mangku Pastika. The Governor has publicly announced his commitment to prevent Inter-tabac ASIA from taking place in his province. He has issued orders that no permit be granted to the tobacco trade fair.
This decision of a man with real integrity sends a clear signal to the city of Dortmund, whose reputation is being tarnished in this affair. Let us hope Mr. Ullrich Sierau listens and learns the lesson and does not miss this opportunity to get better educated in the ethical and moral implications of the tobacco trade.(2)
The ties between Dortmund and the tobacco industry are indeed highly detrimental to the city’s reputation: a lot of people in the world now know Dortmund mainly through the slogan “Dortmund Kills.” Your company and the mayor should realize that the city’s involvement in Inter-tabac is irremediably doomed – soon or later, Dortmund will have to give up all activities linked – directly or indirectly – to the tobacco industry and comply with the legal requirements of the FCTC. The tobacco issue is not going to fade away – on the contrary, it is now considered a priority risk factor in the global fight against non-communicable diseases.
Today, the FCTC has 177 Parties, covering 90% of the population of the world. Situations where a public institution is in bed with the tobacco industry are no longer acceptable and will be increasingly targeted as aberrations to eliminate. It is illusory to think that Dortmund’s Inter-tabac will escape this worldwide phenomenon. The sooner Messe Westfalenhallen Dortmund GmbH will cut all links with the tobacco industry, the better and less painful the process will be. On behalf of my association, I urge your company and the mayor of Dortmund to do it without delay.
(1) Proctor, Robert N. (2012). Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition. Berkeley: University of California Press.ISBN 9780520270169
Earlier this year, tobacco control advocates from around the world supported an effort by their counterparts in Japan to block a proposed appointment of Mr Katsuhiko Honda, former President of Japan Tobacco, to serve on the Board of Governors of NHK, Japan’s public broadcaster (Japan’s equivalent of the BBC). Unfortunately, the temporary success there has been fully reversed.
This month, Honda’s name came through again, this time after the summer election where a coalition led by the powerful Liberal Democratic Party (LDP) obtained a majority in the Upper House and accordingly the LDP gained essentially complete control over the nation’s legislative affairs. Renominated by Prime Minister Abe, Mr. Honda’s appointment was approved by both houses of Japan’s national Parliament on Friday 10 November.
According to the University of Hawai’i’s William S. Richardson School of Law Professor Mark Levin, author of a Spring 2013 law journal article on Japanese tobacco control law and policy: “This appointment is troubling for many reasons, work in tobacco control being just one. Nonetheless, the fact that this appointment violates Japan’s international obligations under the World Health Organization Framework Convention on Tobacco Control Article 5.3 seems very clear. At the very least, this matter deserves to be noted and criticised accordingly with regards to international tobacco control advocates’ reports on and discussions with Japan.”
Tobacco control advocates in Japan are dismayed both for the immediate implications to their efforts and the challenge to the application of Article 5.3’s principles more broadly. Katsuhiko Honda still serves as an adviser to Japan Tobacco Inc., while this posting will give him direct authority over important management and policy decisions and presumably indirect sway in NHK’s daily operations as well. The Japan Society for Tobacco Control has condemned the move. (Japanese)
However, Levin points out that context here also matters. “Of course, Mr Honda’s desire to serve might well be driven by his unmitigated pro-tobacco industry agenda. But it’s important to note that the motivation for Abe’s selection of Honda may be barely related to tobacco control, at least from Mr Abe’s perspective.”
As widely reported in the national press, the appointment comes as part of a larger political move by Abe to secure a strong say in the selection of NHK’s next president and general affairs of management and budget. Abe seems to be getting many players in place for a dramatic set of legal, political, and even constitutional changes to swing Japan to the right. In this, Honda is a truly long-standing and trusted friend, having been Abe’s private home academic tutor in the future Prime Minister’s high school days.