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Proceedings INGCAT International NGO MObilisation Meeting Geneva, 15-16 May, 1999.

"Tobacco Control Now and in Future"
Prof. Judith Mackay, MD.
Director, Asian Consultancy on Tobacco and Health,
Hong Kong, China.

iepidemic. including the public release of internal tobacco industry documents, new partnerships within the tobacco control community, successful litigation, and the important commitment of the WHO, with the Tobacco Free Initiative programme and development of a Framework Convention for Tobacco Control.

We have known for centuries that tobacco is harmful.

6000 BC: AMERICAS: The tobacco plant begins being grown

ca. I BC: AMERICANS begin smoking and using tobacco enemas

1600s: CHINA: Philosopher Fang Yizhi points out that long years of
smoking 'scorches one's lung'

1729: BHUTAN: First documented legislation bans tobacco use ill all religious places, still observed

1761: ENGLAND: 1st study of  tobacco effects by John Hill

1950: ENGLAND, USA: 2 major reports on moking published

1981: JAPAN: 1st major study on passive smoking by Hirayama

We are failing.
In spite of c :nturies of knowledge and decades of action, 10 World Conferences and many regional, national and sub-national meetings --the number of smokers is  increasing; more are dying; children are still taking up the habit and more than 40% are exposed to ETS; and the economic costs are escalating. In addition, the epidemic is being transferred to developing countries so that by 2030 only 15% of the world's smokers will live in developed countries. If we only continue to do 'more of the same' the statistics will be:

THE GLOBAL TOBACCO EPIDEMIC in 2000 and 2030

                                                                                2000         2030

            Number of Smokers                                     1.26 b      1.6 b

            Tobacco deaths (annual)                                4 m          10 m

            Children exposed to ETS                              700 m       770 m

            Economic losses, US$                                  200 b        ???

There are several reasons why this information has not been translated into action by governments and even by the health profession.

The epidemic is different, and difficult for governments more used to fighting malaria and TB.  Many are mistakenly concerned about the economic consequences of tobacco control action.

But the greatest obstacle is the tobacco industry: Internal tobacco industry secrets are now spilling out through once-confidential company documents, under disclosure requirements from the Minnesota trial.  The documents reveal how the industry:

- concealed information on tobacco
- lied to governments, the media and, most importantly, to the smoker.
- recruited scientists all over the world to challenge the science, especially on passive smoking.

But the tobacco industry documents say much more:

"Collect and use articles ridiculing antis.
Blow the antis out of the water.
Sue the bastards!
Get watchdogs to investigate anti's fund allocations.
Make it hurt to take us on.
Infiltrate the World Health Organisation.
Fund lung cancer research.
Endow chairs for indoor air research.
Create a scientific journal.
Acquire major media vehicle.
Develop our own radio programming.
Create or buy a popular Science magazine.
Acquire an insurance company.
Organise "spontaneous" protests on our issues.
Cement relatiionships with women smokers. e.g., re: childcare.
Create greater pressure on politicians.
Let politicians know the downside of anti activity.
To do this, take on a vulnerable candidate.
beat him/her, let people know we did it."

What more must be done?

This list is only too familiar to those already working in tobacco control, and includes:

- Establishment of a National Office to co-ordinate tobacco control efforts in every country.

- Licensing of nicotine as an addictive drug with manufacture, promotion and sale under regulatory control by agencies usch a s the Food and Drug Administration in the United States.

- Smoke-free areas in workplaces, indoor public areas and public transport.

- Bans on all promotion of tobacco products, including supra-national advertising via satellite, cable, films and internet.

- Plain black and white cigarette packets containing only brank name, tar and nicotine levels, and health warnings.

- Tar levels below 15 mg all over the world.

- Health education by all nations.

- Tobacco on the curriculum in medical and health schools.

- No "Duty Free" tobacco.

- Cessation.  Unless there are massive efforts put into cessation, there will be no reduction in the 200 million deaths caused by tobacco expected to occur before 2030 among those who already smoke.

- Data on prevalence, mortality, economics, attitudes and public opinion.

- Greater regional co-ordination, such as in the European Community and the Association of South East Asian Nations.

- Electronic networking, such as Globalink.

- Litigation by individual claimants, class action suits, and also governments suing to recover tobacco attributable health care costs.

Partners in fighting the tobacco epidemic should include a wide range of women's groups, youth leaders, lawyers, economists, environmentalists, religious leaders, consumer pressure groups, sports bodies, and many others.

Appropriate funding from government and the private sector.

What is new?

Exposure of tobacco industry documents
This has changed the public perception and credibility of th etobacco industry.  Now that it is known that the industry has lied about addiction and the health effects to the smoker, the responsibility for the epidemic has moved from the smoker to the tobacco industry.

Partners
New partnerships are developing between NGOs, as evidenced here today.  As with all partnerships, guidelines are needed for these various partners to work together.

Litigation
Suing th eindustry is increasing -- by individual claimants, class action suits, and also by governments suing for tobacco-attributable health care costs.

WHO/TFI
In 1998, the new Director General of WHO, Dr Gro Harlem Brundtland, made tobacco one of her two initial special cabinet projects.  Funding has increased substantially (but not enough); staff numbers have gone from one to about 17; there is an air of optimism and dynamism.

New partnerships are being forged, for example, within WHO (identifying tobacco actions in all 9 clusters), and also between WHO and the World Bank, UNICEF, the IMF, non-governmental organisations such as the World Medical Association, funding agencies, and the private sector, such as th epharmaceutical industry and other businesses.

There have been many projects, meetings, conferences and more by the TFI, and tobacco has been discussed by WHO at the highest level at meetings such as the 1999 World Economic Forum in Davos and the 9th International Conference of Drug Regulatory Authorities (ICDRA) in Berlin (1999).

Already the tobacco industry has reacted:
"WHO is behaving like a 'super-nanny'",
"WHO will destroy the livelihoods of farmers in developing nations."
"The TFI has been 'hijacked by zealots'."

..... all good signs that WHO is being effective.

FCTC:  The WHO Frame work Convention for Tobacco Control will move tobacco issues to a much higher profile within the UN and with national governments.  The FCTC is essentially an internationally binding treaty between governments advocating model national tobacco control legislation but which also addresses transnational and transborder issues such as global advertising, smuggling an dtrade.  Although the ultimate goal of the FCTC will be to strengthen national tobacco legislation and control programmes, the process of developing an dimplementing the FCTC will also have the following spinoff effects:

- Mobilisation of technical and financial support/resources for tobacco control.

- Raised awareness among many government ministries, e.g. finance, trade, agriculture, international relations.

- Working together of WHO and NGOs.

The convention marks an important shift in the use of international legal instruments as a means of promoting public health.

NGOs have an important role to play in the process, e.g.,

- NGOs in official relations with WHO can participate in negotiations as observers.
- NGOs can disseminate scientific and technical information on the tobacco epidemic as the scientific rationale for the need of a convention.
- NGOs can provide advice, mobilise public and political support, as well as develop strategies for lobbying and funding for work on the convention within each member country.