Islamset - NGOs and the Framework Convention: Summary, Cigarette use in the US, Patterns of cigarette use in the world, NGOs and FCTC, References.

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

NGOs and the Framework Convention
Karen Slama, Ph. D.
Cordinator, INGCAT

Summary
In many developed countries, the prevalence of smoking grew for at least 50 year before reaching peak rates and now, 50 years later, smoking still concerns between one third of the population in these countries. With smoking now increasing in the populous and poor areas of the world due to the aggressive marketing of the tobacco industy, the extent of disease and death from tobacco use will far surpass what has already occurred. The world needs an enforced international standard of behavior for the tobacco industry as well as public health and economic measures necessary to speed up the process towards declining use. This can only be achieved through the international Framework Convention on Tobacco Control. NGOs can be a potent force in developing the convention by proposing the strongest standards for the content of the treaty. Including protection of children, equity for women, adequate and effective help for smoking cessation, appropriate education about, tobacco, sustainable development without tobacco and basic human rights and consumer protection.

Cigarette use in the US: social phenomena The history of tobacco use in an important element in understanding why an international treaty about tobacco is now a necessary step in tobacco control. The use of cigarettes in the United States is a well-documented example of the social nature of tobacco use.

In the 1880s, machine-produced cigarettes were introduced at low cost, and sales multiplied. Over the next 15 years there was a 600% growth in cigarette sales. And then the tobacco industry increased their efforts (1,2). From 1900-1905, the American Tobacco Company handed out bags of free cigarettes to every male immigrant arriving at Ellis Island (3).

Nevertheless, anti-tobacco social norms were high, and by 1909, it-tobacco social norms were high, and by 1909, it was illegal to sell or use cigarettes in 17 states. The expression "coffin nails" came from this period. There was a national anti-tobacco campaign. But despite social resistance, tobacco makers' profits grow, and their power grew, and their means of influencing social norm grew, particularly during the First World War, Cigarettes were craftily promoted as a necessity. This phenomenon was occurring through out the West. A French poster, for example, says, "Cigarettes make us smile. Make sure that your soldier never goes without". Back in the US, General Pershing was famous for saying, "Tobacco is as indispensable as the daily ration." Anti-tobacco talk was considered unpatriotic and punishable under the Espionage Act (3).

By 1927, anti tobacco laws no longer existed, advertising was starting to target women and tobacco had been used by over 50% of men. The trend continued: over 80% of the men born in the 20s and 30s were over smoker, that is, they had smoked cigarettes during during at least part of their lifetime. The result of this epidemic of smoking can be seen in this smoothed graph of maximum rates of men's and women's smoking by 10 year birth cohorts.

It took 50 years to reach the peak of consumption of 4340 cigarettes per capita, in 1963 (4). Since then, men's rates have decreased. Despite the campaigns, the laws and health education, the decrease has only been slow, and the decline in women's rates in only recent. We are already looking at over 100 years.

Patterns of cigarette use in the world
The curve of cigarette use in the US is similar to what we see in other countries that have data over time. What is becoming clear is that it is important to keep the curve low, and to reduce the time it takes to get to the stage at which very few people want to smoke so they quit or they do not start. Now, there are clusters in US society that can be called post-tobacco. Very few doctors smoke, for example. In a study from Minnesota in 1993, only 4% of 30-39 year old doctors were smokers (5). But it has taken the US 100 years to get to the point where small, select sub-groups are leaving the curve.

Men's rates in many richer countries are declining, and have been doing so for 20 year or more. Women's rates in those same countries are just beginning or have not yet begun to decline. This is a massive social problem, and it has been exported to lower income countries. Unhealthy lifestyles and the diseases they cause are already sapping development,

The wealth and the consequent power and corrupting ability of the tobacco industry describe the current situation. This cannot be allowed to continue, and it cannot stop unless a universal and comprehensive standard of behavior and control of the tobacco companies is created.

Opening the door to exploitation and havoc for the healthcare systems in years to come.

Not only are the tobacco industries busy corrupting governments and blocking public health initiatives while they recruit children into smoking, the consumer society is giving some strong messages that reinforce tobacco use:

Consume tobacco to resolve problems
Problems are solved with medical care and medication, rather than being prevented in the first place.
Tobacco use is away to define oneself
The roles of the product, the market, society and the government are minimised, and the issue is framed as individual choice.

So now, tobacco use is growing among men in the populous and poorer regions in the world. And it is growing for women. The problem that confronts us is that we are only at the beginning of the curve for most of the world. Will this go on for another 100 years and more? Remember," the vector here is not a rat flea nor a mosquito but the tobacco industry, which is considerably more adaptable and much richer than are fleas or mosquitoes" (Dr. F. Bass, on Globalink).

NGOs and the FCTC
The Framework Convention for Tobacco Control (FCTC) is an international treaty concernig tobacco control, the contents of which are to be negotiated by nations. It will take the form of a framework document that includes a number of different articles or protocols, so that nations can sign on to the framework, The content of the protocols depends on the work of NGOs. The strongest, most efficient protocols will need a great deal of lobbying and public support to get onto the negotiating table. Here it is time for all NGOs to be involved: writing drafts, getting support, lobbying the government. Indeed, NGOs can expand the conception of what is feasible and necessary (6).

NGOs must join together behind the framework Convention wholeheartedly and in cooperation, using the press, lobbying, being on the internet, mobilising all members of various organisations. And then, when governments sign, NGOs will be there, watching, monitoring and reporting on progress and application and pushing for more.

The working group themes of the NGO mobilisation meeting are categories that can be envisaged in the context of the Framework Convention. What would the best Framework Convention contain to cover these issues?

Children exposed to tobacco and to smoking
Women resisting the tobacco industry
Health care and smoking cessation
Enabling education about tobacco
Sustainable development without tobacco
Human right and consumer protection.

The reports of the Wording Groups will be a first step in looking at possible giant steps for international treaty, the Framework Convention on Tobacco Control.

References:

1. Information from Slade J. Historical notes on tobacco. In Bolliger CT, Fagerstrom KO (eds): The Tobacco Epidemic, Prog Respir Res. Basel: Karger, 1997, vol.28, pp. 1-11.
2. Kluger R. Ashes to Sshes. New York Knopf, 1996.
3. Cited in Moyer D. The Tobacco Almanach. US Gov. Printing Office 1998-783-000/88020.
4. Giovino et al, Epidemiology of tobacco use and dependence. Epidemiol Rev. 1995;17:48-65.
5. Hensrud DD, Sprafka JM. The smoking habits of Minnesota physicians. Am. J. Publich Health 1993;83:415-417.
6. Framework Convention on Tobacco Control Technical Briefing Series. Paper 3 Mobilising NGOs and the media behind the International Framework Convention on Tobacco Control. Geneva: WHO. 1999 .