Societies of the World 25 : Health, Culture and Community: Case

Studies in Global Health

Global Governance:Global Governance:The Case of the Framework The Case of the Framework

Convention on Tobacco Convention on Tobacco ControlControl

Allan M. BrandtNovember 18, 2009

Hugh Cullman, “Partners in Progress: A Report on Philip Morris in the Developing Countries," 1977. Bates Number: 2015006022/6039; http://legacy.library.ucsf.edu/tid/ksk68e00

Deaths from tobacco-related diseases in the developed and developing world, 2000 and 2030

Source: Judith Mackay and Michael Eriksen, The Tobacco Atlas, Geneva: World Health Organization, 2000.

Men Smoking, 2002

Women Smoking, 1998-2003

Daily per capita cigarette consumption in China, the UK, and the US, 1952-1996

0

2

4

6

8

10

12

14

16

1950 1960 1970 1980 1990 2000

Sources: Peto, Richard, et al Mortality from Smoking in Devloped Countries, 1950-2000. Oxford: Oxford University Press, 1994.Liu, Bo-Qi, et al. BMJ 317.7170 (1998): 1411-22.

China

USUK

0

500000

1000000

1500000

2000000

2500000

3000000

3500000

1940 1960 1980 2000 2020 2040 2060

Developed nations China

Tobacco-related deaths per year

Sources: Peto, Richard, et al Mortality from Smoking in Devloped Countries, 1950-2000. Oxford: Oxford University Press, 1994.

Liu, Bo-Qi, et al. BMJ 317.7170 (1998): 1411-22.

Tobacco consumption, death rates and stage of tobacco

epidemic

NCD89%

Injuries7%

CMP4%NCD

86%

Injuries8%

CMP6%

NCD69%

Injuries18%

CMP13%

NCD47%

Injuries11%

CMP42%

By 2020 developing countries will have a disease profile similar to that in 1990 in developed countries

1990 2020

1990 2020

CMP – communicable, maternal and perinatal disease

NCD – non-communicable diseasesSource: Murray and Lopez, 1996

Developing Countries

Developed Countries

Since 1959, Philip Morris has built a substantial commitment in the developing countries. We have invested more in the developing world than we have recovered. We have been investing for the future.

Hugh Cullman, "Partners in Progress: A Report on Philip Morris in the Developing Countries," 1977.

Bates Number: 2015006022/6039; http://legacy.library.ucsf.edu/tid/ksk68e00

BAT15%

Philip Morris16%

China National Tobacco Corp.

25%

Other companies combined

22%

Japan Tobacco7%

RJR6%

Reemsta3%

Altadis2%

SEITA1%

Tekel1%

KT&G2%

Global market share of cigarette production

Source: 2002 WHO Tobacco Atlas; www.tobacco.org

•British American Tobacco promotional campaign for Rothmans brand in late 2002.

•Theme of campaign: "Experience It"

•Main feature was popular Hollywood films, screened in large air-conditioned domes ("promotional first" in Africa).

•Free distribution of lit cigarettes at event entrances.

*This slide is from a powerpoint presentation by Mr. Akinremi Adeola at the 2003 World Conference on Tobacco or Smoking, Helsinki

NIGERIA:

Current photographs from Thailand, where tobacco advertising has been banned since 1988

"I feel the most shameful thing this country did was to export disease, disability and death by selling our cigarettes to the world. What the companies did was shocking, but even more appalling was the fact that our own government helped make it possible."

-Former Surgeon General C. Everett Koop

Quoted in Glenn Frankel, “U.S. Aided Cigarette Firms in Conquests across Asia," The Washington Post, 17 November 1996.

In any event, despite the lingering tobacco liability cases and the drop in cigarette consumption in the United States, the tobacco companies themselves have never been healthier. First, foreign consumption of American cigarettes continues to grow dramatically, because of the falling value of the dollar, a reduction in tariff and non-tariff barriers to cigarettes and the image of American cigarettes as the best in terms of quality and character. Japan is now importing U.S. cigarettes, and China shows great potential.

Burson-Marsteller, "Position Paper, First Draft: THE EFFECT OF PRODUCT LIABILITY LITIGATION ON TOBACCO INDUSTRY STOCKS," (03/18/1988).

Bates Number: 2021269356/9374; http://legacy.library.ucsf.edu/tid/mih48d00.

Demographically, the population explosion in many underdeveloped countries ensures a large potential market for cigarettes. Culturally, demand will increase with the continuing emancipation of women and the linkage in the minds of many consumers of smoking manufactured cigarettes with modernization, sophistication, wealth and success--a connection encouraged by much of the advertising for cigarettes throughout the world. Politically, increased cigarette sales can bring benefits to the government of an underdeveloped country that are hard to resist.

DRAFT: 1982 Analysis? Tobacco Sales in Developing Countries: Philip Morris Inc.; R. J. Reynolds Industries Inc. Philip Morris. 1982. Bates Number: 2025038090/8097; http://legacy.library.ucsf.edu/tid/vpb81f00.}

Social Strategy

Knowledge Base

Political Will

The Richmond Model of Policy

Social Strategies:

The use of law in global public health.What is the quality of the knowledge

base?Is there political will?

Key provisions of the Framework Convention on Tobacco Control

•As a measure to reduce demand, taxes ought to be raised to both cover tobacco-related health costs, as well as increase the price of cigarettes, keeping in mind the importance of price to underage customers. Duty-free sales ought to be reduced or banned. (Article VI)

•Tobacco manufacturers shall be required to disclose ingredients. (Article X)

•Health warnings must cover at least 30% of cigarette packaging. (Article XI)

•Terms such as “light,” low-tar,” or “mild” are considered misleading and ought not appear on tobacco products. These terms were banned in a previous draft; it is now at the discretion of each country whether to ban the terms. (Article XI)

•Each country must promote and strengthen public awareness of tobacco control issues, using all available communication tools. (Article XII)

•Countries ought to develop national laws and encourage regions and municipalities to do the same so that nonsmokers are protected from smoke in public places, including workplaces, public transportation, restaurants. (Article XIII)

Provisions of the FCTC, continued

•Each country ought to enact a comprehensive ban on tobacco advertising, sponsorship and promotion, including cross-border advertising. (Article XIII)

•Each country shall take effective measures to promote tobacco cessation and ensure adequate treatment for tobacco dependence. (Article XIV)

•As an anti-smuggling measure, each cigarette pack must be marked as to determine both the exporting and importing countries. (Article XV)

•To reduce sales to minors, each country must prohibit the distribution of free tobacco products, as well as the sale of individual cigarettes or small packs of cigarettes, both of which increase affordability. Tobacco products may not be sold in any place where they are directly accessible to minors (vending machines, store shelves). Candy, snacks and toys that resemble tobacco products (i.e. candy cigarettes) may not be manufactured or sold. All vendors must ask for proof of age for tobacco purchases. (Article XVI)

• Countries are encouraged to consider tobacco litigation to recover damages. (Article XIX)

Current Health Warnings on Cigarette Packs

Since smoking can damage your health, be careful not

to smoke excessively

United StatesQuitting smoking now greatly

reduces serious risks to your health

ChinaSmoking is harmful to health

Brazil Japan

Smoking causes lung cancer

Canada South Korea

Stopping smoking can lead to

a long and healthy life

Croatia

Smoking is a health hazard

United Arab Emirates

Official Warning: Smoking damages your health. We

advise you to stop.

Health Warnings, continued

In addition, Philip Morris should be unapologetic about its advertising and promotion activity in the third world. There is something patronizing about the WHO approach to smoking and health in the third world. WHO assumes that people must be saved from demon tobacco by their governments; that they can't be trusted to make personal decisions about whether or not to smoke. People in the West, despite increased government intervention, make these decisions all the time, and third world leaders generally resent the implication that they and their people must be protected. Since smoking is often associated with increased affluence, there is the further resentment that part of the lifestyle towards which people in the third world are striving is, by some arbitrary judgment, being made unattainable. Thus nationalism and aspiration for development and a higher standard of living will lead third world governments to resist the efforts of the do-gooders from WHO to impose a smokeless society upon them.

(G. A. Dalley, "THE WORLD HEALTH ORGANIZATION'S CAMPAIGN ON SMOKING AND HEALTH: SOME THOUGHTS ON A CORPORATE RESPONSE (Memo to Donald S. Harris, Philip Morris)," (07/10/1984). Bates Number: 2023272993/2996; http://legacy.library.ucsf.edu/tid/xyv36e00.} )

This is not to say that tobacco is harmless, or that the trade in it is a good thing. It is to say, rather, that where the risk of a product falls entirely on consumers and is fully explained to them, it cannot be the business of unelected bureaucrats to forbid or control it. If we lose sight of this principle, then we lose sight of the truth on which all free societies depend, namely that freedom and risk are inextricable, and whoever assumes the right to save me from risks, is also assuming the right to limit my freedom. Certainly people can be granted that right: but only by some form of democratic election -- not, in Mrs. Brundtland's way, by storming into office on the back of a political career, and with a self-righteous desire to control us whether we like it or not.

Scruton, Roger. "Tobacco and Freedom." The Wall Street Journal Europe, 7 January 2000.

By a semantic trick, therefore, Mrs. Brundtland and her team have been able to classify as a dangerous disease what is, in fact, a voluntary activity and a source of pleasure, the risk of which entirely falls on the smoker. By the same reasoning we could link deaths from driving, drinking and junk food to "epidemics," and put cars, alcohol and McDonald's on the WHO's agenda.

Scruton, Roger. "Tobacco and Freedom." The Wall Street Journal Europe, 7 January 2000.

Scruton, Sophie. E-mail to Quentin Browell, Japan Tobacco. 2002. http://www.ash.org.uk/html/conduct/pdfs/scruton.pdf.

Examination of the draft text will help Philip Morris anticipate the potential protocols that the framework convention will create. The history of framework conventions shows that successful weakening of the language of an article in the framework convention can be easily undermined by the protocol process. The potential protocols are more important to the company in the long-term than the framework convention itself.

Mongoven, Biscoe & Duchin, Inc., "An Analysis of the International Framework Convention Process," p. 33. 1997. Bates Number: 2065219440/9522; whttp://legacy.library.ucsf.edu/tid/nbk83c00.

Aside from delaying the adoption of a convention the company is best served by participating in the development of the agreement. It would be in the company's best interest to have the treaty focus entirely on protecting children and leaving adult choice protected.

Mongoven, Biscoe & Duchin, Inc., "An Analysis of the International Framework Convention Process: Executive Summary--The WHO Tobacco Control Convention,“ p. 3. 1997. Bates Number: 2074292077/2082; http://legacy.library.ucsf.edu/tid/wqp87d00.

[The WHO Framework Convention on Tobacco Control is a] developed world obsession being foisted on the developing world.

Martin Broughton, chairman of British American Tobacco, March 2000, BAT 1999 Annual Review.

Please find enclosed herewith draft with the actions to be developed in conjunction with PM [Philip Morris] in orther [sic] to weaken the 8th World Conference on Tobacco or Health....

AIDS CAMPAIGN PROPOSALThe object will be to scatter the public attention payed [sic] to the Conference and refer it to the AIDS subject, bearing in mind that nowadays Argentina is quite concerned and threatened with AIDS than any other epidemic disease.Being the disease of the century and a preventive disease, AIDS should be 'public enemy No. 1' because of its terminal consequences at every age.Facing the AIDS increasing importance in the world and in Argentina we believe this disease to be the sole matter capable of eclipsing the conference.“

“8th World Conference on Tobacco or Health” (Letter from Jorge R. Basso Dastugue of BATCo. to Sharon Boyse of BATCo.), January 13, 1992; Bates #: 300504295/4298; http://www.library.ucsf.edu/tobacco/batco/html/14400/14454

A clumsy pursuit of global standards can become a form of moral and cultural imperialism, based on assumptions that ‘west is best’. Imposing western priorities, or ‘global solutions’ that force the values and priorities of any one country on another, can become a new form of colonialism.

“GLOBALISATION AND BUSINESS INTEGRITY,” British American Tobacco Website, accessed 10/29/2003, last updated 08/08/2003

A Framework Convention on Global Health?