Center for Tobacco Control Research and Education

This report, WHO's fourth in the series, provides a country-level examination of the global tobacco epidemic and identifies countries that have applied selected measures for reducing tobacco use. Five years ago, WHO introduced the MPOWER measures as a practical, cost-effective way to scale up implementation of specific provisions of the WHO FCTC on the ground.This report focuses on enforcing bans on tobacco advertising, promotion and sponsorship (TAPS). TAPS bans are one of the most powerful tools that countries can put in place to protect their populations. In the past two years, impressive progress has been made. The population covered by a TAPS ban has more than doubled, increasing by almost 400 million people. Demonstrating that such measures are not limited to high-income countries, 99% of the people newly covered live in low- and middle-income countries.This and future editions of this report are key components of the global tobacco control fight, measuring how much has been achieved and identifying places where more work must be done.

 The tobacco industry successfully blocked or displaced strong tobacco control legislation in Costa Rica for nearly 40 years using similar strategies used in the U.S. and the rest of the world, until the country successfully passed a strong tobacco control law in March 2012. During the 1970s and 1980s, the tobacco companies displaced strong tobacco control legislation on tobacco advertising by endorsing weaker executive decrees. In response to increased tobacco control pressure, the industry successfully weakened the 1995 law by secretly hiring scientific consultants to counter the SHS threat and using the hospitality industry to rollout the Courtesy of Choice program in Costa Rica (then Latin America). Tobacco companies then used Costa Rica as a model to rollout industry youth smoking prevention programs and corporate social responsibility campaigns throughout Latin America and the Caribbean. The industry continued its dominance in Costa Rica during the 2000s by developing a cooperative relationship with the Ministry of Health. Although theNational Anti-Tobacco Network(RENATA), a new coalition ofgovernmental health institutions and nongovernmental tobacco control associationsformed in 2007, generated enough public pressure on Legislative Assembly to ratify the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in 2008 and secure Bill 17.371’s introduction in 2009 to implement the treaty, the industry once again worked through the Ministry of Health to delay the bill’s passage. However, RENATA’s abilityto alert the media and mobilize a coalition of international health advocates to effectivelyinform lawmakers on the importance of the FCTCbetween 2010 and 2012 helped pass a strong tobacco control law in March 2012. 

Objetivo. Analizar cómo la industria tabacalera influyó en la formulación de las políticas de control del tabaco en Costa Rica. Materiales y métodos. Revision de documentos de la industria tabacalera, de la legislación costarricense de control del tabaco y de periódicos y entrevistas con informates clave. Resultados. Durante los años ochenta, el Ministerio de Salud aprobó varios decretos para restringir el consumo de tabaco, lo que causó que British American Tobacco y Philip Morris International fortalecieran su presencia politica, cuyo resultado fue la promulgación de una ley débil en 1995 todavia vigente. Desde 1995 la industria tabacalera ha ultizado a Costa Rica como piloto para los programas latinoamericanos y ha dominado la formulación de politicas influenciando al Ministerio de Salud, incluyendo negociaciones privadas con la industria tabacalera en violación de las directrices del Articulo 5.3 del Convenio Marco para el Control de Tabaco (CMCT) de la Organización Mundial de la Salud. Conclusión. La experiencia de Costa Rica demustra la gran importancia que tiene la implementación del Articulo 5.3 del CMCT para proteger las políticas de la salud pública de la interferencia de la industria tabacalera.

Objective. To analyze how the tobacco industry influenced tobacco control policymaking in Costa Rica. Materials and Methods. Review of tobacco industry documents, tobacco control legislation, newspaper articles, and interviewing of key informants. Results. During the mid-to-late 1980s, Health Ministry issued several advanced (for their time) smoking restriction decrees causing British American Tobacco (BAT) and Philip Morris International (PMI) to strengthen their political presence there, resulting in passage of a weak 1995 law, which as of August 2011, remained in effect. Since 1995 the industry has used Costa Rica as a pilot site for Latin American programs and has dominated policymaking by influencing the Health Ministry, including direct private negotiations with the tobacco industry which violate Article 5.3’s implementing guidelines of the World Health Organization Frameowrk Convention on Tobacco Control (WHO FCTC).Conclusions. The Costa Rica experience demonstrates the importance of vigirous implmentation of FCTC Article 5.3 which insulates public health policymaking from industry interference.

We sought to understand how the tobacco industry uses "youth smoking prevention" programs in Latin America. We analyzed tobacco industry documents, so-called "social reports," media reports, and material provided by Latin American public health advocates. Since the early 1990s, multinational tobacco companies have promoted "youth smoking prevention" programs as part of their "Corporate Social Responsibility" campaigns. The companies also partnered with third-party allies in Latin America, most notably nonprofit educational organizations and education and health ministries. Even though there is no evidence that these programs reduce smoking among youths, they have met the industry's goal of portraying the companies as concerned corporate citizens and undermining effective tobacco control interventions that are required by the World Health Organization Framework Convention on Tobacco Control.

References which constitute the “data” for the paper “Civil Society and the Negotiation of the Framework Convention on Tobacco Control” by H.M. Mamudu and S.A. Glantz, published in Global Public Health, that are cited with numbers in the paper.

Communities and countries experiencing poverty, high unemployment, and economic reliance on tobacco growing are vulnerable to predatory tobacco industry behaviour. This analysis presents a cross-national survey of social disruption in tobacco farming to illustrate the association between tobacco companies and tobacco-related child labor, poverty and environmental destruction. The health risks of tobacco farming are beyond the scope of the study. Data on social disruption in tobacco farming was obtained through newspaper stories, published and unpublished reports, scholarly literature, documentary films, and tobacco industry publications such as annual reports and websites. The analysis shows that in all World Health Organization regions (Eastern Mediterranean, Africa, Europe, the Americas, South East Asia and Western Pacific) tobacco farming involves child labor and deforestation as well as tobacco industry behaviour promoting disruption in social and environmental life in tobacco farming communities. Tobacco companies generate huge externalities forcing farmers and consumers to pay the costs and concealing the actual cost of tobacco leaf and other tobacco products.

This paper examines the historical experience of tobacco control in the last five decades and shares important lessons of public health interventions to inform current and future tobacco control programs in other countries. The paper is divided into four parts. The first part gives an overview of the political economy, principal influences and interventions in tobacco control in the United States. It stresses the importance of information shocks and the role played by grassroots organizations. The current situation of tobacco control in the United States is further discussed in the second part, with emphasis on the economic case that led to litigation, as well as the response of the industry and the States. The third part focuses on the present efforts of multilaterals like the World Bank, technical UN agencies such as the World Health Organization, in the context of the new global governance structure: the Framework Convention on Tobacco Control (FCTC). The last section discusses lessons learned and provides recommendations for comprehensive tobacco control programs.

The paper suggests five major policy drivers that constitute components of a comprehensive tobacco control program: – science to inform policy, information strategies to educate consumers, advocacy to stimulate interventions, legal actions to develop regulations, and international collaboration through the FCTC. The paper concludes that while government has the responsibility for funding and implementing these activities; these can be most effective when supported by civil society.

Bans on traditional tobacco advertising highlight the strongly promotional role of tobacco imagery in films and video programs. On World No-Tobacco Day 2005, less than a year after India implemented its universal ban on tobacco advertising, its Minister of Health and Family Welfare announced a ban on tobacco imagery in the nation’s films and broadcast programs.

Opposition, including from the Ministry of Information & Broadcasting, which quickly announced the proposed ban was unworkable and advocated entertainment industry self-regulation, succeeded in delaying limits for on-screen tobacco for more than a year despite NGO advocacy efforts.

Elements of a policy compromise disclosed in June 2006 risk undermining the Ministry of Health’s intention: permanently to reduce adolescent exposure to tobacco imagery of major benefit the tobacco industry, particularly as Philip Morris International enters the Indian market to expand the market for premium cigarettes and battle for share British American Tobacco’s Indian affiliate, ITC.

Recommendations for an effective policy in India’s constitutional and policy environment include:

• In place of the subjective terminology favored by the tobacco industry and its film industry proxies around the world, a categorical standard of zero tobacco imagery except for (a) portrayals of actual historical figures documented to have used tobacco and (b) the unambiguous depiction of the dire health consequences of tobacco use, with no brand display in any case;

• An independent review committee, with no conflicts of interest, mandated to safeguard the public health by transparently applying the policy standards to the relatively few media productions that propose to include tobacco imagery despite the new policy;

• Identical treatment for films imported from overseas and Indian films released before the policy, namely strong anti-tobacco spots vetted by experts in tobacco prevention showing before and after the film or program in any and all distribution channels;

• Public certification, under penalty of perjury, by credited producers of any Indian film or video program with tobacco imagery released after the policy and all imported films and video programs with tobacco imagery that no one associated with the production accepted any consideration to include tobacco.

EXECUTIVE SUMMARY

Germany is one of the few industrialized nations in which the tobacco industry remains a legitimate force in business, government, science and society at large.

Though Germany has been an international leader in environmental protection, the German tobacco industry has been successful in preventing the translation of knowledge of the dangers of pollution from secondhand smoke into effective public health policy through a carefully planned collaboration with scientists and policymakers and a sophisticated public relations program which it initiated in the 1970’s and has been quietly running ever since.

The tobacco industry in Germany founded the Verband der Cigarettenindustrie, a trade association, in 1948. Located in Germany’s capital cities in order to as best as possible influence political decisions, the Verband includes all the multinational and national tobacco companies doing businessin Germany (7 in 2006).

In Germany, secondhand smoke emerged as a political issue in the early 1970s, but the federal government failed to enact a proposed statutory law on protection from tobacco smoke. To date, there has been no passage of effective legislation for the protection against tobacco in public places. Understanding that secondhand smoke was the crucial issue for the tobacco industry’s viability, the Verband engaged the issue long before the German government and the main voluntary health agencies, leading to the industry’s continuing success in preventing government action to protect citizens from the toxic chemicals in secondhand smoke.

The Verband influenced science and policy by challenging the scientific evidence linking secondhand smoke to disease by conducting or financing research, recruiting independent scientists, influencing high-level working groups and commissions, and by coordinating, sponsoring and participating in scientific conferences.

In 1975, the “Research Council Smoking & Health” was created as an advisory body to the scientific department of the Verband to convey the impression that the tobacco industry was committed to objective exploration and further development of its product. Research that was deemed to be too sensitive to be contracted to outside researchers was conducted in a laboratory in Munich, headed by Franz Adlkofer. In 1992, the Research Council was replaced when the Verband created the VERUM foundation with Adlkofer as Scientific and Executive Director.

The Medical Action Group on Smoking or Health, a small nongovernmental organization active in the protection of nonsmokers since the 1970s founded by medical scientist Ferdinand Schmidt, made numerous attempts to influence governmental health policy in Germany. The tobacco industry successfully responded by framing the Medical Action Group and Schmidt as out of the mainstream.

Probably the most important health authority allied with the tobacco industry from the 1980s onwards was Karl Überla, President of the German Federal Health Office until 1985 and simultaneously head of a private research institute, the GIS, in Munich. In 1982, the Verband contracted with Überla’s GIS for a study on “passive smoking and lung cancer.”

In 1983, a working group on smoking-related cancer risks was set up by the Federal Ministry of Health as part of Germany’s contribution to the EU “Europe Against Cancer” program. Of the 24 members the Ministry invited to comprise this working group, at least five individuals, Franz Adlkofer, Dietrich Schmähl, Gerhard Lehnert, Klaus Thurau and Jürgen v. Troschke, had worked for or received funds from the Verband.

Overall, the tobacco industry in Germany has been able to maintain a level of respectability that allowed it access to high-level authorities and scientists who either themselves held a policy-relevant office or served on political advisory bodies, including Karl Überla, President of the Federal Health Office, Dietrich Henschler, Chairman of the MAK-commission, and Helmut Valentin, President of the Bavarian Academy for Industrial and Social Medicine.

Despite the fact that public attitudes in Germany were very supportive of government action to restrict smoking, the industry worked to cast tobacco control as a serious threat to the European culture that was portrayed as too open, modern and enlightened for such action.

Secret tobacco industry polling showed even higher levels of support for smoking restrictions in Germany than in the United States; still, the German tobacco industry portrayed policies protecting workers from secondhand smoke as examples of US extremism. Several unsuccessful efforts to pass non-smoker protection legislation followed in subsequent years, and on October 3, 2002, a revised workplace ordinance took effect that nominally puts the duty on employers to protect their employees from secondhand smoke in the (non-hospitality) workplace; still, the ordinance overall failed to guarantee smokefree workplaces and as of January 2006, the German government had not established any meaningful program to promote implementation and enforcement of the ordinance.

In 2003, approximately one-third (32.5%) of Germans were smokers. Recent data shows at least 9 persons die from passive smoking each day in Germany. As this calculation only takes into account frequent domestic exposure of nonsmokers, the actual death toll is likely to be much higher. Still, as of 2006, with few smokefree laws in place, none of the major voluntary health agencies in Germany had continuously made secondhand smoke a major topic.

Public health policymaking in Germany remains dominated by tobacco interests.

KURZFASSUNG

Deutschland ist eines der wenigen industrialisierten Länder in denen die Tabakindustrie heute in derGeschäftswelt sowie vonseiten der Regierung, der Wissenschaft und der Gesellschaft im Allgemeinen noch als eine legitime Größe angesehen wird.

Obgleich Deutschland im Umweltschutz international eine Führungsrolle einnimmt, hat es dieTabakindustrie in Deutschland erfolgreich verstanden, die Umsetzung der Erkenntnisse über die Schädlichkeit des Passivrauchens in wirksame Gesundheitspolitiken zu verhindern. Sie bediente sich hierzu einer sorgfältig geplanten Kollaboration mit Wissenschaftlern und politischen Entscheidungsträgern, und eines ausgeklügelten PR-Programms das in den 1970er Jahren eingeleitet wurde und seitdem still betrieben wird.

Die Branchenorganisation, der Verband der Cigarettenindustrie (VdC, kurz „Verband“) wurde im Jahr 1948 von der Tabakindustrie in Deutschland gegründet. Der Verband vertritt sowohl nationale als auch multinationale Tabakkonzerne, die in Deutschland ihre Geschäfte treiben und war bzw. ist in der bundesdeutschen Hauptstadt (Bonn, Berlin) ansässig, um politische Entscheidungen bestmöglich zu beeinflussen.

Bereits in den frühen Siebzigerjahren wurde das Thema Passivrauchen in Deutschland zum Politikum, doch die Bundesregierung schaffte es nicht, einen damals existierenden Gesetzesvorschlag für eine Rechtsvorschrift zum Schutz vor Passivrauchen zu erlassen. Vielmehr hat die Bundesregierung es bis heute versäumt, eine wirksame Gesetzgebung zum Schutz vor Tabakrauch im öffentlichen Raum zu erlassen.

Aufgrund der Einsicht dass Passivrauchen der entscheidende Faktor für Lebensfähigkeit der Tabakindustrie ist, hat sich der Verband bereits lange vor der Bundesregierung und den wichtigsten Organisationen im Gesundheitswesen und Interessengemeinschaften dieses Thema zu eigen gemacht. Dies hatte zur Folge, dass die Tabakindustrie Regierungshandeln zum Schutz der Bürger vor den giftigen Inhaltsstoffen des Tabakrauchs erfolgreich verhindert hat.

Der Verband hat Einfluss auf Wissenschaft und Politik genommen indem er die wissenschaftlichen Erkenntnisse über den Zusammenhang von Passivrauchen und Krankheit bestritten hat, Forschungsarbeiten durchgeführt oder finanziert hat, unabhängige Wissenschaftler rekrutiert hat, Einfluss auf hochrangige Arbeitsgruppen und Kommissionen genommen hat sowie an wissenschaftlichen Tagungen teilgenommen, diese koordiniert oder finanziell gefördert hat.

Im Jahr 1975 wurde der „Forschungsrat Rauchen und Gesundheit“ gegründet. Er diente der Wissenschaftlichen Abteilung des Verbandes als Beratungsorgan und sollte den Eindruck vermitteln, dass die Tabakindustrie sich der objektiven Erforschung und Weiterentwicklung seines Produktes verschrieben hat. Untersuchungen die als zu heikel galten, um sie an externe Wissenschaftler zu vergeben wurden in einem Labor in München durchgeführt das von Franz Adlkofer geleitet wurde. Im Jahr 1992 wurde der Forschungsrat Rauchen und Gesundheit ersetzt durch die vom Verband gegründete Stiftung VERUM, deren Wissenschaftlicher und Geschäftsführender Direktor wiederum Adlkofer wurde.

Der Ärztliche Arbeitskreis Rauchen und Gesundheit, eine kleine Nichtregierungsorganisation, die seit den 1970er Jahren im Bereich Nichtraucherschutz aktiv ist und von Ferdinand Schmidt gegründet wurde, machte zahllose Versuche, die Regierungspolitik Deutschlands zu beeinflussen. Die Tabakindustrie reagierte darauf- erfolgreich - damit, dass sie den Ärztlichen Arbeitskreis Rauchen und Gesundheit und Schmidt als jenseits der politischen Mitte darstellte.

Vermutlich die wichtigste Autorität im Gesundheitsbereich, die mit der Tabakindustrie seit den 1980er Jahren verbündet war ist Karl Überla, bis 1985 Präsident des Bundesamtes für Gesundheit und zugleich Leiter einer privaten Forschungseinrichtung in München, der Gesellschaft für Information und Statistik in der Medizin (GIS). Im Jahr 1982 nahm der Verband Überla’s GIS unter Vertrag für eine Untersuchung über „Passivrauchen und Lungenkrebs“.

Im Jahr 1983 stellte das Bundesgesundheitsministerium eine Arbeitsgruppe über „Krebsgefährdung durch Rauchen“zusammen, als ein Beitrag vonseiten Deutschlands zum EU-Aktionsprogramm „Europa gegen den Krebs“. Von den 24 Mitgliedern, die das Ministerium geladen hatte, hatten zumindest fünf Personen, Franz Adlkofer, Dietrich Schmähl, Gerhard Lehnert, Klaus Thurau und Jürgen v. Troschke für den Verband gearbeitet oder von diesem Finanzmittel erhalten.

Im Großen und Ganzen ist es der Tabakindustrie in Deutschland gelungen, einen Grad der Angesehenheit aufrechtzuerhalten, die ihr Zugang zu hochrangigen Autoritäten und Wissenschaftlern verschaffte, die entweder selbst politikrelevante Ämter innehatten oder die als Sachverständige oder Mitglieder von wissenschaftlichen Beiräten direkten Zugang zur Politik hatten. Beispiele hierfür sind Karl Überla, Präsident des Bundesgesundheitsamtes, Dietrich Henschler, Vorsitzender der MAK-Kommission, und Helmut Valentin, Präsidentder Deutschen Gesellschaft für Arbeitsmedizin sowie der Bayrischen Akademie für Arbeits- und Sozialmedizin. Trotz der Tatsache, dass die Einstellung der deutschen Bevölkerung Einschränkungen des Rauchens deutlich unterstützt, war die Tabakindustrie bemüht, die Tabakkontrolle als eine ernsthafte Bedrohung für die Europäische Kultur darzustellen, indem diese als zu offen, modern und aufgeklärt für derartige Aktivitätenporträtiert wurde.

Ungeachtet der Tatsache, dass Umfragen die von der Tabakindustrie durchgeführt und geheim gehalten wurdenfür Deutschland sogar eine stärkere Befürwortung von Einschränkungen des Rauchens zeigten als in den Vereinigten Staaten, karikierte die Tabakindustrie in Deutschland Maßnahmen zum Schutz der arbeitenden Bevölkerung vor Passivrauch als US-amerikanischen Extremismus.

Etliche erfolglose Anläufe zur Verabschiedung eines Nichtraucherschutzgesetzes folgten in den Jahren darauf und am 3. Oktober 2003 trat die novellierte Arbeitsstättenverordnung in Kraft, die die Arbeitgeber nominelldazu verpflichtet, ihre Angestellten am Arbeitsplatz vor dem Tabakrauch zu schützen (ausgenommen sind Arbeitsstätten mit Publikumsverkehr). Durch diese Verordnung werden jedoch übergreifend keine rauchfreien Arbeitsplätze geschaffen und bis Januar 2006 hatte die Bundesregierung noch kein bedeutsames Programm aufgelegt um die Umsetzung und Vollzug der Verordnung zu fördern.

Im Jahr 2003 waren nahezu ein Drittel (32,5%) der deutschen Bevölkerung Raucher, neueste Daten zeigen, dass in Deutschland täglich mindestens neun Menschen an den Folgen des Passivrauchens sterben. Da dieser Berechnung lediglich die häufige Exposition von Nichtrauchern zu Hause zugrunde liegt, ist die wirkliche Zahl der Todesopfer wahrscheinlich deutlich höher. Dennoch garantieren bisher nur wenige Gesetze Rauchfreiheit und auch sonst hat bis heute keine der wichtigsten Gesundheitsorganisation in Deutschland sich kontinuierlich dem Passivrauchen angenommen bzw. dieses zu einem Hauptthema gemacht.

Die Gesundheitspolitik wird in Deutschland bis zum heutigen Tag von Tabakindustrieinteressen dominiert.