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Societies of the World 25 : Health, Culture and Community: Case Studies in Global Health Global Governance: The Case of the Framework Convention on Tobacco Control Allan M. Brandt November 18, 2009

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Title: Societies of the World 25 : Health, Culture and Community: Case Studies in Global Health Global Governance: The Case of the Framework Convention on Tobacco Control Allan M. Brandt November 18, 2009


1
Societies of the World 25 Health,
Culture and Community Case Studies in Global
Health Global Governance The Case of the
Framework Convention on Tobacco Control Allan M.
Brandt November 18, 2009
2
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4
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
5
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.
6
Men Smoking, 2002
7
Women Smoking, 1998-2003
8
China
US
UK
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.
9
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.
10
Tobacco consumption, death rates and stage of
tobacco epidemic
11
Developing Countries
1990 2020
By 2020 developing countries will have a disease
profile similar to that in 1990 in developed
countries
Developed Countries
CMP communicable, maternal and perinatal
disease NCD non-communicable diseases
1990 2020
Source Murray and Lopez, 1996
12
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
13
Global market share of cigarette production
Source 2002 WHO Tobacco Atlas www.tobacco.org
14
NIGERIA
  • 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

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17
Current photographs from Thailand, where tobacco
advertising has been banned since 1988
18
"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.
19
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.
20
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.libra
ry.ucsf.edu/tid/vpb81f00.
21
The Richmond Model of Policy
Social Strategy
Political Will
Knowledge Base
22
  • Social Strategies
  • The use of law in global public health.
  • What is the quality of the knowledge base?
  • Is there political will?

23
  • 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)

24
  • 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)

25
Current Health Warnings on Cigarette Packs
Brazil Japan
  • Since smoking can damage your health, be careful
    not to smoke excessively
  • United States
  • Quitting smoking now greatly reduces serious
    risks to your health
  • China
  • Smoking is harmful to health

Smoking causes lung cancer
26
Health Warnings, continued
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.
27
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/ti
d/xyv36e00. )
28
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.
29
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.
30
Scruton, Sophie. E-mail to Quentin Browell, Japan
Tobacco. 2002. http//www.ash.org.uk/html/conduct/
pdfs/scruton.pdf.
31
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/t
id/nbk83c00.
32
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.
33
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.
34
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 PROPOSAL The 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
35
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
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A Framework Convention on Global Health?
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