The tobacco industry in developing countries
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7537.313 (Published 09 February 2006) Cite this as: BMJ 2006;332:313All rapid responses
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Alcohol and tobacco sales control bill, which was presented to Sri
Lanka parliament in 8th February 2006, was immediately challenged in court
by organizations representing the powerful tobacco and alcohol industries,
which provide over 15 percent of the government tax revenues, on the
grounds that it violated freedom of expression and free choice and the
right to engage in a fair trade.
If passed, the legislation will provide for the setting up of a
statutory body that would regulate the sale of cigarettes and alcohol in
the country. Its aim is to ban the sale of cigarettes and alcoholic
products in supermarkets.
In Sri Lanka majority of people are Buddhists, but many people have
not been heeding the advice given by the Buddha, more than 2500 years ago,
on healthy life styles. A recent study has pinpointed alcohol abuse as
being at the root of many social problems in this country (1). The poor
were affected the most and often male bread winners spend the bulk of
their incomes on alcohol and tobacco resulting in domestic violence and
crime.
Reference:
(1) . Bakuen, B., Smarasinghe, D., Alcohol and poverty, 2004. FORUT
Colombo Sri Lanka.
Free full text of this book is available:
http://www.forut.no/index.php/15703-1
Competing interests:
None declared
Competing interests: No competing interests
In the United Kingdom, smoking prevalence of the adult population is
27% (1). This week British parliament voted overwhelmingly on for a total
ban on smoking in indoor public places. Although eminent British scientist
Sir Richard Doll was the first to document the health risks of smoking,
such as lung cancer, Britain has been slow to prevent workplace and public
exposure. However, the evidence is that the British public is very much
behind greater restrictions on smoking (2).
Smoke-free workplaces not only protect non-smokers from the dangers
of passive smoking but also encourage smokers to quit. A recent systematic
review by Fichtenberg and Glantz (3) shows that totally free smoke-free
workplaces are associated with reductions in prevalence of smoking of
3.8%, and continuing smokers smoke 3.1 fewer cigarettes a day. The
combined effects reduce total cigarette consumption by 29%. To achieve
similar results through taxation would require an increase in the price of
cigarettes of 73%, so that cigarettes would cost £6.59 per pack in the
United Kingdom (4).
Meanwhile for decades, people with juvenile diabetes have been told
that controlling their blood sugar is all they can do to prevent nerve
damage that can lead to the amputation of a foot or leg. A recent large
British study suggests (5) juvenile diabetes should follow the same advice
given to other diabetics: Don't smoke, and watch your weight and blood
pressure. These risk factors for heart disease were almost as important as
blood-sugar levels in predicting which diabetics would develop nerve
problems.
REFERENCES:
(1). Walker A, Maher J, Coulthard M, Godard E, Thomas M. Living in
Britain 2000. London: Stationery Office, 2001.
(2). Smoking in Public Places Investigative Committee. Scrutiny of
smoking in public places in London. London: Greater London Authority,
2002.
(3).Fichtenberg CM, Glantz SA. Effect of smoke-free workplaces on
smoking behavior: systematic review. BMJ 2002: 325: 188-191.
(4). Smoke-free work places cut smoking. BMJ 2002: 325;0
(5).Tesfaye S, Chaturvedi N, Eaton SE, Ward JD, Manes C, Ionescu-
Tirgoviste C, Witte DR, Fuller JH; EURODIAB Prospective Complications
Study Group. Vascular risk factors and diabetic neuropathy. N England J
Med. 2005:27; 352(4):341-50.
Competing interests:
None declared
Competing interests: No competing interests
I disagree with Sebre and Glantz´s characterization of the Mexican
Ministry of Health (MMoH) in their editorial The Tobacco Industry in
Developing Countries. The authors fail to take into account potential
positive effects and disregard important accomplishments of the MMoH in
the area of tobacco control.
Over the past five years, the MMoH, under the leadership of Dr. Julio
Frenk, has implemented several noteworthy tobacco control initiatives. A
major tax increase on tobacco products reversed an industry-friendly trend
set by previous administrations. Restrictions on radio and television
advertising have been put into action and an intensive and carefully
planned media campaign will be launched in upcoming weeks to discourage
tobacco use. Furthermore, the recent development of an efficient system to
monitor and evaluate national trends in tobacco-use, especially among
young adults, is providing epidemiological data that will be key in
guiding mid- and long-term strategies to reduce tobacco consumption.
In order to develop and consolidate policies to restrict and control
the tobacco industry, constructive action is needed. For example,
governmental agencies in Mexico as well as international lobbyists need to
provide pressure to support the MMoH along its path towards a more
aggressive tobacco tax policy and breaking the barrier that impedes the
use of special taxes earmarked for anti-tobacco programs. The MMoH has
circumvented such barriers and used funds provided by the mentioned
agreement to finance medical institutions directly involved in the
treatment of tobacco related illnesses. Activists who issue broad
criticisms based on short-term results and brush aside important advances
may create pressure in the wrong direction and ultimately benefit the
tobacco industry by tarnishing the reputation of an administration that is
making long-term progress.
A more complete analysis than the limited one provided by Sebre and
Glantz would recognize, as Samet et al acknowledges in Mexico and the
Tobacco Industry: Doing the wrong thing for the right reason, that Mexico
has been a leader in tobacco control. The current minister of public
health, Julio Frenk, was an early supporter of the WHO convention and is a
champion of tobacco control in Mexico. The bottom line is that the balance
of the Frenk administration has been positive and Mexico is making
advances towards tobacco control.
Competing interests:
None declared
Competing interests: No competing interests
Response of the Mexican MoH´s Officers to two BMJ editorials
The response to two articles (BMJ 2006;332: 313-4 and 353-4) from
doctors Mauricio Hernández Ávila, Director General of the National Public
Health Institute, and Roberto Tapia Conyer, Under Secretary of Health
Programs Development both Ministry of Health (MoH)´s medical officers is,
once more, a respectful manifestation of full discipline, unconditional
loyalty and complete obedience to Minister of Health Julio José Frenk
Mora.
From the point of view of the Mexican collective health,
Organizations of the Civil Society (OCS) are extremely concerned by the
fact that the MoH authorities continue to be victims of the tobacco
industry strategies, designed to impose fiscal and health policies in
relation to nicotine addiction in our country.
Since October 2004 we advised in detail to MoH, the needless to
implement The Agreement that could benefit only to the tobacco companies,
it could preclude the National Council against Addictions, (CONADIC)’s
tobacco control activities and to distract National Commission for
Protection against Health Risks, (COFEPRIS)’ functions for tobacco
products regulation as a sanitary risk; and above all, it could continue
to worsen the Mexican’s health and institutional damage by increasing the
sales of tobacco products. Our continuous advise suggested MoH to
constitute a task force team to demonstrate the political, scientific,
technical and economic feasibility, and to register the evidence of its
effects on the health services and the impact on the Mexicans collective
health, including the evaluation of relevant conditions and situations
both from the point of view of the producers, commercial agents and
consumers, and from the MoH´s perspective.
We should keep in mind that the main objectives of the tobacco
companies are:
• to induce socially accepted behaviors,
• to secure their future market paid with the money and health of their
clients,
• to increase their profits selling nicotine addiction, disease, suffer
and premature death.
Their globalized system for prices and tax control allows them
• to generate supportive politicians, scientists. consumers and
defenders groups,
• to maintain and reproduce their political and economic power,
• to block sanitary regulation and
• to increase their productivity,
We have asked the following questions repeatedly:
Is The Agreement
• Preventing in any way those diseases attributable to tobacco smoking?
• Promoting and recovering the Mexican’s Collective Health by any means?
• Controlling by any chance the initiation to smoke tobacco in children,
adolescents and women?
• Protecting the Mexican people against nicotine addiction and regulating
tobacco products as sanitary risks?
Is The Agreement requiring respect for diversity (of corrupt
practices), for the sensitivity towards the local reality (of policy
makers and legislators to impede, difficult or postpone the necessary
reforms to the Health General Law) and for adherence to the “unethical”
norms and “pseudo philanthropic” attitudes conceived by the social
irresponsible corporative?
The effective economic global action is the only, transparent and
obvious objective of the tobacco industry, who worded The Agreement as it
was signed. We made a critical and detailed analysis of The Agreement
between decentralized agencies of the MoH and the local tobacco industries
British American Tobacco (BAT), Philip Morris (PM) and CIGATAM, and we
expressed our great concern to the Mexican Society and to Dr. Frenk Mora
(23 January, 2006), through the mass media about the evidence that shows
the danger for adopting the strategies promoted by the tobacco companies:
(a) Interfering the Framework Convention for Tobacco Control-World
Health Organization (FCTC-WHO) implementation,
(b) Intervening in health and fiscal policies in the country,
(c) Impeding the full efficacy of tobacco control and avoiding the
sanitary, economic and environmental consequences of tobacco use,
(d) Serving as precedent for the replication of this type of agreement
against the principles of the FCTC in other countries of the world.
In benefit of the prestige and dignity of the Mexican citizens and
Institutions we asked to the Minister of Health of Mexico:
1. To revalue The Agreement signed in June 2004 between
CONADIC/COFEPRIS and BAT/PM/CIGATAM because
The Agreement:
(a) operates against the approval arguments of the Mexican Senate
that originate the Presidential Bill supporting the (FCTC-WHO) at full
(May,2004);
(b) is juridical inexistent since was signed (June, 2004), after FCTC
was already approved by the Senate (May, 2004). The Agreement only
benefits the tobacco companies, damages health and economy of the Mexican
citizens and compromises the authorities, ethically and politically.
2. To convey immediately the National Inter-sectors Commission for
the Implementation of the FCTC-WHO, including OCS, for collaborating,
together with the Pan American Health Organization/World Health
Organization (PAHO-WHO), and the Alliance for FCTC (AFC) in
providing´technical cooperation for the construction of initiatives to
reform the Health General Law. This endevor will contribute to achieve the
Integral Legislation and the strict regulation of tobacco as a sanitary
risk, for real protection of the Mexican collective health.
Our society should create the juridical bases, expedite mechanisms
and social infrastructure to protect all Mexican Citizens, let all of us
do it properly without any treaty what so ever with the tobacco companies.
Unconstitutionality of The Agreement. It is necessary to excite the
Senate for executing his write and duty to advocate for the
constitutionality, the Supreme Court will decide about the
unconstitutionality of the instrument.
Conclusion
The Agreement is inexistent. The Agreement should be considered as
the “Juridical Nothing”. For constitutional auto protection it is required
to be declared by the administrative authority or by means of the external
protection process from the Judicial Power thru the Senate intervention
and promotion, as been the titular author of the FCTC-WHO approval
faculty. We are not questioning the right activities made by the Mexican
Government for tobacco control, but we are sure that The Agreement is a
serious mistake that should be revalued. To promote, protect and recover
the Mexican citizen’s collective health, our society should:
(a) count and respect the juridical bases for tobacco smoke elimination,
and
(b) work on the strengthening of expedite mechanisms for tobacco products
strict regulation and on the constructing of the efficient infra-structure
for a tobacco integral management system.
Francisco J. López-Antuñano, MD, MPH
President
Alliance Against Tobacco, non profit OCS.
Calle Monterrey No. 150-206. CP 06700
Colonia Roma Sur. México DF, México
alantu@insp.mx
Telephone +52 777 3112463
Competing interests:
None declared
Competing interests: No competing interests