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Analysis And Comment Public health

British American Tobacco's erosion of health legislation in Uzbekistan

BMJ 2006; 332 doi: (Published 09 February 2006) Cite this as: BMJ 2006;332:355
  1. Anna B Gilmore, clinical lecturer in public health (,
  2. Jeff Collin, lecturer in global health policy2,
  3. Martin McKee, professor of European public health1
  1. 1 European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine
  2. 2 Centre for International Health Policy, University of Edinburgh
  1. Correspondence to: A B Gilmore

    Uzbekistan shows how countries that privatise state owned tobacco industry can be manipulated by global companies

    In 1994 Uzbekistan's tobacco industry was privatised in a closed deal enabling British American Tobacco (BAT) to establish a production monopoly.1 While completing this deal, BAT learnt that Uzbekistan's chief sanitary doctor, Mr Iskandarov, had issued Health Decree 30, a potentially highly effective piece of tobacco control legislation that would have banned tobacco advertising and smoking in public places and introduced health warnings. BAT responded aggressively, delaying completion of its investment until the decree was replaced with a voluntary advertising code.

    Until now BAT has implied that it developed the code without prompting and presented it as an example of “the company's responsible attitude to its advertising practices.”2 We have obtained evidence from BAT corporate documents released after litigation in the United States3 that shows how BAT in fact developed this code when overturning health legislation that would have served to protect the health of the Uzbek population. Its behaviour highlights broader concerns about the influence of transnational tobacco companies over health policy when they invest in low income countries. A description of our methodology is available on

    Marketing environment

    The regime of Uzbek President Islam Karimov has held power since independence in 1991, gaining notoriety for serious human rights abuses.4 5 Despite largely rejecting international advice to pursue rapid and extensive privatisation,6 7 President Karimov aligned himself closely with the BAT deal, then Central Asia's largest foreign investment.810 He hoped to use it to project Uzbekistan as a safe investment environment.11

    BAT, in turn, considered Uzbekistan a remarkable opportunity. After a company visit in July 1993 identified only one electronic billboard in the country,12 a marketing report described Uzbekistan as, “unique in the …

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