UK is ranked best at resisting tobacco industry’s influence, Japan worst
BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5982 (Published 10 October 2019) Cite this as: BMJ 2019;367:l5982
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Iacobucci reported that the UK is the least favourable to tobacco industry influence (score 26) in the world according to an analysis from a global tobacco industry watchdog.(1) This deserves scrutiny.
First, why a complex analysis using non validated surrogates when smoking prevalence, a simple indicator, is the endpoint of tobacco control policy? Comparable countries such as the US, Denmark, New Zealand, Iceland Australia, and Canada have lower smoking prevalence than the UK. So, why is the US ranking in the bottom as being favourable to tobacco industry influence (scoring 72)? Even Canada ranks in the middle (scoring 47) despite having the lowest prevalence for smoking with Australia!
Second, why point the finger of blame on the tobacco industry? The so-called Big Tobacco, a low-income worker which gets less than 10% of the retail price, seems a perfect scapegoat. Could the Big Boss be the Secretary of the Treasury who gets more than 80% of the retail price! While Australia may seem among the most proactive countries for tobacco control, with a 15% prevalence of daily smoking in 2016, taxes from tobacco products may be firstly aimed at increasing state income (from 8.0 AU$million in 2001 to 10,4 AU$million in 2016 (expressed in 2012 AU$).(2) An ancillary reward must not be overlooked, tobacco taxes reinforce social cohesion: tobacco preferentially targets the poorest who cannot participate in the budget through income taxes. However, taxes are only the tip of the iceberg. As half of smokers will die prematurely, by two decades, from smoking (3) and as healthcare expenditures skyrocket with age (average spending on 60 year olds is twice as high as the spending for 40 year olds, spending on 70 year olds is four-times as high and 80 year olds have on average six-times higher hospital expenditures than 40 year olds), they may cost less to the healthcare system.(4) Similarly, less pension payments for smokers.(5)
Could pledges for tobacco control be only a smokescreen as there has not yet been either a ban on flavour (menthol first) or reduction in nicotine content in any country. Would these simple measures be too effective. In the '60s Sano marketed a cigarette with the lowest nicotine level on the market, getting the lowest sales among 40 brands, the only commercial failure of the tobacco business ever! At the same time, Philip Morris had begun using ammonia to “freebase” nicotine _“crack nicotine”_ allowing Malboro sales to skyrocket, switching Winston’s first place whose sales fell down. No countries want to kill the goose that lays the golden egg.
Last, China has the largest tobacco industry in the world with 40% of global tobacco production, and the state monopoly China National Tobacco Corporation (CNTC) is the fourth largest Chinese company in terms of profit. India is the world’s 2nd largest producer of tobacco, the government has been supporting its tobacco industry growth. In 1947, it set up the Tobacco Board to increase exports. In 1965, it created the Central Tobacco Research Institute, under the aegis of the Indian Council of Agricultural Research to provide consultancies. According to experts, in 2016, “The performance of FCV tobacco has been impressive, particularly in terms of export and farmer earnings.”(https://www.tiionline.org/facts-sheets/tobacco-production/)
1 Iacobucci G. UK is ranked best at resisting tobacco industry’s influence, Japan worst. BMJ 2019;367:l5982
2 Scollo, MM and Winstanley, MH. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2018. Available from https://www.tobaccoinaustralia.org.au/chapter-13-taxation/13-6-revenue-f... Accessed 15 October 2019.
3 Doll R, Peto R. Mortality in relation to smoking: 20 years' observations on male British doctors. BMJ1976;2:1525-36.
4 Melberg HO. Are healthcare expenditures increasing faster for the elderly than the rest of the population? Expert Rev Pharmacoecon Outcomes Res 2014;14:581-3.
5 Braillon A. Smoking-attributable medical expenditures: Time biases and smokers' social role. Prev Med 2015;81:294.
Competing interests: in 2009 AB, a tenure senior consultant, was illegally sacked by the French secretary of Health from a tenure position while his chief of department, Pr Gérard Dubois was sued for libel. (Witton J, O’Reilly J. Tobacco scientist wins case against illegal sacking. Addiction 2012;107:1714-5)
Re: UK is ranked best at resisting tobacco industry’s influence, Japan worst
The ambition to rate nations for their efforts to keep the tobacco industry from interfering in public health policy is unquestionably important. But this report rates only a very small number of nations. Many of those excluded are those which often score well down on transparency indexes and have poorly developed public information services. But what possible explanation can there be for not ranking Australia in such a list, leading to headlines like the one on this piece?
Australia's record in frustrating and repelling the tobacco industry's efforts to thwart effective tobacco control is surely second to none. Three recent examples (initiating plain packaging and defending it 6-1 in Australia's High Court, the Permanent Court of Arbitration and the World Trade Organization; having the world's most expensive cigarettes; being one of the first nations to ban retail displays of tobacco; and restricting duty free imports to one unopened packet) illustrate our record.
There has been no policy that the tobacco industry opposed which has not been adopted in Australia: the have lost every policy battle they fought. And while the USA is now flailing about trying to stuff the vaping genie back in its bottle, Australia has adopted a highly precautionary approach to ecigarette regulation which is looking increasingly enviable.
Publishing a global league table with this absence is like ranking nations on marathon running, but leaving out Kenya, or red wines while excluding those from Bordeaux.
Competing interests: No competing interests