We do not disagree with the statements that the Mexican government,
led by Minister of Health Julio Frenk, implemented policies to reduce
tobacco use in the past. The Ministry won tax increases and developed
smoking cessation programs, which are among the best in the region.
These accomplishments do not, however, change the fact that the agreement
with the tobacco industry arrest future progress. In making its agreement
with the tobacco industry, the Ministry ignored the evidence, from both
developed and developing countries around the world, that voluntary
agreements with the tobacco industry have never served the public’s
health.
Mexico was an early ratifier of the Framework Convention for Tobacco
Control (FCTC). The FCTC is clear that such voluntary agreements are to
be avoided: Article 5, section 3 states “In setting and implementing their
public health policies with respect to tobacco control, Parties shall act
to protect these policies from commercial and other vested interests of
the tobacco industry in accordance with national law.” A strong
motivation for both the paper by Samet et al [1] and our accompanying
commentary [2] was to alert other ratifying nations that Mexico’s
agreement was not an appropriate model for implementing the FCTC.
The Mexican “legal and fiscal realities” offered by the Ministry as
justification for the agreement are not unique to Mexico; they apply in
one form or another in most democracies. Many governments prohibit
dedicated taxes and virtually all democracies allow parties affected by
government regulations to sue if they believe that these regulations are
unfair or illegal. As Sebrié and Glantz [2] pointed out, the prohibition
on dedicated taxes does not, in any way, prevent the government from
increasing cigarette taxes and then, in separate legislation,
appropriating the same amount of money to health programs.
The tobacco industry could – and probably would – sue to stop
effective restrictions on cigarette advertising or effective graphical
warning labels on the front of cigarette packages. Despite this threat,
many countries have successfully implemented image-based warnings on
packages, including Brazil, Venezuela, and Uruguay in Latin America, as
well as Canada, Australia, Thailand, Singapore and a number of EU
countries. Being sued by the tobacco industry has become a cost of
implementing effective tobacco control strategies [3, 4]. If the Mexican
government is not willing to consider policies that the tobacco industry
might fight, then it has effectively left the scope of tobacco control
policy to the multinational tobacco companies.
More to the point, at least one tobacco control measure has already
been successfully defended against a legal challenge in Mexico. The weak
local legislation on “Health Protection of Nonsmokers” in Mexico City
(establishing 30% of the total area for nonsmokers and allowing for
ventilation systems) that passed at the end of 2003, was challenged in
court in 2004 by the Vips restaurant chain under the Mexican “Ley de
Amparos” [5]. The court dismissed the case in 2005 [5].
The statement that Mexico’s agreement with the transnational tobacco
companies (Philip Morris and British American Tobacco) is temporary and
that it will end in December 2006 is not correct. Clause 19 states “This
Agreement will take effect between the parts [the Ministry of Health and
the transnational tobacco companies] the day of its signature… It will
have an indefinite effect or until the moment in which all of its
provisions are incorporated into new legislation or regulation, and it
will only be modified by written agreement between the parties. [emphasis
added]”
While it is true that the cigarette taxes have increased under the
current government, the claim that the current tax level is
“unprecedented” is not accurate. In 1981, the year that the tobacco tax
was established, the tax was 139.3% of the price, more thant the present
110%. The tax was also much higher than now during 1986-1987, reaching
180%. Most important, the agreement with the tobacco companies to make
their “donation” to the health fund would be terminated if new taxes are
imposed on cigarettes. Therefore, as long as the agreement is in place it
creates a de facto restriction on taxing cigarettes, effectively blocking
implementation of the FCTC provision (article 6) calling for tax
increases.
The agreement with the tobacco industry will also prevent Mexico from
completely ending tobacco industry advertising, promotion, and sponsorship
as required by the FCTC (article 13). The partial restrictions such as
the removal of advertisements on radio and television in the agreement
simply reflect the tobacco industry’s September 2001 voluntarily self-
regulating advertising code “International Marketing Standards. In its
agreement with the companies, the Ministry simply received a pledge from
the tobacco companies to comply with their own voluntary code.
Indeed, the only effect of the agreement on advertising appears to
have been the proliferation of advertising at eye level throughout the
cities of Mexico (see photo taken in Mexico City in January 2006).
The increase of the health warning labels up to 50% on the back face
of the cigarette packages was also a voluntary measure conceded by the
tobacco industry to prevent large warnings on the front of packages as
recommended by the FCTC (article 11). The agreement explicitly precludes
“images or pictures,” which are more effective than text alone in
communicating important information to smokers and their families.
In addition, the industry voluntarily included one warning label
printed on the lateral side of the pack that reads “Currently there is no
cigarette that reduces health risks” and an insert (written in complex
language in small type) with information for smokers warning that “tobacco
consumption causes different types of cancer, heart and cerebrovascular
disease, embolism, chronic bronchitis, and emphysema.” These last two
measures might be used by the industry to defend itself from future
lawsuits brought by injured smokers or their families, and in any case are
too obscure to be expected to have an impact. It also allows the industry
to continue using misleading and deceptive descriptors such as “mild” and
“light” on the packages, which the FCTC requires (article 11) to be
eliminated within 3 years of entry into force (for Mexico, this would be
27 February 2008).
Claims that federal government buildings are smokefree are also
exaggerated. Consistent with the tobacco industry’s goals, the
government’s regulations require smoking areas for smokers.
The Ministry of Health has ignored the fact that, by agreeing to
accept a “contribution” from the tobacco industry, it gives the
multinational tobacco companies (based in New York and London) a tax break
that, through December 2006 alone, will cost the Mexican people 1000
million pesos (US$96 million).
The agreement with the tobacco companies has also another major
effect, documented in other parts of the world [6, 7]: it creates a
corrupting influence on government. The money the tobacco industry
“donates” can buy a new building for the National Cancer Institute of
Mexico, or funding for treating children with leukemia [8], but these
“gifts” come at the cost of premature deaths of smokers and secondhand
smokers when the government agrees to abandon the effective tobacco
control strategies required and recommended by the FCTC.
Ernesto Sebrie, MD MPH
Postdoctoral Fellow
Stanton A. Glantz, PhD
Professor of Medicine
University of California San Francisco
References
1. Samet, J., et al., Mexico and the tobacco industry: doing the
wrong thing for the right reason? BMJ, 2006. 332(7537): 353-4.
2. Sebrie, E. and S.A. Glantz, The tobacco industry in developing
countries. BMJ, 2006. 332(7537): 313-4.
3. Nixon, M.L., L. Mahmoud, and S.A. Glantz, Tobacco industry
litigation to deter local public health ordinances: the industry usually
loses in court. Tob Control, 2004. 13(1): 65-73.
4. Ibrahim, J.K. and S.A. Glantz, Tobacco industry litigation
strategies to oppose tobacco control media campaigns. Tob Control, 2006.
15(1): 50-8.
5. Aviles, C., Defienden derechos de no fumadores, in El Universal.
2005: Mexico. p. 2.
6. Glantz, S.A. and E.D. Balbach, Tobacco War: Inside the California
Battles. 2000, Berkeley: University of California Press.
7. Gilmore, A., J. Colin, and M. McKee, British American Tobacco's
erosion of health legislation in Uzbekistan. BMJ, 2006. 332(7537): 355-8.
8. Godlee, F., A time for courage. BMJ, 2006. 332(7537):
doi:10.1136/bmj.332.7537.0-f.
Competing interests:
None declared
Competing interests:
No competing interests
14 March 2006
Stanton A Glantz
Professor of Medicine
Ernesto Sebrie
University of California San Francisco, CA 94143-1390
Rapid Response:
Response to the Ministry of Health
We do not disagree with the statements that the Mexican government,
led by Minister of Health Julio Frenk, implemented policies to reduce
tobacco use in the past. The Ministry won tax increases and developed
smoking cessation programs, which are among the best in the region.
These accomplishments do not, however, change the fact that the agreement
with the tobacco industry arrest future progress. In making its agreement
with the tobacco industry, the Ministry ignored the evidence, from both
developed and developing countries around the world, that voluntary
agreements with the tobacco industry have never served the public’s
health.
Mexico was an early ratifier of the Framework Convention for Tobacco
Control (FCTC). The FCTC is clear that such voluntary agreements are to
be avoided: Article 5, section 3 states “In setting and implementing their
public health policies with respect to tobacco control, Parties shall act
to protect these policies from commercial and other vested interests of
the tobacco industry in accordance with national law.” A strong
motivation for both the paper by Samet et al [1] and our accompanying
commentary [2] was to alert other ratifying nations that Mexico’s
agreement was not an appropriate model for implementing the FCTC.
The Mexican “legal and fiscal realities” offered by the Ministry as
justification for the agreement are not unique to Mexico; they apply in
one form or another in most democracies. Many governments prohibit
dedicated taxes and virtually all democracies allow parties affected by
government regulations to sue if they believe that these regulations are
unfair or illegal. As Sebrié and Glantz [2] pointed out, the prohibition
on dedicated taxes does not, in any way, prevent the government from
increasing cigarette taxes and then, in separate legislation,
appropriating the same amount of money to health programs.
The tobacco industry could – and probably would – sue to stop
effective restrictions on cigarette advertising or effective graphical
warning labels on the front of cigarette packages. Despite this threat,
many countries have successfully implemented image-based warnings on
packages, including Brazil, Venezuela, and Uruguay in Latin America, as
well as Canada, Australia, Thailand, Singapore and a number of EU
countries. Being sued by the tobacco industry has become a cost of
implementing effective tobacco control strategies [3, 4]. If the Mexican
government is not willing to consider policies that the tobacco industry
might fight, then it has effectively left the scope of tobacco control
policy to the multinational tobacco companies.
More to the point, at least one tobacco control measure has already
been successfully defended against a legal challenge in Mexico. The weak
local legislation on “Health Protection of Nonsmokers” in Mexico City
(establishing 30% of the total area for nonsmokers and allowing for
ventilation systems) that passed at the end of 2003, was challenged in
court in 2004 by the Vips restaurant chain under the Mexican “Ley de
Amparos” [5]. The court dismissed the case in 2005 [5].
The statement that Mexico’s agreement with the transnational tobacco
companies (Philip Morris and British American Tobacco) is temporary and
that it will end in December 2006 is not correct. Clause 19 states “This
Agreement will take effect between the parts [the Ministry of Health and
the transnational tobacco companies] the day of its signature… It will
have an indefinite effect or until the moment in which all of its
provisions are incorporated into new legislation or regulation, and it
will only be modified by written agreement between the parties. [emphasis
added]”
While it is true that the cigarette taxes have increased under the
current government, the claim that the current tax level is
“unprecedented” is not accurate. In 1981, the year that the tobacco tax
was established, the tax was 139.3% of the price, more thant the present
110%. The tax was also much higher than now during 1986-1987, reaching
180%. Most important, the agreement with the tobacco companies to make
their “donation” to the health fund would be terminated if new taxes are
imposed on cigarettes. Therefore, as long as the agreement is in place it
creates a de facto restriction on taxing cigarettes, effectively blocking
implementation of the FCTC provision (article 6) calling for tax
increases.
The agreement with the tobacco industry will also prevent Mexico from
completely ending tobacco industry advertising, promotion, and sponsorship
as required by the FCTC (article 13). The partial restrictions such as
the removal of advertisements on radio and television in the agreement
simply reflect the tobacco industry’s September 2001 voluntarily self-
regulating advertising code “International Marketing Standards. In its
agreement with the companies, the Ministry simply received a pledge from
the tobacco companies to comply with their own voluntary code.
Indeed, the only effect of the agreement on advertising appears to
have been the proliferation of advertising at eye level throughout the
cities of Mexico (see photo taken in Mexico City in January 2006).
The increase of the health warning labels up to 50% on the back face
of the cigarette packages was also a voluntary measure conceded by the
tobacco industry to prevent large warnings on the front of packages as
recommended by the FCTC (article 11). The agreement explicitly precludes
“images or pictures,” which are more effective than text alone in
communicating important information to smokers and their families.
In addition, the industry voluntarily included one warning label
printed on the lateral side of the pack that reads “Currently there is no
cigarette that reduces health risks” and an insert (written in complex
language in small type) with information for smokers warning that “tobacco
consumption causes different types of cancer, heart and cerebrovascular
disease, embolism, chronic bronchitis, and emphysema.” These last two
measures might be used by the industry to defend itself from future
lawsuits brought by injured smokers or their families, and in any case are
too obscure to be expected to have an impact. It also allows the industry
to continue using misleading and deceptive descriptors such as “mild” and
“light” on the packages, which the FCTC requires (article 11) to be
eliminated within 3 years of entry into force (for Mexico, this would be
27 February 2008).
Claims that federal government buildings are smokefree are also
exaggerated. Consistent with the tobacco industry’s goals, the
government’s regulations require smoking areas for smokers.
The Ministry of Health has ignored the fact that, by agreeing to
accept a “contribution” from the tobacco industry, it gives the
multinational tobacco companies (based in New York and London) a tax break
that, through December 2006 alone, will cost the Mexican people 1000
million pesos (US$96 million).
The agreement with the tobacco companies has also another major
effect, documented in other parts of the world [6, 7]: it creates a
corrupting influence on government. The money the tobacco industry
“donates” can buy a new building for the National Cancer Institute of
Mexico, or funding for treating children with leukemia [8], but these
“gifts” come at the cost of premature deaths of smokers and secondhand
smokers when the government agrees to abandon the effective tobacco
control strategies required and recommended by the FCTC.
Ernesto Sebrie, MD MPH
Postdoctoral Fellow
Stanton A. Glantz, PhD
Professor of Medicine
University of California San Francisco
References
1. Samet, J., et al., Mexico and the tobacco industry: doing the
wrong thing for the right reason? BMJ, 2006. 332(7537): 353-4.
2. Sebrie, E. and S.A. Glantz, The tobacco industry in developing
countries. BMJ, 2006. 332(7537): 313-4.
3. Nixon, M.L., L. Mahmoud, and S.A. Glantz, Tobacco industry
litigation to deter local public health ordinances: the industry usually
loses in court. Tob Control, 2004. 13(1): 65-73.
4. Ibrahim, J.K. and S.A. Glantz, Tobacco industry litigation
strategies to oppose tobacco control media campaigns. Tob Control, 2006.
15(1): 50-8.
5. Aviles, C., Defienden derechos de no fumadores, in El Universal.
2005: Mexico. p. 2.
6. Glantz, S.A. and E.D. Balbach, Tobacco War: Inside the California
Battles. 2000, Berkeley: University of California Press.
7. Gilmore, A., J. Colin, and M. McKee, British American Tobacco's
erosion of health legislation in Uzbekistan. BMJ, 2006. 332(7537): 355-8.
8. Godlee, F., A time for courage. BMJ, 2006. 332(7537):
doi:10.1136/bmj.332.7537.0-f.
Competing interests:
None declared
Competing interests: No competing interests