An international perspective on tobacco control
When the measures are introduced at the end of the year, depending on legal challenges, Australia will become the first country in the world to require that tobacco products be sold in standardised packs that have been stripped of their colourful logos and instead plastered with prominent health warnings. While clearly proud of her country’s achievement, Jones humbly stresses that the Australians shouldn’t get all the credit. Australia may have been the first to take the leap, but it was the introduction of the WHO Framework Convention on Tobacco Control (FCTC) that really transformed the landscape and made it all possible, she says.
“That has really helped us enormously in Australia because it has given our government a bit more impetus to go down the pathway towards more reforms. So thank goodness for the treaty.”
The FCTC, which has been agreed to by over 170 countries, as a whole is greater than the sum of its parts. However, one point is worth singling out. Article 5.3 states that: ‘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.’
This particular article inspired the theme of this year’s World No Tobacco Day – tobacco industry interference – which, according to WHO, was selected to focus on the need to “expose and counter the tobacco industry’s brazen and increasingly aggressive attempts to undermine the WHO FCTC”. To mark the occasion, Jones was in Edinburgh to attend the launch of The International Union Against Tuberculosis and Lung Disease (The Union) FCTC Article 5.3 toolkit. The free toolkit provides guidance and assistance to governments and other agencies involved in tobacco control. Fact sheets ranging from ‘How do I take steps to prevent interference by the tobacco industry in my country’, to ‘Why do we treat the tobacco industry differently from other industries’, offer stepby- step guidance on the key legislative and policy elements of a strategy to safeguard laws and policies from tobacco industry interference. While the toolkit also includes model directives, policy and legislation based on legislation that has already been enacted in various countries that governments can adapt to suit their own situations.
Being able to share best-practice examples, such as those tobacco control measures already introduced in Australia and Scotland, helps other countries to realise that change is possible, explains Dr Ehsan Latif, the Union’s director of tobacco control, as he urges the international community to unite and act as one.
“We need examples from other countries that have shown progress where the smoking rates have not only stabilised but [are] also starting to decrease. This gives encouragement to those low- and middleincome countries to say, yes, it is effective. We may not see a change tomorrow but there will be a subsequent change and we will be saving not only lives but resources and money.”
According to WHO, the global tobacco epidemic kills nearly 6 million people each year, of which more than 600,000 are people exposed to second-hand smoke. Unless action is taken, it will kill up to 8 million people by 2030, of which more than 80 per cent will live in low- and middle-income countries.
Jones, who is also a technical adviser to the Union, agrees with Latif that a global response is required and emphasises our collective responsibility.
“It is sometimes hard getting this message across to individual countries because they are very focused on their own country and what works for them, but I think the lesson from Australia and from other countries is that the industry is trying to drag down every country and delay their health policies, delay them taking action to protect their own people and we do need a global response to that. And that is why working together, using the treaty, using the obligations within the treaty to fight back and resist is most important.”
Earlier this year the UK Government launched its own consultation on standardised packaging, which will run until 10 July.
“Smoking remains one of the most significant challenges to public health. Each year it accounts for over 100,000 deaths in the UK and one in two long-term smokers will die prematurely from a smoking disease,” UK Health Secretary Andrew Lansley said.
“That is why the health ministers across the UK have a responsibility to look closely at initiatives that might encourage smokers to quit and stop young people taking up smoking in the first place.”
Lansley has said that his mind is “open” to proposals to strip cigarette packets of branding. However, if the UK does choose to follow in Australia’s footsteps and introduce its own plain packaging legislation, Australia’s experience may prove invaluable.
Jones believes that many of the arguments made against plain packaging in Australia will soon become familiar in the UK.
“I’m convinced that the tactics we’ve seen in Australia will be used here in Scotland on plain packaging and that means economic threats, legal threats using whatever trade treaties they can to say that they have been violated.”
Opponents of the legislation in Australia argued that it was a nanny state policy that will lead to an influx of cheap cigarettes flooding the market, create job losses, and increase smuggling and illicit tobacco. Naturally, Jones disagrees. She explains that one of the things that helped quash these arguments at the time from an industry that was fighting hard as it no doubt feared the domino effect of such legislation succeeding in one country, was having a government that was prepared to stand up and a particularly strong champion in the then health minister, Nicola Roxon.
“I can’t really underestimate the significance of that because you don’t always get a health minister of that calibre who is prepared to fight to the death…” Roxon, who received a medal from the WHO for her efforts, has continued to fight for the legislation as Australia’s Attorney General, where she is now at the forefront of the legal challenges issued against the government. She also recently announced tougher penalties for tobacco smugglers, who could now face up to ten years imprisonment for bringing illegal tobacco into the country.
Political leadership is key. But to protect public health policies from tobacco industry interference it is also important to be prepared, Jones says. In Australia, ASH prepares a monthly monitoring report to keep them abreast of the industry’s recent activities.
“I think we do have to do monitoring well so we can predict and counter the false information, the misrepresentation, but we have to move beyond that and put something systematically in place because otherwise it will just be another battle.” Her other advice would be that governments need to have a systematic approach to how they will deal with the industry and should also limit their interactions, she says.
“If we didn’t have such an aggressive industry, imagine how governments would have done so much to protect, we’d have a pretty healthy population because they wouldn’t be listening to them. They wouldn’t give them a seat at the table. They wouldn’t take their political donations. So we need to have a systematic approach, whether it is legislation or codes of conduct, whatever, we need to have that in place so we are clear about how we deal with this industry because they are not like any other industry. They are basically selling death and disease. So to sit down and treat them like we would treat another industry is completely wrong.”
However, despite these challenges, those in tobacco control have much to celebrate and recently some have begun to talk of an “end game”, says Jones. Australia has an ambitious target to reduce the smoking rate to ten per cent or less by 2018, while New Zealand has already begun to talk about ending the commercial sale of tobacco products by 2025. However, while an end may be in sight for some of the richer countries, Jones adds that for the vast population of the world the epidemic hasn’t yet peaked and so if millions of lives are to be saved, this needs to become a global trend.
“That is such an important point,” Latif agrees. “Because when the Scottish Parliament discusses plain packaging or raising taxes or any of these ideas, they are not only looking at, and I think they should realise this, they are not only talking about the Scottish people; the whole world is watching. And that whole world is trying to take an example from the Scottish Government. If that can be done, why can’t we do it?”