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The Union has joined forces with organisations from across the globe to expose the tobacco industry’s efforts to interfere with tobacco control, as part of STOP.

STOP (Stopping Tobacco Organizations and Products) is a new global tobacco industry watchdog group funded by Bloomberg Philanthropies and collectively directed by The University of Bath, The Global Centre for Good Governance in Tobacco Control, The Union, and Vital Strategies.

Launched in December 2018, STOP is working to expose the tobacco industry’s efforts to hook a new generation of smokers, attempts to undermine tobacco control, work to derail policy and unethical business practices.

The Union is supporting the broad strategy of the project by creating in-country connections and synergizing with those already doing industry interference work on the ground.

The Union’s role in the project is also to facilitate linking to and coordinating with the wider Bloomberg Initiative to Reduce Tobacco Use network.

Overall, STOP aims to expose tobacco industry tactics in all forms and arm stakeholders with evidence and tools to effectively counter the industry and advance policy.

 

In June 2018, The Union launched a new Global Enforcement Programme funded by Bloomberg Philanthropies. This is a pilot programme running for three years in two cities in each of the following countries: China, Indonesia, India and Pakistan.

The focus is on sub-national support, working with city governments to increase compliance with laws on smoke-free and tobacco advertising, promotion and sponsorship (TAPS) ban at points of sale.

The Johns Hopkins University School of Public Health is supporting the programme by conducting pre- and post-compliance surveys in each city. The baseline surveys have already taken place in China and Indonesia; India and Pakistan surveys will be completed this year. In addition to the program activity in each city, a global resource hub is being developed to share learning, tools, resources and case studies with other cities and countries across the globe.

 

Today the Task Force on Fiscal Policy for Health has published “Health Taxes to Save Lives”, calling on countries to significantly raise tobacco, alcohol and sugary beverage taxes to save lives and address the growing burden of noncommunicable diseases (NCDs).

The Task Force, co-chaired by Michael Bloomberg and economist Larry Summers, former Secretary of the U.S. Treasury and former Director of the National Economic Council, examined the use of excise tax policy for health and how countries can best leverage fiscal policies to yield improved health outcomes for their citizens with the added benefit of bringing in additional revenue.

The Union welcomes the Task Force’s recommendation to increase taxes on tobacco, alcohol and sugary beverages to save lives and help economies, particularly in low- and middle-income countries.

The analysis within the report shows we could prevent 50 million premature deaths in the next 50 years if countries implemented taxes to raise prices of tobacco, alcohol and sugary beverages by 50 percent.

NCDs are the leading cause of death in the world, killing 40 million people each year and representing 70 percent of all annual deaths. Eighty percent of NCD deaths occur in low- and middle-income countries, straining health care systems, contributing to poverty and posing a major barrier to development. Tobacco use, obesity and risky alcohol consumption are three leading risk factors for the development of NCDs.

As the report highlights, Ministers of Finance control a powerful tool to reduce the harmful use of these products: tax policy.

The Task Force brought together fiscal policy, development and health leaders from around the globe to address the enormous and growing health and economic burden of NCDs with fiscal policy tools that are currently underutilised by governments and their leaders.

The report can be found on the Task Force website here: https://www.bloomberg.org/program/public-health/task-force-fiscal-policy-health/#overview

 

The following speech was given by José Luis Castro, Executive Director of The Union, at the first Global Forum on Human Rights and a Tobacco-Free World, on 26 March in the Cotroceni Palace, Bucharest, Romania. Global leaders in public health and human rights came together to focus on the ongoing tobacco epidemic and to determine what is needed to create an actionable plan to end it.

“A year ago this month, at the 17th World Conference on Tobacco or Health in South Africa, delegates endorsed the “Cape Town Declaration on Human Rights and a Tobacco-free World.” The declaration includes a phrase I want to highlight. It states:

“We agree that the manufacture, marketing and sale of tobacco are incompatible with the human right to health.”

“In the spirit of the Cape Town Declaration, I want to call on all of us working to fulfil the implementation of the Framework Convention on Tobacco Control (FCTC) to utilise human rights mechanisms to advance the objectives of the FCTC. At the same time, I want to urge all of us to work together to see that the United Nations Human Rights Council includes support for the implementation of the FCTC within its objectives.

Implementing the FCTC is a way for the tobacco control community to advance human rights objectives. And the human rights community must see tobacco control as an important human rights issue. These two goals reinforce each other.

“I’m encouraged that the UN intergovernmental working group on transnational corporations and other business enterprises with respect for human rights is paying close attention to the FCTC. As many of you know, this body is working to advance an internationally binding instrument to regulate the activities of transnational corporations and business enterprises within human rights law. And the FCTC Secretariat is actively participating in those negotiations.

“All of us have the right to achieve the highest attainable standard of physical and mental health. And when it comes to protecting that right, there might be no other area of public policy as important as tobacco control.

“For tens of millions of people around the world, who have become addicted to tobacco products by using those products as intended, the tobacco industry remains one of the main obstacles to improving their standard of health.

“The rhetoric of the tobacco industry has always been intended to confuse and mislead governments and the public. Nothing has changed. Even though the industry has begun to speak the language of public health, we all know their goal is to weaken the adoption and implementation of the Framework Convention.

“Their interference is more than rhetorical, however. The Foundation for a Smoke-Free World, founded with an enormous investment from Philip Morris International (PMI), is working to secure a seat at the table with public health policymakers around the world. They have stated that their company strategy is to phase out the sale of traditional cigarettes. We saw the headlines, saying that PMI was “giving up cigarettes.”

“Yet PMI has not set any kind of timeline for stopping its sale of cigarettes. In fact, the company continues to make new investments in its capacity to produce traditional cigarettes. In January, for example, it was reported that PMI was in negotiations to buy a large stake in Mastermind Tobacco, Kenya’s second-largest cigarette producer. And last year, PMI opened a new cigarette factory in that country, which was inaugurated by Tanzania’s president. While PMI is making new investments in cigarettes, its parent company recently acquired a 35-percent stake in e-cigarette maker Juul.

“It appears that their objective is to maximise the sale and profit from cigarettes, heated tobacco products, and e-cigarettes… all at the expense of people’s right to health.

“The truth still holds: what is good for the tobacco industry is bad for public health.

“If we want to reach SDG 3.4, which is to reduce premature death from non-communicable diseases by one-third by 2030 and to promote mental health and wellbeing. If we want to reach SDG 3.3, which is to end the epidemics of AIDS, tuberculosis and other communicable diseases.

“Then we know that we need countries to fully implement the Framework Convention. And we know that, despite its new rhetoric that uses the language of public health, the tobacco industry would have governments to move in the opposite direction.

“This is why it’s so important that we continue to work together to persuade governments to place our human right to health well above the interests of the tobacco industry. Governments must fulfil their binding obligations and implement all measures of the Framework Convention, and they must do so urgently.

“Implementing the Framework Convention is the minimum of what we should expect governments to do. We know that the treaty actually encourages States Parties to implement measures beyond those required by the Convention and its protocols.

“Jeff Collin, a professor of global health policy at the University of Edinburgh, and others have been making the argument that the Sustainable Development Goals do not do enough to address the commercial determinants of health. And because of that, we need new approaches to governing the commercial determinants of health.

“One important way that we can fight back against the commercial determinants of poor health is to work more within a human rights framework. This includes advocating for human rights bodies to champion the cause of tobacco control as a human rights issue. I would like to see the UN Human Rights Council adopt a resolution on tobacco control. This would provide a valuable tool for advocates to influence public policy at the national level.

“Among other things, it would establish closer working relationships between the Human Rights Council and the Convention Secretariat. It would help us to embed support for the FCTC within national human rights plans. It would help us clarify, for policymakers, exactly where tobacco control and human rights intersect.

“I would also like to see us successfully secure a human rights decision at the upcoming COP9. We were close to securing this at the last COP and fell short. I very much hope we are successful next time.

“And I would like to see the human rights community work with us to hold the tobacco industry accountable for phasing out the commercial sale of traditional cigarettes. PMI has stated that this is its strategy, and we need to do everything we can to hold them accountable for doing so along a clear timeline. If they will not set a timeline, then perhaps it is up to us to set a deadline and campaign around it together.

“There is so much progress to be made by putting human rights at the centre of our work, and by becoming true partners with human rights advocates. I am confident that this forum is the start of something new and important for tobacco control, and for the millions of people whose right to health continues to be attacked by the tobacco industry.”

 

Last week, the American Heart Association published a policy statement regarding the actions that must be taken to achieve the end of all tobacco use and nicotine addiction in the United States.

The Union welcomes the statement, published in the scientific journal Circulation, which describes what governments, public health community and health care providers need to do to achieve the “tobacco endgame”. Such a goal first requires minimising the use of all combustible tobacco products and ensuring electronic cigarettes and other recent products do not addict the next generation of youth and adolescents.

According to the American Heart Association, electronic cigarettes have become the most popular tobacco products for youth and adolescents in the United States and are attracting youth to new avenues for nicotine addiction.

The American Heart Association state that this endgame goal is at risk with the tobacco industry’s increasingly aggressive targeting of youth and adolescents, which has driven the rapid rise of electronic cigarettes and other new and emerging tobacco products. They believe these pose an unprecedented threat to human life and the decades of public health efforts to reduce tobacco use.

Dr Gan Quan, Director of Tobacco Control at The Union, said: “We fully support this balanced, comprehensive and timely presidential advisory from the American Heart Association.

“The tobacco endgame is within reach, but we must not let the tobacco industry derail this through the development and promotion of electronic cigarettes.

“Although these products might help people stop smoking, it is still unclear what the long-term health effects of e-cigarettes are.”

For the endgame to be achieved the American Heart Association urgently calls for robust US Food and Drug Administration regulation of all tobacco products to avoid the significant economic and population health consequences of continued tobacco use.

The endgame strategy also needs to be coordinated with the long-standing, evidence-based tobacco control strategies that have significantly reduced tobacco use and initiation in the United States.

Nancy Brown, CEO of the American Heart Association, said: “We are truly at a crossroads in the decades-long war against Big Tobacco over the future of our children.

“We could allow current trends to continue on their disturbing path or we could take action to change the course of tobacco use in this country. If lawmakers, policymakers, health care providers and the public health community seize this moment and do what is necessary to reach the tobacco endgame, we will save millions of lives in the process.”

Please read The Union’s position papers on e-cigarettes and heated tobacco products through the links below:

- e-cigarettes - https://tobaccofreeunion.org/images/The_Union_Summary_Position_Statement_ECs-ENDS_Update_2014_-_2016_update.pdf

- Heated tobacco products - https://tobaccofreeunion.org/images/Heated_Tobacco_Product_Union_Position_Statement_-_Final_25.01.18.pdf

 

In El Salvador, the Fondo Solidario para la Salud (FOSALUD), with support from The Union, has recently held a press conference to announce the results of two research studies, to help understand the processes by which consumers purchase tobacco and thereby strengthen tobacco control in El Salvador.

The first study explored how advertising and the display of cigarettes at the point-of-sale impacted on the consumer’s impulse to purchase. Findings demonstrated that the display of tobacco products is the principal promotional strategy adopted by retailers. It was found that 91 percent of retailers display cigarettes, and in most cases the display is positioned near to the selling point, or till. This, in turn, had a large impact on consumers’ impulse to purchase, with eight out of 10 smokers saying they had decided to purchase cigarettes at least once at the time of paying their bill because they saw those packages being displayed.

The study went on to demonstrate that, despite point-of-sale promotion, the population is strongly supportive of tobacco control. It was found that 92.3 percent thought that young people should not be exposed to advertisements of products deemed damaging to health, and eight out of 10 approved of the complete removal of point-of-sale display and advertising of tobacco products to discourage consumption amongst young people. Current legislation permits advertising and product display at the point-of-sale.

The second study analysed the impact of health warnings and plain packaging of tobacco products on public perceptions. The World Health Organization Framework Convention on Tobacco Control (FCTC) supports plain packaging and stipulates that packaging carries health warnings describing the harmful effects of tobacco use. Evidence finds that plain packaging reduces the attractiveness of tobacco products; restricts use of the pack as a form of advertising; limits misleading packaging and increases the effectiveness of health warning. Studies have also shown that plain packaging increased an urgency among smokers to quit.

Findings in the FOSALUD study confirmed that health warning labels are effective in stimulating negative emotions and result in an increased number of people who have tried to stop smoking, particularly young people. Young people were also of the opinion that the use of colour had the potential to make the packaging less attractive, induce a sensation of fear, provide an association with a product of inferior quality, and make health-related imagery more visible. The project confirmed that neutral packaging would achieve its objective of reducing demand for tobacco products.

Verónica Villalta, FOSALUD’s Executive Director, stated that the findings from both projects provided the scientific evidence to drive the reform of tobacco control legislation. The case for investment in Tobacco Control in El Salvador, presented by FOSALUD last October, had already proposed specific actions to reduce tobacco consumption: to ban all forms of tobacco advertising, promotion and sponsorship, and to update health warning imagery and introduce neutral packaging.

Mr. Gustavo Soñora, The Union’s Regional Director of Latin America, speaking at the press conference to launch the results of both studies said: “Hopefully, the scientific evidence from the studies by FOSALUD will support new tobacco control legislation, one based on the protection of health as a human right. I also hope to witness the benefits on people’s health of stricter controls in the near future. The sooner these controls are adopted and enforced the better off Salvadorians will be”.

In El Salvador during 2016, 1,624 people died as a consequence of using tobacco, 46 percent of these being classified as premature (when the person concerned was under 70 years). Seventy-eight percent of these deaths can be linked directly to tobacco consumption, with exposure to tobacco smoke making up the remaining 22 percent. It is estimated that in the same year, tobacco consumption cost the nation US$263.6m, which is equivalent to approximately 1 percent of GDP.

 

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