Contents - Lokal bez papierosa
Transcription
Contents - Lokal bez papierosa
Contents 03 Introduction 05 Selling smoke: the business of deceit 07 Big Tobacco’s 7 deadly Ds 15 Blowing the smoke away 20 Global Smokefree Map 22 Africa 25 Americas 30 Eastern Mediterranean 32 Europe 40 South East Asia 42 Western Pacific 46 References The Global Smokefree Partnership is a multipartner ini- For more information on smokefree air: tiative formed to promote effective smokefree air policies www.globalsmokefreepartnership.org worldwide. The Partnership helps practitioners and advocates of smokefree policies to: email: [email protected] • access the evidence for smokefree policies • request assistance from a network of experts • take action in support of smokefree policies The Partnership would also like to thank Corporate Accountability International for assistance with this report and for its ongoing monitoring of Big Tobacco’s abusive tactics around the world. The Partnership is hosted by the American Cancer Soci- For more information on tobacco industry attempts to ety and the Framework Convention Alliance. The partners undermine health policy, or to join Corporate Accountare: ability International’s campaign to protect the global tobacco treaty against tobacco industry interference, visit Action on Smoking and Health - DC www.StopCorporateAbuse.org Action on Smoking and Health London Americans for Nonsmokers’ Rights Campaign for Tobacco-Free Kids Cancer Research UK HealthBridge India International Union Against Cancer International Union Against Tuberculosis and Lung Disease Johnson and Johnson Johns Hopkins Bloomberg School of Public Health global smokefree partnership Pfizer Director: Cassandra Welch Project Manager: Antonella Cardone Promoting Action for Smokefree Environments (APALTA) Project Co-ordinator: Ami Valdemoro Report Writer: Tanith Muller Roswell Park Cancer Institute Report Design and layout: Pixel Entropy, Naples, Italy Smokefree Partnership Europe Southeast Asia Tobacco Control Alliance World Heart Federation World Lung Foundation Suggested Citation: Global Smokefree Partnership (2009) Global Voices Report: Rebutting the Tobacco Industry, winning smokefree air, 2009 Status Report. © Global Smokefree Partnership 2009 Introduction In mid 2009, more than 400 million people are protected by comprehensive smokefree laws. These are the strongest smokefree laws, which do not allow any designated smoking rooms and include only extremely limited exemptions. A further 500 million people are covered by strong smokefree laws. These laws protect most people, most of the time. Overall, close to a billion people in some 44 countries now have local or national regulations protecting them from secondhand smoke in most enclosed public places and workplaces. We expect to see continuing progress in the year ahead, as more and more countries prepare to take action. Smokefree air defining the terms Smokefree air for all Strong law: limited hospitality exemptions such as cigar lounges, or with DSRs allowed. This rapid progress is delivering smokefree air to people in countries around the globe. Policies are being implemented successfully in a variety of places - in low income nations and more affluent ones, in small localities, major cities, and vast countries. Despite the wide variation in countries covered by smokefree laws, their experiences are very similar. In country after country: • smokefree laws are good for health In this report, the following definitions are used: Comprehensive law: no exemptions, or with exemptions limited to residential and quasi-residential premises. Does not allow Designated Smoking Rooms (DSRs) and/or ventilation. Effective law: comprehensive or strong legislation National law: covers whole country Local law: covers regions, states or cities • most people support smokefree laws • with proper planning and resources, enforcement is straightforward • hospitality sector profits and jobs remain safe The message is clearer than ever: smokefree air works. Focus on low and middle income countries Global Voices Status Report 2009 Photo: Per Foreby However, there is a long way to go. Despite the rapid progress, more than 85% of the world’s people remain without meaningful protection from secondhand smoke, many of them in the low and middle income countries that will bear the brunt of the global tobacco epidemic. Clear tobacco control policies are urgently needed.Without them, tobacco related illness, disability and death will cost low and middle income countries dearly. Smokefree air laws must be a priority for low and middle income countries. globalsmokefree partnership 3 The target: a smokefree world by 2012 Governments must continue to act, if they are to meet the goal of protecting everyone from secondhand smoke by 2012. Most countries will need to considerably strengthen their existing smoking restrictions in order to meet this target, which was unanimously agreed by Governments July 2007.1 The Framework Convention on Tobacco Control (FCTC) guidelines on protection from exposure to tobacco smoke state that smokefree laws must: • cover all enclosed public places, workplace and public transport without exemptions • include other places as appropriate Big Tobacco’s dirty tricks • avoid designated smoking rooms, The biggest barrier to smokefree air is the multinational tobacco companies ineffective ventilation and air fil- who stand to lose billions of dollars if smokefree laws are implemented. tration schemes From fake “science” to buying influence, and from scare stories to coverups, tobacco companies continue to devote their considerable wealth to stopping smokefree laws in every region of the world. This report details the tobacco industry’s tactics to hold back legislation, alongside the positive impact of governments, organizations and individuals who are taking on Big Tobacco, and winning. In late 2008, world governments agreed to a series of FCTC guidelines based on the recognition that tobacco company interests are fundamentally incompatible with health, welfare or “good causes.”2 These guidelines outline governments’ responsibilities under Article 5.3 of the FCTC on tobacco industry interference. They are expressly designed to stop Big Tobacco’s dirty tricks. The guidelines are essential to winning the battle for smokefree air. 4 Introduction Selling smoke: the business of deceit Introducing Big Tobacco Global Cigarette Tobacco is big business. And it is Market Share, 2007 manufactured and sold by some of the biggest businesses in the world. The global tobacco market is valued at $378 billion.3 If Big Tobacco were a country, it would have the 23rdlargest gross domestic product in the world, making it richer than Norway and Saudi Arabia.4 Cigarettes account for some 92% of the value of the global tobacco market.5 Others 15.8%6 Imperial/ Altadis 5.6% China National Tobacco Corporation 32% Philip Morris 18.7% Japan Tobacco International 10.8% British American Tobacco 17.1 % More than eight in every ten cigarettes sold worldwide are made by just five companies. All but one of these companies have their headquarters in rich countries, like the United States, United Kingdom, Japan, France and Spain – but their key markets are low and middle income countries where the majority of the world’s smokers live. Money over health: the death dividend In 2008 an estimated 5.4 million people died as a result of tobacco use, and millions more suffered serious disability. At least one in every two smokers will lose their life because of tobacco. ble step to ensure that they recruit and retain addicted smokers to maximize their profits. The tobacco market is projected to grow by nearly 5% each year to 2012.7 If we do nothing to stop Big Tobacco, the death toll will Nonetheless, the tobacco industry takes every possi- rise to 8.3 million people each year by 2030.8 Global Voices Status Report 2009 globalsmokefree partnership 5 The death dividend in 2007 Global tobacco industry sales: US$ 378 billion a year Number of deaths per year: 5.4 million Tobacco industry revenues per death: US$ 69 thousand Why does the tobacco industry oppose smokefree laws? In addition to protecting people from the deadly impact of secondhand smoke, smokefree laws encourage smokers to quit or reduce their consumption. They can stop children and young people from starting to smoke or becoming addicted smokers.They send a strong message that smoking is socially unacceptable. All of this reduces profits. Internal tobacco industry documents reveal the tobacco industry’s own scientists had established that secondhand smoke was harmful to health in the 1970s. The tobacco companies identified public concern about secondhand smoke as a major threat to their business. Rather than protecting people’s health, the tobacco industry focused on protecting its profits. Secondhand smoke – the view from the boardroom “Let’s face it. We are interested in evidence which we believe denies the allegation that cigaret(te) smoking causes disease” Philip Morris, 19709 “Passive smoking is the most dangerous development to the viability of the tobacco industry that has yet occurred”. (advice to the US Tobacco Institute, 1978)10 “What do these health claims, the heightened public sentiment for smoking restrictions …mean for this industry? Lower sales, of course.” US Tobacco Institute, 198511 “(The) financial impact of smoking bans will be tremendous…. Three to five fewer cigarettes per day per smoker will reduce annual manufacturers’ profits a billion dollars plus per year” Philip Morris, 199512 6 Selling smoke: the business of deceit Big Tobacco’s 7 deadly D’s Denial, Deceit, Distraction, Diversion, Decoys, Dire Predictions, Delay 1. Denial 2. Deceit Denying the evidence on secondhand smoke Secret programs to subvert science Tobacco industry scientists established that secondhand smoke was dangerous in the 1970s.13 In the 1980s, Philip Morris scientists conducted a series of secret experiments on sidestream smoke, which found that it is more toxic than the mainstream smoke inhaled by smokers.14 In spite of what the industry knew, tobacco companies have consistently denied that secondhand smoke is harmful to health. Internal tobacco industry documents reveal that Big Tobacco: • secretly paid scientists and doctors to publish research suggesting that secondhand smoke is not harmful, despite the fact that this was at odds with its own confidential research17 • changed study findings on the advice of PR and legal teams11 19 Worldwide, Big Tobacco spent millions of dollars on PR and scienstrategies to cover up the truth.15 16 There is no reason • recruited consultants on leading medical 20 tific journals to influence content to believe that the industry has changed its behaviour, and new evidence of tobacco industry interference is • infiltrated the WHO International Agency for Reemerging all the time. search on Cancer, to influence and pre-empt its findings on secondhand smoke21 22 • undermined institutions and attacked researchers working on secondhand smoke and health23 24 25 26 27 28 In the 1980s, the tobacco industry developed the “International ETS Consultants Program” to “keep the controversy alive” on secondhand smoke. It recruited doctors and scientists to develop and promote tobacco industry viewpoints in Europe, Asia29 and Latin America.30 Research funded by the tobacco industry is 90 times more likely to conclude that secondhand smoke is not harmful than independent research.31 Global Voices Status Report 2009 globalsmokefree partnership 7 “The debate is over” 3 decades of expert conclusions on secondhand smoke The tobacco industry spent millions of dollars to undermine the health evidence on secondhand smoke. Here are some of the expert reviews that Big Tobacco sought to discredit. Year Expert Body Conclusions 1982 US Surgeon General Secondhand smoke is a “possible serious public health problem.”32 1986 The International Agency for Research on Cancer (IARC) Exposure to secondhand smoke increases the risk of lung cancer.33 34 35 US Surgeon General Australian National Health and Medical Research Council 1988 UK Independent Scientific Committee on Smoking and Health Further publicity of the link between secondhand smoke and lung cancer is needed.36 1992 US Environmental Protection Agency (EPA) Secondhand tobacco smoke is a Group A (known human) carcinogen.37 1997 Australian National Health and Medical Research Council Secondhand smoke “causes lower respiratory illness in children and lung cancer in adults and contributes to the symptoms of asthma in children. … may also cause coronary heart disease in adults.”38 1998 UK Scientific Committee on Tobacco and Health Secondhand smoke is a “cause of ischaemic heart diseases” with current research suggesting it is “a substantial public health hazard.”39 1999 WHO Secondhand smoke is “a real and substantial threat to child health, causing death and suffering throughout the world.”40 2002 International Agency for Research on Cancer (IARC) Secondhand smoke is a cause of lung cancer in humans.41 Irish Health and Safety Authority “Legislative measures are … required to protect workers from the adverse health effects of ETS exposure.”42 2004 International Agency for Research on Cancer (IARC) Secondhand smoke increases the risk of lung cancer by 20-30% and heart attacks by 25-35%43 2006 US Surgeon General “There is no safe level of exposure to secondhand smoke”44 “The scientific evidence is now indisputable”45 8 Big Tobacco’s 7 deadly D’s: Denial, Deceit, Distraction, Diversion, Decoys, Dire Predictions, Delay 3: Distraction Promoting Rival Problems The tobacco industry has promoted a range of alternative health hazards to divert the public and policy makers from taking action on secondhand smoke. These include: • “Sick building syndrome • Keeping pet birds • External air pollution, such as vehicle exhaust fumes 4: Diversion Proposing ineffective alternatives The tobacco industry’s opposition to comprehensive smokefree laws includes the offer of alternative proposals. These divert policy makers from effective legislation. Big Tobacco’s diversionary tactics can include proposals for voluntary regulation, or weak laws with many exemptions. Voluntary codes cannot deliver clean air. Only countries with comprehensive smokefree legislation have eradicated secondhand smoke in all enclosed workplaces and public places. In the UK, after more than five years of a voluntary code, the majority of bars did not comply with the scheme. Staff and customers were exposed to secondhand smoke in more than 99% of bars and in the majority of restaurants.50 Earlier this year, BAT Egypt agreed to a non-binding memorandum of understanding with the Governor of South Sinai. Under the agreement, there will be separate seating for smokers and nonsmokers, and training for staff.51 This voluntary scheme will not protect people from secondhand smoke. Tobacco industry-funded “accommodation” schemes, such as “Courtesy of Choice” and “Living in Harmony” have been rolled out worldwide. They aim to promote “tolerance” and “good manners”, and involve smoking and non-smoking areas or separate rooms. Global Voices Status Report 2009 The tobacco industry and “Sick Building Syndrome” Sick Building Syndrome describes incidents of acute illness and discomfort that appear to be linked to time spent in a specific building. Tobacco companies bankrolled “expert organizations” and consultants, which sought to minimise the role of secondhand smoke in poor indoor air quality. These bodies claimed that other chemicals in building materials, carpets and furniture were responsible for health symptoms and aggressively promoted ventilation and air cleaning technology ahead of smokefree buildings.46 globalsmokefree partnership 9 “Sick as a parrot” – blaming birds Industry documents show that tobacco industry consultants were involved with research suggesting that keeping pet birds was an independent risk factor for lung cancer. 47 48 49 This research was part of the tobacco industry’s efforts to minimise secondhand smoke as a cause of lung cancer. Studies have shown that non-smoking areas including separate non-smoking rooms make little or no difference to workers’ exposure to secondhand smoke.52 53 The tobacco industry aggressively promotes ventilation and air filtration technologies as an alternative to smokefree laws, despite knowing that they do not make smoky air safe.54 55 Studies have shown that filtered smoke is as carcinogenic as unfiltered smoke,56 and that ventilation technology cannot remove the harmful constituents of secondhand smoke from the air.57 58 Bodies including the WHO,59 EU,60 US Surgeon General,61 and the international standard-setting body on ventilation and air conditioning (ASHRAE)62 63 have examined the scientific evidence. They conclude that: • ventilation and other air filtration technologies do not work • the only effective way to eliminate the health risks caused by secondhand smoke is to make all indoor places entirely smokefree. There is also evidence of the tobacco industry backing weak laws in order to block more effective legislation from being introduced. Accommodation strategies – costly, ineffective, unlawful “Accommodation” strategies do not protect workers’ health. Designated smoking rooms (DSRs) and ventilation systems create an uneven playing field. Big businesses have the space and money to install and maintain them, but they are prohibitively expensive or impractical for smaller establishments. In Canada, laws allowing DSRs have been overturned on the grounds of unfair competition.64 In Berlin, small bar owners successfully argued that because smoking areas were allowed in larger premises, the law discriminated against them, and it was overturned.65 10 In Ecuador, Philip Morris pursued a sophisticated strategy to block comprehensive smokefree regulations, by supporting ineffective tobacco control legislation instead.66 In Germany in 2007, attempts to draft a comprehensive national smokefree law were hijacked by the tobacco industry – substantially weakening the proposals. The legislation was subsequently dropped altogether.67 5: Decoys Making friends and influencing people “Sometimes we will need to speak as independent scientists, scientific groups and businessmen; at other times we will talk as the industry; and, finally, we will speak as the smoker.” Philip Morris, 198968 The tobacco industry works with a range of other groups to pursue its interests. Tobacco company involvement is often secret, and evidence of tobacco industry involvement may only emerge afterwards. Big Tobacco’s 7 deadly D’s: Denial, Deceit, Distraction, Diversion, Decoys, Dire Predictions, Delay Media Journalists are crucial allies in Big Tobacco’s propaganda war. Fighting back – convincing journalists The industry has spent billions of dollars worldwide on funding think tanks, securing the services of high profile columnists, and operating seminars and training opportunities for journalists.69 70 In the USA, Philip Morris funded the National Journalism Center (NJC). This created a generation of journalists willing to run stories sympathetic to the industry.71 In Nigeria, BAT runs an annual competition for journalists covering the company, and has also hosted lavish meetings for media executives and journalists, who received gifts to attend.72 In Mexico, there was a great deal of media coverage of the country’s smokefree law before it came into force. Analysis of the articles showed that only 10% of the coverage was negative about the new law. This shows that journalists will be convinced by the arguments for smokefree places law, making them essential allies for pro-health groups.73 Politicians and government officials Fighting Back – Politicians fighting for health Cultivating relationships with politicians and officials has helped the tobacco industry to resist effective smokefree laws. In Zambia, BAT is using its close relationship with a Government Minister to shape the country’s smokefree law. At a recent BAT-sponsored event, the Minister announced her support for smoking zones, which were not included in the legislation.74 In New Zealand, tobacco companies briefed a core group of legislators about secondhand smoke, to oppose legislation. They failed to weaken or stop the country’s comprehensive smokefree law.75 Business Groups Partnering with other business interests is a key tobacco industry strategy. These can include trade associations such as tobacco retailers and manufacturers, the gaming industry, hospitality organizations, investors and business lobbying groups. These groups can voice tobacco industry arguments while maintaining the illusion of independence. Charities and good causes The tobacco industry supports good causes to distract attention from the debate on secondhand smoke,77 78 or to position themselves favourably with lawmakers and the public.79 In China, BAT funded a liver disease charity from its inception in 1997 to at least 2002. The charity was used to divert attention away from smoking and health and towards liver disease. It created an indirect channel for comGlobal Voices Status Report 2009 In many jurisdictions smokefree laws, politicians have stood up to tobacco company interests and fought for health. In March 2006, President Tabaré Vázquez of Uruguay implemented a decree to make the country entirely smokefree, the first country in Latin America to do so. President Vázquez was previously a cancer doctor, and has described himself as “a man of science in governmental duty.” His story demonstrates that the tobacco industry doesn’t always get things all its own way. Fighting Back – Separating Big Tobacco from its allies In England, the tobacco industry had allied itself with hospitality industry groups, following a strategy that had worked in other countries. However, NGOs led by ASH (Action on Smoking and Health) exposed the differences between the tobacco industry’s interests and those of the hospitality industry. The British Hospitality Association came to support the smokefree law.76 globalsmokefree partnership 11 munication with the Chinese Ministry of Health, and sought to influence Government health policy away from tobacco. Crucially, BAT also used the charity’s website as a vehicle for disseminating its papers showing that secondhand smoke is not harmful to health.80 In December 2008, the Chinese Government sent a strong message the tobacco industry “philanthropy” should not be rewarded. The Government acted to withdraw its nomination to state-owned tobacco companies for their charitable work. This is an important recognition that tobacco interests are fundamentally at odds with good causes.82 Indian tobacco company Godfrey Phillips sponsors an annual competition to identify and reward copurageous citizens in an annual competition to publicise the company’s “corporate social responsibility”.81 Photo: Kafka4Prez Fighting Back – Chinese Government withdraws tobacco company charity award nomination Smokers’ Rights Groups Smokers’ rights groups claim to be grassroots organizations, representing individual smokers. Tobacco industry documents show financial links to smokers’ rights groups in at least 26 countries outside North America, including the UK, Sweden, Australia, Japan, Hong Kong, France, Germany, Greece, Ecuador, Guatemala and the Philippines.83 Freedom Organization for the Right to Enjoy Smoking Tobacco (FOREST) was established in the UK in 1979. Internal tobacco industry documents show that the tobacco industry has influenced decisions and controlled budgets.84 In 2000, 96% of FOREST’s funding came from the tobacco industry.85 Organized labor Fighting Back – Unions advocating for clean air Smokefree laws protect workers’ health, and a number of unions have been active in pursuing smokefree air. In the USA, unions representing Flight Attendants were instrumental in achieving laws to make domestic flights smokefree.89 In Ireland, the union representing bar workers, argued that a smokefree law was needed to protect its members from the health effects of secondhand smoke. In France and Sweden, hospitality unions played a similar role. 12 Job losses in the tobacco industry are driven by tobacco company practices such as mechanization and privatization and not health policy.86 Despite this evidence, tobacco workers’ unions have traditionally argued against tobacco control measures on the basis that they will put their members’ jobs at risk. Internal tobacco industry documents also show that the industry built broader coalitions within the trade union movement. For example, the US Tobacco Institute funded a coalition with the labor movement to fight against smokefree workplace policies, for sixteen years until 2000.87 88 6: Dire Predictions The Tobacco Industry’s scare tactics Big Tobacco’s response to the threat of smokefree laws is the same the world over. By predicting terrible consequences of regulating secondhand smoke, the industry hopes to frighten governments and the public from taking effective action. Big Tobacco’s 7 deadly D’s: Denial, Deceit, Distraction, Diversion, Decoys, Dire Predictions, Delay However, as more and more jurisdictions implement smokefree laws with few or no problems, tobacco industry scaremongering is becoming harder to sustain, and easier to expose. Compliance with smokefree laws Ireland 94%105 Dire Prediction: “Hospitality profits and jobs will plummet” Experience shows: No negative economic impact Ottawa, CA 95%106 New York City, USA 97%107 New Zealand 97%108 Massachusetts, USA 96%109 Robust independent studies have repeatedly shown that smokefree laws do not have a negative economic impact on the hospitality or tourism industries.91 92 93 Norway 97%110 In some jurisdictions,94 smokefree laws have increased hospitality industry profits. Italy 98.5%111 • In the US, the sale values of restaurants increased,95 and there was no change in the values of bar businesses96 after smokefree laws Scotland 96%112 • Tasmania,97 Norway98 and Massachusetts,99 among others have adopted smokefree legislation without significant job losses. In Minnesota, comprehensive laws led to an increase in bar and restaurant workers100 Wales 98%113 England 98%114 • The economic benefits of smokefree legislation are greater than any costs associated with implementation and enforcement.101 Sweden 99.1%115 “The economic arguments often used by the [tobacco] industry to scare off smoking ban activity … simply had no credibility with the public, which isn’t surprising when you consider our dire predictions in the past rarely came true.” Philip Morris, 199490 Dire Prediction: “Making it work is mission impossible” Experience shows: implementation and enforcement strategies support high compliance The tobacco industry argues that smokefree laws are hard to implement and impossible to enforce. In country after country, the overwhelming majority of smokers and businesses obey the law. With effective implementation and enforcement strategies, compliance rates exceed 90%. Over time, these laws are largely self-enforcing. Changing Public Opinion Ireland121 59% (2003) Italy 83% (2001) 94% (2006) New Zealand123 61% (2004) Dire Prediction: “Prepare to lose popularity contests” Experience shows: People love smokefree laws Sweden The tobacco industry argues that smokefree laws will be unpopular. Tobacco companies know that this is untrue. Philip Morris poll data from 1989 showed that smokefree policies enjoyed strong public support in Europe and the US.116 France126 Global Voices Status Report 2009 93% (2005) 122 82% (2006) 124 125 85% (2005) 90% (2006) 70% (2007) 85% (2008) % support before the law % support after the law globalsmokefree partnership 13 Making savings from smokefree laws In the real world, smokefree laws save money. Employers gain because: • productivity increases because workers take fewer smoking breaks • workers take less sick leave • fire risks are significantly reduced • cleaning and redecoration costs are lower102 There are also big savings for healthcare systems: • Smokefree workplaces have saved about US $5bn a year in medical costs and the indirect costs associated with disability • In New York, a reduction in heart attacks after the law came in saved $56million in direct medical costs However, continued exposure to secondhand smoke still costs over US$10bn a year in direct medical costs and indirect costs.103 In the state of Minnesota, the direct health cost of secondhand smoke exposure works out as $44.58 per resident.104 Smokefree laws are extremely popular, and support grows as legislation comes into force. Support also increases as people learn more about the health risks associated with secondhand smoke. In countries including Ireland,117 Uruguay,118 Colombia119 and New Zealand,120 smokefree laws are supported by the majority of both smokers and non-smokers. And there is no turning back – once people have experienced comprehensive smokefree laws, they do not want to return to the bad old days of smoke-filled rooms. 7: Delay “Sand in the gears” – challenging smokefree policies in court If the tobacco industry cannot prevent smokefree laws altogether, it will use a range of tactics to delay their implementation, including taking legal action. Laws may not be implemented until legal challenges are resolved. Tobacco companies may even succeed in overturning or weakening legislation. In the 1990s, the tobacco industry took legal action against the US Environmental Protection Agency (EPA) because it had classified secondhand smoke as a known human carcinogen. It took seven years for the EPA to win the case. In the meantime, the tobacco companies had used the case to undermine the health evidence on secondhand smoke.127 Last year, BAT Kenya and Mastermind Tobacco launched legal action against the Kenyan Government’s Tobacco Control Act, which included smokefree provisions.The future of this legislation is threatened by this challenge, and the dispute may take years to resolve.128 14 Big Tobacco’s 7 deadly D’s: Denial, Deceit, Distraction, Diversion, Decoys, Dire Predictions, Delay Blowing the smoke away using the FCTC to fight back Smokefree air is protected by international law More than 160 countries are now Parties to the Framework Convention on Tobacco Control (FCTC), the world’s first public health treaty. Some 85% of the world’s population now live in countries where the FCTC is legally binding. The FCTC requires governments to take effective action to protect citizens from exposure to secondhand smoke in public places, workplaces and public transport. Recent guidelines on implementing smokefree laws clarify that smokefree policies must: • make all enclosed public and work places 100% smokefree, without ventilation, air filtration, smoking rooms or smoking areas Maximising smokefree air through the FCTC If all the governments that are party to the FCTC implement and enforce smokefree laws, 85% of the world’s people would be protected from secondhand smoke. Despite significant progress from some governments, the overwhelming majority of FCTC countries have yet to meet their treaty commitments. In 2009, more than 85% of people live in countries without an effective smokefree law, most of them in countries that are parties to the FCTC. • include all enclosed public and work premises, without exceptions • be legally binding, not voluntary • be implemented, enforced and monitored Countries with smokefree policies that fall short of these guidelines do not adequately protect the health of their citizens. “Irreconcilable conflict” – public health vs tobacco industry interests Photo: Bella Lago The tobacco industry’s interests are fundamentally at odds with health interests. The FCTC draws on the evidence of the tobacco companies’ conduct over many decades in countries throughout the world. It warns that tobacco industry in- volvement is often not declared. The FCTC concludes that the tobacco industry and its allies have no place in developing public health policy. Countries must protect their health policies against tobacco industry conflicts of interest. Global Voices Status Report 2009 globalsmokefree partnership 15 What does the FCTC say about the tobacco industry? It is a founding principle of the FCTC that Governments must “be alert to … efforts by the tobacco industry to undermine or subvert tobacco control.” Article 5.3 of the FCTC 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.” Governments that allow tobacco industry interests to influence their policies are protecting tobacco industry profits at the cost of their citizens’ lives and health. This is a breach of the requirements of the FCTC. In November 2008, international governments agreed a set of guidelines explaining how governments can meet their FCTC obligations to resist the tobacco industry’s attempts to influence health policy. The guidelines say that governments and policy makers must follow clear principles in any direct or indirect relationship with the tobacco industry. These principles also apply to relationships with people or organizations working to further tobacco industry interests. All Parties must: • recognize the “fundamental and irreconcilable conflict between tobacco industry interests and public health interests” • be accountable and transparent in all its dealings with the tobacco industry • refuse partnerships with the tobacco industry • reject tobacco industry voluntary codes or so-called “corporate social responsibility” schemes • prohibit incentives to the tobacco industry Stubbing out Big Tobacco to gain smokefree air Tobacco industry interference in smokefree air policy is a recipe for ineffective measures that fail to protect health. The FCTC Article 5.3 guidelines make recommendations to protect tobacco control policies from being delayed, derailed or destroyed by the vested commercial interests of the tobacco industry. Following the guidelines can help governments to resist Big Tobacco’s efforts to undermine smokefree policies. A few are particularly relevant to smokefree air. 16 Blowing the smoke away – using the FCTC to fight back Raise awareness of harm from tobacco products, and tobacco industry interference There is no safe level of exposure to tobacco smoke, and citizens should be informed that exposure to secondhand smoke causes fatal conditions including lung cancer, heart disease and respiratory disease.129 Governments should publicise the tobacco industry’s attempts to undermine and subvert smokefree air, including the covert use of individuals and front groups with no obvious link to the tobacco industry to further its ends. Reject partnerships and non-binding agreements with the tobacco industry The tobacco industry forges partnerships with governments to avoid legislation. Tobacco industry “youth smoking prevention” programs have been used to undermine the FCTC.131 Fighting back Putting the tobacco industry out of the European Parliament Tobacco control advocates from across the EU succeeded in preventing a group of “smokers’ rights organizations” from hosting a conference designed to undermine the case for smokefree laws in the European Parliament. Governments should not enter into, support or endorse any partnerships with the tobacco industry or its agents. This includes: The advocates, led by the EU Smoke Free Partnership, wrote to the Parliamentary Bureau and MEPs to state that the European Parliament was not an appropriate venue for the conference, called “Smoking bans and lies”. They successfully argued that the proposed event: • youth or public education programs organized by the tobacco industry • contravened the Parliament’s own rules of procedure as the event had a commercial purpose • offers of assistance with drafting policies, regulations or legislation • Avoid conflicts of interest attacked all of the Parliament’s adopted reports and the European Community’s decisions on this topic • violated the spirit of the FCTC The evidence shows that smokefree policies have to be legally enforced. Voluntary self-regulation has been developed to prevent the introduction of effective laws. In some countries, tobacco companies have used their links with government to directly influence tobacco control legislation.132 • voluntary codes of practice, including “courtesy of choice” or “accommodation” programs The tobacco industry may offer inducements in the form of payments, gifts and other inducements such as research funding or training. All of these should be refused, and clear policies that individuals and departments must Global Voices Status Report 2009 The result? The conference was not allowed to take place on the Parliament’s premises. 130 globalsmokefree partnership 17 Fighting Back US campaigners name and shame tobacco industry interests In 2006, pro-health organizations campaigned for voters to support comprehensive smokefree laws in the US states of Ohio and Arizona. The tobacco and gaming industries sponsored competing proposals for weak and ineffective laws. Health campaigners won the vote in both states by identifying each proposal with its backers, publicizing the tobacco industry’s reasons for proposing weak laws. The health organizations secured media coverage to counteract the tobacco industry’s vast PR budgets. In both states, the comprehensive smokefree law was passed, and the competing pro-tobacco proposal was rejected.133 Fighting back not accept direct or indirect inducements from the tobacco industry are needed. No representatives of the tobacco industry or its allies should be engaged in any activities relating to health of tobacco policy – they should not be treated as stakeholders, and must be barred from sitting on advisory and working groups developing health policy. Treat state-owned tobacco industry the same as other tobacco industry Transnational tobacco companies have used their links with local state tobacco monopolies to subvert tobacco control policies.134 135 136 137 Where governments control tobacco monopolies or are stakeholders in tobacco companies, the business of managing the tobacco company must be kept separate from any domestic or international tobacco control policy. Tackling tobacco monopolies in Thailand Thailand has some of the most rigorous tobacco control policies in the world, including an extensive smokefree law, despite having an active state tobacco monopoly. It’s estimated that the policies implemented after 1991 saved nearly 31,500 lives by 2006, and will save more than 315,000 lives in the two decades to come.138 The tobacco industry and civil society 18 • Refuse tobacco industry funding or support – no matter how “good” the cause • Refuse any meetings with the tobacco industry – even on non-health matters • Publicize examples of tobacco industry behavior • Campaign against tobacco industry interference in government policy Photo: Fire Monkey Fish Non-governmental organizations can also take their cue from the Article 5.3 guidelines and resist tobacco industry interference: Blowing the smoke away – using the FCTC to fight back Photo: Simply Fragile Fighting Back: What you can do to block tobacco industry influence Corporate Accountability International and the Network for Ac- • countability of Tobacco Transnationals (NATT) are campaigning for effective implementation of the Article 5.3 guidelines in countries around the world. Here’s how you can get involved: • • Monitor tobacco industry interference in tobacco control in your country. Send examples of how the tobacco industry is undermining public health policy to [email protected]. Build civil society capacity to challenge Big Tobacco. Recruit NGOs active on health, consumer rights, environmental protection, human rights fair trade and other issues. Educate these allies on the tobacco industry’s fundamental conflict of interest with public health, and mobilize them to support implementation of smokefree laws and the Article 5.3 guidelines. • Generate national and international media attention. Share Campaign for laws and policies to protect against tobacco the results of your monitoring with interested journalists industry interference in public health. Meet with government and international allies. officials to learn what the tobacco industry is doing to block smokefree laws and other health policies—and offer your Visit www.stopcorporateabuse.org for tools and resources to help in challenging these tactics. help protect against tobacco industry interference. Global Voices Status Report 2009 globalsmokefree partnership 19 Comprehensive National Policies Countries with smokefree policies without exemptions, or with exemptions limited to residential and quasi-residential premises. Countries in this category do not allow Designated Smoking Rooms (DSRs) and/ or ventilation. Policies apply across the whole country. Strong National Policies with Limited Exemptions Countries with smokefree policies with limited hospitality exemptions such as cigar lounges, or which permit DSRs. Policies apply across the whole country. Comprehensive or Strong Local Policies Countries where local legislators have implemented comprehensive or strong smokefree policies at a sub-national level Global smokefree map 20 Global Smokefree Map Global Voices Status Report 2009 globalsmokefree partnership 21 African Region Overview Africa is starting to make progress on smokefree laws, with a number of countries putting smokefree laws into place. Mauritius has recently passed a new law that is close to meeting the standards required by the FCTC, which is a first for the region. lenging, but it is important to recognise that smokefree public places are a low cost, effective intervention to protect health. In 2009, the Nigerian Parliament is considering tobacco control legislation. In the meantime, local legislation in the country’s capital Abuja is currently in force. Local laws have also been used in Kenya, but this strategy has not been used as widely in Africa as in other regions. Proposals for a new national law are also being developed in Burkino Faso over the next year. South Africa continues to play an important role in the region. Since 1999, South Africa has demonstrated that smokefree laws can work in Africa, and the government has moved with the evidence base to update the law when required.The law is strong and there is good compliance. Finally, the influence of the tobacco industry must be Implementation of smokefree laws remains a challenge recognised, particularly in countries that grow tobacco. in many places, including Uganda, Ghana and the Dem- In Kenya, the tobacco industry has issued a legal chalocratic Republic of Congo. Niger provides an inspi- lenge to a strong smokefree law passed by the Parliarational example of what can be achieved. In previous ment. In Zambia, BAT’s political influence has helped years, lack of enforcement has led to a strong law having to dilute proposals for a smokefree law.The current prolittle or no impact on people. However, civic society and posal falls a long way short of meeting FCTC requiregovernment have worked together to improve aware- ments for protection from secondhand smoke. ness of the law, and have renewed efforts to enforce the law. Initial reports show that the law is being enforced Regional Leader in most places, which is a great success for the country. Mauritius is the first country in Africa to adopt a comIdentifying resources for implementation can be chal- prehensive smokefree law. These laws come closest to 22 African Region meeting the standards set by the FCTC. They offer high DSRs undermine smokefree laws because: standards of protection for most people, and their laws • they contain high levels of secondhand smoke, putare among the most robust in the world. ting staff and patrons at risk141 Nonetheless, these laws mean that a very small number • staff must work in them, offering service, providing of people remain exposed to secondhand smoke, usually security and cleaning because they live in, work, or visit places that are not • smoke leaks from DSRs into the rest of the premises, covered by the law. leaving people exposed to secondhand smoke142 Newly smokefree in 2009 Mauritius Continuing downward trend in tobacco consumption Mauritius’s smokefree law continues a trend of tobacco control measures, including high tobacco tax and health promotion, which have driven a decline in smoking rates tobacco consumption on the island.139 • they create an uneven commercial playing field Newly smokefree in 2008 Kenya Tourism a major part of GDP Tourism accounts for more than one in four jobs in Mauritius, and over a quarter of GDP.140 The smokefree law is not expected to impact on tourism revenues. Smokefree law Includes Exemptions DSRs Smokefree from People protected Close to meeting FCTC requirements Public places, hospitality sector, some outside areas Limited None permitted March 2009 1.3 million Strong Laws Kenya, Niger and South Africa have a strong law which offers high standards of protection for most people, most of the time. However, they fall short of the standards set by the FCTC because they allow Designated Smoking Rooms (DSRs). Global Voices Status Report 2009 Smokefree law Includes Exemptions DSRs Smokefree from People protected Using legal action to stop smokefree law The law in Kenya has been challenged in the Courts by the tobacco industry. BAT Kenya has enjoyed a virtual monopoly on the tobacco industry in Kenya, and has successfully influenced government health policy for decades.143 The company is now using expensive legal action to thwart the law, a strategy familiar in developed countries. Most places smokefree. Separate Designated Smoking Rooms (DSRs) Close to meeting FCTC requirements. Falls short because smoking rooms permitted Workplaces and public places, hospitality sector Limited. Private dwellings In workplaces and hospitality sector. Limited in size July 2008 39 million globalsmokefree partnership 23 Niger Smokefree law Includes Exemptions DSRs Smokefree from People protected Renewed enforcement efforts Niger adopted a smokefree law in 2006, but it was unsuccessful because of a lack of enforcement. Non-Governmental Organizations have worked with the Niger Government to build consensus about the law, and to enforce it. It is now reported to be working well in most places. Most places smokefree. Separate Designated Smoking Rooms (DSRs). Close to meeting FCTC requirements. Falls short because smoking rooms permitted Workplaces and public places, hospitality sector Limited. Private dwellings. In workplaces and hospitality sector. Limited in size September 2008 15.3 million Local action In Africa, local smokefree initiatives have not been developed to the same extent as in some other parts of the world. Nigeria South Africa Smokefree law Includes Exemptions DSRs Smokefree from People protected Restaurants continue to thrive VAT returns showed South Africa’s smokefree law had no significant effect on restaurant revenues, and may have had a positive effect.144 Restaurant owners believe that nearly all customers have accepted the law.145 Most places smokefree. Separate Designated Smoking Rooms (DSRs). Close to meeting FCTC requirements. Falls short because smoking rooms permitted. Workplaces and public places, hospitality sector. Limited. Private dwellings. In workplaces and hospitality sector. Limited in size. September 2008 15.3 million Smokefree jurisdic- 1 smokefree territory tion Federal Capital Territory Good examples People protected by 1.4 million smokefree laws 1% of population protected by strong smokefree law. Low awareness that secondhand smoke kills In Abuja, the majority of school students (55%) are not aware that secondhand smoke is harmful to health.146 Smokefree legislation needs to address this low awareness. 24 African Region American Region Overview The American region is a real success story, despite the fact that many countries have high smoking rates. There has been rapid expansion in smokefree provision throughout the Americas, with new laws at both national and local level offering protection to millions of people. It is particularly exciting to see that so much progress is being made in middle income countries. icant change is shown in Canada, where a patchwork of smokefree laws will mean that more than 99% of Canadians are protected by strong or comprehensive smokefree laws by 2010. There are also some encouraging initiatives in the Caribbean, with countries including Trinidad and Tobago, and Barbados considering legislation. Civil society is Following Uruguay’s example, a further three middle playing an increasingly important role in the regions, income countries – Panama, Colombia, and Guatemala with established Non Governmental Organizations - have introduced national comprehensive smokefree campaigning for smokefree laws in a number of counpolicies in the last year. tries including Peru and Ecuador. There has also been remarkable progress in local poli- There is little doubt that a tipping point has been reached cies. Two of the world’s largest urban areas, Mexico City in the Americas, with more and more people covered and the State of São Paulo in Brazil have also introduced by effective smokefree policies. However, the tobacco comprehensive laws. The power of local policies is also industry has a very strong presence in the region, and apparent in countries as diverse as Argentina and the there is evidence that it is doing all that it can to impede USA, where smokefree laws are expanding year on year. progress towards smokefree laws. Campaigners and govProgress is expected to continue in 2009 and 2010. ernments must beware of attempts to undermine and The potential for local policies to deliver real and signif- subvert smokefree laws. Global Voices Status Report 2009 globalsmokefree partnership 25 Regional Leaders Newly smokefree in 2008 Uruguay and Panama have laws that come close to meeting the standards set by the FCTC. These laws offer high standards of protection for most people, and are among the most effective at protecting people from secondhand smoke in the world. Panama Nonetheless, these laws mean that a very small number of people remain exposed to secondhand smoke, usually because they live in, work, or visit places that are not covered by the law. Smokefree law Includes Uruguay Leading the way in Latin America Uruguay was the world’s first middle-income country and the first in Latin America to adopt a comprehensive smokefree policy. One million signatures were collected in support of the measure during a campaign called “Un Millón de Gracias” (a million thanks), and polls show that eight in ten people support the law.147 Uruguay’s experience has directly influenced politicians elsewhere in the region, from Mexico City to Colombia and Guatemala. Exemptions DSRs Smokefree from People protected Colombia Continuing to make progress Panama is the first country in Central America to go smokefree. Its history of strong tobacco control policies has led to it being one of only four Latin American countries where youth smoking rates have fallen significantly in recent years.148 Comprehensive. Close to meeting FCTC requirements Workplaces, public places, hospitality venues. Some outdoor places (sports facilities) Very limited None April 2008 3.4 million Smokefree law wins popular support Nine out of every ten Colombians support the comprehensive smokefree policy, including seven in ten smokers.149 This policy is under threat because it is not as powerful as a national law. If the Colombian Parliament passes a weaker law, it would take precedence over the resolution. Smokefree law Includes Exemptions Smokefree since People protected 26 Comprehensive. Close to meeting FCTC requirements workplaces and public places, hospitality sector, gaming venues. Some outdoor places (eg grounds of health facilities) Very limited March 2006 (by decree); February 2008 (by law) 3.5 million Smokefree law Includes Exemptions DSRs Smokefree from People protected Comprehensive. Close to meeting FCTC requirements All enclosed public and workplaces, hospitality sector Very limited None February 2009 13.3 million American Region Newly smokefree in 2009 Guatemala Smokefree law Includes Exemptions DSRs Smokefree from People protected Bermuda Local Action In countries across the Americas, millions of people are Before the law came into force, secondhand protected from secondhand smoke because of smokefree smoke was present in more than two thirds policies adopted at a local level – in towns, cities, states, of all Guatemalan workplaces, and nearly all provinces and territories. bars and restaurants.150 These local policies are incredibly powerful. They are often easier to enact than national laws, and are able to be implemented and enforced more quickly. They can protect large numbers of people - in populous countries such as the USA, Mexico and Brazil, the number Comprehensive. of people living in a single city or state can outnumber Close to meeting FCTC requirements a smaller country’s total population. All enclosed public and workplaces, There has been rapid progress across the region over the hospitality sector last few years. Local initiatives have transferred easily withVery limited in and between countries, as the benefits of smokefree air None can be seen and the lessons passed on to other localities. Protecting workers in all sectors February 2009 13.3 million Argentina Curbing exposure to secondhand smoke Despite the fact that only 13% of Bermuda’s population smokes, nearly half of Bermuda’s non-smokers were exposed to secondhand smoke before the law came into force.151 Smokefree Jurisdictions Good Examples Smokefree law Includes Exemptions Smokefree from People protected Comprehensive. Close to meeting FCTC requirements Workplaces and public places, hospitality sector, private clubs, residential homes, gaming venues. Enclosed places only Very limited April 2006 0.1 million Global Voices Status Report 2009 People protected Rapid progress on smokefree In just four years comprehensive smokefree policies have been introduced protecting one in three of all people in Argentina. Local measures have been highly successful here, effectively counteracting more than three decades of tobacco industry influence over federal health policy, which has led to weak and ineffective national policies.152 6 provinces (out of 23) and 16 municipalities with comprehensive smokefree laws Provinces: Santa Fe, Córdoba, Tucumán, Mendoza and Neuquén, Entre Rios Municipalities: Bahía Blanca, Berazategui, Cipolleti, Coronel Dorrego, Coronel Rosales, Coronel Suárez, Corrientes, General Roca, Olavarría, Pilar, Puerto Madryn, Resistencia, Río Grande, Saavedra, Tres Arroyos, Villarino 13 million 32% of people protected by comprehensive laws globalsmokefree partnership 27 Brazil Smokefree Jurisdictions 1 State and 5 cities with comprehensive smokefree laws Good Examples State: São Paulo Cities: Recife, Campina Grande, Patos, Cabedelo, Sumé People protected 43.7million 22% of people protected by comprehensive laws Widespread popular support for secondhand smoke protection Brazil is the third biggest producer of tobacco in the world.153 Public support for smokefree laws is very high. More than eight in ten of Brazil’s youth and young adults support smokefree environments.154 In Sao Paulo, organised protests against the smokefree law, disrupted a public hearing, but failed to derail the legislation.155 Mexico Smokefree Jurisdictions Good Examples People protected 1 metropolitan area with a comprehensive smokefree law Mexico City 8.9 million 8% of people protected by comprehensive smokefree laws Canada Canada’s local laws close to making whole country smokefree In April 2009, the Government of Prince Edward Island announced that it would be removing the exemptions for the law and abolishing DSRs. When this is implemented, more than 99% of Canadians will be protected by comprehensive or strong smokefree laws. All Canadian prisons are smokefree by law. In Toronto, a smokefree law reduced bar workers’ exposure to secondhand smoke by 94%.156 Smokefree Jurisdictions 7 provinces and territories (out of 13) have comprehensive smokefree laws, 5 have good laws. All Canadian prisons are 100% smokefree inside Alberta, British Columbia, Manitoba, New Good Examples Brunswick, Nova Scotia, Ontario, Yukon 21.4 million People protected by comprehensive 64% of population supported by comprehensive smokefree laws laws 10.2 million People protected by good smokefree 94% of people protected by comprehensive or strong smokefree laws laws Mexico City is the biggest smokefree city in the Americas. It shows that a comprehensive smokefree law without exemptions or DSRs can work.157 The tobacco industry is active in Mexico, and is fighting against an effective national smokefree law. In 2006, BAT Mexico launched a PR campaign to portray secondhand smoke as a nuisance rather than health risk. The same year, it re-launched accommodation program “Convivencia en Armonía” as an alternative to comprehensive laws.158 Philip Morris and BAT’s Mexican subsidiaries have successfully lobbied to weaken the national smokefree law. This law has yet to be enacted. Mexico City law has support of more than eight in ten residents 85% of Mexico City residents believe that the smokefree law is justified.159 28 Photo: meantux Mexico City leads way American Region United States of America Heart attack rates fall In Pueblo, Colorado, heart attack rates fell by 41% over three years following the smokefree law.160 Similar results have been seen in New York,161 Montana162 and Indiana.163 Smokefree Jurisdictions Venezuela Photo: wallyg 19 states and territories (out of 56) have comprehensive smokefree laws, 7 other states have good laws. Over 300 cities and local jurisdictions have comprehensive smokefree laws. Good Examples Arizona, Delaware, District of Columbia, Hawaii, Illinois, Iowa, Maryland, Massachusetts, Minnesota, Montana, Nebraska, New Jersey, New York, Ohio, Oregon, Rhode Island, Utah, Washington, Puerto Rico. People protected 109.2 million >36% of people protected by comprehensive laws by State-level comprehensive laws People protected 54.8 million >53% of people protected by comprehensive or by State-level strong laws good laws Smokefree air: necessary and popular In 2003, before the law came into force, four in ten young people in Monagas reported being exposed to secondhand smoke in public places. Eight in ten supported a smokefree law.164 Smokefree Jurisdictions 1 state (out of 23) with comprehensive smokefree law Good Examples Monagas People protected 0.9 million 3% of people protected by comprehensive law Global Voices Status Report 2009 globalsmokefree partnership 29 Eastern Mediterranean Region Overview Progress in the Eastern Mediterranean region remains somewhat slower than in other parts of the world, but there are encouraging signs of progress. At least four countries are currently planning comprehensive policies. Tunisia is planning to introduce a decree making all public places and workplaces smokefree in 2009, and Oman, Qatar and Sudan are currently developing smokefree laws. In Egypt, the city of Alexandria – home to more than four million people - has plans to go completely smokefree with no designated smoking rooms (DSRs) permitted. This law was originally comprehensive, but the 2008 decision to exempt teahouses from the law means that many people remain exposed to secondhand smoke. Recent theological rulings that tobacco is haram (prohibited under Islamic law) could help to encourage more widespread acceptance of the harms of secondhand smoke, and promote smokefree laws. In Saudi Arabia’s religious cities of Medina and Mecca tobacco products are neither openly sold nor advertised, and there are smokefree regulations. Greater enforcement is needed.166 There are no comprehensive or strong smokefree policies being enforced in the region. Although many counties have introduced some restrictions on smoking in some public places, places serving food and drinks are typically exempt. Enforcement of these policies tends to be very weak or non-existent, although there are exceptions to this, particularly Oman.165 The government of Yemen has recently announced that it will take action to enforce the country’s existing smokefree law in 2009. There are significant barriers to be overcome to achieving smokefree laws. Some countries have very high male smoking rates – in Jordan and Tunisia, the majority of men are smokers.167 The lack of effective smokefree policies means there are high levels of secondhand smoke in public places. Measurements of secondhand smoke in Syria and Lebanon are some of the highest in the world.168 In Syria, almost all non-smokers are exposed to secondhand smoke.169 Although cigarette smoking is very widespread, much At present, the strongest legislation is found in Iran. secondhand smoke is also generated from waterpipe 30 Eastern Mediterranean Region Photo: Michael Foley (also known as shisha or narghile) smoking. There is evidence that people perceive waterpipe smoking very differently from cigarette smoking.170 Many people believe that waterpipe smoke is less harmful than cigarette smoke,171 but waterpipe smoking can lead to levels of harmful particles that are more than 50% higher than cigarettes.172 In order to protect health, and to comply with the FCTC, smokefree laws must apply to all forms of smoked tobacco. The tobacco industry is becoming increasingly active in the region, using tactics seen elsewhere. In Egypt, British American Tobacco has made an agreement with local politicians to introduce its accommodation scheme “Respecting Choices” in South Sinai, which includes the popular tourist destination Sharm-el Sheikh.173 Photo: Lars Plougmann In Pakistan, concern is growing over the influence of former government officials now acting as lobbyists for the tobacco industry. In 2008, the Pakistan Ministry of Health issued Guidelines on the implementation of Designated Smoking Areas, at a time when the FCTC Article 8 Guidelines make clear that these should be abolished. It is feared that tobacco industry influence will derail plans to introduce and enforce a comprehensive smokefree law.174 BAT is rolling out industry sponsored “youth prevention programmes in Kuwait, Qatar and Bahrain.”175 These developments are of serious concern. Urgent action is needed throughout the region to enforce the FCTC Article 5.3 Guidelines, and prevent the tobacco industry from influencing health policy. Global Voices Status Report 2009 Photo: premasagar In spite of tobacco industry efforts, there is very strong support for smokefree public places from young people. In the Eastern Mediterranean region, more than eight in every ten students support smokefree policies.176 The time has come for Governments to listen. globalsmokefree partnership 31 European Region Overview There has been rapid progress on smokefree laws in Europe. In the five years since Ireland became the first country in the world to go completely smokefree, laws providing effective protection from secondhand smoke are now in place in some seventeen European countries, reaching from the Arctic Circle in the North to the Mediterranean in the South. In the last year, Moldova, Finland and Monaco have adopted strong smokefree laws. Greece have also committed themselves to take action. Historically high smoking rates mean that workplace and public exposure to secondhand smoke is high in Eastern Europe and the Commonwealth of Independent States. Despite this, Lithuania, Estonia and Moldova demonstrate that effective smokefree laws can be achieved. Georgia and Latvia are also taking incremental steps towards smokefree status, with additional regulations expected in 2010. There is a strong – and growing - mandate for smokeRussia’s recent accession to the Framework Convention free laws. In 2008, two thirds of citizens across the EU on Tobacco Control (FCTC) is expected to stimulate supported smokefree bars, and eight out of ten supportchange, but the tobacco industry enjoys privileged aced smokefree restaurants.177 cess to politicians, including presence at the Parliament’s Turkey becomes completely smokefree in July 2009, and influential health committee. While this continues, efwill become a world leader in protection from second- fective action on secondhand smoke is unlikely. hand smoke. Its successful smokefree workplace legislaThe tobacco industry has considerable political inflution was introduced last year and will be extended to covence across the European region, both directly and iner the hospitality sector. No Designated Smoking Rooms directly. Health advocates are working to expose their will be allowed, and exemptions will be limited. There is involvement, and to persuade politicians, officials and a strong commitment from politicians, officials and civil the public of the fallacy of their arguments. society to make this legislation work. Governments in other Southern European countries, including Serbia and Resisting weak and ineffective regulations remains a chal32 European Region lenge across Europe. Some countries are adopting legislation that leaves unacceptably high numbers of people exposed to secondhand smoke. Examples of weak laws include creating smoking areas, allowing smoking in hospitality venues, and restricting smoking to certain times of the day. Such laws are bad for health, and do not comply with the FCTC. Regional Leaders Ireland and the UK have laws which come closest to meeting the standards set by the FCTC. These laws offer high standards of protection for most people, and their laws are among the most robust in the world. Nonetheless, these laws mean that a very small number of people remain exposed to secondhand smoke, usually because they live in, work, or visit places that are not covered by the law. Global Voices Status Report 2009 Ireland Smokefree law Includes Exemptions DSRs Smokefree since People protected United Kingdom* Five years on – benefits of the Irish smokefree law After five years, the Irish smokefree law has achieved: • reduced respiratory symptoms amongst heavily exposed workers178 • more than 80% reduction in fine particles in bars179 • more than 90% reduction in two cancer causing chemicals in bars180 • a compliance rate of 97%181 • support from hospitality workers182 and the public183 Close to meeting FCTC requirements Workplaces and places to which the public has access, hospitality sector, gaming venues and private clubs. Enclosed places only. Very limited. Including prisons, and bedrooms in: residential homes, hotels, hospices and psychiatric institutions None March 2003 4.1 million 17% Reduction in heart attacks In Scotland, heart attacks admissions fell by 17% after the smokefree law was introduced,184 echoing findings in the US,185 186 187 188 and Italy.189 * Scotland, Wales, Northern Ireland and England Smokefree law Includes Exemptions DSRs Smokefree since People protected Close to meeting FCTC requirements. Similar legislation exists in the four countries of the UK Workplaces and public places, hospitality sector, gaming venues and private clubs. Enclosed places only. Very limited. Including bedrooms and sealed designated smoking rooms in prisons and oil rigs and private bedrooms in: residential homes, hospices, hotels. None March 2006 (Scotland) April 2007 (Wales and Northern Ireland) June 2007 (England) 60.7 million globalsmokefree partnership 33 Newly smokefree in 2009 Turkey High smoking rates no barrier to comprehensive smokefree law Most of Turkey’s public places and workplaces have been smokefree since May 2008. The law has been a great success and enjoys strong public support, despite high smoking rates – some studies show that more than six in ten Turkish men are smokers.190 Smokefree law Includes Exemptions DSRs Smokefree since People protected Close to meeting FCTC requirements Workplaces and places to which the public has access, hospitality sector and private clubs. Enclosed places only Very limited. Including prisons, and bedrooms in: residential care homes, hotels, and psychiatric institutions None July 2009 76.8 Million Countries with Strong Smokefree Laws Fourteen European countries now have national laws that offer high standards of protection for most people, most of the time. However, they fall short of the standards set by the FCTC. Typically, this is because they allow Designated Smoking Rooms (DSRs) in hospitality venues and/or workplaces. There is a wide variation in the uptake of DSRs in the different countries. The most effective legislation is in countries like France and Sweden, where there are very strict regulations on designated smoking rooms. DSRs undermine smokefree laws because: • staff must work in them, offering service, providing security and cleaning • smoke leaks from DSRs into the rest of the premises, leaving people exposed to secondhand smoke192 • they create an uneven commercial playing field 34 Photo: Marcos.Zion • they contain high levels of secondhand smoke, putting staff and patrons at risk191 European Region Newly smokefree in 2008 Moldova Leading the way in the Commonwealth of Independent States Monaco Moldova is the first of the CIS countries to pass an extensive smokefree law. Tobacco cultivation is an important element of the country’s economy, smoking rates are high, and the tobacco industry is an important political force. Moldova proves that these barriers can be overcome. Smokefree law Includes Exemptions DSRs Smokefree since People protected Most places smokefree Close to meeting the FCTC requirements. Falls short because smoking rooms permitted Public places, hospitality sector. Enclosed places and playgrounds Limited In hospitality venues with service permitted. Limited to less than 50% of total area March 2008 4.3 million Global Voices Status Report 2009 No fear of negative impact on tourism or gaming industries Monaco is world famous for its casinos, and attracts many tourists, but the law appears to have had no effect on these. Smokefree law Includes Exemptions DSRs Smokefree since People protected Most places smokefree. Close to meeting the FCTC requirements. Falls short because smoking rooms permitted. Public places and workplaces, hospitality sector. Enclosed places only. Limited In hospitality venues with service permitted September 2008 33,000 globalsmokefree partnership 35 Newly smokefree in 2009 Finland Smokefree workplaces extended to all Most Finnish workers have been protected from secondhand smoke at work since 1995, and Finland was the first country in the world to legislate against secondhand smoke as a workplace carcinogen, in 2000. Under the previous smoking restriction policy in the hospitality sector, the highest levels of ETS were found in the “non smoking area” of some establishments, showing the need for a comprehensive law.196 Established smokefree countries Estonia Making a difference in countries with high smoking rates Smokefree law Includes Exemptions DSRs Smokefree since People protected France Over half of all Estonian men are current smokers.197 Before the law was introduced about one in five Estonian adults reported being exposed to secondhand smoke for more than an hour each day outside the home.198 Smokefree law Includes Exemptions DSRs Smokefree since People protected 36 Most places smokefree. Close to meeting the FCTC requirements. Falls short because of cigar lounge and casino exemptions, and because smoking rooms permitted Workplaces and public places, hospitality sector, anywhere where food or drink is served. Enclosed places only Cigar lounges; casinos In hospitality venues, with service permitted. In workplaces. On long distance trains and on ships. Ventilation regulations June 2007 1.3 million Most places smokefree. Close to meeting the FCTC requirements. Falls short because smoking rooms permitted. Public places and workplaces, hospitality sector. Enclosed places only Limited In hospitality venues over 50m2. No food, drink or entertainment permitted. In workplaces. Size regulations June 2009 5.3 million Widespread compliance with the law in capital In Paris, fewer than 2% of establishments were fined for breaches of the legislation in the year after it was introduced.199 Smokefree law Includes Exemptions DSRs Smokefree since People protected Most places smokefree. Close to meeting the FCTC requirements. Falls short because smoking rooms permitted. Public places and workplaces, hospitality sector, gaming venues. Enclosed places only None in the law, but discussion is ongoing about spaces that are substitute homes Hospitality venues only, with no service permitted. Size and ventilation regulations. Workers may only enter the room one hour after it was last used for smoking. Very few installed February 2008 60.7 million European Region Iceland Smokefree air latest chapter in 40 years of tobacco control Italy After the smokefree law came into force, smoking rates fell by more than 7% and the average smokers consumed one and a half fewer cigarettes a day.201 Iceland has been at the forefront of tobacco control for 40 years, from the first health warnings on packs in 1969 onwards. Iceland’s tobacco control strategy means that fewer than one adult in five is a smoker.200 Smokefree law Includes Exemptions DSRs Most places smokefree. Close to meeting the FCTC requirements. Falls short because smoking rooms permitted Workplaces and public places, hospitality sector, gaming venues. Enclosed places only Smokefree law Limited. Designated bedrooms in hotels, residential care homes, prison cells In hospitality venues, no food or drink permitted. In workplaces. Size regulations June 2007 0.3 million Exemptions DSRs Photo:Trey Ratcliff Smokefree since People protected Includes Smokefree since People protected Lithuania Smokefree law Includes Exemptions DSRs Smokefree since People protected Global Voices Status Report 2009 Reducing smoking rates and tobacco consumption Most places smokefree. Close to meeting the FCTC requirements. Falls short because smoking rooms permitted Workplaces and public places. Enclosed places only Limited In hospitality venues with service allowed. In workplaces. Size and ventilation regulations. Few have been installed January 2005 58.1 million Beating tobacco interests The first attempt to introduce a smokefree law in Lithuania was defeated because of organized opposition from the tobacco industry. Health organizations worked strategically to win a comprehensive law second time around. Most places smokefree. Close to meeting the FCTC requirements. Falls short because of exemption for cigar and pipe clubs and because smoking rooms permitted Workplaces and public places, hospitality sector, gaming venues. Enclosed places only Limited. Cigar and pipe clubs In workplaces and on long distance trains only January 2007 3.6 million globalsmokefree partnership 37 Malta Big Tobacco fears spread of Maltese smokefree law Slovenia BAT Malta has been lobbying the European Commission to prevent comprehensive Maltese-style legislation being rolled out across the EU.202 Smokefree law Includes Exemptions DSRs Smokefree since People protected Norway Most places smokefree. Close to meeting the FCTC requirements. Falls short because smoking rooms permitted Workplaces and public places, hospitality sector, gaming venues. Enclosed places only Limited. Residential bedrooms In hospitality venues, with service allowed. In workplaces. Size regulations October 2005 0.4 million Smokefree law Includes Exemptions DSRs Smokefree since People protected Lawmakers resist hospitality trade threats In Slovenia, hospitality groups threatened to strike to disrupt the implementation of the smokefree law. Lawmakers resisted the attempts to undermine the law, which has been implemented successfully. Government figures show that hospitality trade incomes have increased since the law came into effect.204 Most places smokefree. Close to meeting the FCTC requirements. Falls short because smoking rooms permitted Enclosed places only Limited. Hotel bedrooms, areas in care centers for older people, prisons In hospitality venues, with service permitted. In workplaces. Size and ventilation regulations August 2007 2 million Comprehensive legislation easier to enforce Smokefree law Includes Exemptions DSRs Smokefree since People protected 38 Most places smokefree. Close to meeting the FCTC requirements. Falls short because of exemption for cigar and pipe clubs and because smoking rooms permitted Workplaces and public places, hospitality sector, anywhere where food or drink is served. Enclosed places only Limited. Offices occupied by a sole individual. Living rooms in institutions In workplaces only June 2004 4.6 million Photo:Dragon Woman Norwegian bar staff reported that the smokefree law was easier to enforce than prior legislation requiring non-smoking areas. Staff experienced fewer unpleasant incidents and better compliance.203 European Region Smokefree law Includes Exemptions DSRs Smokefree since People protected Workers’ health improved Swedish hospitality workers’ sensory and respiratory symptoms were halved as a result of the smokefree law.205 Most places smokefree. Close to meeting the FCTC requirements. Falls short because smoking rooms permitted Workplaces and public places, hospitality sector, gaming venues. Enclosed places only Limited In hospitality venues only, no food or drink permitted. Size regulations. Few have been installed June 2005 9 million Photo:Hector Melo A. Sweden Local action Most European countries are making progress with national laws, but in Switzerland change is being driven by action at local level. Switzerland Smokefree laws prove popular In Ticino206 and Geneva,207 eight in every ten residents voted in favour of the smokefree laws. Photo:Dragon Woman The legal challenge to the Geneva law shows that it is vital that policies are well drafted. Global Voices Status Report 2009 Smokefree jurisdictions Good examples 6 cantons (out of 26) with most places smokefree Ticino, Appenzell Ausserrhoden, Graubünden, Solothurn, Valais, Geneva (implementation delayed following legal challenge) globalsmokefree partnership 39 South East Asia Overview There are many challenges in South East Asia, including a strong tobacco industry and high rates of male tobacco use in many countries. However, Thailand has had laws restricting smoking in public places since 2002, which shows that these obstacles can be overcome.The Thai law was extended to cover the hospitality industry in 2008. In Indonesia, some local initiatives are delivering smokefree public places, but many of these fall well short of the Standards required by the FCTC because of exemptions, or problems with enforcement. Local laws have achieved excellent results in other parts of the world, providing a strong model for success in South East Asia. The major development in the region is India’s decision in late 2008 to adopt a national smokefree law. India’s new law has very few exemptions. With a population of over one billion people, this is a huge undertaking, and the law is being implemented and enforced on an area-by-area basis. If the law is enacted across the whole country, more than a billion people will be protected from secondhand smoke.There is strong political leadership at both national and local level to make this a reality, but this will need to be sustained. Regional Leaders Following a recent announcement, Sri Lanka is expected to strengthen its existing law, so that all hospitality premises are included in 2009-10. The government of the Maldives is hoping to pass a similar smokefree law. A number of other countries are expected to introduce laws, including Bhutan and Nepal. 40 Thailand and India have strong laws that offer high standards of protection for most people, most of the time. However, these laws fall short of the standards set by the FCTC because they allow Designated Smoking Rooms (DSRs). DSRs undermine smokefree laws because: • they contain high levels of secondhand smoke, putting staff and patrons at risk208 • staff must work in them, offering service, providing security and cleaning • smoke leaks from DSRs into the rest of the premises, leaving people exposed to secondhand smoke209 • they create an uneven commercial playing field South East Asia Thailand Smokefree law Includes Exemptions DSRs Smokefree from People protected Eight in ten international visitors support Thai law Newly smokefree in 2009 A third of Thailand’s national income comes from tourism, and a recent poll showed that eight out of ten international visitors supported the Thai legislation.210 India Most places smokefree. Close to meeting FCTC requirements. Falls short because smoking rooms permitted Workplaces and public places, restaurants, bars, nightclubs, discos, pubs There has been limited local action in South East Asia to date, and local measures in Indonesia have been compromised by a lack of enforcement in some places. In the coming years, more local smokefree laws are expected. Indonesia Smokefree law Includes Exemptions Smokefree laws needed in Indonesia More than six in every ten Indonesian men is a regular smoker,213 which contributes to high levels of secondhand smoke exposure. More than eight in ten teenagers are exposed to secondhand smoke in public places – the highest in the ASEAN region.214 Indonesia has yet to ratify the FCTC. 1 city with most places smokefree, and with no Designated Smoking Rooms (DSRs) permitted Cirebon City 0.2 million <1% of people protected by smokefree law Global Voices Status Report 2009 India’s population dwarfs any country that has yet adopted a strong smokefree law, and this new law has massive potential to improve health. However, there are unique challenges in implementing a smokefree law on this scale. The cost of smoking In India, about 900 thousand people die because of smoking every year, and the cost of treating tobacco related cancers, heart disease and lung disease alone runs to US $6.5billion a year.211 Limited DSRs in non-air conditioned restaurants and workplaces February 2008 65.1 million Local Action Largest country ever to go smokefree Wide range of secondhand smoke sources About half of secondhand smoke in India comes from bidis.212 Tobacco smoke also comes from hookah, cheroots and cigars as well as cigarettes. Secondhand smoke from all sources is toxic. Smokefree law Includes Most places smokefree. Close to meeting FCTC requirements. Falls short because smoking rooms permitted Workplaces and public places, restaurants, bars, nightclubs, discos, pubs Exemptions DSRs Limited In hotels, restaurants and airports. No service permitted Enforcement notes Enforcement being taken forward locally, due to size of country. 3 states, 3 metropolitan areas, 2 cities and several other municipalities are currently enforcing the law. October 2008 Smokefree from People potentially 1.2 billion protected >138.5 million People currently protected by enforced law globalsmokefree partnership 41 Western Pacific Region Overview There are several excellent examples of smokefree laws in the Western Pacific. New Zealanders were among the first people in the world to be protected by a national law making all enclosed public places and workplaces 100% smokefree. People in Singapore have received some legal protection from secondhand smoke for over three decades, with the legislation regularly reviewed and made stronger. In addition, the overwhelming majority of Australians have long been protected by strong and comprehensive smokefree laws, and it’s expected that the whole country will be protected in 2010. There has been good progress in the last year, with Hong Kong removing the final exempt premises from its smokefree law, which is now comprehensive. In the Philippines, organizations in six areas are working towards adopting comprehensive smokefree laws. progress there is extremely important. Many public places in the capital, Beijing, went smokefree during the Olympics and Paralympics, although the regulations did not extend to the hospitality sector. Three major cities – Shanghai, Guangzhou and Beijing – have plans to extend smokefree policies in 2009-10. More than 40 million people live in these three cities alone. Regional Leaders New Zealand and Hong Kong have laws that come close to meeting the standards set by the FCTC. These laws offer high standards of protection for most people, and are among the most effective at protecting people from secondhand smoke in the world. Nonetheless, these laws mean that a very small number The Malaysian Government has announced plans to exof people remain exposed to secondhand smoke, usually tend its smokefree law in 2009. because they live in, work, or visit places that are not China is home to a third of the world’s smokers, so any covered by the law. 42 Western Pacific Region Increasing revenues in parts of the hospitality sector Photo: Travelling Pooh New Zealand The New Zealand law had an overall positive effect on the hospitality industry215 Smokefree law Includes Exemptions Up 0.9% Sales in cafes and restaurants Up 9.3% Employment in pubs, taverns and bars Up 24% Employment in cafes and restaurants Up 9% Employment in clubs Down 8% Comprehensive. Close to meeting FCTC requirements Workplaces and public places, hospitality sector, gaming venues. Outdoor areas of schools and early childhood centers Very limited. Private premises, smoking rooms for live in patients and residents None December 2004 4.1 million Newly smokefree in 2009 Hong Kong Special Administrative Region of China Photo: mandolux DSRs Smokefree since People protected Sales in bars and clubs Hong Kong has had a strong smokefree law since 2007, with exemptions for venues including bars, bathhouses and nightclubs. These exemptions are removed in 2009. Smokefree law popular with public About eight in ten Hong Kong residents say that they are more likely to visit restaurants now that they are smokefree, and more than seven in ten believe that there should be no exemptions to the smokefree law.216 Smokefree law Includes Exemptions DSRs Smokefree since People protected Global Voices Status Report 2009 Hong Kong takes final step to comprehensive law Close to meeting FCTC requirements Workplaces, public places, hospitality venues Very limited None June 2009 7.1 million globalsmokefree partnership 43 Countries with Strong Smokefree Laws DSRs undermine smokefree laws because: • they contain high levels of secondhand smoke, putting staff and patrons at risk217 Photo: Jungene In 2008-9, Brunei Darussalam and Singapore introduced • staff must work in them, offering service, providing national laws that offer high standards of protection for security and cleaning most people, most of the time. However, they fall short of the standards set by the FCTC. This is because they • smoke leaks from DSRs into the rest of the premises, leaving people exposed to secondhand smoke218 allow Designated Smoking Rooms (DSRs) in hospital• they create an uneven commercial playing field ity venues and/or workplaces. Newly smokefree in 2008 Brunei Darussalam Smokefree law Includes Exemptions DSRs Smokefree since People protected 44 Tobacco declared haram in Brunei Brunei’s State Mufti has decreed that tobacco use is forbidden – haram – to Muslims.219 Most places smokefree. Designated Smoking Rooms (DSRs) permitted in workplaces. Close to meeting FCTC requirements. Falls short because smoking rooms permitted Workplaces and public places, hospitality sector. Some outdoor spaces Limited In workplaces, at airport June 2008 0.4 million Newly smokefree in 2009 Singapore Smokefree law Includes Exemptions DSRs Smokefree since People protected Responding to new standards Singapore’s first smokefree law was passed in 1970, and has been revised many times. This year, the law was extended to cover all indoor places and some outside places. Singapore has one of the lowest smoking rates of any high income country – about 13% of people smoke,220 and more than three quarters of adults have never been exposed to secondhand smoke at work.221 Most places smokefree. Designated Smoking Rooms (DSRs) permitted in workplaces. Close to meeting FCTC requirements. Falls short because smoking rooms permitted Workplaces and public places, hospitality sector. Some outdoor spaces Limited. Prisons. DSRs in workplaces, airport In workplaces, in hospitality venues January 2009 4.7 million Western Pacific Region Local Action Some Western Pacific countries are introducing smokefree laws at a local level – in towns, cities, states, provinces and territories. Lao People’s Democratic Republic Smokefree laws in a Low Income Country Smokefree jurisdictions Good examples People protected 3 cities smokefree in most indoor public places, including restaurants and cafes Luang Prabang, Champasak, Vientiane 0.6 million 9% of people protected by strong laws These local laws can be incredibly powerful. They are often easier to enact than national laws, and are able to be implemented and enforced more readily. In Australia, state-level laws are becoming progressively more alike, and offering more effective protection from secondhand smoke. By 2010, every State will have at least a strong law on secondhand smoke. In Lao People’s Democratic Republic and the Philippines, local smokefree laws continue to spread. Australia Local laws will protect all Australians by 2010 Local laws have proliferated across Australia. By the end of 2010, the whole country will be protected by comprehensive or good laws. Action is now needed to tackle exemptions for “high roller rooms” in casinos in Queensland, Victoria and New South Wales. Philippines Smokefree jurisdictions 3 states and territories (out of 8) with comprehensive smokefree laws. 4 with good smokefree laws and limited exemptions. 1 will implement a good law in 2010 American Capital Territory, South Australia, Good examples Tasmania People protected 2.5 million by comprehensive 12% of people protected by comprehensive laws laws People protected 18.9 million 99% of people protected by compreby good laws hensive or strong laws Global Voices Status Report 2009 Smokefree jurisdictions Good examples People protected Lao PDR is a low income country, and relies heavily on tourism revenues for foreign income. World Heritage Site Luang Prabang and the capital Vientiane are major tourist centers and appear unharmed by the smokefree laws. Overcoming tobacco industry interference Tobacco industry lobbying remains a barrier in the Philippines. 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