Meet me in Uruguay: Public health versus Big Tobacco

By Max J. Castro
majcastro@gmail.com

Last weekend in Punta del Este, Uruguay, at a meeting of 172 nations organized by the United Nations’ World Health Organization (WHO), the world health community struck a series of hard blows against the gigantic tobacco companies that have increasingly been seeking higher profits and laxer regulations outside the United States.

After decades of denying the science that unequivocally demonstrated the harmful health effects of cigarettes, spending millions of dollars to lobby politicians, and using hardball tactics to intimidate critics of the industry, the tobacco companies suffered their first significant defeat in 1964 when the U.S. Surgeon General issued a report (“Smoking and Health: Report of the Advisory Committee to the Surgeon General” http://profiles.nlm.nih.gov/NN/Views/Exhibit/narrative/smoking.html) that conclusively linked smoking with cancer and other diseases leading to a 70 percent higher death rate for smokers compared with non-smokers.

While the landmark report did not cause Americans to suddenly stop smoking en masse, it did have an immediate impact on the national and international consciousness. As then-Surgeon General Luther L. Terry remembers it, the report “hit the country like a bombshell. It was front page news and a lead story on every radio and television station in the United States and many abroad.”

“Smoking and Health: Report of the Advisory Committee to the Surgeon General,” also was the impetus for the long and still ongoing trend toward decreasing rates of smoking in the United States. Yet, forty-six years and myriad law suits and anti-smoking campaigns and laws later, an estimated 435,000 Americans die every year of smoking-related diseases. This compares with 85,000 deaths a year due to alcohol, 30,622 resulting from suicide, 26,347 caused by auto accidents, and 20,308 from homicides.

Notwithstanding the lethal toll smoking still inflicts in the United States, between 1964 and 2010 this country became a declining market for Big Tobacco. While on the home front continuing to fight new regulations, attract new smokers through youth-oriented promotions, and manipulating nicotine levels so as to deepen addiction to make it more difficult for smokers to quit, the tobacco industry began to aggressively market their product outside of the United States, especially in the “emerging economies” of Asia, Africa, and Latin America.

The strategy has met with significant success. Sales of cigarettes worldwide are increasing by two percent per year. This trend, if it continues unabated, will lead to tens of millions of deaths across the world in the coming decades.

The demonstrated perils of tobacco underlined in the 1964 U.S. Surgeon General’s reports eventually led to various kinds and degrees of regulation of tobacco advertising and smoking bans in public places in an increasing number of nations. In some countries, tobacco taxes were increased to discourage sales. Yet, as the continuous rise in cigarette sales globally demonstrate, these measures have not been sufficient to avert a looming public health disaster as nicotine addiction conquers every corner of the planet.

In many relatively poor countries like Indonesia, already the fifth-largest market for cigarettes in the world, there are virtually no regulations on tobacco advertising or on marketing and selling cigarettes to children. In some countries smoking cigarettes, especially best-selling American brands, is still seen as sign of status or modernity. In addition, governments often have an incentive to stand by as cigarette use increases. Indonesian government officials say the collect $2.5 billion annually from Philip Morris alone.

The gravity and global reach of the problem led to the 2003 “Framework Convention on Tobacco Control,” an international agreement that in the last seven years has been ratified by 171 countries, not including the United States (George W. Bush signed the treaty but never submitted it to the Senate; the Obama administration says it hopes to submit it to the Senate in 2011).

The gathering in Uruguay last weekend was intended to work toward a treaty binding nations to engage in a set of evidence-based measures to reduce smoking. It comes against the backdrop of a pending law suit against tiny Uruguay brought by Philip Morris International, the world’s largest cigarette company. The company, with annual sales that are double the Gross National Product of Uruguay, claims that the small country’s tough new regulations on the packaging of cigarettes are unreasonable.

But the attack against Uruguay, which could cost the country tens of millions of dollars, is hardly an isolated incident but rather part of a wide-ranging campaign by the two biggest tobacco companies (Philip Morris and British American Tobacco) to beat back the trend toward anti-smoking measures in many countries, including huge markets like Brazil.

The result of the Punta del Este gathering was a resounding victory for public health and a disappointing defeat for Big Tobacco. The cigarette industry had been fighting especially hard to prevent a ban on adding flavors, such as chocolate, strawberry, and many other substances, to cigarettes. These substances attenuate the harshness of tobacco smoke and thereby make it easier for young people to acquire the habit. But the countries gathered in Uruguay last weekend recommended that countries restrict or ban flavor additives.

The tobacco companies’ fierce attack on bans on additives is based on research that shows that smokers start young. Tobacco companies know they have their best chance at a point in the life cycle when people are especially susceptible to concerns about peer acceptance and rebellion against authority. But because cigarettes are highly addictive, what may start as adolescent experimentation more often than not turns into a life-long, deadly habit.

The 172-nation group also agreed to support Uruguay in its legal defense against Philip Morris International, to establish a working group to develop guidelines on taxing tobacco to reduce consumption, to provide continued funding for the tobacco control convention (which is currently running in the red), to recommend that smoking cessation programs be paid for by national health systems, and to encourage governments to train experts to help more smokers to quit.

The propaganda peddled by Big Tobacco and its allies emphasizes the economic cost of new regulations and bans, zeroing in especially on the only possibly sympathetic group that might be hurt by these, namely small, struggling tobacco farmers in poor countries. In reality, any economic benefits or hardships incurred by these groups are dwarfed by the colossal human, social, and economic cost of tobacco addiction.

The 2010 Uruguay conference, like the 1964 Surgeon General’s report, is a milestone in a long struggle against those whose only purpose is to generate maximum profits without regards for the consequences for human life and health versus the interests of the rest of humanity.