In the case of tobacco use the pivotal factor is the tobacco industry's
continued promotion of its products and agressive resistance to regulation.
You might also be interested in what C. Everett Koop has to say about
tobacco as a public health issue.
Lynn Greaves
Public Health Services
Regina Health District
2110 Hamilton St
Regina, SK Canada S4P 2E3
306-766-7903 Fax 306-766-7798
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Tobacco Free Initiative
World Health Organization
22 Avenue Appia
1211 Geneva 27 Switzerland
My name is Dr. C. Everett Koop, and I am submitting this comment as Senior
Scholar of the C. Everett Koop Institute at Dartmouth College in the United
States. Although I am not able to attend the hearings, I would like to ask
that my comments be read by a member of the Framework Convention Alliance.
The mission of the C. Everett Koop Institute is to promote the health and
well-being of all people, by working to enhance our understanding of mental
and physical health and the prolongation of a high quality of life. Funding
for the Institute comes from private companies, governmental bodies and
private foundations. We accept no funds from tobacco companies or their
affiliates.
Between 1981 and 1989, I served as the U.S. Surgeon General under Presidents
Reagan and Bush. In that capacity I was dedicated to educating scientists
and the public about the hazards of tobacco use and doing what I could to
decrease the death and disease caused by tobacco use. I also served as
chief delegate to WHA (except when the secretary of HHS was present) from
1981-1989. In 1984 I announced that it should be our goal to create a
smoke-free society. During my tenure as Surgeon General, my office issued
eight reports on the death and diseases caused by smoking and smokeless
tobacco, including reports on cancer, cardiovascular disease, chronic
obstructive lung disease, nicotine addiction and the health consequences of
environmental tobacco smoke. Among the many scientific findings established
by those reports were:
* Cigarette smoking is the number one preventable cause of disease and
premature death in the United States
* Cigarette smoking is the major cause of lung cancer and laryngeal
cancer,
and a major cause of oral cancer and esophageal cancer in the United States
* Cigarette smoking is a major cause of coronary heart disease in the
United
States for men and women, and is the most important of the known modifiable
risk factors for CHD
* Cigarette smoking is the major cause of Chronic Obstructive Lung
Disease
morbidity in the United States and 80 to 90 percent of the COLD in the US is
attributable to cigarette smoking
* Cigarettes and other forms of tobacco are addictive and nicotine is
the
drug in tobacco that causes addiction
* Involuntary smoking is a cause of disease, including lung cancer, in
healthy nonsmokers
* Snuff, a form of smokeless tobacco, can cause cancer, especially
cancer of the oral cavity, and smokeless tobacco can be addictive
Although these findings were made over a decade ago, each of these findings
is as true today as it was when these reports were issued. The unfortunate
truth is that we as a society, the Unites States as a nation, and the world
as a whole have done shockingly little to reduce the death toll from tobacco
use. We have also done far too little to rein in the activities of the
tobacco industry that have promoted the use of this product and hidden what
it knows about its products.
In my capacity as the Surgeon General of the United States I also
represented the United States at the World Health Organization and studied
the impact of tobacco use and the behavior of the tobacco companies around
the world. The scientific conclusions in the reports I issued as Surgeon
General know no boundaries and are as true outside the United States as they
are inside the United States. Every year tobacco robs millions of people in
every nation of their health. While the tobacco industry touts the economic
benefits of growing and manufacturing tobacco, the economic toll that
tobacco takes in terms of lost lives, lost productivity, health care costs,
and environmental destruction far outweighs any economic benefits.
Given the current death toll from tobacco and the predicted death toll from
tobacco worldwide, tobacco control deserves to be a top priority of the
World Health Organization and governments throughout the world. The tobacco
industry would like to divert attention away from the magnitude of the
problems caused by tobacco, but we should not be fooled. They are doing as
they have always have done: putting their profits over the health and safety
of the public.
Let me also dispel another myth that the tobacco industry is currently
trying to promote. In the United States, tobacco companies are claiming
that they have changed and they are claiming that they do not want kids to
smoke. Their rhetoric does not match their actions. While the tobacco
industry has agreed not to advertise in certain locations, it has continued
to promote its products as aggressively as ever before and has not curtailed
the use of the images that make its products appealing to our children. It
also continues to oppose the most reasonable government regulation and
distorts the scientific evidence about the health effects of its products.
Have the tobacco companies changed? The answer is no. We must not be
deceived again.
The Tobacco Free Initiative of the World Health Organization
For decades the World Health Organization did not focus enough attention on
the health problems caused by tobacco. I commend Dr. Gro Harlem Brundtland'
s 1998 decision to establish the Tobacco Free Initiative as a Cabinet level
WHO project to elevate tobacco as a WHO priority and to coordinate a global
strategic response to tobacco as a major public health issue.
I also want to commend the WHO and its member states for starting the
process for developing a Framework Convention on Tobacco Control. I want to
raise my voice in favor of the strongest possible Framework Convention. The
May 1999 decision of the World Health Assembly unanimously endorsing the
start of negotiations for the Framework Convention on Tobacco Control is
potentially one of the most important public health steps taken by the WHO
in its history. If done right, the Convention could provide a set of
standards and rules that could save tens of millions of lives and could
change the course of the history of the health of the world. I know that
these are grand words - but with current predictions that the number of
tobacco-caused deaths are expected to rise to ten million deaths a year by
2030, there is no more important public health mission.
There are many things that make me optimistic about the progress that is
being made in a number of nations that have taken strong steps in recent
years to reduce tobacco use. More nations than ever have begun to take
strong steps, but for every nation that has acted there are a dozen that are
watching the epidemic rise without taking strong countermeasures. As the
wealthier nations of the world act to reduce tobacco consumption, we are
seeing rising rates of tobacco use in poorer and less wealthy nations. And,
we are seeing the multinational tobacco companies increasingly focus their
marketing muscle and expertise in these poorer nations.
It is vital that the nations of the world continue their individual actions
within their borders to combat the tobacco industry and the death and
disease caused by tobacco products. It has also never been more clear that
tobacco is an international problem that must be addressed with
international solutions. For example, tobacco marketing can no longer be
confined within one nation's borders. The World Wide Web and satellite
television ensure that advertising crosses borders, even into countries
where there are strict advertising bans in place. The tobacco industry uses
smuggling to circumvent individual nations' rules and tax policies. And the
tobacco industry uses the same arguments and political ploys to undermine
reasonable regulation in country after country. The tobacco industry knows
the world is an interconnected market, and we must be able to respond with
solutions that create uniform standards and treat tobacco control as an
international issue.
We must also be aware of the history of tobacco control efforts. All too
often the tobacco industry has succeeded in convincing governments to accept
proposals that sound good on their face but do little to actually reduce
tobacco use. The negotiators of the Framework Convention must not fall into
the same trap. The Convention must contain meaningful specific restrictions
on the tobacco industry's marketing and manufacturing practices, require
governments to take strong concrete steps to reduce tobacco use, and must
not just be a "feel good" treaty that speaks in glowing, general language
but has no real force or effect.
Speaking as a U.S. citizen, I believe the United States has an important
role to play. Our multinational tobacco companies have played a leading
role in spreading the plague of tobacco throughout the world. President
Clinton has spoken out forcefully about the need for the establishment of
strong public policy changes to rein in the tobacco industry and to reduce
tobacco use. I urge the United States government to speak with the same
voice in Geneva that it does at home and to support a strong, specific and
effective FCTC - even if it includes policies that the tobacco industry has
successfully blocked in the United States.
The United States has a leadership role to play in promoting health around
the world. The positions of the U.S. delegation during the Framework
Convention negotiations should be based on the protection and promotion of
global public health, and nothing else. If the U.S. government fails to
actively support a strong FCTC or urges the adoption of a weak convention
because of political considerations back home, we will be doing the entire
world a disservice. The United States has an opportunity to use its
knowledge and its experience to assist in the creation of the strongest
possible treaty, one that can help the other nations of the world avoid a
tobacco epidemic of the magnitude faced by the United States. How the U.S.
responds during these negotiations will be the truest test of our
leadership.
Containing a Rogue Industry
We now recognize that tobacco is different from other plagues that have
faced the world because it is promoted by an unscrupulous industry that will
stop at nothing to promote its products and raise its profits. Other
diseases and conditions have various etiologies, but tobacco-related
diseases and conditions are the direct result of the work of a business
enterprise -- Big Tobacco. Over the course of the 20th century, Big Tobacco
has secured special privileges that honest businesses do not have. In the
United States, tobacco companies and their foreign affiliates have gained
protection and avoided accountability from every consumer protection law
adopted during the last eight decades. Traditional public health measures
are critical to our success in reducing the harm caused by tobacco, but we
also must recognize that we must also be engaged in the noble task of
bringing the tobacco industry to justice if we are to succeed.
The evidence is irrefutable. The tobacco industry plunders communities and
nations. The industry's own internal documents prove that Big Tobacco knows
that what it has been doing is wrong. On a scale never before known to
commercial enterprises, Big Tobacco has engaged in the most devastating
cover-up of scientific evidence and consciously sought to deceive and
defraud the entire world about the health consequences of its products. It
has preyed on our children and lied to our governments. It has manipulated
nicotine and political systems. And it has created a public relations
apparatus designed to make the world think it was behaving responsibly even
while engaging in the most heinous behavior.
Big Tobacco seeks to control what people think, not only by nicotine
addiction, but through an unremitting assault on the public's senses by
using false and misleading images and statements. It knows that public
behavior follows public perceptions. It denies that tobacco is addictive -
and then claims that consumers have a choice. It claims an allegiance to
free speech so that it can promote its product in any way it pleases, but
uses its economic and political muscle to silence its critics. And it pays
millions of dollars to advertising agencies to sell its image as a good
corporate citizen, even though its products kill millions of people every
year.
We must resolve never again to let Big Tobacco's false and misleading
statements go unanswered. Public policy makers need to know the truth about
tobacco products and the tobacco industry. Every child and adult needs to
know the truth. People of every race, of every culture, and indeed every
person in every walk of life needs to know the truth about an industry that
harms, knows that it harms, and has every intention to continue to harm.
And a strong Framework Convention is a critical weapon that is needed to
counteract the tobacco industry's wrongdoing.
Conclusion
The world needs a strong Framework Convention, so that no nation is forced
to fight the tobacco industry or the plague of tobacco use alone or unarmed.
The tobacco industry must be prevented from shifting its practices from
country to country as its advertising and promotional tactics are
increasingly scrutinized and regulated. The FCTC must unite the countries
of the world in order to contain the tobacco industry's wrongful practices.
The FCTC should seek to bring the tobacco industry under proper governmental
and international controls with concerted action on advertising, smuggling,
product regulation, treatment programs, environmental tobacco smoke and many
other areas. The Convention should guarantee that every person, no matter
where he or she lives, is effectively provided with information about the
health hazards of tobacco use and empower them to resist the tobacco
industry's messages.
The FCTC and its related protocols can fulfill these ambitious goals. Now
that WHO has seized the initiative at the global level we have the ability
to change the behavior of multinational tobacco corporations at every level.
We have the opportunity to stop the spread of disease and death transported
by tobacco companies across borders into new populations of non-users. I
strongly support the process that WHO has begun and encourage the countries
of the world to come together and enact a meaningful and effective FCTC.
> ----------
> From: Eberhard Wenzel[SMTP:[log in to unmask]]
> Reply To: Health Promotion on the Internet
> Sent: September 1, 2000 3:41 AM
> To: [log in to unmask]
> Subject: tobacco dirty tricks and the WHO
>
> On 29 Aug 2000, at 9:08, Concha Colomer wrote:
>
> > We, health professionals, should think about the complete tobacco
> picture,
> > with the different economical and political existing interest and not be
> > naïf and not let them to use us. Do we think really that tobacco is the
> > most important population's health problem in the world? Does the
> > magnitude of the problem justify fight against smoking habits to be the
> > priority at WHO, European Union, and most of the health strategies at
> > international, national and local level?.
>
> Concha, I join you in these questions. While tobacco use is a major
> health problem, it is certainly not the key problem of public health at
> all, neither nationally and certainly not globally.
>
> Social determinants in health are increasingly neglected, and one has
> to wonder why this is so.
>
> Why do we have these difficulties to stand up and tell the people what
> we know from our research? Why do we always take the easy way-out
> and focus on one particular individual behavior?
>
> Looks like we're missing the point ...
>
>
> Eberhard Wenzel MA PhD
> International Public HealthWatch
> Griffith University
> School of Public Health
> Meadowbrook, Qld. 4131
> Australia
> Tel.: +61-7-3382 1026
> Fax: +61-7-3382 1034
> e-mail: [log in to unmask]
> Web-site International Public HealthWatch at:
> http://www.ldb.org/iphw/index.htm
>
> Doubt is not a pleasant condition, but certainty is absurd.
> Voltaire (1694-1778)
>
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