This editorial published in the Tobacco Reporter was written by Canadian philosopher John Luik.
Billionaires and Big Tobacco - Tobacco Reporter
September 5, 2008
John Luik
Given the way they have chosen to spend their money, Michael Bloomberg and Bill Gates may not achieve the reductions in smoking they are seeking
What do you get when you take two billionaires, $500 million and mix them together with the “experts” in traditional tobacco control? Not much good and the possibility of some real harm. Of course that’s not the take of much of the international press, which has championed the recent announcement from Microsoft founder Bill Gates and New York City mayor Michael Bloomberg, who have teamed up to provide $500 million to tobacco control over the next four years. As the International Herald Tribune wrote, “When two highly visible billionaire philanthropists put their resources and stature behind a campaign, the results are apt to be good.”
Bloomberg, who is known for his ardent dislike of smoking, is adding some $250 million to the $125 million that he pledged to tobacco control programs two years ago. Gates, who recently retired from Microsoft to spend his time running the Bill and Melinda Gates Foundation, will chip in $125 million over five years. These amounts dwarf the roughly $20 million that is currently spent by middle- and lower-income countries on tobacco control.
So how could the brains, drive and $500 million of Gates and Bloomberg possible go wrong? The answer lies partly in Bloomberg’s views about what constitutes effective tobacco control, the organizations and people who will be getting the money and their beliefs about smoking prevention, and finally in the recipients’ track record in tobacco control.
More of the same
Let’s begin with Mayor Bloomberg. Bloomberg is obviously the driving intellectual force behind this vast amount of new money. His foundation, the Bloomberg Family Foundation, gave the WHO $2 million to devise a strategy on tobacco control. That strategy, called Mpower, was rolled out in February by Bloomberg and WHO Director General Dr. Margaret Chan.
Like much else from the WHO that touches on tobacco control, it is based on the same failed paradigm of what causes smoking and what can prevent it that has dominated the anti-tobacco movement and the public health establishment for more than 25 years. It includes public smoking bans, sharply increased tobacco taxes, complete bans on tobacco advertising, “denomoralization” campaigns and providing nicotine patches and other smoking cessation aids.
Bloomberg obviously sees New York City as the shining example for tobacco control, as the centerpiece of the WHO strategy takes a leaf from the city’s core policies of high tobacco taxes and ban on public smoking. No doubt the mayor regrets that the U.S. constitution stands in the way of him introducing a complete ban on tobacco advertising.
But it isn’t just the mayor who is the problem—it is also who the mayor and Bill Gates are giving their money to, and more particularly their track record in smoking prevention. The $500 million will go to five organizations: the Bloomberg Initiative to Reduce Tobacco Use (and through it to the WHO), the World Lung Foundation, the John’s Hopkins Bloomberg School of Public Health, the U.S. Centers for Disease Control and Prevention Foundation, and the Campaign for Tobacco Free Kids.
The trouble then lies in the fact that a massive amount of money—money that could do an enormous amount of good in terms of public health in the developing world—is being given to the same old group of anti-tobacco advocates and public health types whose ideas about preventing youth smoking have not changed for the last 25 years and, just as crucially, who have failed to win the war on youth smoking, not once but countless times. In effect, what the Bloomberg-Gates initiative means is that the consistent track record of first-world tobacco control failure is now going to be exported to the developing world—where it will be equally unsuccessful.
Consider that record. COMMIT (Community Intervention Trial for Smoking Cessation), one of the largest tobacco control programs ever run, involving 11 U.S. communities and designed to help smokers, particularly heavy smokers quit, failed to reduce smoking. Or take ASSIST (American Stop Smoking Intervention Study), an eight-year project in 17 U.S. states run by the National Cancer Institute and the largest attempt to put smoking prevention theory into practice ever attempted. The strategy had all of the Bloomberg favored policies—limits on tobacco advertising, public smoking bans, tougher access to tobacco and recommended increases in taxation. But in terms of reducing smoking prevalence and consumption, the program was statistically nonsignificant. One could hardly ask for a clearer demonstration of how wrong-headed the Bloomberg-WHO recipe for tobacco control is.
Then too there are the massive attempts at smoking education and prevention in the schools. The Hutchinson Smoking Prevention Project, which involved intensive anti-smoking education and which followed students over 15 years, was a massive failure with no differences in terms of daily smoking between students who had the program and those who did not.
And what about those swinging taxes that are supposed to deter youth smoking? Here again, the record speaks otherwise. Studies by De Cicca et al (1998) and Douglas and Hariharan (1994) found virtually no evidence that “higher cigarette prices would have a significant impact on teenage decisions to pick up the smoking habit.” And more recent policy initiatives, such as graphic warnings, have been equally ineffective.
None of this should be surprising given a study last year that found that the WHO rarely based its health policies on a systematic review of the evidence of what worked. In other words, tobacco policy is made in the dark.
The fundamental problem is that there is a basic disconnect between what huge amounts of the research literature on youth smoking says, and what smoking prevention policy says. Indeed, the defining characteristic of most policies designed to prevent youth smoking is how disconnected they are from the root causes of smoking.
For instance, youth smoking literature is full of discussions of how socioeconomic factors such as poverty, lack of success at school and dysfunctional families are the most reliable predictors of whether someone will smoke as a youth and as an adult. It is hardly a secret that lower social-economic status is clearly associated with smoking and conversely that as people become both wealthier and better educated, they smoke less or quit entirely. But when one comes to smoking prevention policies, there is hardly a mention of these risk factors or this connection.
Better ways to spend
If Bloomberg and Gates really wanted to prevent youth smoking in the developing world, they would give not a penny to the anti-tobacco activists or the public health establishments committed to traditional tobacco control, but instead take all that $500 million and spend it on poverty alleviation and improving education. Not only would they succeed in significantly reducing smoking, they would address a score of other unhealthy behaviors linked to poverty and lack of education.
The one hope in all of this is Bill Gates. He is smart, curious and highly innovative. His previous efforts in health funding for the developing world have pushed at the “usual” way in which things are done, particularly in such areas as malaria control. Perhaps now that Gates is no longer pressed with his Microsoft responsibilities, he will take the time to look at the sad story of first-world tobacco control, read some of the research literature on what leads young people to smoke and bring the same fresh insight, ingenuity and enthusiasm for breaking with conventional wisdom to tobacco control that he did to the world of computers.
It could prove difficult, not least because Bloomberg thinks of himself as an expert in these matters and he has surrounded himself with the like-minded. He will either have to change his mind or be pushed aside. Still it would make a world of difference to the cause of smoking prevention. One can only hope.
Source: Tobacco Reporter
September 5, 2008
John Luik
Given the way they have chosen to spend their money, Michael Bloomberg and Bill Gates may not achieve the reductions in smoking they are seeking
What do you get when you take two billionaires, $500 million and mix them together with the “experts” in traditional tobacco control? Not much good and the possibility of some real harm. Of course that’s not the take of much of the international press, which has championed the recent announcement from Microsoft founder Bill Gates and New York City mayor Michael Bloomberg, who have teamed up to provide $500 million to tobacco control over the next four years. As the International Herald Tribune wrote, “When two highly visible billionaire philanthropists put their resources and stature behind a campaign, the results are apt to be good.”
Bloomberg, who is known for his ardent dislike of smoking, is adding some $250 million to the $125 million that he pledged to tobacco control programs two years ago. Gates, who recently retired from Microsoft to spend his time running the Bill and Melinda Gates Foundation, will chip in $125 million over five years. These amounts dwarf the roughly $20 million that is currently spent by middle- and lower-income countries on tobacco control.
So how could the brains, drive and $500 million of Gates and Bloomberg possible go wrong? The answer lies partly in Bloomberg’s views about what constitutes effective tobacco control, the organizations and people who will be getting the money and their beliefs about smoking prevention, and finally in the recipients’ track record in tobacco control.
More of the same
Let’s begin with Mayor Bloomberg. Bloomberg is obviously the driving intellectual force behind this vast amount of new money. His foundation, the Bloomberg Family Foundation, gave the WHO $2 million to devise a strategy on tobacco control. That strategy, called Mpower, was rolled out in February by Bloomberg and WHO Director General Dr. Margaret Chan.
Like much else from the WHO that touches on tobacco control, it is based on the same failed paradigm of what causes smoking and what can prevent it that has dominated the anti-tobacco movement and the public health establishment for more than 25 years. It includes public smoking bans, sharply increased tobacco taxes, complete bans on tobacco advertising, “denomoralization” campaigns and providing nicotine patches and other smoking cessation aids.
Bloomberg obviously sees New York City as the shining example for tobacco control, as the centerpiece of the WHO strategy takes a leaf from the city’s core policies of high tobacco taxes and ban on public smoking. No doubt the mayor regrets that the U.S. constitution stands in the way of him introducing a complete ban on tobacco advertising.
But it isn’t just the mayor who is the problem—it is also who the mayor and Bill Gates are giving their money to, and more particularly their track record in smoking prevention. The $500 million will go to five organizations: the Bloomberg Initiative to Reduce Tobacco Use (and through it to the WHO), the World Lung Foundation, the John’s Hopkins Bloomberg School of Public Health, the U.S. Centers for Disease Control and Prevention Foundation, and the Campaign for Tobacco Free Kids.
The trouble then lies in the fact that a massive amount of money—money that could do an enormous amount of good in terms of public health in the developing world—is being given to the same old group of anti-tobacco advocates and public health types whose ideas about preventing youth smoking have not changed for the last 25 years and, just as crucially, who have failed to win the war on youth smoking, not once but countless times. In effect, what the Bloomberg-Gates initiative means is that the consistent track record of first-world tobacco control failure is now going to be exported to the developing world—where it will be equally unsuccessful.
Consider that record. COMMIT (Community Intervention Trial for Smoking Cessation), one of the largest tobacco control programs ever run, involving 11 U.S. communities and designed to help smokers, particularly heavy smokers quit, failed to reduce smoking. Or take ASSIST (American Stop Smoking Intervention Study), an eight-year project in 17 U.S. states run by the National Cancer Institute and the largest attempt to put smoking prevention theory into practice ever attempted. The strategy had all of the Bloomberg favored policies—limits on tobacco advertising, public smoking bans, tougher access to tobacco and recommended increases in taxation. But in terms of reducing smoking prevalence and consumption, the program was statistically nonsignificant. One could hardly ask for a clearer demonstration of how wrong-headed the Bloomberg-WHO recipe for tobacco control is.
Then too there are the massive attempts at smoking education and prevention in the schools. The Hutchinson Smoking Prevention Project, which involved intensive anti-smoking education and which followed students over 15 years, was a massive failure with no differences in terms of daily smoking between students who had the program and those who did not.
And what about those swinging taxes that are supposed to deter youth smoking? Here again, the record speaks otherwise. Studies by De Cicca et al (1998) and Douglas and Hariharan (1994) found virtually no evidence that “higher cigarette prices would have a significant impact on teenage decisions to pick up the smoking habit.” And more recent policy initiatives, such as graphic warnings, have been equally ineffective.
None of this should be surprising given a study last year that found that the WHO rarely based its health policies on a systematic review of the evidence of what worked. In other words, tobacco policy is made in the dark.
The fundamental problem is that there is a basic disconnect between what huge amounts of the research literature on youth smoking says, and what smoking prevention policy says. Indeed, the defining characteristic of most policies designed to prevent youth smoking is how disconnected they are from the root causes of smoking.
For instance, youth smoking literature is full of discussions of how socioeconomic factors such as poverty, lack of success at school and dysfunctional families are the most reliable predictors of whether someone will smoke as a youth and as an adult. It is hardly a secret that lower social-economic status is clearly associated with smoking and conversely that as people become both wealthier and better educated, they smoke less or quit entirely. But when one comes to smoking prevention policies, there is hardly a mention of these risk factors or this connection.
Better ways to spend
If Bloomberg and Gates really wanted to prevent youth smoking in the developing world, they would give not a penny to the anti-tobacco activists or the public health establishments committed to traditional tobacco control, but instead take all that $500 million and spend it on poverty alleviation and improving education. Not only would they succeed in significantly reducing smoking, they would address a score of other unhealthy behaviors linked to poverty and lack of education.
The one hope in all of this is Bill Gates. He is smart, curious and highly innovative. His previous efforts in health funding for the developing world have pushed at the “usual” way in which things are done, particularly in such areas as malaria control. Perhaps now that Gates is no longer pressed with his Microsoft responsibilities, he will take the time to look at the sad story of first-world tobacco control, read some of the research literature on what leads young people to smoke and bring the same fresh insight, ingenuity and enthusiasm for breaking with conventional wisdom to tobacco control that he did to the world of computers.
It could prove difficult, not least because Bloomberg thinks of himself as an expert in these matters and he has surrounded himself with the like-minded. He will either have to change his mind or be pushed aside. Still it would make a world of difference to the cause of smoking prevention. One can only hope.
Source: Tobacco Reporter
Comments