Rendez-vous 159 - November 19, 2006
Our previous rendezvous with Luk took place in february 2002 and was mostly focused on smuggling.
I would like first to congratulate him for being one of
the winners of the 2006 Luther Terry Awards and for having been nominated as strategic leader in the tobacco control field for the International Union Against Cancer.
Q1. In the June 2006 issue of Tobacco Control you co-authored with Martin Raw a research paper about the Tobacco Control Scale, a new scale to measure country activity. Can you tell us how it has been received (only 4 countries scored 70 or more Ireland, UK, Norway, Iceland) and if it is meant to be an ongoing and enlarged process: do you intend to keep "grading" the EU countries and do you intend to extend your scope to countries outside of the EU?
Luk Joossens: We will repeat the tobacco control scoring system next year for the 30 European countries, taking into account the tobacco control situation on July 1 2007 in these countries.
We will present the results of the new scores at the next European Conference on Tobacco or Health 2007 which will take place in Bazel from 11-13 October 2007. www.ectoh.07
There is also a lot of interest to apply a similar system for monitoring tobacco control performance for all countries in the world. We hope the scale can be used even more widely, to enable comparisons between countries and by doing so encourage them to strengthen policy areas in which they are weak.
We hope countries will not use it to boast of their ‘success’ or rest on their laurels. All countries surveyed had low scores in some policy areas, in other words, have room for improvement.
Norway and Iceland for example have very low scores for treatment, while the UK currently has the lowest score on public place smoking bans, along with Lithuania.
Ireland improved its total score a lot as result of its smoke free legislation, for which, along with New York City, it gained a lot of publicity.
For this it has been an inspiring example to many countries, yet it has a low score for public information campaign spending, and did not increase tobacco taxes in 2005, for the first time since 1995.
This was noted by stock analysts: “In Ireland, following the decline in volumes triggered by the pub ban, the government chose not to increase tobacco taxes in its December 2004 budget. (Historically Ireland has raised the tax on tobacco, year in, year out.)
We interpret this decision as meaning that even the anti-tobacco Irish government wants to moderate the decline in cigarette volumes”
Q2. One key weakness of many tobacco control programs (as demonstrated in your scale) is funding. While tobacco taxes bring billions to the state treasuries, governments very rarely fund tobacco control at the adequate level. What do you consider an adequate level of funding? Is there hope for the states that don't have initiative rights that allow citizens to make sure adequate funding is provided when their representatives don't want to do it?
Luk Joossens: There is also an urgent need for more investment.
In the EU only the UK spent more than €2 per capita per year on tobacco control.
The
2004 report “Tobacco in the EU: past, present and future”, the so
called “ASPECT report” recommended that EU member states immediately
increase per capita spending by €1-3.
The best system is
illustrated by Iceland where per capita spending is €2.27 per annum,
and the law obliges the government to spend at least 0.9% of the total
amount spent on tobacco, on tobacco control.
Contributions to
tobacco control spending by the tobacco industry appear to be extremely
bad for tobacco control and for tobacco control budgets. Tobacco
control funding by the German government was only €0.01 per capita in
2004 – an incredible one cent.
Spending appears to be low because
the tobacco industry provides funding, as the result of a five year
€11.8 million contract between the German of Ministry of Health and the
industry.
Belgium has a similar problem. The Rodin Foundation is a
non-profit organization founded in 2000, partly at the initiative of
the finance minister, funded by the tobacco industry, with a budget of
€1,850,000 per year for 6 years
Q3. One measure that does not cost anything to governements is to
introduce graphic health warnings on tobacco products packs. How do you
explain so few governements have yet done it?
Having been instrumental in Belgium to bring such warnings are there some advices you would like to share on how to proceed?
Luk Joossens: Belgium adopted
legislation to introduce pictorial warnings in November 2005. So far, Belgium is the
only European country which has introduced legislation on pictorial warnings. Pictorial
warnings were part of the Belgian Federal action plan to combat smoking in
2004. It takes some 6 to 12 months to prepare such legislation. I am surprised
and disappointed that no other countries followed the Belgian example in the EU
or the rest of Europe
. My advice would be
to contact your health ministry on regular basis on this issue and you might be
successful. The introduction of pictorial health warning legislation has no
cost for the health ministry. It requires only the management of the
bureaucratic procedure to get the Decree passed.
Q4. In your interview of 2002 you were hoping for an international treaty to tackle smuggling. Is the FCTC an effective tool against smuggling?
Luk Joossens: Since 2002 the
discussion on combating smuggling has changed completely. And we made really
progress. In May 2003, the WHO Framework
Convention on Tobacco Control (FCTC) was adopted.
Article 15 of the WHO FCTC
contains obligations for countries to reduce the illegal tobacco trade. At the
first conference of the parties of the FCTC, in February 2006, it was decided
to invite each WHO region to nominate up to four experts per region to prepare
a template for a protocol on illicit trade. The first meeting of the expert
group for the elaboration of a template for a protocol on illicit tobacco trade
took place from 25-27 September 2006 in Geneva.
The template elaborated by the
experts could include measures such as
tracing and tracking systems, licensing, record keeping, anti money laundering
provisions, enforcement and penalties, the control of second hand machinery,
recognition of counterfeit cigarettes, exchange of information mechanisms, data
collection, confiscation of proceeds etcera.
At the
next meeting of the expert group, which will take place in Cairo from 3 to 5
December 2006,
the draft template should be adopted by expert group.
The next step would be
the discussion of the template at the second conference of the parties of FCTC
which will take place in Thailand from June 30 to
July 6, 2007.
Q5. What is your assessment of the smoking bans in Europe?
Luk Joossens: The biggest fear of the tobacco industry has always been that European countries would introduce American type smoke free legislation. An internal document of PM described the worst case scenario in for the period 1993-2000 in following way: “If one assumed that smoking restrictions and social acceptability in reach the same levels as they have in North America, it could result in a market drop of 150 billion units by the end of the decade.”
In fact, nothing happened on smoking restrictions in Europe in the period 1993-2000. The debate in Europe was entirely focused on the advertising ban.
But this situation changed as Ireland, Norway, Italy and Malta launched the debate on smoke free legislation. No European country had banned smoking in bars and restaurants by January 2004.
By 2006 six countries (Ireland, Norway, Italy, Malta, Sweden and Scotland) had introduced smoke free bars and restaurants and in 2007 four other countries will follow their example (Lithuania, Iceland, Finland, England+ Wales + Northern Ireland). France will have smoke free legislation (even in bars and restaurants) in January 2008.
One could say that several smoke free miracles happened in Europe.
The first miracle was that beer drinking Ireland adopted smoke free legislation (including in the famous Irish pubs) in March 2004.
The second miracle was that fun loving Italy respected smoke free legislation in January 2005.
The third miracle was that Westminster adopted smoke free legislation with an overwhelming majority in February 2006 despite the lack of support of the big chief, Prime Minister Tony Blair.
The fourth miracle is that France adopts smoke free legislation six months before the presidential elections. The adoption of smoke free legislation in an election year is extremely difficult.
What we consider as miracles, must be a nightmare for the tobacco industry.
Thank you Luk for taking the time to be with us.
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