Tobacco use is the leading cause of preventable death in the world today, yet 4 million people die from tobacco related diseases every year. By 2030, an estimated 10 million people worldwide will die from smoking-related causes. Most of those deaths will occur in developing countries where the tobacco industry has been working hard to open markets, especially to women and youth, to promote its product and ensure its profits. Within 25 years, tobacco will surpass infectious diseases to become the leading threat to human health worldwide. Few families around the world have not been touched by lethal tobacco related illnesses.

Transnational tobacco companies advertise and market their products in ways that have long been banned in the United States, such as selling cigarettes without health warnings, advertising on television, and selling cigarettes with higher tar content. Under the guise of free trade agreements and economic help, these companies interfere with national public health laws of developing countries through political and commercial pressures to open markets and promote their product. According to a study by the National Bureau of Economic Research, price competition and advertising – both introduced by U.S. tobacco companies – caused cigarette consumption to increase by nearly 10 percent in some Asian countries.

The tobacco industry is dominated by giant corporations that are not bound by borders. As restrictions on the use and advertising of tobacco have gained ground in the U.S. and Europe, these corporations have sought out new markets utilizing the tools of trade liberalization. The free trade of tobacco benefits shareholders and CEOs in the rich countries while farmers in poorer nations are locked into producing cash crops like tobacco rather than food. No corporation has benefited more from this trade liberalization than U.S.-based Philip Morris, the largest tobacco corporation in the world, holding 16% of market share.

A growing global movement is standing up to these transnational tobacco corporations. Nowhere is this David and Goliath battle more evident than in the fight for a strong Framework Convention on Tobacco Control (FCTC). This first international treaty on tobacco control marks a turning point in which public health interests could potentially prevail over trade.

Locally, the San Francisco Tobacco-Free Project began working with the International Agency on Tobacco and Health in Great Britain in 1998 to develop a tobacco control advocate buddy system with health groups in other countries. In 2000, Washington, D.C.-based Essential Action launched Global Partnerships for Tobacco Control to support and strengthen international tobacco control activities at the grass roots level. The then-fledgling San Francisco buddy project was folded into Global Partnerships, which pairs groups in the United States and Canada with groups in Asia, Africa, Latin America, Central and Eastern Europe, and the former Soviet Union, and assists them to initiate meaningful shared activities. Today, over 360 groups in over 100 countries and 40 U.S. states and territories are involved in the program.

In November 2002, the Global Action Task Force (GATF) of the San Francisco Tobacco-Free Project hosted its second Intercambio, or joint learning conference. Eight tobacco control activists from seven countries attended the conference along with their local “buddy” or partner organizations. This exchange aimed to convene anti-tobacco advocates from around the world – particularly Third World countries where the tobacco industry concentrates its marketing – to meet their American counterparts, exchange tobacco control and prevention strategies and resources, and identify, plan, and carry out specific joint activities with San Francisco partners.

Intercambio participants had concrete goals about what they hoped to gain from the conference:

• Find better strategies to confront tobacco companies.
• Share what is being done in home country.
• Be engaged in a global cause.
• Work with other advocates internationally to pass a strong FCTC.
• Learn more about how to educate the community about tobacco.
• Validate the work being done in their respective countries.
• Identify other organizations that could help fund the work being done in countries with few resources.

The 2002 Intercambio began with a 2-hour “Meet and Greet” session, followed by a day-long meeting for international participants and their local buddy organizations, Tobacco-Free Project staff, and Polaris Research and Development evaluators. Buddies spent the day getting to know about each other, sharing information about tobacco control activities in their respective countries, and beginning to plan joint actions. A presentation was made about the history of tobacco control in California since the passage of Proposition 99 in 1988, and training was provided to assist the group to prepare for a press conference scheduled later in the week. The Intercambio had been planned to coincide with the National Conference on Tobacco or Health (NCTOH) meeting in San Francisco so that participants had a rich menu of events throughout the week. The Intercambio ended with a one-half day meeting for each buddy group to finalize plans for joint actions in fighting the globalization of tobacco.

After the Intercambio, advocates in San Francisco were interviewed to assess how being involved in global tobacco work affected their work locally, and the eight international participants were sent evaluation forms to complete. The results of these interviews and surveys are summarized below.

Impact of Global Work on Local Advocates

Local Intercambio participants generally believe that working with international partners on global tobacco control issues helps to “open our eyes” to everything else out there, including the necessity of becoming part of a broader movement and developing a global response. As one advocate remarked, “This process serves to heighten awareness about the next plague that is likely to happen in Africa if we don’t help to share our gains.”

Local advocates believe that San Francisco projects benefit from doing global as well as local work. “The work teaches them that what is happening in their community is not just an isolated incident.” Another advocate is pleased that global tobacco control work provides an opportunity to use an environmental health education approach through the process of analyzing deep-rooted causes of problems and identifying various levels of intervention needed for change, as opposed to the traditional health education focus on targeting the individual. Youth involved with the Latino Issues Forum (LIF), for example, were so energized by the Intercambio experience that they fundraised to send representatives to Ecuador for a week in the summer of 2003 for an Intercambio-type training with Ecuadorian student activists. LIF members have also become more interested in the FCTC, particularly how it will impact Latin American countries.

The Intercambio provided unique and broad perspectives to new as well as long-time advocates. One participant new to tobacco control work remarked that the Intercambio helped her learn a lot about the variety of issues involved. For veteran tobacco control advocates, international work helps to broaden their perspective, provides a larger global economic and social picture, and continually poses new and intellectually challenging situations that stimulate developing an analysis beyond San Francisco and California. “It’s a great learning experience,” said one long-time S.F. tobacco control advocate. “Bringing people from other places to talk about their experiences firsthand carries a credibility and authority that is not to be matched just by our talking about it here.”

Post-Intercambio survey results

Two months after they returned home, the eight international tobacco advocates received an Intercambio evaluation form. Seven surveys were returned to the Tobacco-Free Project evaluator. The following provides a summary of their responses.

The first question asked respondents to rate the different components of the Intercambio, with “5” representing the highest level of satisfaction. The average ratings for the various aspects of the Intercambio were all between 4.0 and 5.0:

• Team building activities
• Educational information on globalization of tobacco
• Education about the FCTC
• Press conference
• Global economy workshop
• National Tobacco Conference
• Joint poster board activity
• Choosing a joint action
• Logistics (airline, etc.)
• 4.0 Logistics (hotel)

All seven respondents described their Intercambio experience as “better than expected.” And each respondent reported having learned something new about the work of anti-tobacco advocates in the U.S., including:

• The level of specialization among anti-tobacco activists.
• U.S. interest in tobacco activities in developing countries.
• Smoke-free workplaces, especially bars and restaurants in California.
• Getting support from politicians by involving youth.
• Achieving wonderful results “even in the face of an Administration that is in bed with big tobacco.”
• Using community capacity building as an effective strategy.
• Receiving excellent materials and information.

Respondents were asked what one thing could have been done differently to maximize the educational skills-building experience for Intercambio participants. A number of constructive suggestions were made, including:

• More presentations from experts in legislative advocacy and activism.
• Language issues were a little difficult to deal with. The conference might have been more interesting for people who spoke other languages if they had a translator with them the whole time.
• More emphasis on advantages and consequences of the FCTC in developing countries.
• Skills building in areas we need to strengthen.
• Have participants spend more time together rather than each buddy group doing what it wanted most of the time.
• Computer/internet access.

Finally, respondents were asked to share any comments or thoughts on their Intercambio experience. Many expressed how pleased they were to have such a unique experience and commended the Tobacco-Free Project staff for working so hard to make the visitors feel at home. Summaries of their comments follow:

• The Intercambio experience has served to strengthen my resolve (and that of my organization) to continue to reduce and ultimately eradicate tobacco related heath hazards from the Nigerian society.
• California is the best example of what the sheer will of common people pushing for what they understand to be right can do. Never had it crossed my mind that there are people who could stand up against an industry that powerful.
• Most shocking was to learn and see what tobacco transnational corporations are doing globally, especially in developing nations.
• It is wonderful that the Intercambio can be timed to coincide with events such as the National Tobacco Conference.
• We are ready to come back. Thank you for your collaboration.

Eight individuals from seven countries participated in the 2002 San Francisco Intercambio. Each one was paired with a local “buddy” organization. The 10-day Intercambio was an opportunity for local and international buddies to meet and get to know each other, and plan the joint work they would undertake over the next year. Each project received a small stipend to help offset the cost of their work.

The following briefly describes the tobacco environment in each country, the international tobacco control advocate and their San Francisco partner organization, the proposals each group of buddies made during the Intercambio regarding their future joint projects, and the results of their work together. Most groups were able to achieve some or all of the plans made during the Intercambio.

Uganda

Tobacco is the second largest cash crop in Uganda, far outstripping the traditional cotton and tea crops. Tobacco is grown in 16 out of 56 districts. An estimated 600,000 Ugandans – including about 50,000 families who grow tobacco – make their living directly or indirectly from the tobacco industry. In Northern Uganda’s Arua District, tobacco accounts for 70% of revenue from agriculture. A recent Global Youth Tobacco Survey conducted in Uganda found up to one-third of 13-15 year olds living in the Arua District were smoking and 80% had tried unsuccessfully to quit. The Ugandan government receives about 8% of its total revenues from British American Tobacco Uganda (BAT) which, at about $1.50 for the most expensive pack of cigarettes, has kept the cost of smoking very affordable. Tobacco advertisements run on private television (although banned on state-owned television and radio stations), and BAT sponsors concerts, sports events, and agricultural and trade fairs.

Two Ugandan tobacco control advocates attended the Intercambio. Each advocate had a buddy and joint project, and each is separately described below.

Participants

Philip Karugaba is an attorney at law. He founded The Environmental Action Network (TEAN), a public interest litigation group working on Ugandan tobacco and environmental issues.

Polaris Research & Development is a San Francisco-based social science research and consulting organization.

Proposed joint project

Polaris will work with TEAN to update the “Focus on Uganda” booklet; hold another workshop for government ministers on the FCTC and the need to control the tobacco industry in Uganda; and develop the first TV and radio public service ads about environmental tobacco smoke.

Results of project

Philip attended the first Intercambio held in 2000. Shortly afterwards, TEAN filed a lawsuit against the Ugandan government for a total ban on smoking in public places. The lawsuit was resolved in December 2002 with the Ugandan court ruling that smoking in public places was a violation of non-smokers’ rights to life and to a clean and healthy environment. The judge ordered the National Environment Management Authority to develop regulations prohibiting smoking in public places within one year.

Building on the momentum of the lawsuit, and with the help of Polaris, TEAN designed and had broadcast the first ads on secondhand smoke in Uganda.

TEAN was also able to lobby and mobilize strong support against the adoption of a weak warning label on cigarette packs. The label “Cigarette smoking is harmful to your health” has been changed to “Smoking causes lung cancer, heart disease and death” and will be more prominently displayed on the full side panel of the package.

Uganda signed the FCTC on March 5, 2004, and TEAN is working on the ratification process. As part of the process of creating awareness, with the help of Polaris, TEAN ran a newspaper insert showing the “smoker’s body” on one side and the FCTC information on the back. The insert resulted in considerable discussion of tobacco related diseases in the media.

Polaris is also supporting TEAN to update its “Focus on Uganda” booklet. The booklet, which was developed and published as a result of the first Intercambio, is part of a series describing the overseas expansion of tobacco companies and their impact on various countries. This series was paid for by the San Francisco Tobacco-Free Project with Proposition 99 funds.

The second team includes:

Participants

Malumba Badru Dean is a journalist covering tobacco control issues for the independent Ugandan newspaper, The Monitor.

Literacy for Environmental Justice (LEJ) promotes long-term ecological and human health in Southeastern San Francisco by educating and organizing youth around the principles of environmental justice and urban sustainability.

Proposed joint project

LEJ youth will work with Badru to develop a short video of youth in America and Uganda that focuses on smoking in the United States. The video would include youth experience with smoking, why they started to smoke, what influenced them to smoke. Each country will try to conduct in-depth interviews of 10 youth, and then edit the 20 interviews into one video that could be used here and in Uganda to raise awareness among youth in both countries about smoking and the impact of globalization on how youth are targeted.

Results of project

These buddies collaborated on a joint article on food security. Badru compiled information about the food security project LEJ youth are working on in San Francisco’s Bayview Hunter’s Point via interview and email. The article will discuss how the youth got involved in the issue and compare San Francisco with Uganda in terms of the unhealthy foods carried by food markets. Badru also wrote an article supporting Philip’s activities to ban smoking in public places.

Nigeria

The Nigerian tobacco industry has an aggressive marketing program that targets youth, placing huge billboards next to schools that blatantly market directly to students. The industry provides generous financial gifts to government officials making it difficult for citizen groups to work against them.

Participants

Ezekewesiri Israel Eluchie is an attorney at law and Executive Director of People Against Drug Dependence and Ignorance (PADDI). This organization aims to raise public awareness through outreach about tobacco and hard drugs.

Girls After School Academy (GASA), located in San Francisco’s Sunnydale Housing Projects, helps adolescent girls attain healthy, stable, and independent lives.

Proposed joint project

GASA will work with PADDI to deglamorize the perception among Nigerian youth about tobacco use by American teens. They plan to interview 100 Nigerian youth on video to explore what they think and believe about smoking habits among U.S. youth. The results of the interviews will be summarized and sent to GASA who will, in turn, interview U.S. youth about myths vs. facts regarding youth smoking. The two sets of interviews will then be sent to Eze who will edit them into one video. The video will be used as a tool to raise awareness about tobacco in Nigerian schools.

Results of project

Lawsuits have not yet been filed against tobacco companies in Nigeria however the general increase in public awareness about the harm done by transnational tobacco companies is viewed as a promising sign in gauging the mood of the public before moving towards litigation.

Girls After School Academy (GASA) and People Against Drug Dependence and Ignorance (PADDI) worked to debunk myths shown in Nigerian tobacco advertisements about the supposed smoking habits of African American youth. In 2003, using a survey instrument designed by PADDI, each group surveyed 100 of their peers to measure the perceptions of Nigerian youth vs. the reality of smoking habits among San Francisco youth. The Nigerian youth documented the results of their survey (see sidebar) in a video and sent it to GASA who, in turn, added their own results. A short video based on the two surveys is being produced to correct misconceptions promoted by tobacco advertisements in Nigeria about the smoking habits of American youth.

Colombia

Colombia’s national tobacco corporation holds 55% of the market while foreign companies (British American Tobacco and Philip Morris) hold 45%. The cost of smoking is very inexpensive. A pack of Marlboros costs $1 and local brands are 39 cents. Taxes represent 55% of the price, but there is no support in congress or the government to raise taxes further. A law passed in 1986 prohibiting the sale of cigarettes to minors has never been enforced. Ironically, most cigarettes today are actually sold by children. Direct advertising is not permitted on television from 6 a.m. to 11 p.m., but indirect advertising (e.g., promoting events with colors and logos similar to cigarette brands) is widespread and found on cars and buses. Cigarette packs have a small health warning (using 10% of the surface) with weak text (“smoking is harmful to your health”). Colombian youth are inundated with tobacco advertising and starting to smoke as young as 11. Girls are now smoking at higher rates than boys. The only mention of anti-tobacco issues by the media is during World No Tobacco Day on May 31st.

Participants

Guillermo Martinez Gallon is the Coordinator of Education for the Liga Colombiana Contra El Cancer (LIGA) or Colombia League Against Cancer, which works to prevent smoking and alcohol use among youth through a team of physicians, health educators, social workers, sociologists, and adult volunteers.

American Lung Association (ALA) works to prevent lung disease and promote lung health by actively opposing the pervasive influence of the tobacco industry.

Proposed joint project

ALA and LIGA aim to focus on college campuses and have planned two joint actions. First, they hope to establish a tobacco-free policy on one college campus in Columbia that will include conducting a survey of college youth and holding a series of workshops and a press conference. ALA will help them to design the survey tools and workshops. Secondly, they hope to pilot test a youth/adult cessation program in Columbia, adapting cessation materials provided by ALA.

Results of project

LIGA and ALA actually began work on their joint project during the Intercambio when ALA certified Guillermo as a smoking cessation instructor. ALA has also sent cessation materials to him in Columbia.

Guillermo made a two-day presentation at a secondary school for girls, Lorencita Villegas De Santos, presenting to 750 students in the morning and 655 in the afternoon to explain the project and its goals.

With technical assistance provided by ALA on developing protocol, Guillermo surveyed 370 high school students on their smoking habits and history, demographic information, and attempts at quitting. He analyzed and presented the results on World No Tobacco Day, holding two workshops on the survey for parents, teachers, and administrators. Students created posters opposing the use of cigarettes that were exhibited in the school during May 2003. He also conducted a workshop on the rights and responsibilities of smokers and offered a smoking cessation workshop at the school although unfortunately, none of the students attended. Overall, the project was a good opportunity for students to participate in conducting the surveys, presenting the results, organizing and carrying out World No Tobacco Day activities, organizing the poster contest, and attending the forums to inform their peers about the dangers of smoking.

The next team involves two countries, Togo and Senegal, in partnership with a local buddy.

Togo

Tobacco advertising is prominent and blatant in Togo. Marlboro advertises on children’s clothing given to children who come into stores to buy cigarettes for their parents. Tobacco advertising appears in telephone books, giant billboards, and even in HIV/AIDS educational pamphlets. The tobacco industry provides significant funding for sports activities, including 60 million francs for the soccer federation – a governmental entity – money that is difficult for a poor country to refuse. In 2001, tobacco control advocates worked with the World Health Organization to draft the first law preventing tobacco advertising on radio, TV, billboards, prohibiting sponsorship of youth activities, selling cigarettes to youth, and selling single cigarettes. The bill also includes a tax increase that would be used in part to support activities for young people. This legislation was submitted to the National Assembly, but has not yet been voted on. Tobacco control advocates continue to work with a group of anti-tobacco politicians hoping for its eventual passage.

Senegal

In the early 1980s, Senegal was one of the first African nations to pass comprehensive tobacco control legislation, including a ban on television advertising, and bans on smoking in some public places. Within several years, tobacco industry pressure resulted in the law being watered down or simply eliminated. Senegalese are now exposed to a tobacco epidemic fueled by an industry that can do whatever it wants and represents itself as helping the public by sponsoring sporting and other types of events. The lack of restrictions on selling cigarettes to minors (at 30-80 cents per pack, or 2-4 cents per stick) makes youth a prime target of industry marketing. Senegal, as other African countries, finds it difficult to create effective legislation that is not blocked by the tobacco industry.

Participants

Ghislain Aledji is the assistant to the director of the Togolese Association Against Alcoholism and Other Substance Abuses (ATLAT), which provides alcohol and tobacco related treatment and prevention services.

Medard Bassene has worked, volunteered, and collaborated with Movement Anti Tobacco (MAT) in Senegal since its inception and currently serves as its board president.

San Francisco African American Tobacco-Free Project (SFAATFP) works with youth, the media, and community members to counter tobacco industry’s targeting of youth and communities of color.

Proposed joint project

In partnership with SFAATFP, this joint project will develop a three-pronged Global Awareness Campaign to focus on raising awareness about the globalization of tobacco and its impact on Senegal and Togo. First, they will compile a music/rap/spoken word CD from each country with each organization handling the contest and selection process as they see fit. Second, they will produce a 10-minute video from still photographs to be furnished by MAT and ATLAT. Finally, they will develop a joint social marketing ad/banner and brochure in French and English highlighting each respective organization and the tactics of multinational tobacco companies used in each country.

Results of project

A rap/spoken word anti-tobacco CD was produced through youth competitions. SFAATFP recorded and sent copies of the CD it developed to its African partners, and received a rap/spoken work CD from MAT-Senegal.

The partners produced a short video (“Une Vie C’est Une Vie) from still photographs and live footage furnished by MAT and ATLAT showing examples of tobacco advertising in both African countries. The video includes voice-over commentary and uses the MAT and SFAATFP CDs. New footage was shot in San Francisco, and a variety of graphic elements were assembled for the final video. During a visit to ATLAT-Togo in June 2003, SFAATFP videotaped tobacco billboard advertising to include in the video. In 2004, SFAATFP visited Senegal and videotaped a press conference, ministerial visits, and a youth protest march that are also included in the video. Although the video evolved into a much more complex project than originally anticipated, with live footage, graphics, photos, and subtitling, it has been completed.

SFAATFP is also in the process of designing the layout for a three-panel 11″x14″ brochure highlighting the respective organizations, the tactics of multinational tobacco companies, and the problems and issues facing tobacco control work in their respective countries.

In February 2004, SFAATFP project director, in association with Essential Action and other global tobacco control advocates, traveled to MAT in Dakar, Senegal. During that trip, the video, Une Vie C’est Une Vie (A Life is a Life), and the CDs produced by the partners were previewed. The delegation also met with Senegalese political and community leaders and participated in a youth demonstration against the predatory activities of the tobacco industry. In May 2004, SFAATFP hosted an event at which the video was officially premiered and an update on current tobacco control activities and issues in Senegal was presented to the community. SFAATFP has also submitted a mini-grant for WNTD to support Senegal’s tobacco control efforts.

Ecuador

A tobacco control act passed by the Ecuadorian Congress in 1998 has not yet been enforced. Although there is a national tobacco company in Ecuador, Philip Morris holds about 80% of the market, having bought out many of the local companies. Ecuador receives about $1 million in cigarette taxes, and the tobacco industry provides about 6,000 jobs – a significant number in a country that has considerable poverty. Tobacco advertising is rampant, including magazines, radio, TV, movie theaters, and billboards. Promotional activities and contests where people win automobiles, appliances, trips and other items for purchasing cigarettes are continuous. Cigarettes are sold everywhere, and the no smoking signs that are posted – even in hospitals – are generally ignored.

Participants

Angela Pinoargote Mendoza is a health educator working for the Society Against Cancer (SOLCA). She conducts a tobacco control education program for youth in the Province of Manabi.

Latino Issues Forum (LIF) conducts policy and research analysis and is involved in coalition building, community education, media resources, and advocacy to encourage wider participation by Latinos in public policy issues.

Proposed joint project

LIF youth advocates will assist SOLCA youth tobacco control advocates by compiling the results of their statewide survey on youth smoking prevalence and using the results to conduct a statewide – and eventually countrywide – advocacy campaign to address youth smoking through policy change. They plan to purchase a computer for the SOLCA office in Portoviejo to be used exclusively for work on tobacco control. Students will input the survey data into survey processing software set up by LIF student advocates. LIF students will also develop and send advocacy tools such as tobacco control links in Spanish, templates for petitions, posters, information and endorsement letters, press releases, resolutions, and sample tobacco control policies in Spanish. LIF students will also seek mini-grants and other types of funding to visit the Ecuadorian student advocates to exchange information about their campaigns, train students in policy/advocacy campaigns, and explore ways to sustain on-going contact around youth tobacco control advocacy between the two countries.

Results of project

SOLCA’s program “En Vez de Humo, Llenense de Vida” (“Instead of Smoke, Fill Yourself with Life”) aims to educate middle and high school students about the dangers of smoking cigarettes and limit exposure of youth to tobacco products and advertising. Twice each year, during World Tobacco Day and the beginning of the school year on May 31, SOLCA conducts contests, joint anti-tobacco actions, and surveys. The last big action was a funeral in which a huge cigarette was buried – “the happiest funeral procession in the world.”

For their joint project, LIF and SOLCA purchased a computer workstation (including computer, fax, scanner, printer) solely for tobacco control work in Ecuador. Angela worked with students who conducted a survey in four cities served by SOLCA to collect data on the number of students that smoke, tobacco ads that they see, and where the ads are placed, and LIF student advocates analyzed the data. The computer was used to input the data. LIF also sent Angela templates for an anti-tobacco campaign in schools, including petitions, letters, community outreach, and other forms that are to be translated into Spanish for use in Ecuador.

In August 2003, LIF sent a student advocate and project coordinator from its Tobacco-Free College Campuses Project to Ecuador to participate in a tobacco control intercambio with Ecuadorian high school and college students. Participants discussed the FCTC and exchanged ideas about decreasing the number of Ecuadorian and San Francisco youth who smoke. San Francisco students had a chance to train their Ecuadorian peers in tobacco control. The Ecuadorian students constructed poster displays on the dangers of smoking, the influence of the tobacco industry, and marketing of cigarettes in Ecuador and other South American countries. The students also summarized group projects on tobacco control issues from each of the six participating high schools. The San Francisco students presented the Community Action Model for community members to achieve policy changes and actions, and developed a plan with their Ecuadorian counterparts to achieve local policies to limit smoking in public places and prohibit tobacco billboard advertising close to schools.

India

As the world’s third largest producer of tobacco and eighth largest exporter, India is responsible for about 6% of the world tobacco trade. Although four Indian companies account for 99% of the cigarette market, the recent elimination of restrictions on foreign investment in tobacco firms is expected to result in the eventual complete takeover of the market by multinationals. About 24% Indian adults use some form of tobacco. Every day, some 55,000 Indian children begin to use tobacco, and an estimated 4.6 million children under the age of 15 are already addicted to tobacco. Tobacco advertising is widespread in India, appearing in newspapers, magazines, and movie trailers. Sponsorship of sporting events is still permitted. The government has agreed to industry requests for a voluntary code of conduct for tobacco advertising that includes banning tobacco ads that use public personalities to promote tobacco. The government has banned smoking – through executive order rather than legislation – in hospitals, government offices, schools, and on some domestic transport, and requires health warnings on all cigarette packages.

Participants

Bobby Ramakant works with Health and Development Networks providing communication support for children, youth, and media to develop coalitions and mobilize communities.

Youth Skills Project – Operated out of the Department of Public Health, the Youth Skills Project sought to extend the smokefree entrances in public buildings policy.

Proposed joint project

YSP and Health and Development Networks planned several joint projects. First, YSP youth will submit articles to Tobacco Kills Magazine, a publication developed by Bobby’s group in India. Second, YSP agreed to update the HDN website (TAMBAKOOKILLS.globalink.org), adding some content and implementing a message board to encourage communication between youth in India and San Francisco. Third, they agreed to conduct a survey of 500 youth ages 12 through 18 about tobacco promotions and tobacco industry targeting of youth. They also want to raise funds for youth delegates in San Francisco and in India to attend the World No Tobacco Conference in Finland. If successful, they would aim to hold a press conference in Finland highlighting youth related tobacco issues. Finally, they want to conduct community forums and a press conference in the United States and India on World No Tobacco Day to raise awareness about the globalization of tobacco and its impact on youth.

Results of project

This team achieved its first objective. They collaborated on a writing a column in the Tobacco Kills magazine published by HDN. The YSP coordinator then left the project for a position at another agency. After just a few months, his replacement was unable to continue and the joint project ended in March 2003.

Tobacco-Free Project staff then stepped in to work with Bobby and develop a new project. As a result HDN – which provides support for conferences – became involved with the International Non-Governmental Coalition Against Tobacco (INGCAT) Task Force for South East Asian-India. INGCAT sent a delegation to the India Institute of Medical Sciences in New Delhi in October 2003 to participate in the All India Student Parliament on Health sponsored by WHO and the Ministry of Health & Family Welfare. The delegation, made up of six students, two teachers, and a coordinator, was selected from students participating in a day long inter-school debate on the need for an international treaty for effective tobacco control in India held in 20 Lucknow and Faizabad schools. During the event, a questionnaire regarding the impact of advertising on youth smoking was conducted (see sidebar).

Following the event, the Chief Editor of the Hindustan Times (National Edition) published preliminary survey results in her Sunday editorial column. In early 2004, copies of the editorial along with the survey results were sent to 200 selected policymakers, including members of Parliament, members of the Legislative Assembly, and government officials in the states of Delhi and Utter Pradash. The same information will also be submitted to the Prime Minister’s and President’s offices in June 2004, along with nearly 10,000 signatures petitioning for stringent implementation of existing tobacco control legislation and prohibitions, including the FCTC which was implemented on May 1, 2004.

The focal point for tobacco control advocates worldwide is the Framework Convention on Tobacco Control, the first treaty to establish an international standard addressing advertising, smuggling, tobacco taxes, passive smoking, and rules on labeling and packaging. While more than 110 nations are committed to a strong FCTC that emphasizes public health over profits, the United States has taken a weak stand on key provisions that require a total ban on tobacco advertising, prohibit the use of deceptive terms, and require large warning labels on cigarette packs. To date, the United States has ratified, but not signed the agreement.

Intercambio participants expressed unanimous concern about the possibility of the treaty being weakened by U.S. delegates who thus far have sided with the tobacco industry, blocking the efforts of countries that support a strong public health treaty. A strong FCTC is needed, participants argued, not only because it is so difficult to get laws passed and enforced, but also to help countries with fewer resources fight against transnational tobacco companies and begin to develop anti-tobacco laws and policies.

Participants criticized the obvious double standard wherein the U.S. has strong laws outlawing tobacco advertising to protect it citizens, but refuses to support similar policies overseas. “The U.S. is looked to for direction,” said one participant. “There are strong laws in the U.S. and the position of the U.S. should be clear,” said another participant. “If you can’t do certain things in the U.S. then it shouldn’t be OK to allow those activities in other countries.”

Many participants pointed out that the current U.S. position on the FCTC negatively affects tobacco control efforts in other countries. “A strong position for a strong framework on the part of the U.S. will influence my government to also take a strong position,” said a participant. Another put it more bluntly: “If the U.S. maintains such a position, then poorer, tobacco-dependent countries will have an excuse to follow suit.”

For close to two and a half years now, we have been engaged in tobacco control in Uganda, doing media advocacy, research and litigation. In Uganda, more and more people are taking up the habit. Increased smoking means increases in deaths and diseases. In a local hospital, it was established that three out of four victims of mouth cancer had a history of smoking. The FCTC presents a historic and timely opportunity to stop this tobacco epidemic. A strong FCTC would serve to unite the world in the cause of public health and bring countries to a common stand against tobacco. Only by such multinational action can we hope to impose an effective control on this multibillion dollar tobacco industry. Given this historic opportunity, it is a big shame that the U.S. has continued to take patently pro tobacco positions, despite its long leadership in tobacco control, the science, the litigation and the legislation.

The U.S. position not only threatens to weaken the FCTC, but it may also weaken the resolve of poorer countries. If the world’s richest and most powerful nations – U.S., Japan, and Germany – are seen to be protecting their tobacco companies, then poorer countries may follow suit. In Uganda, British American Tobacco is the second largest taxpayer, contributing 8% of our revenue and provides livelihood directly or indirectly to 600,000 people. BAT is our president’s favorite investor, and he does not believe that cigarette smoking causes cancer.

In Uganda, we are a nation of survivors. We struggle to survive poverty and malnutrition on a daily basis. We have survived wars, insurgencies and bloodthirsty dictators. We have survived the Ebola virus and still struggle with the AIDS virus. We have had enough. We do not need this manmade tobacco epidemic. U.S. delegates to the FCTC must do the right thing. Health comes before trade. You cannot trade with dead men. Without health you have nothing. The American people must demand accountability from their government and their corporations. We need to join hands to preserve the gift of life. We need to join hands to work for a strong Framework Convention for Tobacco Control.

Philip Karugaba
Environmental Action Network
Uganda

Peto, R., et al. (1996). “Mortality from Smoking Worldwide,” British Medical Bulletin, Vol. 52, No. 1 (1996).
Christopher Murray and Alan Lopez (1996, November 1) “Evidence-Based Health Policy — Lessons from the Global Burden of Disease Study,” Science, Vol. 274.
Chalopuka, F. and Laixuthai, A. (1996, April). “Cigarette Smoking in Pacific Rim Countries: The Impact of U.S. Trade Policy.” National Bureau for Economic Research, Working Paper No. 5543.
CorpWatch. Tobacco, Free Trade and Globalization. Retrieved May 22, 2004, from www.corpwatch.org/article.php?list=type&type=109

“Tobacco is the leading cause of preventable death in the world. There is no strong leadership against tobacco because of the strength of the industry.”

Philip Karugaba, Uganda

Tobacco is a gateway drug…those who start to smoke at a young age have a higher probability of using drugs.

Eze Eluchie, Nigeria

“The amount of advertising and free samples leads consumers to believe that “light” cigarettes are safer to smoke. In just a few months, four new brands have been introduced in Colombia.”

Guillermo Martinez Gallon, Colombia

“The tobacco industry is taking young people hostage in Togo.”

Ghislain Aledji, Togo

“TNTs come into Senegal saying they’re doing good things for society. There are few [tobacco control] laws in Senegal, and the ones that do exist are not enforced.”

Medard Bassene, Senegal
“Tobacco laws are not enforced by the government in Latin America. Advertising is everywhere, and youth copy the images they see coming from American movies.”

Angela Pinoargote Mendoza, Ecuador

“Smoking in India is increasing among women and children.”

Bobby Ramakant

“The U.S. is looked to for direction…If you can’t do certain things in the U.S. then it shouldn’t be OK to allow those activities in other countries.”

Intercambio participants

“Being able to work globally will make it a stronger fight and that helps a lot not to be just one little country fighting against the tobacco industry.”

Intercambio participant

44% of the 100 Nigerian youth surveyed in two cities admitted to being smokers.

75% of Nigerian youth identified African Americans as being dominant characters in tobacco ads seen in Nigeria.

PADDI 2003 survey results

Indian Youth Tobacco Survey Results

Some 4,447 Indian youth, mostly between the ages of 10 and 18 (with about half in the 8th and 9th grades) participated in the survey. Among the Indian students surveyed, chew seems to be more popular than cigarette smoking. While less than 1% admitted to smoking cigarettes, about 45% use chew.

The heaviest influences on their use of tobacco were film stars smoking in movies (39.9%). In fact, 88% of respondents reported seeing a film start smoking in a movie in the past three months.
Other influences to use tobacco were peer pressure (19.7%), cigarette advertisements (18.8%), stress (11.0%), and other influences (10.4%).
Ads played a big role in influencing students to use tobacco. Some 38.6% of students reported seeing tobacco ads once a day, 21.5% reported seeing them 1-5 times a week and 6.5% that saw them 1-4 times per month. One third of students (33.4%) said they saw tobacco ads less than once a month.
Most of the ads students saw were on billboards (70.8%), followed by newspapers (33.5%), magazines (10.8%), and events (7.2%).
About three-quarters of those surveyed believe that advertisements are very effective at influencing young people to smoke.
Over one-third of Indian youth believe that over 70% of American youth smoke. Surprisingly, while very few Indian youth reported smoking cigarettes, nearly one-half of those surveyed indicated they believed over 70% of Indian youth smoke.

 

“It’s important to keep that optimism that the tobacco industry is not so immortal. It’s a good message to bring home to people who have lost their hope of fighting the tobacco industry.”

Intercambio participant

“I’ll be able to go home with the pictures I took here to show politicians in my country that this is what is happening in America.”

Intercambio participant

“I was impressed with the community perspective that involves gay, lesbian, and transgender populations, their participation and concern about the higher prevalence of smoking among sexual minorities, as opposed to at home where smoking is not on their agenda at all.”

Intercambio participant

Global FCTC Survey

In October 2001, the San Francisco Tobacco-Free Project surveyed tobacco control advocates from ___ countries to collect international data that could be used to further strengthen the need for a strong FCTC. Completed surveys were received from 18 countries. Highlights include:

Some 72% of the countries surveyed indicated they had some restrictions on tobacco advertising, most commonly no TV or radio advertising, minimum age laws to purchase tobacco, and policies for smokefree workplaces and public buildings.
The majority of respondents reported disagreement with the weak position the U.S. has taken on the FCTC and felt that the U.S. position would negatively affect tobacco control efforts in their countries.