Center for Tobacco Control Research and Education

This report, WHO's fourth in the series, provides a country-level examination of the global tobacco epidemic and identifies countries that have applied selected measures for reducing tobacco use. Five years ago, WHO introduced the MPOWER measures as a practical, cost-effective way to scale up implementation of specific provisions of the WHO FCTC on the ground.This report focuses on enforcing bans on tobacco advertising, promotion and sponsorship (TAPS). TAPS bans are one of the most powerful tools that countries can put in place to protect their populations. In the past two years, impressive progress has been made. The population covered by a TAPS ban has more than doubled, increasing by almost 400 million people. Demonstrating that such measures are not limited to high-income countries, 99% of the people newly covered live in low- and middle-income countries.This and future editions of this report are key components of the global tobacco control fight, measuring how much has been achieved and identifying places where more work must be done.

 The tobacco industry successfully blocked or displaced strong tobacco control legislation in Costa Rica for nearly 40 years using similar strategies used in the U.S. and the rest of the world, until the country successfully passed a strong tobacco control law in March 2012. During the 1970s and 1980s, the tobacco companies displaced strong tobacco control legislation on tobacco advertising by endorsing weaker executive decrees. In response to increased tobacco control pressure, the industry successfully weakened the 1995 law by secretly hiring scientific consultants to counter the SHS threat and using the hospitality industry to rollout the Courtesy of Choice program in Costa Rica (then Latin America). Tobacco companies then used Costa Rica as a model to rollout industry youth smoking prevention programs and corporate social responsibility campaigns throughout Latin America and the Caribbean. The industry continued its dominance in Costa Rica during the 2000s by developing a cooperative relationship with the Ministry of Health. Although theNational Anti-Tobacco Network(RENATA), a new coalition ofgovernmental health institutions and nongovernmental tobacco control associationsformed in 2007, generated enough public pressure on Legislative Assembly to ratify the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in 2008 and secure Bill 17.371’s introduction in 2009 to implement the treaty, the industry once again worked through the Ministry of Health to delay the bill’s passage. However, RENATA’s abilityto alert the media and mobilize a coalition of international health advocates to effectivelyinform lawmakers on the importance of the FCTCbetween 2010 and 2012 helped pass a strong tobacco control law in March 2012. 

Objetivo. Analizar cómo la industria tabacalera influyó en la formulación de las políticas de control del tabaco en Costa Rica. Materiales y métodos. Revision de documentos de la industria tabacalera, de la legislación costarricense de control del tabaco y de periódicos y entrevistas con informates clave. Resultados. Durante los años ochenta, el Ministerio de Salud aprobó varios decretos para restringir el consumo de tabaco, lo que causó que British American Tobacco y Philip Morris International fortalecieran su presencia politica, cuyo resultado fue la promulgación de una ley débil en 1995 todavia vigente. Desde 1995 la industria tabacalera ha ultizado a Costa Rica como piloto para los programas latinoamericanos y ha dominado la formulación de politicas influenciando al Ministerio de Salud, incluyendo negociaciones privadas con la industria tabacalera en violación de las directrices del Articulo 5.3 del Convenio Marco para el Control de Tabaco (CMCT) de la Organización Mundial de la Salud. Conclusión. La experiencia de Costa Rica demustra la gran importancia que tiene la implementación del Articulo 5.3 del CMCT para proteger las políticas de la salud pública de la interferencia de la industria tabacalera.

Objective. To analyze how the tobacco industry influenced tobacco control policymaking in Costa Rica. Materials and Methods. Review of tobacco industry documents, tobacco control legislation, newspaper articles, and interviewing of key informants. Results. During the mid-to-late 1980s, Health Ministry issued several advanced (for their time) smoking restriction decrees causing British American Tobacco (BAT) and Philip Morris International (PMI) to strengthen their political presence there, resulting in passage of a weak 1995 law, which as of August 2011, remained in effect. Since 1995 the industry has used Costa Rica as a pilot site for Latin American programs and has dominated policymaking by influencing the Health Ministry, including direct private negotiations with the tobacco industry which violate Article 5.3’s implementing guidelines of the World Health Organization Frameowrk Convention on Tobacco Control (WHO FCTC).Conclusions. The Costa Rica experience demonstrates the importance of vigirous implmentation of FCTC Article 5.3 which insulates public health policymaking from industry interference.

We sought to understand how the tobacco industry uses "youth smoking prevention" programs in Latin America. We analyzed tobacco industry documents, so-called "social reports," media reports, and material provided by Latin American public health advocates. Since the early 1990s, multinational tobacco companies have promoted "youth smoking prevention" programs as part of their "Corporate Social Responsibility" campaigns. The companies also partnered with third-party allies in Latin America, most notably nonprofit educational organizations and education and health ministries. Even though there is no evidence that these programs reduce smoking among youths, they have met the industry's goal of portraying the companies as concerned corporate citizens and undermining effective tobacco control interventions that are required by the World Health Organization Framework Convention on Tobacco Control.

References which constitute the “data” for the paper “Civil Society and the Negotiation of the Framework Convention on Tobacco Control” by H.M. Mamudu and S.A. Glantz, published in Global Public Health, that are cited with numbers in the paper.

Communities and countries experiencing poverty, high unemployment, and economic reliance on tobacco growing are vulnerable to predatory tobacco industry behaviour. This analysis presents a cross-national survey of social disruption in tobacco farming to illustrate the association between tobacco companies and tobacco-related child labor, poverty and environmental destruction. The health risks of tobacco farming are beyond the scope of the study. Data on social disruption in tobacco farming was obtained through newspaper stories, published and unpublished reports, scholarly literature, documentary films, and tobacco industry publications such as annual reports and websites. The analysis shows that in all World Health Organization regions (Eastern Mediterranean, Africa, Europe, the Americas, South East Asia and Western Pacific) tobacco farming involves child labor and deforestation as well as tobacco industry behaviour promoting disruption in social and environmental life in tobacco farming communities. Tobacco companies generate huge externalities forcing farmers and consumers to pay the costs and concealing the actual cost of tobacco leaf and other tobacco products.

This paper examines the historical experience of tobacco control in the last five decades and shares important lessons of public health interventions to inform current and future tobacco control programs in other countries. The paper is divided into four parts. The first part gives an overview of the political economy, principal influences and interventions in tobacco control in the United States. It stresses the importance of information shocks and the role played by grassroots organizations. The current situation of tobacco control in the United States is further discussed in the second part, with emphasis on the economic case that led to litigation, as well as the response of the industry and the States. The third part focuses on the present efforts of multilaterals like the World Bank, technical UN agencies such as the World Health Organization, in the context of the new global governance structure: the Framework Convention on Tobacco Control (FCTC). The last section discusses lessons learned and provides recommendations for comprehensive tobacco control programs.

The paper suggests five major policy drivers that constitute components of a comprehensive tobacco control program: – science to inform policy, information strategies to educate consumers, advocacy to stimulate interventions, legal actions to develop regulations, and international collaboration through the FCTC. The paper concludes that while government has the responsibility for funding and implementing these activities; these can be most effective when supported by civil society.

Bans on traditional tobacco advertising highlight the strongly promotional role of tobacco imagery in films and video programs. On World No-Tobacco Day 2005, less than a year after India implemented its universal ban on tobacco advertising, its Minister of Health and Family Welfare announced a ban on tobacco imagery in the nation’s films and broadcast programs.

Opposition, including from the Ministry of Information & Broadcasting, which quickly announced the proposed ban was unworkable and advocated entertainment industry self-regulation, succeeded in delaying limits for on-screen tobacco for more than a year despite NGO advocacy efforts.

Elements of a policy compromise disclosed in June 2006 risk undermining the Ministry of Health’s intention: permanently to reduce adolescent exposure to tobacco imagery of major benefit the tobacco industry, particularly as Philip Morris International enters the Indian market to expand the market for premium cigarettes and battle for share British American Tobacco’s Indian affiliate, ITC.

Recommendations for an effective policy in India’s constitutional and policy environment include:

• In place of the subjective terminology favored by the tobacco industry and its film industry proxies around the world, a categorical standard of zero tobacco imagery except for (a) portrayals of actual historical figures documented to have used tobacco and (b) the unambiguous depiction of the dire health consequences of tobacco use, with no brand display in any case;

• An independent review committee, with no conflicts of interest, mandated to safeguard the public health by transparently applying the policy standards to the relatively few media productions that propose to include tobacco imagery despite the new policy;

• Identical treatment for films imported from overseas and Indian films released before the policy, namely strong anti-tobacco spots vetted by experts in tobacco prevention showing before and after the film or program in any and all distribution channels;

• Public certification, under penalty of perjury, by credited producers of any Indian film or video program with tobacco imagery released after the policy and all imported films and video programs with tobacco imagery that no one associated with the production accepted any consideration to include tobacco.