At a briefing in California last week a group of multiracial activists assembled in support of the passage of the California Cancer Research Act (CCRA), writes Olu Alemoru of the Los Angeles Wave. The CCRA would add $1 to each pack of cigarettes sold in California and generate over $855 million in its first year which could be used for cancer research as well as California’s tobacco control and prevention program. Speakers cited research showing that African-Americans lose more years of life than all other groups from smoking-related causes, and that tobacco outlets and advertising are disproportionately concentrated in the African-American community. They also noted that three thousand Hispanics die every year from smoking-related illnesses.
West Virginia Court Tries Altria and Reynolds American
Bloomberg News reports tobacco companies including Altria Group Inc.’s Philip Morris unit and R.J. Reynolds Tobacco Co. are on trial for more that 600 smoking-related personal- injury cases. The trial is to determine whether cigarettes are defective products, whether the companies failed to warn about the dangers of smoking, broke express warranties and fraudently concealed information from smokers. Kenneth McClain, a lawyer for the smokers, said last week, “This case is about the corporations’ responsibility. They were actively keeping from the public the information that they had.” Courts are hearing similar cases in Florida and Missouri.
Judge Weighs Constitutionality of Graphic Labels on Cigarette Packages
The five major tobacco companies sent their lawyers to federal court in Washington last week to argue in support of their effort to obtain an injunction that would bar the US Food and Drug Administration from enforcing regulations requiring graphic new warning labels. The tobacco companies claim that the new requirements violate the First Amendment by forcing the companies to take up the government’s anti-smoking campaign.
Indonesia Challenges Global Tobacco Reform
With 240 million people and weak public health regulations, Indonesia is of the world’s last countries refusing to sign the Framework Convention on Tobacco Control, the World Health Organization’s treaty to limit the tobacco industry’s influence by encouraging nations to restrict tobacco advertising and raise excise taxes. In a major investigation on the role of the tobacco industry in Indonesia, the International Consortium of Investigative Journalists documents the role of the tobacco industry in Indonesian politics.
R.J. Reynolds Loses Bid for Appeal of $28.3 Million Tobacco Verdict
Florida’s Supreme Court declined to hear R.J. Reynolds Tobacco Co.’s appeal of a $28.3 million verdict in a case that the cigarette maker argued may affect thousands of so-called Engle tobacco claims in the state, reports Bloomberg News. The court turned aside the company’s bid for an appeal of the 2009 verdict in favor of Mathilde Martin, who claimed her husband, Benny Ray Martin, died from a smoking-related disease. The decision leaves in place a lower state appeals court ruling that affirmed the verdict.
Advertisers, Tobacco Industry and Convenience Stores Charge New Cigarette Warning Labels Infringe on Free Speech
In response to the new warning labels on cigarette packs proposed last week by the US Food and Drug Administration, Dan Jaffe, the Association of National Advertisers’ exec VP for government relations, told Ad Age that the ANA thinks the proposal is unconstitutional because “the government on its own … can’t put words in the mouths of advertisers.” The second, third and fourth largest tobacco companies in the United States, Reynolds American Inc, Lorillard Inc. and Commonwealth Brands are part of a federal lawsuit that challenges the legality of the new labels. Also joining the opposition is the National Association of Convenience Stores, a group representing an industry that interacts with 160 million Americans a day. “You’re going to run into people that will not necessarily like this,” said Jeff Lenard, an NACS spokesman. “When somebody’s hungry, they get something to eat. When somebody’s thirsty, they get something to drink, and we just want to make sure that when they go in, they still want to get that.”
Will the UN High Level Meeting on Non-Communicable Diseases Stand up to Multinational Corporations?
Note: This post is a longer version of a correspondence that appeared in Lancet on August 13, 2011.
Alarmed that non-communicable diseases (NCDs), the world’s number one killer, now pose a growing threat to economic development, this September the United Nations General Assembly will convene its first High Level Meeting on NCDs in New York City. World leaders and public health officials will consider how to reduce the growing threat that cardiovascular disease, cancer, chronic respiratory disease and diabetes pose to population health, economic development and health care systems.
These conditions cause an estimated 35 million deaths annually; 80% occur in low and middle income countries and one quarter among people younger than 60 years of age. By 2030, NCDs will cause more than three quarters of all deaths in the world.
In preparation for the UN meeting, groups as varied as the NCD Alliance, a coalition of four global voluntary health organizations, the Commonwealth Heads of Government and theMillennium Development Goal Summithave proposed important but uncontroversial actions such as improving surveillance for NCDs, integrating NCD prevention and control into national health systems, making NCD prevention an economic development issue, and allocating more international assistance for NCDs.
The NCD Alliance has also recommended more controversial steps such as ratification and full and universal implementation of the WHO’s Framework Convention on Tobacco Control and the elimination of “all forms of marketing, particularly those aimed at children, for foods high in saturated fats, trans-fats, salt and refined sugars.” The most pressing question facing the UN meeting is whether participants will be willing to tackle the corporate practices of the tobacco, food, alcohol, automobile and pharmaceutical industries that have so significantly contributed to the global spread of NCDs.
How Corporations Promote the Spread of NCDs
A growing body of evidence demonstrates that how corporations create, market, retail and price their products has contributed to increases in NCDs. For example, food and beverage makers market products high in fat, sugar, salt and calories; increase portion size; target children with ads and video games promoting unhealthy food; lobby for policies that make unhealthy foods cheaper than healthier ones and export their least healthy products such as sugar-sweetened beverages, fast food, cereals and snack foods to low and middle income countries. The result has been rising rates of diet-related NCDs.
The alcohol industry advertises aggressively to young and problem drinkers, contributing to liver diseases as well as injuries and violence. The industry uses its political clout to stop excise taxes that would discourage youth and problem drinking and sponsors ineffective “responsible drinking” campaigns that compete with under-funded effective approaches and emphasize individual rather than social responsibility for discouraging problem drinking. The automobile industry produces cars that fail to use available pollution control technology, opposes stricter standards for pollution control, and resists policies that favor cleaner public transportation. Increasing evidence links auto pollution with chronic respiratory disease, heart diseases and cancer.
Tobacco is predicted to contribute to one billion premature deaths in this century. The tobacco industry manipulates nicotine levels to make cigarettes more addictive and promotes its products, especially to women and young people in developing countries, their emerging markets. By increasing the rate of women’s smoking through targeted advertising, the tobacco industry has helped to shrink the longevity benefit that women have long enjoyed over men, a perverse way of reducing inequities.
Finally, while the pharmaceutical industry has developed drugs that have helped to control NCDs, it also promotes inadequately tested or dangerous drugs to treat NCDs and invests in developing minor variations of patented drugs that are profitable rather than in cheaper, safer and more effective alternatives.
While NCDs have multiple causes, a growing body of evidence shows that their burden on global health are inextricably linked to the practices of a small number of global companies in industries that are becoming increasingly concentrated. Ten multinational food companies account for 80% of the global food and beverage advertising. The three largest tobacco companies sell close to two-thirds of the world’s cigarettes and a few companies produce most of alcohol the world drinks. Thus, altering the practices and policies of a few dozen corporations could substantially improve the prospects for preventing and managing NCDs but this requires political leaders to demand changes in some of the world’s most powerful corporations.
Making Corporations Accountable
To date, the business world has been remarkably successful in avoiding responsibility for its role in NCDs. It does this by exploiting or manufacturing several myths about chronic disease. First, many people see NCDs as the inevitable consequence of economic development and population aging, the collateral damage of progress. But many people now develop NCDs in early and mid-adult years, so their rapid growth is not simply a function of aging populations. China, Egypt, Jamaica and Sri Lanka have NCD mortality profiles similar to the US and other developed nations, contradicting the view that NCDs are the unique curse of better off countries. Business benefits from portraying NCDs as the unavoidable corollary of aging and development because this view spares closer scrutiny of the role of corporate practices.
Second, conventional wisdom posits lifestyle as the primary cause of NCDs: if only people ate better, moved more, smoked less and consumed less alcohol, the world could prevent many deaths and lower the costs imposed by NCDs. As a result, NCD prevention focuses on programs designed to change health-related behavior, often one person at a time. Of course individuals’ health behavior contributes to NCDs. However, no evidence demonstrates that the world’s population has recently become more gluttonous or susceptible to addiction. What has changed is the behavior of the organizations that shape the environments in which people make health decisions. Global expenditures for advertising increased from $50 billion in 1950 to $570 billion in 2005. In the last few years the number of corporate lobbyists working in the capitals of the United States, the United Kingdom, the European Union and wherever international trade negotiations occur has skyrocketed, giving business a disproportionate voice in the policy decisions that shape health and lifestyle.
Corporations and their political supporters insist that business has an important role in shaping NCD policies and promote a third myth that voluntary corporate codes are the most effective tool for changing their health-damaging practices. Last summer, UK Health Secretary Andrew Lansley invited Mars, Cadbury and Coca Cola to play greater roles in the national anti-obesity initiative and the development of new food regulations. Corporate health leaders at Pepsi Cola and other companies have called for more private-public partnerships to address NCDs. However, their claim that voluntary agreements for corporate social responsibility suffice to protect public health is not supported by independent assessments of such codes in the food, alcohol and tobacco industries.
Calls for public sector collaboration with businesses fail to acknowledge that many companies profit from promoting NCDs. Corporate managers are legally required to maximize profits and too often depend on business models that exploit biological vulnerabilities (e.g., a craving for high fat, sugar and salt diets), addictions, or social insecurities. Some companies may temporarily benefit from selling healthier food or promoting more responsible drinking but in the long run increasing consumption and market share usually require promoting disease rather than health.
In the final analysis, if the UN meeting is to make progress in stopping the rise in NCDs, participants will need to find the backbone to stand up to corporate propaganda and lobbyists. Specific policies that could put a dent in the incidence of NCDs include: tighter restrictions on advertising unhealthy products; laws and taxes that discourage companies from transferring or externalizing the health costs of their products onto consumers or tax payers; legal corporate codes of conduct that require global companies to disclose known health effects of their products and practices; and stronger restrictions corporate lobbying and campaign contributions in order to provide health advocates with a more level political playing field. Absent forceful political mobilization by social movements, local governments and health professionals and their organizations, it is unlikely that businesses will agree to such a platform but will instead argue for the incremental, ineffective approaches they have advanced so far. Stay tuned for further developments.
For Further Reading
Beaglehole R, Bonita R, Horton R, et al. Priority actions for the non-communicable disease crisis. Lancet. 2011;377(9775):1438-47.
Cecchini M, Sassi F, Lauer JA, Lee YY, Guajardo-Barron V, Chisholm D. Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Lancet 2010;376 (9754):1775-84.
Freudenberg N, Galea S. The impact of corporate practices on health: implications for health policy. J Public Health Policy. 2008;29(1):86-104.
Geneau R, Stuckler D, Stachenko S, et al. Raising the priority of preventing chronic diseases: a political process. Lancet. 2010;376(9753):1689-98.
Monteiro CA, Levy RB, Claro RM, de Castro IR, Cannon G. Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil. Public Health Nutr. 2011;14(1):5-13.
World Health Organization. 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases, 2008.
Image Credits
1. Non-Communicable Disease Alliance Briefing Paper for UN Meeting on NCDs
2. gbaku via Flickr
3. StephenZacharias via Flickr
The Smoke-Filled Revolving Door
Last week, Lorillard, the third largest tobacco company in the United States, named Neil Wilcox, a former Food and Drug Administration science policy analyst, as senior vice president and chief compliance officer. Prior to his 13 years at the FDA, Wilcox was director of global regulatory affairs at The Gillette Company and vice president of global regulatory and scientific affairs at the Kimberly Clark Corporation. At Lorillard, Wilcox will oversee compliance with the federal Family Smoking Prevention and Tobacco Control Act. Lorillard is market leader in menthol cigarettes with an estimated 35 percent market share. FDA is expected to rule soon on how to regulate menthol.
Interview with Michael Schwalbe, Author of Smoke Damage
Michael Schwalbe is author of the recently published book Smoke Damage: Voices from the Front Lines of America’s Tobacco Wars (Madison, WI: Borderland Books, 2011). He is a professor in the Department of Sociology and Anthropology at North Carolina State University in Raleigh. Recently, Corporation and Health Watch editor Monica Gagnon interviewed Schwalbe about his new book. An edited version of the transcript is presented here.
CHW: Why did you want to write a book about the people affected by the tobacco industry?
MS: The initial impetus was watching my mother care for my father as he was dying of lung cancer caused by smoking. The experiences of caregivers under those conditions are not well documented.
We know a lot about how many people die, but we don’t know a lot about how the dying and the decline affect people around them. Watching what my mother went through for a year and a half—between the first diagnosis, treatments, and my father’s death—made me think that this was something that really needed to be documented.
CHW: How did you end up expanding from tobacco widows to all of the faces we see in your book now?
MS: As I thought more about it, it occurred to me that there are many categories of people in our society whose lives are changed in dramatic ways because of the health damage caused by tobacco use. I thought the book would be more compelling if I could document a wider range of the experiences related to tobacco-related disease.
CHW: Your book has a lot of images and seems like it’s really about giving the tobacco industry’s victims a human face. What did you hope to accomplish by that?
MS: I wanted to make the magnitude of the problem have more emotional weight. We can look at the statistics and say that 443,000 die every year [in the United States] of tobacco-related disease. We can say that 3.6 million suffer from some kind of chronic disease related to tobacco use. But those figures are overwhelming, so it’s hard to feel what they mean. If people don’t feel what those figures mean, as well as grasp them intellectually, I don’t think it motivates much action. That’s why I did the photographs and the interviews—to try to put the experience in people’s own words. In the book there’s a brief descriptive paragraph about each person and then a 500-word excerpt from the interview in which the person talks about his or her experience as related to tobacco and tobacco-related disease.
CHW: What was it like taking photographs of these people—meeting them and hearing their stories?
MS: Some of the stories were familiar to me from my own family, but I learned a lot about how people experience the problem in different ways, especially struggling with addiction. Some of the people I interviewed were still struggling to quit smoking. Talking to the litigators was new for me. I found it interesting to get their perspective on the industry and on efforts to use the courts to bring the industry to heel. Legislators were a new group too, and it was interesting to get their perspective on what they hoped to accomplish. It took me ten months to find three ex-tobacco farmers. These are people who the industry portrays as absolutely dependent on tobacco to make a living. Certainly there’s an economic dependency on the part of some farmers, but the ones I interviewed had decided that they didn’t want to be in it anymore, [not just] for market reasons [but also] for moral reasons. And they were doing fine as farmers. So this idea that farmers can’t get out of the industry is simply not true. I had never talked to farmers in that situation before, so that was new to me. In general, people in every category were cooperative and helpful.
CHW: How did you feel the experience was for them, to talk about their interaction with tobacco in this context?
MS: Part of what makes the material in the book powerful is that people spoke honestly about some very difficult experiences in their lives. I think it comes through in the text.
CHW: Talk about the economic and political interests that keep tobacco so widely available to the public.
MS: Most people know that the tobacco corporations have a clear interest in profits and in continuing to profit from selling an addictive and disease-causing product. Many government units also have a stake in deriving revenues from tobacco taxes and the Master Settlement Agreement. So I don’t think we’re going to see the government move any time soon to put the tobacco corporations out of business. And of course there are a host of secondary industries dependent on tobacco—advertising, marketing, retailing. It’s an industry that has its tentacles spread deeply throughout our society, throughout our economy and into government, so it’s a difficult industry to combat.
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CHW: What concerns should readers have about workers in the tobacco industry?
MS: Certainly we want to look for solutions that aren’t going to deprive ordinary folks of their livelihood. On the other hand, we don’t want to hold that out as a reason for protecting industries that do more harm than good. This is what the tobacco industry has done for a long time. We see it clearly in North Carolina. I say we should weigh tobacco industry jobs against the economic costs of the 12,000 North Carolinians who die every year from tobacco-related disease. In this state, it doesn’t take long for tobacco to kill more people than it employs. We also pay about $2.5 billion a year in health care costs because of tobacco—again, that’s just in North Carolina. So, while we need to be concerned with how people can make a living, we also need to be concerned with how people can live. In the long run, this is an industry that has to go by the wayside.
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CHW: How have the tobacco companies changed to adapt to the new environment they face?
MS: They’re amazing in their ability to adapt to new marketing restrictions. They can’t use terms like “light” and “mild” anymore to suggest that some cigarettes are safer than others, so they’ve started to color-code the packs to convey the same message. Now that more people can’t smoke in the workplace and in some public spaces, they’ve put money behind smokeless products that can be used anywhere. Tobacco products that can be used without giving off smoke are partly a way to keep people addicted. In fact, if you look at the advertising for some of these products, you’ll see that these aren’t offered as paths to quitting, but as alternatives to smoking if people can’t smoke in a particular situation.
In other parts of the world, tobacco industry marketing operates pretty much as it did in the U.S. thirty or forty years ago. In some parts of the world there’s also a considerable amount of illegal activity. In Africa in particular, cigarette giveaways and breaking up packs to sell one or two at a time are ways to get kids addicted. This is why comprehensive marketing bans are so important.
CHW: What do you think is the role of the tobacco industry in exacerbating health disparities?
MS: The industry is adept at targeted marketing. They know what kinds of messages appeal to which groups. Some of this developed over time; the classic example is probably the marketing of menthol cigarettes to African-Americans. Once that market began to take shape, it became something the industry could continue to exploit with its marketing imagery, selling Newports and Kools and other menthol cigarettes to African-Americans. What the industry cares about is selling its product, and it will find ways to sell product to different demographic groups based on the kinds of messages that are likely to be appealing to those groups. Marketing is a craft in that sense—a craft of figuring out how best to tap into the manufactured desires and insecurities of different groups of people and sell them a product that they’re led to believe will resolve their insecurities and satisfy their needs. In the larger sense, we’re seeing patterns develop today where it’s clear that the more education people have, the less likely they are to smoke; it’s almost a linear relationship. So we see much higher rates of smoking among high school dropouts and less-educated people in general. Rates are also higher among people in poverty. The industry takes advantage of the fact that these vulnerable populations exist. Marketing messages are tailored to these demographics, especially to young people, who are the industry’s main concern – “replacement smokers,” to use their language.
CHW: On the individual level, what can people do to influence this face of tobacco that you’ve portrayed in your book?
MS: When people ask this, I always tell them to look for a group to join so that they can benefit from other people’s experience and from the power of collective action. But whether you’re part of a group or speaking as an individual, there are certain kinds of policies that we know work and need to be lobbied for. This means bringing pressure to bear on legislators. I also tell people that a good way to pull resources away from the industry, if only in a small way, is to quit smoking. Every pack of cigarettes bought gives the industry money to continue to promote its products, and so it’s a small act of individual resistance to withdraw support from the industry, even at that level of not buying its products. Most CHW readers probably aren’t smokers, but still they can use these kinds of arguments to encourage others not just to quit smoking, but to quit giving the industry money to carry on its destructive behavior.
CHW: What about the role of the tobacco survivors in helping to mobilize people?
MS: I think it can be effective, but it’s a small effort in the face of a still-powerful industry. Education is important, and that’s one of the roles survivors can play. But policy is important too. We need policies and laws that restrict the industry’s behavior. That’s what’s crucial. So my hope is that when the survivors take their message out, they’re not just saying, “You shouldn’t smoke,” but rather, “Not only should you not smoke but you need to press your representatives for policies that will, in the long run, keep other people from becoming addicted.” We especially need policies that give people additional incentive to quit. Smoke-free air laws and higher taxes on tobacco products have this effect.
CHW: What about a grassroots movement against tobacco? Do you think that public interest on this issue has given way to newer issues or is there still a vibrant movement against the tobacco industry? If not, how would you suggest we re-mobilize the grassroots movement?
MS: The movement has taken different forms over the years. Originally there was a lot of mobilization around control of advertising and passing smoke-free air laws. We’ve still got a ways to go on the smoke-free air laws. About half the states do not have comprehensive indoor smoke-free air laws, so there’s clearly work to be done in those states—and people are doing it. There’s also been an institutionalization of the movement, which has meant less energy at the grassroots level and more professionalization. Most states have tobacco-control agencies and branches that work on the issue. And so yes, in places where smoke-free air laws have been won there has been a predictable easing-up of effort. Now it seems like, “OK we’ve won, we’ve got smoke-free air laws. We can relax.”
On the other hand, there are strengths to institutionalization. Thousands of people have full-time professional careers in tobacco control, and they’re tremendously knowledgeable. They understand tobacco industry strategies and how to counter those strategies, and that’s a good thing. The institutionalization of the movement is a two-edged sword. Yes, some of the grassroots energy has been dissipated, but at the same time we’ve developed a stable base of expertise and personnel. In general, grassroots groups working with tobacco-control professionals have been extremely effective in promoting smoke-free air laws and other practices that have helped reduce tobacco-related disease.
Another problem is that movement organizations can get caught up in the issue of the day, so I think lately there’s been some displacement of public health energy from tobacco to obesity, for instance. Obesity is a serious problem, of course, and needs citizen energy as much as tobacco. But I think people have to remember that the tobacco problem is not behind us. That’s part of what I wanted Smoke Damage to do—keep public awareness of the issue alive and help people understand that there’s much more that needs to be done. We can’t be complacent. If politicians are going to do the right thing, grassroots groups need to bring pressure to bear. As far as reigniting the movement, people have to understand that corporations act in the interest of profit-making, not public health, and that if we’re going to protect health, we’re going to have to confront corporate power. Maybe what we’ll see is a kind of an enfolding of grassroots tobacco-control efforts into a larger anti-corporate power movement directed against corporate interests that promote obesity, tobacco use, and other kinds of unhealthy behaviors.
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CHW: Where do you think there is potential for bringing health advocates together across these issues?
MS: Some of this is going on already. Maybe the uniting vision needs to be one that looks at all the determinants of public health and asks, “What needs to be challenged?” If people understand the threat that corporate power poses, that could be an umbrella under which people come together. Industry, whether fast food or tobacco, wants to define public health problems as stemming from individual choice. They benefit from promoting the notion that this is all about individual choice. They don’t want us to see our national health problems as consequences of how corporations engage in marketing, lobbying, buying political influence through campaign contributions, and shaping public opinion. So maybe that awareness would help people come together. It’s work that needs to be done, and sometimes you have to rise above your particular issue to see what the issues have in common, whether it’s obesity, alcoholism, or tobacco-related disease.
Image Credits:
1. Smoke Damage
2. Sherryl Kleinman
Philip Morris Reports Weak Local but Robust Global Sales
Philip Morris is increasing its tobacco sales in Europe, Latin America and Southeast Asia, even as U.S. sales remain stagnant.
As Investorguide reports, “As long as the company keeps reaching overseas to offset weak domestic sales and the falling dollar, Philip Morris will grow.” The human toll of this growth is documented in a report by Corporate Accountability International, which explains that 80 percent of the 8 million tobacco deaths predicted by 2030 will occur in the developing markets that Philip Morris is currently targeting.
Corporations and Health Watch 