Tobacco Control Policy - Research Paper Example

? Tobacco control Introduction Tobacco consumption has been a key health concern for most counties in the past century. There are over 1.25 billion tobacco smokers in the world at present. This represents at least a third of the world’s inhabitants aged above 15. Tobacco consumption is the key source of unnecessary death worldwide and the main cause of avoidable death in developed countries. The menace is fast spreading to developing countries. At present, tobacco smoking is expected to kill over 10 million people per year by 2020. Two thirds of the effects are to be felt in developing countries. Every year, around 443,000 people perish prematurely due to exposure to smoke from cigarettes. An additional 8.6 million individuals live illnesses caused by smoking. Despite the risks posed by cigarette smoking, an estimated 46.6 million adults in the US smoke tobacco today. Another 88 million non-smokers are exposed to dangers of cigarette smoking. Fifty four percent of these are children. It is predicted that by 2015, tobacco will account for 10% of the deaths globally (Mathers and Loncar 2006; WHO 2008). Many countries have not succeeded in controlling tobacco totally despite the various efforts made some scholars argue that this failure is motivated by the fact that most counties have not adequately understood the political economy behind tobacco production (Jha, Chaloupka et al. 2006). Most policy makers have even ignored the vitality of these concerns. Perhaps this is why it is impossible to effectively control the consumption of tobacco. The rest of this paper bases on the enormity of the tobacco epidemic. How tobacco use gained popularity A group of European explorers who were off to the New World is credited for the discovery of tobacco. The use of tobacco then gained popularity in Europe and Asia in the following centuries. The manufacturing process of tobacco however began in the 19th century. In the US, tobacco consumption per capita increased enormously in the 20th century. After the Wold Wars, there was widespread advertising of tobacco through television. Concerns as regards the health effects of tobacco only came to the fore in the 1950s. However, the addictiveness of nicotine contained in tobacco was not known until recently. Nicotine addiction continued to influence the demand for tobacco. The turning point in people’s attitudes towards consumption of tobacco changed following the Surgeon General’s report of 1964. The report suggested that smoking of cigarettes was the main cause of cancer and other respiratory diseases. Years following the release of this report have seen regulation of tobacco come into the public limelight. Consequently, the US banned televised advertising of cigarettes in 1971. This saw the usage of tobacco products drop significantly especially among adults in the US. Fascinatingly, the augment in popularity of tobacco is linked to the dawn of television and radio advertising. The popularity of tobacco consumption has declined considerably over the years. The percentage of adult smokers has declined from 45% in 1965 to 20% in 2009. Most countries have begun to enact Legislations and ordinances that make the consumption of tobacco less socially tenable. There has been a decline in the number of youth who take up the practice. The effort to restrict tobacco use has increased over time. Evidence stipulates that the U.S tobacco industry is slowly accepting legislative manacles imposed on smoking. In 2004, both republicans and democrats joined hands in approving the prolonged role for Food and Drug Administration in tobacco control. Dangers of tobacco consumption Tobacco contains over 4000 chemicals. Most of these chemicals are harmful substances like carbon monoxide, nicotine, tar, hydrogen cyanide, formaldehyde and benzene. The substances are also quite addictive. Experts rate nicotine higher than heroin, alcohol and cocaine in terms of addiction and dependency. No user of tobacco can escape the risks they are exposed whether they are active or passive smokers. More than 96 billion dollars is spent every year on the medical costs relating to tobacco consumption. This poses a heavy economic burden on money that would rather be spent on productivity. Second hand smoking alone causes serious illnesses including lung cancer and other heart diseases. It is the main cause of sudden death in infants and acute respiratory infections. Cigarette smoking causes coronary diseases, which is the leading cause of death in the US. It also reduces the circulation of blood by narrowing the blood vessels exposing smokers to peripheral vascular disease. Smoking is the main cause of lung diseases like bronchitis, chronic airway obstruction and emphysema. Smoking also has adverse effects on fertility. It leads to still birth, infertility, low birth weight and preterm delivery. Tobacco use and poverty are also closely associated. Studies have concluded that in the poorest households in emerging economies allot more than 10% of their expenditure on tobacco. This translates to inability to meet the daily needs of food and other basic items. The role of tobacco in poor families has hindered economic development in emerging economies. Smoking has been associated with periodontal disease in young people. Why a tobacco policy is necessary For over four decades, the United States congress has ignored over twenty-five reports by the Surgeon General opting instead to entertain a system that allows the tobacco sector to make overwhelming profits at the expense of the American people. The system has cost taxpayers billions as they have been compelled to foot bills ascribed to tobacco in Medicare and Medicaid. After many years, manufacturers have agreed that their products are posing as a substantial health hazard to many and are quite addictive. One of the main manufacturers, previously known as RJ Reynolds Tobacco, has contended that the products they produce have inherent and significant health risks for several serious diseases. His acknowledgement is reason enough to necessitate change. The number of people and stakeholders gaining interest in the matter has been growing daily. As such, it is imperative that a policy that incorporates inclusiveness, transparency and openness be formulated. Origin of the tobacco control policy The World Health Organisation convened in 1993 following a decision by Allyn Taylor and Ruth Roemer that the WHO should utilise the authority bestowed upon it to initiate conventions that would advance global health. In 1995, the two proposed several options to the World Health Organisation recommending a framework convention for tobacco control. Initially, the proposal was welcomed with resistance by some officials of the WHO, but later gained broad acceptance (Taylor, 2000). In 1996, the World Health Assembly voted to continue with its advancement. The framework for Convention on Tobacco Control was later adopted in 2003 by consensus. It was the first international treaty adopted with the backing of the WHO. The treaty was officially implemented from 27th February 2005. It was the first internationally recognised instrument designed to promote polygonal cooperation and state-run action to minimise the spread of the global tobacco epidemic (Taylor, 2000). The framework is designed to strengthen cooperation worldwide in a bid to minimise the effects of tobacco. The framework proposes a variety of measures. It calls on member states to put restrictions on advertising, promotion and sponsorship. The treaty also recommends that restrictions to on labelling and packaging of tobacco products. It stipulates that counties should strengthen legislation that combat smuggling of tobacco. The prices and taxing of tobacco products are already helpful in plummeting tobacco consumption (Taylor, 2000). As such, the framework recommends enactment and implementation of these tax rates and pricing. The treaty also recommends measuring, regulating and testing of contents of tobacco products. It proposes that administrative measures should be incorporated to compel stakeholders in the tobacco company to reveal the contents and emission of their products to authorities. Tobacco control policies Europe was the first WHO region block to adopt a policy on tobacco. In 1987, the comprehensive approach was founded in Europe as its first action plan towards tobacco consumption. It included restrictions on production, promotion and distribution of tobacco. It included pricing policies, smoking cessation training for professionals and help on how to give up smoking. In 1992, thirty-seven proposals were designed to strengthen commitment of member states in what came to be known as the Second Action Plan. This emphasised on the significance of building alliances to support tobacco control. It recommended allocation of additional human and financial resources towards tobacco control. The third action plan came in the period between 1997 and 2001. It set targets for member states in the areas of a smoke free environment, public education among others. In 2008, the World Health Organisation revealed its report called MPOWER through a state of the art presentation. The package contained proven strategies for tobacco control. The report provided an overview of the progress of six key policies areas: tobacco use and prevention policies, protecting people from tobacco smoking, raising taxes on tobacco and education on the dangers of tobacco. Components of the U.S tobacco policy The tobacco policy provides an oversight of how tobacco products should be manufactured, distributed, sold, labelled and marketed. The policy requires warning information on each tobacco product concerning the risks of using them. The policy also establishes manufacturing practices for the manufacture of these products. The policy also requires manufacturers to register with FDA. The tobacco policy also provides for reforms and restructuring of agricultural production of tobacco. This is to ensure the integrity of the crop in its processing and production stages as well as stop illicit smuggling and sales. The policy outlines the steps to be followed to stop smuggling, illegal manufacturing, trafficking and illicit distribution. It requires anyone shipping tobacco products in foreign commerce and interstate to be registered and should keep records of sales and distribution. It stops distribution of trafficked goods as a source of revenue. The policy recommends integration of federal agencies and formulation of a tobacco policy for the private sector. Such agencies to include: the Environmental Protection Agency (EPA), the Federal Trade Commission Department of Homeland Security, among others. Beneficiaries of the tobacco policy The tobacco policy benefits all sectors at large. The main beneficiaries include Public Health, growers and their communities, consumers of tobacco products, manufacturers and the government. For the public health sector, the number of deaths will reduce, and tobacco consumption among children and adolescents will be limited. The growers have a chance to provide solutions for the tobacco epidemic. The consumers will be protected since the manufactures are required to disclose the contents of their products. The competition within the industry has been levelled through standards that ensure continuity and consistency in the economy. The government is capable of preventing illegal trafficking of tobacco products thereby safeguarding the security, the state and its public health. Coalitions and tobacco control A tobacco control policy cannot be successful and comprehensive without coalitions put in place to advocate for the policy change. More often, tobacco control programs do not have the influence to promote tobacco free norms. As such, coalitions are needed to enhance the efforts of the state in tobacco control (Butterfoss, 2007). Merits of tobacco control coalitions From 1960s, following the release of the Surgeon’s report, individuals alarmed about the effects of tobacco to human health came together to form a group to advocate for non-smokers rights in the U.S. since then the groups have reorganised themselves into coalitions that work at grassroots, national and state levels (Butterfoss, 2007). National programs have reinforced and absorbed coalitions in an effort to control tobacco consumption. One such program is the National Cancer Institute’s American Stop Smoking Intervention (ASSIST). Despite the difficult legislative and cultural environment, coalitions have become leading advocates and policy promoters for tobacco control. Coalitions have been on top of the tobacco control policy to the extent that there are coalitions in almost all states of the United States. The coalition incorporates ethnicity, politics, skill and professionalism in the tobacco control efforts. This ensures diversity. The coalition is an umbrella body including various organisations collaborating to achieve a common goal. Their achievements are therefore beyond an individual organisation’s contribution. The coalitions also help sustain the tobacco control programmes by rallying public support and enhancing community mobilization. Coalitions act as a powerful force in changing community values by eliminating pro-tobacco influences through insistence on pro-health issues (Butterfoss, 2007). These successes demonstrate some of the roles that tobacco control coalitions helped change the social norms and enhance the national tobacco control efforts. Ethical reasons behind the tobacco industry Ethics is defined as moral philosophy or something that is noble, principled, decent, just or upright. There are many reasons why ethics should be integrated into the tobacco control efforts. However, smoking of tobacco can never be justified it can only be made less harmful. The pursuit of measures to reduce the harm of tobacco products is one of the ethics in the tobacco industry. Various ethical considerations to reduce the harm of tobacco have not been welcomed by the tobacco industry. Most policy makers came up with a strategy to reduce the amount of tar in tobacco to minimise the total smoke dose and consequently the amount of carcinogen inhaled (Gray, 2002). Rules like the restriction of smokers through smoking zones are more ethical as they protect non-smokers from health risks (Bonnie, 2007) Ethics require that the standard limits for carcinogens and toxins be raised to produce less harmful cigarettes (Cohen, 2002). There is a nicotine replacement therapy (NRT) for people who aspire to stop smoking (Gray, 2002). In Sweden, low nitrosamine snuff that is anon-inhaled source of nicotine thus it reduces the health risks of nicotine consumption. There are nicotine delivery devices called PREPs that use heated tobacco rather than smoked. They are widely used in the United States (Bonnie, 2007). Stakeholders and tobacco control policy Stakeholders are the people who matter in any system. The fact that they matter implies that they affect the decisions and policies in whatever field they belong. The tobacco industry has made efforts to influence the tobacco control policy. The industry has recognised that their economic relevance is not only dependent on consumer marketing, but also on the environment within which they conduct business. The tobacco industry has vested interest in cultivating close relations with the government in order to counter any proposals and Legislations that work against them. The main goal for tobacco control is to prevent possible deaths and the risk of diseases. However, some stakeholders mainly the industry players have not welcomed the efforts to control consumption of tobacco. In 2000, the World Health Organisation (WHO), published tobacco industry strategies to undermine tobacco control at the WHO. The report established that the tobacco industry uses a variety of strategies to frustrate the efforts towards tobacco control (Mackay, 2003). The industry players have strategically established inappropriate relationship with the WHO staff. The tobacco industry was also found to be using its finances to get influence through other United Nations agencies. They were also accused of discrediting the WHO officials by use of surrogates such as trade unions and front groups (Mackay, 2003). The industry’s main stakeholders have also been accused of distorting World Health Organisation researches through media events that distract tobacco control initiatives. Lastly, the organisation has accused them of closely monitoring and surveying all their activities through their links. The report found that tobacco companies have operating over the years with the deliberate intention of subverting the hard work of the WHO to tackle tobacco issues. Their attempted subversion is elaborate, sophisticated and well financed. Their counter campaigns are tactical and intense. This report argues that tobacco control is not only struggle because of addictions and cardiovascular diseases but also the organised active and calculative industry. The tobacco industry also consists of other stakeholders like manufacturers, farmers, distributors and salespersons. The World Health Organisations FCTC describes the tobacco industry as tobacco manufacturers, importers of tobacco products and wholesale distributors. These industry allies and other third parties cooperate to benefit from the sale of tobacco products. Consolidation has been a leading trend in the tobacco industry for the past two decades. Privatisation of state owned tobacco companies is also in the offing. The Turkish government sold its tobacco company Tekel to the British American Tobacco. Multinationals, state owned companies and local companies have come up with joint ventures. The stakeholders also cooperate through licence agreements where local companies are allowed to manufacture international brands like Camel and Marlboro. For example, Philip Morris International has 90% shares in Pakistan’s Lakson Tobacco. The stakeholders also cooperate through memoranda of understanding between governments and tobacco companies. Such agreements also apply to projects like policies to minimise counter branding of tobacco products. The implications for interference of the tobacco industry stakeholders in tobacco control efforts also depend on whether they are government owned or private. Countries where the tobacco industry is widely government owned is less likely to support efforts to control tobacco consumption. Interdependencies between the different groups of stakeholders Farmers There is enough evidence in the US to show that tobacco farmers have made efforts to frustrate the political class concerning measures for tobacco control (Mackay, 2003). Countries that have ratified with WHO FCTC face opposition from farmers who get support from manufacturers and various trade unions. The suppliers of agrichemicals to the tobacco farmers and the local communities in which tobacco grown also join the farmers in the opposition of tobacco control. The farmers argue that tobacco control could be catastrophic to the local communities who have no alternative employment. The industry has sponsored a lobby group for farmers, the International Tobacco Growers Association that lobbies for farmers at the WHO (Mackay, 2003). Importers, retailers and distributors Retail shops are the main links with the consumers especially considering the restrictions on advertising. Retailers are the main beneficiaries of revenue collected from tobacco sales. The distributors and retailers cooperate with the tobacco manufactures to oppose bans on display of tobacco products citing layoffs, economic hardship and business closure. They have distributed tobacco friendly petitions and materials to consumers to ensure smokers opposition to tobacco control initiatives. Importers also cooperate with the tobacco industry. A confidential report from the British American Tobacco states that importation of products for legitimate duty-free sales has provided a means for supplying smuggled cigarettes. In a submission to the WHO FCTC public hearing, Japan’s Duty Free Shop Association opposed a planned ban on duty free sales relating the sale of tobacco products as one of the delights of duty free shopping for travellers. It also argued that the ban might result into a problem with grave ramifications for the itinerant industry. Consumers Research through public opinion polls has continually shown that there is strong support for initiatives and programmes to protect the public from second hand smoking. There is also support for programs to help smokers quit and prevent children from resorting to smoking. Smokers Rights Association has surprisingly supported the tobacco industry and has been in the forefront in opposing indoor smoking. Allies and third parties The tobacco industry has several business allies and third parties that work together with it to block the implementation of tobacco control initiatives. Most of these groups are more socially acceptable. These groups appear in legislative hearings and the media where they try to reframe strategies of tobacco control as economic issues rather than health initiatives. These industries include; advertising, transport, hospitality, gambling and gaming, labour unions, investment advisers among others. These allies have come up with initiatives like The Advancement for Sound Science Coalition, which was launched on behalf of Philip Morris to battle smoking limitations that were intended to minimise exposure of the public to second hand smoking. Public relations firms are used by the tobacco industry to manipulate public opinion on varied aspects of tobacco control and mobilise the support of government. An example is Mongoven, Biscoe & Duchin public policy specialists based in Washington DC, assisted tobacco companies like R.J. Reynolds and Philip Morris to destroy efforts of tobacco control including the WHO FCTC. The identity of some of the industry allies is not often directly obvious. The WHO TFI identified cooperation between two main companies in the tobacco industry and the International Life Science Institute to undermine tobacco control efforts. The WHO concluded that tobacco companies use some non-governmental organisations that are in official relations with the WHO for commercial interests. The tobacco industry is also reputed with funding of researchers, scientists and other academics to act in their favour. How different states implement the tobacco policy The United States Campaigns and programs against smoking have been initiated in schools to help students in grades eight and nine (Flay, 2007). These programs include the Tobacco and Alcohol Prevention Project, project SHOUT and the Life Skills Training Program. The media has also had its own share of campaigns on consequences of smoking (Flay, 2007). In 1967, it started with the Fairness Doctrine mandate that required all the stations advertising tobacco products to air antismoking public service announcements (PSAs). The PSAs were credited with the first realistic reduction in per capita consumption of tobacco in the 20th century in the US. The US tobacco control initiatives in California, Minnesota, Massachusetts, Florida and Oregon involved the media in television, billboards and newspaper campaigns. The US clinical practices guidelines provide for universal insurance coverage for treatment of nicotine dependency. The state has also reduced financial barriers on treatment of nicotine dependency. The US through the Cigarette Smoking Act and other Legislations has effectively put promotion and advertising restrictions on tobacco products. The US enacted the clean indoor air legislation that prohibits smoking in government buildings, offices, health facilities and public places. Almost all the 44 states have adopted these laws. The US congress authorised the Federal Agency (FDA) to regulate tobacco products. The Cigarette Labelling Act was enacted in 1969. It requires nicotine and tar yields to be indicated in the cigarette packs. The packages are required to have warnings with large graphics and pictorial contents. The US Centre for Disease Control (CDC) has reported progress in the development and financing of inclusive state programs on tobacco control. California was the leading state in tobacco control in 1990 with a 25-cent additional tax on all tobacco products. This brought in returns of more than 600 million dollars in the yearly tax revenue. Tobacco prices have also been on the rise reducing adult and underage consumption. England The latest tobacco control efforts are evident in the Government Tobacco Control Plan of 9th March 2011. The plan involves the efforts to reduce the prevalence of smoking from 21% to 18.5% by 2015. It also includes reduction of smoking rates among teenagers from the age of 15 from 15% to 12%. The plan commits to the termination of display of tobacco products in small and large shops alike. The UK department of Health Plans is planning to publish a program spread over three years with the objective of minimising tobacco use in Europe. Tobacco products are to be packaged in less attractive, uncomplicated packages that include calamitous health warnings. The UK is looking at imposing higher taxation on tobacco products and maintaining the already high tobacco prices. Tobacco vending machines also face future elimination threats according to the report’s target of October 2011. References Taylor AL, Roemer R. An International Strategy for Tobacco Control. Background Document for the World Health Organization for WHA 48.11, WHO Doc. WHO/PSA/96.6, 1996. Retrieved on November 29, 2012 from, http://www.who.int/tobacco/framework/wha_eb/wha48_11/en Mackay J. (2003). The making of a convention on tobacco control. Bull World Health Organ. 81:551 Taylor AL. The power of process: the impact of the WHO FCTC negation process on global public health. Paper presented at the 11th World Conference on Tobacco or Health, August 19 2000, Chicago, Ill. Bonnie RJ, Stratton K, Wallace RB, (2007) eds. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: Institute of Medicine (IOM). The National Academies Press. Butterfoss, FD (2007) Coalitions and Partnerships in Community Health. San Francisco, CA: Jossey-Bass, A Wiley Imprint. Midwest Academy. Organizing for Social Change. Santa Ana, CA: Seven Locks Press; 2008. Centers for Disease Control and Prevention. Smoking and Tobacco Use. Retrieved on November 29, 2012 from, http://www.cdc.gov/tobacco The US Centers for Disease Control and Prevention. Adult Cigarette Smoking in the United States: Current Estimates. Retrieved on November 29, 2012 from, http://www.cdc.gov/tobacco/data_statistics/Factsheets/adult_cig_smoking.htm Gray N, Boyle P (2002) Regulation of cigarette emissions. Ann Oncol. Flay B. (2007) The Long-term Promise of Effective School-based Smoking Prevention Programs. Appendix D. In: Ending the Tobacco Problem: Institute of Medicine, National Academies of Science. The US Centres for Disease Control and Prevention. Adult Cigarette Smoking in the United States: Current Estimates. Retrieved on November 29, 2012 from, http://www.cdc.gov/tobacco/data_statistics/Factsheets/adult_cig_smoking.htm RJ Reynolds.1986. “Partisan Project.” Bates No. 505467389/7392. Retrieved on November 29, 2012 from, http://tobaccodocuments.org/landman/505467389-7392.html Fox B, Cohen JE. (2002) Tobacco harm reduction: a call to address the ethical dilemmas. Nicotine Tob Res (suppl 2):S81–7. Read More