Governments and public health professionals have been warned against developing partnerships with a new tobacco industry-funded organisation that says it wants to eliminate smoking globally.
Philip Morris International has pledged to contribute about $US80 million annually** over the next 12 years to the new Foundation for a Smoke-Free World. (**This figure has been corrected since first publication when “annually” was omitted.)
The organisation states that independence and transparency are its “core principles”, and that its by-laws will ensure an independent research agenda, independent governance, ownership of its data, freedom to publish, and protection against conflict of interest.
“Furthermore, strict rules of engagement will be put into place to ensure any interactions with the tobacco industry are fully transparent and publicly reported,” it says.
However, the World Health Organization says the tobacco industry’s longstanding history of misleading conduct “means that research and advocacy funded by tobacco companies and their front groups cannot be accepted at face value”.
“When it comes to the Foundation for a Smoke-Free World, there are a number of clear conflicts of interest involved with a tobacco company funding a purported health foundation, particularly if it promotes sale of tobacco and other products found in that company’s brand portfolio,” said a WHO statement.
“WHO will not partner with the Foundation. Governments should not partner with the Foundation and the public health community should follow this lead.”
Meanwhile, the Foundation is likely to be a hot topic at the forthcoming 2017 Oceania Tobacco Control Conference, to be held in Hobart on 17-19 October, with the theme: “From vision to reality: A tobacco-free Oceania”.
Journalist Marie McInerney, who will cover #OTCC2017 for the Croakey Conference News Service, previews some of the hot conference topics in this Q and A with Sarah White, Director of Quit Victoria and Chair of the OTCC 2017 Program Committee.
White describes the new Foundation as the industry’s “latest, cynical attempt to play a corporate social responsibility card”, and says the public health sector must “ensure our politicians and law-makers don’t fall for the spin-doctoring”.
Q and A with Sarah White
Q: Tobacco giant Philip Morris has just launched the Foundation for a Smoke-Free World, claiming that it wants to see a future in which people will stop smoking. This news follows a Reuters investigation that found the company is waging a secret campaign to subvert the World Health Organization’s anti-smoking treaty. What can the public health sector do in response and how might it need to change its approaches?
A: The tobacco industry is actively trying to reinvent itself as part of a “solution” to the problem it has created and continues to perpetuate. This so-called ‘Foundation’ is just the latest, cynical attempt to play a corporate social responsibility card. It’s also designed to create a new frame around their endeavours to make money from ‘heat not burn’ products. It’s so obvious, it’s almost laughable.
The public health sector needs to recognise this strategy for what it is, and stay the course in keeping commercial interests out of public health policies. Our challenge might be to ensure our politicians and law-makers don’t fall for the spin-doctoring.
Q: Staying with Philip Morris, it was recently ordered to pay Australia’s legal costs after unsuccessfully challenging our plain packaging laws. Is it fair to say that Australia has won the fight against tobacco? Or did the recent debate over whether smoking rates have begun to rise again signal a new battleground?
A: I wish we could say there is an end to the battle against tobacco in sight, let alone that Australia was close to winning. Tobacco companies continue to deliberately and actively block and/or subvert public health endeavours through every back-channel they can find, plus openly promote cigarettes to new target markets in other parts of the world. The constant focus on illicit tobacco by the tobacco industry and its allies, innovations such as flavour capsules, recessed filters and smaller loose leaf pouches, pricing strategies to undercut tax increases – these all point to the industry still fighting hard to get and keep people hooked on its products.
I actually don’t think there has been a debate about whether smoking rates have begun to rise. One individual put this story out as part of an advocacy campaign for e-cigarettes, and got some media. Epidemiologists and public health researchers around Australia dismissed the interpretation as flawed because absolute numbers and not rates were used, and we all get on with our work. I would prefer to give the individual the benefit of the doubt and describe this as a straightforward error, and not part of a tobacco-industry driven agenda.
Q: There is deep division in public health over whether e-cigarettes and other smoke-free nicotine delivery systems are a harm reduction tool or a stealth weapon for the tobacco industry. How will the conference explore that tension and the implications of the federal parliamentary committee inquiry into the impact of e-cigarettes on rates of smoking?
A: Well, these are not mutually exclusive! Our challenge, though, is to not let our contempt for the tobacco industry occlude our true objective, which is to reduce the deaths and disease caused by cigarettes. Of course, this is what public health people have been doing for decades, and – in speaking to both “camps”, for want of a better description – I see less division in reality than what there appears to be in public posts and media soundbites.
If one takes a reductive approach and drills down to specific risks and benefits, there are only a few differences in opinion about what the risks and benefits are and how these might be managed. More importantly, shared goals and concerns outnumber and outweigh the differences. Two easy examples… no-one wants children becoming addicted to nicotine delivered in any form, and everyone agrees there should be basic consumer safety standards covering things like device construction, battery quality and liquid labelling. I think we all need to get to that common ground and build from there based on evidence, not ideology one way or the other.
Oceania is going to focus on evidence and experiences of people who have used or are using e-cigarettes. Dr Becky Freeman is presenting a plenary session on a review of the evidence on e-cigarette use specifically for quitting cigarettes; not harm reduction, not dual use, not gateway, not regulatory models. Just what the studies are showing us specifically on whether and how e-cigarettes are helping people to get off tobacco, and what regular users – not the highly vocal vaping advocates – are saying about e-cigarette use. We also have quite a few really interesting presentations from researchers in Oceania on things like patterns of use among smokers and quitters, consumer reasons for dual use, real-time collection of data from e-cigarette users, Indigenous smokers’ perceptions of harm and more.
Q: The theme of the conference is “From vision to reality: A tobacco-free Oceania”. What are the main issues remaining for countries like Australia and New Zealand where rates have plummeted? What about other nations across the region, where smoking prevalence is still high and potential smokers are targeted?
A: The main issue for countries like Australia and New Zealand is to not become complacent and believe that tobacco control is ‘done’. Continued vigilance and policy reform is needed in order to ensure the tobacco industry is unable to exploit remaining avenues to promote its products, recruit new smokers and keep existing smokers smoking.
Tobacco industry interference is a significant problem in Pacific Island countries where attempts to implement tobacco control measures are often thwarted. No matter how successful or otherwise countries have been in reducing smoking prevalence, support for proven tobacco control interventions must be maintained. For many countries in the Pacific, tobacco excise increases are the top priority. For countries like Australia and New Zealand where excise increases are already policy, the priority is to reinstate evidence based levels of funding for public education campaigns, which are the next most effective intervention to support quitting.
And of course, we have to do everything we can to make sure that disadvantaged groups are not left behind as smoking prevalence falls in the general population. Providing extra, targeted support for priority populations is an essential element of the comprehensive approach to tobacco control that all countries in Oceania must pursue.
Q: Is the Australian government and public health sector doing enough to assist nations in the broader region? What are the barriers? What else should we do?
A: I’m really not across everything the Australian government and the public health sector do to assist other nations, I must confess. I know the Australian Government provides assistance to countries in the region with respect to training in capacity building. The McCabe Centre for Law and Cancer (based at the Cancer Council Victoria) runs an international legal training program that supports low and middle-income countries in the Indo-Pacific Region to implement the WHO FCTC. The focus is on countering tobacco industry legal challenges, sharing Australia’s experiences in implementing tobacco plain packaging and defending the laws in the High Court, the World Trade Organization and against an investment treaty challenge. The program receives primary funding support from the Australian Department of Foreign Affairs and Trade. The Australian Department of Health provides funding support for the McCabe Centre’s performance of its functions as a WHO FCTC Knowledge Hub.
Cancer Council Victoria provides a great deal of information and support to other countries on policy issues and Quitline operations; in fact, we provided training to enable Tonga to set up its own Quitline not so long ago. Cancer Council Australia, too, has provided long-term support to the region through its funding of the Western Pacific FCTC Implementation Project. This Project directs support to Pacific Island Countries who are often ineligible or overlooked for other funding assistance, which has been crucial in allowing Pacific Island Countries to participate in FCTC negotiations and processes and in building capacity in the region. Assistance from the public health sector remains an ongoing necessity if we are to continue to reduce the death and harm caused by this deadly industry in Oceania.
I think this subject could take up a whole other Croakey article, as I’m sure I am missing a lot!
Q: Croakey recently reported that while Australia may be a world leader in efforts to curb smoking, mainstream campaigns are not reaching the lesbian, bisexual and queer community, with tobacco use 2-2.5 times higher, including a staggering 42 per cent of 16-24 year olds. Has public health failed this community?
A: I think “failed” is too strong a description. Measures such as smokefree legislation, plain packaging, tax increases, health warnings and so on reach all members of the population, and if you look at the National Drug Strategy Household Survey there was a decrease in daily smoking from 2010 to 2013 among those who identify as homosexual/bisexual. Now granted this is a fairly broad and blunt categorisation, and the rates among sub-populations – such as LBQ women, who were surveyed to generate the figures you quote – are likely to be higher.
It is very clear we must do more to engage groups that have normalised smoking within strong and distinct cultures so we can, together, change attitudes to smoking and quitting. It’s critical we work with the community to ensure LBQ women, and other people in rainbow communities, who want to quit are encouraged and supported to access safe services.
ACON’s work in highlighting some of the issues and advocating for change deserves real recognition, and now that groups like ACON and the Victorian Aids Council are actively working to address smoking, I’m feeling very optimistic we’ll start to see progress here. I’m really looking forward to the presentations from the ACON team at Oceania… I freely admit I am going to be stealing ideas (with attribution, of course)!
Q: What about for other vulnerable populations who were the focus of the 2015 conference: Indigenous communities, prisoners, and people with mental health issues – are we seeing progress for them?
A: Forgive me if I sound like a politician, but that depends what you mean when you say “progress”. We are seeing progress in the sense that smoking prevalence is falling among Indigenous communities in Australia and New Zealand. I am particularly looking forward to the plenary presentation by Dr Raymond Lovett, from the Australian National University, on that issue.
For many of our vulnerable populations, though, we simply don’t have ways to systematically and comprehensively measure quit attempts or changes in prevalence. We’re certainly making progress in convincing more and more health, community and social sector professionals that smoking is an important issue for their clients/consumers/patients, which is a really important first step.
Quit Victoria hears time and time again from carers and consumers that people with mental illness want to quit “because of the ads on TV” and struggle with the cost of cigarettes, but then they’re living in accommodation where smoking is permitted and they’re going to see health professionals who are not supportive of them trying to quit and, sometimes, actively telling them not to try. Engaging and educating the people working with vulnerable populations, and using them to encourage and support smokers to take up available, evidence-based cessation treatments seems a very simple approach but, in reality, it’s pretty rare.
This time around in Oceania we have multiple sessions on how public health is working with health professionals to encourage quitting at each contact with health, community or social sector organisations. We have presentations from several mental health clinicians and also the CEO of a PHN—who’ve never been to a “tobacco conference” before—speaking about their experiences. We also have a workshop focused on developing, not the “what to do”, but the “how do we” make smoking cessation just part of routine care in mental health.
Q: Who are your main keynote speakers and why will they be of particular interest at this year’s event? What other themes or issues will be in focus?
A: We’re going to start the conference with three terrific speakers, each covering the ‘state of the nation’ for Australia, New Zealand and the Pacific Islands. Dr Michelle Scollo, Professor Richard Edwards and The Honourable Nandi Glassie, the Health Minister for the Cook Islands, are going to set the scene of our reality today, and what ‘vision’ might entail for each country.
Dr Patricia Nez-Henderson, from Black Hills Center for American Indian Health, is coming from the US to be our keynote speaker. Patricia has done a lot of work with communities on tobacco use and health disparities amongst American Indians and Alaskan Natives. She has a strong focus on culturally-relevant research and cessation programs, which ties in with the very strong theme—running right through Oceania—of showcasing culturally-relevant work being undertaken by, and among, Indigenous communities in Australia, New Zealand and the Pacific Islands.
We’re also really privileged to have Professor Kurt Ribisl, a professor of Health Behaviour at University North Carolina, as a keynote speaker. He has a particular focus on policy issues related to sales and marketing of tobacco; a hot topic for policy-makers in Australia and New Zealand, who are looking closely at supply side measures. Kurt is the principal investigator of the $19.4M Center for Regulatory Research in Tobacco Communication funded by the NIH Tobacco Centers of Regulatory Science, and has agreed to run a workshop – along with Associate Professor Sarah Durkin from the Centre for Behavioural Research in Cancer at Cancer Council Victoria – on the challenges we’re all facing around public communication channels and messaging.
A third and very strong theme will cover how public health is grappling with engaging primary and community health professionals and redesigning health and community systems to reach and support vulnerable and special populations, particularly pregnant women who smoke and people with mental illness.
• Follow on Twitter: @SarahWhisar
The conference countdown (as at 3 October, 2017)