News analysis 365 is an answer: the skull and crossbones, not scholarship scheme for gifted young just familiar from the flags of cartoon pirate people to study at the University of ships, but widely used on containers of Mauritius may turn out not to have been poisonous chemicals and other dangerous money well spent. Tob Control: first published as on 29 November 2007. Downloaded from products and on electrical installations. Together with graphic images of diseased organs, the government included the skull South Africa: Swedish and crossbones in its wish list. But it was not to be. snus snare British American Tobacco (BAT) recently In a lengthy period of debate, it emerged sent a delegation of South African mem- that the tobacco industry did not just bers of parliament to Sweden on a ‘‘fact oppose disease-related graphic warnings Mauritius: cigarettes marked with a skull and crossbones received overwhelming approval in a finding’’ trip, to learn about the blessings (though some more than others) but was survey, even by smokers. of snus oral tobacco. The trip was particularly desperate to prevent the skull organised by a group called the and crossbones from appearing. This may having a skull and crossbones on cigar- Association of Reduction of Tobacco- at first sight appear surprising, but the ette packs, as well as on each individual related Harm (ARTH). manufacturers of bidis, the leaf-wrapped, cigarette, is Mauritius. Health organisa- When a draft programme came to light local product used by millions of lower tion ViSa carried out a detailed survey just two weeks before the start of the trip, income smokers, were especially desperate with people visiting prison inmates, it revealed that the snus manufacturer to prevent the government imposing a which among other benefits got Swedish Match and other pro-snus pro- warning that was particularly effective at responses from a sample of the country’s moters were to entertain members of the reaching their customers. less affluent citizens. Both their mocked group, who were to stay at the most But how could tobacco interests coun- up packs and cigarettes got highly favour- prestigious hotels and dine at the very ter such a simple, universally recognised able ratings as to general acceptability, best restaurants during their five days in symbol of poison and danger, especially and concurrence with the view that such Sweden. Strangely, no tobacco control when it was already part of the govern- warnings might help smokers quit and experts or government officials in Sweden ment’s plans, which meant that an deter those who do not yet smoke from seemed to know anything about the visit amendment would have to be debated starting. Such ideas would have been until a copy of the draft programme came in parliament? The debate generated unlikely to be taken up by the govern- to the attention of Doctors Against much favourable comment and media ment in the past when British American Tobacco (DAT). In order to offer the coverage for the government’s plans, http://tobaccocontrol.bmj.com/ Tobacco (BAT), the dominant player in group a broader picture of Swedish which should have been quite sufficient this small country with Africa’s highest conditions and the snus issue in particu- for it to stick to its guns. However, a per capita cigarette consumption, seemed lar, DAT members then emailed the pernicious argument was then wheeled to hold great sway. However, times are chairs of the two chambers of the visitors’ out by industry interests: the skull symbol changing, and in the face of declining parliament, inviting the group to a meet- would be offensive in a religious sense, tobacco consumption, BAT recently ing during their stay in Stockholm. especially to those people, such as closed its factory in Mauritius. Perhaps A few days before the group’s arrival, Muslims, who bury their dead. the large sums BAT used to spend on DAT was contacted by the South African Public health researchers swung into schemes such as its undergraduate embassy in Stockholm, expressing the action. A survey of more than a thousand people not only confirmed that the symbol was the most widely understood to mean on September 29, 2021 by guest. Protected copyright. danger, especially by less literate, rural people, but also that the religious argument was nonsense. More than nine out of ten Muslims shown the symbol said it would not hurt their religious sensibilities, with only 1.4% saying it would do so. Similar figures for Hindus and followers of other religions showed how baseless it was, but for reasons that may never be known, the industry prevailed and the amendment to remove the skull and crossbones warning waspassed.Butwithprovenandgrowing public and parliamentary support for more effective tobacco control, will the govern- ment not show greater political courage and let the roller coaster pick up speed again next time? Mauritius: poorer people like tough warnings Another country where health advocates Mauritius: a Pall Mall cigarette pack from Thailand and one sold in Mauritius: Mauritian smokers have been researching the acceptability of strongly supported the idea of their government adopting Thai-style health warnings.

www.tobaccocontrol.com 366 News analysis group’s strong interest in a meeting. It Canada a global exemplar of tobacco appeared that efforts to arrange meetings control by fully meeting all its FCTC with government officials and snus- obligations, in every province and territory, friendly Swedish parliamentarians had by 2011. The statement has been sent to the Tob Control: first published as on 29 November 2007. Downloaded from been unsuccessful, perhaps in part Canadian minister of health and to all the because of the approaching summer holi- provincial and territorial governments. days. The visitors were able instead to have a full morning’s meeting with Swedish doctors, a health-friendly Thailand: planning Swedish parliamentarian and a youth ahead representative from Sweden’s Non-smok- Last year, 2006, ended with new restric- ing Generation national youth anti- tions on smoking in public places in tobacco programme. Also present at the Thailand, including in transport stations, ‘‘harm reduction by snus’’ information public parks, at bus stops and in tele- and discussion session, held at the phone booths. Although there are some famous Karolinska University Hospital, places where smoking is still permitted, were representatives of BAT and ARTH. Belgium: Jenga, the game supplied by BAT to 36 specific types of location have had BAT has made it clear that it wants to Belgian retailers to reward their best customers smoking prohibited or restricted. There get into the snus market, with South and a pack of its Bastos cigarette brand. has been heightened activity for smoke- Africa a major target. Swedish health free places through world no tobacco day advocates, knowing that the visiting cause the eventual collapse of the lung and the second conference (COP 2) of South African delegates might be meeting and other organs. This is why tobacco the parties of the World Health only pro-snus advocates from the tobacco companies say they do not want children Organization’s Framework Convention industry, were glad to have been able to to start smoking. But while Jenga is on Tobacco Control (FCTC) took place in invite them to a meeting. Perhaps it may described as suitable for children aged 6 Bangkok in the summer. Thailand’s Dr have served as a vaccination against any years and above, its packaging has the Hatai Chitanondh was selected as the excesses of those who may later have put same colours as Bastos, a leading Imperial new conference president to preside over commercial interests before a balanced, Tobacco cigarette brand in Belgium. COP 3, to be held in South Africa in 2008. science-based examination of the com- Whatever can Imperial Tobacco be think- Despite impressive achievements in plex topic they were studying. ing of? 2006 and 2007, next year promises new opportunities, with smoking cessation http://tobaccocontrol.bmj.com/ Belgium: retail and tobacco control research the areas Canada: health likely to get special attention. While incentives are child’s workers agree next Thailand has made rapid tobacco control progress through legislation and regula- play targets tory policies, it has been unable to take The British tobacco company Imperial Canada has long been a world leader in advantage of the restrictions on public Tobacco has been supplying Belgian tobacco control, especially with its early smoking or the research information retailers with an unusual gift with which triumphs on banning virtually all promo- available because of a lack of infrastruc- to reward their loyal customers, presum- tion and its subsequent triumph over a ture for population-based cessation and ably to encourage them to buy even more furious tobacco industry in pioneering science-based collaborative research. of the company’s cigarettes. It is illegal to graphic health warnings illustrating dis- Fortunately, the new Thai health pro- on September 29, 2021 by guest. Protected copyright. supply free gifts with tobacco products eases caused by smoking. One might fessionals alliance against tobacco brings but so far giving a supply of gifts to assume that by now, Canada has done it prospects for progress in these areas. retailers, to be handed out to customers at all. However, tobacco control leaders Aided by the new tobacco control their discretion, has not been challenged meeting at their annual conference in research and knowledge management by the government. Edmonton, Alberta in September took centre of Mahidol University, this alliance However, instead of something that stock of progress to date and focussed on of nine health professional groups has might be suitable mainly for smokers the one major area still requiring atten- been working to build capacity in these themselves, Imperial Tobacco has gone tion. It is the need for total protection areas. Plans are under way for a national for something rather more homely or at from second-hand smoke in all public smoking cessation ‘‘quitline’’ system. In least more appropriate for homes with places and in the workplace. The con- addition, new opportunities for nicotine children. It is a game called Jenga, which ference duly set targets for achieving this, and tobacco research are on the horizon normally costs J15–18 (US$21–26). as well as for reducing overall tobacco through the first Asian regional confer- Jenga is a game of physical and mental consumption. ence of the Society for Research on skill marketed by Hasbro, which describes Around 700 delegates agreed a national Nicotine and Tobacco, SRNT Bangkok itself as a worldwide leader in children’s position summary and target list, the 2008, scheduled for 28–31 October. and family leisure time entertainment. Edmonton statement, calling for Canada STEPHEN HAMANN Players of the game first build a tower to become the second smoke-free country Thai Health Promotion Foundation, Bangkok, from 54 wooden blocks, then take turns in the Americas (after Uruguay) by the end Thailand; [email protected] to remove them one by one from a layer of 2008. They set a target to reduce other than the top one, placing them on Canada’s overall smoking prevalence to top until the tower collapses. The player 12% by 2011. The statement also chal- USA: still welcome in who caused the collapse is the loser. lenged the government to fulfil its obliga- By contrast, when children play the tions under the World Health the community game of smoking, the loser is the one who Organization’s Framework Convention on Despite suffering revelations that might keeps taking the cigarettes, which can Tobacco Control (FCTC) and to make have driven other companies out of www.tobaccocontrol.com