News Analysis Tob Control: first published as 10.1136/tobaccocontrol-2019-055319 on 23 August 2019. Downloaded from

cigarettes#) detailed how Philip Morris PMI-funded Foundation for a Smoke Free Worldwide news is running marketing and promotion World (FSFW). In 2018, FSFW provided campaigns to sell its heated tobacco a US$1 million grant that created a and comment product IQOS at half price, or on a free Centre for Research Excellence: Indige- trial basis, in areas with high Māori popu- nous Sovereignty and Smoking, led by a lations such as sports clubs, as part of a Māori researcher and prominent advocate On 26 July the latest WHO Global Tobacco process the company calls ‘community for vaping and other alternative prod- Report was launched in Brazil. While it activations’ or ‘community outreaches’. ucts. Although based in Aotearoa/New showed progress in expanding the number The company has hired a Māori ex-jour- Zealand, the Centre is intended to be of people globally who are covered by at nalist as their communications person, global in scope. least one MPOWER measure, it starkly and a Māori woman as their community In May this year, an editorial by 13 highlighted how much remains to ensure relations lead; she attributes the ‘exten- leading Indigenous health researchers and that the right of all people to good health sive hyper-care’ programme run by Philip leaders from New Zealand, Canada, the is fulfilled. As implementation of Frame- Morris International (PMI) for many USA, Australia and Papua New Guinea work Convention on Tobacco Control people taking up the product. was published in Tobacco Control, firmly (FCTC) measures progresses, the tobacco Co-opting Māori to lead the sales rejecting tobacco industry strategies industry—like any aggressive vector— push has been strongly criticised. Long- and funding, no matter how these are continually mutates, finding new forms time tobacco control advocate Shane packaged. The authors noted that for and strategies to attempt to convince Kawenata Bradbrook said in an inter- indigenous peoples for whom tobacco politicians and the general public it has view with Māori Television: “Before they has always been part of their culture changed. Among its key strategies are infil- used to just kill us – now they’re hiring ‘the modification, transformation and trating and subverting agendas for health our people, and saying ‘get out into your commercialisation of the nicotiana and development, as well as co-opting communities and sell this stuff directly tobacco plant belittles and disrespects allies (whether wilfully ignorant, or simply to your community’…there’s a prime something which is held sacred’ and willing to take blood money) to sing from example (of exploitation of our people). ‘tobacco industry–funded research activ- its song sheet. In this issue, we look at Use your own people to get into your ities can be seen as a form of contem- recent events which highlight manoeuvres community, sell it as a good product. At porary colonisation’. They concluded: to impede progress to address the human- the end of the day, who are you pleasing? ‘Indigenous peoples should not accept caused, greed-driven disaster that is the Ultimately, it’s the shareholder and the tobacco industry funding. Whether it is CEO and all the other machinery behind explicit or implicit, the tobacco industry tobacco epidemic. copyright. these big tobacco companies.” (Interview will use the Foundation to meet its agenda New Zealand/USA: PMI, JUUL and available at: https://www.maoritelevi​ - which is in stark contrast to the health the exploitation of indigenous sion.​com/​shows/​te-​ao-​moana/​S01E007/​ and well-being agendas of Indigenous te-​ao-​moana-​series-​1-​episode-​7). peoples peoples. Indigenous communities and Earlier this year, PMI stated that it Like most indigenous peoples who have the public health sector must act now to wanted to phase out sales of its combus- resist co-optation of Indigenous culture, experienced colonisation, the Māori of tible cigarette products in Aotearoa/New seek a genuine end to nicotine addiction

Aotearoa/New Zealand have dispropor- http://tobaccocontrol.bmj.com/ Zealand by the end of the year—but tionately high smoking prevalence. Among among our peoples and unify against linked the commitment to the govern- adults, 13% of all New Zealanders smoke, the industry’ (See: https://tobaccocon​ - ment offering tax breaks and ‘appropriate’ trol.​bmj.​com/​content/​early/​2019/​05/​10/​ compared with 31% of Māori. Tobacco regulation for alternatives such as heated tobaccocontrol-​2018-​054792). was not part of Māori culture before colo- tobacco products. Prime Minister Jacinda nisation, and there is a strong tradition Ardern slammed the move as not sincere, of Māori resistance to it. Central to this noting: “I think if they (Philip Morris) are W T orld: BA ’s (selective) resistance was an emphasis on the need to really focused on reducing harm, ending celebration of world parents’ shift attention away from individuals to the premature deaths caused by smoking day commercial tobacco companies and their then just not selling cigarettes would make In a shameless public relations strategy, products. Unfortunately, Māori resistance a huge contribution.” British American Tobacco (BAT) hopped to tobacco has faced significant challenges on September 25, 2021 by guest. Protected In a similar move, JUUL is reported to on the Global Day of Parents bandwagon in recent years, not least due to substan- be targeting native American communi- this year, co-opting the day as a way to tial disinvestment from tobacco control, ties in the USA. The company (in which project itself as a family friendly employer. including Māori-focused activities. tobacco giant Altria—parent company of The Global Day of Parents, celebrated Now, a new challenge is emerging: Philip Morris USA—recently purchased on 1 June each year, is proclaimed by promotion of new products, supported a 35% stake) has been sending represen- the United Nations as ‘an opportunity by targeted discounting to Māori. A July tatives to communities to give out free to appreciate all parents in all parts of media report (available at https://www.​ samples and starter kits. Similar to the the world for their selfless commitment newsroom.​co.​nz/​2019/​07/​11/​677880/​ PMI approach in New Zealand, JUUL is to children and their lifelong sacrifice big-​tobacco-​targeting-​maori-​with-​e-​ offering the strategies as part of a smoking towards nurturing this relationship.’ The cessation/switching programme, with a UN also makes reference to the Sustain- ‘full time programme director’ offered to able Development Goals (SDGs) and All articles written by Marita Hefler the tribe at no cost. their focus on ending poverty, promoting unless otherwise attributed. Ideas and There is a striking coherence to these shared economic prosperity, social devel- items for News Analysis should be sent targeted strategies, which also aligns opment and people’s well-being while to: [email protected] with the activities and rhetoric of the protecting the environment.

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The tobacco industry repeatedly screens, and quotes for the use of the event attempts to use corporate social respon- lounge for PMI events. sibility initiatives to position itself as a Switzerland is one of a handful of coun- contributor to achieving the SDGs. In tries that has not ratified the FCTC (an reality, the industry and its products create omission which is reflected in its mani- and exacerbate poverty and inequality, festly inadequate tobacco control poli- hamper social development, harm well- cies), and is therefore not bound by its being and contribute to environmental obligations. The deal nonetheless raised degradation. Bearing all this in mind, it concerns both within Switzerland and at was a crazy audacious move to try and WHO headquarters. The WHO stated that co-opt Global Day of Parents for their the deal likely breached a 2011 memo- own ends. So, how did they approach it? randum of understanding it signed with According to their website, proud the Bureau International des Expositions parents in their UK headquarters were (BIE), which addresses public health issues asked ‘What does being a parent mean linked to global events, and includes a ban to you?’. Interestingly, there was no on tobacco advertising, sales, promotion mention of whether these ‘proud parents’ and sponsorship. Critics within Switzer- consume the products of their employer— land included the Federal Office of Public or whether they dreamed of their child/ F igure 1 Former UN Development Health, the National Tobacco Preven- ren using BAT products when they grow Programme Administrator and New Zealand tion Working Group, the Swiss School of up. Of course, readers familiar with the Prime Minister Helen Clark’s tweet in response Public Health and several politicians. tobacco industry would be well aware that to Michael Møller’s departing memo urging a Tobacco companies often find that minis- tobacco industry employees tend to see rethink on the UN policy of non-engagement ters with portfolio responsibilities outside their products as being for ‘other people’. with the tobacco industry. The tweet was health are receptive to their overtures. The winning entries were then given retweeted by WHO Director General Tedros However, this sponsorship decision was a professional family photo shoot and Adhanom Ghebreyesus. Source: Twitter/Helen particularly disappointing , given that the showcased on the BAT website with lots of Clark. Swiss foreign minister Dr Ignazio Cassis is fluffy, feel good comments about ‘making a medical doctor who practised for over a the world a better place’, ‘realising the decade until 2008, holds a Master of Public francs (approximately US$1.815 million),

meaning of life’ and knowing your child Health and was the vice president of the copyright. the sponsorship was to contribute to costs ‘can do anything’. Touching indeed— Swiss Medical Association from 2008 to for Switzerland’s pavilion and presence as long as you don’t think about all the 2012. Unlike some non-health government at Expo 2020, to be held in Dubai. The parents taken from their children too ministers, he could hardly plead ignorance Swiss Foreign Ministry had stated that it soon because they were a loyal consumer about the impact of tobacco, nor the tactics was trying to save public money by seeking of BAT products, or the tobacco farmers of the tobacco industry. Cassis was reported sponsorships to cover 50% of the cost of its caught in poverty, producing a crop that to have viewed the deal with ‘scepticism’ Expo presence. harms them and their children for the and believed the arrangement could under- PMI’s largest research and development http://tobaccocontrol.bmj.com/ profit of shareholders and comfortably mine the intended goal of Switzerland’s centre is located in the Swiss city of Laus- middle-class employees in high-income presence at the event, to project a positive anne. A company spokesperson said the countries like Britain. image of the country. company saw an opportunity to ‘highlight At the time of going to press, there were science and innovation’, and that it would reports that the deal had been scrapped not promote cigarettes at the Expo but a Switzerland: PMI strikes short- following continued criticism. The fact smoke-free product—presumably its heated lived PR deal with government that such a deal could have been agreed to tobacco product IQOS. The sponsorship As described in the editorial for this by the Swiss government in the first place deal would have given PMI the ‘association edition, behind the polite veneer of political is a damning indictment of its willingness of their image with that of official Switzer- neutrality, Switzerland is an epicentre for to embrace the tobacco industry. global tobacco industry lobbying, helped by land’. It also provided the right to use the the fact that it is home to the global head- official logo of the Swiss pavilion for their on September 25, 2021 by guest. Protected quarters of three of the four largest trans- own communications, public relations and France: Cannes festival puts national tobacco companies, and several advertising, logo presence on billboards and Philip Morris on ‘good track’ cigarette factories. Together with the fact Being featured as an organisation on the that WHO headquarters are also in Swit- ‘Good Track’ at an internationally known zerland, it provides fertile ground for the high profile festival, and sharing the stage industry to exert global influence. with organisations such as UN Women, Shortly after the eyebrow-raising memo Greenpeace and the child-focused US by outgoing UN office head Michael non-profit Sesame Workshop is a dream Møller urging a reconsideration of UN opportunity for an organisation trying to non-engagement with the tobacco industry find new ways to present itself as a public (the language of which echoed PMI rhet- health stakeholder, and gain a seat at the oric), the Swiss foreign minister was global policy-making table. PMI made under scrutiny for a new sponsorship deal Figure 2 A mock picture showing much of it when it was featured on the between PMI and the Swiss government. Switzerland as the ashtray of Europe. Created ‘Good Track’ programme at the Cannes Reported to be worth 1.8 million Swiss by: Pascal Diethelm. Lions Festival in June.

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The purpose of the ‘Good Track’ is to a slow, protracted death because sales countries have joined and more are highlight life-changing work and initia- avenues for its main product are strangled, expected to sign up. The BRI mainly tives which make the world a better place and there is insufficient opportunity for its focuses on infrastructure development by focusing on brands, talent and industry newer products to prosper, that is frankly (such as rail, roads and ports), trade, leaders who positively impact society. As no concern of public health. Throughout and culture and tourism. As with other a company which markets products that history, decent, legitimate businesses and government initiatives, state-owned harm both people and the environment, industries have died out; many of which enterprises will be expected to be and whose business model is based on provided a net benefit to humanity, in ‘dragon heads’ and lead by example. building a customer base for an addic- stark contrast to the tobacco industry. CNTC, as a key state-owned enterprise, tive substance from as young as possible, While PMI’s promotions such as has indicated willingness to be a leader in the inclusion of PMI in the programme its ‘Unsmoke’ campaign do note that the initiative back in 2015, when then-di- is ”puzzling at best and deeply troubling the best option for smokers is to quit rector Ling Chengxing emphasised the at worst“, according to Sandra Mullins of smoking and nicotine altogether, in importance of using the opportunity of global non-profit health organisation Vital business-focused media, the compa- ‘the national implementation of BRI…to Strategies. She also stated: “Their appear- ny’s narrow commercial interests are accelerate industry’s ‘Go global’ develop- ance at Cannes is a calculated effort by a more nakedly on display. An article ment’. In 2017, BRI was officially adopted deservedly maligned industry to remain published through Business Wire about by the Chinese tobacco industry, as the State relevant and continue to thrive. They are PMI’s involvement in the festival states: Tobacco Monopoly Administration issued a positioning their latest marketing strategy ‘Philip Morris International (PMI) is ‘Work plan on the tobacco industry partici- as a conscience-driven, reputation-re- leading a transformation in the tobacco pating in One Belt One Road to implement furbishing mission of working towards a industry to create a smoke-free future ‘Go Global’ development’. ‘smoke free world’…despite the fact that and ultimately replace cigarettes with Specifically, the work plan calls for they will produce 800 billion cigarettes in smoke-free products to the benefit of market expansion in BRI countries and 2019.” adults who would otherwise continue support for the construction of offshore The event proved to be another plat- to smoke, society, the company and its production facilities. BRI countries, espe- form for PMI to attempt to convince the shareholders’. Note the absence of any cially those in Central Asia and the Middle world it has transformed and should be pretence that the goal is for people to East, are seen as particularly attractive for considered part of the solution, rather quit completely. market expansion, as they remain rela- than a major contributor to the global tively underserved and not yet dominated tobacco problem. It paid the actor Rose by the transnational tobacco compa- copyright. McGowan and marketing entrepreneur China: Tobacco and Belt and Road nies. With these countries accounting for Bonin Bough to attend an ‘Open Mic’ Initiative—the new ‘Go Global’? 54.1% of global tobacco sales, the poten- session it hosted with a range of other China National Tobacco Company tial for growth is enormous. In line with organisations and people, many featured (CNTC) is the world’s largest manufac- past statements, CNTC anticipates the on the PMI website with quotes well turer of cigarettes, accounting for a third introduction of its products via Chinese aligned with PMI’s narrative. of the total global output. The powerful workers, who will no doubt be recruited It also focused on repositioning its state-owned tobacco monopoly, previ- to work on infrastructure projects, and heated tobacco products and vaping ously focused on the vast domestic market an expected influx of Chinese tourists, http://tobaccocontrol.bmj.com/ products as a primary strategy for ending with 350 million smokers, has been especially as China flexes its soft power by smoking, rather than one small (potential) nurturing growing global ambitions since negotiating more favourable visa require- component of a full and comprehensive the early 2000s. Faced by an increasingly ments. According to industry statements, tobacco control approach. As detailed in saturated domestic market and the poten- CNTC’s market expansion is now focused the final article below, the most recent tial for stricter tobacco control regulation, on BRI’s emerging and growth markets, WHO report on the tobacco epidemic is a CNTC adopted the central government’s and includes monitoring for investment testament to the as-yet unrealised potential ‘Go Global’ strategy in 2003, to replace and joint venture opportunities, and of full implementation of evidence-based lost domestic revenue with exports. It market development measures to both reduce smoking uptake has since expanded its global reach to 20 Domestic smoking rates in China and encourage increased quitting among countries, operating through 34 offshore declined for the first time in decades smokers. A recent supplement published facilities, which include sales offices, following 2015 tax increases, fueling on September 25, 2021 by guest. Protected by Tobacco Control also showed the manufacture plants and specialised CNTC’s international push. The unprec- importance of the FCTC and the ongoing procurement companies. edented public listing of CNTC’s challenges of tobacco industry efforts to The One Belt One Road strategy, also international arm—China Tobacco derail effective tobacco control policies known as the Belt and Road Initiative International—on the Hong Kong stock (https://​tobaccocontrol.​bmj.​com/​content/​ (BRI), is President Xi Jinping’s signa- exchange in June 2019, is the strongest 28/​Suppl_​2). Meanwhile, PMI continues ture foreign policy launched in 2013. indicator to date of the industry’s global- to oppose the implementation of such The ambitious infrastructure initiative isation ambitions. The move is expected measures, while aggressively marketing is comprised of two parts: overland Silk to fund CNTC’s overseas ventures, as and selling cigarettes in countries such as Road Economic Belt, linking western it aggressively expands into unknown Indonesia. China to Europe through Central Asia markets. It appears that China’s push for Of course, full implementation of the and the Middle East along the ancient political and economic dominance in the complete suite of evidence-based measures trading route; and the Maritime Silk region via the BRI may need to come with to reduce tobacco use globally would Road, connecting coastal China to a health warning. be a fatal blow to commercial tobacco. Europe through South-East Asia and Jennifer Fang is a Project Administrator However, if the tobacco industry dies East Africa. To date, more than 125 and Research Fellow at the Global Tobacco

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offer support at the highest level. Of the remainder, 116 provide fully or partially funded services at some or most health facilities. Thirty-two countries offer smoking cessation services, but do not cover the cost. Over half the world’s population (3.9 billion people living in 91 countries) are covered by graphic health warnings with all recommended features, making it the MPOWER measure with the highest global population coverage and most countries covered. Despite having a high impact and being cost-effective for govern- ments, taxation remains the measure with the least coverage of the world’s popula- Figure 3 A graph from the seventh WHO global report on the tobacco epidemic, showing tion. Although it has increased by 7% since the growth in the number of countries and global population covered by at least one MPOWER 2007, only 14% of the global population measure at the highest level of achievement. is covered. Since the previous report, 10 countries have increased taxes to at least Control Research Programme, Faculty de Janeiro, Brazil on 26 July contained 75% of the retail price, in line with best of Health Sciences, Simon Fraser Univer- mixed news. While significant progress practice. sity, Canada. Her research mainly focuses has been achieved, implementation of There has also been a significant increase on the Asian tobacco industries, with an MPOWER measures at the highest level of in smoke-free environments from 7% to emphasis on China. achievement remains the exception rather 19% of the world’s population between Jennifer Fang than the norm. Brazil is only the second 2007 and 2018, including in several Simon Fraser University, Canada country, after Turkey, to implement all low-income and middle-income coun- jennifer_​ ​fang@sfu.​ ​ca MPOWER measures at the highest level. tries. Encouragingly, 17 of the world’s 34 The focus of this latest WHO report low-income countries have implemented at least one MPOWER measure to the W orld: WHO tobacco report is on helping tobacco users to quit. In copyright. highlights both progress and 2007, only 400 million people globally highest level. However, 59 countries have gaps were covered by this measure; in 2018 yet to adopt a single MPOWER measure The seventh WHO global report on it had increased to 2.4 billion. While 171 at the highest level of achievement, of the tobacco epidemic, launched in Rio countries offer cessation services, only 23 which 49 are low-income or middle-in- come countries. Given the forces lined up against effec- tive implementation of the FCTC and MPOWER measures, the progress in the http://tobaccocontrol.bmj.com/ last decade has been remarkable. However, there is still much unrealised potential for these measures—further highlighting that, contrary to tobacco industry rhetoric, alternative products such as e-cigarettes have—at best—a minor role to play in ending the tobacco epidemic. The report can be accessed at: https:// www.​who.​int/​news-​room/​detail/​26-​07-​ 2019-​who-​launches-​new-​report-​on-​the-​ global-​tobacco-​epidemic. on September 25, 2021 by guest. Protected

© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

Tob Control 2019;28:481–484. Figure 4 A graph showing the increase in selected tobacco control policies since 2007. doi:10.1136/tobaccocontrol-2019-055319

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