13 Countering the tobacco industry Pick battles big enough to matter, small enough to win. — Jonathan Kozol BUILDING BLOCKS FOR TOBACCO CONTROL: A HANDBOOK INTRODUCTION Tobacco is unique among the risks to health in that it has an entire industry devot- ed to the promotion of its use, despite the known adverse health impact of tobacco consumption. Predictably, the tobacco industry aggressively blocks any attempt to effectively reduce tobacco use. Chapter 2 describes some of the global strategies employed by the industry to impede effective tobacco control interventions. This chapter focuses on strategies to counter the tobacco industry. Building capac- ity to face the greatest opponent of successful tobacco control must be a priority for national and local tobacco control officers. In many cases, tobacco control advocates and nongovernmental organizations (NGOs) are more experienced in this area, and much can be learned from them. THE FIRST STEP TO COUNTER THE INDUSTRY – KNOW THEM WELL The tobacco industry documents – a rich source of information Chapter 2 provides background information on the tobacco industry documents. Because valuable insights can be gained from the tobacco industry documents, tobac- co control programme officers should ensure that the analysis of the country scenario includes an initial assessment and regular analysis of industry documents with local relevance. (Annex 1). As rich as the information provided by these documents is, the documents have limitations. There are missing pages, often it is difficult to place the information with- in the proper context, and there are incomplete sets in correspondence exchange, to name a few of the problems. In addition, not many of the British American Tobac- co (BAT) documents at the Guildford depository are available online, and the access to the paper archives is often difficult, which adds complexity to the search strate- gies (1-3). Nevertheless, the availability of these documents for public and academic analysis has been interpreted by many as the most significant outcome of the litiga- tion against the tobacco companies. OTHER STEPS TO COUNTER THE TOBACCO INDUSTRY After searching tobacco industry documents for specific references to your country, and becoming familiar with the local tobacco industry, proceed with the following steps to monitor and counter the industry: 202 BUILDING BLOCKS FOR TOBACCO CONTROL: A HANDBOOK Keep an eye on the local tobacco industry In addition to learning about industry practices, monitoring the local tobacco indus- try’s daily activities can alert tobacco control programme officers about possible interference with national tobacco control efforts. World Health Assembly (WHA) Resolution 54.18 “calls on WHO to continue to inform Member States on activ- ities of the tobacco industry that have negative impact on tobacco control efforts.” Reports produced pursuant to this resolution provide countries with information on their tobacco companies’ activities based on the analysis of the international media (4). The industry’s own web sites are often good sources of press releases and other industry-related news. At the national level, monitoring the tobacco industry might involve activities such as: • noting media coverage of industry-related issues regularly; • reviewing industry publications as well as marketing and economics publications that may report on tobacco issues, and taking note of authors (and their institu- tional affiliations) of pro-industry reports and publications; • accessing local company web sites frequently; • searching for and identifying organizations and activities sponsored by the industry; • undertaking political mapping, which includes reviewing speeches and declara- tions of legislators and performing interviews with key ministry officials to identify those who promote industry views, and those who support tobacco control meas- ures; and • reviewing reports on the enforcement of tobacco-related laws and of court cases that resulted from their infringement. Sources of information include the Internet, national and local media, and documents stored in public libraries (e.g. minutes of parliamentary meetings, legal documents of groups likely supported by the industry, collections of industry publications and industry commissioned research papers). Agencies responsible for enforcing rules related to tobacco and smoking might provide information on the industry’s compli- ance with these rules. In many cases, tapping personal networks can be invaluable. Inform and involve the public Results of efforts to monitor the industry can be used to raise the awareness of the public about the industry’s attempts to deter and derail tobacco control. Choose the appropriate means of publicizing information on the industry based on the nature of the information and the target audience whose attention must be secured. Some pos- sibilities include press conferences, press releases, presentations at scientific meetings, publications, scientific articles and letters to editors of influential newspapers, letters to key actors in the political arena such as members of legislative bodies, testimonies 203 BUILDING BLOCKS FOR TOBACCO CONTROL: A HANDBOOK in legislative forums and public hearings. If necessary, obtain legal counsel before releasing sensitive or controversial information. Involve the public in monitoring the tobacco industry. Well-informed citizens can demand that the tobacco industry be held accountable for actions that undermine public health. This can be done through public hearings, public inquiries and the stra- tegic use of channels of communication through which the public may inform the National Tobacco Control Programme (NTCP) of tobacco industry efforts to dis- rupt or sabotage tobacco control interventions. In Brazil, for example, the Minister of Health initiated the use of telephone “hot lines” that enable members of the public to report to the NTCP on suspicious activity by the industry. The Minnesota Smoke-free Coalition maintains a web site that encourages individuals to inform local policy-mak- ers of the tactics the industry uses to oppose proposals for tobacco control ordinances during public hearings. Other possible channels include the use of e-mail, text mes- saging, or designated mailboxes, which the public can use to reach the NTCP. Presenting the public and key decision-makers with the facts about the tobacco industry, when done effectively, can reinforce tobacco control efforts greatly. As the United States Advocacy Institute puts it: “tobacco control advocacy flourishes best in an environment of fresh public outrage at the tobacco industry’s wrongful behavior.” Obtain and use evidence strategically Tobacco industry documents can reveal evidence of industry interference in tobacco control in the past. This information needs to be strategically coupled with up-to-date local data on the magnitude, patterns, determinants and impact of tobacco consump- tion and exposure to tobacco smoke, to enable policy change. The legislative agenda influences the pattern of data sets needed. For example, to regulate tobacco market- ing a variety of information and evidence is needed. Such data could include: • information on industry advertising and promotional expenditures; • evidence of the significant impact of advertising on motivating young people to smoke; • information on how valuable the industry regards advertising; and • past industry efforts to block advertising bans, including attempts to get govern- ments to agree to the use of deceptive voluntary marketing codes. To achieve smoke-free public places, current data on the impact and magnitude of second-hand smoke exposure on the population is vital. Also essential is information on how the industry covered up the adverse health effects of second-hand smoke and how it uses the hospitality industry to promote a culture of accommodation through its “Courtesy of choice” programme. Proper surveillance for data gathering and a thorough search of the industry documents as part of national tobacco control strat- egies are crucial to obtaining these types of information. In addition, data on public knowledge, attitudes and beliefs on planned measures (e.g. does the population sup- port a ban on tobacco advertising?) can be helpful in persuading decision-makers to support effective interventions to curb tobacco use. 204 BUILDING BLOCKS FOR TOBACCO CONTROL: A HANDBOOK Use champions to speak the truth about tobacco Champions are individuals who have high visibility and/or high credibility in soci- ety. Their presence is usually enough to attract the media’s attention. They wield immense influence over the general population. When they speak the truth about tobacco, people pay attention. In Kiribati, the Ministry of Health tapped the coun- try’s young athletic stars to promote a tobacco-free lifestyle, with good results. In the Republic of South Korea, a popular comic actor who was struck with a tobacco-relat- ed malignancy, became a vocal critic of smoking during the final days of his life. His advocacy is credited with having helped lower the smoking prevalence among Kore- an adults in recent years. Apply lessons learned from international experience The experience of nations with more advanced tobacco-control policies provides val- uable insight for countries struggling to establish sound tobacco control policies and interventions. Likewise, international tobacco control organizations can advise and assist local advocates in developing and implementing tobacco control strategies. Les- sons