Opening speech by Norwegian Minister of Health for Tobacco Regulation meeting in Oslo, 9-11 Feb 2000

Distinguished guests,

I am very pleased to wish you all welcome to this important consultation on regulating tobacco products. I am especially pleased to see representatives from all WHO Regions. I must also take this opportunity to officially congratulate Dr. Marc Danzon with his election to the post of Regional Director for Europe. Your presence at this conference is a good signal for your priorities.

Globally and nationally we are facing an enormous challenge: The tobacco epidemic. Unlike other epidemics the world has seen, this epidemic is man made, it is totally unnecessary and its driving force is the huge profits of the tobacco industry.

Figures from WHO tell us that tobacco will cause about 150 million deaths in the first quarter of the century and 300 million in the second quarter. Half of these deaths will occur in middle age - between 35 and 69 - with an average loss of 20-25 years of life. Whereas until recently this epidemic mainly affected the rich countries, it is now rapidly shifting to the developing world. By 2020, seven of every 10 people killed by smoking will be in low- and middle-income nations.

There are many signs that the war against tobacco is gaining momentum world wide.

I am very happy to see that tobacco control is put high up on the agenda for the World Health Organization. I strongly support the initiative for a WHO Framework Convention on tobacco control. The tobacco industry operates globally, and as the counterpart we must think in global measures and global strategies to get full effect of our national strategies.

I have been supporting the establishment of the WHO, Tobacco Free Initiative, from its inception. I am impressed by the results Dr. Derek Yach and his team have achieved so far. The first steps towards a global convention were laid in Vancouver in 1998. I remember the discussions we had during the World Health Assembly last year and the resolution that came out of it. This resolution, together with the World Bank Report on "Curbing the Epidemic" which was presented at the same time, represented a milestone in the process towards a convention. This was followed by the first meeting of the working group in Geneva October last year and I am informed that the Working Group will meet again next month. I anticipate the negotiations to start soon after this years World Health Assembly.

At the Ninth International Conference of Drug Regulatory Authorities in Berlin in April 1999 Dr Gro Harlem Brundtland noted that cigarettes are highly engineered consumer products. She called upon international food and drug regulators to bring cigarettes and tobacco industry products under the same type of regulatory frameworks as other drugs. "A cigarette", she said "is a euphemism for a cleverly crafted product that delivers just the right amount of nicotine to keep its user addicted for life before killing the person. ..The tobacco companies will inevitably tell you they are selling a simple agricultural product – chopped up tobacco leaves rolled into a paper tube. This is categorically untrue. Cigarettes are one of the most highly engineered consumer products available…the problem is the product itself." She noted that the time now has come for concerted regulation of tobacco products, and committed WHO to convening an expert meeting on product regulation.

This Oslo Conference will carry forward the recommendations from several other conferences that have explored issues related to regulation of tobacco products. In October 1999 Finland hosted a conference together with WHO's Regional Office for Europe dealing with regulation of tobacco products and tobacco dependence treatment products. The Helsinki conference was attended by many of you who are present also here in Oslo. I was told that the conference in Finland contributed considerably towards raising awareness among professionals within the European region and called for further international co-operation towards a Tobacco Free Europe.

Today there is a global momentum in the war against tobacco. Many countries experience a new political awareness to this extremely important public health issue. Many governments and international organisations are now taking strong action to control the tobacco epidemic.

I have noted with great interest that the European Union recently decided to introduce a ban on tobacco advertising. Last fall the European Union also presented a proposal for a Directive of the European Parliament and of the Council: "Adopting measures for the consolidation, harmonisation and approximation of the laws, regulations or administrative provisions of the Member States regarding the manufacture, presentation and sale of tobacco products." The draft proposal sets out that Member states shall require the tobacco industry to submit a list of all non-tobacco ingredients and constituents, including additives, accompanied by statements setting out the reasons for the inclusion of such ingredients. The industry is also required to provide toxicological data on non-tobacco ingredients in burnt and unburnt form, and to demonstrate that the ingredients are safe for the health of the consumers when used as intended. Obviously these requirements represent progress in European tobacco product control. At the same time we have an obligation to ask if this directive, from our present level of knowledge, is good enough. I am glad to hear that this audience will closely examine this topic in a dinner session tomorrow.

The British Government has presented a Tobacco White Paper with a call for a global ban on tobacco advertising. The Paper emphasises the need for coherence between domestic and international policies. That is certainly needed in all areas of tobacco control.

Canada was the first country to call for a global convention on tobacco control and has been a pioneer in initiating new approaches to prevent smoking among young people, including an innovative and effective media program targeting youth to help them to quit. Last month my colleague The Minister of Health, Mr. Allan Rock, announced Health Canada's proposal to bring in tough new regulations that would require hard-hitting graphics with health warning messages, smoking cessation messages, and disease-specific information on all tobacco product packaging. The full-colour graphics that shall occupy 50 per cent of the front panel of the package shall illustrate smoking-related diseases and situations. He will also require manufacturers to print more information on toxic chemicals. This initiative is certainly of interest to an audience like this one, and I assume that the Canadian experience will be discussed in other regions.

Thailand and Canada so far are the only countries that have laws that explicitly requires producers of tobacco products to disclose the amount of ingredients in each brand of tobacco. Other countries have much to learn from their experience – anticipating tobacco industry response to the introduction of these laws is not the least important lesson. And I assume this issue will be addressed during the conference.

The United States is breaking barriers through the recent legal cases against the tobacco industry. The internal tobacco industry papers that are obtained through the lawsuits are indeed revealing. We are now all closely watching the Supreme Court deliberations on whether the Food and Drug Administration will assert jurisdiction over tobacco.

Invited by the American senators Susan M. Collins, Richard J. Durbin and Ron Wydon, I had the pleasure of participating at the International Policy Conference on Children and Tobacco in Washington last March. It is of crucial importance that policymakers all over the world now join forces to discuss best political options in this area.

Last fall my Government presented a National Strategic Plan for Tobacco Control that is based on WHOs recommendations for a comprehensive national tobacco prevention policy. The Plan includes new steps to be implemented according to the Norwegian Tobacco Act that gives people full protection from involuntary exposure to tobacco smoke in public places and smoke-free workplaces. (see attached 10 strategic points).

A tobacco-prevention programme for youth between 12 and 15 years, called BE smoke FREE, have shown promising results. Participants had 25% lower rates of smokers than the control group. Programs for pregnant smokers and parents of small children must also be mentioned. Norway had a very high percentage of pregnant smokers, up to 42% of these women smoked some years ago. The good news are that recent surveys show that the figures are cut by half down to 21%. And we are working hard to get the percentage even further down!

In Norway there is considerable public concern about "safe food". There are lengthy disputes in mass media about the safety of gene-manipulated food, additives and so on. This is an important issue which needs broad and comprehensive discussions. But it is a paradox to me that tobacco products are not receiving the same amount of attention by the same public. I challenge this audience to give us advice on a scientific sound basis so that strategies for regulatory mechanisms can be found. Strategies that could reach the same level of public involvement and consideration on behalf of the health of people.

During the last fifty years, cigarettes have undergone an intense product development. Before big scale mass production started, cigarettes could more rightly be considered an agricultural product than an industrial one. The products of that time, when smoked, seemed to be distinctly more toxic than today's products. On the other hand, at that time the tobacco industry research departments had not yet found ways to relieve the irritating and corroding effects of cigarette smoke to the throat and respiratory passage. The products were not sugared and scented as they are today, and the industry had not yet learned how to manipulate nicotine absorption and tar content estimates. Since those days the tobacco industry certainly has put on a lot of "cosmetics" on their products. This makes cigarettes more palatable and lowers the threshold to start smoking "mild" products.

I trust that the question of safety and justification of additives will be discussed here. An additive, for instance scents like vanilla, cocoa or chocolate may be shown not to be toxic to the human body as such. But if these taste-refinements can be shown to increase consumption of cigarettes and encourage minors to smoke, there may be reason to say that these additives are dangerous to the health of the consumer.

The tobacco industry has studied our saliva and central nervous systems to determine the right dose of nicotine so that addiction occurs and is sustained. A senior scientist at Philip Morris says in one of the internal papers: ''The cigarette should not be construed as a product but a package. The product is nicotine. Think of the cigarette pack as a storage container for a day's supply of nicotine. Think of the cigarette as a dispenser for a dose of nicotine. Think of a puff of smoke as a vehicle of nicotine.''

During the 1990s there seemed to be a lack of progress in reducing smoking prevalence in many countries. Experts have suggested that the remaining smokers may be more addicted because the cigarettes of today's are manufactured in a different way from before. One of the questions to which I hope this conference will give guidance, is whether and how the tobacco industry could be prevented to modify and change the tobacco production without governmental knowledge and control.

There are challenging dilemmas here. The Virginian company Star Scientific and British American Tobacco last month claimed to have produced a safer cigarette which would cut the number of cancer deaths among smokers by a third. A tobacco advocate (Cliff Douglas) recently compared the alleged removal of nitrosamines in the absence of many other potential changes to removing a few bullets from a rapid-fire machine gun that shoots 5 000 bullets per minute. He asked if the industry should be allowed to make such a change and then advertise, explicitly or implicitly, to the public that the gun is now shooting a lot of blanks?

I am sure that this conference will debate the need to have governmental oversight and control over the introduction of new products into the market, including how the industry are allowed to present such a product to the public.

What should be the end point of regulating tobacco products? I have been told that this question was raised in different ways at the Helsinki conference on regulation of tobacco products. What is our level of ambition? Are we satisfied with providing safer products – if this is possible? Or should tobacco product regulation be seen as a tool for reducing consumption? Or should regulations aim at products made less attractive to the consumers by dramatically reducing nicotine level or banning additives that accounts for good taste? I hope that during these three days we can come up with concrete recommendations on these issues.

Last December, the national corporate accountability organisation INFACT in the US released new data showing that that 69% of adults agree that the tobacco corporations should be regulated by the Food and Drug Agency. The poll also demonstrates public support for corporate accountability in a global context. Almost four-fifths (79%) of US adults surveyed believe that people have a right to hold corporations accountable if their actions are harmful to human health and the environment.

For policy makers public opinion is crucial. The alarming prognosis on the development of tobacco epidemic may induce policy makers, legal and public health experts to feel an urgent need to act.

As authorities for public health we have to mobilise the best resources in society to counter the advances of the tobacco industry and find alternatives to the tobacco growers, we need to anticipate what reaction that might follow in response to regulatory actions, and, finally, we need to bring all elements to bear in a comprehensive strategy. I know that you who are present in this audience are committed to take on this responsibility. This Oslo Conference on Advancing Knowledge in Regulating Tobacco Products will be an important foundation stone for the development of The Framework Convention on Tobacco Control and for comprehensive tobacco product regulation.

Let me end by wishing you all fruitful discussions. Your recommendations will be scrutinised by all different parties and stakeholders.

Norway is a mountainous country. Only a house that is built on rocks will endure attacks of manmade or natural origin. Your recommendations must be built on a solid rock of scientific evidence and be able to stand bad weather in the years to come. There is a war out there. Give us better weapons !

I wish you creative and conclusive deliberations !

Thank you !