The tobacco control movement has existed for more than 30 years and was created in the 1960s after the Reports of the UK Royal College of Physicians in 1962 and of the US Surgeon General in 1964. Smoking in developed countries declined, but not in developing countries. Even in developed countries the uptake of smoking by youngsters is increasing.

World wide production of cigarettes was 2.100 billion in 1963 and 5.600 billion in 1997. According to the tobacco industry it can have a bright future: "The global opportunities today are larger than ever." Annual Report Philip Morris 1997.

The strength and the weakness of the tobacco control movement will be discussed during this presentation. Key elements of the future strategy of the tobacco control movement in the next century will be described.

There are different ways to look at the future of tobacco control. Some are rather hopeful, such as Donald Shopland in 1990: "Hopefully, not long after the beginning of the 21st century, the ashtray will be viewed in much the same light we now view the spittoon – as an item for antique collectors – inviting curiosity by those whose only knowledge comes from reading history books and seeing old movies."

Others are less hopeful as they take into account the confidence of tobacco industry executives for the near future :

1. " Our global opportunities today are larger than ever. We have had considerable success in international markets, and believe we will continue to be a strong competitor in these markets going forward."

Geoffrey Bible, CEO Philip Morris, February 1998

2. " World-wide volumes are still increasing and can be expected to continue to do so, particularly given the positive trends in the incidence of female smoking, the current increase of the world’s population, as well as the prospects for continuing world economic growth and real increases in average disposable incomes."

William Ryan, CEO Rothmans October 1997.

3. " I see no reason why we should not enter the new millennium with well-founded confidence and optimism in our prospects."

Ulrich Herter, Managing Director BAT, October 1998.

Based on the experience of the last 35 years there is no reason to believe that the optimistic predictions of Donald Shopland will soon become reality. The tobacco control movement was created in the 1960s after the Reports of the UK Royal College of Physicians in 1962 and of the US Surgeon General in 1964.

After 35 years the positive aspects of tobacco control activities were the following

• most people know the dangers of smoking
• millions of smokers stopped smoking, mainly male, better educated and older persons
• most countries enacted tobacco control legislation
• in countries with a comprehensive tobacco policy the number of smokers declined sharply

The disappointing aspects, however, were:

• at world level a steady increase of sales of cigarettes: production (which is close to consumption) of cigarettes increased from 2.100 billion cigarettes in 1963 to 5.600 billion in 1997

• in most developing countries an increase of global sales and a trend that more women take up smoking
• in most developed countries an increase of youngsters who smoke and a trend that girls smoke more than boys.
• the surprising capacity of the tobacco industry to take advantage of tobacco control legislation

While it is true that comprehensive tobacco policies lead to less smokers, it is also true that the industry was able to take advantage of tobacco control legislation:

Health warnings: health warnings were first introduced in the USA in 1965. The purpose of the health warnings was to influence smoking behaviour by providing additional information to support the motivation not to start smoking or to give up smoking. The reality is that labelling in most countries did not influence smoking behaviour, as the health warnings were weak and hardly visible. The reality is also that these weak health warnings have been only an advantage for the industry, as they were the perfect legal protection in the product liability lawsuits.

Advertising restrictions: most countries banned television advertising for tobacco products or restricted the content of the tobacco ads. Partial bans have only led to a shift of resources to even more effective forms of promotion such as sports sponsorship and the distribution of different kind of promotional items such as tee-shirts, gadgets, caps etc. The advantage for the industry is that the sponsored organisations and federations will defend the interests of the industry at the national and international level and did become formidable opponents of tobacco control. Furthermore, promotional activities are far more effective to influence the youngsters’ behaviour than the classical advertising media. In the US the tobacco industry spends 8 times more money in 1996 on promotional allowances than it does spend on outdoor advertising.

Tar content: Since the early 1970s, health authorities have recommended that people who are unwilling or unable to give up smoking switch to cigarettes of lower tar and nicotine yield, in the expectation that the adverse effects of smoking could be reduced. There is growing evidence that low tar and light cigarettes are not less carcinogenic, but are misleading consumers and reassuring smokers in the false belief that light cigarettes offer some protection. Low tar and light cigarettes have probably not led to less but to more health damage. In fact the tobacco industry profits from the promotion of light cigarettes in several ways: first, they provide their brands with a new and trendy image; secondly, they prevent many smokers from quitting, especially women and; thirdly, some of those who switch to low tar brands admit to smoking more, which means still more sales for the industry. If we should give a prize for the most misleading tobacco marketing strategy of the last decade, the marketing of the light cigarettes would have won the first prize. In the European Union, for instance, 48% of all women cigarette smokers in 1995 are smoking light cigarettes, which represent 20 million women light smokers. If 10-20% of female light smokers had quit entirely instead of smoking low tar cigarettes, there would now be 2-4 million fewer women smokers in the European Union

Smuggling and taxation: Taxation is often considered as one of the most effective measures for reducing consumption. The industry opposes tax increases and is using more and more the same argument that higher taxes are an incentive for smuggling. The reality is that not only higher taxes, but also the activities of tobacco industry itself can lead to smuggling. Since 1997, there have been several court cases and official investigations in different part of the world which accused the industry of supplying the smuggled cigarettes or at least of being aware of the illegal destination of their products.

The tobacco industry benefits from smuggling in several ways:

• smuggling stimulates consumption both directly ( through the street sale of cheap cigarettes) and indirectly (through pressure to lower or keep down taxes)

• the threat of smuggling has also been used to avoid trade barriers or to force open new markets

Sales of tobacco products will increase in the next century as cigarettes are popular among the youth and adults have great difficulties to give up smoking. The large financial resources of the tobacco industry make it easy to defend their interests at political level. But also the tobacco control movement has its strength. It is amazing how much we could achieve with so few resources. According to internal documents of Philip Morris from 1994 on the so called activist movement, the industry is aware that our "movement has evolved in structure and momentum and consequently has gained credibility in the public eye since the 1980s." and "The fact that the activists movement is spirited by a small group of committed and vociferous activists and the close associations that they have formed has lent itself effective information, strategy and idea sharing."

If you read other tobacco industry documents, it is clear that the industry is jealous about our commitment, jealous about our solidarity, jealous about our interpersonal links, jealous about globalink. Solidarity is clearly our most successful weapon. The biggest mistake we can do in Europe is to repeat the mistake of our American colleagues, who in 1997-98 were totally divided during the discussions of the Global Tobacco Settlement. Personally I was shocked by the tone of the debate and the continuous flood of personal attacks against people of the same public health community. Only the industry benefits from this division.

The tobacco control movement in Europe has a future, only if we are united. Our future action could, among others, be based according to the following lines.

To control the content of cigarettes should be our first, but will be our most difficult task. The tobacco control community has probably underestimated the capacity of the tobacco industry chemists and flavour specialists to produce cigarettes which maintain addiction, but which taste "milder", "lighter", "healthier". Both the success of light cigarettes and Marlboro can be partly explained through the chemical manipulation by the industry. Until recently, we were unaware that Philip Morris added ammonia in Marlboro cigarettes, which boosted the brand’s nicotine "kick" as well as improved the taste. Competitor RJ Reynolds called ammonia "the secret of Marlboro". More information is needed about the role of constituents, chemicals, flavourings and other additives.

There are a number of potential opportunities to make tobacco less dangerous, less addictive, less attractive than they presently are, but it is essential to know more about the product in order to regulate it correctly.

Reliable sources estimate that there are 50 million Internet access points at present around the world, and some forecast growth to 500 million by the end of the millennium. While Internet advertising is only a two-year-old phenomenon, total annual ad spending on the Internet for all products and services was expected to reach $4,352 million in 2000. Tobacco companies also have begun to openly advertise on the Internet.

The need to tackle advertising on the Internet through an international convention is evident. Hong Kong has already banned placing a tobacco advertisement on Internet. An international convention is needed to ban both the sales of tobacco products and the advertising on the Internet. Internet selling of cigarettes has caused serious concern in Sweden, where many were buying cigarettes in low price countries via the Internet through the use of mail order.

Cigarette smuggling is now so widespread and well organised that it poses a serious threat to public health, and to government treasuries, which are losing thousands of millions of Euro in revenue. The main threat to public health comes by the use of the smuggling argument to attack high tobacco taxes. In its report on taxes on tobacco products of May 1998, for instance, the European Commission stressed that the smuggling factor must be taken into account when a tax increase is being considered, as the public-health objective of reducing consumption through high taxation will fall short of its target if tobacco products evade this taxation. If large-scale cigarette smuggling is not eradicated in the next century, we may loose one of our most efficient methods to reduce consumption, which are tax increases.

Several European countries around the world have banned tobacco advertising through legislation, such as Italy (1962), Iceland (1970), Norway (1973), Finland (1976), Portugal (1982), France (1991), Sweden (1994), Turkey (1996), Belgium (1997). More recently the European Parliament and the Council have adopted the Directive 98/43/EC of 6 July 1998 which will ban all tobacco advertising in the 15 EU Member States. All direct and indirect advertising (including sponsorship) of tobacco products will be banned within the EU, with full and final entry into force of all provisions by 30 July 2006. This EU ban could be extended to the all European region by the year 2010.

Cigarette sales are increasing in Central and Eastern Europe and cigarette sales are increasing in developing countries as American and European tobacco companies are promoting their products in these countries. US Vice President Dan Quayle said in 1990: " Tobacco exports should be expanded aggressively, because Americans are smoking less." Exports of US cigarettes quadrupled in the period 1986-96. Not only the exports of cigarettes cause concern. The European Union is exporting its high tar leaf tobacco at dumping prices to Central and Eastern Europe. Exports of leaf tobacco to Central and Eastern Europe doubled in the period 1991-95. The dumping of this cheap high tar tobacco on the markets of neighbouring, poorer countries must distort markets, and encourage consumption. Solidarity between Western and Eastern Europe and between the North and the South of the world should be crucial for our action in the next century.

Generally speaking, the largest cigarette producing countries have been an obstacle for more tobacco control around the world. Sometimes, their political leaders- such as President Reagan, Prime Minister Thatcher and Chancellor Kohl- became themselves involved to protect the interests of international tobacco companies. Chancellor Kohl remained in power for 16 years, tried personally to prevent the adoption of the EU advertising ban and challenged the European advertising ban at the European Court of Justice. Germany, the strongest economy in Europe, is now the biggest obstacle for more tobacco control in Europe. In the European Parliament, for instance, almost all German Members, with the exception of the greens, voted against the tobacco advertising ban. A new government, with chancellor Schröder, took office in October 1998. According to a recent tobacco trade article the friendly climate with the tobacco industry persists as the new German government decided to go ahead with the legal challenge of the ad ban. The task of the German Coalition against Tobacco is difficult and they need our full support.

Since the end of the Second World War the prevalence of female smoking has risen sharply in Western Europe. Growing social acceptance of women's smoking has contributed to increased smoking initiation among women. In most EU countries girls are smoking slightly more than boys. If these trends continue, it is possible that in the near future more women than men will smoke in the adult population. Women are underrepresented in the tobacco control movement and should take a lead role in the near future. The nomination of Dr Brundtland as Director General of the World Health Organisation can be considered as a first positive step. During the discussions in the Belgian Senate on the tobacco advertising ban, I noticed that mainly women defended the public health objectives and were less influenced by the classical economic blackmail techniques of the tobacco lobby.

The pharmaceutical industry has been involved in the marketing of smoking cessation products for more than 20 years, but only during recent years several pharmaceutical companies showed a clear interest to link with the tobacco control community and are willing to support not only conferences or research projects but also common projects such as the WHO European Partnership Project on Tobacco Dependence which got the support of three major pharmaceutial companies. The interest of pharmaceutical companies creates a new situation and can be benefcial for both sides. However, this cooperation should be based on clear and transparent rules. More tobacco control means more smokers willing to stop and possibly more persons willing to use the products of the pharmaeutical companies. A long term relationship with the pharmaceutical industry will only be possible, if it is a win-win solution for both parties. While the industry can expect us to support good smoking cessation therapies, we expect the industry to support not only smoking cessation projects, but also the creation of an environment which leads to more smoking cessation.

The unemployed, the poor and the less educated don’t give up smoking: social class has become an important differentiating factor in smoking behaviour in most countries. As a result, the health damage caused by smoking is greater among the poor than among the rich. Specific programmes have to be developed to help low income smokers to stop smoking.

The capacity of exchanging information, sharing experiences and building alliances is the strength of the tobacco control movement. A recent example of such strategy was the campaign for the EU advertising ban last year. In January 1998 70 European tobacco control activists met in London and agreed on a common strategy. The SAME message was repeated to all European Members of the Parliament. The strategy was based on good and updated information and accurate guidelines for action. The commitment of the different European and National organisations against tobacco, all over Europe , was total. On May 13 1998, we won the battle in the European Parliament. We won this battle, because were united.

United, we have to remain in the next century.