Efforts to reduce cigarette smoking and tobacco use in western Europe and north America, through strict advertising and vigorous health policies, have driven the tobacco industry to seek more susceptible and lucrative markets elsewhere.
Europe offers these in abundance, and leading health sector officials in the region are alarmed at the high death toll related to smoking.
"Lung cancer in Poland has broken all records", Witold Zatonski, public health advisor to the Polish prime minister, told journalists in Helsinki, 1October. "The chances of a 15-year old reaching the age of 60 is about the same as in India, and lower than in Latin America and China."
He was speaking prior to the opening of the Smokefree Europe Conference on Tobacco or Health being held in the Finnish capital this week. Some 500 experts and representatives from health and anti-smoking lobbies in 50 countries will take part in the forum. One of the aims of the conference is to define a pan-European health strategy aimed at reducing tobacco consumption and breaking the health divide that separates east and west more tangibly than did the Berlin Wall.
"The recent sponsorship of large rock concerts by Marlboro and Prince tobacco brands in Poland was clearly aimed at young people. Tobacco consumption in this group is growing by about ten percent among the male population and 30 percent among young women", Zatonski said.
Endre Morava, head medical officer at Hungary's National Public Health Centre, drew an equally gloomy picture. "Some 35 percent of people aged between 15 and 65 are smokers, and every fourth death is due to tobacco and alcohol. The amount of cigarettes smoked each day per person is twice that of western Europe."
In Russia smoking is highest among men, with nearly 60 percent of them hooked, while the figure for women is somewhere between ten and 15 percent. This is reflected in mortality statistics. Male life expectancy is just 58 years, whereas women on average live to the age of 72. Raphael Oganov, Professor of medical research in Moscow and public health ministry advisor, said that legislation affecting cigarette advertising in Russia is full of loopholes, and that federal programmes controlling smoking cannot be properly put in to effect because of lack of funding.
Despite the downward trend there is a fight back. The east European experts were keen to stress the positive influence of anti-smoking and pro-health campaigns being taken up in their countries. The prize giving Quit and Win competition has caught the imagination of at least some smokers, and this year's round of the contest hooked some 30,000 participants in Russia. Hungarian participation was proportionately higher, coming second in the world competition after China.
Finland's sponsorship and hosting of the Smokefree Europe conference is tied closely to the country's success story in reducing smoking and reaping the results in the form of a massive drop in deaths from heart disease and lung cancer over the last 25 years. Relative smoking levels in the country are the lowest in Europe.
And it is perhaps this success that underscores the trend taking place across the continent. The day before the Smokefree Europe Conference opened, Amer Tobacco, Finland's leading cigarette manufacturer, which sells Philip Morris products under license, announced that it is to start the manufacture and distribution of cigarettes in St Petersburg, Russia.
"The objective of this new cooperation in St Petersburg is to gain a solid foothold in the Russian cigarette market", the company announcement explained, "which is estimated at 250 billion cigarettes a year; in comparison the Finnish market represents only 5 billion cigarettes."
The Smokefree Europe Conference is being organised by the Finnish Centre for Health Education in cooperation with the Ministry of Social Affairs and Health. It's official sponsor is the President of Finland Martti Ahtisaari.
MW/Conference Press Service
As an instrument to curtail the activities of the tobacco industries and combat smoking, litigation is gradually acquiring a leverage that was inconceivable a few years ago. In the US, there are currently hundreds of law suits against tobacco firms, and in Europe there are signs this legal approach is catching on.
"The point about litigation is that if tobacco companies start to have to pay for the harm they do, they'll have to start raising their prices, which in turn will make their products less available", Richard Daynard, Professor of Law and chair of the Tobacco products Liability Project in the US, told journalists today.
Daynard is a keynote speaker at the 50 nation Smokefree Europe Conference on Tobacco or Health, being held in Helsinki this week.
The conference is in part aimed at outlining an all-European tobacco policy, and there is keen interest in the rising tide of legal rulings in the US in favour of the anti-tobacco lobby. "Litigation has effectively raised the problem about the harm being done to people's health by tobacco, and the misconduct of the tobacco industry", said Daynard. "Many very incriminating things have come out about nicotine addiction as a root cause of smoking and smoking as a cause of death."
Daynard stresses that the mushrooming of court actions against cigarette producers is a recent phenomena. For most of the post-war period the industry has been able to manipulate court actions in its favour and against the plaintiff. "The industry did an impressive job in defending itself from losing cases", Daynard recalls. "Its tactic was two-fold: 'making lawsuits prohibitively expensive through endless delays, and then blaming the victim - for foolishly believing the industry's claims that smoking does not cause cancer."
Amazingly, the industry continued to claim that there is no proof that cigarettes cause lung cancer. The industry would back its claim by wheeling on doctors who would put the 'scientific case' that there is no link between smoking and illness.
This approach was used repeatedly and won the tobacco giants many good days in court.
The tide turned in 1994. "There were many leaks from within the industry. One of these was that in 1963 the General Counsel of the American subsidiary of British-American Tobacco had stated that it was 'in the business of selling nicotine as an addictive drug", Daynard explained. "It also became clear that from the 1960s the industry was fully aware that smoking causes diseases."
According to Daynard, the cover was blown. When in spring 1994 the presidents of seven major tobacco companies testified before a Congressional hearing they raised their right hands and swore that nicotine is not addictive. "People saw for themselves that these people were lying".
The image of the tobacco industry flipped 180 degrees. Daynard told how in the recent case in Florida of lung cancer sufferer Grady Carter, which led to an award of $750,000 by British American, the jury foreman declared: "We cannot believe the hypocrisy of the tobacco company."
There are now some 600 individual cases in process in the US, as well as 14 state Attorney General suits seeking Medicaid reimbursement and over a dozen state class action cases. The charges brought against the industry range from personal injuries and wrongful death to damage claims due to nicotine addiction.
Marcello Stalteri, an expert in comparative Anglo-American law at the University of Florence, Italy is keen that the US legal example should be taken up as widely in European efforts to tackle the activities of tobacco companies. The technicalities of US legal practice pay far more attention to the issue of product liability than the national laws of European countries, he told journalists at the Smokefree Europe forum.
"Because of this, if we compare the situation in Europe to that of the US things look very weak from the point of view of legal room to manoeuvre. There are not many incentives for people to sue, which is remarkable if you bear in mind that it is mainly American tobacco products that are being sold in Europe."
Stalteri argued that product liability is the most suitable legal route by which people damaged by tobacco use, or authorities on their behalf can seek legal redress. This should aim at compensation for the negligent behaviour of domestic and foreign tobacco producers, in the form of 'failure to warn' prosecutions.
Stalteri, whose father died from lung cancer caused by smoking, pioneered the first tobacco products liability case in Italy, which is due to be decided in early 1997 before going to appeal. The thrust of the case is directed at the lack of warning labels on cigarette packs in Italy before 1991. He believes that courts in other countries should also focus on when health warnings were used, using the bench mark of 1965 - the date such labels were first used in the US.
The first tobacco trial in Europe began in Finland in 1988, in the case of Pentti Aho, who suffered from several smoking related diseases, including cancer.
Although the case, which hinges on proof of tobacco's health hazard, has been upheld at various stages, the leading lawyer for the plaintiff, Professor Erkki Aurej„rvi explained that the appeals process will continue for the next three years. Despite the slow pace of progress the case is something of a trailblazer for Europe, and has had to counter the usual obstacles thrown up by the tobacco industry, including the lack of proof of smoking being harmful.
In boosting efforts for a European policy on smoking, Stalteri argued that a specialised agency should be set up to coordinate legal action internationally, and to pool advice and information. he said that such a body is clearly needed if Europe is to upgrade its legal processes to bring the tobacco industry to account.
MW/Conference Press Service
EU Commissioner Padraig Flynn today pledged that measures to cut cigarette smoking and tobacco use will be given major priority in EU health policy in the period 1997-2000.
Flynn, who deals with health, social affairs and employment in the EU Commission, was attending a conference being held this week in Helsinki, Finland, on the theme Smokefree Europe.
The Commissioner was presented with proposals drawn up by medical experts from the Europe Against Cancer Programme taking part in the conference. They outline a nine-point plan to introduce tougher measures for the EU on tobacco control.
These include a smoking ban on all airline flights in the EU. Tobacco toxicity would also reduced, with a ceiling on nicotine at 1 mg from the end of 1997 and a 10 percent reduction each subsequent year until levels of 0.5 mg are reached - the equivalent of extra light cigarettes.
Other measures advanced aim at strengthening health warnings on cigarette packets and allowing only generic pack designs from the end of the century.
Flynn lambasted the culture of social acceptability linked to tobacco use, which he said is exploited to the hilt by the cigarette industry. But he stopped short of detailing how the EU would help implement the demands of the European experts.
In the area of cigarette advertising the EU is unable to move forward to a total ban because of opposition from Britain, Germany, Netherlands, Greece and Denmark.
Nevertheless, health lobby representatives, researchers and legal experts attending the Smokefree Europe conference welcomed Flynn's commitment to their proposals.
The EU Commissioner also launched the European Network for Smoking Prevention, a liaison forum for smoking prevention groups in the member states.
He emphasised that smoking prevention is the most important way to challenge the health toll resulting from tobacco use. He said that the target group for prevention should be under 18 year-olds.
Some 500 people from 50 countries are attending the Smokefree Europe conference.
MW/Conference Press Service
Gao Ghanquan a 48 year old electrician from China has won $5,000 in the latest round of the international Quit and Win anti-smoking competition. The sum is the equivalent of what he earns in six years.
The award was handed over to China's ambassador to Finland, Hena Wan Lian, at the international Conference on Tobacco or Health, being held here this week. The prize will be finally presented to Gao Ghanquan by China's health minister.
The Helsinki forum, which has brought together some 500 participants from 50 countries to debate cutting tobacco use in Europe and worldwide, heard the final results of this year's Quit and Win contest.
The competition winner is drawn from the largest number of contestants per country, and this year China came in first with 15,000. Altogether some 66,000 smokers were registered in the contest, which tested the entrants' resolve to kick the nic' habit over a four week period.
Quit and Win competitions have been held nationally for some years. Since 1994, however, the campaign has been coordinated internationally by Finland. Each year it attracts more contestants.
While their numbers pale beside those of the millions of smokers around the world and the 3 million who die of the habit each year, Quit and Win organisers are confident that its rewards are getting people hooked.
MW/Conference Press Service
William B. Shultz, assistant director at the US Food and Drug Administration (FDA) said in Helsinki today that work on the Clinton administration's robust new limits on tobacco advertising took account of similar measures carried out in Finland and France. He is attending a conference on tobacco or health under the banner Smokefree Europe, and being held in the Finnish capital this week.
The US government has gone much further than most European countries or the European Union, and has defined nicotine categorically as an addictive substance.
While litigation against tobacco firms is taking place in countries such as Finland, Britain and Italy, court cases in the US run into the hundreds.
Shultz believes that the vast amount of research into the effects of smoking carried out by the tobacco industry, and either leaked or otherwise seeing the light of day because of increased law suits, can be used to enhance European action to curtail tobacco use.
"The cases have been critical in revealing documents from the tobacco companies, showing their strategies to focus on children, as well as their research, which in many cases was more advanced than other studies done on the effects of smoking", Shultz told journalists.
"I am sure that this information will be shared and will be useful to any country considering measures similar to ours."
Shultz described the government move on tobacco as a "sea change" for US policy. "It is a commitment by the president to invest time and resources into keeping kids from smoking."
He points out, though, that the tobacco companies are not taking the new measures lying down.
"They are suing the FDA, arguing that the advertising restrictions violate free speech and that nicotine is not a drug and so should not be regulated. But the case that nicotine is addictive is extremely strong."
MW/Conference Press Service
Smoking trends and smoke-free policies in Finland have been under the spotlight this week. The country boasts the lowest levels of smoking and related diseases in Europe among adults. Young Finns, though, smoke on average more voraciously than their contemporaries in other parts of Europe.
Finand's successes in cutting cardio-vascular and lung cancer since the early 1970s are seen as exemplary. Some 500 health experts and activists attending a conference in Helsinki this week under the banner Smokefree Europe have been inspired by the Finnish example in formulating strategies to cut tobacco use in east and west Europe.
"Finland is about 10 years ahead of other countries" Director of the World health Organisation's European region, Jo Asvall, told journalists today.
The Director of Finland's National Public Health Institute (NPHI), Professor Jussi Huttunen, said that the numbers of Finns who smoke have continued to drop. This year's figures for men who smoke are 27 percent, and 18 percent for women. Last year's numbers were 29 and 20 percent respectively.
"But these figures concern people over 25 years old", Huttunen pointed out.
"We are faced with the odd situation that the adult population is behaving increasingly better, while adolescents and young people are smoking more than their population group in other countries. We have to focus more on smoking among young people."
Huttunen said that in tackling smoking by younger sections of the population a variety of issues have to be taken into account. These include drinking habits among young people, as well as drug abuse and the climate of high unemployment.
"I am not so sure that legislation can help here. The problem is more to do with the culture of young people, including family and school life, recreation, and even military service."
Dr Tapani Piha, of the Finnish Ministry of Social Affairs and Health, said that while the numbers of young people who smoke in Finland has decreased slightly the problem persists. "The truth is that we have not been successful in reducing smoking among young people as we had hoped."
Legislation has been key to creating more smoke-free environments in Finland, in particular in places of work. Although there has been a slight rise in the figures reflecting smoking at work - due to more employers organising special smoking rooms, NPHI data shows that more people are happier about the smoke-free work environment policy - 92 percent compared with 82 for last year.
MW/Conference Press Service
Some 500 health professionals and anti-smoking activists form 50 countries wound up their conference on tobacco or health today in Helsinki, held under the banner Smoke-free Europe, by issuing a range of proposals calling for tough legislation on tobacco controls.
The forum had spent three days debating problems of guaranteeing smoke-free, environments, and the disparity in east-west European health trends as tobacco firms increasingly set up shop in former Soviet bloc countries where there are less strict anti-smoking policies.
In an effort to coordinate the large number of national and international initiatives on smoking and health, the conference issued a resolution on a European tobacco strategy. This endorses the specific proposals of cancer experts from the Europe Against Cancer programme, who earlier in the conference had presented EU Commissioner Padraig Flynn with a nine-point plan for upgrading the Union's rulings on tobacco.
The Smokefree conference was concerned to bridge the health divide that splits Europe in the context of smoking-related illnesses, and draw together the efforts of organizations such as the WHO into an overall strategy for the continent.
"In countries of central and eastern Europe the tobacco industry should be made to comply with the same rules as in the European Union countries", the resolution stated. It also singled out women as often "more vulnerable than men to some principle diseases related to tobacco" and as a "prime target" of tobacco sales policy, and urged all countries to "adopt strategies" to address the problem.
Assessing the future perspectives for tobacco control, Dr Nigel Gray, President of the UICC, said that while advances continue to be made in health protection and reducing tobacco use, the expansion of the tobacco industry in developing countries as well as in eastern Europe presents a tough challenge. The global problem of tobacco use will be the focus of the 10th World Conference on Tobacco or Health, to be held in Beijing next year.
The resolution of the Helsinki forum outlined 15 areas on which tobacco reduction efforts should focus. They include upgrading existing pro-health initiatives and education, focusing on tobacco liability and litigation as tools for tobacco control, and making tobacco a top health priority.
The proposals also recommend resolute changes in national and pan-European legislation to ensure a full ban on tobacco advertising, increasing tobacco taxation and using some of the extra money for health promotion, ending duty-free tobacco sales, and regulating the tar and nicotine yields of tobacco products.
MW/Conference Press Service
How would you describe the situation in health-divided Europe. Isn't tobacco use only part of the picture?
There is a tremendous difference between the eastern and western parts of Europe in relation to tobacco. This has several dimensions. First, there is the difference in the amount of smoking, which is increasing in eastern Europe, and which is stable or even decreasing in many of the western countries. Second, there is a difference in health status in the sense that the health impact of smoking is rising faster in the eastern countries. For instance, if you look at cardiovascular diseases you find that they are still on the rise in the east. This has to do with lifestyle issues where smoking is an integral element. It has been demonstrated that when you examine life expectancy for men around the age of 35, in terms of their chances of reaching the age of 70, some 10 percent of this group in western Europe will die of smoking-related diseases, whereas in the east twice that percentage will die early.
In one aspect there is an advantage in the eastern part of Europe - with regard to smoking among women and young people, which traditionally has been very much lower. This, however, is rapidly changing because of the huge cultural, social and political changes we have seen in the last five years since the communist system collapsed. The conditions that influence smoking are much more negative in many ways in eastern Europe.
If you look at legislation, these countries did in the past have fairly strong measures against smoking, such as advertising bans. With the collapse of the system most laws and regulations fell by the wayside, and you suddenly got a strong trend toward privatisation. It was not only a question that private industry came in as a new force, but that much of the population saw privatisation as a sign of independence and liberty. This environment allowed the tobacco industries to enter as a first example of the new freedom and more western ways. People saw them as such, and this was further enhanced by the type of image the tobacco industries presented, and through the kind of advertising and brand stretching they went in for.
But do health trends already reflect these developments?
I think that with regard to smoking rates, changes in health in eastern Europe are occurring now and since recent years. Some of these changes are very abrupt. We have seen a sharp rise in infant mortality and a decline in life expectancy.
I don't think these problems are in themselves smoking-related; they are to do partly with the general social and economic conditions. But the medium-term changes we are seeing in cardiovascular diseases and lung cancer are related quite clearly to smoking, as well as to things such as nutrition. It will take some 15-20 years before we see the full impact of smoking on lung cancer.
There seems to be much frustration and anger at the way things are going.
All of us should be frustrated at the situation and also with ourselves. Those who can change the problem are those who know about it, and they are the public health physicians, and internationally it is the WHO - we are the ones who are responsible for overall health and who are trying to stimulate countries to promote it.
We did much good work with the WHO Madrid Conference in 1988 and there has been a lot of follow-up work in countries. But all this has been much slower than anticipated, and we in the Regional Office have been less involved in the early 1990s than we were at the end of the 1980s.
The reason is very simple - because of the collapse of the Soviet Union, eastern Europe and the war in former Yugoslavia. WHO-Europe went suddenly from 31 countries to 49, of which about 10-15 are in reality developing countries with enormous problems. We also suffered a 15 percent budget cut. We had to completely reorganise our work and we simply did not have the capacity.
That situation has now stabilised. We are back to a more balanced situation in developmental terms, and it is now time for us to return to the tobacco issue because it is clear we are not making the headway we should. In 1984 the Regional Committee of WHO-Europe of the then 31 member countries set an 80 percent non-smoking target for the year 2000. Not a single country is going to reach that.
What is your message to the Smoke-free Europe Conference?
I think that we have come to a kind of milestone in our work. It is time to reflect on where we are now and compare it to how far we thought we would have come. The 1988 Madrid Conference came out with six basic ethical principles and action strategies that are still the bases of our work. What we can add to them concerns mainly tactics. If you look at Europe in general there is clearly a situation where there is not the progress we anticipated. One reason is because of what happened in the east, and a problem is that for those countries tobacco prevention is given relatively low priority compared with the other problems that have to be dealt with.
Another reason is that in western Europe we have been too slow in all countries.
How can it be that in Norway, for instance, we have such a high ratio of smoking among young men and women despite the enthusiastic efforts of the health sector?
In part, lack of progress is due to the fact that we have not managed to get key decisions taken. There are some measures, such as smoke-free environments, where legislation is being used. But it has been too slow, and the reason is that the public health lobby has not been active enough and there has been a lot of resistance by politicians. The situation can only be changed by local pressure, by NGOs, in situations where the governments themselves won't act. If we want to influence the general attitude, the combination of smoke-free environments and legislation has to be advanced. We need a combination of national level and multi- country level measures.
MW/ Smoke-free Europe Conference Press Service
EU Commissioner Padraig Flynn officially launched the European Network for Smoking Prevention (ENSP) during the Smoke-free Europe Conference on Tobacco or Health, held in helsinki 2-4 October. The network is an umbrella forum which brings together representatives from smoking prevention groups in EU member states.
Its aim is to promote pan-European strategies and projects on smoking prevention within the frame work of the Europe Against Cancer Programme. The network is also being organised to coordinate the work of the many pressure groups working on the problem of cancer.
Professor Albert Hirsch, of UICC and the leading French pneumonicist, is the chairman of the new network. Tom Hudson, the chief executive of the Irish Cancer Society and chair of the European Cancer Leagues also leads the network.
"Our goal is very simple", Hirsch told the journalists at the Helsinki conference. "It is to reduce the health effects of tobacco consumption within the European Community."
The European Network is being set up to coordinate the existing work of other fora that work at the Community level, such as the European Network on Young People and Tobacco, the European No-smoking Towns Network, and the European No-smoking Hospitals Network. The new structure also brings in observers from the UICC, the WHO and the International Non-Governmental Coalition Against Tobacco.
"Our immediate objectives are to disseminate information and research through the European Community, and to build professionalised national alliances - bodies in which members can pressure and lobby national governments in ways that are not possible within the Community as a whole", said Hirsch.
"It is important that all actions are coordinated", said Hudson, who as a long time business leader brings a strong sense of corporate realism to campaigning on smoking prevention.
"There is always the possibility that there are people who have a particular agenda they wish to pursue, but we feel that within the network the strength of our actions lies in unity. If we can get a coordinated programme functioning through the network in each European state, then we'll be able to send a strong message to the governments."
Professionalism and coordination are the hallmarks of the tobacco industry, and both Hirsch and Hudson want to see the same qualities brought into smoking prevention.
"We must organise professionally in order to counteract a very sophisticated, well-equipped, and well-financed opponent. The tobacco industry is highly organised, which means that we must work at the same level. We can do that because we have the best experts in the Community", Hirsch explained.
A particular objective of the network is to create an annual European anti-tobacco project. "This has been strongly requested by the Commission and DG-V", said Hirsch. "It will take some years before we can put such a project fully into effect, to elaborate what is needed and work towards the right level of involvement. It would be counter-productive to try to launch it now."
In the mean time, the network will focus on attainable goals. It will receive funding form the Commission for the practical running of campaigns and will have an office in Brussels. "I hope that through this we will be able to tie-in with other organisations and create a centre of excellence in good communications and the practical management of the cancer leagues", said Hudson.
Hirsch points out that EU funding for the network is crucial. "It will allow us to build national professional bodies. In many of the member states there are simply no means to engage paid skilled people in the kind of work we are doing", said Hirsch.
Both Hirsch and Hudson are sceptical about the political utterances made by politicians and believe that only swift legislation and action by governments is a measure of their commitment to smoking prevention. While they have no illusions of being able to reverse smoking trends overnight, they seen the new network as a tangible step in the right direction. They do not want to see another decade go by with only minimal results, and they want the network to revamp the campaigning style of smoking prevention activities.
"We have to look at what we are doing as anti-tobacco activists", said Hudson. "We are using the same old cliches, and they no longer work. We need to re-target our members and redesign a new approach."
MW/Conference Press Service