WPC= 2kB RT Z#|]!"m^+9FVV999Va+9+0VVVVVVVVVV00aaaL|rr|i_||9C|i||_|r_i||||i909PV9LVLVL9VV00V0VVVV9C0VV|VVLR"R]9+999998999999S9V0xJxJxJxJxJrrJiJiJiJiJ8.8.8.8.{SxSxSxSxS{S{S{S{SxSxJ{V|VxSxS{S`S|L|L|LrLrLrLrL|ViLiLiLiL|V|V|V|V|V|V|V|V9.909090z]C|Vi0i0i0i.i0|V|c|V|V|V|V|r9r9r9_CZA_C_Ci0i0i0|V|V|V|V|V|V||ViLlJiL|Vi0|Vr9_Ci0|V|V|V|V|VNDgFdddgF9CgggEEggzzddd~rrEgdF"m^>R{{RRR{>R>E{{{{{{{{{{RR{沥`{RER{R{nnR{EREΉ{n`R{{{na6aR>RR)RRRPRRRRRRxRExxxxxkkkkk]C]C]C]Cxxxxxx{xxx{{{nnnnnnnn{{{{{{`C`E`E`Eډ{EEE]E{{nnn`]``RRR{nknEn`R{{{NV>{R{{{{{{JQ{Txxx{TEP{{{RR{{xxxȉR{xT2v 3  "m^3ETggEEEgt3E39gggggggggg99ttt[~rEP~rr~•~E9E`gE[g[g[Egg99g9ggggEP9gggg[c)coE3EE"EEECEEEEEEdEg9YYYYYY~Y~Y~Y~YC8C8C8C8ddddddddddYggdddsd[[[[[[[g~[~[~[~[ggggggggE8E9E9E9oPg~9~9~9~8~9gvggggEEErPkNrPrP~9~9~9gggggg•g~[Y~[g~9gErP~9gggggNH3]gE[ggggg9@gFdddgF%C[[gEEggzzdddwrrE[dF"m^>Re{{RRR{>R>E{{{{{{{{{{EEn㲥R`۲鲲RERt{Rn{n{nR{{EE{E{{{{R`E{{{{nv1vR>RR)RRRPRRRRRRxR{EkkkkkۥkkkkkPCPCPCPCxxxxxxxxxxk{{xxxxnnnnnnn{nnnn{{{{{{{{RCRERERE`{EEECE{{{{{۲RRR`]``EEE{{{{{{鲲{nkn{E{R`E{{{{{NV>p{Rn{{{{{DM{Txxx{T,Pnn{RR{{xxxȉRnxT"m^+9_VV999Vb+9+0VVVVVVVVVV99bbbV|r||riCVr|i|_r||||r909dV9V_L_L9V_09_0_V__LC9_V|VVLD&DY9+999998999999S9_0xSxSxSxSxS|xJoJoJoJoJA.A.A.A.x]SSSSx]x]x]x]xSxSx_VSxSxSf]|V|V|V|L|L|L|L|_rLrLrLrLVVVVVV__C.C0C0C0_V_r0r0r0oAr0|_||_|_VV||L|L|L_C]A_C_Cr9r9r9|_|_|_|_|_|_||VrLoJrL|_r0|_|L_Cr9|V|V|_V|_N,U`4  p 7iC3,ƒXi\  P6XP A~P>,B-~\  P6P y.\8+,\4  pZ 5hC3,-Xh*f9 xr XXto the public, and to pursue advocacy against tobacco with governmental organizati Significant public health benefit and reduction in disease occurrence can be  b @IV - @   6&6&StandardHPLAS4.PRSX\ 6&6&StandardHPLAS4.PRSX\  #Xn4  p4X#       CHAPTER IV  b WORKING TOWARD COMPREHENSIVE TOBACCO CONTROL:#Xi\  P6ƒXP#  b2  GATHERING SUPPORT FROM ALL SECTORS   X(  55In Chapter I, reference was made to resolutions on smoking or health passed by the World Health Assembly. Of particular importance is the 1986 resolution (WHA 39.14) which outlines the essential components of comprehensive tobacco control programmes. But which agencies need to become involved, and what role will they play? How is the tobacco or health situation to be analyzed in each country, in order to decide the direction that future tobacco control activities will take? This chapter will provide some guidance on these issues. A.55THE PARTICIPANTS IN A%"5  Xm 55NATIONAL TOBACCO CONTROL PROGRAMME %"5 55In ensuring the highest possible standards of public health, governments have an important role in tobacco control. While health departments take a position of leadership in this area, they must also secure the collaboration of several other government departments, the media, voluntary organizations, professional organizations and business and industry. The following section will give a brief description of the kinds of contributions to a comprehensive national tobacco control policy that can ideally be provided by each of these institutions.  X  GOVERNMENT SECTOR  X" Introduction 55A strong political will and government commitment to reduce the burden of tobaccocaused diseases are essential in the development and maintenance of effective tobacco control policies. If policies are to be truly comprehensive, tobacco control activities of some type could extend to virtually all departments of government. *-++Ԍ55The following sections will outline roles that various ministries can play in comprehensive tobacco control. These suggestions will apply at the national level and may apply at the state or provincial level as well. This is especially the case in large countries like Brazil, where activities are needed not only by the national government, but also by the various ministries in all 26 state governments. It should be noted that the examples given are illustrative only. The division of responsibility among ministries will vary greatly among countries.  X  Health ministry 55Normally, the national Health ministry has major responsibility for health promotion and health protection, and therefore has a clear lead role in tobacco control. Nevertheless, occasionally this role is assumed by another ministry. Wherever lead responsibility for tobacco control may lie, that ministry should ensure that a focal point is established to stimulate, support and coordinate tobacco control activities. 55NN& & %"N  Xs  Finance and Treasury ministries 55Ministries of Finance and the Treasury usually have responsibility for setting tax policy and collecting taxes. Raising tobacco taxes has a proven effect on discouraging tobacco consumption, particularly in youth, and would at the same time increase government revenues. In addition, imposing and collecting tobacco taxes is usually one of the logistically least difficult forms of tobacco taxation. Health ministries can play an important role in making a case to Finance ministries for a workable, comprehensive, healthoriented tobacco taxation policy.  X  Customs and Excise ministries 55These ministries can benefit from working with public health workers interested in tobacco control by learning of new proposed directions in tobacco taxation and, often, by the sharing of consumption information. They can also assist tobacco control efforts by: 55NNProviding information on smuggling and working with health bodies on the development of antismuggling measures such as prominent and noncounterfeitable tax markings.%"N 55NNProviding detailed information on current and past tobacco taxation levels, tobacco sales and tobacco tax revenues. %"N*-++Ԍ55NNAlerting health groups about measures being used by tobacco companies or others to legally circumvent the intent of tobacco tax laws, or to exploit favourable tax treatment of particular products.%"N   X  Trade and Commerce ministries 55In order to promote the development of business and industry, national ministries of Trade and Commerce may promote the establishment of tobacco manufacturing plants, or factories for the manufacture of tobacco industry supplies. Additional incentives to tobacco companies may include lowinterest loans, tax concessions or land, as well as buildings, building materials, machinery and equipment at belowmarket prices. 55This sort of activity runs counter to the recommendations on tobacco control of the World Health Assembly (WHA39.14, item 4) and to the spirit of current economic development policy of the World Bank. It is now recognized that encouraging the development of tobacco industries poses a threat to the health of the population. When health is threatened, longterm social and economic development are also threatened. Health and economic development authorities now agree that shortterm economic gains from supporting the development of the tobacco industry, are, in the long term, detrimental to health, social and economic development. 55NNNew opportunities exist for trade and commerce ministries to provide incentives for industrial development that can replace other economic activity in the tobacco growing and manufacturing sectors. %"N 55 55NNTrade and Commerce Ministries can provide economic alternatives to tobacco growing and manufacturing, to bring national policies into line with those of WHO and the World Bank.  %"N 55Where they have authority to ensure orderly functioning of retail trade, they can use their authority to limit where tobacco products can be purchased, such as eliminating sales in health and educational establishments. Licensing authority can also be used to prohibit sales to minors.  X'  Consumer affairs ministry 55A Ministry of Consumer Affairs can often contribute to a comprehensive policy of tobacco control through the administration of regulatory requirements on tobaccoF*-++ marketing, advertising, packaging and labelling. Regulatory control of tobacco testing, disclosure of information on tobacco additives and toxic constituents may also rest with this Ministry. Alternatively, such legislation and regulation can be administered by the  X Health Ministry, with support and collaboration from the Ministry of Consumer Affairs.  X Agriculture ministry 55Agriculture ministries typically provide economic and technical assistance to farmers, and tobacco farmers can often benefit from these programmes. As tobacco is often seen as an important cash crop, these farmers often receive special subsidies or technical assistance. Like tobacco manufacturing industries, tobacco agriculture is regarded as an inadvisable route to health improvement and economic development by both the WHO and the World Bank. Upon request, the Food and Agricultural Organization (FAO) will provide assistance to countries for the development of economic alternatives to tobacco growing. Agriculture ministries can avoid providing new incentives for the development of tobacco agriculture. 55NNEven the most comprehensive tobacco control policies will result in only very slow declines in tobacco demand, leaving plenty of time for economic adjustment in the agricultural sector. Even as per capita demand for tobacco may be slowly dropping, absolute demand for the product will probably remain stable or increase because of population growth.%"N 55NNTruly comprehensive tobacco control policies will recognize the slowly falling demand for tobacco leaf and could have some provisions for assisting economic readjustment in the tobacco agricultural sector. Any compensation plan for farmers should, however, be strictly tied to the attainment of health goals. %"N  XG  Ministries of external affairs and international trade 55These ministries can: 55NNanalyze balance of payments on tobacco and related industry inputs and outputs;%"N 55NNprovide sound advice on the international law implications of tobacco control policy proposals;%"N 55NNassist in promoting the development of complementary tobacco control in neighbouring countries;%"N I*-++Ԍ55NNresponding to challenges by foreign tobacco companies who might attack domestic tobacco policies.%"N  55Government ministries that are concerned with the development of foreign markets for locallyproduced products, and for overseeing imports and exports of goods can also contribute to comprehensive tobacco control policies. It should be remembered that tobacco creates a net loss to the majority of developing countries. An international trade policy that followed the recommendations of WHO and the World Bank would subject both imported and domestic tobacco products to similar taxation, controls on marketing, advertising and labelling. Coordinated international policy can also move towards phasing out government subsidies for tobacco growing and export. Since tobacco control policies have been recommended for all nations, the longterm economic prospects for tobacco and products as an export commodity are ultimately not favourable. At the same time, if farm subsidies were phased out, countries with comparative advantages in the growing of tobacco need not face significant declines in production for the foreseeable future. 55External trade ministries of developing nations with emerging tobacco manufacturing industries should be especially wary of authorising the use of scarce foreign exchange reserves for the purchase of tobacco machinery, tobacco leaf and other tobacco manufacturing inputs. The expectation of economic development benefits, even in the short term, can be thwarted if such development significantly depletes foreign exchange reserves.  X  Law and Justice Ministries 55Tobacco control legislation serves an important role as part of a country's comprehensive tobacco control program. The World Health Assembly has urged all Member States "to consider including in their tobacco control strategies plans for legislation or other effective measures..." (WHA43.16, 1990). For countries who heed this WHA resolution, the Ministry of Justice will play an important role, in collaboration with the Ministry of Health, in developing, implementing, administering and enforcing tobacco control legislation. D*-++Ԍ55The Justice ministry can also: 55NNprovide vigorous defence against legal challenges to tobacco control legislation;%"N 55NNprovide advice on constitutional matters and international treaty obligations;%"N 55NNassist in the development and drafting of tobacco control laws and regulations.%"N 55In most countries government inspection and enforcement authorities have responsibility for law enforcement of smokefree areas, advertising restrictions, restrictions on sale of tobacco products to minors and other tobacco control legislation. Police departments or the appropriate inspection and enforcement authorities can also help in the enforcement of tobacco control laws and other related statutes, such as antismuggling laws.  X  Ministries of Labour, Transport and Public Service Personnel 55 Ministries of Labour, or some other body that administers occupational health and safety legislation and regulation should ensure effective protection from involuntary  X0 exposure to tobacco smoke in enclosed public places via legislation, regulations, standards, or guidelines. Protection from environmental tobacco smoke (ETS) should be ensured in such places as worksites, public transport vehicles and government buildings, particularly those which serve the public. Many governments have already found that the implementation of smokefree policies in their own workplaces are quickly followed by the voluntary adoption of similar policies in the private sector. 55Transportation authorities can be encouraged to abolish tobacco advertising in public transport, and to provide protection from ETS in public transport vehicles. In cases of international transportation, bilateral or multilateral agreements may need to be negotiated. & &  !+ %"  X' Education ministry 55A comprehensive tobacco control policy would not be complete without the involvement of the Education Ministry. Health and education authorities could require:F*-++ 55NNThat children receive effective education about the dangers of tobacco use and the benefits of a tobaccofree life at repeated intervals throughout their educational careers;%"N 55NNThat all schools be smokefree for staff and students alike, both to provide protection from involuntary exposure to tobacco smoke and to provide smokefree role models to children;%"N 55NNThat teacher training and inservice training for teachers should both include elements on how to teach tobaccorelated matters in schools.%"N 55NNThat health science schools (including medical, dental and nursing schools) include information on tobacco and health, tobacco dependence, and intervention techniques for cessation of smoking and encourage an advocacy role for health professionals, as part of the curriculum;%"N  Xy  Ministry of the environment  55This ministry can contribute to comprehensive tobacco control by providing assistance in the following areas: 55NNProtection of the environment from deforestation, from the use of toxins in tobacco manufacturing, from the excess use of wood cure tobacco, from the excess use of paper in cigarette manufacturing, excess litter, excess use of agricultural chemicals, forest fires and property fires, related to tobacco and smoking materials;%"N 55NNProvision of protection from involuntary exposure to tobacco smoke in indoor environments under the ministry's jurisdiction, in countries where this responsibility is assigned to the Ministry of the environment. %"N  X  Defence ministry 55A large number of young people are in the armed forces. The armed forces can contribute to comprehensive tobacco control by: 55NNpromoting the health and fitness of its personnel and minimizing its long term health costs by adopting policies that favour a smokefree life, such as:%"N 55NNprotection from involuntary exposure to tobacco smoke in all indoor locations;%"N 55NNrequiring that all tobacco products sold in military establishments be sold at a price at least as high as in adjoining nonmilitary areas, which could have the double benefit of not only reducing tobacco use but also preventing smuggling.%"N)-++Ԍ X ԙ Culture and sports ministries 55These ministries can provide support to comprehensive tobacco control policies by: 55NNUsing designated tobacco taxes to promote healthy lifestyles through sponsorship of sports and cultural events;%"N 55NNinsisting that events they sponsor be smokefree and free of all tobacco promotion;%"N 55NNprotecting athletes from being used to endorse tobacco products;%"N 55NNpromote prominent sports and cultural personalities as role models for healthy lifestyles, free from tobacco.%"N  X  Religion ministries 55Where present, religion ministries or religious groups can support tobacco control policies by: 55NNmarshalling support for tobacco control in religious communities;%"N 55NNensuring that places of worship are smokefree; 55NNencouraging religious leaders to serve as a rolemodel by refraining from 55NNsmoking.   X Other levels of government 55Some elements of tobacco control policies may be best administered by local governments. These could include: 55NNproviding protection from involuntary exposure to tobacco smoke in enclosed places under local jurisdiction;%"N 55NNenforcement of restrictions on sales of tobacco products to minors, limitation and regulation of points of retail sale of tobacco products;%"N 55NNsome aspects of health education about tobacco;%"N 55NNprovision of smoking cessation instruction;%"N 55NNcontrolling tobacco advertising.%"N )-++Ԍ55Where local governments can play an effective role in tobacco control, national health authorities should provide support and encouragement to them as they seek to contribute to overall tobacco control policies. Local governments can also adopt model tobacco control legislation, the successful elements of which may be introduced later on at the provincial or national level.  X.  The Media 55Although media can serve as a vehicle to promote tobacco, media can also effectively support tobacco control. Billboards, newspapers, magazines, radio and television can all be valuable means of disseminating important educational messages about the health hazards of tobacco use, and for reporting progress in implementing tobacco control programmes. 55Even if a legislated ban on advertising is not in effect, health forces can persuade newspapers to adopt editorial positions in favour of a ban on tobacco advertising. This strategy has been pursued with success in some countries. In many cases, the editorial position taken by newspapers in favour of a ban on advertising was accompanied by voluntary refusals (based on health and ethical issues as well as pressure from health organizations) to accept tobacco advertising. There are also some successful international publications that have along history of voluntarily refusing tobacco advertising. 55Although some media mistakenly believe that substantial revenue will be lost if they support tobacco control efforts, either through editorials or by refusing to accept tobacco advertisements, research indicates that this is not the case. Media can: 55NNChoose to not accept tobacco advertisements;%"N 55NNOffer, free of charge, public service promotional and educational messages about the hazards of tobacco use.%"N Opportunities for media collaboration should be explored. W! : 4 dd : At the suggestion of local WHO staff in Papua New Guinea, a local newspaper began publishing a periodic health supplement, sponsored by pharmaceutical companies. The supplement contained regular features on the hazards of tobacco control. Advertising revenue was sufficient for the production of advertisementfree versions of the supplement in both English and the local language. In this form, the government was happy to send it to community health workers throughout the country, for use with the local populations. Thus, collaboration between a newspaper and public health workers succeeded in providing information about the hazards of tobacco use to an entire country, at no monetary cost to WHO, the government or the media.W 0* -++"! 0Ԍ$%"%"%"%" !"$ԙ  X` NONGOVERNMENTAL ORGANIZATIONS  X  Health Organizations 55Health organizations, such as national heart, lung and cancer societies, along with antidrug and antitobacco groups play key roles in the development of comprehensive national tobacco control programmes. In some countries, these organizations have large numbers of members and supporters, and can play a prime role in collaborating with governments in offering health education and smoking cessation programmes in schools, health centres and other community settings. These groups also have potential for international collaboration. Health organizations play an important role in: 55NNSupplying information on tobacco and health issues to decision makers and the media;%"N 55NNLobbying governments to improve their tobacco control policies and programmes;%"N 55NNProviding support and encouragement to businesses and industries to become smokefree;%"N 55NNEncouraging the media and others to support the development of comprehensive tobacco control programmes at all levels of society.%"N0" -++"! 0 A!"e4 dd~  X #Xi\  P6ƒXP#INTERNATIONAL SOCIETY AND FEDERATION OF CARDIOLOGY Resolution regarding physicians and smoking  Xv  Whereas the International Society and Federation of Cardiology is dedicated to the prevention of cardiovascular disease throughout the world, in co-operation with its member cardiac societies and foundations. Tobacco smoking is identified as a major risk factor involved in the serious morbidity and mortality due to cardiovascular disease across the world. Physicians, and especially cardiologists, are ideally positioned to recognise the impact of tobacco on health, to serve as role models to their patients and to the public, and to pursue advocacy against tobacco with governmental organizations. Significant public health benefit and reduction in disease occurrence can be achieved by diminishing the prevalence of smoking.  X  Therefore, be it resolved that the International Society and Federation of Cardiology urges all its member societies and foundations to initiate or intensify vigorous efforts to persuade their membership to stop smoking, to promote non-smoking policies among their physician colleagues and other health professionals, including students of medicine and of the health professions, and to make health care sites, as well as all meetings in which those organizations are involved, smoke-free.  V  #Xh*f9 xr XX#Resolution adopted by the Executive Board of the International Society and Federation of Cardiology, 16 September 1995.$%"%"%"%"#A$"$  Xh$  Health professionals  X%  Introduction 55The advice and treatment given by health professionals can be a major factor in whether or not a person tries and succeeds in quitting smoking. Brief, opportunistic and consistent advice from a health professional to stop smoking has been identified as a0) -++$"e'A 0 leading strategy to reduce tobacco use. However, health professionals often do not even address the issue of tobacco, and when they do, it is discussed in a perfunctory manner. This problem is frequently compounded by high rates of tobacco use among the health professionals themselves. In these circumstances, it is even less likely that smoking cessation will be addressed. Obviously, the effectiveness of health advice about the dangers of smoking will be negated further if the patient observes the health professional smoking.  X Doctors 55 In developed countries, the majority of the population will visit a physician at least once a year, presenting strategic opportunities for the dispensation of effective antismoking counselling. Even in countries where there is less direct contact with physicians, physicians opinions on health questions are still valued and respected. However, in many countries, the rates of tobacco use among physicians are as high or even higher than rates among the general population. 55In response, groups such as the European Medical Association: Smoking or Health (EMASH), Doctors Ought to Care (DOC) in the United States, and Physicians for a Smokefree Canada (PSC) engage in some of these activities: 55NNwork to increase physicians' awareness of the health consequences of tobacco use, to discourage them from using tobacco;%"N 55NNpromote the effective use of appropriate interventions with patients to encourage and support cessation of smoking; %"N 55NNwork as advocates for improvements in national tobacco control policies. %"N   X!  Other international medical groups, such as the World Medical Association (WMA) and International Doctors against Tobacco (IDAT) can play a key role in tobacco control.  X%  Nurses 55Nurses account for the largest number of health professionals, and their counsel and example can have an important influence on the smoking behaviour of their patients. However, in some countries, smoking prevalence among nurses is about as high or) -++ higher than in the general population. Even in some countries where smoking prevalence is low among physicians, it is higher among nurses. Nurses can play a key role by serving as positive nonsmoking role models and actively counselling patients about smoking, including cessation.  Xt  Pharmacists 55In the countries where tobacco products are sold in pharmacies, pharmacists' professional organizations have actively been working to change this. However, success has been far from universal, and efforts should continue to restrict the sale of tobacco products in pharmacies. In connection with the sale of cessation aids, pharmacists can play an important role in instructing and counselling their customers.  X Dentists and other health professionals 55Dentists have a strong interest in tobacco control because they see the numerous oral and other health problems arising from tobacco use. They are preventionoriented; they can effectively give advice, especially to young people, about smoking prevention and smoking cessation. They, as well as other health professionals are in a key position to actively promote tobacco control measures, including advice to quit smoking. $"$"] 55Where possible, health professional societies should act collectively to provide support and encouragement for the establishment of comprehensive national tobacco control policies. Their effectiveness in this kind of community and political activity can be multiplied if the various health disciplines coordinate their activities with each other and with other voluntary organizations working toward tobacco control.  X Other voluntary organizations 55In many countries, other voluntary organizations including service clubs, youth groups, consumer groups, environmental groups, women's organizations, and religious organizations have been willing to lend their support to the development of comprehensive national tobacco control programmes. For example, in many countries, youth groups have actively participated in the organization and execution of celebrations of World NoTobacco Day. Some religious groups also take a strong interest in tobacco control activities. Notably, the SeventhDay Adventists, a Christian group, also offersC* -++ smoking cessation courses in a number of countries. In Malaysia, the Islamic Medical Association in Malaysia is active in tobacco control. Smoking is strongly proscribed by the Sikh and other religions.  Xt  Teaching and helping professions 55Members of the teaching and helping professions, including educators and social workers, may also play a role in tobacco control. They can set an example of nonsmoking as the social norm. These organizations can also lend their support to other groups calling for general improvement in national tobacco control policies. Teachers can advocate for smokefree schools as well as more effective and more frequent school X based smoking prevention programmes.  X\ Lawyers 55Lawyers can be particularly valuable since laws are such an essential part of effective tobacco control. Lawyers can advocate for legislative changes, help in the drafting and amendment of laws, respond to tobacco industry arguments and monitor the enforcement of existing laws. They can also assist efforts to apply general laws (eg. consumer protection, packaging, advertising) to tobacco products. The role of lawyers has increased in importance in recent years as protobacco forces try to fight public health measures by using complicated legal arguments based on such things as constitutionality or international trade agreements. Local legal experts, or those available through international organizations, can usually respond to the alleged problems and prevent the delay, weakening or termination of the health measures. 55Lawsuits against tobacco companies have received increasing attention in a number of countries. This is an important development for tobacco control and it can attain significant results, both in terms of eventual outcomes and in terms of the information made public as a result of these cases. At the same time litigation against tobacco companies can also be an expensive and timeconsuming exercise. For most countries it is often better to concentrate legal resources on the development of legislative interventions, or in litigation directed towards issues such as smokefree spaces, bans of tobacco advertising, and the application of existing laws.C*-++Ԍ X  ÙBusiness, Industry, and Labour Unions 55The problem of involuntary exposure to tobacco smoke in the workplace is one that touches virtually all sectors of business and industry, and all sectors can contribute to its solution. Government ministries could establish regulations to provide protection from passive smoking. Yet, rather than waiting for these to come about, businesses and industries are welladvised to implement smoking control policies of their own. Unions, with a history of concern for the health and safety of the workers, have a natural role in this area. These policies can be implemented in a way that does not compromise their profits or interests. Government could then benefit from the experience of businesses' and industries' smokingcontrol policies, and the government regulations, once imposed, are likely to be more relevant for the population they are meant to serve. Finally, as some recent jurisprudence has made clear, employers who fail to provide sufficient protection to their workers from involuntary exposure to tobacco smoke may be liable for damages that courts could oblige employers to pay to employees who are harmed or feel aggrieved by the presence of tobacco smoke in the workplace. 55Some business sectors, such as drug companies developing pharmaceutical aids to smoking cessation can be expected to support tobacco control measures. Increasingly, large sectors of industry are recognizing the benefits of a smokefree workplace and offering assistance with quitting smoking. In many countries, life insurance companies, on the basis of actuarial calculations offer much lower premiums for life insurance to nonsmokers.  X[  B. OPPOSITION TO NATIONAL TOBACCO CONTROL PROGRAMMES  X  55Attempts to implement such policies are likely to encounter opposition from the tobacco industry, and it allies, encompassing those who receive financial benefit, directly or indirectly, from the tobacco industry. The tobacco manufacturing industry maintains a web of supporters among its suppliers and clients, such as tobacco growers, packaging suppliers, its advertising firms, the media which accept tobacco advertising, and wholesalers and retailers. In South Asia, for example, this web of affiliation extends to the industries involved in the growing and processing of temburni (used to wrap bidis, the most popular smoking product in India) and betel nuts and leaves (used inC*-++ conjunction with a wide variety of chewing tobacco products in India). 55In addition to the sectors that do business with tobacco companies, many others have developed some dependence on the tobacco industry, either because they have been purchased by tobacco companies in diversification strategies, or because their sports or cultural pursuits have benefited from tobacco sponsorship. 55The financial power of the tobacco industry is considerable. For example, the diversified company that owns the world's largest commercial tobacco company had operating revenues of US$ 65 thousand million in 1994, approximately equal to the Gross National Product of Portugal or Israel. With large financial resources at its disposal, the tobacco industry can exert considerable influence to defeat or retard tobacco control measures. 55It is important to understand the nature of the tobacco industry and its allies, the nature of the opposition that is likely to be mounted against comprehensive tobacco control measures, and to plan accordingly. Some specific techniques to counter arguments from tobacco interests are discussed in Chapter III. 55In order to overcome the opposition to comprehensive tobacco control strategies, it is possible to use techniques and arguments which have proven successful around the world. This information is often easily obtainable. It will also be important to be able to critically evaluate available information for its accuracy. In particular, it would be unwise to accept information from tobacco interests without careful analysis for veracity, quality of documentation, and possible biases. It should also be assumed that information distributed by health interests will be subject to careful scrutiny and challenge by tobacco interests. Therefore, the preparation of an information base that is accurate, scientifically sound and welldocumented can be extremely useful. C*-++Ԍ X C.55TOBACCO IS EVERYBODY'S PROBLEM %"5 55A large proportion of people smoke themselves and are therefore at risk of developing tobaccorelated diseases. Those who do not smoke will inevitably have colleagues, friends or relatives who do, and they are therefore at risk of prematurely losing a friend or relative to a tobaccorelated disease. The preventable premature death of millions of welltrained and wellexperienced people in their most productive middle years of life is a collective loss that transcends national boundaries. In addition, many nonsmokers suffer some degree of involuntary exposure to tobacco smoke, and are also at risk of developing tobaccocaused diseases. It is not surprising, therefore, that such a broadlybased problem requires broadlybased solutions, involving many sectors of society.  X\  CONCLUSION: KEY ISSUES IN GATHERING SUPPORT FOR  XE COMPREHENSIVE TOBACCO CONTROL 55The following are some of the groups or institutions whose support will be useful in working toward comprehensive tobacco control policies and programmes:  Government ministries  Other levels of government  The media  Health organizations and health professionals  Other voluntary organizations  Other professions, including lawyers, educators, and religious leaders