Tobacco control policy: the European dimension

Memoranda of understanding: a tobacco industry strategy to undermine illicit tobacco trade policies

OBJECTIVE

Analyse the transnational tobacco companies' (TTCs) memoranda of understanding (MoUs) on illicit trade and how they could undermine the WHO Framework Convention on Tobacco Control (FCTC) and the Protocol to Eliminate Illicit Trade in Tobacco Products (Protocol).

METHODS

Review of tobacco industry documents and websites, reports, news and media items using standard snowball search methods.

RESULTS

Facing increasing pressure from governments and the FCTC to address illicit tobacco trade during the late 1990s, TTCs entered into voluntary partnerships embodied in MoUs with governments' law enforcement and customs agencies. One of the earliest known MoUs was between Philip Morris International and Italy in 1999. TTCs agreed among themselves to establish MoUs individually but use the Italian MoU as a basis to establish similar connections with other governments to pre-empt more stringent regulation of illicit trade. TTCs report to have signed over 100 MoUs since 1999, and promote them on their websites, in Corporate Social Responsibility reports and in the media as important partnerships to combat illicit tobacco trade. There is no evidence to support TTCs' claims that these MoUs reduce illicit trade. The terms of these MoUs are rarely made public. MoUs are non-transparent partnerships between government agencies and TTCs, violating FCTC Article 5.3 and the Protocol. MoUs are not legally binding so do not create an accountability system or penalties for non-compliance, rendering them ineffective at controlling illicit trade.

CONCLUSION

Governments should reject TTC partnerships through MoUs and instead ratify and implement the FCTC and the Protocol to effectively address illicit trade in tobacco products.

The impact of Thatcherism on health and well-being in Britain

Margaret Thatcher (1925-2013) was the United Kingdom's prime minister from 1979 to 1990. Her informal transatlantic alliance with U.S. President Ronald Reagan from 1981 to 1989 played an important role in the promotion of an international neoliberal policy agenda that remains influential today. Her critique of UK social democracy during the 1970s and her adoption of key neoliberal strategies, such as financial deregulation, trade liberalization, and the privatization of public goods and services, were popularly labeled Thatcherism. In this article, we consider the nature of Thatcherism and its impact on health and well-being during her period as prime minister and, to a lesser extent, in the years that follow; we focus mainly on Great Britain (England, Scotland, and Wales). Thatcher's policies were associated with substantial increases in socioeconomic and health inequalities: these issues were actively marginalized and ignored by her governments. In addition, her public-sector reforms applied business principles to the welfare state and prepared the National Health Service for subsequent privatization.

Health law and policy in the European Union

From its origins as six western European countries coming together to reduce trade barriers, the European Union (EU) has expanded, both geographically and in the scope of its actions, to become an important supranational body whose policies affect almost all aspects of the lives of its citizens. This influence extends to health and health services. The EU's formal responsibilities in health and health services are limited in scope, but, it has substantial indirect influence on them. In this paper, we describe the institutions of the EU, its legislative process, and the nature of European law as it affects free movement of the goods, people, and services that affect health or are necessary to deliver health care. We show how the influence of the EU goes far beyond the activities that are most visible to health professionals, such as research funding and public health programmes, and involves an extensive body of legislation that affects almost every aspect of health and health care.

Multilevel Governance and Shared Sovereignty: European Union, Member States, and the FCTC

The Westphalian idea of sovereignty in international relations has undergone recent transformation. "Shared sovereignty" through multilevel governance describes the responsibility of the European Union (EU) and its Member States in tobacco control policy. We examine how this has occurred on the EU level through directives and recommendations, accession rules for new members, tobacco control campaigns, and financial support for antitobacco nongovernmental organizations. In particular, the negotiation and ratification of the Framework Convention on Tobacco Control (FCTC) and the participation in the FCTC Conference of the Parties illustrates shared sovereignty. The EU Commission was the lead negotiator for Member States on issues over which it had jurisdiction, while individual Member States, through the EU presidency, could negotiate on issues on which authority was divided or remained with them. Shared sovereignty through multilevel governance has become the norm in the tobacco control policy area for EU members, including having one international organization negotiate within the context of another.

Tobacco industry influence on science and scientists in Germany

Using tobacco industry documents, we examined how and why the tobacco industry sought to influence science and scientists in Germany as a possible factor in explaining the German opposition to stricter tobacco regulation. Smoking and health research programs were organized both separately by individual tobacco companies and jointly through their German trade organization. An extensive network of scientists and scientific institutions with tobacco industry links was developed. Science was distorted in 5 ways: suppression, dilution, distraction, concealment, and manipulation. The extent of tobacco industry influence over the scientific establishment in Germany is profound. The industry introduced serious bias that probably influenced scientific and public opinion in Germany. This influence likely undermined efforts to control tobacco use.

Korean male smokers' perceptions of tobacco control policies in the United States

The purpose of this secondary data analysis is to report Korean male smokers' perceptions of tobacco control policies in the United States. Descriptive data from four focus groups held in New York City in 2003 are presented. Focus group interviews were used to collect data, and the two investigators independently analyzed all four recorded group sessions. Korean male immigrants living in New York City area were recruited, and 22 volunteered to participate. Exclusion criteria included immigration to the United States before age 12, no smoking history, and use of chemical substance other than tobacco. Korean men differed in perceptions of the policies based on smoking status and length of U.S. residency. Among current smokers, recent immigrants had difficulty understanding smoking restrictions, whereas longtime residents complained of price increases. Both groups suggested that policies target the tobacco industry and do not target smokers. In contrast, former smokers supported more regulation of public smoking and suggested use of more aggressive antismoking campaigns. Public policymakers should take into consideration cultural attitudes and beliefs about smoking behavior in the design and implementation of tobacco control policies that affect ethnic groups whose cultural and value orientations may differ from the mainstream.

Health impact assessment: assessing opportunities and barriers to intersectoral health improvement in an expanded European Union

On 1 May 2004 the European Union (EU) underwent unprecedented enlargement, from 15 to 25 countries, increasing its population by 20% to over 450 million. Although EU law has limited specific competence in the area of health, its influence on other policy sectors such as agriculture, trade, and employment has wide ranging implications for health. Yet with the exception of provisions on communicable disease control and food safety, public health considerations have played little part in negotiations on EU accession. This paper argues for an intersectoral public health approach in the expanded EU. It reviews the legal basis for assessing the health impacts of policy in the EU and, using health impact assessment as a case study, it examines how well the new member states may be prepared to tackle intersectoral public health action within the constraints imposed by EU policy.

Awareness and use of smoking cessation treatments among diabetic patients

AIMS

To investigate awareness of pharmacotherapeutic aids to smoking cessation in diabetic cigarette smokers.

METHODS

A structured questionnaire-based interview was held by a research nurse individually with consecutively attending cigarette smokers.

RESULTS

Of 597 diabetic patients attending a routine clinic, 100 (17%) were current cigarette smokers. Mean (+/-sd) age was 58+/-11 years, 58% were male, and 96% Type 2 diabetic patients. Mean daily cigarette consumption was 16/day, for a mean duration of 35 years. There were 34% who had never heard of nicotine replacement therapy (NRT), and of those who had, only 49% considered it safe with diabetes. Bupropion (Zyban) was unknown to 46%, and of those who knew of it, 39% thought it unsafe in diabetic patients. Only 31% of the group had been previously offered NRT, and 14% bupropion. The NHS Quitline was known of by 84%, but only 8% had used it.

CONCLUSIONS

Cigarette smokers with diabetes have poor uptake, awareness and knowledge of NRT and bupropion as aids to smoking cessation. They comprise a high-risk group, for large and small vessel disease, and these findings are therefore of concern. More active education and support for these patients by medical and nursing staff is needed.