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Contents
03
Introduction
05
Selling smoke: the business of deceit
07
Big Tobacco’s 7 deadly Ds
15
Blowing the smoke away
20
Global Smokefree Map
22
Africa
25
Americas
30
Eastern Mediterranean
32
Europe
40
South East Asia
42
Western Pacific
46
References
The Global Smokefree Partnership is a multipartner ini- For more information on smokefree air:
tiative formed to promote effective smokefree air policies
www.globalsmokefreepartnership.org
worldwide. The Partnership helps practitioners and advocates of smokefree policies to:
email: info@globalsmokefreepartnership.org
• access the evidence for smokefree policies
• request assistance from a network of experts
• take action in support of smokefree policies
The Partnership would also like to thank Corporate Accountability International for assistance with this report
and for its ongoing monitoring of Big Tobacco’s abusive
tactics around the world.
The Partnership is hosted by the American Cancer Soci- For more information on tobacco industry attempts to
ety and the Framework Convention Alliance. The partners undermine health policy, or to join Corporate Accountare:
ability International’s campaign to protect the global tobacco treaty against tobacco industry interference, visit
Action on Smoking and Health - DC
www.StopCorporateAbuse.org
Action on Smoking and Health London
Americans for Nonsmokers’ Rights
Campaign for Tobacco-Free Kids
Cancer Research UK
HealthBridge India
International Union Against Cancer
International Union Against Tuberculosis and Lung Disease
Johnson and Johnson
Johns Hopkins Bloomberg School of Public Health
global smokefree
partnership
Pfizer
Director: Cassandra Welch
Project Manager: Antonella Cardone
Promoting Action for Smokefree Environments (APALTA) Project Co-ordinator: Ami Valdemoro
Report Writer: Tanith Muller
Roswell Park Cancer Institute
Report Design and layout: Pixel Entropy, Naples, Italy
Smokefree Partnership Europe
Southeast Asia Tobacco Control Alliance
World Heart Federation
World Lung Foundation
Suggested Citation: Global Smokefree Partnership (2009) Global Voices
Report: Rebutting the Tobacco Industry, winning smokefree air, 2009 Status Report.
© Global Smokefree Partnership 2009
Introduction
In mid 2009, more than 400 million people are protected by comprehensive smokefree laws. These are the strongest smokefree laws, which do not
allow any designated smoking rooms and include only extremely limited
exemptions. A further 500 million people are covered by strong smokefree
laws. These laws protect most people, most of the time. Overall, close to a
billion people in some 44 countries now have local or national regulations
protecting them from secondhand smoke in most enclosed public places
and workplaces. We expect to see continuing progress in the year ahead, as
more and more countries prepare to take action.
Smokefree air
defining the terms
Smokefree air for all
Strong law: limited hospitality exemptions such as cigar lounges, or with
DSRs allowed.
This rapid progress is delivering smokefree air to people in countries around
the globe. Policies are being implemented successfully in a variety of places
- in low income nations and more affluent ones, in small localities, major
cities, and vast countries. Despite the wide variation in countries covered by
smokefree laws, their experiences are very similar. In country after country:
• smokefree laws are good for health
In this report, the following definitions
are used:
Comprehensive law: no exemptions,
or with exemptions limited to residential and quasi-residential premises.
Does not allow Designated Smoking
Rooms (DSRs) and/or ventilation.
Effective law: comprehensive or strong
legislation
National law: covers whole country
Local law: covers regions, states or cities
• most people support smokefree laws
• with proper planning and resources, enforcement is straightforward
• hospitality sector profits and jobs remain safe
The message is clearer than ever: smokefree air works.
Focus on low and middle income countries
Global Voices Status Report 2009
Photo: Per Foreby
However, there is a long way to go. Despite the rapid progress, more than
85% of the world’s people remain without meaningful protection from secondhand smoke, many of them in the low and middle income countries that
will bear the brunt of the global tobacco epidemic. Clear tobacco control
policies are urgently needed.Without them, tobacco related illness, disability
and death will cost low and middle income countries dearly. Smokefree air
laws must be a priority for low and middle income countries.
globalsmokefree
partnership
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The target: a smokefree world by 2012
Governments must continue to act,
if they are to meet the goal of protecting everyone from secondhand
smoke by 2012.
Most countries will need to considerably strengthen their existing
smoking restrictions in order to
meet this target, which was unanimously agreed by Governments July
2007.1 The Framework Convention
on Tobacco Control (FCTC) guidelines on protection from exposure to
tobacco smoke state that smokefree
laws must:
• cover all enclosed public places,
workplace and public transport
without exemptions
• include other places as appropriate
Big Tobacco’s dirty tricks
• avoid designated smoking rooms, The biggest barrier to smokefree air is the multinational tobacco companies
ineffective ventilation and air fil- who stand to lose billions of dollars if smokefree laws are implemented.
tration schemes
From fake “science” to buying influence, and from scare stories to coverups, tobacco companies continue to devote their considerable wealth to
stopping smokefree laws in every region of the world.
This report details the tobacco industry’s tactics to hold back legislation,
alongside the positive impact of governments, organizations and individuals
who are taking on Big Tobacco, and winning.
In late 2008, world governments agreed to a series of FCTC guidelines
based on the recognition that tobacco company interests are fundamentally incompatible with health, welfare or “good causes.”2 These guidelines
outline governments’ responsibilities under Article 5.3 of the FCTC on
tobacco industry interference. They are expressly designed to stop Big Tobacco’s dirty tricks. The guidelines are essential to winning the battle for
smokefree air.
4
Introduction
Introducing Big Tobacco Global Cigarette
Tobacco is big business. And it is
Market Share, 2007
manufactured and sold by some of
the biggest businesses in the world.
The global tobacco market is valued
at $378 billion.3 If Big Tobacco were
a country, it would have the 23rdlargest gross domestic product in the
world, making it richer than Norway and Saudi Arabia.4
Cigarettes account for some 92% of
the value of the global tobacco market.5
Others 15.8%6
Imperial/ Altadis 5.6%
China National Tobacco
Corporation 32%
Philip Morris 18.7%
Japan Tobacco
International 10.8%
British American
Tobacco 17.1 %
More than eight in every ten cigarettes sold worldwide are made by
just five companies. All but one of
these companies have their headquarters in rich countries, like the
United States, United Kingdom,
Japan, France and Spain – but their
key markets are low and middle income countries where the majority
of the world’s smokers live.
Money over health: the death dividend
In 2008 an estimated 5.4 million people died as a result
of tobacco use, and millions more suffered serious disability. At least one in every two smokers will lose their
life because of tobacco.
ble step to ensure that they recruit and retain addicted
smokers to maximize their profits. The tobacco market
is projected to grow by nearly 5% each year to 2012.7
If we do nothing to stop Big Tobacco, the death toll will
Nonetheless, the tobacco industry takes every possi- rise to 8.3 million people each year by 2030.8
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The death dividend in 2007
Global tobacco industry sales:
US$ 378 billion a year
Number of deaths per year:
5.4 million
Tobacco industry revenues per death:
US$ 69 thousand
Why does the tobacco industry
oppose smokefree laws?
In addition to protecting people from the deadly impact
of secondhand smoke, smokefree laws encourage smokers to quit or reduce their consumption. They can stop
children and young people from starting to smoke or
becoming addicted smokers.They send a strong message
that smoking is socially unacceptable. All of this reduces
profits.
Internal tobacco industry documents reveal the tobacco
industry’s own scientists had established that secondhand
smoke was harmful to health in the 1970s. The tobacco
companies identified public concern about secondhand
smoke as a major threat to their business. Rather than
protecting people’s health, the tobacco industry focused
on protecting its profits.
Secondhand smoke – the view from the boardroom
“Let’s face it. We are interested in evidence which we believe denies the allegation that cigaret(te) smoking causes
disease” Philip Morris, 19709
“Passive smoking is the most dangerous development to the
viability of the tobacco industry that has yet occurred”. (advice to the US Tobacco Institute, 1978)10
“What do these health claims, the heightened public sentiment for smoking restrictions …mean for this industry?
Lower sales, of course.” US Tobacco Institute, 198511
“(The) financial impact of smoking bans will be tremendous…. Three to five fewer cigarettes per day per smoker
will reduce annual manufacturers’ profits a billion dollars
plus per year” Philip Morris, 199512
6
Big Tobacco’s 7 deadly D’s
Denial, Deceit, Distraction, Diversion, Decoys, Dire Predictions, Delay
1. Denial
2. Deceit
Denying the evidence on
secondhand smoke
Secret programs to subvert
science
Tobacco industry scientists established that secondhand
smoke was dangerous in the 1970s.13 In the 1980s, Philip Morris scientists conducted a series of secret experiments on sidestream smoke, which found that it is more
toxic than the mainstream smoke inhaled by smokers.14
In spite of what the industry knew, tobacco companies have consistently denied that secondhand smoke is
harmful to health.
Internal tobacco industry documents reveal that Big
Tobacco:
• secretly paid scientists and doctors to publish research suggesting that secondhand smoke is not
harmful, despite the fact that this was at odds with
its own confidential research17
• changed study findings on the advice of PR and legal teams11 19
Worldwide, Big Tobacco spent millions of dollars on PR
and scienstrategies to cover up the truth.15 16 There is no reason • recruited consultants on leading medical
20
tific
journals
to
influence
content
to believe that the industry has changed its behaviour,
and new evidence of tobacco industry interference is • infiltrated the WHO International Agency for Reemerging all the time.
search on Cancer, to influence and pre-empt its
findings on secondhand smoke21 22
• undermined institutions and attacked researchers
working on secondhand smoke and health23 24 25 26
27 28
In the 1980s, the tobacco industry developed the “International ETS Consultants Program” to “keep the
controversy alive” on secondhand smoke. It recruited
doctors and scientists to develop and promote tobacco
industry viewpoints in Europe, Asia29 and Latin America.30
Research funded by the tobacco industry is 90 times
more likely to conclude that secondhand smoke is not
harmful than independent research.31
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“The debate is over”
3 decades of expert conclusions on secondhand smoke
The tobacco industry spent millions of dollars to undermine the health evidence on secondhand smoke.
Here are some of the expert reviews that Big Tobacco sought to discredit.
Year
Expert Body
Conclusions
1982
US Surgeon General
Secondhand smoke is a “possible serious public health problem.”32
1986
The International Agency for
Research on Cancer (IARC)
Exposure to secondhand smoke increases the risk of lung cancer.33
34 35
US Surgeon General
Australian National Health and
Medical Research Council
1988
UK Independent Scientific Committee on Smoking and Health
Further publicity of the link between secondhand smoke and lung cancer is
needed.36
1992
US Environmental Protection
Agency (EPA)
Secondhand tobacco smoke is a Group A (known human) carcinogen.37
1997
Australian National Health and
Medical Research Council
Secondhand smoke “causes lower respiratory illness in children and lung cancer
in adults and contributes to the symptoms of asthma in children. … may also
cause coronary heart disease in adults.”38
1998
UK Scientific Committee on Tobacco and Health
Secondhand smoke is a “cause of ischaemic heart diseases” with current research suggesting it is “a substantial public health hazard.”39
1999
WHO
Secondhand smoke is “a real and substantial threat to child health, causing death
and suffering throughout the world.”40
2002
International Agency for Research on Cancer (IARC)
Secondhand smoke is a cause of lung cancer in humans.41
Irish Health and Safety Authority
“Legislative measures are … required to protect workers from the adverse health
effects of ETS exposure.”42
2004
International Agency for Research on Cancer (IARC)
Secondhand smoke increases the risk of lung cancer by 20-30% and heart attacks
by 25-35%43
2006
US Surgeon General
“There is no safe level of exposure to secondhand smoke”44
“The scientific evidence is now indisputable”45
8
Big Tobacco’s 7 deadly D’s: Denial, Deceit, Distraction, Diversion, Decoys, Dire Predictions, Delay
3: Distraction
Promoting Rival Problems
The tobacco industry has promoted a range of alternative health hazards to
divert the public and policy makers from taking action on secondhand smoke.
These include:
• “Sick building syndrome
• Keeping pet birds
• External air pollution, such as vehicle exhaust fumes
4: Diversion
Proposing ineffective alternatives
The tobacco industry’s opposition to comprehensive smokefree laws includes the offer of alternative proposals. These divert policy makers from
effective legislation. Big Tobacco’s diversionary tactics can include proposals
for voluntary regulation, or weak laws with many exemptions.
Voluntary codes cannot deliver clean air. Only countries with comprehensive smokefree legislation have eradicated secondhand smoke in all enclosed
workplaces and public places.
In the UK, after more than five years of a voluntary code, the majority of bars
did not comply with the scheme. Staff and customers were exposed to secondhand smoke in more than 99% of bars and in the majority of restaurants.50
Earlier this year, BAT Egypt agreed to a non-binding memorandum of understanding with the Governor of South Sinai. Under the agreement, there
will be separate seating for smokers and nonsmokers, and training for staff.51
This voluntary scheme will not protect people from secondhand smoke.
Tobacco industry-funded “accommodation” schemes, such as “Courtesy of
Choice” and “Living in Harmony” have been rolled out worldwide. They
aim to promote “tolerance” and “good manners”, and involve smoking and
non-smoking areas or separate rooms.
The tobacco industry and “Sick
Building Syndrome”
Sick Building Syndrome describes incidents of acute illness and discomfort
that appear to be linked to time spent
in a specific building. Tobacco companies bankrolled “expert organizations”
and consultants, which sought to minimise the role of secondhand smoke
in poor indoor air quality. These bodies
claimed that other chemicals in building materials, carpets and furniture
were responsible for health symptoms
and aggressively promoted ventilation
and air cleaning technology ahead of
smokefree buildings.46
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“Sick as a parrot” – blaming birds
Industry documents show that tobacco
industry consultants were involved
with research suggesting that keeping
pet birds was an independent risk factor for lung cancer. 47 48 49 This research
was part of the tobacco industry’s efforts to minimise secondhand smoke
as a cause of lung cancer.
Studies have shown that non-smoking areas including separate non-smoking rooms make little or no difference to workers’ exposure to secondhand
smoke.52 53
The tobacco industry aggressively promotes ventilation and air filtration
technologies as an alternative to smokefree laws, despite knowing that they
do not make smoky air safe.54 55
Studies have shown that filtered smoke is as carcinogenic as unfiltered
smoke,56 and that ventilation technology cannot remove the harmful constituents of secondhand smoke from the air.57 58
Bodies including the WHO,59 EU,60 US Surgeon General,61 and the international standard-setting body on ventilation and air conditioning
(ASHRAE)62 63 have examined the scientific evidence. They conclude that:
• ventilation and other air filtration technologies do not work
• the only effective way to eliminate the health risks caused by secondhand smoke is to make all indoor places entirely smokefree.
There is also evidence of the tobacco industry backing weak laws in order
to block more effective legislation from being introduced.
Accommodation strategies –
costly, ineffective, unlawful
“Accommodation” strategies do not
protect workers’ health.
Designated smoking rooms (DSRs)
and ventilation systems create an uneven playing field. Big businesses have
the space and money to install and
maintain them, but they are prohibitively expensive or impractical for smaller
establishments.
In Canada, laws allowing DSRs have
been overturned on the grounds of unfair competition.64 In Berlin, small bar
owners successfully argued that because smoking areas were allowed in
larger premises, the law discriminated
against them, and it was overturned.65
10
In Ecuador, Philip Morris pursued a sophisticated strategy to block comprehensive smokefree regulations, by supporting ineffective tobacco control legislation
instead.66 In Germany in 2007, attempts to draft a comprehensive national
smokefree law were hijacked by the tobacco industry – substantially weakening
the proposals. The legislation was subsequently dropped altogether.67
5: Decoys
Making friends and influencing people
“Sometimes we will need to speak as independent scientists, scientific groups and
businessmen; at other times we will talk as the industry; and, finally, we will speak
as the smoker.” Philip Morris, 198968
The tobacco industry works with a range of other groups to pursue its
interests. Tobacco company involvement is often secret, and evidence of
tobacco industry involvement may only emerge afterwards.
Media
Journalists are crucial allies in Big Tobacco’s propaganda war.
Fighting back – convincing
journalists
The industry has spent billions of dollars worldwide on funding think tanks,
securing the services of high profile columnists, and operating seminars
and training opportunities for journalists.69 70 In the USA, Philip Morris
funded the National Journalism Center (NJC). This created a generation of
journalists willing to run stories sympathetic to the industry.71 In Nigeria,
BAT runs an annual competition for journalists covering the company, and
has also hosted lavish meetings for media executives and journalists, who
received gifts to attend.72
In Mexico, there was a great deal of media coverage of the country’s smokefree
law before it came into force. Analysis
of the articles showed that only 10%
of the coverage was negative about the
new law. This shows that journalists
will be convinced by the arguments for
smokefree places law, making them
essential allies for pro-health groups.73
Politicians and government officials
Fighting Back – Politicians
fighting for health
Cultivating relationships with politicians and officials has helped the tobacco industry to resist effective smokefree laws.
In Zambia, BAT is using its close relationship with a Government Minister
to shape the country’s smokefree law. At a recent BAT-sponsored event,
the Minister announced her support for smoking zones, which were not
included in the legislation.74
In New Zealand, tobacco companies briefed a core group of legislators
about secondhand smoke, to oppose legislation. They failed to weaken or
stop the country’s comprehensive smokefree law.75
Business Groups
Partnering with other business interests is a key tobacco industry strategy.
These can include trade associations such as tobacco retailers and manufacturers, the gaming industry, hospitality organizations, investors and business
lobbying groups. These groups can voice tobacco industry arguments while
maintaining the illusion of independence.
Charities and good causes
The tobacco industry supports good causes to distract attention from the
debate on secondhand smoke,77 78 or to position themselves favourably with
lawmakers and the public.79
In China, BAT funded a liver disease charity from its inception in 1997 to
at least 2002. The charity was used to divert attention away from smoking
and health and towards liver disease. It created an indirect channel for comGlobal Voices Status Report 2009
In many jurisdictions smokefree laws,
politicians have stood up to tobacco
company interests and fought for
health.
In March 2006, President Tabaré Vázquez of Uruguay implemented a decree
to make the country entirely smokefree,
the first country in Latin America to do
so. President Vázquez was previously a
cancer doctor, and has described himself as “a man of science in governmental duty.” His story demonstrates that
the tobacco industry doesn’t always get
things all its own way.
Fighting Back – Separating Big
Tobacco from its allies
In England, the tobacco industry had
allied itself with hospitality industry
groups, following a strategy that had
worked in other countries. However,
NGOs led by ASH (Action on Smoking
and Health) exposed the differences
between the tobacco industry’s interests and those of the hospitality industry. The British Hospitality Association
came to support the smokefree law.76
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munication with the Chinese Ministry of Health, and sought to influence
Government health policy away from tobacco. Crucially, BAT also used the
charity’s website as a vehicle for disseminating its papers showing that secondhand smoke is not harmful to health.80
In December 2008, the Chinese Government sent a strong message the tobacco industry “philanthropy” should not
be rewarded. The Government acted to
withdraw its nomination to state-owned
tobacco companies for their charitable
work. This is an important recognition
that tobacco interests are fundamentally at odds with good causes.82
Indian tobacco company Godfrey Phillips sponsors an annual competition
to identify and reward copurageous citizens in an annual competition to
publicise the company’s “corporate social responsibility”.81
Photo: Kafka4Prez
Fighting Back – Chinese
Government withdraws tobacco
company charity award
nomination
Smokers’ Rights Groups
Smokers’ rights groups claim to be grassroots organizations, representing
individual smokers. Tobacco industry documents show financial links to
smokers’ rights groups in at least 26 countries outside North America, including the UK, Sweden, Australia, Japan, Hong Kong, France, Germany,
Greece, Ecuador, Guatemala and the Philippines.83
Freedom Organization for the Right to Enjoy Smoking Tobacco (FOREST)
was established in the UK in 1979. Internal tobacco industry documents show
that the tobacco industry has influenced decisions and controlled budgets.84
In 2000, 96% of FOREST’s funding came from the tobacco industry.85
Organized labor
Fighting Back – Unions
advocating for clean air
Smokefree laws protect workers’ health,
and a number of unions have been active in pursuing smokefree air. In the
USA, unions representing Flight Attendants were instrumental in achieving
laws to make domestic flights smokefree.89 In Ireland, the union representing
bar workers, argued that a smokefree
law was needed to protect its members
from the health effects of secondhand
smoke. In France and Sweden, hospitality unions played a similar role.
12
Job losses in the tobacco industry are driven by tobacco company practices
such as mechanization and privatization and not health policy.86 Despite this
evidence, tobacco workers’ unions have traditionally argued against tobacco
control measures on the basis that they will put their members’ jobs at risk.
Internal tobacco industry documents also show that the industry built
broader coalitions within the trade union movement. For example, the US
Tobacco Institute funded a coalition with the labor movement to fight
against smokefree workplace policies, for sixteen years until 2000.87 88
6: Dire Predictions
The Tobacco Industry’s scare tactics
Big Tobacco’s response to the threat of smokefree laws is the same the world over.
By predicting terrible consequences of regulating secondhand smoke, the industry hopes to frighten governments and the public from taking effective action.
However, as more and more jurisdictions implement smokefree laws with
few or no problems, tobacco industry scaremongering is becoming harder
to sustain, and easier to expose.
Compliance with smokefree laws
Ireland
94%105
Dire Prediction: “Hospitality profits and jobs will plummet”
Experience shows: No negative economic impact
Ottawa, CA
95%106
New York City, USA
97%107
New Zealand
97%108
Massachusetts, USA
96%109
Robust independent studies have repeatedly shown that smokefree laws do not
have a negative economic impact on the hospitality or tourism industries.91 92 93
Norway
97%110
In some jurisdictions,94 smokefree laws have increased hospitality industry profits.
Italy
98.5%111
• In the US, the sale values of restaurants increased,95 and there was no
change in the values of bar businesses96 after smokefree laws
Scotland
96%112
• Tasmania,97 Norway98 and Massachusetts,99 among others have adopted
smokefree legislation without significant job losses. In Minnesota, comprehensive laws led to an increase in bar and restaurant workers100
Wales
98%113
England
98%114
• The economic benefits of smokefree legislation are greater than any
costs associated with implementation and enforcement.101
Sweden
99.1%115
“The economic arguments often used by the [tobacco] industry to scare off smoking
ban activity … simply had no credibility with the public, which isn’t surprising when
you consider our dire predictions in the past rarely came true.” Philip Morris, 199490
Dire Prediction: “Making it work is mission impossible”
Experience shows: implementation and enforcement strategies support
high compliance
The tobacco industry argues that smokefree laws are hard to implement and
impossible to enforce.
In country after country, the overwhelming majority of smokers and businesses
obey the law. With effective implementation and enforcement strategies, compliance rates exceed 90%. Over time, these laws are largely self-enforcing.
Changing Public Opinion
Ireland121
59% (2003)
Italy
83% (2001)
94% (2006)
New Zealand123
61% (2004)
Dire Prediction: “Prepare to lose popularity contests”
Experience shows: People love smokefree laws
Sweden
The tobacco industry argues that smokefree laws will be unpopular. Tobacco companies know that this is untrue. Philip Morris poll data from 1989
showed that smokefree policies enjoyed strong public support in Europe
and the US.116
France126
93% (2005)
122
82% (2006)
124 125
85% (2005)
90% (2006)
70% (2007)
85% (2008)
% support before the law
% support after the law
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Making savings from smokefree laws
In the real world, smokefree laws save money.
Employers gain because:
• productivity increases because workers take fewer smoking breaks
• workers take less sick leave
• fire risks are significantly reduced
• cleaning and redecoration costs are lower102
There are also big savings for healthcare systems:
• Smokefree workplaces have saved about US $5bn a year
in medical costs and the indirect costs associated with
disability
• In New York, a reduction in heart attacks after the law
came in saved $56million in direct medical costs
However, continued exposure to secondhand smoke still
costs over US$10bn a year in direct medical costs and indirect costs.103
In the state of Minnesota, the direct health cost of secondhand smoke exposure works out as $44.58 per resident.104
Smokefree laws are extremely popular, and support
grows as legislation comes into force. Support also increases as people learn more about the health risks associated with secondhand smoke. In countries including
Ireland,117 Uruguay,118 Colombia119 and New Zealand,120
smokefree laws are supported by the majority of both
smokers and non-smokers.
And there is no turning back – once people have experienced comprehensive smokefree laws, they do not want
to return to the bad old days of smoke-filled rooms.
7: Delay
“Sand in the gears” – challenging
smokefree policies in court
If the tobacco industry cannot prevent smokefree laws
altogether, it will use a range of tactics to delay their
implementation, including taking legal action. Laws may
not be implemented until legal challenges are resolved.
Tobacco companies may even succeed in overturning or
weakening legislation.
In the 1990s, the tobacco industry took legal action
against the US Environmental Protection Agency (EPA)
because it had classified secondhand smoke as a known
human carcinogen. It took seven years for the EPA to
win the case. In the meantime, the tobacco companies
had used the case to undermine the health evidence on
secondhand smoke.127
Last year, BAT Kenya and Mastermind Tobacco launched
legal action against the Kenyan Government’s Tobacco
Control Act, which included smokefree provisions.The
future of this legislation is threatened by this challenge,
and the dispute may take years to resolve.128
14
Blowing the smoke away
using the FCTC to fight back
Smokefree air is protected by
international law
More than 160 countries are now Parties to the Framework Convention on
Tobacco Control (FCTC), the world’s first public health treaty. Some 85%
of the world’s population now live in countries where the FCTC is legally
binding.
The FCTC requires governments to take effective action to protect citizens from exposure to secondhand smoke in public places, workplaces and
public transport. Recent guidelines on implementing smokefree laws clarify
that smokefree policies must:
• make all enclosed public and work places 100% smokefree, without
ventilation, air filtration, smoking rooms or smoking areas
Maximising smokefree air
through the FCTC
If all the governments that are party
to the FCTC implement and enforce
smokefree laws, 85% of the world’s
people would be protected from secondhand smoke.
Despite significant progress from some
governments, the overwhelming majority of FCTC countries have yet to meet
their treaty commitments. In 2009,
more than 85% of people live in countries without an effective smokefree
law, most of them in countries that are
parties to the FCTC.
• include all enclosed public and work premises, without exceptions
• be legally binding, not voluntary
• be implemented, enforced and monitored
Countries with smokefree policies that fall short of these guidelines do not
adequately protect the health of their citizens.
“Irreconcilable conflict” – public
health vs tobacco industry interests
Photo: Bella Lago
The tobacco industry’s interests are fundamentally at odds with health interests.
The FCTC draws on the evidence of the tobacco companies’ conduct over many
decades in countries throughout the world. It warns that tobacco industry in-
volvement is often not declared. The FCTC concludes that the tobacco industry and its allies have no place in developing public health policy. Countries must protect their health policies against tobacco industry conflicts of
interest.
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What does the FCTC say about
the tobacco industry?
It is a founding principle of the FCTC
that Governments must “be alert to …
efforts by the tobacco industry to undermine or subvert tobacco control.”
Article 5.3 of the FCTC states: “In setting
and implementing their public health
policies with respect to tobacco control,
Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in
accordance with national law.”
Governments that allow tobacco industry interests to influence their
policies are protecting tobacco industry profits at the cost of their
citizens’ lives and health. This is a breach of the requirements of the
FCTC.
In November 2008, international governments agreed a set of guidelines
explaining how governments can meet their FCTC obligations to resist the
tobacco industry’s attempts to influence health policy.
The guidelines say that governments and policy makers must follow clear
principles in any direct or indirect relationship with the tobacco industry.
These principles also apply to relationships with people or organizations
working to further tobacco industry interests.
All Parties must:
• recognize the “fundamental and irreconcilable conflict between
tobacco industry interests and public health interests”
• be accountable and transparent in all its dealings with the tobacco industry
• refuse partnerships with the tobacco industry
• reject tobacco industry voluntary codes or so-called “corporate social
responsibility” schemes
• prohibit incentives to the tobacco industry
Stubbing out Big Tobacco to gain
smokefree air
Tobacco industry interference in smokefree air policy is a recipe for ineffective measures that fail to protect health.
The FCTC Article 5.3 guidelines make recommendations to protect
tobacco control policies from being delayed, derailed or destroyed by
the vested commercial interests of the tobacco industry. Following
the guidelines can help governments to resist Big Tobacco’s efforts
to undermine smokefree policies. A few are particularly relevant to
smokefree air.
16
Blowing the smoke away – using the FCTC to fight back
Raise awareness of harm from tobacco
products, and tobacco industry
interference
There is no safe level of exposure to tobacco smoke, and citizens should
be informed that exposure to secondhand smoke causes fatal conditions
including lung cancer, heart disease and respiratory disease.129
Governments should publicise the tobacco industry’s attempts to undermine
and subvert smokefree air, including the covert use of individuals and front
groups with no obvious link to the tobacco industry to further its ends.
Reject partnerships and non-binding
agreements with the tobacco industry
The tobacco industry forges partnerships with governments to avoid legislation. Tobacco industry “youth smoking prevention” programs have been
used to undermine the FCTC.131
Fighting back
Putting the tobacco industry out
of the European Parliament
Tobacco control advocates from across
the EU succeeded in preventing a group
of “smokers’ rights organizations” from
hosting a conference designed to undermine the case for smokefree laws in
the European Parliament.
Governments should not enter into, support or endorse any partnerships
with the tobacco industry or its agents. This includes:
The advocates, led by the EU Smoke
Free Partnership, wrote to the Parliamentary Bureau and MEPs to state that
the European Parliament was not an
appropriate venue for the conference,
called “Smoking bans and lies”. They
successfully argued that the proposed
event:
• youth or public education programs organized by the tobacco industry
•
contravened the Parliament’s own
rules of procedure as the event had
a commercial purpose
• offers of assistance with drafting policies, regulations or legislation
•
Avoid conflicts of interest
attacked all of the Parliament’s adopted reports and the European
Community’s decisions on this topic
•
violated the spirit of the FCTC
The evidence shows that smokefree policies have to be legally enforced.
Voluntary self-regulation has been developed to prevent the introduction of
effective laws. In some countries, tobacco companies have used their links
with government to directly influence tobacco control legislation.132
• voluntary codes of practice, including “courtesy of choice” or “accommodation” programs
The tobacco industry may offer inducements in the form of payments, gifts
and other inducements such as research funding or training. All of these
should be refused, and clear policies that individuals and departments must
The result? The conference was not allowed to take place on the Parliament’s
premises. 130
globalsmokefree
partnership
17
Fighting Back
US campaigners name and shame tobacco industry
interests
In 2006, pro-health organizations campaigned for voters to
support comprehensive smokefree laws in the US states of
Ohio and Arizona. The tobacco and gaming industries sponsored competing proposals for weak and ineffective laws.
Health campaigners won the vote in both states by identifying each proposal with its backers, publicizing the tobacco
industry’s reasons for proposing weak laws. The health organizations secured media coverage to counteract the tobacco
industry’s vast PR budgets.
In both states, the comprehensive smokefree law was passed,
and the competing pro-tobacco proposal was rejected.133
Fighting back
not accept direct or indirect inducements from the tobacco industry are needed.
No representatives of the tobacco industry or its allies
should be engaged in any activities relating to health
of tobacco policy – they should not be treated as stakeholders, and must be barred from sitting on advisory and
working groups developing health policy.
Treat state-owned tobacco industry the same as other
tobacco industry
Transnational tobacco companies have used their links
with local state tobacco monopolies to subvert tobacco
control policies.134 135 136 137
Where governments control tobacco monopolies or are
stakeholders in tobacco companies, the business of managing the tobacco company must be kept separate from
any domestic or international tobacco control policy.
Tackling tobacco monopolies in Thailand
Thailand has some of the most rigorous tobacco control policies in the world, including an extensive smokefree law, despite having an active state tobacco monopoly. It’s estimated
that the policies implemented after 1991 saved nearly 31,500
lives by 2006, and will save more than 315,000 lives in the
two decades to come.138
The tobacco industry and civil society
18
•
Refuse tobacco industry funding or support – no matter
how “good” the cause
•
Refuse any meetings with the tobacco industry – even on
non-health matters
•
Publicize examples of tobacco industry behavior
•
Campaign against tobacco industry interference in government policy
Photo: Fire Monkey Fish
Non-governmental organizations can also take their cue from the
Article 5.3 guidelines and resist tobacco industry interference:
Blowing the smoke away – using the FCTC to fight back
Photo: Simply Fragile
Fighting Back: What you can do to block tobacco industry influence
Corporate Accountability International and the Network for Ac- •
countability of Tobacco Transnationals (NATT) are campaigning for
effective implementation of the Article 5.3 guidelines in countries
around the world. Here’s how you can get involved:
•
•
Monitor tobacco industry interference in tobacco control in your
country. Send examples of how the tobacco industry is undermining public health policy to FCTC@stopcorporateabuse.org.
Build civil society capacity to challenge Big Tobacco. Recruit NGOs active on health, consumer rights, environmental protection, human rights fair trade and other issues.
Educate these allies on the tobacco industry’s fundamental
conflict of interest with public health, and mobilize them to
support implementation of smokefree laws and the Article
5.3 guidelines.
• Generate national and international media attention. Share
Campaign for laws and policies to protect against tobacco
the results of your monitoring with interested journalists
industry interference in public health. Meet with government
and international allies.
officials to learn what the tobacco industry is doing to block
smokefree laws and other health policies—and offer your Visit www.stopcorporateabuse.org for tools and resources to
help in challenging these tactics.
help protect against tobacco industry interference.
globalsmokefree
partnership
19
Comprehensive National
Policies
Countries with smokefree policies without exemptions, or
with exemptions limited to
residential and quasi-residential premises. Countries in this category do not
allow Designated Smoking Rooms (DSRs) and/
or ventilation. Policies apply
across the whole country.
Strong National Policies
with Limited Exemptions
Countries with smokefree policies with limited hospitality exemptions such as cigar lounges,
or which permit DSRs. Policies
apply across the whole country.
Comprehensive or Strong
Local Policies
Countries where local legislators
have implemented comprehensive or strong smokefree policies at a sub-national level
Global
smokefree map
20
Global Smokefree Map
globalsmokefree
partnership
21
African Region
Overview
Africa is starting to make progress on smokefree laws,
with a number of countries putting smokefree laws into
place. Mauritius has recently passed a new law that is
close to meeting the standards required by the FCTC,
which is a first for the region.
lenging, but it is important to recognise that smokefree
public places are a low cost, effective intervention to
protect health.
In 2009, the Nigerian Parliament is considering tobacco
control legislation. In the meantime, local legislation in
the country’s capital Abuja is currently in force. Local
laws have also been used in Kenya, but this strategy has
not been used as widely in Africa as in other regions.
Proposals for a new national law are also being developed in Burkino Faso over the next year.
South Africa continues to play an important role in the
region. Since 1999, South Africa has demonstrated that
smokefree laws can work in Africa, and the government
has moved with the evidence base to update the law
when required.The law is strong and there is good compliance.
Finally, the influence of the tobacco industry must be
Implementation of smokefree laws remains a challenge recognised, particularly in countries that grow tobacco.
in many places, including Uganda, Ghana and the Dem- In Kenya, the tobacco industry has issued a legal chalocratic Republic of Congo. Niger provides an inspi- lenge to a strong smokefree law passed by the Parliarational example of what can be achieved. In previous ment. In Zambia, BAT’s political influence has helped
years, lack of enforcement has led to a strong law having to dilute proposals for a smokefree law.The current prolittle or no impact on people. However, civic society and posal falls a long way short of meeting FCTC requiregovernment have worked together to improve aware- ments for protection from secondhand smoke.
ness of the law, and have renewed efforts to enforce the
law. Initial reports show that the law is being enforced Regional Leader
in most places, which is a great success for the country. Mauritius is the first country in Africa to adopt a comIdentifying resources for implementation can be chal- prehensive smokefree law. These laws come closest to
22
African Region
meeting the standards set by the FCTC. They offer high DSRs undermine smokefree laws because:
standards of protection for most people, and their laws • they contain high levels of secondhand smoke, putare among the most robust in the world.
ting staff and patrons at risk141
Nonetheless, these laws mean that a very small number • staff must work in them, offering service, providing
of people remain exposed to secondhand smoke, usually
security and cleaning
because they live in, work, or visit places that are not
• smoke leaks from DSRs into the rest of the premises,
covered by the law.
leaving people exposed to secondhand smoke142
Newly smokefree in 2009
Mauritius
Continuing downward trend in tobacco
consumption
Mauritius’s smokefree law continues a trend
of tobacco control measures, including high
tobacco tax and health promotion, which
have driven a decline in smoking rates tobacco consumption on the island.139
• they create an uneven commercial playing field
Kenya
Tourism a major part of GDP
Tourism accounts for more than one in four
jobs in Mauritius, and over a quarter of
GDP.140 The smokefree law is not expected to
impact on tourism revenues.
Smokefree law
Includes
Exemptions
DSRs
Smokefree from
People protected
Close to meeting FCTC requirements
Public places, hospitality sector, some
outside areas
Limited
None permitted
March 2009
1.3 million
Strong Laws
Kenya, Niger and South Africa have a strong law which
offers high standards of protection for most people, most
of the time. However, they fall short of the standards set
by the FCTC because they allow Designated Smoking
Rooms (DSRs).
Smokefree law
Includes
Exemptions
DSRs
Smokefree from
People protected
Using legal action to stop smokefree law
The law in Kenya has been challenged in the
Courts by the tobacco industry. BAT Kenya
has enjoyed a virtual monopoly on the tobacco industry in Kenya, and has successfully
influenced government health policy for decades.143 The company is now using expensive legal action to thwart the law, a strategy
familiar in developed countries.
Most places smokefree. Separate
Designated Smoking Rooms (DSRs)
Close to meeting FCTC requirements.
Falls short because smoking rooms
permitted
Workplaces and public places, hospitality sector
Limited. Private dwellings
In workplaces and hospitality sector.
Limited in size
July 2008
39 million
globalsmokefree
partnership
23
Niger
Smokefree law
Includes
Exemptions
DSRs
Smokefree from
People protected
Renewed enforcement efforts
Niger adopted a smokefree law in 2006, but
it was unsuccessful because of a lack of enforcement. Non-Governmental Organizations
have worked with the Niger Government to
build consensus about the law, and to enforce it. It is now reported to be working well
in most places.
Most places smokefree. Separate Designated Smoking Rooms (DSRs). Close to
meeting FCTC requirements. Falls short
because smoking rooms permitted
Workplaces and public places, hospitality sector
Limited. Private dwellings.
Limited in size
September 2008
15.3 million
Local action
In Africa, local smokefree initiatives
have not been developed to the same
extent as in some other parts of the
world.
Nigeria
South
Africa
Smokefree law
Includes
Exemptions
DSRs
Smokefree from
People protected
Restaurants continue to thrive
VAT returns showed South Africa’s smokefree law had no significant effect on restaurant revenues, and may have had a positive
effect.144 Restaurant owners believe that
nearly all customers have accepted the law.145
Most places smokefree. Separate Designated Smoking Rooms (DSRs). Close to
meeting FCTC requirements. Falls short
because smoking rooms permitted.
Workplaces and public places, hospitality sector.
Limited. Private dwellings.
Limited in size.
September 2008
15.3 million
Smokefree jurisdic- 1 smokefree territory
tion
Federal Capital Territory
Good examples
People protected by 1.4 million
smokefree laws
1% of population protected by
strong smokefree law.
Low awareness that secondhand smoke kills
In Abuja, the majority of school students (55%) are not aware that
secondhand smoke is harmful to health.146 Smokefree legislation
needs to address this low awareness.
24
African Region
American Region
Overview
The American region is a real success story, despite
the fact that many countries have high smoking rates.
There has been rapid expansion in smokefree provision
throughout the Americas, with new laws at both national and local level offering protection to millions of
people. It is particularly exciting to see that so much
progress is being made in middle income countries.
icant change is shown in Canada, where a patchwork of
smokefree laws will mean that more than 99% of Canadians are protected by strong or comprehensive smokefree laws by 2010.
There are also some encouraging initiatives in the Caribbean, with countries including Trinidad and Tobago,
and Barbados considering legislation. Civil society is
Following Uruguay’s example, a further three middle playing an increasingly important role in the regions,
income countries – Panama, Colombia, and Guatemala with established Non Governmental Organizations
- have introduced national comprehensive smokefree campaigning for smokefree laws in a number of counpolicies in the last year.
tries including Peru and Ecuador.
There has also been remarkable progress in local poli- There is little doubt that a tipping point has been reached
cies. Two of the world’s largest urban areas, Mexico City in the Americas, with more and more people covered
and the State of São Paulo in Brazil have also introduced by effective smokefree policies. However, the tobacco
comprehensive laws. The power of local policies is also industry has a very strong presence in the region, and
apparent in countries as diverse as Argentina and the there is evidence that it is doing all that it can to impede
USA, where smokefree laws are expanding year on year. progress towards smokefree laws. Campaigners and govProgress is expected to continue in 2009 and 2010.
ernments must beware of attempts to undermine and
The potential for local policies to deliver real and signif- subvert smokefree laws.
globalsmokefree
partnership
25
Regional Leaders
Uruguay and Panama have laws that come close to
meeting the standards set by the FCTC. These laws offer high standards of protection for most people, and
are among the most effective at protecting people from
secondhand smoke in the world.
Panama
Nonetheless, these laws mean that a very small number
of people remain exposed to secondhand smoke, usually
covered by the law.
Smokefree law
Includes
Uruguay
Leading the way in Latin America
Uruguay was the world’s first middle-income
country and the first in Latin America to
adopt a comprehensive smokefree policy.
One million signatures were collected in support of the measure during a campaign called
“Un Millón de Gracias” (a million thanks),
and polls show that eight in ten people support the law.147
Uruguay’s experience has directly influenced
politicians elsewhere in the region, from
Mexico City to Colombia and Guatemala.
Exemptions
DSRs
Smokefree from
People protected
Colombia
Continuing to make progress
Panama is the first country in Central America to go smokefree. Its history of strong tobacco control policies has led to it being one
of only four Latin American countries where
youth smoking rates have fallen significantly
in recent years.148
Comprehensive.
Workplaces, public places, hospitality
venues. Some outdoor places (sports
facilities)
Very limited
None
April 2008
3.4 million
Smokefree law wins popular support
Nine out of every ten Colombians support the
comprehensive smokefree policy, including
seven in ten smokers.149
This policy is under threat because it is not
as powerful as a national law. If the Colombian Parliament passes a weaker law, it would
take precedence over the resolution.
Smokefree law
Includes
Exemptions
Smokefree since
People protected
26
Comprehensive.
workplaces and public places, hospitality sector, gaming venues. Some outdoor
places (eg grounds of health facilities)
Very limited
March 2006 (by decree); February 2008
(by law)
3.5 million
Smokefree law
Includes
Exemptions
DSRs
Smokefree from
People protected
Comprehensive.
All enclosed public and workplaces,
hospitality sector
Very limited
None
February 2009
13.3 million
American Region
Guatemala
Smokefree law
Includes
Exemptions
DSRs
Smokefree from
People protected
Bermuda
Local Action
In countries across the Americas, millions of people are
Before the law came into force, secondhand protected from secondhand smoke because of smokefree
smoke was present in more than two thirds policies adopted at a local level – in towns, cities, states,
of all Guatemalan workplaces, and nearly all provinces and territories.
bars and restaurants.150
These local policies are incredibly powerful. They are
often easier to enact than national laws, and are able to
be implemented and enforced more quickly. They can
protect large numbers of people - in populous countries such as the USA, Mexico and Brazil, the number
Comprehensive.
of people living in a single city or state can outnumber
a smaller country’s total population.
All enclosed public and workplaces,
There has been rapid progress across the region over the
hospitality sector
last few years. Local initiatives have transferred easily withVery limited
in and between countries, as the benefits of smokefree air
None
can be seen and the lessons passed on to other localities.
Protecting workers in all sectors
February 2009
13.3 million
Argentina
Curbing exposure to secondhand smoke
Despite the fact that only 13% of Bermuda’s
population smokes, nearly half of Bermuda’s
non-smokers were exposed to secondhand
smoke before the law came into force.151
Smokefree
Jurisdictions
Good Examples
Smokefree law
Includes
Exemptions
Smokefree from
People protected
Comprehensive.
Workplaces and public places, hospitality
sector, private clubs, residential homes,
gaming venues. Enclosed places only
Very limited
April 2006
0.1 million
People protected
Rapid progress on smokefree
In just four years comprehensive smokefree
policies have been introduced protecting
one in three of all people in Argentina. Local
measures have been highly successful here,
effectively counteracting more than three
decades of tobacco industry influence over
federal health policy, which has led to weak
and ineffective national policies.152
6 provinces (out of 23) and 16 municipalities
with comprehensive smokefree laws
Provinces: Santa Fe, Córdoba, Tucumán,
Mendoza and Neuquén, Entre Rios
Municipalities: Bahía Blanca, Berazategui,
Cipolleti, Coronel Dorrego, Coronel Rosales,
Coronel Suárez, Corrientes, General Roca,
Olavarría, Pilar, Puerto Madryn, Resistencia,
Río Grande, Saavedra, Tres Arroyos, Villarino
13 million
32% of people protected by comprehensive laws
globalsmokefree
partnership
27
Brazil
Smokefree
Jurisdictions
1 State and 5 cities
with comprehensive
smokefree laws
Good Examples State: São Paulo
Cities: Recife, Campina Grande, Patos,
Cabedelo, Sumé
People protected 43.7million
22% of people
protected by comprehensive laws
Widespread popular support for secondhand smoke protection
Brazil is the third biggest producer of tobacco in the world.153
Public support for smokefree laws is very high. More than eight in ten
of Brazil’s youth and young adults support smokefree environments.154
In Sao Paulo, organised protests against the smokefree law, disrupted a public hearing, but failed to derail the legislation.155
Mexico
Smokefree
Jurisdictions
Good Examples
People protected
1 metropolitan area
with a comprehensive smokefree law
Mexico City
8.9 million
8% of people
protected by
comprehensive
smokefree laws
Canada
Canada’s local laws close to making
whole country smokefree
In April 2009, the Government of Prince
Edward Island announced that it would be
removing the exemptions for the law and
abolishing DSRs. When this is implemented,
more than 99% of Canadians will be protected by comprehensive or strong smokefree
laws.
All Canadian prisons are smokefree by law.
In Toronto, a smokefree law reduced bar
workers’ exposure to secondhand smoke by
94%.156
Smokefree
Jurisdictions
7 provinces and territories (out of 13) have
comprehensive smokefree laws, 5 have
good laws.
All Canadian prisons are 100% smokefree
inside
Alberta, British Columbia, Manitoba, New
Good Examples
Brunswick, Nova Scotia, Ontario, Yukon
21.4 million
People protected
by comprehensive 64% of population supported by
comprehensive smokefree laws
laws
10.2 million
People protected
by good smokefree 94% of people protected by comprehensive or strong smokefree laws
laws
Mexico City is the biggest smokefree city in the Americas. It shows
that a comprehensive smokefree law without exemptions or DSRs
can work.157
The tobacco industry is active in Mexico, and is fighting against an
effective national smokefree law. In 2006, BAT Mexico launched a PR
campaign to portray secondhand smoke as a nuisance rather than
health risk. The same year, it re-launched accommodation program
“Convivencia en Armonía” as an alternative to comprehensive laws.158
Philip Morris and BAT’s Mexican subsidiaries have successfully lobbied
to weaken the national smokefree law. This law has yet to be enacted.
Mexico City law has support of more than eight in ten residents
85% of Mexico City residents believe that the smokefree law is justified.159
28
Photo: meantux
Mexico City leads way
American Region
United
States of
America
Heart attack rates fall
In Pueblo, Colorado, heart attack rates fell by 41% over three
years following the smokefree law.160 Similar results have been
seen in New York,161 Montana162 and Indiana.163
Smokefree
Jurisdictions
Venezuela
Photo: wallyg
19 states and territories (out of 56) have comprehensive smokefree laws, 7 other states have good laws. Over 300 cities and
local jurisdictions have comprehensive smokefree laws.
Good Examples Arizona, Delaware, District of Columbia, Hawaii, Illinois, Iowa,
Maryland, Massachusetts, Minnesota, Montana, Nebraska, New
Jersey, New York, Ohio, Oregon, Rhode Island, Utah, Washington, Puerto Rico.
People protected 109.2 million
>36% of people protected by comprehensive laws
by State-level
comprehensive
laws
>53% of people protected by comprehensive or
by State-level
strong laws
good laws
Smokefree air: necessary and popular
In 2003, before the law came into force, four in ten young people
in Monagas reported being exposed to secondhand smoke in public places. Eight in ten supported a smokefree law.164
Smokefree
Jurisdictions
1 state (out of 23) with comprehensive
smokefree law
Good Examples
Monagas
3% of people protected by comprehensive law
globalsmokefree
partnership
29
Eastern Mediterranean Region
Overview
Progress in the Eastern Mediterranean region remains
somewhat slower than in other parts of the world, but
there are encouraging signs of progress. At least four
countries are currently planning comprehensive policies. Tunisia is planning to introduce a decree making
all public places and workplaces smokefree in 2009,
and Oman, Qatar and Sudan are currently developing
smokefree laws. In Egypt, the city of Alexandria – home
to more than four million people - has plans to go completely smokefree with no designated smoking rooms
(DSRs) permitted.
This law was originally comprehensive, but the 2008
decision to exempt teahouses from the law means that
many people remain exposed to secondhand smoke.
Recent theological rulings that tobacco is haram (prohibited under Islamic law) could help to encourage
more widespread acceptance of the harms of secondhand smoke, and promote smokefree laws. In Saudi
Arabia’s religious cities of Medina and Mecca tobacco
products are neither openly sold nor advertised, and
there are smokefree regulations. Greater enforcement
is needed.166
There are no comprehensive or strong smokefree
policies being enforced in the region. Although many
counties have introduced some restrictions on smoking
in some public places, places serving food and drinks
are typically exempt. Enforcement of these policies
tends to be very weak or non-existent, although there
are exceptions to this, particularly Oman.165 The government of Yemen has recently announced that it will
take action to enforce the country’s existing smokefree
law in 2009.
There are significant barriers to be overcome to achieving smokefree laws. Some countries have very high male
smoking rates – in Jordan and Tunisia, the majority of
men are smokers.167 The lack of effective smokefree policies means there are high levels of secondhand smoke
in public places. Measurements of secondhand smoke
in Syria and Lebanon are some of the highest in the
world.168 In Syria, almost all non-smokers are exposed
to secondhand smoke.169
Although cigarette smoking is very widespread, much
At present, the strongest legislation is found in Iran. secondhand smoke is also generated from waterpipe
30
Eastern Mediterranean Region
Photo: Michael Foley
(also known as shisha or narghile) smoking. There is evidence that people perceive waterpipe smoking very
differently from cigarette smoking.170 Many people believe that waterpipe smoke is less harmful than cigarette
smoke,171 but waterpipe smoking can lead to levels of
harmful particles that are more than 50% higher than
cigarettes.172 In order to protect health, and to comply
with the FCTC, smokefree laws must apply to all forms
of smoked tobacco.
The tobacco industry is becoming increasingly active
in the region, using tactics seen elsewhere. In Egypt,
British American Tobacco has made an agreement
with local politicians to introduce its accommodation
scheme “Respecting Choices” in South Sinai, which
includes the popular tourist destination Sharm-el
Sheikh.173
Photo: Lars Plougmann
In Pakistan, concern is growing over the influence of
former government officials now acting as lobbyists for
the tobacco industry. In 2008, the Pakistan Ministry
of Health issued Guidelines on the implementation of
Designated Smoking Areas, at a time when the FCTC
Article 8 Guidelines make clear that these should be
abolished. It is feared that tobacco industry influence
will derail plans to introduce and enforce a comprehensive smokefree law.174 BAT is rolling out industry
sponsored “youth prevention programmes in Kuwait,
Qatar and Bahrain.”175 These developments are of serious concern. Urgent action is needed throughout the
region to enforce the FCTC Article 5.3 Guidelines,
and prevent the tobacco industry from influencing
health policy.
Photo: premasagar
In spite of tobacco industry efforts, there is very strong
support for smokefree public places from young people.
In the Eastern Mediterranean region, more than eight
in every ten students support smokefree policies.176 The
time has come for Governments to listen.
globalsmokefree
partnership
31
European Region
Overview
There has been rapid progress on smokefree laws in
Europe. In the five years since Ireland became the first
country in the world to go completely smokefree, laws
providing effective protection from secondhand smoke
are now in place in some seventeen European countries, reaching from the Arctic Circle in the North to the
Mediterranean in the South. In the last year, Moldova,
Finland and Monaco have adopted strong smokefree
laws.
Greece have also committed themselves to take action.
Historically high smoking rates mean that workplace
and public exposure to secondhand smoke is high in
Eastern Europe and the Commonwealth of Independent States. Despite this, Lithuania, Estonia and Moldova demonstrate that effective smokefree laws can be
achieved. Georgia and Latvia are also taking incremental
steps towards smokefree status, with additional regulations expected in 2010.
There is a strong – and growing - mandate for smokeRussia’s recent accession to the Framework Convention
free laws. In 2008, two thirds of citizens across the EU
on Tobacco Control (FCTC) is expected to stimulate
supported smokefree bars, and eight out of ten supportchange, but the tobacco industry enjoys privileged aced smokefree restaurants.177
cess to politicians, including presence at the Parliament’s
Turkey becomes completely smokefree in July 2009, and influential health committee. While this continues, efwill become a world leader in protection from second- fective action on secondhand smoke is unlikely.
hand smoke. Its successful smokefree workplace legislaThe tobacco industry has considerable political inflution was introduced last year and will be extended to covence across the European region, both directly and iner the hospitality sector. No Designated Smoking Rooms
directly. Health advocates are working to expose their
will be allowed, and exemptions will be limited. There is
involvement, and to persuade politicians, officials and
a strong commitment from politicians, officials and civil
the public of the fallacy of their arguments.
society to make this legislation work. Governments in
other Southern European countries, including Serbia and Resisting weak and ineffective regulations remains a chal32
European Region
lenge across Europe. Some
countries are adopting legislation that leaves unacceptably high numbers of
people exposed to secondhand smoke. Examples of
weak laws include creating smoking areas, allowing
smoking in hospitality venues, and restricting smoking to certain times of the
day. Such laws are bad for
health, and do not comply
with the FCTC.
Regional
Leaders
Ireland and the UK have
laws which come closest
to meeting the standards
set by the FCTC. These
laws offer high standards
of protection for most
people, and their laws are
among the most robust in
the world.
Nonetheless, these laws
mean that a very small
number of people remain
exposed to secondhand
smoke, usually because
they live in, work, or visit
places that are not covered
by the law.
Ireland
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
United
Kingdom*
Five years on – benefits of the Irish smokefree law
After five years, the Irish smokefree law has achieved:
• reduced respiratory symptoms amongst heavily exposed workers178
• more than 80% reduction in fine particles in bars179
• more than 90% reduction in two cancer causing chemicals in bars180
• a compliance rate of 97%181
• support from hospitality workers182 and the public183
Workplaces and places to which the public has access, hospitality sector, gaming venues and private clubs. Enclosed places only.
Very limited. Including prisons, and bedrooms in: residential homes, hotels,
hospices and psychiatric institutions
None
March 2003
4.1 million
17% Reduction in heart attacks
In Scotland, heart attacks admissions fell by 17% after the smokefree law was
introduced,184 echoing findings in the US,185 186 187 188 and Italy.189
* Scotland, Wales, Northern Ireland and England
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
Close to meeting FCTC requirements.
Similar legislation exists in the four countries of the UK
Workplaces and public places, hospitality sector, gaming venues and private
clubs. Enclosed places only.
Very limited. Including bedrooms and sealed designated smoking rooms in prisons and oil rigs and private bedrooms in: residential homes, hospices, hotels.
None
March 2006 (Scotland)
April 2007 (Wales and Northern Ireland)
June 2007 (England)
60.7 million
globalsmokefree
partnership
33
Turkey
High smoking rates no barrier to comprehensive smokefree law
Most of Turkey’s public places and workplaces have been smokefree since May
2008. The law has been a great success and
enjoys strong public support, despite high
smoking rates – some studies show that
more than six in ten Turkish men are smokers.190
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
Workplaces and places to which the public
has access, hospitality sector and private
clubs. Enclosed places only
Very limited. Including prisons, and bedrooms in: residential care homes, hotels,
and psychiatric institutions
None
July 2009
76.8 Million
Countries with Strong
Smokefree Laws
Fourteen European countries now have national laws
that offer high standards of protection for most people,
most of the time. However, they fall short of the standards set by the FCTC. Typically, this is because they allow Designated Smoking Rooms (DSRs) in hospitality
venues and/or workplaces.
There is a wide variation in the uptake of DSRs in the
different countries. The most effective legislation is in
countries like France and Sweden, where there are very
strict regulations on designated smoking rooms.
DSRs undermine smokefree laws because:
• staff must work in them, offering service, providing
34
Photo: Marcos.Zion
• they contain high levels of secondhand smoke, putting staff and patrons at risk191
European Region
Moldova
Leading the way in the Commonwealth
of Independent States
Monaco
Moldova is the first of the CIS countries to
pass an extensive smokefree law. Tobacco
cultivation is an important element of the
country’s economy, smoking rates are high,
and the tobacco industry is an important political force. Moldova proves that these barriers can be overcome.
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
Most places smokefree
Close to meeting the FCTC requirements.
Falls short because smoking rooms permitted
Public places, hospitality sector. Enclosed
places and playgrounds
Limited
In hospitality venues with service permitted.
Limited to less than 50% of total area
March 2008
4.3 million
No fear of negative impact on tourism or
gaming industries
Monaco is world famous for its casinos, and
attracts many tourists, but the law appears
to have had no effect on these.
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
Most places smokefree.
Falls short because smoking rooms permitted.
Public places and workplaces, hospitality
sector. Enclosed places only.
Limited
In hospitality venues with service permitted
September 2008
33,000
globalsmokefree
partnership
35
Finland
Smokefree workplaces extended to all
Most Finnish workers have been protected
from secondhand smoke at work since 1995,
and Finland was the first country in the world
to legislate against secondhand smoke as a
workplace carcinogen, in 2000.
Under the previous smoking restriction policy in the hospitality sector, the highest levels
of ETS were found in the “non smoking area”
of some establishments, showing the need
for a comprehensive law.196
Established smokefree countries
Estonia
Making a difference in countries with
high smoking rates
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
France
Over half of all Estonian men are current
smokers.197 Before the law was introduced
about one in five Estonian adults reported being exposed to secondhand smoke for more
than an hour each day outside the home.198
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
36
Falls short because of cigar lounge and
casino exemptions, and because smoking
rooms permitted
sector, anywhere where food or drink is
served. Enclosed places only
Cigar lounges; casinos
In hospitality venues, with service permitted. In workplaces. On long distance trains
and on ships. Ventilation regulations
June 2007
1.3 million
sector. Enclosed places only
Limited
In hospitality venues over 50m2. No food,
drink or entertainment permitted. In workplaces. Size regulations
June 2009
5.3 million
Widespread compliance with the law in
capital
In Paris, fewer than 2% of establishments
were fined for breaches of the legislation in
the year after it was introduced.199
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
sector, gaming venues. Enclosed places only
None in the law, but discussion is ongoing
about spaces that are substitute homes
Hospitality venues only, with no service permitted. Size and ventilation regulations. Workers may only enter the room one hour after it
was last used for smoking. Very few installed
February 2008
60.7 million
European Region
Iceland
Smokefree air latest chapter in 40 years
of tobacco control
Italy
After the smokefree law came into force,
smoking rates fell by more than 7% and the
average smokers consumed one and a half
fewer cigarettes a day.201
Iceland has been at the forefront of tobacco
control for 40 years, from the first health
warnings on packs in 1969 onwards. Iceland’s tobacco control strategy means that
fewer than one adult in five is a smoker.200
Smokefree law
Includes
Exemptions
DSRs
Smokefree law
Limited. Designated bedrooms in hotels,
residential care homes, prison cells
In hospitality venues, no food or drink permitted. In workplaces. Size regulations
June 2007
0.3 million
Exemptions
DSRs
Photo:Trey Ratcliff
Smokefree since
People protected
Includes
Smokefree since
People protected
Lithuania
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
Reducing smoking rates and tobacco
consumption
Workplaces and public places. Enclosed
places only
Limited
In hospitality venues with service allowed.
In workplaces. Size and ventilation regulations. Few have been installed
January 2005
58.1 million
Beating tobacco interests
The first attempt to introduce a smokefree
law in Lithuania was defeated because of
organized opposition from the tobacco industry. Health organizations worked strategically to win a comprehensive law second
time around.
Close to meeting the FCTC requirements. Falls
short because of exemption for cigar and pipe
clubs and because smoking rooms permitted
Limited. Cigar and pipe clubs
In workplaces and on long distance trains only
January 2007
3.6 million
globalsmokefree
partnership
37
Malta
Big Tobacco fears spread of Maltese
smokefree law
Slovenia
BAT Malta has been lobbying the European
Commission to prevent comprehensive Maltese-style legislation being rolled out across
the EU.202
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
Norway
Limited. Residential bedrooms
In hospitality venues, with service allowed.
In workplaces. Size regulations
October 2005
0.4 million
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
Lawmakers resist hospitality trade threats
In Slovenia, hospitality groups threatened to
strike to disrupt the implementation of the
smokefree law. Lawmakers resisted the attempts to undermine the law, which has been
implemented successfully.
Government figures show that hospitality
trade incomes have increased since the law
came into effect.204
Enclosed places only
Limited. Hotel bedrooms, areas in care
centers for older people, prisons
In hospitality venues, with service permitted. In workplaces. Size and ventilation
regulations
August 2007
2 million
Comprehensive legislation easier to
enforce
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
38
Close to meeting the FCTC requirements. Falls
short because of exemption for cigar and pipe
clubs and because smoking rooms permitted
Workplaces and public places, hospitality sector, anywhere where food or drink is
served. Enclosed places only
Limited. Offices occupied by a sole individual. Living rooms in institutions
In workplaces only
June 2004
4.6 million
Photo:Dragon Woman
Norwegian bar staff reported that the smokefree law was easier to enforce than prior legislation requiring non-smoking areas. Staff
experienced fewer unpleasant incidents and
better compliance.203
European Region
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
Workers’ health improved
Swedish hospitality workers’ sensory and
respiratory symptoms were halved as a result
of the smokefree law.205
Limited
In hospitality venues only, no food or drink
permitted. Size regulations. Few have been
installed
June 2005
9 million
Photo:Hector Melo A.
Sweden
Local action
Most European countries are making progress with national laws, but in Switzerland change is being driven by
action at local level.
Switzerland
Smokefree laws prove popular
In Ticino206 and Geneva,207 eight in every ten
residents voted in favour of the smokefree
laws.
Photo:Dragon Woman
The legal challenge to the Geneva law shows
that it is vital that policies are well drafted.
Smokefree
jurisdictions
Good examples
6 cantons (out of 26) with most places
smokefree
Ticino, Appenzell Ausserrhoden, Graubünden, Solothurn, Valais, Geneva (implementation delayed following legal challenge)
globalsmokefree
partnership
39
South East Asia
Overview
There are many challenges in South East Asia, including
a strong tobacco industry and high rates of male tobacco
use in many countries. However, Thailand has had laws
restricting smoking in public places since 2002, which
shows that these obstacles can be overcome.The Thai law
was extended to cover the hospitality industry in 2008.
In Indonesia, some local initiatives are delivering smokefree public places, but many of these fall well short of the
Standards required by the FCTC because of exemptions,
or problems with enforcement. Local laws have achieved
excellent results in other parts of the world, providing a
strong model for success in South East Asia.
The major development in the region is India’s decision
in late 2008 to adopt a national smokefree law. India’s
new law has very few exemptions. With a population
of over one billion people, this is a huge undertaking,
and the law is being implemented and enforced on an
area-by-area basis. If the law is enacted across the whole
country, more than a billion people will be protected
from secondhand smoke.There is strong political leadership at both national and local level to make this a reality,
but this will need to be sustained.
Regional Leaders
Following a recent announcement, Sri Lanka is expected to strengthen its existing law, so that all hospitality
premises are included in 2009-10. The government of
the Maldives is hoping to pass a similar smokefree law.
A number of other countries are expected to introduce
laws, including Bhutan and Nepal.
40
Thailand and India have strong laws that offer high standards of protection for most people, most of the time.
However, these laws fall short of the standards set by the
FCTC because they allow Designated Smoking Rooms
(DSRs).
• staff must work in them, offering service, providing
South East Asia
Thailand
Smokefree law
Includes
Exemptions
DSRs
Smokefree from
People protected
Eight in ten international visitors support
Thai law
A third of Thailand’s national income comes
from tourism, and a recent poll showed that
eight out of ten international visitors supported the Thai legislation.210
India
Close to meeting FCTC requirements. Falls
short because smoking rooms permitted
Workplaces and public places, restaurants,
bars, nightclubs, discos, pubs
There has been limited local action in South East Asia to date,
and local measures in Indonesia have been compromised by
a lack of enforcement in some places. In the coming years,
more local smokefree laws are expected.
Indonesia
Smokefree law
Includes
Exemptions
Smokefree laws needed in Indonesia
More than six in every ten Indonesian men
is a regular smoker,213 which contributes to
high levels of secondhand smoke exposure.
More than eight in ten teenagers are exposed
to secondhand smoke in public places – the
highest in the ASEAN region.214
Indonesia has yet to ratify the FCTC.
1 city with most places smokefree, and with no
Designated Smoking Rooms (DSRs) permitted
Cirebon City
0.2 million
<1% of people protected by smokefree law
India’s population dwarfs any country that
has yet adopted a strong smokefree law,
and this new law has massive potential to
improve health. However, there are unique
challenges in implementing a smokefree law
on this scale.
The cost of smoking
In India, about 900 thousand people die because of smoking every year, and the cost
of treating tobacco related cancers, heart
disease and lung disease alone runs to US
$6.5billion a year.211
Limited
DSRs in non-air conditioned restaurants
and workplaces
February 2008
65.1 million
Local Action
Largest country ever to go smokefree
Wide range of secondhand smoke sources
About half of secondhand smoke in India
comes from bidis.212 Tobacco smoke also
comes from hookah, cheroots and cigars as
well as cigarettes. Secondhand smoke from
all sources is toxic.
Smokefree law
Includes
Workplaces and public places, restaurants,
bars, nightclubs, discos, pubs
Exemptions
DSRs
Limited
In hotels, restaurants and airports. No service permitted
Enforcement notes Enforcement being taken forward locally,
due to size of country. 3 states, 3 metropolitan areas, 2 cities and several other municipalities are currently enforcing the law.
October 2008
Smokefree from
People potentially 1.2 billion
protected
>138.5 million
People currently
protected by
enforced law
globalsmokefree
partnership
41
Western Pacific Region
Overview
There are several excellent examples of smokefree laws
in the Western Pacific. New Zealanders were among the
first people in the world to be protected by a national law
making all enclosed public places and workplaces 100%
smokefree. People in Singapore have received some legal protection from secondhand smoke for over three decades, with the legislation regularly reviewed and made
stronger. In addition, the overwhelming majority of Australians have long been protected by strong and comprehensive smokefree laws, and it’s expected that the whole
country will be protected in 2010.
There has been good progress in the last year, with Hong
Kong removing the final exempt premises from its smokefree law, which is now comprehensive. In the Philippines,
organizations in six areas are working towards adopting
comprehensive smokefree laws.
progress there is extremely important. Many public
places in the capital, Beijing, went smokefree during the
Olympics and Paralympics, although the regulations did
not extend to the hospitality sector. Three major cities –
Shanghai, Guangzhou and Beijing – have plans to extend
smokefree policies in 2009-10. More than 40 million
people live in these three cities alone.
Regional Leaders
New Zealand and Hong Kong have laws that come
close to meeting the standards set by the FCTC. These
laws offer high standards of protection for most people,
and are among the most effective at protecting people
from secondhand smoke in the world.
Nonetheless, these laws mean that a very small number
The Malaysian Government has announced plans to exof people remain exposed to secondhand smoke, usually
tend its smokefree law in 2009.
China is home to a third of the world’s smokers, so any covered by the law.
42
Increasing revenues in parts of the
hospitality sector
Photo: Travelling Pooh
New Zealand
The New Zealand law had an overall positive
effect on the hospitality industry215
Smokefree law
Includes
Exemptions
Up 0.9%
Sales in cafes and restaurants
Up 9.3%
Employment in pubs, taverns
and bars
Up 24%
Employment in cafes and
restaurants
Up 9%
Employment in clubs
Down 8%
Comprehensive.
sector, gaming venues. Outdoor areas of
schools and early childhood centers
Very limited. Private premises, smoking
rooms for live in patients and residents
None
December 2004
4.1 million
Hong Kong
Special Administrative
Region of China
Photo: mandolux
DSRs
Smokefree since
People protected
Sales in bars and clubs
Hong Kong has had a strong smokefree law
since 2007, with exemptions for venues including bars, bathhouses and nightclubs.
These exemptions are removed in 2009.
Smokefree law popular with public
About eight in ten Hong Kong residents say
that they are more likely to visit restaurants
now that they are smokefree, and more than
seven in ten believe that there should be no
exemptions to the smokefree law.216
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
Hong Kong takes final step to
comprehensive law
Workplaces, public places, hospitality venues
Very limited
None
June 2009
7.1 million
globalsmokefree
partnership
43
Countries with Strong
Smokefree Laws
Photo: Jungene
In 2008-9, Brunei Darussalam and Singapore introduced • staff must work in them, offering service, providing
national laws that offer high standards of protection for
most people, most of the time. However, they fall short
of the standards set by the FCTC. This is because they • smoke leaks from DSRs into the rest of the premises,
allow Designated Smoking Rooms (DSRs) in hospital• they create an uneven commercial playing field
ity venues and/or workplaces.
Brunei
Darussalam
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
44
Tobacco declared haram in Brunei
Brunei’s State Mufti has decreed that tobacco
use is forbidden – haram – to Muslims.219
Most places smokefree. Designated Smoking Rooms (DSRs) permitted in workplaces.
sector. Some outdoor spaces
Limited
In workplaces, at airport
June 2008
0.4 million
Singapore
Smokefree law
Includes
Exemptions
DSRs
Smokefree since
People protected
Responding to new standards
Singapore’s first smokefree law was passed
in 1970, and has been revised many times.
This year, the law was extended to cover all
indoor places and some outside places. Singapore has one of the lowest smoking rates
of any high income country – about 13% of
people smoke,220 and more than three quarters of adults have never been exposed to
secondhand smoke at work.221
Most places smokefree. Designated Smoking Rooms (DSRs) permitted in workplaces.
sector. Some outdoor spaces
Limited. Prisons. DSRs in workplaces, airport
In workplaces, in hospitality venues
January 2009
4.7 million
Local Action
Some Western Pacific countries are introducing smokefree laws at a local level – in towns, cities, states, provinces and territories.
Lao People’s
Democratic
Republic
Smokefree laws in a Low Income Country
Smokefree
jurisdictions
Good examples
People protected
3 cities smokefree in most indoor public
places, including restaurants and cafes
Luang Prabang, Champasak, Vientiane
0.6 million
9% of people protected by strong laws
These local laws can be incredibly powerful. They are
often easier to enact than national laws, and are able to
be implemented and enforced more readily.
In Australia, state-level laws are becoming progressively
more alike, and offering more effective protection from
secondhand smoke. By 2010, every State will have at
least a strong law on secondhand smoke.
In Lao People’s Democratic Republic and the Philippines, local smokefree laws continue to spread.
Australia
Local laws will protect all Australians
by 2010
Local laws have proliferated across Australia.
By the end of 2010, the whole country will be
protected by comprehensive or good laws.
Action is now needed to tackle exemptions for “high roller rooms” in casinos in
Queensland, Victoria and New South Wales.
Philippines
Smokefree
jurisdictions
3 states and territories (out of 8) with comprehensive smokefree laws. 4 with good
smokefree laws and limited exemptions.
1 will implement a good law in 2010
American Capital Territory, South Australia,
Good examples
Tasmania
by comprehensive 12% of people protected by comprehensive laws
laws
99% of people protected by compreby good laws
hensive or strong laws
Smokefree
jurisdictions
Good examples
People protected
Lao PDR is a low income country, and relies heavily on tourism revenues for foreign
income. World Heritage Site Luang Prabang
and the capital Vientiane are major tourist
centers and appear unharmed by the smokefree laws.
Overcoming tobacco industry interference
Tobacco industry lobbying remains a barrier in
the Philippines. Tobacco companies have misrepresented the science on secondhand smoke
and have successfully prevented policies from
being introduced at national level.222 There is
also evidence that the tobacco industry is lobbying against local smokefree laws.223
3 cities and 1 municipality with most places
smokefree, but with Designated Smoking
Rooms (DSRs) permitted
Davao City, Makati City, Legazpi, Talisayan
3.3 million
4% of people protected by strong laws
globalsmokefree
partnership
45
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globalsmokefree
partnership
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