~·~6~, k :-::::i 5 GdeF~ the case against tobacco advertising the eoronarl prevention group BATCo document for Legal Services : Health Canada 21 May 1499 Tne iollowin~ organisations would support a ban on tobacco advertising and s:omotion and have endorsed ti~b dac~ment: iictioo on Sno;cing and iiealth (r\SH) X~ticipatorl, t3rPleans IhCT) r\ssodation of Primn~ Care Fadlitaas Bribh Cardiac Soderi B~i~ish Dietetic ~dat~or. British Heart Foundation Brihsh ~edic31 ~sodation British Nu~tion Founda~on British Paedia~e c~ss~dation C~zest, Heart & Stroke Asrodafion CoUe~eofHealh Fan~lh of Public Heath 4ledione Farr~; Heart ~ssodation Health Education Xuthoritv Health PromotionAuthori~ for ~laies Hea;t~ ?romotion ~genor ior Northern L~land Health ~si~b' ~ssociation ~d~onal .IssoLi~fion of Health Authoritia andTrusts ,Vorthem ireland Chest, Heart dr Stroke kjodation Nortnem Ireland Coronary Prevention Group Public Heal~ i~liance Roval College of General Prach~ioners Rival Collge of Nursing Ro;al College of Obste~e~dans and Cy~ecolo~sts Ro;al CoUe~e of Phvsidsru, of Edinburgh Ro;al Coile%e of PhySiddN Oi London RovalCoUe~e oi Rabioloysb RJvai College or Suigec~ ciEdinburgh Ro;al College ofSu~wns oi England Ro;ai Ins~tuteoi Public Health & Hygiene Rolal Pham~aceutic~ Sodet)r of Great Britain sabeiv of Healt~ Edula~on and Health Pmmohbn Spedaiists rrade;UnionCon~ess BATCo document for Legal Services : Health Canada 21 May 1999 Foreword It is now nearly :O Irears since the saloking of tobacco was sho~ to have manu serious eifeas on health. In the intenm, thie has been an encourapg dedno in the praprion of people who smoke. ~ti~ou~ other iaiton certau~lv have had an elied, it seems likely thd: the decline in rmobg was h~~~ br the CovwrunenYr dwsian in !463 to ban the adve~i~ti oi d~areces on tele~sion. torernments ail over the sorid hase since ioiiowed the British example. Tnis Government no" i~a.E an op?ofimit·i' to take another step io~a!d and join with other countries ir. the European Communih~ to ban all promotion 61 this additive and deadly product. rois reposition ~ill be opposed b!bv lome people~ espedallv by hose who lear the ~nansl implications of a ban. Tne Corona~ Prevention Group and many other o~msations beliece health ehwid be the ii~rt pnorin! h ban on tobacco ad,e~bin· xiil reduce the pressures on children to take up smoking. We must 5e aware that the children oi todav are the cancer and heart disease victims of tomonole me pwpie of the linite;i Kingdom have a right to protect themselves and their chiid~n troLI those who promote an addicb~o~ which kills over 300 people in t~ coulm' even' dav. In his Green Paper,TnP Heith oi the Nation', the Secretary of 5hte for Health has justannounced his ~ar~et for redudne smoking prevalence to 11 per cent of the populationbv the vear 2WO, nbe Covemment'i commitment to this objective will be ydged j~ whethe: it is prepared to sehe the; oppormnih to itaF tie e100 million a var advertising r~mpai51~ to promote smoki?g Tnis booklet sets out the arEumentr wh! tobacco ad~ertirinp should be baNled~ ~;·"L~a~p Sir Richard Doll FRS FRCP Emerikls professor of Medidne O\ University oiOxford BATCo document for Legal Services : Health Canada 21 May 1999 The European Community proposal "Everj minute of every hour of every day,one dti2en of the Communitl dier from a disease directly related to smoking,' Vane Papandreou European Commissioner for Employment Industrial Relations and Social Affairs Although the primary intention of the European Community Directive to ban tobacco advertising is to harmonise trade, it d have a weitome'eiiect on the health of Europeans. Some countries of the Cownunit)r · Porm~, Itaiv and now France · have le~]ation to ban tobacco advertising. In order to remove trade harr;ea caked by difierent ~adi3gconditions in Member States, the European Commission is ci~ged with harmonising these conditions When harmonamg conditions oi trade, the Cormission must take as its base th, coun~y's regdatlons that afford a hit level of health arotection. (Treaty oi Rome, Article 100A (311 This has been done in the case of tobacco adve~ing on television. Tne U.IC's 1963 ban on cigarette adve~sinp will be seen~ened by European le~iria~on that also removes d~u and pipe tobacco adve~sements ~om television. In order to effect a European ban, the Directive must be supported by most Member Suer. So mr, the majority has supported the proposal, but t~e minontv · Germany, the Netherlands, De~mKk and the U~K.· has indira!ed that they will oppose it. Voting arrangements are such on this Directive that ii the U.K, supports it, the measurewill be suceess~ul. Thus ~e poriCon of the U.K, may be the key to the i~ture hea~th of Europe's cbiidren. But why do health organiratians consider 3 ban an iobart~o advertising to be so impornnt! BATCo document for Legal Services : Health Canada 21 May 1999 The dangers of smoking 'Of the 250 million ~hiidren alive in Europe today', 10 million will be killed before their time by tobacco." Richard Pete FRS Reader in Canter Studier, University of Oxford Smoking account! for 113,OMI premature deaths each vear in the CK, [Han~ard,1989], One m iorr smokers d be ]uiied by smoking ~ulth an average ioir of B Years of iiie (RC~ 19831 Miller, 1990)~ Onb the tobacco indushv questions the iact that smoking is bad ior your health. What is less well known is the range of diseases caused or made worse b!' smoidng. ThPs enrompss a nde vanerv of tancm, utduding those pi ~e lung, mouii, throat ,nd.~ei, among othe~; vas;ular aad rerplmtoly disease ~nduc~ng roroaarv heart disease, swke, bronci~itis and eplphysema; and numerous other conditions such as tompiicafions of p"~M"CV and pepde ukers (OoU, 19901. The jenefits of stopping smoking are dear. Just a year after quitdng, a smoker's excess ~sk of eorona~ heart disease is reduced bu about haY. After Ii years wiihout dga~ettes, an ex~rmoker's nsk of heart disease is;imilar to that of someone who has never smoked (1:.5. Su~eon Generall9901. Des~te these facts, one in three adults in the U,K. still smokes dgaretta. In sruve~s, about two thirds of smokers Say they want to Cuit, and most have tried. But ~vinp up smoking is difficult because the nicotine in tobacco is addictive. The pharmacological processes involved are similar to those implicated in heroin and cocaine addic~on (U.S. Surgeon General, 1989). (I in the World Health Organization's European Re~on) BATC6 document for Legal Services : Health Canada 21 May 1999 The effect of tobacco advertising Yhe presence of massive amounts of tobatro prornati6nr,..rimply dwarfs efforts to communicate the health hands of Imnking~ Simply stated, many people jun do not take health warnings seriously when they are bombarded at every turn of the head with soothing tcbaao company ads promoting their product as normal, good add glamorous," The Hen, late EPP Minister for Health, Canada The tobaccoinduia needs to iind MO aea U.K. Naoners ,day just to replace those who have been killed by smoking: 4lost of ihen neiY rec~uis are children: si~t n ten smokers j~Kt before the age ot !O (Gtseral Household Su~ey, 19e8) in the I'.K, alone, the tobacco industry spends over E1l0 million 2 year on ddvertis;n~ and promo~ian. ~iealth organiradoni have been ~onw:ed by eompellirg evider.te that dgarette adver~dsing encourages children to take up smokin~. The U.S, Su~eon General, Dr Everett Koop, condudd ist "the c~ll~ch've empiribi. ~yperimental and logical evidence ma~es it more likely t~n not that adverbsing and promotional anvities do stimulate d~arette tonsumpbon" (Koop, 19891. Those advertising other products and senticerreadiiv admit that one of the main pur;loses of adve~d~ing is to recrtit new c~stomen. But the tobacco indust~v denies that its adverfisin~ has this effect, This posi~on has been refuted by advertisers themselves, induding Enerson Foote, io;mer Chairman of one of the world's largest advwtising a~endes,~lCann Licson: 'Tne dg·arene indm~ has been artiullv maintaining that cigarette advemsing tas nothing to do wi~ total sales. Tais : complete and utter nonsehee..·l am always amused by be su~estiofls that ddverti~ir.~ a irocticn that has been shown to ina~ease conslmption of virtually eve~ ?rodur, jamehow ~uraorlowlv fails to work for tobacco products" ifoote, 19BI). BATCo document for Legal Services : Health Canada 21 May 1999 How does the tobacco industry get its new custamers~ "Every industry has to recruit new runomen. We recruit our new customers oee they're over the age of 16~ Oi course they see the advertising before that age, of course they see people smoking beicre that age. They make up their ,,,.the decisions perhaps before that age." Brendan Brady Tobacco AdYiKIPI Council (tobarco industry spokesman interviewed on HTV Wales, 115191) The tobaccoindus~ dalms !ht its t100 mil~on promohbnal budget is Limed not at .cuihng neh' snoke~ but at perr;adi~g current smokers to switch brands. b most independent people, the argument tbat you ran makr smoking a pamcuiar brand seem at~achve t~thout naldng smoking itself ram athaet~ve does not hold u~. Proving what makes children take up a pdrticuiar habit is not easy, but care~l academic studies show a strong correlation between awareness of adveaising and under-age smok~ng (WHO, Aitken, 1988) If tie tobacco industn' wishes to claim that tobacco adve~sin% is un~4ue in not at~a~n~ new costomers, the burden of proof should tall upon them. Some might argue that even if advertising does attract new customers, it is acceptable If it is seen Dnlv by adults. Yet children see cigarette advertising aenwhere Be~ go: on the i~eeu ~~here ihey play; in shops where tEev buv tneir sreets; in the nagaziner they read; in the sped they watch on Ti! Although d~arette adversing is banned on ~n~ nearir ~wo·llrrds of duldrw ddrm $ ha\le seen such advertising (Heal~ Education Authont~ 19901. Tnis is becauie oi the huge tobacco company sponsoahip ols~omngeven(sbni~'· BATCo document for Legal Services : Health Canada 21 May 1999 Why voluntary agreements are not enough "Therecord of the tobacco companies that have 'vaiuntarily' undertaken to curb tobacco promotion is lurh that no one lan seriously consider lelf regulation by the iodun~ to be a serious option: World Health Olganitation RegionalOffite for Europe, t990 Except ior the ban on dgarette advertising on radio and teiecision, res;ric~ons on tobacco advertisin~ and sponsorship in the U,K· have been d$eed in private between the tobacc~ indusa and the Govenuneni. Th, main result oi such agreements has Deen to ,j Nc[ess~·e governm~nb oi the ~olii~cal wdl to ban iobaao advertisin~ completelv~ These nonbindin~ "roluntati~' agreements have been heav~y ntidsed. Tney have con'jouei demeats oi the qrie of tobacco adver6sing.d its placement, but not iG amount or Ifiectivenejs~ li~oteover, some promob'onal actici~es a:e outside the scope oi the a~eements; when the Government controls one area 3t advertising, the tobacco companies e~c~JanC ir~ another, The voluntary agreement between the Government and the tobacco industry amounts to little more than a i~~rimisabon oi tdaatco adve~ng. Tii ivstlm of se~-re~lbtion is certainly not a iigniii~ani ~.tncbDn on the iObdt[O Il;dUlmii abilit)r to i~romote $ pmd~ca. Even alter m pe aivolunt~y a8~wena, cearotie advertising is prominent in the street and homes of Britain. The tobacco industry would preier to advertise, as it does in Third World coun~ies, without even the restrictions of a weak voluntary agreement It pays this small price in ihe U.K. because it has ~arm successive ~overnments into an unholy alliance which has ~derminrd their will to ban tobacco advertising compieteiv. BATCo document for Legal Services : Health Canada 21 May 1999 The health implications of a ban on advertising *[Tobaa6's] retruianent of its future addicts and victims by direct and indirect advertising can only be Copped by legirlation.." The Hen. Helen Uarle Minister of Health, New Zcaland No one is suppesbhgthai a ban oil advertising alone can stop children irom starang to smoice. Counaiec that have hied seriously io tadde the tobacco epidemic han purs~ed strate~es in w~cr, ie~btion is one ;omponent in a comprehensive poiic?r It is not~ therefore, easy toisolate the eiiea di an advertising ban hom the efiecs ct other tobacco conwl measures. Hpw~e·, counhes that hare had a ban in place ior several yeaa can P~e us some idea of the possible coweque?ces. Norwav banned tobacco promo6on in 198 as part of a i3bacco con~oi poil? 'aoking had been on the increase since the late 19jOs and by 19ij, ii per cent ai13 to tS year old Nonvegian children wen daily smokers~ By 1990, tt~i pmpomon had fallen to 10 per ~ent iNationai Coundl on Snoi~ng sh Health, Norway, 19911. IE 11 M;e 11 115 IpW~----~c; "-- I 1 a----~ Pi -jl! I m iSI 5n a --~ Ti 'I k: Pi j a as a i n as II a It hdr be ngge~i that an adveaiin~ ban would stop pwple swilding to lower tar dgaietles mis is nM tue In Nonua~ during the five years after the datro ad O\ ban, tar content perligarette iell as rapidly as in neighbourir,g Denmark which has O never had a ban, O Nor has the absence oi advertising prohibited the indusmt fmm inooduang new c, brands. h new lo~r tar cigarette was introduced in 1'984 and even without advertirinS, it tad captured iix per rent oi the mariet in Norway after ody one year. u~ BATCo document for Legal Services : Health Canada 21 May 1999 Other implications of a ban on tobacco advertising Curtaiiine ~he tobacco indwav's 5100 rm~on annual promotional budget would not be withoc: shortterm financial loss for iame lon·tobacco businesse~, but tL e~ieci would not be nearly as dras~e as opponer.rs ot the measure would like the public to believe. last vear :obacco adve~sing accounted ior little more than one per cent of the total advert~i3g elpendirure in the European Communi;v, so the overall e~ects oi a ban would be jmall (Xowsthom, 1991). B~ore was enacted in Norway it was argued that the press and advertising indu~~v would suaer Featly without tobacco advertisia~ revenue. That'Nas iar from 9e ore, as total advertising expendihue ~ew ever, laster in the eight yaa~ after the 19ij ban than in the eight yeas before it iNationai Council on Smoking and Heal~.~onay 1991). Dire waning about the effect on the U.K. lenodical market bye been dismissed a "scaremon~erin$ by the Chief Executive ;i the IPC magazines group, john Meilon. He desc~c~eed IPC as "fairly rehxed" about d pwsible ban ICarrett, 1991). SLe 1986, many women's magazines have not been allowed to carr! ci,oarette advertises.ents· Dmpping dgarette advejiing does not aWea; to have advesely affected these publications, some of which, like Vogue and Cosmopolitan, remain among ~e nw: successful on ihe U.K. market Spoasoahip has been dwaibed as "a seie~ve form of high quality advemsing" by Lord Reef ~ogg, e~·Cnaim~an of' the Xr Council (Shaw,19901 The U,K, tobacco indusbY spends fl?million a vear on sports sFoasoskip (Crosbie, 1991)1 But since sponsoaiup is such a rost-ei~c~five r,, or adverSingl ii would be quite possible to ~nd altenative sponsors. David Hardson. ~iei Executive oi stooker's governing bodv the World Professional Billiards anC Snooker Assodation, and Pea Smith of the Test and County Cridtet Board have loth adai~ted that they would. be abie to replace to~aao sponsors [HicWing, 1991). What have other countries done! ~ncreasinglvl governments concerned about the threat to the health of future q generations posed by tobacco are legislating to end all forms of its promoh~on. Countner Jat have banned tobacco promob~on indude Canada, Noaay, Fmland, New Zea~nd and Frame. ~i Canada's Health Wi~b lake Epc, told the Canadian Parliamen: when debating that coun~j tobacco advertisi?Q ban: Yhe time has Ca came she:e ~ilirJs~en responsible for heiti~ cannot sinpiy utter nice, cooliorting words about health, Amen has to be taken'' iEpp, 19881. BATCo document for Legal Services : Health Canada 21 May 1999 What are the arguments against a ban! 'Legal to sell · legal to advertise" 'If dgatettes were introduced today, their production and lale would probably be banned." virginiaBottamley Minister of state for Healttt Some argue that a(~ tobaeo ir sold I~aUlit should Sp logalto advemiP ii h~ th~ Health Ministerh. .aCroa :a ;1P.' "U"[~~~i~~:~3~·~'~ so became an entlemhed habit in this co;mtn- from a~bng nov to protect knoHn, Should we let an accident of historr rtop us children tron future disease! yniuntary controls are better than legislation" Tne Government supports th,,vstem of voluntarv ageementr in p'eierence to le~tian, but that S not tie issue. Ii the tobacco indust~ were voiuntariiy to agree to stop adve~dsing, that rould be fine, but no one believes thu W1U t~ppen. Ihe issue is the amount or resmction The Covemmene already supports a ~ and radio ban, along with limited restrictionsIst other fie0ia, presumably with%ood reason~ it is not dear why a a totalbaa would. not be e~en'wtter. Some daim that the Europeanmcthin Indettho v~edge' ~miaian H~anii to ban advt~ig !or a whalP rang of ?roducts, These fears are a0UIl,0 ,~~t~,~,~i~ilLrihto~v produd which i~s one iniour oiiis ~oFs~tmw .Ininiringlmon~offr~edom01rpoeth" bliltdi~~ncoboiw~mpPriopalKld Most people u;ill feel intuitivel~ that there is a commercial hee ~peed~· a dis~s~dz.mon which has been drawn b the U~. Supreme Court~ Arbcde 10 of the European Convention of Human Rights also points out that the exercise of the right of free speech car;iPs with ii certain duties and ~,ponsibili~B. What the unre~lated aerdse of freedom oi speech meam for the tobacco indus~ is the license ts make an addictir~e and dead$ substance seem attractive and to use words like "mad", "lux~' and "iight" to disguise the aue nature oi1 product that ki~ one in fourof its users, ·n will only keep not importrc O Some have argued that countries that haveenacted legislation to ban tobacco advertising have onl\l done so to keep out forei~n brands or to shore up a state- O owned tobacco monopoly international ecponence indicates otherv~· in No~ap P th~ market than of dome~de manuiaaur~d dp'gls' iell horn 31 pp! cent Q 10 per L~ cent in the 10 yearsioiloring the 'diertising ban 18jam'eit,19901 nis argument implies that a monopoly doer not need to advertise, When an ad ban C ,~~s suggrstcd in Fr"""~ iil~ F'Ot]~""i:'d' Riiiirj [1V SPild, ihY siaieo;vned nlanufactuter. 11 BATCo document for Legal Services : Health Canada 21 May 1999 References Aitken 8 in Pushin% Smoke Blarid Health OISj.niwCon Rgonai OfE,ce for Europe. ~.~i::~li~:~:p:noirca)Eia~a~:rnjj,ioa ~silaaninrducloru Fmrdny of :he Srverth World tonieance on~pbacco and Health, Health Delawent Oi Western :~'~~:~l~,~,~,,~,iio"Oidlil~!i :ih~Y1RI Gall ii, Cdn we predict disease ~ the iurure? Fmceedin8bi Ihe Sevenih World Conference ,, Icba~o, and Heaib iieaili ~e?anntnt of Western ~usmlia Epp I Euharts imm House or Commons Debates 31 ~av 1988. Foote E· laumal oi the ~merican ~vldidissabliion 1b81; i!.': 166l1668. tarrett A· Now even the admen rant to B" YP imoldng· Clo irccpendent 11 I'J( 1991. General Household Survey ·1988. Oifice ori PopulaCon Ce"uier and SI~~vr. London, 1990, Hansard I july 1989, Cols· 1~1:·18 Health Education Autharity~ Beadng the Bah london, 1990. ttidtling M· T~Tjn~ over a new leg yodshire Post l;~lav 1991, Koop, E ]oumai oi the i\melic;in Medical ~wada~on. 148b; ?1: 2891·1894 at 30: nonsmoldn~ verjus,moiciog men. Contingendes. Miller G etal, We ape~tancv ~i~i~~~~l on smoking and Htaith. No~ay~ ~iaMim~mun~i~anon 1Al Rowsthom A, Tobacco ad ban faces bumFy ride. FmdnCal Tim8· ~ blay 199!. Royal (oBegeof Physidans. Health or Smoking! Pitman, 196:. Shaw R, ~n adiuna to the adveflsingg bpensr! PolbcalQua~sly~ Or~Dec 1990: m·380. United Staa Surgeon General. TRe Health Corwquscer oi Smokin% Nicohne Addiition U,S. Departmwt or Health ,d Human Senicer. 1989. United Stater Sul4ea" General·TheHenlthBeneiits~i jmoking Cessation U.S. Do?altm~~t oiHealland Human Senita· B90. ItCanBeDone: '~iib World Health Organiption Regional Ot~ce for Europe, Europe, Copeaba~e~, 1990. Acknowledgements I would W(e to thank Rt~ White br edi-~g this doolment ~han~sL to the ?idonal FOIILTI i01 Coronary Heart Disease kevendoa io, help irith coordinating t~e e"doseme~$ of suppoai9 o""isations ~ nun~ba oi other indhdua~ BC.~ helpY commas and iniom~a~ion at'" Ihod nodee, ~or wh~ich , are p~o~r ~alet~i. nhey are: Keith Ball, Neii CoLiaw, Bobbie jacobson, jp~y ~indd, Tapani Piha, ?ngela PoiiitLen )~d~n i~L~w, Clthcnne Roy" Imo~en Sharp: DavidSimpron, DaYid Swean, and Pamela ~avior ~eda] thanks are due to Eiichi Kono at Kono Comm~cadon~ Ltd ilr Le de~ig of tic;bwlllt. and to the Health Education ~thodty ior $ NppOd' Without YihiCi compict~g the ~ioi~ct would have beer. much more diffictlt. O Michaei OIConnor ps Direaor, tomnarv Prevention Group W BATCo document for legal Services : Health Canada 21 May 1999 The Comnaly Prevention GmUp The Coronan' Prevention Group is a dlKI~ whore aim is to help preen: death and disability hom coronary heart disease by pomotin~ moa~ue~ ia miom~, mo&a:e and enable people to adopt heaithv lilertvies, and by woddng with gpwmment, heaiti waricers end others to de~elop polices to ti~e'same end· CPG does ao~ accept funding fmm iwd, drug o~ tabars compaluer. Individuaii and ,~ga~i~atiom can show theisu~po~t ior CPG'iaims and keep in touch wi'h ia irork jr ~~~ as Assodate ivlenberj Menberr Ace~ve Heart ma~h~e and iree ropier o: all CPG'5 ne~r bookiett Fo;~tther ihinmaiion dnd sample putlicafions please send a $e ~,p stdmoed sa.e, toCPG atlM Gloucester Tlace, london WIH;DA. I~Clwc#mPlace, london WIH 30Am: O;I Ijj 288~ Fax: WI 8569! Pnridcntl Si! Douplas Blade ~O FRCF YinRrsidena:Roiessw Su Ridurd Doll DMFRCPFRS,Dr.lrithBaIIOBEHonMDm~~~ O Romsor]ohnGoodwin Mo FRCP FACC Ouirn~II: Froierrorphihplames Mo Rb Q Onm~~rmiaa~indMSrml~UN nUillCm Nym""h~l Q S~buia and Epld~rmolog~, Srmndw RpYe"b~n and Rehabilitation: RPrcrxlr Ccofh~v Rose CBE~, FRC: Dr~n~PoS~ioCad MRCP FACCP, hmawr Phlip j;Rla MD FRCP, kalrsar]em. Yar~ OBE HonMDFRC~· P~inrar Mirhall YlwlMBBS ~Ki~~ Dr HuSh Uhdl MRC~ #RCGI~ Imallh~L~~L*dmACZ1BS Ila~ull va~mirlba sccnMnlOl~laUJ"~" ISr~OuMn~~B ~pW~ndCI*n~tr BATCo document for legal Services : Health Canada 21 May 1999