Tobacco Control Playbook

KEY MESSAGE: Tobacco is not a normal industry: it is the world’s most lethal industry, which products cause 7 million deaths each year around the world. The tobacco industry has not changed despite the evidence for the harm it causes: its primary role remains to sell as many cigarettes as possible, and it still seeks to oppose any action that might reduce sales.

What is the issue?

The tobacco industry seeks to present itself as a normal, ethical and responsible industry selling a legitimate consumer product.

What is the evidence for concern?

• Tobacco companies have for decades argued that their industry is a responsible industry that should be treated similarly to other industries, and should be allowed to play a full part in policy and other discussions with the government and community. It should be recognised as responsible in areas ranging from marketing to product claims and should not be subject to many of the constraints that are proposed by tobacco control ^[1][2][3].
• Notwithstanding Article 5.3 of the FCTC, the industry seeks to engage actively in discussions with government and others on the basis that it is fully entitled to this form of engagement ^[4][5][6].
• The tobacco industry specifically seeks to engage with governmental agencies outside Health that are not always aware of Article 5.3 or that it applies to all parts of government, and further seeks to exploit areas for co-operation such as reducing the illicit tobacco trade ^[7][8].
• Tobacco companies present themselves and seek to engage with governments and the community as part of industry groups. They also seek to engage indirectly as well as directly, through public relations organisations, lobbyists, front groups and political donations ^[9].
• Tobacco companies seek to be seen as contributing to the community across a range of areas, including tax revenue and employment. They promote their “Corporate Social Responsibility” through a wide range of philanthropic and community contributions, and publishing and promoting reports on social responsibility, sustainability, environmental and other activities, from promoting human rights and diversity to clean neighbourhoods ^{[10][11][12][13][14]}. Through industry events they also seek to promote an image of public service, for example through an award for the “Most Impressive Public Service Initiative” at the Global Tobacco and Nicotine Forum conference, or awards and recognition for their roles as employers ^[14][15].
• The industry presents itself as health-conscious, aiming to benefit society through development of less harmful products ^[16][17].
• Tobacco companies promote an apparent interest in and support of research into the consequences of smoking, and about possible approaches to reducing or eliminating the harm. Recent initiatives from tobacco companies even include funding of new research processes and claims such as that they want to see a Smokefree World, although these have met with substantial criticisms and rejection by WHO and other health authorities ^{[18][19][20][21][22][23][24][25]}.
• Tobacco companies claim not to promote their products irresponsibly, for example claiming that they see smoking as an adult behaviour and do not advertise to children ^[26].
• Even when there is recognition of previous wrongdoing, the case has long been made, even in advertising, that “that was then… this is now…”^[27]. The companies seek to promote a perception that they have changed, and are now concerned for the public good.

What is the reality?

• The tobacco industry’s products cause 7 million deaths each year around the world. The World Health Organisation and US National Cancer Institute (NCI) estimate that this will rise to 8 million deaths by 2030 ^[28][29].
• Tobacco is the only industry whose product kills at least half of its regular consumers when used precisely as intended. Recent research from Australia shows that cigarettes in a country with a mature epidemic are likely to cause the deaths of two thirds of regular smokers ^[30].
• Tobacco consumption imposes massive economic burdens. The WHO/NCI report concludes that tobacco costs more than $US 1 trillion globally in health care and lost productivity costs, and that tobacco control reduces the disproportionate burden that tobacco use imposes on the poor ^[29].
• The health, social and economic burdens of smoking are borne increasingly by low- and middle-income countries (LMICs), which have been heavily targeted by the tobacco industry. The WHO/NCI report notes that around 80% of smokers live in LMICs, and, of the anticipated increase in global deaths to 8 million annually, more than 80% will occur in LMICs ^[29].
• The tobacco industry sees their greatest potential for the future in LMICs and other “emerging markets” ^[31].
• There has been incontrovertible evidence that smoking is lethal for more than 75 years. Despite this tobacco companies have continued to promote and sell their products wherever possible, targeted children and vulnerable communities, fiercely opposed any action that might result in reduced smoking, and directly and indirectly targeted and attacked organisations and individuals seeking to reduce smoking ^[32][33].
• Through lies, deceit, and corruption, the tobacco industry has a long history of opposing anything that might reduce sales of its products. Much of this evidence comes from the industry’s own documents, made available for public scrutiny following the 1998 US Master Settlement Agreement. In 1967, at the First World Conference on Smoking and Health, the late Senator Robert Kennedy said, “The industry we seek to regulate is powerful and resourceful. Each new effort to regulate will bring new ways to evade. Still we must be equal to the task. For the stakes involved are nothing less than the lives and health of millions all over the world…” ^[33][34].
• Many reports from governments and health authorities have condemned the tobacco industry’s past and present activities. A recent UK High Court judgment noted that the tobacco industry “….facilitates and furthers, quite deliberately, a health epidemic. And moreover, a health epidemic which imposes vast negative health and other costs upon the state” ^[35].
• Activities presented as being responsible, from education to self-regulation, are either ineffective or counter-productive, and likely to be part of public relations and distraction strategies. The tobacco industry’s research and other scientific activities are highly selective, never focused on reducing use of its products, and based solely on promoting the industry’s interests. The tobacco industry’s approach to corporate social responsibility and similar activities was well described by a British American Tobacco executive as providing “air cover” to distract governments and others ^[36].
• As stated in WHO resolution supporting Article 5.3 of the FCTC, “the tobacco industry has operated for years with the express intention of subverting the role of governments and of WHO in implementing public health policies to combat the tobacco epidemic” ^[37][38]. Claims that tobacco companies want to see a Smokefree World are inconsistent with the industry’s fierce opposition to measures that will reduce smoking and its continuing promotion in both LMIC and other countries, as well as the companies’ own comments about the long-term prospects for smoking, and confirmation that tobacco remains the “core” product. The most recent research funding proposal has been widely criticised, including by WHO and the FCTC Secretariat, with similar recognition that any involvement with it by governments would breach Article 5.3 of the FCTC ^[23][24][39].
• There is now growing international momentum for major investment funds to cease investing in the tobacco industry ^[40].
• The tobacco industry has been subjected to a series of damning legal judgements, many requiring substantial payments arising from the death and disease caused by its products. Further tobacco companies in the US will now have to run court-ordered corrective advertising telling the truth about their lethal products including even their role in intentionally designing cigarettes to make them more addictive ^[35][41][42].

Key messages

• Tobacco is not a normal industry: it is the world’s most lethal industry.
• The tobacco industry has not changed despite the evidence for the harm it causes: its primary role remains to sell as many cigarettes as possible, and it still seeks to oppose any action that might reduce sales.
• The tobacco industries’ “Corporate Social Responsibility” and related activities are part of a broader public relations program.
• The tobacco industry is promoting smoking to LMICs and other vulnerable populations and “emerging markets”.
• Article 5.3 is there for good reason and should be fully observed by all parts of government.