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WHO European Ministerial Conference for a Tobacco-free Europe [02/19/02] REPORT on WHO European Ministerial Conference for a Tobacco-free Europe by Andrei K. Demine, M.D., President of Russian Public Health Association, representing The World Federation of Public Health Associations I. The aim and participants of the Conference. The Conference was organized by the WHO Regional Office for Europe. It was aimed at development of a common tobacco control strategy by 51 countries of WHO European Region and building support for a strong European position on FCTC on the eve of INB4 to take place in Geneva on 18-23 March 2002. The consensus on these issues was embodied in “The Warsaw Declaration” adopted by the Conference participants. High-level representatives of 46 WHO member states, WHO Director General, WHO-EURO Regional Director, attended the Conference. The Prime Minister of Poland greeted the participants. In the end of his speech he promised to quit smoking. Among participants were Deputy Prime Minister of Moldova, 22 Health Ministers or Secretaries of State. The Conference was attended by representatives of Integrational and Intergovernmental organizations: European Commission, International Labor Office, World Bank, and Non governmental organizations: British Medical Association, European Network on Young People and Tobacco, European Forum of Medical Associations and WHO, European Network for Smoking Prevention, Federation of International Football Associations (FIFA), International Association of Cancer Registries (IACR), International Council on Alcohol and Addictions (ICAA), International Federation of Pharmaceutical Manufacturers Associations, International Olympic Committee and World Federation of Public Health Associations. II. Conference program. Available at: http://www.who.dk/eprise/main/WHO/Progs/TOBCONF/Home A. Keynote speakers: Dr. Gro Harlem Brundtland, Director General WHO presented a comprehensive
review on tobacco consumption prevalence levels and trends, tobacco control
efforts and industry counter-measures, including youth campaigns and voluntary
restrictions. She termed smoking a communicated disease and emphasized
the key role of the governments of the European Region in the FCTC and
coming INB4. Professor Kenneth E. Warner (USA) discussed economic and political issues related to tobacco control. He claimed that tobacco control does not jeopardize national economies even in tobacco producing countries. Professor Witold Zatonski (Poland) presented case study of Poland’s experience in tobacco control. He concluded that successful tobacco control measures facilitated by democratic transition is one of key factors which resulted in dramatic improvement of public health indices in Poland in recent years. Dr. Vera Da Costa e Silva (WHO) spoke about necessity to protect children from smoking. Professor Rafael Oganov (Russia) presented data on impact of smoking on mortality in Russia and other countries of Europe, including cancers and cardiovascular diseases in comparative perspective. He emphasized importance of second hand smoke and described recent legislation on tobacco smoking control adopted in Russia, He also expressed support for a strong FCTC. Professor Joy Townsend (UK) spoke on economic and social implications of smoking in Europe. She claimed that the enormous health impact of tobacco is a sufficient reason for the governments of Europe to agree a common strategy to support and lead the WHO FCTC. Ms. Sibylle Fleitmann (Secretary General of the European Network for Smoking Prevention) presented a paper with examples of NGOs role in tobacco control. She concluded that because democracy is the art of thinking independently together, NGOs acting as a link between civil society and government bodies, having capacity to mobilize individuals, organizations and networks, can add to a stronger political leadership from Europe for an effective FCTC. ENSP should put more emphasis on support of NGOs in countries targeted by the industry, including Russia. Anthony Kingham (UK representative) discussed INB4. He said that only one candidate for a chairperson from Brazil is left. David Byrne (Member of the European Commission responsible for health
and consumer protection). His presentation became an important event of
the Conference. He came with a passionate and balanced speech “Turning
the tide on the tobacco epidemic” available at: http://europa.eu.int/rapid/start/cgi/guesten.ksh?p_action.gettxt=gt&doc=IP/02/274|0|RAPID&lg=EN&display
He strongly urged governments of the states to fight tobacco consumption,
and also called for continued role of NGOs in development of a strong
FCTC. His speech has considerably added to the final document (Warsaw
Declaration) strengthening and contains points for furthering tobacco
control. He emphasized importance of tobacco control in future member
states of the EU, and of solidarity on the issue within EU on supranational
level. He attacked Germany’s position, blocking the EU position on
advertising. He also criticized UK’s position on the rights of non-smokers
to clean air. Part of his presentation was devoted to! B. Government representatives of many countries, including Belgium, France, Finland, Norway, The Netherlands, Poland, Slovenia, Czech Republic, Norway, Ireland spoke about necessity for tobacco control within a comprehensive tobacco control policy, including a total ban on advertising. The organizers of the Conference only partly succeeded in an attempt to orient discussion towards political and economic aspects. More emphasis should have been be placed not on causality between tobacco and disease, acknowledged now even by the industry, or well-known epidemiological evidence on benefits of quitting smoking, but on political and economic aspects of tobacco war in the era of globalization. Positions and behaviors of the government, private business, civil society and international anti- and pro-tobacco players should have been analyzed for each country as the basis for future strategy development and public health governance. Emphasis of specific countries, being primary targets in the industry expansion, such as Russia should have been made in tobacco control efforts. The potential of civil society was not used adequately. NGOs did not coordinate their activities prior to and during the Conference as vigorously as it is being done in INB process. Speakers at the Conference voiced support for tobacco control and strong FCTC. However, the key issues of economic and political components of tobacco control, or gaps in legislation, or input of civil society, or rising prevalence of tobacco use among children, or behavior of the industry were not addressed in many presentations. Some speakers voiced their concerns on the issue of compensations related to switching production away from tobacco. Health Minister of Tajikistan, chairing one of sessions, explicitly voiced proposal that the industry representatives should participate in such meetings and have an opportunity to express and substantiate their attitudes, etc. Several questions from the audience after the reports resembled “classical” industry questions. C. There were organized several Lunchtime workshops on the following topics: · Role of doctors in tobacco control. D. On the first day The Tobacco Free Forum was convened including an award ceremony for the WHO Clearing the Air Competition World No Tobacco Day 2001. First Lady of Poland and Dr Brundtland attended the Ceremony. Keith Cooper, Director of the Communications Division of the FIFA (International Football Association) chaired the session. Five projects were awarded: · Healthy City project of Bologna (Italy), E. On the second day at the Conference final session “The Warsaw Declaration” was unanimously adopted with the exception of Germany. Representative of Germany said that the issue of total ban on advertising couldn’t be supported by Germany according to direct instructions from the Chancellor’s office to register a reservation based on constitutional grounds. Blocking position of Germany was announced only at the final session, when any possibilities for lobbying have vanished. Among the key points of the Declaration are high taxes, bans on tobacco advertising, sponsorship and promotion, protection against involuntary exposure to environmental tobacco smoke in public places and workplaces, access to cessation measures and strict controls on smuggling. Dr. Mariusz Lapinski, Minister of Health of Poland and Dr Marc Danzon signed the Warsaw declaration in the name of the conference participants. III. Documents of the Conference. A. Warsaw Declaration. Available at: http://www.euro.who.int/eprise/main/WHO/Progs/TOBCONF/ConfDocs/20020219_1 B. The European Report on Tobacco Control Policy. Available at: http://www.who.dk/document/tob/tobconf2002/edoc8.pdf In fact, in Russia in 1995-2000 only legal production of cigarettes has increased from 141 up to 341 (!) billion. By 2000 the share of transnational industry in production has risen to 65% (!), though privatization of tobacco industry with participation of foreign capital was started by the Government only in 1993. Prevalence of smoking was rising fast among children in 1997-2001. C. WHO EUROPE country profiles on tobacco control 2001. D. WHO-EURO Website on tobacco control was launched at the Conference.
However it was declared that only governmental data would be available
there. There is a risk that the voice of civil society and NGOs will not
be heard, biasing the picture and response especially in the countries
with strong position of the industry. Taking into consideration the dramatic
change of tobacco situation in recent years in many countries, the most
up-to-date data should be presented there to satisfy population and tobacco
control community needs. Issues of tobacco control activities of WFPHA and RPHA, FCA were discussed with members of national delegations, WHO staff, representatives of Integrational and Intergovernmental organizations: European Commission, International Labour Office, World Bank, and Non governmental organizations. There were also discussions with Professor Witold Zatonski and Dr Krzysztof Przewozniak on the forthcoming 3rd European Conference Tobacco or Health (3ECTOH) to be held in Warsaw on 22-23 June 2002 and participation of Russian representatives. It was also agreed that discussion of GYTS evidence and policy proposals at 3ECTOH and INB4 should be prepared, because some delegations were using tobacco statistics for adults, painting much less critical picture of tobacco situation in specific countries. In order to attract attention of the Conference participants to the critical
tobacco situation in Russia, specially for distribution among the Conference
participants Russian Public Health Association has published a brochure
“Tobacco Policy Making in Russia and the Role of Civil Society”
(attached). The brochure is based on recent book by Professor N.F.Gerasimenko,
Chairman of State Duma Committee on Health Protection and Professor A.K.Demine,
President of RPHA. However one of the members of the Russian delegation
opposed wide distribution of the brochure. Only 15 copies of the brochure
were presented to interested participants at their request during personal
discussions (WHO-EURO, EU, Russia, Latvia, The Netherlands, Poland, USA
and others). Response to the book and brochure was positive. For example, one of the keynote speakers at the Conference, Professor Kenneth Warner, Department of Health Management and Policy, School of Public Health, University of Michigan, proposed to organize a seminar on tobacco policy in Russia within activities of the University of Michigan Tobacco Research Network. During the Conference there was an interview for the TV broadcast on tobacco control in Russia developed by Russian TV journalist with financial support from WHO-EURO. Upon returning to Moscow, a meeting of the Russian National Coalition "For Tobacco Free Russia!" was convened on 6 March 2002. The participants were informed on the Warsaw WHO conference. Materials brought from Warsaw Conference aroused much interest. The issue of participation in 3ECTOH was discussed. It was suggested that over 20 presentations by different Russian authors could be prepared for the Conference. Conference organizers’ proposal to convene a meeting on Russian tobacco control issues within 3ECTOH was enthusiastically supported. Participants also discussed future activities of the Coalition and FCTC progress, including the forthcoming INB4. The issue of inadequate transparency of the national process of FCTC development for the civil society and NGOs in Russia was raised. It was agreed that the Coalition should address the Government on that point. V. Conclusions. A. Warsaw Conference is a major development in tobacco control in countries of Europe, after Madrid (1988) Conference and an important event in building support for development of a stronger FCTC. B. Documents and new evidence produced by the Conference participants should be used widely for tobacco control and building support for a stronger FCTC. C. Participation of NGOs representing civil society was limited. Lobbying activity and coordination of NGOs at the Conference was less vigorous compared to INBs. D. Progress in tobacco control in majority of countries of Europe is not satisfactory according to the review of implementation of 3rd Action plan for a tobacco free Europe between 1997-2001. Design and effectiveness of the past and future efforts should be reviewed critically. It is obvious that health Ministers are not the strongest lobbyists in tobacco control. May be it would be relevant to convene a parallel meeting of Ministers of finance of European courtiers on economics of tobacco control with involvement of World Bank. E. Organizers tried to orient discussion towards political and economic aspects. However, even more emphasis should be placed in tobacco control not on causality between tobacco and disease, acknowledged now even by the industry, but on economics and especially politics. Positions and behaviors of the government, private business, civil society and international anti- and pro-tobacco players should be analyzed for each country as the basis for future strategy development. Emphasis of specific countries, being primary targets in the industry expansion, such as Russia should be made in tobacco control efforts and the Fourth Action Plan for a Tobacco-free Europe. F. German Government’s position on advertising ban should be addressed by the European and global anti-tobacco community, being very important for the EU position. *** Warsaw declaration for a tobacco-free Europe Acknowledging that tobacco is a toxic and addictive substance and that the tobacco epidemic is one of the greatest public health challenges facing WHO’s European Region, which therefore needs a joint response; Emphasizing that there is a growing gap in tobacco control between Member States in different parts of the European Region; Noting that, in spite of successful examples in the Region, a number of Member States are still to establish comprehensive tobacco control policies; Recognizing that present and future generations deserve smoke-free air and protection from involuntary exposure to environmental tobacco smoke and the negative health, economic and social impacts of tobacco use; Emphasizing that smoking cessation strongly contributes to a decrease in smoking prevalence; Building upon the foundations of the first European Conference on Tobacco Policy (Madrid, 1988) and the three consecutive Action Plans for a Tobacco-free Europe spanning the period 1987-2001; Endorsing the central role of governments in agreeing to, reviewing and strengthening their action plans, drawing together contributions from government, nongovernmental organizations and health professionals; Highlighting the competence and leadership of the World Health Organization (WHO) within the United Nations system in the field of tobacco control; Commending the significant value of strengthening regional partnerships and solidarity for efficient action against tobacco consumption; We, Ministers and Representatives of the States participating in the WHO European Ministerial Conference for a Tobacco-free Europe, are seriously concerned about the continuing threat posed by smoking to global health. We accordingly: 1. commit ourselves to developing and adopting the European Strategy for Tobacco Control (Fourth Action Plan) for a Tobacco-free Europe in accordance with the following guiding principles: tobacco control is at the top of our public health priorities; combating the tobacco epidemic is of great importance in protecting the health of individuals, particularly children and young people, who shall be appropriately informed about the addictive and lethal nature of tobacco consumption and the recruiting tactics of the tobacco industry; comprehensive policies with measurable impact on the reduction of tobacco use shall be effectively implemented throughout the Region. The most important components of such comprehensive policies are: high taxes, bans on tobacco advertising, sponsorship and promotion, protection against involuntary exposure to environmental tobacco smoke in public places and workplaces, access to cessation measures and strict controls on smuggling; the new Strategy, building on the results from previous Action Plans, should set clear and specific targets to be achieved in the Region by 2007; attention must be focused as a priority on the alarming trends in tobacco consumption among young people, women and persons from vulnerable socioeconomic and minority groups; public health protection has priority over tobacco production, therefore viable alternative economic activities to tobacco production should be promoted, as well as the gradual transfer of subsidies for tobacco growing to other activities; tobacco policies should include gender-specific concerns and perspectives in all aspects of tobacco control; 2. declare our strong support for preparing a comprehensive WHO Framework Convention on Tobacco Control (FCTC) and urge all Member States in the European Region and the European Commission to: highlight the priority of public health protection and contribute actively to the development, adoption and implementation of a strong and effective FCTC; work towards a set of integrated tobacco control measures and agreed international responses against the tobacco epidemic; 3. urge Member States and intergovernmental organizations to strengthen European partnership and solidarity in tobacco control by: creating a proper intergovernmental mechanism for the regular exchange of information in the technical, scientific and legal fields of tobacco control; closing gaps in tobacco control policies between the different parts of Europe by using the experience of successful programmes; facilitating assistance in developing national tobacco control policies to countries in special circumstances, such as Member States in economic transition; reinforcing the role of national counterparts for the European Strategy for Tobacco Control for a Tobacco-free Europe as an important network for efficient tobacco control policies in the Region; making efforts to involve all segments of society in combating tobacco consumption; 4. ask the WHO Regional Director for Europe to: - give high priority to providing guidance and support to Member States in their activities to develop and implement comprehensive tobacco control policies; - continue to develop the European Strategy for Tobacco Control for a Tobacco-free Europe, for decision by the WHO Regional Committee for Europe in 2002; - assist Member States in the eastern part of the Region, in the light of the particular seriousness of the problem, to obtain support from developmental and donor agencies for developing and implementing tobacco control policies; - facilitate partnerships between Member States and relevant intergovernmental
and nongovernmental organizations for coordinated action against the tobacco
epidemic in the European Region; |
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