Americas: Industry remains a hindrance to the fight against smoking

A special issue of the journal Tobacco Control is devoted to the fight against smoking in the Americas. One of the articles in this issue takes stock of the progress in this area on the continent and notes some significant progress, even if many efforts remain to be made to counter the tobacco lobby.

Grouped within the Pan American Health Organization (PAHO), the 35 countries of the American continent are regionally uniting their efforts to combat various non-communicable diseases. After a finding of slowdown in 2017, the fight against tobacco was reaffirmed as a priority objective through the 2018-2022 Action Plan to Strengthen Tobacco Control in the Americas.

Based on the 2015, 2017 and 2019 reports of the World Health Organization (WHO) on the global tobacco epidemic, an article takes stock of the situation in the American countries on this subject[1].

More non-smoking places and health warnings

Among the main advances observed in 2020, the generalization of enclosed non-smoking spaces, in public buildings, workplaces and public transport, is now enacted in 22 countries, covering approximately half of the continent's population. The other most widespread measure is the affixing of large health warnings on tobacco products (at least 50 % of the surface), implemented in 21 countries representing just over half of the population.

The targets set for 2022 for a total ban on advertising, promotion and sponsorship of tobacco products are, however, only implemented in eight countries (30 % of the regional population), and in an identical proportion for the ban on tobacco product displays in points of sale. The establishment of tobacco tax rates at 75 % or more was only effective in five countries (32 % of the population) and remains one of the main projects to be implemented to finance smoking prevention and care. Eleven countries (22.5 % of the population) nevertheless adopted increases in tobacco excise duties of at least 10 % between 2014 and 2018.

Strong disparities between sub-regions

This overall situation, however, hides significant disparities on the continent. The non-Spanish-speaking Caribbean sub-region thus continues to lag significantly behind in implementing the measures contained in the Framework Convention on Tobacco Control (CCLAT), but has made significant progress on smoke-free areas, health warnings and a total ban on advertising. The implementation of the six measures MPOWER WHO's best practices guideline has reduced smoking prevalence in Brazil from 15.6 % in 2007 to 9.8 % in 2019. The ban on smoking in enclosed spaces is widespread throughout South America, but remains partial in practice and is not widespread in Central America. Standardized plain packaging for tobacco products, on the other hand, is only applied in Canada and Uruguay, the latter of which is recently in the process of revising its position.

The tobacco industry's permanent brake

In all countries, tobacco industry interference was the main obstacle to the adoption or implementation of the measures envisaged, whether advertising, health warnings, plain packaging or taxation. The COVID-19 pandemic period was notably marked by significant offensives by this industry, in terms of advertising and attempts to interfere in public policies. The threat of an increase in illicit trade, brandished by the industry in the event of an increase in taxes on tobacco products, is nevertheless contradicted by independent studies carried out, in the Americas region as in other parts of the world. The Protocol to Eliminate Illicit Trade in Tobacco Products appears to be the most useful bulwark here, but has only been ratified by six countries in the region.

The authors regret the absence of instruments to limit interference from this industry, and suggest establishing legislative tools to protect against conflicts of interest. They recommend, in order to better implement the provisions of the FCTC, increasing exchanges between the different ministries of a country, and between the different countries of the South for the transmission of good practices.

Ultimately, this assessment, which seems mixed, should only partially achieve the objectives of the Action Plan in 2022. It nevertheless contains significant progress, which shows, with the example of Brazil, that the deployment of FCTC measures makes it possible to obtain significant results concrete, contrary to what the tobacco industry claims.

Keywords: Americas, FAHO, WHO, CCLAT, lobby, tobacco industry interference

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