Premature mortality due to tobacco: Counting the dead and saving lives

1. Premature mortality due to tobacco: Counting the dead and saving lives Neil Collishaw Research Director Physicians for a Smoke-Free Canada Ottawa, Ontario June 1, 2007

2. “30,000 die while feds sit on hands”

3. Smokers and non-smokers life tables: R. Pearl 1938

4. Survivorship curves,smokers & non-smokersR. Pearl1938

5. Shifting the burden of tobacco-caused death

6. Estimated adult smoking prevalence by WHO region, early 1990s

7. The slow-moving tobacco epidemic

8. FCTC history: 1994: WCTOH calls for convention 1995: WHO asks for feasibility study 1996: WHA accepts framework convention approach 1999–2000: Working groups 2000-02: Negotiation sessions 2003: Treaty text agreed to 2004: 40 countries ratify (including Canada) 2005: Came into force on Feb. 27 2006: 1st Conference of Parties in Feb., 2006 2007: 2nd CoP in July, 2007: 147 parties

9. Ten key obligations are in Articles… • 5: general obligations • 6: prices and taxes • 8: protection from second-hand smoke • 11: health warnings on packages • 12: health promotion and education • 13: tobacco advertising • 14: smoking cessation • 15: smuggling • 20: surveillance and research • 22: international cooperation

10. In the future the FCTC could: • Protect non-smokers • End tobacco advertising • Control cigarette smuggling • Protect from unfair trade challenges • Help developing countries put measures in place • Hold tobacco companies accountable • Monitor global tobacco use • Improve warnings on packages • Increase research

11. Cooperate…cooperation…cooperate…cooperation…cooperation…cooperate…cooperative… cooperation…cooperation…cooperate…cooperation…cooperate…cooperation…cooperate…cooperation…cooperate…cooperation…cooperate…cooperation…cooperate…cooperation…cooperate…cooperation…cooperate…cooperation…cooperate…cooperation…cooperate…cooperation…cooperate…cooperation…cooperate…cooperation…cooperate…cooperation…cooperate…

12. Organize regional training seminars to train trainers Send trained workers to help in selected developing countries Fund local personnel and projects Ongoing monitoring and encouragement, including follow-up visits to target countries Attract additional partners With participation of additional partners, expand project beyond original target countries, eventually to all countries We have a plan…

13. Brief to Commons Health Committee (Isabelle Committee), 1969. ITL head Paul Pare presents for industry 1969: External Statements

14. Minutes of BAT Research & Development Meeting, July 1969. R.S. Wade from Imperial Tobacco Canada participated. 1969: internal research • du Maurier • Players • Matinee

15. Dr. S.J. “Jim” Green Senior Scientist, BAT UK, 1976

16. The dissembly continues in 1987… “It is not the position of the industry that tobacco causes any disease … The role, if any, that tobacco or smoking plays in the initiation and development of any these diseases is still very uncertain.” Jean-Louis Mercier President, Imperial Tobacco House of Commons Parliamentary Committee on Bill C-204 and C-51. November 24, 1987

17. Before TPCA After TA

18. Are tobaccocompaniesevil?Are theypscyhopaths?

19. Imperative to maximize profits • which restricts corporations from acting in ways that protect public health if the result is a reduction in short and long term profits. • 122. (1) Every director and officer of a corporation in exercising their powers and discharging their duties shall (a) act honestly and in good faith with a view to the best interests of the corporation;

20. "The cigarette company is to the lung cancer epidemic what the mosquito is to malaria. It is the vector of disease."

21. The anatomy of a mosquito

22. Limited accountability Corporate law & duty to shareholders The anatomy of a tobacco corporation Invisible hand of the marketplace Limited liability Access to capital Corporate immortality Ability to own other corporations Separation of ownership and management Mobility

23. What if we had been successful from the start

24. At this rate ….

29. Long-term solution:Tobacco can be supplied by public-interest enterprises

31. New potential • Tap the secret knowledge of tobacco experts • Tobacco marketers become tobacco demarketers • R&D department stops designing cigarettes that will sell more, and starts designing cigarettes that will sell less • Increase innovation • Meet the needs of smokers • End the war between Big Tobacco and public health • Resolve the ambiguity of government’s intentions • Create a more cohesive society

32. Revolution?Evolution?

33. Bolder goal-setting and tobacco control actions by governments

34. Tobacco retailing in Canada • 60,000 retailers get $80 million per year in promotional allowances from Big Tobacco. • Advertising banned; power walls being banned. • Sale to minors prohibited and enforced. • Smoker buys cigarettes once a day but only visits his doctor once a year.

35. Power walls Blank walls

36. Transformed walls

37. Transforming tobacco retailers from Big Tobacco lackeys to public health agents and community centres. • Create incentives for transformation. • Train clerks in brief counselling and smoking cessation referral, and other health promotion techniques. • Transform stores into meeting places, neighbourhhood watch and community information centres.

38. Billions ofcigarettes and cigars 2007 34.5 2017 14.5 2018 13.5 2031 0.5 Billions of grams of all other tobacco products 2007 2.25 2017 0.75 2018 0.70 2031 0.05 Obliging tobacco companies to meet public health goals

39. Lesson # 1:We can change the world • Lesson # 2:Tobacco companies adapt to overcome public health measures • Lesson #3:Tobacco corporations are compelled to maximize profits.