REPORT TO SENATOR PIA CAYETANO

RE: De-normalization of Tobacco Industry

Policy Analysis Paper

Arvin Maceda

Policy Analyst

Executive Summary

Tobacco industry denormalization, or TID, is a public health strategy aimed at reducing

tobacco use. The need to denormalize or to put it out of the norm is because the

industry is known to produce products that are harmful to man. The issue therefore is

the absence of any legal mechanism that will denoramalize the tobacco industry and

protects the government from its manipulation, subversion and tactics.

This analysis examines three policy alternatives. (1) status quo, (2) full compliance to

the recommended actions in Article 5.3 and (3) CSR regulation. Policy goals was set

and determined which includes limiting tobacco liberty, efficiency to protect youth and

citizens and social acceptability. All the three policy alternatives were analyzed

according to the set policy goals and it was identified that the CSR regulation would be

the best course of action to denormalize the tobacco industry in the Philippines.

Introduction

Tobacco use continues to be the leading cause of preventable death making tobacco

addiction a pandemic wreaking the most havoc in the most vulnerable countries and

creating an enormous toll of disability, disease, lost productivity and death. It continues

to claim nearly 6 million people every year and causes hundreds of billions of dollars of

economic losses and others. If not addressed, by 2030 tobacco will kill more than 8

million people worldwide with 8 out of 10 of these deaths are among people in low-and-

middle-income countries. (1)

The 21st and 20th century is marked with efforts to protect people from harms of

smoking. But recently the fight to protect people from the harms of smoking tobacco has

evolved to the fight to protect people from the influence, interference and manipulation

of the tobacco industry—operationally defined as tobacco industry denormalization. (1)

Tobacco industry denormalization, or TID, is a public health strategy aimed at reducing

tobacco use. It is carried out by alerting the public the tobacco industry’s status as a

vector of disease and its role in developing and perpetuating the tobacco epidemic. It

aims to show the public why, despite the fact that tobacco is a legal product, the

tobacco industry and its behaviors fall outside the norms of behavior of legitimate

business and to reverse the process of industry normalization promoted by cigarette

manufacturers over the decades. (2)

Mahood distinguishes between the denormalization of tobacco use (which focuses on

the addicted individual) and the denormalization of the industry, arguing that only the

latter offers the prospect of addressing the chief structural cause of the tobacco disease

epidemic: industry activity. (2)

Dr. Margaret Chan of WHO states that “the enemy, the tobacco industry, has changed

its face and its tactics. The wolf is no longer in sheep’s clothing, and its teeth are bared.”

(1)

In the effort to denormalize the industry one cannot underscore enough the fundamental

and irreconcilable conflict between the tobacco industry’s interests and public health

policy interests. The tobacco industry produces and promotes a product that has been

scientifically proven to be highly addictive, to harm and kill many and to give rise to a

variety of social ills, including increased poverty while many governments and public

health workers try to increase the health of the population by implementing measures to

reduce tobacco use. (3)

The profit-driven tobacco industry has used its resources to halt these public health

policies where it can, water them down when it cannot stop them altogether, and

undermine their enforcement when they are adopted. That is why by common logic we

can conclude that the tobacco industry should not be treated as a friend or as an ally in

the government’s aim to increase and protect public’s health. (3)

In a presentation to the Philip Morris Board of Directors in 1995, the then Senior Vice-

President of Worldwide Regulatory Affairs of the company stated: “Our goal is to help

shape regulatory environments that enable our businesses to achieve their objectives

… [fighting] aggressively with all available resources, against any attempt, from any

quarter, to diminish our ability to manufacture our products efficiently, and market them

effectively …” (1)

In its efforts to derail or weaken strong tobacco control policies, tobacco industry

interference takes many forms. These include: (1)

1. maneuvering to hijack the political and legislative process;

2. exaggerating the economic importance of the industry;

3. manipulating public opinion to gain the appearance of respectability;

4. fabricating support through front groups;

5. discrediting proven science; and

6. intimidating governments with litigation or the threat of litigation.

Maneuvering to influence political and legislative decisions involve creating and

exploiting legislative loopholes. One of most exploited loophole in the Philippines is the

use of Corporate Social Responsibility Projects. RA 9211, or the Tobacco Regulation

Act of 2003, explicitly prohibits promotion of tobacco products to the youth but it did not

have any provision to limit or prohibit CSRs. The tobacco industry, specifically Philipp

Morris International, doubled its spending on these projects in the effort of gaining public

trust and projecting a socially responsible company as an image. This subverts

prohibition laid down by the law because these efforts subsequently reach to the youth

and in the long term silently promotes the use of cigarettes. (1)

The tobacco industry is also known to exaggerate the economic importance of the

industry arguing that the industry provides employment and boosts the economy of

tobacco growing countries—such as the Philippines. The tobacco industry is known to

have close ties with tobacco producing provinces in the countries and much of the

opposition in passing legislations for tobacco control came from these provinces. (1)

The WHO wishes to counteract this argument by stating that sound economic studies

show that industry claims of potential job and other economic losses resulting from

stricter tobacco controls are significantly overstated anyway; in fact, these losses are

negligible. If consumption declines, job losses in tobacco-dependent sectors, are more

than offset by increases in employment in other sectors with no negative impact on the

overall economy. (1)

The tobacco industry devotes considerable resources to twist public opinion, not solely

to their product but to the company itself. As previously stated, this is referred to as

Corporate Social Responsibility or (CSRs). The industry uses these to concoct and spin

the news to promote its lethal business. To fully quantify the effects of these CSRs to

cigarette smoking prevalence, Malone et al conducted a meta-analysis. (1,2)

The study identified that beliefs about tobacco industry behavior and marketing

practices were related to youth smoking behavior. Malone et al stated that occasional

and regular smoking behavior was significantly related to student beliefs about tobacco

companies doing good things in the community, manipulating young people to think

smoking is cool, advertising to youth, and using athletes and sports sponsorships to get

young people to smoke. The better the perception, the more likely they are to smoke

and the industry is ready to pour out its resources to increase good perception and

subsequently market their product to their “next customers”. (2)

Tobacco Regulation in the Philippines

In 2003, the Philippines enacted RA 9211, or the Tobacco Regulation Act. It is the

policy of the State to protect the populace from hazardous products and promote the

right to health and instill health consciousness among them. It is also the policy of the

State, consistent with the Constitutional ideal to promote the general welfare, to

safeguard the Interests of the workers and other stakeholders in the tobacco industry.

For these purposes, the government shall institute a balanced policy whereby the use,

sale, and advertisements of tobacco products shall be regulated in order to promote a

healthful environment and protect the citizens from the hazards of tobacco smoke, and

at the same time ensure that the interest of tobacco farmers, growers, workers and

stakeholders are not adversely compromised.

The act thrusts to:

a) Promote a healthful environment;

b) Inform the public of the health risks associated with cigarette smoking and

tobacco use;

c) Regulate and subsequently ban all tobacco advertisements and sponsorships;

d) Regulate the labeling of tobacco products;

e) Protect the youth from being initiated to cigarette smoking and tobacco use by

prohibiting the sale of tobacco products to minors;

f) Assists and encourage Filipino tobacco farmers to cultivate alternative

agricultural crops to prevent economic dislocation; and

g) Create an Inter-Agency Committee on Tobacco (IAC-Tobacco) to oversee the

implementation of the provision of this Act.

This act lays the foundation for tobacco regulation and protection of the youth from its

harmful act. The act is a step forward in denormalizing tobacco use however it does not

give the government any power to denormalize tobacco industry, albeit the act gives

ample protection to the industry.

The Philippines is one of the participating countries to the WHO Framework Convention

on Tobacco Control. This is the first treaty negotiated under the auspices of the World

Health Organization. It is an evidence-based treaty that reaffirms the right of all people

to the highest standard of health. It represents a paradigm shift in developing a

regulatory strategy to address addictive substances; in contrast to previous drug control

treaties, the WHO FCTC asserts the importance of demand reduction strategies as well

as supply issues.

Article 5.3 of this convention gives the member states 4 guiding principles on the

protection of public health policies with respect to tobacco control from commercial and

other vested interests of the tobacco industry. These principles are:

1. There is a fundamental and irreconcilable conflict between the tobacco

industry’s interests and public health policy interests

2. Parties, when dealing with the tobacco industry or those working to further its

interests, should be accountable and transparent.

3. Parties should require the tobacco industry and those working to further its

interests to operate and act in a manner that is accountable and transparent.

4. Because their products are lethal, the tobacco industry should not be granted

incentives to establish or run their businesses

Guided by these principles the framework recommends the following actions on the

protection of public health policies with respect to tobacco control from commercial and

other vested interests of the tobacco industry:

1. Raise awareness about the addictive and harmful nature of tobacco products and

about tobacco industry interference with Parties’ tobacco control policies.

2. Establish measures to limit interactions with the tobacco industry and ensure the

transparency of those interactions that occur.

3. Reject partnerships and non-binding or non-enforceable agreements with the

tobacco industry.

4. Avoid conflicts of interest for government officials and employees.

5. Require that information provided by the tobacco industry be transparent and

accurate.

6. Denormalize and, to the extent possible, regulate activities described as “socially

responsible” by the tobacco industry, including but not limited to activities

described as “corporate social responsibility”.

7. Do not give preferential treatment to the tobacco industry.

8. Treat State-owned tobacco industry in the same way as any other tobacco

industry.

As a member-state of the WHO and as signatory to the FCTC the question arises if the

current policies enough to protect public health policies with respect to tobacco control

from commercial and other vested interests of the tobacco industry.

As previously discussed, there is a need to denormalize not only the use of tobacco but

the tobacco industry itself to intensify tobacco regulation and to promote health in the

country. The current laws and policies that are in place in the country do not give

government power to denormalize albeit it gives protection to the tobacco industry.

According to SEATCA, the Philippines ranked third among the ASEAN countries in

terms of level of tobacco industry interference, highest in the level of tobacco industry

participation in policy development and has the lowest scores in having preventive

measures to curb tobacco industry interaction. (4)

Under these conditions, if left without intervention the industry will continue in its

practice to increase social acceptability of tobacco, maneuver and subvert laws and

legislation for regulation, and partially—if not totally—diminish our efforts to protect the

youth, the poor and the general public from the known harms of tobacco.

WAYS OF DENORMALIZING TOBACCO INDUSTRY

The analysis presented in the remainder of this report compares the status quo policy to

the following alternatives.

Full Compliance to the Recommended Actions in Article 5.3

The clear way of denormalizing tobacco industry is the full compliance of the

recommended actions found in Article 5.3 of the FCTC for the protection of public health

policies with respect to tobacco control from commercial and other vested interests of

the tobacco industry. This is an internationally accepted recommendation with expert

review and analysis. As listed previously, this will include comprehensive actions to

deformalize the industry, protect the government and expose the industry’s dirty tactics.

However, this will severe the relationship between the industry and the government. But

in the pursuit of health for all this might be the trade-off that the country needs.

Regulation of Corporate Social Responsibility Projects of the Tobacco Industry

This alternative is a compromise alternative. This is a small step into full compliance

and taking into count possible drawbacks and conflicts from the tobacco industry. This

includes enacting into law Recommendations 5 and 6 which states aims to require that

information provided by the tobacco industry be transparent and accurate; and

denormalize and, to the extent possible, regulate activities described as “socially

responsible” by the tobacco industry, including but not limited to activities described as

“corporate social responsibility”.

POLICY GOALS

What policies should govern the regulation of tobacco and denormalization of tobacco

industry? An answer to this question requires the specification of policy goals that

provide appropriate basis for comparing current policy with possible alternatives.

First, because tobacco is proven to cause harm to others, tobacco industry should not

enjoy liberty in its distribution and promotion. A primary policy goal, therefore, should be

limited liberty of tobacco industry. The liberty that we are trying to regulate is the

industry’s liberty to sell, produce, and promote itself and its product because of the

known harm it causes. We are interested in placing a policy that would yield the best

results in SEATCA’s tobacco industry interference index. Specifically, we would want a

policy that would decrease industry interference and participation, increase preventive

action from the government, increase in transparency and a decrease of benefits from

the tobacco industry.

Second, the current policy aims to protect the youth from being initiated to cigarette

smoking and tobacco use by prohibiting the sale of tobacco products to minors.

Efficiency to protect the youth and the public from smoking should be a policy goal. The

policy should be able to curb behaviors and perception of the youth that will discourage

them from trying and encourage smokers to quit. It also involves strengthening the

measures to restrict industries from engaging the youth sector.

Lastly, it is vital that our policy is socially acceptable by different key stakeholders. It is

important that our measures be pleasing to the general public’s perception and will gain

the most support from experts, health care sector, education sector, politicians and key

decision makers.

A COMPARISON OF THE ALTERNATIVES

The following discussion compares the status quo, full implementation of WHO FCTC

Article 5.3 Recommendations and Regulation of Tobacco Industry’s CSR in terms of

limiting liberty of tobacco industry, efficiency to protect the youth and the public from

smoking, and social acceptability.

Status Quo

Limiting liberty. The status quo, although prohibits promotion and places regulation on

some actions of the industry, it does not explicitly prohibit actions of the industry trying

to make it socially acceptable. RA 9211 also gives power for the industry to be involved

in the implementation, regulation and enforcement of the act. If status quo remains, then

the high participation and interference index will be sustained limiting the liberty of the

tobacco industry to a mere minimum.

Efficiency to protect the youth and the public from smoking. Much of the success

of the status quo to protect the youth is from the succeeding laws passed such as the

sin tax law. It is after the sin tax law has been enacted that a mere drop of prevalence of

youth smoking was observed. In effect we can conclude that the effects are seen

primarily because of taxation and not because of the policy. The law lacks

implementation and enforcement citing from personal experiences that the analyst at an

early age can acquire cigarettes from sari-sari store. Prohibitions are not executed

properly and if the tobacco industry continues its efforts to make brand “cool” or “socially

acceptable” the probability to curb the perception of the youth to start smoking scores

low to moderate.

Social Acceptability. The status quo is socially acceptable to the industry and to the

tobacco farmers. But health experts and the health care sector will tend to disagree

calling forth actions to comply with the international standards and to level up actions on

regulations.

Full Compliance to the Recommended Actions in Article 5.3

Limiting Liberty. Assuming the proposal is gratified, the analyst measured how the

country would score in the SEATCA’s index. For this policy alternative there will be

marked decrease in index for tobacco interference and participation to policy making

limiting it to a mere minimum. The policy includes guardrails to protect the government

from the tobacco industry interference and it will prohibit its participation in policy

making. Because the policy is in itself a preventive measure to limit tobacco

interference, the index of prevention measure will also increase. Among the three, this

will produce the most limiting consequence for the tobacco industry and the highest

yield in protection and welfare of the community.

Efficiency to protect the youth and the public from smoking. The policy will

partially—if not totally—denormalize the tobacco industry. This denormalization will

significantly affect the youth’s perception of the industry and as study shows good

perception have a negative effect on the prevalence of smoking. Among the three, this

will effectively curb behavior, protect the youth and the citizens from smoking and will

encourage smokers to quit.

Social Acceptability. Among the three alternatives, this policy alternative will receive

the most polar response in terms of support from legislators and other sectors. Health

advocating legislators, the international community (limited to the WHO and UN), youth

sector, and some citizens will support this highly especially if packaged and marketed

as a policy to protect the people from the harms of the tobacco industry. On the other

side, representatives from tobacco growing provinces and the tobacco industry will

highly resent this policy.

CSR Regulation

Limiting liberty. Assuming the proposal is gratified, the analyst measured how the

country would score in the SEATCA’s index. For this policy alternative there will be

marked decreased, but relatively lower than the other alternative, in index for tobacco

interference and participation to policy making. The policy includes regulation of the

CSRs which would affect how the CSRs are being done, marketed and implemented

meaning the government can review and limit CSRs which can potentially increase

social acceptability of tobacco and the industry. Because the policy is in itself a

preventive measure to limit tobacco interference, the index of prevention measure will

also increase. Among the three, this will produce the middle ground in terms of

consequence for the tobacco industry and the yield in protection and welfare of the

community.

Efficiency to protect the youth and the public from smoking. The policy will partially

denormalize the tobacco industry through regulation of its CSRs. This denormalization

will significantly affect the youth’s perception of the industry and as study shows good

perception have a negative effect on the prevalence of smoking. This is not as effective

as the full compliance and its effect might not be seen immediately but their long term

effect is similar to the full compliance and relatively better than the status quo.

Social Acceptability. Among the three alternatives, this policy alternative will receive

the least polar response in terms of support from legislators and other sectors. Health

advocating legislators, the international community (limited to the WHO and UN), youth

sector, and some citizens will support this highly especially if packaged and marketed

as a policy to protect the people from the harms of the tobacco industry. On the other

side, representatives from tobacco growing provinces and the tobacco industry will still

oppose it but their opposition will be felt less compared to the other alternative.

ASSESMENT AND RECOMMENDATION

The issues discussed in this section of the report are summarized in Annex 1 that

presents policy alternatives on one direction and the goals for assessing them on the

other. It should be stressed that these are predictions, based on the extent of research,

of how each of the alternatives would perform in terms of the stated goals. Of course,

the preferred alternative depends on how the Senator weighs the goals described

above. But, because the senator has instructed to make a recommendation, the analyst

based the recommendation on the following comparisons.

The analyst weighed between the three policy goals namely, limiting liberty, efficiency

and social acceptability. There were trade-offs such as what is most limiting and most

efficient might not be socially acceptable to the most of the society. The Full

Compliance Policy will indeed be the most effective and the most limiting however we

can foresee a great opposition from legislators and from the industry and in turn it might

not be acceptable and politically feasible. The CSR regulation is a valid compromise

which may be less effective and less limiting but might be the most feasible and socially

acceptable alternative.

Our recommendation is for the Senator to enact as law the regulation of Corporate

Social Responsibility Projects of the Tobacco Industry in the aim of denormalization and

decreasing interference.

Works Cited

1. WHO. Tobacco Industry Interference; A global brief Geneva: WHO; 2012.

2. Malone RE, Grundy Q, Bero LA. Tobacco industry denormalization a tobacco control intervention: a

review. Tob. Control. 2012 Mar; 21(2).

3. WHO. Article 5.3 Framework Convention on Tobacco Control Geneva: WHO; 2008.

4. SEATCA. Tobacco Industry Interference Index Bangkok: SEATCA; 2014.