News analysisINDIA: SURROGATES AND SPOOFSBarely a week after the World Conferenceon Tobacco OR Health had closed inMumbai, India, the city was awash in theglamour of the Wills Lifestyle FashionWeek, a five-day media extravaganza anda feast for fashion photographers. Newsreports were carried around the world,including in newspapers for which thetobacco conference did not appear to havehappened, decorated by photographs ofexotic models wearing equally exoticdesigner creations. Yet Wills has beenone of India’s best known cigarette brandsfor as long as most people can remember.Comprehensive tobacco control legisla-tion is in place, so how can suchdiametrically opposed uses of the brandname be permitted?

Indians’ awareness of Wills cigarettesdates from the days of British colonialrule, when in 1910 the UK-based BritishAmerican Tobacco (BAT) set up an Indiansubsidiary, Imperial Tobacco Company(the original long form name of modernITC). Through ITC, BAT made andpromoted cigarettes including Wills,Gold Leaf and John Player, though ironi-cally, the rights to make these Britishbrands in BAT’s own home country werelater sold off to a UK rival. In recentdecades, ITC has become progressivelymore diversified and Indian-owned,though as recently as last year, BAT stillearned a tidy £117 million from itsminority stake in the company.

Meanwhile, part of ITC’s diversifica-tion had been carried out under a titlethat was bound to raise suspicion amonghealth advocates. In 2000, it had enteredwhat it termed the ‘‘lifestyle retailing’’business, with Wills Sport (casualclothes), later expanded to include WillsClassic formal wear (2002) and WillsClublife evening wear (2003), with JohnPlayers menswear along the way, in 2002.In 2006, it launched Wills Lifestyle IndiaFashion Week, with Miss Players youngwomen’s fashion clothes being added ayear later. Giving a presence on the street,a chain of Wills Lifestyle stores were setup to sell the new ranges of clothes.

To the fashion-wear ranges were added,among other goods, Essenza Di Willscosmetics and grooming products andFiama Di Wills and Vivel De Wills soapsand bath products. A cynic might suspectthat all these fragrant goods were spe-cially selected for being at the veryopposite end of the spectrum of olfactoryexperience from the products that madeWills a household name over the pastcentury.

How and why did all this happen? Onemotivating factor cited by commentatorsat the time was a law passed in 1994prohibiting direct or indirect advertisingof tobacco or alcohol on commercialbroadcasting and cable networks. Inensuing years, as some interpreters won-dered whether it was the end of cigarettebrand extension and surrogate advertis-ing, the government issued a raft of whatwere billed as ‘‘fine-tuning’’ clarifications.Even the wisest of lawyers or philoso-phers might have been hard pressed tounderstand, but in effect, the authoritiesseemed to be saying that the new rulesdid not to apply to ‘‘genuine products’’,but only to those that were new or hadhardly been established.

In 2004, ITC specifically acknowledgedthe problems of using the Wills name inboth tobacco and non-tobacco productswhen it announced that it was dissociatingthe Wills brand name from its cigarettes.This was, it said, so that Wills Lifestyleproducts could be promoted withoutbeing accused of surrogate advertising.

Dissociating? Well, not entirely. As theboss of ITC’s tobacco division put it, theWills brand name would become ‘‘incon-spicuous’’ and the product sold and pro-moted as Navy Cut.

Certainly, the Wills name is nowseparate from and smaller than the restof the name on a pack of Navy Cutcigarettes. However, it is hardly a shrink-ing violet among the names and logos onthe pack. Its prominence in embossed goldis enhanced by the familiar WD & HOWills coat of arms above it, which in turnis oddly reminiscent of the WLS—forWills Lifestyle—that appears in associa-tion with some of the new non-tobaccoproducts.

To health advocates, it looks as thoughITC may have things both ways. Manyare not impressed with the purportedinconspicuousness of the Wills name,arguing that even if it never appeared atall on cigarette packs, it is so well knownfrom decades of promotion as a cigarettethat its use should not be permitted onany other products.

To draw attention to this, cancersurgeon Dr Pankaj Chaturvedi, who dailysees the ravages caused by often terminaldiseases caused by tobacco, created aspoof logo for a notional event remark-ably reminiscent of Wills Fashion Week.Dr Chaturvedi’s work will already befamiliar to readers of this journal (seeTobacco Control 2009;18:9 and 17:297). Itmay now be quite familiar to ITC’speople, too, since between operating onsome of tobacco’s hundreds of thousandsof victims in India each year, his artistictalents have focused on lampooning someof ITC’s own, less lifesaving operations.For example, his thoughts on Wills

All articles written by David Simpsonunless otherwise attributed. Ideas anditems for News Analysis should be sentto: d.simpson@iath.org India: the Wills Lifestyle Fashion Week logo

(above) and Dr Chaturvedi’s spoof logo (left).

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Lifestyle make fun of the brand name’sproximity to the last will and testamentthat many tobacco users have to make asthey anticipate their premature demise.

This sort of creative health promotionhad an unforeseen benefit due to theaccuracy of the internet search engineGoogle. It seems that if Indian web surfersentered Wills Fashion Week Logo intoGoogle, they got Dr Chaturvedi’s spoofrather than the official logo. Similarly, aremarkable number of searches for othertobacco-related word sequences also ledIndians to some of his other creations(http://chaturvedi.pankaj.googlepages.com/tobaccokills). Perhaps health advo-cates in other countries will be in forsimilar, pleasant surprises. In India, any-way, it seems that in some ways, the pencan be mightier than the scalpel.

NORWAY: $2 BILLION SALE OF TOBACCOSTOCKThe Norwegian Government announcedon 3 April that it is to divest its fundsfrom all companies which take more thanfive percent of their profits from tobaccoproduction. Its pension fund, Global,reputedly the second largest in the world,has until recently held an estimated US$2.1 billion in the tobacco industry. Adebate over divestment of tobacco hold-ings from the pension fund has been goingon in Norway since 2004, when ethicalguidelines were introduced for the fund.Tobacco control activists from a numberof national non-governmental organisa-tions had rallied politicians since theguidelines were introduced, arguing thatthe investments were neither morallyviable nor economically sensible. Amongthe tools used by health advocates as theylobbied their elected representatives wasan impressive-looking book solemnlyentitled, The Tobacco Industry Code ofEthics: Moral Guidelines for a NewMillennium. Those politicians who hadnever thought much about the topic werethe only ones likely to have got a surprisewhen they opened it. Every single pagewas blank (see front cover).

Norway was an early leader in compre-hensive tobacco control legislation,including a total ban on tobacco promo-tion since the mid-1970s, one of thecomponents most bitterly fought againstby tobacco companies. It therefore set animportant precedent for other Europeancountries. Now, once again, it plans totake the lead to become the first countryin the world to implement the recentlyreleased guidelines for the World HealthOrganization’s Framework Conventionon Tobacco Control (WHO FCTC).

These advise governments to divest allholdings in tobacco companies in order tokeep public health interests free fromadverse economic influence.

Norway has long demonstrated above-average concern for the welfare of lowincome countries, with a disproportio-nately large and effective contribution todevelopment projects. Similarly, healthorganisations hope the government’snew move will have a knock-on effect inlow-and middle-income countries. TheSecretary General of the NorwegianCancer Society, Ms Anne Lise Ryel, said,‘‘The tobacco industry is exploiting vul-nerable populations in developing coun-tries to fill their own pockets. Norway hastaken clear action to show that it wantsno part in this practice.’’ The WHO’sDirector-General who presided over theconcept and negotiations for the FCTCwas Dr Gro Harlem Brundtland, a publichealth doctor by profession—and for-merly the prime minister of Norway.

HONG KONG, CHINA: TAX RISE AT LASTAs readers of this journal will know, theapparent lack of need for extra taxrevenue has been among the most unu-sual aspects of the special administrativeregion of Hong Kong, China for manyyears (see Hong Kong, China: smokingban boosts business. Tobacco Control2009;18:6–9). Thus the driver for manycountries’ regular reviews of tobacco taxhas been missing, compounding whatappears to be lessening political concernabout the ill heath caused to Hong Kongcitizens by tobacco and the apparentlyrelatively greater concern given to repre-sentations from tobacco interests. HongKong used to be a shining beacon oftobacco control leadership for the region,all the more powerful due to its success as

a free trade haven, but nowadays thislight shines far less brightly.

In fact, among public health profes-sionals, the government’s failure to raisetobacco tax for more than eight years,with a consequent cheapening of smokingin real terms, vied for top place as a causeof frustration with its dithering onwhether to go all the way on publicplaces clean air legislation. As the annualbudget announcements approached,health organisations went into overdrive.A series of programmes on leading broad-casting stations presented a tough healthposition in support of a rise. In a highvisibility campaign, Hong Kong Councilon Smoking and Health (COSH), togetherwith hundreds of medical and nursingstudents and students of Chinese tradi-tional medicine, marched to the Treasuryto present a petition demanding a tobaccotax rise, something that many financeministers would give a lot to receive.

Tobacco interests had long been busylobbying against any change in theconsumption-friendly status quo and lessthan a month before the announcement,an apparently well informed insiderreckoned the rise would not happen.However, it seems as though the increas-ing volume of the health campaign washeard in the corridors of power, espe-cially as the Finance Secretary, makingthe announcement of a rise at last, said itwas for health reasons. Although the risehe announced, 50 per cent, may sound alot, and despite the wide range ofpersonal disposable income in HongKong, it still leaves cigarette pricescomparatively low in Hong Kong, asthe tax rate before the rise accountedfor such a small proportion of the retailprice. The end result is that the compa-nies have only raised the retail price of anaverage pack by around 5.7 per cent,which still leaves it little over half theprice of a pack in some of the higher-taxing countries of Europe.

Time will tell whether this heralds anew chapter in Hong Kong’s roller coasterof tobacco control. Many are sceptical,especially after the Finance Secretary said,incredibly, that he hoped not to receiveincreased revenue from the rise. While thiscould mean he hoped for reduced tobaccouse and something near the notionaldiminishing returns that have never beenreached even with much higher tax andprices in similar economies, some think itindicated a lingering resentment amongsenior government personnel about givingin to public health demands. After all,they point out, the government hasremoved all tax from beer and wine and

India: concept for an advertisement involvingwills, as seen by cancer surgeon Dr Chaturvedi.

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shows no sign of reversing this extra-ordinary situation, even in a period ofeconomic downturn. One thing that isclear, however, is that a well organised,well informed public health lobby doesseem to be able to persuade even anunwilling government to take pro-healthaction.

SRI LANKA: INDUSTRY PROMOTIONSri Lanka enacted comprehensive tobaccocontrol legislation in December 2006under the requirements of the WorldHealth Organization’s FrameworkConvention on Tobacco Control. In par-allel, it set up a new monitoring andenforcement agency, the NationalTobacco and Alcohol Authority (NATA),though health advocates say this is still inits infancy. The new law bans sales tominors and smoking in enclosed publicareas. In addition, it imposes a compre-hensive ban on tobacco advertising andpromotion, including sponsorship.

According to health advocates, theprohibition of smoking in enclosed publicareas is not very successful so far, assmokers find various loopholes to exploit.In response, the government has beensaying that it will extend the law to allpublic areas. As for promotion, in acountry where it has long been wide-spread, and despite British AmericanTobacco having a near monopoly, it wasinconceivable that efforts to increase saleswould suddenly stop.

In recent months, retailers havereported significant encouragement to

increase their tobacco sales, includinglavish parties and offers to refurbish theirshops and sales booths. One retailer in aremote area felt so oppressed by suchovertures, including offers of commer-cially attractive discounts and stocks onloan, that he decided to take exactly theopposite action to that intended by thetobacco marketing people: he completelystopped selling cigarettes. Instead, heposted a simple notice to his customersabove the entrance to his shop. Painted inthe Sinhala language, it says, ‘‘For thesake of you and your children I havestopped selling cigarettes here.’’

UKRAINE: LARGE TAX RISEOn 31 March, the Ukrainian Parliamentvoted in favour of a law that will impose afour-fold increase in tobacco tax. The newlaw mandates an excise of 40-45 per centof the retail price, starting on 1 May. Thisis a four-fold increase from previous levelsand will bring Ukrainian tobacco taxescloser to European standards, as well ashigher than in neighbouring Russia. It isestimated that the increase will bring inadditional annual revenue for the govern-ment equivalent to around one billion USdollars.

BANGLADESH: HUMAN CHAIN AGAINSTCULTIVATIONOn 21 March, a human chain wasorganised to demand an end to tobaccocultivation in environmentally sensitiveareas in Bangladesh such as the country’shill tracts. The demand was made by theBangladesh Anti-Tobacco Alliance andPratyasha, an organisation workingagainst drugs, that tobacco cultivationbe stopped in environmentally sensitiveareas, that trees no longer be cut down tocure tobacco, and that non native trees nolonger be planted in sensitive areas. Theyalso demanded that farmers be assisted ingrowing alternative crops, particularlyfood for local consumption. The human

chain was held in front of the NationalMuseum in the capital, Dhaka.

BRAZIL: SMOKE-FREESao Paulo’s parliament passed a total banon smoking indoors, including bars, res-taurants and hotels on 8 April. There areno exceptions permitted and the law waspassed in the face of massive oppositionfrom the hospitality industry and somenewspapers. Health advocates see thevictory as all the more significant in viewof Sao Paulo state’s role model status andsize—it has 40 million inhabitants. Thehistoric move was led by the stategovernor, Jose Serra, a former healthminister, supported by ACTBR, a broadcoalition of organisations working withthe state government.

WORLD CONFERENCE: NOTES FROM THEFIELDPresentations on a data stick? Check.Back-up copies on the laptop and a CD?Check. Hard copy too, just in case alltechnology fails? Check. These are alwaysmy final thoughts before setting off toattend a conference. I also get this familiarfeeling of nervousness combined withexcitement—what if no one comes tomy presentation; will I finally get to meetthat mystery man from Globalink; whichspeaker will be outrageous enough tomake the audience audibly gasp; andmost importantly, will the food be anygood?

I’ve only been to one other worldconference, the one held three years agoin Washington DC, so it was hard not tocompare the two. In Washington, Iremember feeling totally overwhelmed atthe vast number of concurrent sessionsand the ocean of participants assembled atthe opening plenary. The feeling wasmuch more intimate at the India con-ference—and this is not to say it wassomehow lacking in participants or con-tent. Quite the opposite. There wereenough people—more than 2000 from108 countries—to make you feel thatsomething really important was happen-ing, but not so many that you were afaceless follower among the tobacco con-trol masses.

No one likes reading fawning and dullconference reports, so in an effort topresent pithy and I hope interesting fieldnotes, here are some of the things that leftan impression on me.

People like seeing the ‘‘Who’s Who’’names of tobacco control engaged in asizzling debate. Harm reduction, second-hand smoke and breast cancer, smoking in

Sri Lanka: industry pressure to sell morecigarettes pushed this shopkeeper to stopselling tobacco altogether. The sign above himexplains to customers that his decision is forthe sake of his customers and their children.

Bangladesh: the human chain.

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the movies—these were just a few of thetopics where temperatures ran high andthe experts clearly didn’t agree. Let’s havemore of this at future conferences; it is farmore engaging than back-slapping andhand-holding.

The FCTC was a strong backgroundpresence throughout the conference.Cynthia Callard of Physicians for aSmoke-Free Canada said that plain (gen-eric) packaging and the adoption of aninternational convention on tobacco con-trol were both resolutions from the 1994world conference held in Paris, France andhad been proposed in several countriesbefore that. Fifteen years later, whowould have known that getting theFCTC ratified by more than 160 nationswould be achieved before getting plainpackaging adopted in even a single coun-try?

From the large number of presentationson tobacco marketing and sales, it was alltoo clear that the tobacco industry stillhas innumerable avenues through whichto market and sell their products to prettymuch whoever they like, wherever theylike, and whenever they like. This bothdepresses and inspires me to keep workingin the field.

MPOWER is a big brand with bigmoney. My only previous knowledge ofthis acronym had been through the WHOtobacco epidemic report (the one thatcame with the packet of coloured pens).While on the one hand I wholeheartedlywelcome this critical source of funding forfundamental projects, my inner socialist isleft squirming at the feeling that tobaccocontrol NGOs are being forced to adopt acorporate-style identity.

Diversity and new voices were mostevident at the concurrent and postersessions. I challenge the organisers of the

15th World conference, to be held inSingapore, to extend this mix to theplenary sessions.

Mumbai is a city of contradictions:abject poverty alongside serious wealth;gorgeous sunsets thanks in part to theheavy pollution; high tech wizardryamongst the oxen carts. And peacefuland historic Elephanta island versus theglitz and glamour of Bollywood.

Finally, as I’m sure was true of manyother speakers, it was with great relief Ifound that people did attend my presen-tations. The best conference gift ever wasan 8 gigabyte data memory stick—some-thing practical that I will actually use!And I met the Globalink mystery man,there was plenty of audience gaspingduring the Luther Terry Award speeches(someone buy Glantz a new watch,please), and the food really was quitetasty.

BECKY FREEMANUniversity of Sydney, Australiabfreeman@health.usyd.edu.au

BMJ JOURNALS AWARDDr Judith Mackay, who has worked ontobacco control since the 1980s, first inHong Kong, China, where she is based,and later internationally, in the Asia-Pacific region and with the InternationalUnion Against Lung Disease, wasawarded the British Medical Journal(BMJ) Group Lifetime AchievementAward in April. This year saw the launch

of this awards scheme, which the BMJGroup, publishers of Tobacco Control andmore than thirty other specialist journalsin addition to the BMJ, intends to makean annual event. There are nine other,more specific clinical and professionalcategories. Apart from honouring DrMackay, many will see her choice for thefirst Lifetime Achievement award as asignificant seal of approval for tobaccocontrol in particular and public health ingeneral, both of which tended to lack thedegree of status and general approvalafforded other specialties in the past.

JUDY WILKENFELD AWARDThe second annual recipient of the JudyWilkenfeld Award for InternationalTobacco Control Excellence is RachelKitonyo of Kenya. A lawyer by training,Ms Kitonyo left practice in 2005 to estab-lish the Institute for Legislative Affairs(ILA), of which she is ExecutiveDirector. The ILA took a leading role instrengthening a stalled tobacco control billand helped guide its parliamentaryapproval, giving Kenya one of Africa’sstrongest tobacco control laws. The awardwas created to recognise internationaladvocates who have made a major con-tribution to reducing tobacco use andunited and inspired others to do the same,in the spirit exemplified by Judy Wilkenfeldwhen she led the international efforts ofthe Campaign for Tobacco Free Kids.

India: the Gateway to India, the most famouslandmark in Mumbai, venue of the WorldConference on Tobacco OR Health.

Dr Judith Mackay

Rachel Kitonyo.

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