Canada scores 75% on a new index for sustainable tobacco control

A month ago, the International Union against Tuberculosis and Lung Disease launched an index to measure the sustainability of tobacco control programs. The index was published in the BMJ journal, Tobacco Control.

The Union and its network have identified 31 indicators that they considered to be associated with the future security of tobacco control programs. These included diverse and comprehensive adminstrative and legal structures -- whether there was someone assigned by government to implement tobacco control, whether that person was trained and funded, whether tobacco control laws were in place, etc.

The indicators were weighted based on their importance to the results, with a maximum total score of 131. Of these indicators, two were related to the circumstances of developing countries and were therefore not relevant to Canada. Discounting the scores for these 2 issues, a developed country like Canada might aspire to a total of 123 points.

Canada has long prided itself on being a "leader" in tobacco control, and might therefore be expected to do well on this score. A quick run-down, however, shows that there are many areas where Canada has not yet implemented measures that are expected by the Union and others of developing countries.

The list, annotated with our results for Canada, is pasted below. By our account, Canada gets a score of 92, or 75%.  In most schools that would be a B-.  Had Canada sustained the measures that were in place in the early 2000s (a national strategy, structures for input from civil society and experts, mass media, etc), the score would have been 104 (85%).

Until scores for other countries have been tallied, we won't know whether Canada is still a "leader". In the meantime, the index helps identify areas where we have lost ground -- demonstrating the usefulness of this as a "sustainability" index.


Index of tobacco control sustainability (ITCS): a tool to measure the sustainability of national tobacco control programmes

Indicators	Present/ Absent 2016	Weighted score	Score for Canada -2016	Score for Canada -2000
Prerequisite indicator: >4 MPOWER policies in place	P	9	9	9
National tobacco control (TC) budget (annual)	P	7	7	7
National TC law	P	6	6	6
National budget allocation for TC capacity-building	P	6	6	6
Tobacco taxation>75% of retail sales price (RSP)	P/A	6	3	3
Tobacco taxation increases faster than ‘inflation plus GDP growth	P/A	6	3	3
National TC unit/cell	P	5	5	5
Civil society TC network	P	5	5	5
Civil society representation in national TC advisory committees	A	5		5
Health promotion fund for/including TC	A	5
National policy against TI CSR	A	5
TC-related mortality and morbidity recording system	P	5	5	5
National evaluation framework/plan in place	P	5	5	5
Evaluation built into all major policy implementation plans	P	5	5	5
National TC strategy	A	4		4
TC and non-communicable diseases form part of the national health policy	P	4	4	4
TC forms part of the national Development Plan	N/A	4
Human resource for implementation (national)	P	4	4	4
GTSS surveys (GATS/GYTS)	P	4	4	4
Intergovernmental coordination mechanism	P	3	3	3
Capacity-building plan for TC-specific personnel	P	3	3	3
‘Developmental assistance’ funding includes TC	N/A	3
Code of conduct for government officials/staff	P	3	3	3
Ministry of health 5.3 policy	P	3	3	3
5.3 Policy across all Ministries	A	3
Economic/social TC costs data	P	3	3	3
National ‘focal point’ post	P	3	3	3
National advisory committee	A	2		2
Capacity-building plans on research and evaluation	P	2	2	2
Mass media campaigns funded	A	1		1
Capacity-building plan for non-TC specific personnel	P	1	1	1
Total Score (adjusted for measures not applicable to developing countries)		123	92 (75%)	104 (85%)

Tobacco Taxation: The index calls for tobacco taxes to represent 75% of the retail price, and for the taxes to increase greater than inflation and GDP growth. This is the case in some, but not all provinces. Quebec and Ontario stand out as jurisdictions which have allowed taxes to fall below the threshold of price and in which increases have not kept up with inflation.

Civil society representation in national TC advisory committees. A few decades ago, NGOs were included in the Steering Committee of the National Strategy to Reduce Tobacco Use. This structure was abandoned in the early 2000s.

Health promotion fund for /including TC:  There is no long-term funding mechanism for tobacco control at the federal or provincial levels. Unlike Australia, Switzerland and other countries, Canada has not established an independent health promotion fund, and parliamentary allocations for tobacco control are not secured against departmental decisions to reallocate funds, a common circumstance in some years.

National policy against TI CSR: There are no legal or policy barriers to the tobacco industry using corporate social responsibility to buy influence.

National tobacco control strategy.  The Canadian National Strategy to Reduce Tobacco Use, developed in 1985 and renewed in the late 1990s by federal and provincial governments and non governmental organizations, was abandoned in the early 2000s in favour of distinct federal and provincial strategies. 

5.3 Policy across all Ministries. There is no whole-of-government policy to protect against tobacco industry interference, as required by Article 5.3 of the Framework Convention on Tobacco Control.

National Advisory Committee:  There is no longer a forum established for input from tobacco control experts. The Ministerial Advisory Committee was abandoned in the early 2000s. 

re-allocation.

Mass media campaigns funded: There are currently no federal or provincial mass media campaigns to support tobacco control implementation. In 2000, the anticipated budget for such programs was over $50 million per year. 

Health Canada moves to ban menthol!

Usually Friday afternoons are when governments try to bury news. So it is a bit of a head scratcher that it was at a TGIF moment that news leaked out that the federal government was proposing to ban menthol in cigarettes, blunt wraps (used to smoke marijuana) and many cigars.

The move came in the form of a proposed regulation published in the Canada Gazette, only a day after Prince Edward Island confirmed that it would be the sixth province to ban menthol.

It is a 180 degree reversal from the position taken by the previous federal government. Barely 4 months have passed since a federal additive ban which expressly exempted menthol came into force last December.

Tobacco companies have resisted the ban by filing lawsuits, and are likely behind the objections being raised at the World Trade Organization in response to the bans introduced in Nova Scotia and elsewhere. 

It was after the provinces moved forward with their measures that the companies defiantly launched newer styles of menthol cigarettes in Canada. (The click-menthol "Next" brand shown below was launched by Philip Morris last year. Imperial Tobacco has also launched click-menthol products)

This industry provocation is all the more reason for the federal government to step up its action. It is all the more reason for us to applaud their actions.

Bill Casey holds a private meeting with Big Tobacco. Should we care?

If the president of a tobacco company has a private meeting with the chair of a parliamentary health committee, is there a breach of Canada's treaty obligations to protect public health from tobacco industry interference?

This question is more than hypothetical after Imperial Tobacco Canada, filed a communication report with the Office of the Commissioner of Lobbying, stating that a meeting was held between Imperial Tobacco and Bill Casey, who is a Member of Parliament from Nova Scotia and also the chair of the House of Commons Health Committee.

The meeting took place on March the 8th, and was reported to the Commissioner's office on April 13th by Jorge Araya, the "most senior paid officer" responsible for providing such reports.

Whether or not it was Mr. Araya or some other representative of the company who actually met with Mr. Casey need not be disclosed.

Bill Casey, M.P. 

Nor is the company (or Mr. Casey) required to disclose more information than what is demanded in a drop-down menu choice of very broad topics. On that day, apparently, the "communication" involved "health". Nothing more has been made public

Mr. Casey was not the only Member of Parliament to grant a hearing to Imperial Tobacco representatives this spring, but he was the only one for whom "health" was the primary agenda item. (Communications reports were filed by Mr. Araya with respect to meetings with 10 other members of the governing Liberal party: Marc Miller, Bernadette Jordan, Pat Finnigan, Michel Picard, Sean Casey, T J Harvey, Darell Samson, Frank Baylis, Wayne Easter and Bill Blair. "Justice and Law Enforcement" and "Taxation" were the primary topics of these meetings.)

The FCTC Obligation

Article 5.3 of the Framework Convention on Tobacco Control imposes the following obligation on Parties to the treaty:

In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.
Guidelines to help interpret this somewhat vague obligation were adopted in an early Conference of the Parties. These guidelines note the fundamental and irreconcilable conflict between the tobacco industry's interests and public health, and recommend that the formulation of public policy on tobacco be protected from the industry to "the greatest extent possible" and that any interaction with the industry is "accountable and transparent."

Differing views on Canada's implementation of Article 5.3

In its most recent (2014) report regarding treaty implementation, the Canadian government took the view that (a) it was not bound by the guidelines, and (b) public health policies were protected from tobacco industry interference. (Their complete response is pasted below.)

While Parties to the FCTC are not bound by the Guidelines, Canada has reviewed the Article 5.3 Guidelines in relation to the Canadian policy, legal and constitutional context. Canada has adopted administrative measures, such as Health Canada's policy of not partnering with the tobacco industry on tobacco control programming....

Generally, in Canada the primary channels of communication between governments and the tobacco industry are limited to (i) technical discussions in regard to both health and tax-related regulations and (ii) litigation-related responses."

Non-governmental organizations, including our own, found that this was one of the few areas of the FCTC where implementation in Canada did not meet the minimum standards. In the Shadow Report on FCTC implementation prepared by the Global Tobacco Control Forum in 2010, we found that Canada had failed to implement at least 13 aspects of the Article 5.3 guidelines.

A Grey Zone and a policy void

It is not at all clear that parliamentarians would be subject to the obligations of the FCTC, which focuses on the executive branch of government more than its legislative arm.

Mr. Casey, after all, is a back-bencher and a member of parliament accountable to his constituents. He was elected as chair of the Commons Health Committee by his legislative peers. In theory, he is not appointed by government, and is not an agent of government. 

The reality, of course, is a little more nuanced. It would be disingenuous to claim that committee chairs are completely independent of the executive branch of government. 

Moreover, the committee that Mr. Casey chairs has a particular role to play in the development of tobacco control policies, given that regulations under the Tobacco Act are automatically referred to it for approval. These would likely include any regulations to fulfill the government's pledge to implement plain packaging.

It is highly likely that Mr. Casey has never heard of the FCTC, let alone Article 5.3. The industry may have mobilized well ahead of the capacity of the new government to fill in the gap left by the previous government's decision to dismiss concerns about industry interference. 

A sunnier way forward

It may be that Members of Parliament who have specific responsibilities for health policy face no prohibition on private meetings with tobacco industry officials. But they are certainly under no obligation to agree to such meetings.

Those who make such judgement calls could only benefit from some guidance. If Imperial Tobacco can arrange a meeting to discuss "health" with Mr. Casey, hopefully the health ministry can similarly be scheduled for a discussion about the "tobacco industry".

Canada's 2014 report on its implementation of Article 5.3 Protection of public health policies with respect to tobacco control from commercial and other vested interests of the tobacco industry 3.1.2 Have you adopted and implemented, where appropriate, legislative, executive, administrative or other measures or have you implemented, where appropriate, programmes on any of the following:  3.1.2.1 – protecting public health policies with respect to tobacco control from commercial and other vested interests of the tobacco industry? Yes  3.1.2.2 – ensuring that the public has access, in accordance with Article 12(c), to a wide range of information on tobacco industry activities relevant to the objectives of the Convention, such as in a public repository? Yes 3.1.2.3 If you answered “Yes” to any of the questions under 3.1.2.1 or 3.1.2.2, please provide details in the space below    While Parties to the FCTC are not bound by the Guidelines, Canada has reviewed the Article 5.3 Guidelines in relation to the Canadian policy, legal and constitutional context. Canada has adopted administrative measures, such as Health Canada's policy of not partnering with the tobacco industry on tobacco control programming.  Lobbying at the federal level in Canada is regulated under the Lobbyist Registration Act. It is illegal for corporations of any kind to contribute to political campaigns for electoral purposes. Some provinces also regulate lobbying. Furthermore, the Lobbyist Registration Act introduced a requirement that consultant lobbyists (ie: tobacco related activities) file a return with the Commissioner of Lobbying if they communicate with a designated public office holder under certain conditions. This registry can be searched by anyone through a publicly-accessible website.  Health Canada has discussed the Article 5.3 Guidelines with its federal partner departments and with relevant departments of provinical/territorial governments who are collaborators in the Federal Tobacco Control Strategy (FTCS). Generally, in Canada the primary channels of communication between governments and the tobacco industry are limited to (i) technical discussions in regard to both health and tax-related regulations and (ii) litigation-related responses.  In Canada, many aspects of the tobacco industry's health policy, business and promotional activities are matters of public record. In addition, civil society organizations keep close track of tobacco industry activities and maintain web sites, publications etc for this and related purposes. The tobacco industry must report to government on its research and promotional activities pursuant to these Regulations. Public access to information is governed by the Canadian Charter of Rights and Freedoms, Access to Information & Privacy Act, and the common law as it relates to confidential business information.

In case you thought Big Tobacco was on its way out...

Big tobacco still makes big money 

Big tobacco still makes big money, according to Shelly Banjo of Bloomberg News. She reported on March 15, 2016:

The three big U.S.-based tobacco companies -- Reynolds, Altria, and Philip Morris -- returned 103 percent, 87 percent, and 34 percent to investors over the past two years, respectively, compared to a 14 percent return on the S&P 500. 

Mergers and greater cooperation among supposed competitors are cited as some of the reasons for greater profitability. It also seems that that price of gasoline is important for cigarettes sales. The price of gas is dropping, so consumers have money left over to run in and buy a pack of cigarettes at the convenience store, now so conveniently attached to nearly every gas station.

Safer tobacco products, or just more tobacco products? 

Some hold out hope that e-cigarettes and other non-combustible tobacco products might one day replace burning tobacco as less hazardous nicotine delivery devices. Maybe it will happen some day, but the tobacco companies are pursuing a much different strategy and piling up the profits while doing so. It seems that electronic cigarettes are not so much displacing regular cigarettes in the marketplace as they are being added on as one more addictive product. Kenneth Shea, a Bloomberg market analyst figures they are giving consumers more occasions to consume tobacco and that dual use of e-cigarettes and conventional cigarettes is common. This is confirmed by surveys reported by Action on Smoking and Health in the United Kingdom. 17.6% of current UK smokers also use e-cigarettes.

The reasons they give for doing so are given by the blue bars in the following graph.

 

Tobacco companies do not want to improve public health; they want to make money (Surprise! Surprise!)

They appear to already be profiting from dual use of conventional cigarettes and e-cigarettes.Their plans, previously revealed during investor day presentations in 2015, are being effectively carried out. For example, British American Tobacco (BAT)( www.bat.com) wants to be the “world’s best at satisfying consumer moments in tobacco and beyond.”

More ways for tobacco companies to make more money in the future 

If tobacco companies continue to be left to their own devices and if dual use of combustible and non-combustible tobacco continues to increase, continuing profitability of tobacco companies can be expected.
A new heat-not-burn tobacco product called iQOS developed by Philip Morris is currently available for sale in Italy, Switzerland and Japan. It might turn out to be another money-maker. BAT has similar products in development. BAT has a number of non-combustible tobacco products already on the market or in development. It refers to them collectively as “Next Generation Products” (NGP). One might wonder how such products will be regulated. Instead of wondering about it, BAT is setting about to create the regulatory environment it desires. As told to its investors in 2015, BAT is “shaping future regulation.”

In seeking “marketing and distribution freedoms that enable category growth”, “product safety standards that become the benchmark of industry & regulators”, and “fiscal policies that are aligned with the risk spectrum”, will BAT run afoul of Article 5.3 of the Framework Convention on Tobacco Control (FCTC) which states:

 “In setting and implementing public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.” 

Most countries, including Canada have, at best, a spotty record in upholding Article 5.3 and keeping the tobacco industry out of influencing and shaping tobacco control policies. With BAT already engaged in “shaping future regulation”, how well will governments do at keeping the tobacco industry fox out of the public health henhouse?

Many people and organizations are looking to profit from the looming legalization in Canada of marijuana for recreational use. Organizations as diverse as medical marijuana suppliers, big drug store chains and the Ontario government have all expressed an interest in claiming a piece of the potential legal marijuana trade. So far, the Canadian tobacco industry has not publicly declared any interest in the marijuana business.

Canada’s Liberal government announced in the December, 2015 Throne Speech that it intends to “legalize, regulate and restrict access to marijuana.” Given Big Tobacco’s appalling track record on public health protection and continuing desire to maximize profits, governments would do well to think long and hard about what role, if any, tobacco companies might be permitted to play in the legal-but-regulated marijuana business.

Important Progress in France and Quebec

Two important advances were made this week in tobacco control laws in key members of La Francophonie.

On Wednesday, the French parliament adopted a law to require plain packaging of cigarettes, becoming the fourth country to put this measure into law (after Australia, Ireland and the United Kingdom).

And this Thursday morning, the Quebec legislature gave unanimous consent to Bill 44, An Act to bolster tobacco control, which contains a number of regulations that raise the bar for public health.

The bill brings controls on smoking in Quebec up to the level currently in place in other provinces (no smoking in cars with children present, or on certain outdoor public places, like patios or near doorways of public spaces).

It also imposes new regulatory restrictions on cigarette marketing, including:
* a ban on flavours, including menthol (to come into force 6 months after Assent)
* an end to bonuses or other incentives paid by manufacturers to retailers
* a minimum size for warnings, which will have the effect of removing from the market smaller packages for slim cigarettes. (The reduction in warning size for these packages is shown below)

One of the most encouraging aspects of the Quebec bill is the breadth of support that it received in the National Assembly, whose members further strengthened the law that was proposed by the Minister of Health, Mme. Lucie Charlebois.

A special shout-out is warranted for the Minister, for her opposition counterpart, Mr. Jean François Lisée, and for our colleagues in the Quebec health community who encouraged their efforts.
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