The Tobacco War

The tobacco industry has taken off its gloves and is going after anti-tobacco lobbyists

archana

Archana Mishra | August 1, 2017 | New Delhi


#FAIFA   #PHFI   #anti tobacco lobbyists   #insurance firms   #health   #smoking   #addiction   #ministry of health and family welfare   #tobacco   #Philip Morris   #VHAI  
(Photo: Arun Kumar)
(Photo: Arun Kumar)

Tobacco companies are not known to be the fairest of fighters in market battles. But Philip Morris International (PMI) seems to have gone to extremes in its grand strategy to sweep the Indian market, where an estimated 2 million people take up smoking every year. A presentation on the Indian market by Philip Morris (the makers of Marlboro cigarettes) that has been accessed and released by Reuters news agency recently singles out some anti-tobacco groups for special attention. And from among anti-tobacco lobbyists, it marks out the photograph of Dr K Srinath Reddy – a prominent cardiologist from AIIMS, an expert on public health, and chairman of the Public Health Foundation of India (PHFI) – with a red circle. Dr Reddy’s photo finds its place among those of seven other global advocates of anti-tobacco policies, including Dr Judith Mackay, former advisor to the WHO; Prof Rob Moodie, Australia-based public health expert who advocates a dedicated tobacco tax; and Prof Simon Chapman, an acclaimed tobacco-control activist. But none of these is marked out in red. 

“I deem it an honour,” says Dr Reddy. “I regard the tobacco industry marking me out as a principal adversary the best possible recognition of my impact as an advocate and agent of change.” HRIDAY, or Health Related Information Dissemination Among Youth, which he set up in 1992, during his tenure at AIIMS as a cardiologist, educates youth about the dangers of tobacco and alcohol and encourages them to follow nutritious diets. Besides, PHFI has been at the forefront of anti-tobacco advocacy among policymakers.
 
The singling out of Dr Reddy and some groups may be part of a global offensive by tobacco giants. On July 19, World Health Organisation (WHO) published its report on the global tobacco epidemic, in which Dr Douglas Bettcher, its director for prevention of non-communicable diseases, pointed to the continuous interference of the tobacco industry in government policy-making as a deadly barrier to advancing health and development. Dr Bettcher did not name any country, but from how PMI’s strategy honchos put forth their roadmap for India, it’s clear that India is in their crosshairs.


A slide from the Philip Morris presentation, with Dr Reddy’s photo circled in red
 
 
“The tobacco industry is known to target tobacco control advocates the world over through tactics of intimidation, harassment, misinformation and covert attacks on their organisations,” says Dr Reddy. “I’m not surprised to see the Philip Morris document including me in the select group of public health champions who have been committed advocates of global tobacco control. However, the fact that my photograph has been specially marked out with a red circle indicates that I am being specially targeted for my role in effectively negotiating for strong provisions in the Framework Convention on Tobacco Control (FCTC) and organising the first International Conference on Tobacco Control and advocating for effective tobacco control measures in India.”
 
Importantly, Dr Reddy has been representing India in important tobacco control conferences. In 2003, he was a key negotiator of the Indian delegation, appointed by the government for the FCTC, the world’s first public health treaty related to tobacco. Last year, when the seventh session of the Conference of the Parties (COP7) was held in India for the first time, Dr Reddy was once again appointed key negotiator by the Indian government. His organisations have worked in tandem with the health ministry on the external evaluation of the National Tobacco Control Programme in 2012-13.
 
In all, the Philip Morris document (of 2014) lists 12 Indian anti-tobacco organistions under the head ‘Corporate Affairs Approach and Issue’. Besides Dr Reddy’s organisations, on the list are the Voluntary Health Institution of India (VHAI), HRIDAY, the Institute of Public Health (Karnataka), and the Madhya Pradesh and Rajasthan Voluntary Health Association. It also includes state-run agencies like Gujarat Tobacco Control Cell and the Directorate of Public Health and Preventive Medicine, Tamil Nadu. While the document sticks to euphemism, there is no subtlety about what the tobacco giant wants to achieve: [from] “tracking, responding or challenging these organisations when appropriate to playing political games to have a political cover and win.”
 
Says Bhavna Mukhopadhyay, executive director of VHAI, “We are on the hit-list of these companies because our work is making a difference in terms of tobacco consumption. We are able to influence policies and having an impact.” The VHAI works with the health ministry in its National Tobacco Control Programme (NTCP). Its representatives were on the expert committee on increasing the size of the pictorial warning mandated on all tobacco products to 85 percent of the package. The organisation also provides expertise and shares evidence on anti-tobacco use. At the cutting edge, it works on the implementation and compliance of the Cigarettes and Other Tobacco Products Act (COTPA), 2003, by sensitising important stakeholders and supporting the local administration with technical expertise and by creating public awareness. As to targetting by tobacco giant Philip Morris, like Dr Reddy, she says it’s a “badge of honour”.
 
For Mukhopadhyay, the fall in number of tobacco users by 81 lakh, according to the WHO Global Adult Tobacco Survey-2 (2016-17), is a big dent on the tobacco business. “Take these figures as a decline in the number of tobacco buyers. This plunge in tobacco consumption from 34.6 percent in 2009-10 to 28.6 percent in 2016-17 shows how tobacco companies have lost business in all these years,” she says.
 
Governance Now contacted Philip Morris’s Delhi office for comments, but they refused to share contact details or e-mail IDs of executives.
 
Hitting the kitty
 
The PHFI, the Institute of Public Health (Karnataka) and VHAI’s state unit in Assam receive funds from Bloomberg Philanthropies, provider of the biggest anti-tobacco funding in Asia. The group has since 2012 spent almost $4 million on 12 anti-tobacco advocacy groups. In the last six months, however, the funding of these organisations has been disturbed. The foreign funding licences of the PHFI, the Assam Voluntary Health Association (which works as an autonomous unit VHAI, as do all of its state-level units), and the Institute of Public Health were not renewed: the termination of the Foreign Contribution Regulation Act (FCRA) licence means they cannot accept funds such as those provided by Bloomberg Philanthropies.
 
A January statement from the Institute of Public Health says: “Unfortunately, we have not been provided any reason for the refusal to renew our FCRA registration. On repeated e-mails and formal inquiries, no reason has been provided yet and we continue to sincerely appeal to the government to provide us with reasons for this refusal.” It goes on to say: “In the lack of any reason forthcoming, we are forced to believe that vested industry interests could have played role in maligning and misrepresenting IPH’s work. We have made a sincere evidential appeal to concerned authority adducing facts and figures about IPH’s public health activities over time. Unfortunately, this appeal was also denied without providing any information on the reasons.”
 
 
Similarly, it has been three months since Dr Reddy’s PHFI lost its FCRA licence; again, there has been no response from the government to questions on why the licence has not been renewed. Although there has been talk that PHFI may have been targeted because of Dr Reddy’s perceived closeness to the the previous UPA regime and Dr Reddy has offered to quit to make way for someone else to run the show so that the work continues, there are sinister undertones to the whole affair and how sharply the blow was struck. People from the field are inclined to believe that the tobacco lobby might have been at work.
 
Flank attack
 
The onslaught takes some devious tacks. Says Ashim Sanyal of Consumer VOICE, a voluntary action group that filed a suit against the ‘Made for Each Other’ campaign of Wills cigarettes, an ITC brand, “Lobbying is generally through putting frontal faces. There are tobacco farmers who are made to stand as representatives on behalf of tobacco industries.” He was referring to groups such as the Federation of All India Farmers Association (FAIFA), which has been putting up posters of forlorn farmers and seeking to “protect their livelihood” against the onslaught of “foreign-funded anti-tobacco lobbies”.
FAIFA, a society registered under the Andhra Pradesh Societies Registration Act, 2001, was set up in 2015 and is headquartered in Guntur. Andhra Pradesh is one of the major tobacco-producing states of India. FAIFA came into the limelight when India hosted COP7 (or the seventh Conference of the Parties, where all parties to the Framework Convention on Tobacco Control meet for discussion) last year. It demanded that the prime minister boycott the convention; it was riled the most when the WHO’s FCTC convention secretariat rejected its application for the status of observer at the conference. Generally, the media, industries and private organisations are not allowed to attend the convention because they might have connections to the tobacco industry.
 
FAIFA then went to Delhi high court on the grounds that the conference guidelines are not binding on the Indian government as there is no domestic law enacted by parliament to adopt/implement the treaty. It’s petition also said that India’s hosting of and participation in COP7 went against the interests of tobacco farmers. The argument runs somewhat like this: the FCTC (which, under Article 21, speaks of providing alternatives to wean tobacco farmers away from the cash crop) is not enacted by parliament nor is there any Indian law making it binding on the country, whereas the Tobacco Board Act of 1975, an Indian law, is for promotion of tobacco cultivation. So the government should rather go by an Indian law. “We are working on behalf of farmers. Our livelihood should not be affected,” says Murali Babu, general secretary of FAIFA, himself a tobacco farmer, though by no means a small farmer: he told Governance Now he owns 40 acres of tobacco-producing land. He says FAIFA is funded through contributions from farmers.
 
FAIFA was most visible in Delhi and other major cities with its poster campaign last year; even today, its posters are seen on several auto-rickshaws in Delhi and on hoardings at prominent places. It uses the appeal of sympathy-seeking, pitching the case of small tobacco farmers facing the onslaught of foreign-funded NGOs that lobby against tobacco use. It deploys every kind of red herring argument – that anti-tobacco lobbies might actually encourage cigarette smuggling, through which foreign cigarette companies want to put local tobacco producers out of business. (It’s well known that some big cigarette MNCs have been under the shadow of cigarette smuggling charges.) Here is what FAIFA’s website says:
 
  • “FCTC Article 6 with recommendations for imposing excessively high taxation on tobacco products will have serious livelihood impact for Indian Cigarette tobacco farmers. Legal Cigarettes are already subjected to very high and discriminatory taxation in the country which has led to a shift of consumption to smuggled cigarettes which do not use local tobacco. This affects negatively the demand for tobacco grown by us and supplied to the domestic legal industry.”
  • “Tobacco taxation policies should not create arbitrage opportunities for unscrupulous anti-social elements which would fuel smuggling in India and across the globe.”
 
 
Angle of attack
 
But then, FAIFA’s petition to Delhi high court, while pleading the case of farmers, makes particular mention of Bloomberg Philantrophies and the funds granted to Dr Reddy’s PHFI. (The Bill and Melinda Gates Foundation also finds mention.) It says the ministry of health report on tobacco control in India is jointly supported by the Centre for Disease Control and Prevention Foundation (CDC), one of the entities administering Bloomberg grants; and that Dr Reddy receives grants from Bloomberg and is a contributor to the tobacco report. Public health campaigners wonder why a farmers’ organisation, instead of presenting the legit case of farmers, would particularly go against an anti-tobacco campaigner and those who fund him. Of course, big farmers stand to lose huge profits if tobacco consumption goes down drastically through the efforts of people like Dr Reddy. There is also a case to be made for small tobacco farmers, who may find it difficult to shift to an equally profitable alternative crop or occupation. But rich tobacco growers have already profited enough over many generations to be able to diversify into other businesses. Considering the sustained campaign and its pointed targeting, there seems to be more than what meets the eye, namely, those posters and campaign hoardings depicting poor farmers.


A FAIFA hoarding thanking the government for acting against anti-tobacco campaigners (Photo ciurtesy: VHAI)

 
In April, when the media was abuzz with the news of PHFI’s FCRA licence not being renewed, FAIFA was prompt to put up a hoarding outside Nirman Bhavan which houses the health ministry, thanking the government for taking action against anti-tobacco NGOs and calling for punishing them. It was almost gleeful. It’s not clear if this should be read in the light of Philip Morris’s presentation, which marked out Dr Reddy in red, but several experts working in public health have wondered how an organisation of poor farmers can afford such an advertising campaign: a blitz of ads on autorickshaws, hoardings in prime locations that stayed for almost a month. Its ads have also been appearing in newspapers. Asked why Dr Reddy was being targeted in its petition while there are so many NGOs working on tobacco policy control, FAIFA’s Murali Babu, says, “We are being targeted, we are not targeting anyone. Our concern is the livelihood of farmers.”
 
Recently, FAIFA has also jumped into the fray in the PIL in Bombay high court on the LIC stake in ITC and other tobacco companies (see profile of lead petitioner Sumitra Hooda Pednekar on page 24). Advocate Waseem Pangarkar of MZM Legal, who is fighting the case on behalf of petitioners Sumitra and others, says, “Farmers have nothing to do with the case! It is completely a financial issue, which demands disinvestment of public fund from cigarette manufacturing companies. FAIFA’s interference is a way to divert attention.” FAIFA has also started a campaign opposing the five percent GST on raw tobacco, saying that it’s an unrealistic tax that will “severely endanger their livelihoods”.
 
Read about Sumitra Hooda Pedneker: The lady fights baccy
 
Dr Reddy, on the other hand, speaks of how a case was made for poor tobacco farmers. He says, “While negotiating the FCTC and also at COP7, the Indian delegation argued powerfully and successfully for inclusion of provisions and detailing of measures to support transition to economically viable alternate crops and occupations. I put forth those arguments with the strong conviction that it is the duty of governments to implement multi-sectoral actions to assist smooth and sustainable transition while protecting society from the ill effects of tobacco. The answer lies not in slowing down tobacco control but in speeding up the transition.”
 
Cost to country
 
Policy experts are worried more about the increasing healthcare burden on the government due to tobacco-related diseases like cancer, tuberculosis and heart disease. Besides, the loss of so many lives and mandays translates into steep decline in national productivity. The judiciary and parliament, too, have pointed this out. In 2001, the supreme court, in the Murli S Deora vs Union of India case, observed, “Treatment of tobacco-related diseases and the loss of productivity caused therein cost the country almost Rs 13,500 crore annually, which more than offsets all the benefits accruing in the form of revenue and employment generated by the tobacco industry.”
 
Also, the parliamentary standing committee on science and technology, environment and forests, in 2016 discouraged expenditure incurred by the government in relation to tobacco-related disease treatment and death caused by it. It recommended disincentivising tobacco production and encouraging farmers to move to other profitable crops.
 
Long reach
 
Against all that, lobbying goes a long way: the tentacles of industry reach right up to parliamentarians. The delay in the implementation of pictorial health warnings covering 85 percent of cigarette packets is a fine example. In October 2014, government announced the introduction of larger pictorial warnings. As planned, the decision was to come into effect on April 1, 2015. Dilip Gandhi, the BJP MP from Ahmadnagar who steered the 15-member subordinate legislation committee, interacted with representatives from the tobacco lobby. Eight of its members were opposed to having bigger warning photos. 
 


Pictorial warnings may be further increased. The new idea is plain packaging – no branding (Photo: Arun Kumar)

 
Gandhi was later quoted by The Indian Express as saying, “No Indian study has established that tobacco causes cancer. Whether it actually causes cancer or other diseases is subject to a study in the country. That has never happened. And the basis of our stance towards tobacco products is basically that studies that have happened in a foreign setting.” 
 
It is expected that plain packaging of tobacco products – where the warning or message to quit will cover almost the entire pack, with very little space for the brand name – will be next big thing. The idea is to allow the sale of cigarettes and other tobacco products without any brand association. Countries like Australia have already implemented this measure. Pro-tobacco lobbyists will be jumping in to oppose the measure as much as they can. They are also expected to lobby vigorously against higher taxation of tobacco products, which the National Health Policy 2017 recommends. Prabhat Jha, a tobacco taxation expert and founder of the Centre for Global Health Research, says, “The problem is that governments don’t raise taxes on all lengths of cigarettes, so the tobacco industry then pushes more of cheaper, shorter cigarette (which are also being used as a lure for bidi smokers to make the switch). So what is needed is a big tax but also a smart one that prevents such manipulation.”
 
According to Jha, in the past five union budgets, tax on tobacco has been raised twice by a modest extent, which has hiked the price of shorter cigarettes. The challenge, according to him, is taxation on beedis. “Note that beedi taxation in India is hard, and it will continue to be difficult unless all beedi manufacturers are registered and monitored. The hope is that with GST registration now required, they can be regulated first, after which taxation can be introduced. In contrast, the cigarette industry is smaller and can be taxed more aggressively.”
 
Taxes alone will not work. Tobacco control calls for a multipronged effort: if providing tobacco farmers with an alternative is important, equally important is education against tobacco use and effective policy interventions. In the last two, it’s the voluntary sector that has played a sterling role. The health costs of tobacco use – at the individual and the national levels – are too high to ignore the aggressive and cynical war the tobacco lobby has unleashed on such NGOs. 
 

COTPA: Much needed amendments

In January 2015, the health ministry released the draft of the COTPA Amendment Bill in the public domain. Comments and views from stakeholders along with general public were submitted by February 15, 2015. After that, there hasn’t been any progress so far. Some of the prominent amendments proposed are:

  • A clause that provides for protection of public health policies with respect to tobacco control from the commercial and other vested interests of the tobacco industry
  • To do away with provisions of ‘designated smoking area’ (like international airports) which invite exemption
  • Control the mushrooming of hookah bars and commercialisation of hookah tobacco
  • ‘Prohibition of smoking in public places’ to be replaced with ‘prohibition of tobacco use in public place’
  • Prohibit tobacco advertisements at point of sale and in/on packages of tobacco products
  • Extend prohibition on advertisement, promotion and sponsorship of tobacco products to mediums like films, internet, mobiles, etc.
  • Extend prohibition on brand sharing or brand stretching of tobacco brands and trademarks
  • All means of tobacco use, whether by adding additives or through sale of any imitation products, should be discouraged
  • Need to plug the real or potential misuse of the corporate social responsibility (CSR) activities by tobacco companies to indirectly promote or advertise tobacco products
  • Increase the minimum legal age for sale of tobacco products from 18 years to 21 years
  • Prohibit sale of cigarettes or beedis in loose (single sticks) and other tobacco products in small pouches instead of intact packages
  • Prohibit employment, engagement or use of children below 18 years of age in the cultivation, processing and sale of tobacco or tobacco products
  • Display nicotine and tar content with maximum permissible limit on tobacco product packages
  • Disclosure of information on constituents and emissions to the government by manufacturers or producers
  • Designation of special courts to ensure effective implementation of COTPA
  • Penalty for selling tobacco products within 100 yards from educational institutes should be enhanced from existing Rs 200
  • Suspension or cancellation of the licence of the manufacturer, importer, supplier, distributor or seller in case of violation

 

 
See Infographics: Toxic Tobacco Truths

 
A man on a mission
 
Tobacco companies resort to surreptitious tricks to get around the ban on advertising. Dr SK Arora fights back



(Photo Courtesy: State tobacco control cell) 


For the last two years Dr SK Arora, chief tobacco control officer and additional director health, Delhi, has been working on a mission with befitting zeal. He has been campaigning against surrogate advertisements by tobacco firms. For this, the man in his fifties visits dozens of kiosks and writes to a plethora of authorities to do something about misleading advertisements. 
 
“Pataka Industries Pvt Ltd, Shikhar Gutka Pvt Ltd, Kuber Group (Kuber khaini) and Som Pan Product Pvt Ltd (Dilbag) are the tobacco companies violating The Cigarette and Other Tobacco Products (Prohibition of Advertisements and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 [COPTA] through surrogate advertisements,” says Arora.
 
He tells Governance Now that the Act prohibits direct or indirect promotion of a tobacco brand/trademark. But these companies use some innocuous products to popularise their brands. For example, Pataka Industries, a bidi manufacturer, is promoting the brand by advertising Pataka tea. Likewise, Shikhar, Dilbag and Kuber are primarily gutka/chewable tobacco manufacturers but are promoting the brand as pan masalas.
 
Arora has been writing letters to the health ministry, the Advertising Standards Council of India and Delhi police, among others. In two years, his department has not received any response except from the directorate of advertising and visual publicity (DAVP), the centre’s publicity wing. “They said they are not the enforcement agency,” says Arora. 
 
In enforcing the ban on surrogate advertising, police has a proactive role to play. It is an enforcement agency that can initiate action on the violation. But so far Arora has not received any action taken report from police. He says, “It is not a compoundable offence where you cut challans or take action on the spot. An FIR has to be filed and a court case has to be initiated.”
 
Delhi, he says, is the only state in the country which has called for filing FIRs against surrogate advertisements. Of course, “it’s not Delhi alone where violations are taking place, surrogate advertisements are shown everywhere. But Delhi is the state which has taken the initiative,” says Arora. 
 
Usually, the main task of a tobacco control office in a state is to raise awareness about the ill effects of tobacco as well as about tobacco control laws to help users to quit tobacco. Arora has taken up the task in full seriousness. Recently, his concerted efforts stopped big cigarette companies from putting advertisements at point-of-sale anywhere in the capital.
 
He says tobacco control is possible only if COTPA is enforced effectively. “Though we need amendments or extensions in certain legal provisions, we have enough laws and the need of the hour is to enforce the existing laws religiously and genuinely. We should strengthen implementation through different modalities,” says Arora.
 
 
 
archana@governancenow.com

(The story appears in the August 1-15, 2017 issue of Governance Now)
 
 
 
 
 
 

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