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"Tobacco smoking is the single largest preventable cause of
premature death and disease in Australia."1 This is the first line of a
document distributed recently with the Ministerial Council on Drug
Strategy's National Tobacco Strategy 1999 to
2002-03.2 The World Health
Organization, in recognition of the unabating global rise in
tobacco-caused deaths -- forecast to reach 10 million a year in the
decade 2020-2030 -- has elevated tobacco control to one of its
priority projects,3 alongside malaria control
and the essential drugs program.
So, how is tobacco control faring in Australia? It is popular for
Australian governments to be tough on illicit drugs, but of late they
have been decidedly weak on tobacco. They have allowed smoking
prevalence to languish unchanged in the 1990s, after having
successfully driven it down during the preceding three
decades.4 A small gain has been
that several State governments have announced or have
implemented bans on smoking in restaurants, but, relative to
government funding of other public health issues, funding for
tobacco control is appallingly neglected. Moreover, for some of the
other public health issues, such as illicit drug use prevention,
little evidence for policy or program effectiveness exists (Box 1).
Further progress with tobacco control appears to be shackled by:
- ideological recoil at regulating a "legitimate product";
- concern for short term political industry patronage; and
- ill-informed views that robust tobacco control will rapidly
strangle the goose that lays the annual $5 billion golden egg of
tobacco excise.
In April this year, in the face of huge criticism, the Liberal Party
accepted sponsorship from Philip Morris for a lunch at its annual
conference, with the Federal Director, Lynton Crosby, and the Prime
Minister, John Howard, shrugging off criticism, claiming that
tobacco products are legal,13 just as politicians of 150
years ago might have said of opium or even slavery. The Labor Party's
record is little better, having received many donations from tobacco
companies over the years.14 Only the Democrats refuse
tobacco sponsorship. In 1999, Prime Minister Howard said on radio
"the only way you could further reduce smoking in this country is
probably by making it illegal".15 Borrowing Thatcherite
vernacular, he has previously declared tobacco control to be a "nanny
State" activity.16 Federal Health Minister
Michael Wooldridge has championed the national tobacco campaign,
although he has failed to make it a priority within his portfolio.
Funding for the national tobacco campaign is now at a historic low,
with the National Tobacco Strategy brimming with promises, but
remaining woefully underfunded.2 In 1999, after seven years of
lobbying by the Australian Cancer Society, the tobacco tax system was
changed, but not a cent of the $400 million windfall expected from the
changed basis of excise (from per weight to per cigarette stick) has
been committed to smoking prevention. For all its occasional
rhetoric on the importance of tobacco control, the Federal
Government, over the coming two years, is likely to derive at least a
thousand times more ($10.25 billion) from tobacco excise17 than it
committed to "tobacco harm minimisation" in its 1998-99 Budget ($3.8
million -- additional small allocations come from other public
health programs).18
Australia and New Zealand's nine Attorneys General agreed in March
this year to investigate whether to emulate their US counterparts and
sue the tobacco industry. International precedents suggest that
they could choose from charges ranging from conspiracy, misleading
and deceptive conduct, or common law negligence. Criminal charges
against individuals are allegedly also receiving active
consideration.19 In the United States case,
the tobacco industry hoisted the white flag in November 1998 and
settled, agreeing to pay the US States $US206 billion over 25
years.20 (Population adjusted, at
today's exchange rates, this would translate into $A25.7 billion.)
The money from this case -- the largest settlement in world history --
will compensate the US States for the public costs of caring for
uninsured, dying smokers and fund massive education programs to
redress decades of industry misinformation.
Since the settlement, four US civil cases have seen juries return
verdicts in favour of plaintiffs.21 The latest, the Florida
Engle class action, may result in an award of punitive damages
totalling hundreds of billions of dollars.22 Some analysts believe it
could bankrupt the industry,23 ushering in a new era of
fully regulated tobacco sales with tobacco classified as a toxic
substance.
What has brought about these successes? Everything changed
overnight for the tobacco companies when, on 8 May 1998, the Minnesota
District Court ordered US tobacco companies to place on the World Wide
Web what has now run to over 30 million pages of internal
documents.24 Among this Niagara of
revelations are thousands that are highly incriminating, including
a great many authored by Australian industry operatives. The
decades-long industry claims that lung cancer was only
"statistically associated" rather than caused by smoking, that
nicotine was not addictive, and that tobacco companies did not want
children to smoke, have been confirmed as carefully orchestrated
positions designed to avoid litigation. These views contrast with
the industry's private admissions and its elaborate efforts to deny
evidence, delay government action and deceive smokers. As a Philip
Morris executive wrote in 1978:
". . . an admission by
the industry that excessive cigarette smoking is bad for you is
tantamount to an admission of guilt with regard to the lung cancer
problem. This could open the door to legal suits in which the industry
would have no defence."25
The internal documents detail a massive international conspiracy
designed to muddle public thinking about tobacco and stall
government action26 (Box 2).
After the documents were revealed, the Australian tobacco companies
have been attempting to deny that the arguments that sustained the US
settlement are relevant to Australia. They are amassing a collection
of press cuttings about smoking, presumably in an effort to argue
that, even if the tobacco companies were determined to promote public
doubt about tobacco's harms, this counted for little against what the
public could read in the press. The centrepiece of this argument is
that, because Australian tobacco tax more than covers the public
costs of treating diseased smokers, smokers pay their way --
government claims for recompense are therefore
unsupportable.38 This argument has all the
moral force of a company polluting the environment, attempting to
cover it up with commissioned and carefully managed science and then
pleading -- but our customers pay taxes . . . use that to pay for the
damage you claim, but that we dispute, occurs.
A lobbying document has been circulated by Philip Morris threatening
that, if the Australian and NZ Attorneys General proceed with legal
action, governments risk huge legal costs and closure of Australian
tobacco manufacturing with attendant job losses.38 Predictably,
it fails to mention any of the recent legal decisions against the
tobacco industry, nor the seachange in evidence provided by the
availability of the internal documents. If the Attorneys General
take courage, the industry will walk naked into court, with its
manifest vulnerabilities illuminated by thousands of its own
documents.
If the Attorneys General proceed and succeed, we are entitled to
wonder whether the money they extract will be used for the intended
purpose. One year on from the settlement in the United States only
three cents in the dollar were being used for tobacco
control.39 Cynics might well ask if
the present momentum is motivated solely by revenue raising.
References
- Ministerial Council on Drug Strategy. Background paper. A
companion document to the National Tobacco Strategy 1999 to 2002-03.
A framework for action. Canberra: Commonwealth of Australia, 1999:
1.
-
Ministerial Council on Drug Strategy. National Tobacco Strategy
1999 to 2002-03. A framework for action. Canberra: Commonwealth of
Australia, 1999.
-
Brundtland GH. WHO's International Conference on Global Tobacco
Control Law: Towards a WHO Framework Convention on Tobacco Control.
Speech text. January 7, 2000.
<http://www.who.int/director-general/speeches/2000/
20000107_new_delhi.html> (accessed 18 May 2000).
-
Hill DJ, White VM, Scollo MM. Smoking behaviours of Australian
adults in 1995: trends and concerns. Med J Aust 1998; 168:
209-213.
-
Anderson J. Black spot road safety a national priority in federal
budget. Media release.
<http://www.dotrs.gov.au/budget/anders/ABudget12_99.htm>
(accessed 22 May 2000).
-
Lawrence C. Human Services and Health Portfolio Budget
Statement 1995-96, Budget Related Paper No. 4.9.
Canberra: AGPS, 1995: 31-52.
-
Willis R. Budget Statements 1994-95. Budget Paper No. 1. Canberra:
AGPS, 1994: 3.63.
-
Wooldridge M. Health and Family Service Portfolio Budget
Statement, Paper No. 1.8. Canberra: AGPS, 1997.
-
Costello P. Budget measures 1998-99. Budget paper No. 2. Canberra:
AGPS, 1998, 1-42. (Also: Commonwealth Department of Health and
Family Services. Fact Sheet 1. Investment in preventive public
health measures, Budget 1998-99.)
-
Costello P. Budget measures 1999-00. Budget paper No. 2.
Canberra: AGPS, 1999. (Also: Department of Health and Aged Care. Fact
Sheet 4. Tough on drugs, Budget 1999-2000, May 1999.)
-
Australian Bureau of Statistics. Causes of death, 1998.
Canberra: ABS, November 1999. (Catalogue No. 3303.0.)
-
English DR, Holman SDJ, Milne E, et al. The quantification of
drug-caused morbidity and mortality in Australia, 1995 edition.
Canberra: Commonwealth Department of Human Services and Health,
1995.
-
Hardaker D. 7.30 Report, ABC Televison, 2000; 13 April.
<http://www.abc.net.au/
7.30/730subjectidx_Politics.htm> (accessed 18 May 2000).
-
Chapman S. Tobacco Control Supersite.
<http://www.health.usyd.edu.au/
tobacco/worddocs/political_donations.txt> (accessed 18 May
2000).
-
Howard J. Comments on Jeremy Cordeaux radio program 5DN. 1999;
July 22.
-
Brough J. Minister tips tobacco sponsorship to stay. Sydney
Morning Herald 1997; 3 Sept: 1.
-
Costello P. Australian Budget, 2000-01; Budget paper No. 1.
Budget strategy and outlook, Statement 5 revenue: Part II. Budget
estimates of revenue, Table 6. Indirect tax.
Canberra: Ausinfo.
<http://www.ausinfo.gov.au/budget/papers/
bpl/html/bs5-01.htm#P57_5844> (accessed 18 May 2000).
-
Costello P. Budget measures 1998-99, Budget paper No 2. Canberra:
AGPS, 1998, 1-42. (Also: Commonwealth Department of Health and
Family Services. Fact Sheet 1. Investment in preventive public
health measures. Budget 1998-99.)
-
Griffin T (South Australian Attorney General). ABC-TV.
Lateline 23 March [transcript].
<http://www.abc.net.au/lateline/archives/S113020.htm>
(accessed 22 May 2000).
-
Kelder G, Davidson P, editors. The multistate Master Settlement
Agreement and the future of state and local tobacco control; 1999
March 24. <http://tobacco.neu.edu/msa/index.html Executive
Summary> (accessed 18 May 2000).
-
Levin M, Menn J. $33m award to smoker who knew risks. Sydney
Morning Herald 2000; March 29: 11.
-
Williams B. Smokers win case in Fla. News and Observer
(Raleigh, Va) 2000, April 8.
<http://www.news-observer.com/daily/2000/04/08/nc00.html>
(accessed 18 May 2000).
-
Tobacco Control Resource Center Inc., and the Tobacco Products
Liability Project, Northeastern University.
<http://tobacco.neu.edu/> (accessed 18 May 2000).
-
The Tobacco Archives.
<http://www.tobaccoarchives.com> (accessed 18 May 2000).
-
Osdene TS. Roper study proposal to Tobacco Institute, 1978, 16
February.
<http://www.tobaccoinstitute.com/getallimg.asp?DOCID=TIOK0034601/4602>
(accessed 18 May 2000).
-
Cullman H. (Philip Morris) Memorandum to the files
(Confidential). Interoffice correspondence. 1976; December 3.
Search for -- Did:2025025286 at
<http://www.pmdocs.com/default1.asp> (accessed 23 May
2000).
-
Proposal for the organisation of the Whitecoat Project.
<http://www.ash.org.uk/ papers/2501474262.pdf>
(accessed 18 May 2000).
-
Project Down Under. 1987; June 26. Search for --
Did:2021502671/2678 at
<http://www.pmdocs/com/default1.asp> (accessed 23 May
2000).
-
Boyse S (British American Tobacco). Minutes of a special meeting
of the UK industry on environmental tobacco smoke. 1988, February 17.
<http://www.ash.org.uk/papers/401247331.pdf>
(accessed 18 May 2000).
-
Headden S. Papers you weren't ever supposed to see. How Big Tobacco
fought an all-fronts war. US News 1998; May 4.
<http://www.usnews.com./
usnews/issue/980504/4toba.htm> (accessed 22 May 2000).
-
Marlboro marketing strategy (Australia) 1990. Search
for -- Did:2048571302/1384 at
<http://www.pmdocs.com/default1.asp> (accessed 23 May
2000).
-
Philip Morris (Australia) Corporate Affairs Plan 1992.
Search for -- Did:2023240608/0627 at
<http://www.pmdocs.com/default1.asp> (accessed 23 May
2000).
-
Health aspects of environmental tobacco smoke: an evaluation of
the scientific literature. Submission to the Health Care Committee
of the National Health and Medical research Council. Sydney:
November 1994, 156 pp.
-
Staunton D (Tobacco Institute of Australia) Memorandum 1994; 7
April. Search for -- Did:2504088601/8606 at
<http://www.pmdocs.com/default1.asp> (accessed 23 May
2000).
-
Knopick P. Memorandum to William Kloepfer: TI, USA; 1980.
<http://www.
tobaccoinstitute.com/getallimg.asp?DOCID=TIMN0107822/7823>
(accessed 18 May 2000).
-
Francis P (Philip Morris Australia). Telex to Don Hoel (Shook,
Hardy and Bacon, lawyers, Kansas). 1998; 11 December. Search
for -- Did:2021588889 at
<http://www.pmdocs.com/default1.asp> (accessed 23 May
2000).
-
Chapman S. Tobacco Control Supersite.
<http://www.health.usyd.edu.au/
tobacco/ozdocs.html#Plainpackaging> (accessed 18 May 2000).
-
Philip Morris (Australia). Why US style medical cost recovery
litigation is not right for Australia. Melbourne: Philip Morris,
2000; March 16: 7pp.
-
Rees D. Tobacco money scattered by states. Richmond
Times-Dispatch. Richmond, Va, 1999; 19 Nov.
Authors' details
Department of Public Health and Community Medicine, University of
Sydney, Sydney, NSW.
Simon Chapman, Associate Professor; and Associate
Director, VicHealth Centre for Tobacco Control, Drummond Street,
Cartlton, VIC.
Reprints will not be available from the author.
Correspondence:
Associate Professor S Chapman, Department of Public Health and
Community Medicine, University of Sydney, NSW 2006.
simonc@health.usyd.edu.au
©MJA 2000
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