Abstract
This six page document is a surveillance report on the public health infrastructure in Argentina and Brazil in the late 1980's, and the abilities of these countries to engage in tobacco control activities.
The author is Theodore Sterling, a statistician with Simon Fraser University in Canada, who was a tobacco industry consultant hired to present the tobacco industry's point of view at indoor air quality symposia during the late 1980's.
Sterling assesses the government and public health infrastructure of each of these countries, along with smoking prevalence and attitudes towards tobacco, and then recommends effective strategies to undermine nascent public health efforts against tobacco in these countries.
Sterling says that in Brazil, the "possibility might exist of a unified public health motivated attack on smoking. It would seem to me therefore that some attention ought to be paid to counteract the kind of exaggeration about smoking effects met with in more advanced countries..."
Among other strategies, Sterling suggests that the tobacco industry establish relationships and build alliances with public health organizations and "occupational health investigators." "Such contacts," he says, "could be initiated by offering help and assistance to South American research institutions and bringing a small number of South American investigators to North America where they could...become knowledgeable on smoking related problems." He also suggests offering help with computer systems and offering a Brazilian epidemiologist the opportunity "to spend a year at Vancouver."
Fields
- Quotes
Smoking is as yet not a major issue in the two largest South
American countries. Nevertheless, both countries have
official as well as voluntary anti-smoklng advocacy groups
and some municipal regulatlons have been proclaimed.
(However there doesn't seem to be any enforced restriction
on smoking in publlc buildings, restaurants, or means of
transportation.)
Argentina lacks a strong central public health organization,
especially an organization that would affect localities
outside Buenos Aires. It is unlikely that that society
would adopt or could enforce stringent rules end regulations
to limit smoking. Anti-smoking groups adopt some of the
more visible aims of their North American counterparts. For
instance, there is a push to get smoking advertising out of
public sports or support of the arts. But the country's
political and social problems and lack of an effective
central authority in public health make it unlikely that
anti-smoking actions, even those adopted by government will
be more than token gestures...
...Measured against that minor attention paid to smoking a few years ago, there has been substantial growth in anti-smoking regulation and organizations in South America. It is
reasonable to expect that developments in South America will
follow the North American pattern but will be constrained by
local conditions and certainly will be much slower. The
exception may be Brazil where a possibility might exist of a
unified public health motivated attack on smoking . It
would seem to me therefore that some attention ought to be
paid to counteract the kind of exaggeration about smoking
effects met with in more advanced countries. Three
approaches appear to recommend themselves.
The project of "Placing Smoking in Perspective Among
Major Public Health Problems in South America" may be
somewhat late and, if undertaken, might seem to be an
effort to close the barn door after the horses had
escaped. However, it may still be of some limited
usefulness. There still is need to recognize the major
public health problems in South America, especially in
Brazil and to rank them among problems besetting South
American countries...Contacts with South American publlc health organizations and public health and occupational health investigators ought to be established. Such contacts could be initiated by offering help and assistance to South
American research institutions and by bringing a small
number of South American investigators to North America
research centres where they could participate in ongoing
work and so become knowledgeable on smoking related
problems. (I have, in fact, discussed with Dr.
Tambellini the posslbility of offering help with
developing a suitable computer system for Oswald do
Cruz and I have also explored the possibility with one
of the epidemiologists from the University of Sao Paul.
to spend a year at Vancouver...
- Company
- Lorillard
- Author
- Sterling, Theodor D., PhD (Industry Consultant, Statistician Applied Mathematics)
Theodor Sterling was a statistician with Simon Fraser University, Canada. He is listed as a consulting scientist for the tobacco industry in 1988 memo PM 2023034933/4946 from Andrew Whist to R. Murray. Sterling presented the industry's point of view at indoor air symposia in Tokyo, 1987 and in the U.K. in 1988.Industry Consultant and CTR Special Project recipient.
- Recipient
- Hoel, Donald K. (CTR Industry Research Committee & PM Attorney, Shook Hardy)
Donald Hoel was an attorney with Philip Morris' law firm Shook Hardy and Bacon (SHB). He served as a member of the CTR Industry Research Committee in 1978?. Hoel assisted in screening "apppropriate" projects to received CTR funding.
- Region
- Brazil
- Argentina
- Named Organization
- Fundacentro
- Indoor Air Quality Conference
- Intl Labour Org
- Jorge Duprat Figueiredo of Occupational
- Natl School of Public Health
- Oncological Inst Angel H Roffo
- Oswaldo Cruz Foundation
- Univ of Rio De Janiero
- Universitat De Sao Paulo
- World Health Organization (Concerned with global public health)
International organization concered with public health worldwide
- Litigation
- Txag/Produced
- Named Person
- Tambellini, A.T.
- Brizola, L.
- Costa, D.L.
- Dasilva, L.
- Erundina, L.
- Sarney, J.
- Silvert, F.
- Type
- MEMO, MEMORANDUM
- REPT, OTHER REPORT
- Subject
- Public health
- public awareness
- public health policy
- public health program
- industry activity
- industry surveillance (Intelligence-gathering on public health forces)
Document Images
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MEMO TO: Don Hoel
FROM: Ted Sterling
DATE: December 16, 1988
SUBJECT: OBSERVATIONS ON ATTITUDES TOWARD SMOKING AND
HEALTH AMONG INDIVIDUALS CONCERNED WITH PUBLIC
HEALTH MATTERS IN ARGENTINA AND BRAZIL
During November, 1988, Dr. Frieda Silvert, and I discussed
public health related problems, including smoking, with a
number of professionals, health scientists and politically
active individuals in_Argentina and Brazil. Individuals
with whom either Dr. Silvert or I or both of us discussed
various issues ranged from university presidents to
occupational health investigators and included individuals
of different shades of political opinion and attitudes. A
list of individuals with whom discussions were held is
included.
Interviews followed set procedures covering four topics:
1. A general discussion during which the interviewed
individual was asked to outline his or her concerns
relating to public health matters (in the widest sense);
2. Already existing and/or needed methods and procedures to
regulate levels of exposures to possible toxic
substances by workers or by the general public
(including smoking);
3. A general discussion of attitudes toward smoking
(without, however, stressing smoking as an issue of any
greater interest than any other topic discussed at the
same time or before):
4. Discussion of assistance or information we could
furnish.
While the discussions took place over a short period of time
involving relatively few individuals, a number of
impressions were generated. It is difficult to say how
accurate or how relevant these impressions are, even though
the individuals interviewed were carefully selected,
appeared to be knowledgeable, and the discussions were frank
and honest.
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ARGENTINA
Public health measures are adequate to insure the survival
of human settlements which means that the milk is properly
tested, the water supply relatively clean, streets are kept
swept and garbage is collected. However, there is no strong
central'public health tradition similar to that in the
United States from which edicts concerning smoking can
originate or anti-smoking actions can be monitored.
Smoking is not an issue in Argentina and is frequented
almost with the same prevalence rate for men and women.
There are, nevertheless, centres that advocate anti-smoking
measures. The leading centre probably is the Oncological
Institute "Angel H. Roffo" which forbids smoking even
outside its premises. There are also private anti-smoking
foundations and individuals engaged in anti-smoking
activity. (Unfortunately, my notes were lost on who the key
individual is in that movement). It is my understanding
that the Indoor Air Quality Conference was actually moved to
Bariloche in order to avoid possible unpleasantness with
anti-smoking groups in Buenos Aires.
BRAZIL
In contrast to Argentina, Brazil has and has had for a long
time, a well-organized public health stance. The Oswaldo do
Cruz Foundation, in Rio de Janiero, that was established
some sixty years ago is a strong center for public health
oriented research investigation and for advocacy. That
institute's environmental and public health division is
presently being very substantially enlarged.
The Universitat de Sao Paulo in Sao Paulo has a large
faculty of public health and in fact it has been through the
effort of this faculty that a medical specialty of
occupational health was established years ago. The faculty
of public health at the University of Sao Paulo has been the
major institution in South America for training the leading
public health figures and industrial hygienists in South
America.
Associated with the University is the foundation Jorge
Duprat Fiqueiredo of Occupational Medicine (usually referred
to as Fundacentro) functioning under the Ministry of Labour.
Fundacentro is a superbly equipped centre for industrial
hygiene research and monitoring of work sites and includes
many laboratories with up-to-the-minute equipment for
testing and certification for materials and safety devices
used in industry and is staffed by well trained
professionals. (I was frankly impressed with the facilities
and the professionalism of the staff. The Fundacentro's
equipment and staff were certainly at the level of the best
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that can be found in Canada and the United States). The
International Labour Organization (ILO) has its South
American centre at the University and there is and agreement
of technical corporation between ILO and the University of
Sao Paulo in the field of occupational safety, hygiene and
health that cover all IIA activities in South America.
Smoking did not emerge as an important issue in discussions
at the Oswald do Cruz Foundation, at the University of Rio
de Janiero, or at the University of Sao Paulo and in the
associated Fundacentro. However, a strong anti-smoking
group has been formed within the Ministry of Health as part
of its national campaign to combat cancer. The work is
under the direction of Dera Luida Costa a Silva who heads
the Health Promotion and Protection Program of the health
ministry. While well-funded, the work of the Health
Promotion and Protection Program has limited itself so far
to general advocacy and to the production and distribution
of anti-smoking posters and comic books. Posters and comic
books are also mailed to and made available to anti-smoking
organizations and individuals outside Brazil.
PROJECTION
Smoking is as yet not a major issue in the two largest South
American countries. Nevertheless, both countries have
official as well as voluntary anti-smoking advocacy groups
and some municipal regulations have been proclaimed.
(However there doesn't seem to be any enforced restriction
on smoking in public buildings, restaurants, or means of
transportation.)
While anti-smoking sentiment and actions may be expected to
grow, however, patterns of expanding anti-smoking activity
might sharply differ between the two countries.
Argentina lacks a strong central public health organization,
especially an organization that would affect localities
outside Buenos Aires. It is unlikely that that society
would adopt or could enforce stringent rules and regulations
to limit smoking. Anti-smoking groups adopt some of the
more visible aims of their North American counterparts. For
instance, there is a push to get smoking advertising out of
public sports or support of the arts. But the country's
political and social problems and lack of an effective
central authority in public health make it unlikely that
anti-smoking actions, even those adopted by government will
be more than token gestures.
The situation in Brazil may be quite different. Brazil has
a tradition of strong central force in authority in public
health. For instance, Fundacentro has twenty-four
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industrial hygienists in the field monitoring performance of
industry throughout the country to assure some compliance
with adopted or recommended standards. However, while a
potential of central authority that could support anti-
smoking_and anti-smoking drives exists, the probability of
this happening may depend on political developments.
The Fundacentro and the public health school in Sao Paulo
are relatively conservative and oriented to the solution of
practical problems that face the country. That tradition,
established largely under the influence of Professor Diogo
Pupo Nogueira, one of the major forces at the university,
has been to look toward the practical solution of immediate
problems and to long range preparations for a more vigorous
public health stance in the further, especially in
occupational hygiene. This stance is very much oriented
toward problems created by the industrialization of Brazil.
In contrast, the Oswaldo do Cruz Centre has become
increasingly ideologically oriented. The present head of
the very much enlarged and well-funded Centre for the Study
of Workers Health and Human Ecology (CESTEH) of the National
School of Public Health (ENSP) located in the Oswaldo do
Cruz Foundation is Dr. Annamaria Testa Tambellini who
appears to be a leading Marxist ideologist for the
Brazilian, and in fact for South American, policies.
It is likely that the coming election in Brazil will give
the Marxists a controlling voice. The strong showing by
left-wing candidates in the recent municipal elections in
Brazil has raised the profile of the Marxist challenger for
the 1989 presidential race. Left-wing parties took control
of ten of the nation's largest cities in what was seen as a
rejection of President Jose Sarney's policies. The biggest
surprise was the election of radical Marxist woman
candidate, Luiza Erundina, as mayor of Sao Paulo. It is
almost certain that the election will go to either Lula Da
Silva or Leonel Brizola, both left wing candidates.
With an impending Marxist victory, the responsibility for
setting public policy will shift from Sao Paulo and the
related Fundacentro to the Oswald do Cruz Institute under
the leadership of Annamaria Testa Tambellini. There are a
number of reasons why such a shift might lead to the
adoptions of an anti-smoking policy.
1. Strong public health policy is part of the platform of
the Marxist group. (Luiza Erundina's platform revolved
around public health, transportation, and abandoned
children-in that order.)
2. The national health policy is part of the avowed
platform espoused by Dr. Annamaria Testa Tambellini.
Her writings include such statements as "a National
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Health Policy expresses the power to use strength,
disclosed by means of agreement or coercion, to obtain
the collaboration of all social groups of the nation in
order to achieve better health conditions." (A.T.
Tambellini "Improvements in The Formulation of A
National Health Policy in Brazil", Center For The Study
of Workers Health and Human Ecology, Rio de Janiero,
Brazil, 1988.)
3. Marxists have a peculiar ideological problem when it
comes to occupational health. Their doctrinaire
position is that the workers' lots will worsen steadily
under Capitalism which will serve as a motive for the
working classes to help overthrow the Capitalist order.
However, such a doctrinaire position conflicts with
measures that would improve working conditions under
Capitalism. However, it does not conflict with edicts
against smoking.'
A review of WHO's Health Conditions in the Americas reveals
that smoking was barely mentioned as a health factor as
recently as 1985. In Volume one, (pages 65-67)it is stated
that "with smoking on the rise, this morbidity
(cardiovascular disease) can also be expected to become more
important". A table of cigarette consumption by countries
in the Americas in 1983 is given. Volume two describes
smoking in Colombia for 1977 to 1980. The statement is made
that in Equador 50% of the young people consume alcohol and
cigarettes. No other reference can be found.
Measured against that minor attention paid to smoking a few
years ago, there has been substantial growth in anti-smoking
regulation and organizations in South America. It is
reasonable to expect that developments in South America will
follow the North American pattern but will be constrained by
local conditions and certainly will be much slower. The
exception may be Brazil where a possibility night exist of a
unified public health motivated attack on smoking . It
would seem to me therefore that some attention ought to be
paid to counteract the kind of exaggeration about smoking
effects met with in more advanced countries. Three
approaches appear to recommend themselves.
1. The project of "Placing Smoking in Perspective Among
Major Public Health Problems in South America" may be
somewhat late and, if undertaken, might seem to be an
effort to close the barn door after the horses had
escaped. However, it may still be of some limited
usefulness. There still is need to recognize the major
public health problems in South America, especially in
Brazil and to rank them among problems besetting South
American countries.
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6
2. Contacts with South American public health organizations
and public health and occupational health investigators
ought to be established. Such contacts could be
initiated by offering help and assistance to South
American research institutions and by bringing a small
number of South American investigators to North America
research centres where they could participate in ongoing
work and so become knowledgeable on smoking related
problems. (I have, in fact, discussed with Dr.
Tambellini the possibility of offering help with
developing a suitable computer system for Oswaldo do
Cruz and I have also explored the possibility with one
of the epidemiologists from the University of Sao Paulo
to spend a year at Vancouver.)
3. The possibility ought to be explored to support
investigative work in South American related to public
health issues. These could be directly related to
second hand smoke and its effect within, let us say, the
home environment, or be repetitions of some of the work
already published but which has proven to be helpful
with the intention of publishing results in South
American Journals.
As a final disclaimer I repeat what I started off with. My
review and impressions are based on a very cursory
examination of problems and South America guided perhaps by
intelligent advice and the considerable experience Dr.
Silvert brought to this project. Nonetheless, my contacts
have been few, discussions cursory and over short periods of
time, and there is a great deal of uncertainty for any
conclusions that can be drawn from this modest inquiry.
