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SLIDE 1 : SYMBOL OF 5TH W.C. FIFTH WORLD CONFERENCE ON SMOKING AND HEALTH - WINNIPEG by Hans Verkerk LADIES AND GENTLEMEN, YOU HAVE ALL RECEIVED A REPORT ON THE WINNIPEG CONFEREIICE AND SOME OF YOU MAY EVEN HAVE READ IT! IF YOU FOUND THE TIME TO READ IT, YOU WILL HAVE GAINED A FAIR IMPRESSION OF WHAT TRANSPIRED THERE. IT IS ONE THING, HOWEVER, READING ABOUT IT (AND YOU KNOW HOW DIFFICULT IT IS TO CONVEY ACCURATELY THE ATMOSPHERE OF A CONFERENCE AND ITS MULTIPLE AND SIMULTANEOUS SESSIONS) AND QUITE ANOTHER TO HAVE BEEN THERE WITH A TEAM OF MONITORS AND SENSED THE ENTHUSIASM OF SOME OF THE YOUNGER EVANGELISTS WHO FEEL THEY CAN POINT TO SEVERAL LEGISLATIVE AND POLITICAL SUCCESSES AGAINST THE INDUSTRY. WHAT I INTEND TO DO THIS MORNING IS TO HIGHLIGHT SOME OF THE DIFFERENCES BETWEEN THE STOCKHOLM AND WINNIPEG CONFERENCES AND THEN TO ENLARGE ON SOME OF THE WINNIPEG SESSIONS SUPPORTED BY A FEW SLIDES AND TAPE RECORDINGS. BILL KLOEPFER AND I SHALL THEN SHOW WHAT, IN THE OPINION OF THE TEAM, ARE SOME OF THE ISSUES WHICH NEED TO BE DEALT WITII BY THE INDUSTRY WITH RENEWED EMPHASIS, AND SOi,iE SUGGESTIONS FOR TACKLING THEM. SEVERAL OF THESE WERE AIRED YESTERDAY BUT IT WON' T DO ANY HARP1 TO REPEAT THEM.

- 2 - GOING BACK TO STOCKHOLM FOR A MOMENT, YOU MAY RECALL THAT THE CONFERENCE RECOMMENDATIONS WERE FORMULATED BY THE 1978 W. H. 0. EXPERT COMMITTEE ON SMOKING CONTROL WHO BASED THESE RECOMMENDATIONS PARTLY ON THOSE WHICH THEY HAD ALREADY FORMULATED IN 1974 AND PARTLY ON SOME THEY THREW IN FOR DEVELOPED COUNTRIES, DEVELOPING COUNTRIES AND THE U.N. SYSTEM. SLIDE 2 - THE FIRST SET OF GUIDELINES - TO GOVERNMENT AND HEALTH DEPARTMENTS - HAVE REMAINED LARGELY UNCHANGED TO THIS DAY. THEY INCLUDE ITEMS SUCH AS THE ESTABLISHP4ENT OF A CENTRAL BODY TO COORDINATE SMOKING CONTROL PROGRAMMES, INCORPORATING ANTI-SMOKING PROGRAMMES INTO ALL HEALTH EDUCATION, LEGISLATIVE ACTION TO RESTRICT TOBACCO ADVERTISING AND PROMOTION, CARRYING OF HEALTH WARNINGS AND TAR/NICOTINE/CO NUMBERS, YOU NAME IT. AND ALSO TO ADOPT CONSUMER POLICIES, INCLUDING TAX INCREASES, TO DISCOURAGE CONSUMPTION. THEY WERE THEN (AND THIS IS FROM THE 1974 RECOPMdENDATIONS!) ALREADY TALKING ABOUT DETERMINING THE COST OF SMOKING TO THE COUNTRY AND CONTROLLING SMOKING IN PUBLIC PLACES. - THE SECOND SET OF RECOMMENDATIONS - TO W.H.O. - URGED THEM TO COLLATE INFOR2iATI0N ON Si,IOKI2dG HABITS IN MEMBER STATES AND TO ADOPT STANDARD DEFINITIONS AND WAYS OF SMOKING BEHAVIOUR, TO COORDINATE INFORMATION ON METHODS OF SMOKING

- 3 - CONTROL, TO TRY TO INVOLVE OTHER MEMBERS OF THE U.N. FAMILY, SUCH AS UNESCO AND UNICEF, AND APPROPRIATE N.G.O.s IN ITS ANTI-SMOKING CAMPAIGN. AND ALSO TO TRY TO ESTABLISH COLLABORATION WITH F.A.O. AND I.L.O. IN STUDYING THE PROBLEMS. VERY LITTLE CHANGE TO THIS DAY. - IN 1978 THEY ADDED GUIDELINES SPECIFICALLY ADDRESSED TO DEVELOPED COUNTRIES WHICH (a) URGED THEM TO CEASE THE EXPORTS OF TOBACCO PRODUCTS WHICH CONTAINED HIGHER LEVELS OF TAR/NICOTINE/CO THAN THOSE MARKETED UNDER THE SAME BRAND DESIGNATION IN THE COUNTRY OF ORIGIN AND TO ENSURE THAT ALL PACKS FOR EXPORT CARRIED HEALTH WARNINGS AND EMISSION LEVELS, PRINTED IN SUCH A WAY AS TO BE INTELLIGIBLE TO THE RECIPIENTS. _ - DEVELOPING COUNTRIES WERE ASKED TO GIVE HIGH PRIORITY TO POLICIES DIRECTED TO THE PREVENTION OF SMOKING WHICH INCLUDED THE DEVELOPt•1ENT OF DATA COLLECTION SYSTEMS AND THE ADOPTION OF LEGISLATION AND EDUCATIONAL TECHNIQUES. IF A DEVELOPING COUNTRY DID NOT HAVE A TOBACCO-GROWING OR MANUFACTURING INDUSTRY, THESE SHOULD NOT BE ALLOWED TO START UP AND IF THEY DID HAVE A TOBACCO-GROWING INDUSTRY, PRIORITY SHOULD BE GIVEN TO SUBSTITUTE CROPS, WITH INTERNATIONAL COOPERATION. - THE FINAL SET OF GUIDELINES WAS ADDRESSED TO THE U.N. SYSTEM AS A WHOLE, URGING W.H.O. TO COLLABORATE WITH F.A.O., I.L.O. AND UNCTAD. THEY EXPRESSED CONCERN THAT THE U.N. SYSTEAi AND THE WORLD BANK HAD AS A WHOLE NOT YET ACCEPTED

4 THE IMPORTANCE OF THEIR INVOLVEMENT IN A WORLD SMOKING CONTROL PROGRAMME. THEY AGAIN MENTIONED THAT W.H.O. HAS A SPECIAL RESPONSIBILITY TO FACILITATE THE DEVELOPMENT OF DATA COLLECTION SYSTEMS IN A STANDARD FORM. SLIDE 3 AS FAR AS THE INDUSTRY MONITORS WERE CONCERNED, THEIR GENERAL ASSESSMENT OF THE STOCKHOLM CONFERENCE WAS : a) THAT MAJOR ANTI-TOBACCO FORCES ARE ORGANISING AND JOINING IN A WORLD-WIDE WAR AGAINST SMOKING b) MORE GOVERNMENTS AND GOVERNMENT-SPONSORED ORGANISATIONS WILL BECOME INVOLVED IN ANTI-SMOKING ACTIVITIES c) THE GOAL IS THE EVENTUAL ELIMINATION OF SMOKING, ESPECIALLY OF CIGARETTES. AT THAT TIME, THIS ASSESSP4ENT WAS CONSIDERED A LITTLE EXAGGERATED AND THE CONFERENCE RECOMMENDATIONS ALSO LOOKED A LITTLE STALE. BUT IN THE INTERVENING YEARS YOU WILL HAVE NOTICED THAT THE ANTI-SMOKING MISSIONARIES HAVE NOT SAT STILL AND SOME NOW BELIEVE THE WARNING SIGNS CCULD HAVE BEEN HEEDED SOMEWHAT EARLIER. N tJ'I BLANK OUT SLIDE 3 C _,.. C N ~ -~.j

- 5 - TO THIS DAY THERE ARE STILL A NUMBER OF INDUSTRY PEOPLE WHO ARE SAYING "WHAT'S REALLY NEW SINCE STOCKHOLM?" AND I SHALL THEREFORE TRY TO SHOW SOME IMPORTANT DIFFERENCES BETWEEN THE TWO CONFERENCES. FOR A START THE WINNIPEG CONFERENCE ATTRACTED TWICE THE NUMBER OF PEOPLE THAT STOCKHOLM DID, DESPITE ITS FALLING IN THE MIDST OF THE NORMAL HOLIDAY SEASON AND IN A TOWN WHICH IS CERTAINLY NOT ONE OF THE WORLD CENTRES. All THE SAME, THE CONFERENCE ORGANISERS HAD EXPECTED SOME 2,500 DELEGATES WHEREAS JUST OVER 1,000 TURNED UP, OF WHOM SEVERAL HUNDRED WERE ONE-DAY ATTENDEES ATTRACTED BY LOCAL ADVERTISING CAMPAIGNS. "WINNIPEG" WAS, BY ALL ACCOUNTS, ALSO FAR BETTER ORGANISED THAN "STOCKHOLM". THE ORGANISERS HAD A FORMIDABLE NUMBER OF SESSIONS TO CONTEND WITH (WELL OVER 100) AND JUST TO MAKE THE PO INT , SO HAD WE. SLIDE 4 OTHER DIFFERENCES WERE THAT THE FAMILIAR AGGRESSIVE ANTI-SMOKING ACTIVISTS SUCH AS MICHAEL DAUBE, SIR GEORGE GODBER, NIGEL GRAY, CLAIRMONTE, RAMSTROM ETC. WHO DOMINATED THE SCENE IN STOCKHOLM, WERE AGAIN PRESEI4T IN T•~1I::.diPEG BUT THIS TIME THEY WERE JOINED F?Y .. [-?tfCH LA: Gn NUMBER OF AGGRESSIVE, •`:: L:J? FDGF_[.Er F;, 2EScii::C ;i-=?i E:i^ D IiiVESTIGATORS

- 6 - WHO IN THEIR PRESENTATIONS AND PUBLICATIONS SHOWED ALL THE SIGNS OF BEING BACKED BY PROFESSIONAL P.R. AGENCIES. THESE NEW PEOPLE HAD THREE THINGS IN COMMON :(a) THEY ALL HAD A STRONG ANTI-SMOKING BIAS WHICH h1ADE THEM LINK CIGARETTE SMOKING WITH LITERALLY ANY TYPE OF OBSERVATION, (b) THE GREAT MAJORITY CAME FROM THE ANGLO-SAXON WORLD, AND (c) THEY ALL USED THE TERM "WARFARE WITH THE INDUSTRY". SLIDE 5 IN STOCKHOLM, ONE COULD STILL DISCERN TWO FAIRLY DISTINCT ANTI-SMOKING GROUPS : THE BUREAUCRATS (W.H.O. AND GOVERNMENT AGENCIES) AND THE MOVEMENTS COMPOSED OF GOVERNMENTAL ANTI-SMOKING GROUPS. VARIOUS NON- IN WINNIPEG, IT WAS OBVIOUS THAT A CERTAIN INTERPENETRATION OF THE TWO HAD TAKEN PLACE, THAT THE "MISSIONARIES" HAD BEEN REPLACED BY "TECHNICIANS" AND THAT A NETWORK OF INTERLOCKING GOVERNMENTAL AND NON-GOVERNMENTAL ORGANISATIONS IS BEING SET UP. BEACHHEADS HAVE BEEN ESTABLISHED IN VARIOUS GOVERNMENT AGENCIES AND INTERNATIONAL ORGANISATIONS, AND COMMUNICATIONS BETWEEN THEM APPEAR TO BE REGUL~R AND FAST. ONE OBSERVER PUT IT THIS WAY . THERE APPEARS TO BE A DIVISION OF LABOUR AMONG THE ANTI-SMOKING CAP•1PAIGNERS; THE

7 GLANTZES, DAUBES, GRAYS AND BANZHAFS HAVE TO CHEER UP THE ACTIVISTS BY OUTRAGEOUS STATEMENTS, WHEREAS THE COOLER BREEDS, THE KUNZES AND NOSTBAKKENS ARE PULLING THE STRINGS BEHIND, BY INTEGRATING THEM IN RESPECTED PUBLIC INSTITUTIONS. SLIDE 6 ANOTHER POINT OF DIFFERENCE WORTH NOTING WAS THE CHANGE OF "IMAGERY" FROM ALL THE NEGATIVES ABOUT SMOKING IN STOCKHOLM TO ALL THE POSITIVES ABOUT NON-SMOKING IN WINNIPEG. IT WOULD APPEAR THAT THE STRATEGY OF PLAYING ON THE FEARS OF PEOPLE BY CONTINUOUSLY WARNING THEM OF THE DANCERS OF SP40KING IS CONSIDERED COUNTER-PRODUCTIVE BY MANY ANTI-SMOKING ACTIVISTS AND THEY PREFER TO PROJECT A POSITIVE IMAGE OF HEALTHY LIVING OF WHICH NON-SMOKING IS ONLY A PART. INSERT LUNG RUN SLIDE THEY ARE TRYING TO SELL A NEW INTEGRATED LIFESTYLE : MODERN, WITH-IT, YOUTHFUL AND HEALTHY. THE SCANDINAVIANS STARTED THIS SEVERAL YEARS AGO AND THE CAMPAIGN HAS BEEN INTERNATIONALISED. ONE OF OUR CCNSULTANTS IN WINNIPEG PUT IT LIKE THIS : "THE HEDONISTIC THEME WHICH CULTURALLY USED TO BE ASSOCIATED WITH SMOKING IS NOW EXPROPRI:ITFD AND EMPLOYED IN THE ANTI-SMOKING CAUSE". BACK TO SLIDE 6

8 WHAT NORMALLY ARE COFFEE AND TEA BREAKS AT EVERY OTHER CONFERENCE, WERE IN WINNIPEG CALLED "EXERCISE AND NUTRITION BREAKS". A YOUNG GIRL IN GYM ATTIRE WOULD APPEAR IN FRONT OF THE AUDIENCE, THE MUSIC WAS SWITCHED ON, AND LED BY THE GYMNAST, THE AUDIENCE STARTED JUMPING UP AND DOWN. THE INDUSTRY MONITORS WHO WERE UNDER STRICT ORDERS TO REMAIN INCONSPICIOUS, COULD BE SEEN JUMPING AROUND LIKE MANIACS. THIS WOULD THEN BE FOLLOWED BY THE CONSUMPTION OF HEALTH FOODS AND SOFT DRINKS. SLIDE 7 ALTHOUGH THE STOCKHOLM CONFERENCE COULD BY NO MEANS BE CALLED A MEDICAL CONFERENCE, THERE WAS AT LEAST MORE INTEREST IN SCIENTIFIC INFORMATION THAN AT WINNIPEG. THERE, THE ANNOUNCEMENT OF SIGNIFICANT NEW FINDINGS WAS NEGLIGIBLE AND ONE SPEAKER AFTER ANOTHER STATED THAT THE CASE AGAINST TOBACCO HAS NOW BEEN PROVED AND SO LET'S GET DOWN TO STRATEGIES, TECHNIQUES AND TACTICS, IN OTHER WORDS HOW TO ACHIEVE THEIR AIMS. FOR THEM IT HAS BECOI4E PURE POLITICS. ONE ONLY HAS TO READ SIMON CHAPMAN'S "THE LUNG GOODBYE", (WHICH WAS SENT OUT WITH THE REPORT ON WINNIPEC) TO REALISE HOW CAREFULLY SOME OF THESE TECHNIQUES AND TACTICS ARE WORKED OUT. SLIDE 8 A NEWCOMER TO WINNIPEG WAS `1HE SUBJECT OF "SMOKING AND RELIGION". WHEN WE FIRST SAW THIS ITEM ON THE PROVISIONAL 2501021571 I

9 AGENDA WE IMMEDIATELY THOUGHT OF ISLAM ONLY. WE WERE NOT ENTIRELY DISAPPOINTED, FOR THE SESSION WAS CHAIRED BY AN EGYPTIAN MOSLEM SURGEON. HOWEVER, OTHER SPEAKERS INCLUDED A CANADIAN RABBI, A U.S. SEVENTH DAY ADVENTIST, A U.S. MORMON SURGEON AND AN ANGLICAN ARCHBISHOP. THE AUDIENCE COMPRISED ALL OF 18 PEOPLE OF WHOM 4 WERE FROM THE INDUSTRY. IN THE WINNIPEG REPORT, A FULL PAGE WAS DEVOTED TO THE EGYPTIAN SURGEON'S VIEWS ON SMOKING AND ISLAM WHICH WERE THAT SMOKING MUST BE PROHIBITED BECAUSE IT IS HARMFUL TO HEALTH, INTOXICATING, WASTEFUL, IT BEING NEITHER A NUTRIENT NOR A MEDICINE AND A BEHAVIOURAL MODIFIER, I.E. MAKING A PLEASANT PERSON UNPLEASANT. THE VIEWS OF THE OTHER SPEAKERS COULD BE SUMMARISED BY STATING THAT THE PURE RELIGIOUS QUESTION ON SMOKING IS FAR FROM CLEAR BUT THAT SMOKING SHOULD BE DISCOURAGED ANYWAY. THERE IS NO DOUBT THAT THE ANTI-SMOKING ACTIVISTS ARE ALSO TRYING TO ESTABLISH BEACHHEADS IN RELIGIOUS ORGANISATIONS AND IN FACT, THE CONFERENCE RESOLVED TO MAKE AN APPROACH TO THE WORLD COUNCIL OF CHURCHES WHICH MET IN VANCOUVER A WEEK AFTER THE END OF THE WINNIPEG CONFERENCE. - AT THE SESS ION ON' THE W. H. 0. EXPERT COi4AIITTEE REPOi'cT ON SMOKING CCNTP.OL IN DEVELOPING COUNTRIES, THE CHAIRMAN DR. AL-AWADI WHO IS MINISTER OF PUBLIC HEALTH IN KUWAIT, STATED THAT EFFORTS WERE BEING MADE TO tIAKE SMOKING UNACCEPTABLE TO ISLAII.

- 10 - BLANK OUT SLIDE $(SPACE IN CAROUSEL) WELL, THESE WERE IN OUR OPINION SOME OF THE MAIN DIFFERENCES BETWEEN THE TWO WORLD CONFERENCES AND I WOULD NOW LIKE TO TAKE A CLOSER LOCK AT SOME OF THE ISSUES AT WINNIPEG. SLIDE 9 WELL OVER A YEAR BEFORE THE START OF THE CONFERENCE, IT WAS ANNOUNCED THAT THE AGENDA WOULD CONCENTRATE ON 3 MAIN THEMES : 6'70PLEN, CHILDREN AND THIRD WORLD COUNTRIES. OBVIOUSLY, THE ANTI-SMOKING CAMPAIGNERS WERE GOING TO HOP1E IN ON WHAT THEY DEEMED TO BE THE MOST VULNERABLE GROUPS. I HAVE ADDED PREVENTION AND CESSATION ON THE SLIDE B=~USE OF THE NUMEROUS WELL-ATTENDED SESSIONS DEVOTED TO THOSE SUBJECTS WHICH COULD HAVE MADE THEM QUALIFY AS THE FOURTH MAIN THEME. LET US TAKE A LOOK AT THEM. WOMEN IN THE DEVELOPED COUNTRIES THE DECLINE IN SMOKING HAS AFFECTED WOMEN LESS THAN MEN AND THE ANTI-SMOKING ACTIVISTS ARE VERY CONCERNED ABOUT THIS. THE SESSION ON "SMOKING AND FEMINISM" WAS PARTICULARLY WELL ATTENDED. THE MAIN SPEAKERS WERE BOBI3Y JACOBSON OF THE U. K. AND INGRID EIDE OF NORWAY. THEY TRIED TO TACi:LE THE PROBLEM OF WHY THE DATA ABOUT SMOI:ING WOMEN tvOULD SEEM TO INDICATE THAT SMOKIriG IS CCRREL,%TED WITH EP-IANCIPATICN, WHICH THEY FAVOUR. IT WAS 2501a21573