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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

- 11 - THEREFORE NECESSARY TO ARGUE THAT WOMEN'S SMOKING IS AN ADDITIONAL OPPRESSION (PRESUMABLY FOISTED UPON THEM BY A MALE-DOMINATED SOCIETY) AND NOT TO BE CONFUSED WITH GENUINE LIBERATION. EIDE CONCLUDED THAT HER DATA SHOWED THAT FEMINISM CANNOT BE BLAMED FOR INCREASED SMOKING AMONG WOMEN. AS ONE OF OUR CONSULTANTS POINTED OUT, THE LADIES ARE QUITE CORRECT THAT FEMINISM PER SE CANNOT BE BLAMED FOR WOMEN'S SMOKING BUT THAT THIS IS RATHER BESIDE THE POINT. THE POINT IS SINCE FEMINISTS TEND TO BE UPPER-INCOME INDIVIDUALS, THEY SMOKE LESS THAN LOWER-INCOME INDIVIDUALS AS REFLECTED IN THE SMOKING POPULATION STATISTICS OF SEVERAL DEVELOPED COUNTRIES. WOMEN, ESPECIALLY IN THE LOWER SOCIO-ECONOiIIC GROUPS, SMOKE MORE AS THEY ENTER THE LABOUR FORCE. BUT THAT HAS BEEN EXACTLY ONE OF THE GOALS OF THE FEMINIST MOVEMENT! SO, THEY HAVE A PROBLEM ... CHILDREN I SHALL NOT DWELL TOO LONG ON THE SUBJECT OF CHILDREN SMOKING. THE LITERATURE IS WELL KNOWN TO YOU AND THE SUBJECT IS FRAUGHT WITH EMOTIONAL OVERTONES IN THAT IT SUGGESTS EXPLOITATION OF A PARTICULARLY VULNERABLE GROUP. THE WORD "CHILDREN" WAS USED FOR YOUNG PEOPLE ItT GENERAL, BE THEY 18 OR 12 YEARS OLD. ONE OF OUR CONSULTANTS POINTED OUT THAT THIS IS CONTRARY TO THE TERP•IINOLGGY EMPLOYED IN THE FEMINIST MOVEMENT. WHEREAS AN 18-YEAP. OLD GIRL WHO SMOKES IS REFERRED TO AS A "CHILD", THE SAME INDIVIDUAL GETTING AN

ABORTION WILL BE REFERRED TO AS A "YOUNG WOMAN". IN OTHER WORDS, LANGUAGE IS BEING USED IDEOLOGICALLY TO i•IAKE A PROPAGANDISTIC POINT. ALL THE "CHILDREN" THEMES NATURALLY PERVADED THE MANY SESSIONS ON PREVENTION AND CESSATION OF SMOKING AND AT SOME OF THEM A SERIOUS ATTEMPT WAS INDEED MADE TO USE AN ANALYTICAL RATHER THAN AN EMOTIONAL APPROACH. THIRD WORLD DESPITE ANNOUNCEMENTS BY THE ORGANISERS THAT THIS WOULD BE ONE OF THE MAJOR THEIiES AT THE CONFERENCE, SEESIONS WHERE THIRD WORLD PROBLEMS WERE DISCUSSED GENERATED LITTLE INTEREST. MORE THIRD WORLD DELEGATES WERE PRESENT THAN IN STOCKHOLM BUT THEIR PROPORTION WAS STILL VERY SMALL. MONEY t~1AS OBVIOUSLY AN OBSTACLE AND A NUMBER OF THEM WERE FLOWN TO WINNIPEG AT THE EXPENSE OF THE SWEDISH, NORWEGIAN AND CANADIAN NATIONAL AGENCIES FOR INTERNATIONAL DEVELOPMENT. KURT BAUMGARTNER, THE CONFERENCE SECRETARY GENERAL, REPORTED LATER THAT SOME DELEGATES ARRIVED WITHOUT A PENNY IN THEIR POCKET, OR WITH ONE-WAY TICKETS ONLY, OR WITH VISAS THAT WERE EXPIRED OR ABOUT TO EXPIRE. SPECIAL ARRANGEMENTS HAD TO BE MADE WITH CANADA' S EXTERNAL AFFAIRS DEPARTMENT TO ALLOW ALL DELEGATES TO ENTER THE COUNTRY AND A PETTY CASH FUND WAS SET UP AT WINi•IIPEG AIRPORT TO PROVIDE EXPENSE MONEY FOR DELEGATES ON THEIR ARRIVAL. 2JrO1O21Jr? cJ

ALL THE THEMES DESCRIBED IN THE W.H.O. EXPERT COMMITTEE POSITION PAPER OF 1982 (SENT TO YOU IN JANUARY THIS YEAR BUT NOT YET PUBLISHED OFFICIALLY) WERE DISCUSSED. IT WAS QUITE OBVIOUS THAT THIRD WORLD DELEGATES WERE FED UP WITH BEING TOLD WHAT TO DO ABOUT SMOKING ISSUES IN THEIR COUNTRIES BY PEOPLE FROM WESTERN NATIONS WHO HAD LITTLE APPRECIATION OF THE PROBLEMS IN THE DEVELOPING WORLD. THEY FELT SUBJECTED TO INTELLECTUAL ARROGANCE AND NEO- COLONIALISM. TOWARDS THE END OF THE CONFERENCE, A GROUP OF THIRD-WORLD DELEGATES HELD A SEPARATE MEETING AWAY FROM THE CONFERENCE HALL TO FORMULATE THEIR OWN RECOMZiENDATICNS, UNDER THE CHAIRMANSHIP OF MIKE MULLER WHO WORE A LAPEL BADGE INDICATING HE HAILED FROM MOZAMBIQUE! THEY RECORDED THEIR REGRETS ABOUT THE ABSENCE OF OPPORTUNITIES TO FOCUS IN t•SORE DETAIL ON AREAS PECULIAR TO THEIR COUNTRIES. THEY WISHED FUTURE CONFERENCES TO BE ORGANISED IN A MANNER WHICH ALLOWS TIME FOR DISCUSSION OF SUBJECTS SPECIFIC TO CERTAIN REGIONS WITHOUT CONFLICTING WITH OTHER AGENDA ITEMS. THEY SUPPORTED THE ESTABLISHMENT OF AN INTERNATIONAL NETWORK OF NON-GOVERNMENTAL ORGANISATIONS IN THE FIELD OF SMOKING CONTROL IN DEVELOPING COUNTRIES AND MARTIN KHOR OF THE CONSUMER ASSOCIATION OF PENANG, MALAYSIA OFFERED TO PROVIDE INITIAL COORDINATION. FOR THIS PURPOSE. THEY ALSO RECOrIMEtIDED THAT FUNDS BE SOUGHT TO PERMIT REPRESE:JTATIVFS OF THESE NON-GOVEP.NI•IENTAL ORGnNIS11TICPIS TO ATTEND WORKSHOPS IN DEVELOPING COUNTRIES t1tvD THAT SUPPORT BE SOUGHT TO OPERATE SUCH A NETWORK.

JUST PRIOR TO THIS SPECIAL MEETING, THE 12 NIGERIAN DELEGATES (OUT OF A TOTAL OF 20 FROM AFRICA) ALSO GOT TOGETHER AND FORMED THE NIGERIAN COMMITTEE ON SMOKING AND HEALTH WITH PROF. DEJI FEMI-PEARSE AS PRO-TEM PRESIDENT. N.I.C.O.S.H. WILL BE FORMALLY LAUNCHED IN OCTOBER. DURING 1984, THE U.I.C.C. INTEND TO HOLD WORKSHOPS IN NIGERIA, ZIMBABWE, KENYA, ECUADOR, PANAMA, PARAGUAY AND BRAZIL. AT A SPECIAL SESSION ON TOBACCO GROWING IN DEVELOPING COUNTRIES THE SPEAKERS FROM THE E.I.U. AND THE F.A.O. WERE ABSENT (ALTHOUGH THE E.I.U. DID SEND A PAPER WHICH WAS READ OUT BY AN OFFICIAL) , LEAVING MIKE MULLER AND JOHN MADELEY FREE TO EXPRESS THEIR WELL-PUBLICISED VIEWS ON TOBACCO AND FOOD CROPS, DEFORESTATION AND THE DANGER OF PESTICIDES. IT IS LIKELY THAT MRS. KLEIN OF THE F.A.O. WAS UNDER PRESSURE NOT TO ATTEND IN ORDER TO AVOID A CLASH WITH THE W.H.O. THIS IS POSSIBLY ALSO ONE OF THE REASONS WHY HALFDAN MAHLER, DIRECTOR-GENERAL OF W.H.O., FAILED TO APPEAR AT THE CONFERENCE. OSTENSIBLY, HE WAS ON A FORMAL VISIT TO THE TWO NEWEST MEMBER STATES OF THE W.H.O., THE SOLOMON ISLANDS AND VANUATU. OTHER REASONS GIVEN FOR HIS ABSENCE WERE PRESSURE FROM THE INDUSTRY THROUGH F.A.O. AND THE I.L.O., WHICH IS CONCERNED ABOUT UNEMPLOYMENT. FINALLY, THERE WAS NEVER ANY ATTEP4PT 2A.ADE TO PUT SMOKING IN PERSPECTIVE TO THE TOTAL PUBLIC HEALTH PROBLEM OF DEVELOPING 25a 102 1s77

COUNTRIES. THE LACK OF ADEQUATE NUTRITION, CLEAN WATER, HOUSING AND POVERTY AMONG CITIZENS OF THIRD WORLD COUNTRIES WAS BARELY MENTIONED. HOWEVER, ONE THING IS CERTAIN, AND THAT IS THAT THE ANTI-SMOKING CAMPAIGNERS WILL VIGOROUSLY PURSUE THEIR EFFORTS IN THE DEVELOPING WORLD. PREVENTION/CESSATION A TOTAL OF 31 HOURS WAS DEVOTED TO THESE SUBJECTS IN THE OFFICIAL PROGRA24ME AND IN ADDITION THERE WERE SEVERAL SO-CALLED POSTER SESSIONS HELD ON THESE SUBJECTS BETWEEN 8 AND 9 IN THE MORNING. TIME DOES NOT PERMIT ME TO GO INTO DETAIL HERE BUT MANY CONCENTRATED ON WOMEN AND CHILDREN. ONE OF CUR MEDICAL CONSULTANTS OBSERVED THAT PROGRAMMES AIMED AT ADULT MALES ARE NOT ALL THAT EFFECTIVE AND THERE IS NOT A SUBSTANTIAL EMPLOYMENT FIELD FOR WORKERS CONCENTRATING ON FURTHER REDUCTION OF SMOKING AMONG ADULT MALES. HOWEVER, THEY BELIEVE PROGRAMMES AIMED AT WOMEN MAY BE MORE EFFECTIVE; THEY ARE CENTRED AROUND PREGNANCY AND CHILDBIRTH. HE FEELS THAT THE RELIARKABLE ASPECT ABOUT THAT FOCUS IS THAT THE SMOKING CESSATION PROGRAMME IS NOT SO MUCH MEr'1NT AS A PART OF PREGNANCY HEALTH CARE BUT RATHER THAT PRESSURE TO STOP SMOKING DURING PREGNANCY IS USED AS A LEVER TO CONTROL SMOKING ACTIVITIES AMONG WOMEN IN GENERAL. HE FEELS THEY AI:E BEING INTIMIDATED AND I,',ACE TO FEEL GUILTY ABOUT SMOKING.

SLIDE 10 ON THIS SLIDE I HAVE GROUPED TOGETHER THE SUBJECTS WHICH ANTI-SMOKING CP..P1PAIGNERS USED OVER AND OVER AGAIN AS PRIME TARGETS OR AS A WEAPON FOR ACTION. FIRST ADVERTISING. MIKE WATERSON ATTENDED THE SESSIONS WITH AN ADVERTISING CONTENT AND WAS APPALLED AT THE TOTAL ABSENCE OF ANY ATTEMPT AT SERIOUS ANALYSIS. A PARALLEL CAN BE DRAWN WITH THE HEALTH ISSUES WHERE THE ANTI-Siv10KING ACTIVISTS TRY TO PUT OVER THAT THE CASE AGAINST THE INDUSTRY IS PROVED AND THAT THEREFORE ANY ACTION TO BAN TOBACCO ADVERTISING IS JUSTIFIED. AUSTRALIA'S BUGA-UP EXTREMISTS, WHOSE SESSION WAS THE ONLY ONE TO BE REPEATED BY POPULAR DEMAND, WILL NO DOUBT TRY TO HAVE THEIR TACTICS TRANSFERRED TO OTHER COUNTRIES WHERE PUBLIC OPINION MAY BE FAVOURABLE AND WHERE THE JUDICIARY MAY BE MORE INCLINED TO BOW TO PUBLIC OPINION THAN STRICTLY ENFORCE THE LETTER OF THE LAW. TAXATION THE SESSION 014 "TAXATION AND SOCIAL INTERVENTION" RANGED FAR BEYOND THESE SUBJECTS AND ADDRESSED ITSELF MAINLY TO STRATEGIES AND TACTICS ON THE "ECONOMIC WAR" AGAINST TOBACCO. JOY TOWNSEND OF THE U.I:. HOWEVER, PRESENTED A PAPER OPl TAXATION Pr'HICH WAS LARGELY UNINTELLIGIBLE TO THE AUDIENCE, AND SUBSEQUENTLY ALSO TO AN INDUSTRY EXPERT WHO STUDIED IT. 25oiaZI57

THE WEAPON WILL CONTINUE TO BE ADVOCATED, HOWEVER, AND WAS AGAIN INCLUDED IN THE CONFERENCE REC0MZ~IENDATIONS. RUURD WARTENA WILL EXPAND ON THIS SUBJECT LATER THIS MORNING. "PASSIVE" SMOKING THIS SUBJECT HAD TWO SIDES TO IT : THE SCIENTIFIC ONE WHICH WAS DEALT WITH MAINLY BY HIRAYAMA, PETO AND SHEPHARD, AND THE EMOTIONAL ONE WHICH WAS BROUGHT OUT IN NUMEROUS SESSIONS BY THE CAMPAIGNERS. HIRAYAMA, WHO BY THE WAY WAS ONE OF THE HEROES OF THE CONFERENCE, ONCE AGAIN REVIEWED HIS HUSBAND-WIFE "PASSIVE SMOKING" DATA AND REPORTED TWO "NEG•]° FINDINGS "SIGNIFICANT" RELATIONSHIP BETWEEN "PASSIVE" SI4OKING AND ISCHEMIC HEART DISEASE AND A "STRIKING" RELATIONSHIP WITH NASAL SINUS CANCER IN NON-SMOKING WIVES OF SMOKING HUSBANDS. HE ADMITTED THAT THE LATTER WAS BASED ON ONLY 28 CASES. RICHARD PETO, WHO FOLLOWED HIM AS A SPEAKER ON "PASSIVE SI4OKING AND TOTAL MORTALITY" EXPRESSED A HIGH DEGREE OF SCEPTICISM REGARDING HIRAYAfIA'S DATA AND SAID THAT THE 2f4z~.GNITUDE OF THE "EFFECTS" WHICH HIRAYAAiA REPORTED ARE "VERY DIFFICULT TO BELIEVE". PETO CLEARLY SPELLED OUT WHAT HE, AND OTHERS, SAW AS THE CIiIEF RELEVANCE OF "PASSIVE" SMOKING : "A POLITICAL ISSUE, RATHER TIIAN A HEF.LTH ISSUE".

SHEPHARD (UNIVERSITY OF TORONTO) SPOKE OF THE IRRITATING AND ANNOYING EFFECTS OF CIGARETTE SMOKE ON THE EYES AND NOSE OF NON-SMOKERS, BUT STATED THAT MORE EXPEP.IT•_ENTS ARE NECESSARY TO RULE OUT PROBLEMS OF SUGGESTIBILITY. RATHER OMINOUS WAS HIS CONCLUSION THAT THERE WAS A FALLACY IN SEGREGATING SMOKERS FROM NON-SMOKERS IN BUILDINGS AS IT DID NOT REALLY PROTECT NON-SMOKERS; NOR WAS INCREASED VENTILATION TF.E ANSWER AS IT WOULD BE TOO EXPENSIVE. THE REMEDY WAS THEREFORE TO SEEK LEGISLATION WHICH WOULD ASSURE "CLEAN" AIR FOR NON-ShSOKERS. ACTIVISTS SUCH AS STANTON GLANTZ FROM CALIFORNIA REPEATEDLY USED THE "RIGHT TO CLEAN AIR" SLOGAN. GLANTZ Ct~STIGATED THE T.I. ADS ON "PASSIVE" SMOKING AND CALLED THEM AN EXAMPLE OF "RAMPANT" MIS-REPRESENTATION OF THE SCIENTIFIC DATA. ONE OF THE FINAL CONFERENCE RECOIrIMENDATIONS WAS THAT RESEARCH IN THE AREA CF "PASSIVE" SMOKING AND ITS EFFECTS ON HEALTH SHOULD BE INCREASED. IT WAS OPENLY ADMITTED THAT ALTHOUGH EVIDENCE FROM SEVERAL STUDIES SUGGESTS THAT LUNG CANCER MORTALITY IS INCREASED IN "PASSIVE" SMOKERS, OTHER STUDIES HAVE NOT SHOWN THIS RELATIONSHIP. THERE IS LITTLE DOUBT, HOWEVER, THAT THE SUBJECT OF "PASSIVE" SMOKING IS _ONE IN WIiICIi THERE IS THE GREATFST INTEREST AND OVERALL SUPPORT FOR RESTRICTIVE :LEGISLATION. WE SHALL HEAR MORE ABOUT THIS SUBJECT FROM DR. KONIG TIIIS AFTERNOON. 2501021581

SOCIAL COSTS SEVERAL SPEAKERS CHARGED THAT SMOKING IS RESPONSIBLE FOR INCREASED COSTS TO SOCIETY USING WELL-D70RN DATA FR014 WEIS AND OTHERS. HOWEVER, ROBERT LEU FROM SWITZERLAND PRESENTED A PAPER IN WHICH HE CHALLENGED THE "WIDESPREAD" BELIEF THAT SMOKING IMPOSES A LARGE COST BURDEN ON HEALTH SERVICES. HIS RESULTS IMPLY THAT LIFETIME EXPENDITURE IS HIGHER FOR NON-SMOKERS THAN FOR SMOKERS BECAUSE SMOKERS' HIGHER ANNUAL UTILISATION RATES ARE OVERCOMPENSATED BY NON-SMOKERS' HIGHER LIFE EXPECTANCY. HE ALSO MENTIONS IN HIS INTRODUCTION THAT EXISTING STUDIES FAIL TO DISTINGUISH ADEQUATELY BETWEEN CAUSALITY AND CORRELATION AND NEGLECT EPIDEMIOLOGICAL EVIDENCE THAT DIFFERENTIALS IN MORTALITY AND MEDICAL CARE USE BETWEEN SMOKERS AND NON-SMOKERS, CANNOT BE ATTRIBUTED FULLY TO THE SMOKING HABIT PER SE. A LESSER THEME IN THIS AREA - THE NEED FOR A FIRE-SAFE CIGARETTE - HAS BEEN PROMINENTLY ADVOCATED ONLY IN THE U.S.A. THE LEADING PROPONENT OF THIS THEME IS ANDREW MCGUIRE WHO DELIVERED A PAPER ON THE SUBJECT AT WINNIPEG. SOCIAL ACCEPTABILITY AND INDUSTRY CREDIBILITY THE LATTER TWO SUBJECTS OF COURSE GOT A ZERO-RATING IN A MEETING GROUND SUCH AS WINNIPEG. THE ACTIVISTS DELIGHT::D EACH OTHER AND THEIR AUDIENCES BY CITING OVER AND OVER AGAIN THE GROWING NUMBER OF RESTRICTIONS AND BANS ON SilOKIPiG, A;dD THE DECLINE IN SMOKING INCIDENCE IN SELECTED COUNTRIES.

- 20 - IT IS KNOWN THAT INCREASING WEIGHT IS BEING GIVEN BY THE W.H.O. TO THE ACTIVITIES OF THE DIVISION OF PUBLIC INFORMATION AND EDUCATION FOR HEALTH, IN THE BATTLE FOR PUBLIC OPINION. IT IS ALMOST CERTAIN THAT MORE EMPHASIS WILL BE PLACED ON THE PUBLIC INFORMATION APPROACH, ESPECIALLY IN REACHING DECISICN-MAKERS. THE INDUSTRY HAS A BIG PROBLEM HERE AND THE SUBJECT OF CREDIBILITY IS BEING TAChLED WITH RENEWED URGENCY BY THE TOP ECHELONS OF OUR COMPANIES. SLIDE 11 AND SO WE COME TO THE CONFERENCE RECOMbIENDATIONS WHICH WERE IN TWO SECTIONS : THE FIRST, THROUGH RAPPORTEURS AND THE OTHER, FROM DELEGATES. YOU HAVE ALL RECEIVED COPIES OF THESE. THESE RECOMMENDATIONS WERE HANDED OUT TO DELEGATES ON THE FINAL DAY WITHOUT BEING DISCUSSED IN THE PLENARY SESSION OR PUT TO THE VOTE. THE FIRST SET OF RECOMMENDATIONS IS TAME COMIPARED WITH THE SECOND, AND CONTAINS SEVEP.AL WHICH HAVE BEEN CARRIED FORWARD FROM PREVIOUS CONFERENCES, ALBEIT MORE REFINED. NEW ONES INCLUDE : MORE RESEARCI-i TO BE DONE ON THE EFFECTS OF LOW TAR AND NICOTINE CIGARETTES; NON-SMOKERS' RIGHTS ISSUES TO BE GIVEN APPROPRIATE WEIGHT IN THE PLANNING OF THE SIXTH WORLD CONFERENCE PROGRAM1dE; P40RE RESEARCH IN THE AREA OF "PASSIVE" SMOKING, WHICH I ALREADY MENTIONED; THE :•;EAPON OF TAXATION, 25a1a215s3

WHICH I ALSO ALLUDED T0; MORE EFFORTS ON YOUTH NON-SMOKING ACTIVITIES BY THE YOUNG THEMSELVES; CONTINUED RESEARCH IN THE DEVELOPMENT OF NICOTINE CHEWING GUM AND THE DEVELOPMENT OF CESSATION PROGRAA~.MES SENSITIVE REALITIES IN DEVELOPING COUNTRIES. TO SOCIO-CULTURAL ALL VERY REASONABLE AND MILDLY WORDED.... BUT THEN COMES THE SECOND SET OF 15 RECOP•1MENDATIONS WITH AN INFINITELY SHARPER EDGE. IT WAS UNDERSTOOD THAT THIS SECOND GROUP WAS PROBABLY COMPILED BY A SMALL CADRE OF PEOPLE, UNDER THE UMBRELLA OF THE INTERNATIONAL LIAISON COMMITTEE ON SMOKING AND HEALTH, WHICH IS COORDINATING THE GLOBAL CAMPAIGN AGAINST SMOKING. ONE OF THE LEADING LIGHTS OF THIS COMMITTEE IS DR. NIGEL GRAY OF AUSTRALIA WHO IS THE LONG-TIME HEAD OF THE SMOKING CONTROL PROGRAMME OF THE U.I.C.C. THE INTERESTING POINT ABOUT THIS SET OF RECO:^.I•SEIeTDATIONS IS THAT MOST OF THEM DEMAND COUNTRY-BY-COUNTRY ACIiIEVEMENT REPORTS BY 1987 (THE YEAR OF THE NEXT WORLD CONFERENCE IN JAPAN) AND THAT THE CONFERENCE CHAIRMAN, DR. DAVID NOSTBAKKEN OF CANADA, WHO IS ALSO THE NEW CHAIRi•IAN OF THE INTERNATIONAL LIAISON COMMITTEE ON SMOKING AND HEALTH, HAS BEEN SPECIFICALLY CHARGED WITH THEIR EXECUTION. ACHIEVEMENT REPORTS HAVE BEEN ASKED FOR 117 THE AREAS OF ADVEP.TISIiIG, HEALTH WARNINGS, SALES TO MINORS, HEALTH EDUCATION PROGRADa:ES, THE PREVALENCE OF LOCAL TOBACCO USAGE,

- 22 - FORMATIONS OF NATIONAL SMOKING CONTROL CO-ORDINATING BODIES, REGULAR TAX INCREASES, TAR YIELD LIMITS, TOBACCO PRODUCTION AND SALES, MORTALITY AND MORBIDITY STATISTICS. THE PRIMARY OBJECTIVE WAS THE ESTABLISHMENT OF NON-SMOKING AND THE RIGHT TO A SMOKE-FREE ATMOSPHERE, AS THE NORPi. BLANK OUT SLIDE 11 TO END THIS FIRST PART OF MY PRESENTATION I WOULD LIKE TO MENTION THE STATEMENT WHICH SO MANY ANTI-SMOKING ACTIVISTS MADE AT WINNIPEG, IN DIFFERENT WORDS AND ON DIFFERENT OCCASIONS : - "THE SMOKING AND HEALTH CAMPAIGN IS A WAR THAT MUST BE FOUGHT IN THE POLITICAL ARENA - AGAINST THE TOBACCO INDUSTRY RATHER THAN THE SMOKER!". END OF FIRST PART TAPES AND PHOTOS (SLIDES)

SLIDE 15 F.A.O. TOBACCO GROWERS DEFORESTATION WORLD BANK SLIDE 16 TAXATION SLIDE 17 EXPERT ARGUMENTATION ON ALL MAJOR SMOKING ISSUES. SLIDE 18 REFUTATION OF BLATANTLY INACCURATE STATEMENTS BY ANTI-SMOKING GROUPS. SLIDE 19 RELIGIOUS BODIES

PART TWO SOME RECOMMENDATIONS FOR N.M.A.s AND LEAD COMPANIES N.B. For reasons of security it was considered inadvisable to reproduce the entire text of the presentation. May it suffice to list the text of the various slides which were used to support the presentation. SLIDE 12 MEDICO-SCIENTISTS POLITICIANS GOVERNMENT ECONOMIC DEPARTMENTS SLIDE 13 MEDIA SLIDE 14 ADVERTISING INDUSTRY

SLIDE 20 EDUCATION OF INDUSTRY EMPLOYEES SLIDE 21 STATISTICS SLIDE 22 REPORTING TO INFOTAB : - DEVELOPMENT OF SMOKING ISSUES - INDUSTRY ACTION - IMPENDING CONFERENCES OF ANTI-SMOKING GROUPS