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- 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