Tobacco Documents Online

OBSERVATIONS ON THE FIFTH WORLD CONFERENCE ON SMOKING AND HEALTH BY A CONSULTANT WINNIPEG, JULY 1983 1. Focus and Sources I understood my assignment to be an overall assessment of the conference, with special emphasis on institutional dynamics and ideological themes, using my report on the Stockholm conference (1979) as a "base line". I further understood that I ought to keep the "larger picture" in mind, rather than reporting on details; I have done this in what follows, with two exceptions - the special sessions on religion and feminism, which dealt with two new ideological themes and which I therefore will comment on in some detail. It goes without saying that an overall assessment such as I was asked to make will be subjective to a degree; this too, I believe, was understood, but it should be explicitly stated, since I cannot conclusively prove everything I say here. What I have done is to apply to the conference my own "sociological sensibility" and such knowledge of the anti-smoking phenomenon as I have acquired over the last few years. I'm aware of the

- 2 - possibility that my own impressions may vary from those of others who attended the conference. The main source for the following observations, of course, is my own notes and recollections from attending the conference in its entirety. I attended some sessions in toto, but I also did a good deal of hopping around, to get a better sense of what was going on. Also, I had some informal conversations with conference participants, and I took home various documents that were handed out. 2. Institutional Dynamics One of my main points, in commenting on the Stockholm conference, was that, in my view, there were two quite distinctive institutional interests represented within the anti-smoking complex - bureaucratic interests (WHO, Western government agencies, Third World government agencies) and movement interests (the various non-governmental anti-smoking groups). I further observed that, it seemed to me, these two interests were not at all identical, with the bureaucratic interests being more reasonable, less absolutist. A further observation I made then, to the effect that the Third World emphasis of the Stockholm conference (reiterated as a major theme at Winnipeg) was a sort of bureaucratic imperialism of the West, continues to apply.

- 3 - Third World delegates were once again flown to Winnipeg at the expense of SIDA, the Swedish government foreign aid agency (as proudly stated by Lars Ramstrom, from Sweden, in his presentation at a lunch session on "Special Problems in Developing Nations"); I would guess that very few of the Third World participants came at their own governments' expense. I would continue to doubt whether the enthusiasm expressed by some of these people about the anti-smoking cause is shared by many back home. Despite the efforts in the intervening four years, especially by WHO (which, as a UN agency, must of course legitimate itself by a Third World emphasis), the anti-smoking cause continues to be a Western dominated phenomenon. It should also be noted that the sessions on Third World issues were not well attended. However, it also seems to me that the distinction between bureaucratic and movement interests, while still valid, must now be modified somewhat. There appears to have taken place a certain interpenetration. A number of bureaucrats seem strongly committed to the anti-smoking cause. More important, the movement itself has clearly become more bureaucratized and professionalized since Stockholm. It was striking with how much professional know-how many of the anti-smoking groups are operating now. There has been a displacement of missionaries by technicians - that is, by people with a lot of political and organizing competence. These may be less fanatical in their adherence to the cause, but they are much more formidable in getting things done both on the level of

- 4 - influencing political processes (including legislation) and on the level of shaping public opinion ("education"). In any case, my distinction between the two institutional interests now has to be toned down. It still exists, but there has been a certain merging of institutional identities. One might even speak of an anti-smoking conglomerate, a network of interlocking governmental and non-governmental organizations. There were some indications of tensions within the UN system. WHO continues to be the spearhead of the anti-smoking cause within the system, but the response from other UN agencies, notably FAO, may be less than satisfactory from the anti-smoking viewpoint. I take it that there are good political reasons for this. I cannot judge whether the savage criticisms of UN actions on anti-smoking matters by Frederick Claimonte (UNCTAD) represent only his own views or wider opinions within his agency. As far as Third World governments are concerned, my own knowledge of the UN system (all acquired since Stockholm) inclines me to the view that rhetoric voiced in UN-sponsored settings commonly bears little resemblance to actual government policies back home. The prominent role of some Third World participants (notably Kuwait and Swaziland) may be attributable to the personal inclinations of individual health ministers; I have no knowledge of the domestic political contexts.

- 5 - 3. Ideological Themes Officially, the Winnipeg Conference had three major themes of concentration - women, children and the Third World. The last of these, of course, was a continuation of the Stockholm emphasis; the first two were new, at least as major emphases. The three themes were, logically enough, related to the available empirical data on smoking: In the developed countries, the decline in smoking has affected women and young people less than men, and in the Third World no decline is in sight (on the whole); ergo, the anti-smoking campaign is to concentrate on the most vulnerable (from its point of view) groups. The most obvious ideological linkage in the case of women is with feminism. A special, and very interesting session was devoted to this; I report on this in detail below. The "children" theme, of course, is ideologically potent, in that it suggests exploitation of a particularly vulnerable group. In this connection, the use of language is particularly interesting: As far as I could make out, the word "children" was used for young people in general; that is, both an 18-year old and a 12-year old were discussed under the category of "children". Paradoxically, this is the opposite use of language than that current in the feminist movement - thus, an 18-year old girl smoking is referred to here as a "child", while the same individual getting an abortion will be referred to as a "young woman". In both instances, language is used ideologically, to make a propagandistic point.

6 The Third World theme, as already indicated, does not impress me as having gone very far since Stockholm. Interest by Third World Governments appears to be limited or sporadic, and these countries (with the possible exception of the Muslim world, of which more below in connection with religion) do not strike one as likely soil for the sprouting of anti-smoking movements. Perhaps the absurdity of the Third World theme was best illustrated (for me, at any rate) by the participation of individuals from those countries at the tobacco-burning ceremony in the park in front of the Manitoba capitol on the Wednesday evening. Obviously staged for television, Third World participants, in colourful indigenous dress, were very prominent in the ceremony; the uninformed observer would get a completely disproportionate notion of their importance in the anti-smoking campaign. The pyre was lit by a Nigerian, appropriately garbed. My attention was caught by an Ethiopian, who gleefully threw some tobacco products into the pyre; one had to wonder about the priority of the smoking issue in a country beset by not one but several insurgencies, ruled by one of the most oppressive regimes in Africa, and facing massive starvation. To be sure, Third World participants kept repeating the customary formulas about neo-colonialism, with the tobacco industry representing the multinationals that are the general villains in this Third World rhetoric.

7 My guess is that this is not to be taken very seriously. If it is serious, it is rather in the susceptibility to this rhetoric by intellectuals and people influenced by them in Western countries; there, of course, such rhetoric is part and parcel of Leftist propaganda. I was struck, though, by the fact that, in sessions I personally attended, the address by Clairmonte was the only one that was characterized by an unabashedly Marxist analysis of the situation. Perhaps the decline of the Left in Western countries has an influence here. In my report on Stockholm I commented on the cognitive assumptions in play, scientific as well as political ones. There has been no change in these. The most important assumption, of course, is that smoking (as was repeated ad nauseam in Winnipeg) is the most important casue of preventable death in the world today, is an "epidemic". I did not attend the (quite few) sessions devoted to scientific papers (with one exception, in which "safer cigarettes" were discussed). But the overall assumption in the conference was very clear: Supposedly, there are no more scientific questions of any importance left; the causal link between smoking and a list of diseases has been established beyond reasonable doubt; thus the agenda now is simply how to act on this allegedly scientific certainty.

8 I should add, though, that in the session on "safer cigarettes" that I attended, the atmosphere was very objective and information that might be deemed damaging to the anti- smoking cause was allowed full discussion. The major political assumption continues to be that government has an obligation to control the "epidemic"; given the scientific assumption, this is hardly surprising. Once again, the Scandinavian countries (notably Norway, Sweden and Finland) were held up repeatedly as models, as having gone a long way toward making smoking an activity engaged in "by consenting adults in private" (a phrase already used in Stockholm and repeatedly used in Winnipeg). Yet, while the underlying ideology has not changed, there have been significant changes in the manner in which this ideology is represented in anti-smoking propaganda. These changes were repeatedly underlined by speakers in the strategy session. Overall, there has been a shift from negative to positive imagery. Four years ago there still was a very strong emphasis on the dangers of smoking - images of disease, playing on the fears of people. It appears that this strategy has been deemed by many in the anti-smoking movement to be counter-productive. Increasingly now, the emphasis is on projecting a positive image of healthy living, of which non-smoking is only a part. This new emphasis came out very clearly in the session on the use of media (in the reports on a TV campaign in Austria, on the sponsorship of the Scottish

- 9 - World Cup squad by a British anti-smoking group, and in the Great American Smokeout enacted by the American Cancer Society). The new emphasis was put very eloquently by S. Chapman (Australia), in a session on how to counteract tobacco advertising, who urged that the anti-smoking movement must get over its earlier puritanical, spoil-sport image. Essentially, what is happening now is the selling of an integrated lifestyle - healthy, yes - but also modern, with-it, and above all youthful. The Scandinavian campaign for "A Non-Smoking Generation" has, since 1979, been effectively internationalized. To put it graphically, there has been a shift from portraying people coughing their lungs out to images of sexy blondes jumping around in evidently enjoyable pursuits. In terms of this imagery, it is smoking that is the spoil-sport. Or, to put it differently, the hedonistic theme, which culturally used to be associated with smoking is now expropriated and em loyed in the anti-smoking cause. This, in my opinion, is a significant shift. By way of illustration, one may cite here the physical exercises staged during conference intermissions. A surpri- sing number of individuals (most of them middle-aged and not in obviously good physical condition) participated in these, following the instructions of the teenage cheerleader in charge of these proceedings. The scene reminded one of some

revivalistic healing cult in Southern California - all these people jumping up and down, hands raised to the sky, silly ecstatic smiles all over their faces; I noted that the least attractive ones wore T-shirts that said "Non-Smokers Make Better Lovers" (an expression of desperate hope, one may surmise). I take all this as a rough validation of my origianl intuition about the anti-smoking movement - that it is, au fond, a quasi-religious quest for immortality (or perhaps, slightly more rationally, for the fountain of youth). As far as the evidence from developed countries goes, the campaign has been successful to a remarkable degree. In an age in which health has attained quasi-religious status, and in which, because of secularization, competing ideals have lost plausibility, none of this should be surprising; nor should the continuing fierce hostility against the tobacco industry (no hatred is as deep as religious hatred). However, one sociological reflection may modify this picture slightly: As data from the developed countries continue to indicate, class has become the major factor discriminating smokers from non-smokers. More specifically, smoking has become increasingly an element of working-class culture. I cannot say to what extent working-class individuals (including working-class youth) are impressed by the essentially middle- class imagery of the anti-smoking propaganda. Generally, in Western societies, there is a good deal of working-class resis- tance to the schemes of reform and redemption, and the concomi-