The World Health Organization Takes on the Tobacco Industry

The Conflict

Beginning in 1999 the World Health Organization undertook a series of meetings designed to create a Framework Convention on Tobacco Control (FCTC). Envisioned as a comprehensive, international, multilateral effort to reduce smoking rates, abate smoking-related illnesses, and regulate the trade, sale, and marketing of tobacco products, the FCTC marked the first truly global public health effort against tobacco consumption.

Economic

•Tobacco companies have long argued that undue restrictions on the sale and trade of tobacco interfere with their ability to sell and market their product to consumers, an economic loss that is borne by their shareholders. The effort to reduce smoking also limits the revenue that national governments collect as taxes on tobacco products. In countries where the tobacco sector is state-owned, as in China, the potential economic loss from reduced tobacco consumption is considerable.

Social

• Anti-tobacco efforts in more affluent, industrialized nations have been in place for a generation, and smoking rates have declined accordingly. Smoking rates in many less-developed nations, however, are just beginning to take off as consumers have more to spend on tobacco products. Because of these trends, the WHO predicts that smoking-related illnesses, finally declining in Western countries, will be a major source of mortality in coming decades unless aggressive anti-smoking efforts are put into place on an international basis.

Political

• Although the WHO has issued numerous anti-smoking public health resolutions in past decades, the lack of any comprehensive strategy to help countries coordinate their efforts have rendered such initiatives largely ineffective.

At a Geneva meeting on May 24, 1999, the World Health Assembly's 191 members unanimously endorsed efforts to create a Framework Convention on Tobacco Control (FCTC). Although the assembly had passed 16 resolutions to govern the sale and trade of tobacco during the previous quarter century, the FCTC marked an important new step in coordinating public health efforts against tobacco-related diseases and regulating the production, distribution, and marketing of cigarettes throughout the world. As such, the FCTC was hailed by anti-smoking advocates as the first truly comprehensive program in the area of tobacco regulation and a first step in decreasing the number of smoking-related deaths and illnesses. Because its proposed mandate was so broad, however, the world's major tobacco companies immediately raised objections that the FCTC would impose unfair restrictions on the sale and use of their primary product, cigarettes, and infringe upon the civil liberties of smokers worldwide.

In taking on the global tobacco industry the World Health Assembly's administrative body, the World Health Organization (WHO) hoped to inject a sense of urgency in an increasingly crucial public health matter. With an estimated four million people dying each year from smoking-related illnesses—a figure that threatened to reach over ten million annually by 2030—the WHO viewed tobacco consumption as one of the greatest threats to public health in the twenty-first century. Indeed, with smoking rates soaring in developing countries, the WHO predicted that "the silent epidemic" would have an inordinate impact on countries least able to afford its long-term costs. In light of the immensity of the problem, the WHO set a target date of 2003 for the final resolution of the FCTC.

In contrast, the international tobacco industry—dominated by Philip Morris (PM), British American Tobacco (BAT), and Japan Tobacco (JT), companies that held more than 42 percent of the global cigarette market—were wary of efforts that might impede their ready access to growing markets. As they had long argued, the decision to smoke was a matter of individual choice, one that should not be subjected to undue interference by public authorities. The tobacco lobby also feared that the costs of implementing the FCTC would be passed along to consumers in the form of higher taxes on tobacco products. Aside from these differences, however, there was some common ground between the outlined FCTC and the desire for limited regulatory measures on the part of tobacco companies. If increased vigilance over counterfeiting and smuggling cigarettes were implemented, for instance, it would help protect the valuable brand names that were so immensely profitable to the major tobacco corporations.

Complicating matters was the difficulty in bringing so many nations together in support of one set of tobacco guidelines. Some countries, such as the United States and Japan, had powerful tobacco lobbies that greatly inhibited their national governments' willingness to endorse a strong set of FCTC measures. Other countries, most notably the People's Republic of China, were themselves in the business of trading and selling tobacco and derived a significant portion of their revenue from state-owned tobacco monopolies. Still other countries were not yet convinced of the need to press forward with the FCTC, especially with other, more immediate public health crises raging across the globe.

Historical Background

In the half century since its founding in 1948 the World Health Organization could point to a number of dramatic public health improvements that it had coordinated. In conjunction with numerous local non-governmental organizations (NGOs) the WHO contributed greatly to reducing the incidence of malaria, tuberculosis, venereal disease, poliomyelitis, and other viral diseases around the world. It also spearheaded a number of maternal health programs, helped to formulate nutrition and sanitation guidelines, and worked to ensure appropriate mental health treatments in its member states. In 1997 the tiny European nation of Andorra joined as the WHO's one hundred ninety-first member state; the following year, the organization celebrated its fiftieth anniversary as the world's most influential health agency.

Increasingly, however, the WHO raised controversy for its stance on public health issues. At its 1978 International Conference on Primary Health Care in Almaty, Kazakhstan (then called Alma-Ata as part of the Soviet Union), WHO delegates declared basic health care to be a universal right. Although the Declaration of Alma-Ata endorsed local control of health care policies by respective member states, it also expressed the belief in Section II that "the existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially, and economically unacceptable and is, therefore, of common concern to all countries."

Given the backdrop of both Cold War and North-South tensions, some observers took the Declaration as a not-so-veiled criticism of wealthier Western countries and their perceived lack of concern for conditions in less developed nations. In drawing a causal effect between reduced expenditures on public health and increased funding for military operations, the Declaration also took direct aim at the world's superpowers, then reaching the height of their struggle for Cold War dominance. Approved by the World Health Assembly and the United Nations General Assembly in 1979, the Declaration of Alma-Ata firmly linked public health issues with international political and economic concerns.

Tobacco and Public Health Trends

The WHO's decision to prioritize tobacco consumption as a public health issue reflected both its willingness to influence long-term demographic trends as well as its desire to address the economics of the tobacco trade. Foremost among its concerns was the predicted growth in global mortality rates due to smoking. From a rate of four million deaths per year at the millennium, the WHO estimated that upwards of ten million people would die annually from smoking-related illnesses by 2030. By that date, about 70 percent of smoking deaths would take place in developing countries.

In addition to the obvious demographic trends, there were other reasons for the WHO's focus on anti-tobacco measures to assist developing nations. First, most Western governments—often urged along by non-governmental public health advocates—had already instituted an array of measures to lower tobacco consumption in their countries. Beginning in the 1960s official reports of the dangers of smoking became widely publicized in North America and Europe, leading to a gradual reduction in the incidence of smoking in industrialized nations.

In addition to the health scares Western governments implemented various public health measures to counter tobacco consumption. In the United States the famous "Surgeon General's Warning" of the dangers of smoking began to appear on cigarette packages in 1966; five years later, cigarette advertising was banned from television. Beginning with the state of Arizona in 1973, individual states also began to restrict smoking in public areas. Because of these public health campaigns, smoking rates for American men dropped from 44 percent in 1970 to 28 percent in 2000. Other countries were even more direct in taking anti-smoking messages directly to consumers; a series of large-print health warn-ings—accompanied by photos of smoking-induced maladies such as mouth cancer and brain cancer—helped Canadian smoking rates to plummet two percent annually from 1980 to 2000. Overall, after peaking in the mid-1970s, cigarette consumption in industrialized nations fell continuously over the next 25 years.

While the decline in cigarette consumption in Western nations was welcome news, the WHO predicted that developing nations were just beginning to see smoking rates rise. Outlining a four-stage process that linked tobacco consumption with economic development, the WHO explained tobacco consumption as a trend that increased along with disposable incomes in developing societies before leveling off and eventually declining decades later. In this model the least developed countries—including most of Africa, plus Afghanistan, Bangladesh, Nepal, and Haiti—had the lowest rates of cigarette consumption, mostly due to the extremely scarce amount of disposable income among the populace. In developing nations such as India, along with the newly industrialized Asian nations such as China, Hong Kong, and South Korea, smoking rates surged as consumers had more money to spend on brand-name cigarettes. For men in these countries, smoking rates approached 60 percent; for women, the rates were somewhat lower. For the third group of countries—including Japan and the eastern European countries of the former Soviet Bloc—higher mortality rates from smoking-related cancers caused a drop-off in the number of smokers as the dangers of smoking became more obvious. In the fourth group of countries—including the nations of North America and western Europe—smoking rates were in steady decline as older smokers died and public health warnings prevented more people from taking up the habit.

In essence, the WHO hoped that a set of FCTC guidelines would prevent people in the least developed nations from ever taking up the habit of smoking in the first place. Yet the challenge in accomplishing the task was far more difficult than simply modifying the four-stage model that it had developed. Indeed, in attempting to change the demographic trends of smoking, the WHO also confronted the economic realities of the global tobacco trade.

WHO Charges of "Tobacco Neo-Colonialism"

Although the economics of tobacco consumption and its affect on developing economies was a less obvious part of FCTC discussions, it presented the most contentious part of the WHO's direction. Because a large share of the international tobacco trade was controlled by a handful of multinational corporations, these companies, called transnational tobacco companies or TTCs, were the targets of criticism from the start. The organization did not shy away from outright condemnation of the tobacco companies; in one paper commissioned by the WHO, Dr. Hatai Chitanondh, president of the Thailand Health Promotion Institute, labeled the marketing and promotion of cigarette smoking in developing nations as "tobacco neo-colonialism." He wrote in "Ownership of Tobacco Companies and Implications on Health," "The transnationals have been threatened by stronger laws and regulations in their countries and they must expand overseas. They try to shield an increasing proportion of their assets from lawsuits in developed countries. The TTCs would reap huge benefits from locating cigarette-manufacturing factories closer to tobacco growing areas. They also enjoy cheaper labor and transport costs." Chitanondh also accused the tobacco companies of using free-trade agreements to make inroads in developing nations; engaging in bribery, direct political lobbying, and superficial philanthropic efforts to gain access to markets; and introducing deceptively labeled "light" cigarettes—in fact, no safer than other cigarettes—to gain new consumers.

In a special conference held in Kobe, Japan, in November 1999, "Women and the Tobacco Epidemic: Challenges for the Twenty-first Century," the WHO also paid attention to the impact of tobacco marketing on women in developing nations. Although the estimated global rate of smoking among females was only about one-fourth that of males—at 12 percent versus 48 percent—the WHO feared that the number of women smokers was bound to increase as less developed nations experienced economic growth. Even if female rates of smoking stayed the same, however, the WHO was still concerned about their health. Because an estimated 60 percent of men in Asian countries were smokers, for example, the dangers of secondhand smoke for women and children were especially worrisome throughout the region.

In light of the aggressive marketing tactics to court female smokers the WHO held little doubt but that their ranks would increase. Again, the WHO singled out the development of "light" cigarettes as one deliberate attempt to get more women to smoke in the belief that the product was somehow safer than other cigarettes. The WHO also attacked tobacco company sponsorships of events and contests that targeted women, along with their philanthropic donations to women's organizations. Further, the WHO criticized efforts by tobacco companies to market cigarette smoking to women in developing nations as a symbol of progress and modernity. By emphasizing themes of independence, equality, and sexual attractiveness in their advertisements, tobacco companies had co-opted themes of women's equality to increase their sales.

The International Tobacco Trade

Indeed, developments over the past two decades in the international tobacco trade seemed to bear witness to many of the WHO's charges. The most obvious trend in the tobacco industry was the tendency toward oligopoly, or control of the market by a few producers. In this case, just three publicly traded tobacco companies—Philip Morris, British American Tobacco, and Japan Tobacco—controlled about 42 percent of the global cigarette market. Philip Morris (PM) was the largest of the three major producers; with US$47 billion in tobacco sales in 1999, PM held about 17 percent of the world's cigarette sales. Led by its Marlboro brands—the best-selling line of cigarettes in the world, with 9.4 percent of the world market—PM derived about 54 percent of its revenue from tobacco sales.

Making a move to diversify its holdings and strengthen its bottom line in the face of enormous liability lawsuits in the United States, however, PM had long since ceased to be just a tobacco company. It acquired the Kraft brand name of familiar foodstuffs along with the Miller Brewing Company. Still, cigarette sales remained crucial to PM's long-term strategy. In 1999 the company paid $300 million to obtain certain brand names from competitor Ligget Group, Incorporated. The brands, which included Lark, L&M, and Chesterfield, were strong sellers in Europe and Asia, and PM spent part of its annual $813 million worldwide marketing budget to increase brand recognition even further. To its critics, PM's move to acquire the brands indicated its aggressive stance in going after markets in developing nations.

British American Tobacco (BAT), the second largest publicly held cigarette producer, also made headlines with its acquisitions in the 1990s. In 1994 BAT bought out the American Tobacco Company for $1 billion, gaining control of brand names such as Pall Mall, Lucky Strike, and Tareyton and about 17 percent of the U.S. market. In 1999 BAT paid about $7.5 billion for Roth-man's International of Switzerland, then the world's fourth-largest cigarette maker. Through the deal, BAT added the Rothman's and Dunhill brands to its lineup. Unlike PM, however, BAT concentrated solely on its cigarette business. Although it had previously diversified into financial, insurance, and banking services, BAT split off into a separate company specializing in tobacco products in 1998. In 1999 BAT had tobacco sales of $30.4 billion.

The third-largest tobacco company, Japan Tobacco (JT), had perhaps the most interesting history of all the biggest players. Once a state-held tobacco monopoly, JT was privatized in 1994. The government retained a significant investment in the corporation, however, leading to inevitable charges of conflicts-of-interest by public health advocates. Indeed, smoking restrictions in Japan were some of the least obtrusive in the world, and health warnings included on cigarette packaging omitted any graphic statements about the product's health impact. With one of the highest rates of smoking in the world—at 133.5 packs per person each year—JT's 82 percent hold on its domestic market made the company a profitable one after it went public. In a bid to strengthen its market position outside of Japan, however, JT made the bold move to acquire R. J. Reynolds Tobacco Company's international tobacco operations for somewhat less than $8 billion in 1999. Through the sale JT acquired the rights to market the popular Winston, Salem, and Camel brands outside of the United States. In 1999 JT had tobacco sales of just under $30 billion.

In addition to the three major commercial producers, the state-owned monopoly China National Tobacco Company (CNTC) controlled a major portion of the global tobacco market. Although it was confined just to the People's Republic of China, the domestic market alone gave CNTC a hold on one-third of the world's smokers. Although CNTC kept cigarette prices low for Chinese smokers, the government nevertheless benefited considerably from the estimated ten billion dollars in tobacco taxes that it collected each year. The largest single source of tax revenue from the manufacturing sector, cigarettes contributed 12 percent of China's annual revenue.

Of all the major tobacco companies, PM was the most assertive in its public statements upholding its right to appropriately market and promote its tobacco products. Unfortunately, its tactics sometimes backfired, as in the case of a report commissioned by its subsidiary in the Czech Republic. The report, issued in July 2001, purported to show that the country had in fact saved 46 million dollars annually because of premature deaths from smoking-related illnesses. In arriving at the figure, the report noted the savings to the government from not having to pay out pensions, provide housing, or supply health care to elderly and ailing smokers. Adding tax revenues to the final tally, the report concluded that the Czech Republic had gained about $223 million in 1999 from the tobacco industry and consumption of tobacco products. Once the report was made public, the WHO and other public health agencies led an international outcry. For its part, PM quickly dis-avowed the study; in its apology, it admitted that the report demonstrated "terrible judgment as well as a complete and unacceptable disregard of basic human values." With controversy raging over the Czech study, the WHO redoubled its efforts to get FCTC implementation underway.

Towards a Framework Convention on Tobacco Control

After the World Health Assembly approved a FCTC drive in May 1999, it moved quickly through the WHO to schedule a series of meetings on the agreement. The first set of talks took place in October 1999 in Geneva with 150 WHO member nations attending. Although the first session did not formulate specific FCTC rules, it did end with 25 nations endorsing an outright ban on cigarette advertising. The Geneva meeting also resulted in a set of policy guidelines to serve as a blueprint for further discussions.

Foremost among the FCTC guidelines was a call for comprehensive restrictions on cigarette advertising and promotion in order to combat the incidence of smoking among young people and to prevent cigarette ads from crossing international borders. As visualized by the WHO, the restrictions would not just ban ads for cigarettes themselves, but would apply to any items carrying their brand names as well, such as sunglasses, backpacks, or other promotional items (a practice known as "brand stretching"). The WHO also hoped that a comprehensive ban on advertising would help to protect countries with advertising bans already in place such as Thailand, Norway, and Singapore. In Malaysia, for example, tobacco company-sponsored game shows reached across its borders to be seen by viewers in neighboring Thailand and Singapore, circumventing their complete bans on tobacco advertising and sponsorship.

FCTC proposals also took direct aim at the political lobbying efforts by tobacco companies to influence legislation in individual nations. Noting that Philip Morris spent $60 million on 300 lobbyists in the United States alone, the WHO was deeply critical of the deep pockets that large tobacco companies could bring to bear on elected officials around the world. The WHO also bore down on non-tobacco subsidiaries of the major tobacco corporations, such as PM's Kraft Foods division, that participated in political lobbying. Going a step further, some FCTC supporters urged the WHO to take on an investigative role to monitor NGOs that were funded by tobacco companies.

In addition to demanding a more transparent political process through the FCTC, the WHO advocated greater disclosure of tobacco company information. In opening up internal health studies of cigarette carcinogens and publicizing the information, the WHO believed that consumers would be better informed about the potential risks of using the product. The publicity would also help to counter tobacco company marketing efforts to portray "light" cigarette brands as somewhat safer to smoke than regular cigarettes. In conjunction with the full disclosure of the dangers of cigarette smoking, the WHO also supported international legal liability among the tobacco companies for damages caused by tobacco consumption.

In addition to these proactive measures, the WHO hoped that the FCTC guidelines would roll back free trade provisions that helped tobacco companies market and promote their products transnationally. With international free trade agreements reducing import and export restrictions, tobacco companies could claim that individual nations had no right to impose large excise taxes or product restrictions on cigarette imports. In putting tobacco products outside the realm of free trade agreements, the WHO thus hoped to empower individual countries to set their own standards on the importation and sale of cigarettes.

Finally, the WHO envisioned an FCTC that would set the groundwork for a sustainable, internationally oriented advocacy and watchdog group. The FCTC was proposed not just as a set of model practices, but rather as a group of policy initiatives that would be ratified by each member nation. In conjunction with the WHO, the FCTC provisions would then be enforced—through punitive actions such as sanctions and financial penalities—as a body of international laws. Although individual nations would come up with their own set of policies regarding tobacco control—in line with the Alma-Ata Declaration's statement in support of self-governance—corporations would be subject to the regulations of each individual nation.

The Multinationals Respond

The international tobacco industry watched the WHO discussions closely and responded to WHO proposals at each step of the negotiations. For those who expected tobacco companies to revert to the adversarial stance that they had long held in respect to anti-tobacco initiatives, however, there was a surprising amount of support for the FCTC. The greatest area of common ground covered anti-smoking efforts geared toward children. Although tobacco companies had long been accused of targeting young smokers with ad campaigns such as R. J. Reynolds's "Joe Camel" character or PM's "Marlboro Man," the criticism over such practices—enhanced by severe advertising restrictions in many countries—had led to a dis-avowal of such marketing efforts on the part of the big tobacco companies.

One sign of the about-face occurred when the outcry over the use of Joe Camel—a cartoon image that critics charged was designed to appeal to children—led to a U.S. Federal Trade Commission complaint against R. J. Reynolds; in 1997 the company stopped using the character, even though it had been a major factor in increasing Camel's share of the eighteen-to-twenty-four-year old market from 4.4 percent to 7.9 percent. In addition to retrenching their advertising efforts, the major tobacco companies also endorsed educational programs to teach children about the dangers of smoking. Further, the tobacco industry supported policies to enforce national minimum-age requirements for the purchase of cigarettes.

Cigarette manufacturers also supported FCTC efforts to publicize health information to adult smokers, although they disagreed with the WHO about the extent of such warnings. While the tobacco companies agreed that such information should be widely available in order for adults to make a fully informed decision about whether or not to smoke, it insisted that graphic warnings on cigarette packages served no purpose other than to shock consumers. Photos of body parts riddled with cancer—such as the pictures of diseased brains and gums that appeared on Canadian cigarette packages—were simply too much for the cigarette lobby to endorse.

Addressing the economic dimension of the FCTC, commercial cigarette manufacturers also viewed the WHO's potential regulatory powers as an essential tool against international cigarette smuggling and counterfeiting. The problem was a severe one, with about one-third of all cigarettes around the world being purchased from unlicensed vendors. Some critics viewed the endorsement as a cynical attempt to protect valuable brand names from being associated with an inferior product; indeed, cigarette companies had an important financial incentive in keeping their products off the black market. As the major companies had long known, their success at marketing and promoting their products depended on controlling as many segments of the retail trade as possible. Without the ability to dictate product placement, quality assurance, and the retail price of their product, cigarette companies rightly feared the potential long-term consequences of black-market consumption.

In contrast to their support of vigilant anti-smuggling and anti-counterfeiting measures, however, the tobacco lobby was wary of endorsing increases in cigarette taxes. Claiming that exorbitant excise taxes would make cigarettes prohibitively expensive, the tobacco companies emphasized the right of individuals to choose to smoke. Once again, however, critics assailed their position as another attempt to preserve the tobacco lobby's own control of the cigarette market. Noting that consumers might "trade down" from brand-name substitutes in favor of rolling their own cigarettes—or simply give up smoking altogether—public health advocates pointed to the success of governments in lowering smoking rates by raising cigarette taxes. Some critics even charged that individual tobacco companies had often colluded with smugglers to avoid high excise taxes in the past, rendering their current stance on taxation and smuggling less than sincere.

Despite some of the fundamental disagreements over the FCTC, however, the world's largest commercial producer of cigarettes openly supported its development. In a speech before shareholders in April 2001, PM chairman Geoffrey C. Bible insisted that the only way to design an enforceable and fair FCTC was with the active participation of the tobacco industry. Bible also noted that the efforts of cigarette manufacturers to produce reduced-risk cigarettes with lower levels of carcinogens could only take place if international regulations assured manufacturers of specific production, marketing, and liability measures. Despite Bible's endorsement of the FCTC at the meeting, however, PM shareholders nonetheless rejected similar proposals to publicize the risks of smoking and secondhand smoke, end the use of animals in smoking studies, and supervise PM ads to make sure they did not appeal to children. Even as PM came out in support of the FCTC, then, its own policies continued to generate criticism from the public health sector.

Recent History and the Future

While the momentum generated by the first round of FCTC talks made it seem that the WHO's targeted completion date of 2003 might be feasible after all, the second round of talks in May 2001 proved more contentious. NGOs such as the American Lung Association (ALA) and the Campaign for Tobacco-Free Kids (CTFK) were especially critical of the United States' participation in the talks. Although the Clinton administration had taken a hard line with tobacco companies by supporting a series of law suits against cigarette manufacturers, the incoming George W. Bush administration (2001-) was far less adversarial with the tobacco industry.

The ALA and CTFK were especially concerned that U.S. delegates to the FCTC talks were rolling back key provisions that had already received general support in past negotiations. The Bush administration withdrew an endorsement to ban the use of terms such as "light" and "mild" in cigarette marketing, and fought against efforts to increase taxes on tobacco products to reduce their sales. The United States also declared its opposition to licensing tobacco retail outlets, even though such a system was generally viewed as one of the best ways to reduce smoking among children. In line with tobacco industry guidelines the United States also urged a new round of discussions on banning smoking in public buildings and other work places. Finally, the U.S. delegation worked to weaken the obligatory measures to be included in the FCTC in order to give individual states more freedom to implement or ignore the final agreement.

The United States was not alone in coming under attack by public health advocates after the second round of FCTC negotiations. Critics also accused Japanese delegates of trying to weaken the FCTC and renewed allegations that the Japanese government—with a profitable stake in JT—was trapped in a conflict of interest that rendered its participation in the talks counterproductive. Some observers even expressed the hope that the United States and other obstructionist nations would stay out of the third round of FCTC talks, scheduled for November 2001. As Clive Barnes of the British anti-tobacco group Action on Smoking and Health (ASH UK) told Multinational Monitor, "The U.S. contribution has been entirely negative: weakening, delaying, and deleting anything that might have substance….. It would be best if the United States goes home from Geneva, adopts its increasingly familiar ostrich, and stays out altogether."

In the end, the cigarette companies' own efforts to regulate the tobacco industry may prove far more influential in the short term than any official efforts. In August 2001 the advertising industry publication Ad Age Global reported that a study commissioned by PM, BAT, and JT had come up with a revised set of standards for limiting advertising and promotional efforts by the three largest commercial cigarette producers. Although industry commentators were tightlipped about the report, "International Tobacco Products Marketing Standards," they insisted that the joint effort demonstrated a definitive commitment to curb youth smoking around the world. Indeed, many of the proposed standards—such as banning any models who appeared to be under the age of twenty-five in cigarette advertisements—did show an effort to stay away from the youth market. Other measures went even further to preclude young people from being targeted by cigarette ads, such as a media ban at sites located close to schools or youth centers and a prohibition on cigarette product placement in television shows, concerts, and in night clubs.

In response to the report, public health advocates once again accused the cigarette industry of attempting to corrupt FCTC negotiations for its own benefit. In proposing their own voluntary restrictions, critics argued, tobacco companies hoped to forestall any meaningful and compulsory reforms coming out of the WHO. Further, the attempt to put forth guidelines authored by the tobacco industry was another way of fighting WHO's proposals for an outright ban on cigarette advertising, which 25 countries had endorsed at the very first FCTC session in October 1999. As well, the report convinced those skeptical of the good faith efforts of the tobacco lobby that the industry was continuing to act as an oligopoly, fighting any effort to decrease its control over the international tobacco trade.

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Timothy G. Borden

Chronology

1946 The creation of a World Health Organization (WHO) is endorsed by 48 inaugural members at the International Health Conference in New York City.

June 1948 The first meeting of the World HealthAssembly, the governing body of the WHO, is held in Geneva.

1964 The U.S. Surgeon General issues a report warning of the dangers of smoking.

1966 Cigarette packages in United States begin to carry warning about the health risks of smoking.

1971 Cigarette advertising is banned on United States television.

September 1978 The WHO declares health as a fundamental human right at International Conference on Primary Health Care in Alma-Ata, Soviet Union.

1989 The European Commission bans television advertising for cigarettes in member nations.

May 1999 The WHO approves the beginning of multilateral negotiations on tobacco control under the Framework Convention on Tobacco Control (FCTC).

October 1999 The first FCTC negotiations in Geneva result in twenty-five nations supporting a ban on cigarette advertising.

November 1999 The WHO sponsors the "Women andTobacco" conference in Kobe, Japan.

2000 Estimates of global smoking rates indicate that 48 percent of men and 12 percent of women are regular smokers.

May 2001 A second round of FCTC negotiations is held in Geneva.

May 31, 2001 The first "World No Smoking Day" is held.

Summer 2001 International controversy arises over aPhilip Morris-sponsored report that concludes that the Czech government saved US$46 million from premature deaths of citizens due to smoking.

Summer 2001 An internal report from three major tobacco companies outlines a plan to support self-imposed limits to cigarette advertising.

November 2001 A third round of FCTC negotiations is scheduled.

2003 A proposed completion date is set for FCTC implementation.

2020 The WHO offers conservative estimate of number of smokers globally at 1.25 billion people.

2030 The World Health Organization estimates ten million deaths annually from smoking.

Cigarette Consumption in Asia Cigarettes Smokes per Person Age 15 or Older

Imported Cigarettes Market Share by Percentage