True champion of tobacco control and social development

Manjari Peiris

Dr. Ulysses Dorotheo is a Neuro-Ophthalmologist, who has been a tobacco control advocate for over ten years. Beginning as a volunteer and after co-founding the FCTC Alliance, Philippines (FCAP), he actively participated as a non-governmental observer in the early negotiations for the Framework Convention on Tobacco Control (FCTC)

In 2006, he joined the Southeast Asia Tobacco Control Alliance (SEATCA) as its FCTC Program Manager and the Framework Convention Alliance (FCA) as its Regional Coordinator for ASEAN and the Western Pacific, roles he jointly performed till 2009.

Since 2010, he has been the project director for SEATCA’s Southeast Asia Initiative on Tobacco Tax, a five-year project aimed primarily at raising tobacco taxes and prices in Cambodia, Indonesia, Lao PDR, the Philippines, and Vietnam.

Dr. Dorotheo is a true champion of TC, and has always put forth consensus building in his working style, thereby developing strong working relations with tobacco control NGOs, governments and international agencies and advocates, and earning the admiration of his countrymen and international colleagues, especially in the advocacy for the stronger implementation and development of the FCTC in Southeast Asia.

From his early campaigning days he saw the need to approach tobacco control with a comprehensive approach, grounded in the FCTC and this approach has brought him to work collaboratively with NGOs, governments and international agencies and advocates. He reached out to many people from diverse backgrounds starting with the Philippines first, then internationally through the FCTC negotiations. Dr. Yul is a relentless advocate, tireless leader and a genuine champion for TC, who truly has national, regional and international reach.

In 2011 Dr. Ulysses became a winner of the Judy Wilkenfeld Award for International Tobacco Control Excellence, presented by the Campaign for Tobacco-Free Kids, of the US. He was the first Asian to receive this prestigious award.

Dr. Ulysses expressed the following views sharing his expertise in TC;

TC is important

A country’s best assets are its human resources, thus TC is important to promote health of the people. If people become sick or disabled due to tobacco use, it reduces a country’s productivity, which impacts the country’s economy and social development.

“I began as a volunteer in 2001, subsequently becoming a founding member of the FCTC Alliance, Philippines (FCAP). I was active in the early WHO FCTC negotiations under the umbrella of the Framework Convention Alliance (FCA) and later joined the Southeast Asia Tobacco Control Alliance (SEATCA) as its FCTC Program Manager; concurrently, I was also FCA’s regional coordinator for the ASEAN and Western Pacific. In these roles, I contributed to FCTC-compliant policy development and implementation in ASEAN countries through TC advocacy, building capacity, providing technical assistance, and facilitating regional and international networking among governments and civil societies.

I have been fortunate to be part of a great team of advocates in all areas of my work, primarily in SEATCA, but also in FCA, as well as when working with WHO and other international civil society organizations. At the country level, I am happy to have contributed to the growth over the years in the number of committed TC advocates, both in government and among civil society.”

I believe, medical professionals have a vital role to play in tobacco control, and there are certainly a number of medical professionals at the forefront of TC advocacy, but I believe that, particularly in low- and middle-income countries (LMICs), there is much more that the medical community, as well as individual practitioners, can do to reduce tobacco use.

All medical professionals can contribute to tobacco cessation by providing brief advice in all their patient encounters, while others also have the opportunity to do more counselling and cessation therapy. These individual cessation efforts are important, but will take many years to have the desired significant impact in tobacco use reduction; thus, it is important for medical professionals to advocate for measures that will reduce tobacco use at the wider population level, such as for higher taxes/prices, large graphic warnings, comprehensive ban on tobacco advertising and promotion, and smoke-free public places. This is important because medical professionals speak as health authorities, which is important for countering the commercial and vested interests of the tobacco industry.

FCTC’s objective

The FCTC’s objective is to reduce the devastating health, social, economic, and environmental harms of tobacco use. This means that tobacco harms all sectors and segments of society. Therefore, everyone, who is concerned about human and social development, is a stakeholder in tobacco control. A multi-sectoral approach is needed for effective FCTC implementation; this means that it is not only the mandate of health ministries and health advocates to push for TC. It is important to involve economists, finance officials, lawyers, environmentalists, anti-poverty advocates, advocates of women’s and children’s rights, farmers groups, and others that are not affiliated with the tobacco industry.

Industry interference

As a result of tobacco industry’s market in high-income countries has been decreasing over the past few decades, the industry has been working to expand its market in developing countries. Internal industry documents from the 1990s clearly indicate that transnational companies like Philip Morris have targeted Asia, and we see this being realized in the past 10-15 years.

The growth of the tobacco epidemic is driven, not by the demand for tobacco products, but by the tobacco industry. As people become more aware of the harms of tobacco use and governments take steps to reduce tobacco use, the tobacco industry becomes more aggressive in its promotional tactics and through interference in the development and implementation of effective TC policies. Without the industry’s interference, tobacco consumption would be declining more rapidly in all countries, not just in high-income countries.

There is no reasonable or ethical justification for governments to prioritize tobacco industry revenues/interests over public health, because it is the duty of governments to serve and protect their people. Tobacco is the only consumer product that kills half of all its regular users. Any other consumer product that resulted in harms that are even of a much smaller scale would immediately be banned or very strictly regulated, so it is a wonder that governments allow the tobacco industry to continue doing business as usual and even to influence measure for more stringent industry regulation.

Sri Lanka’s progress

I’m not familiar with the Sri Lanka situation, although I have been trying to follow the campaign for PHWs in Sri Lanka. What I have seen is that the implementation of the government policy requiring 80 per cent-size PHWs has been delayed by tobacco industry interference.

Achieving the 80 per cent PHW was a victory for the Sri Lanka people and for the world (because it is among the world’s largest), but its delayed implementation because of tobacco industry interference shows the huge challenges that countries face when they want to effectively implement strong tobacco control policies.

I’ve also heard that Sri Lanka has a comprehensive TAPS ban and fairly good smoke-free implementation, but since I don’t know enough, I don’t think I can comment further.

Is PHW result oriented strategy?

There is strong evidence that PHWs are effective in informing consumers about the addiction and health harms of tobacco use and this will be effective in preventing tobacco use uptake/initiation by the youth, as well as in encouraging smokers to quit or reduce their consumption.

Even if tobacco products are bought in loose form, the packaging will still be visible and effective, because not everyone buys tobacco in loose form. When packs are displayed at point of sale or by smokers that buy packs (and even when packs are discarded), the PHWs on such packs will be visible to others.

The PHWs on packs can also be strengthened by using the PHWs in posters at points of sale and in mass media campaigns.

Tax policies

Tax and price policies are widely recognized as effective measures for reducing tobacco consumption, especially among the poor and the youth. At the same time, higher taxes will generate higher government revenues that can be used for social development. Unfortunately, not many countries, particularly LMICs, are making use of this tool to reduce consumption.

Even more unfortunate is that LMICs also are not generating enough revenues from tobacco taxes. Thus, both public health and public revenues are on the losing end, while the tobacco industry is the only one that is profiting.

Fortunately, there is growing interest in increasing tobacco taxes in order to reduce tobacco use. However, there are going to be significant challenges. These are not limited only to the narrow experience of many countries in tobacco taxation or the bureaucratic challenges of taxation; the bigger challenges are the tobacco industry’s deceptive misinformation and influence over policy makers.

Most important TC strategies

Full and accelerated implementation of the TC measures in the WHO FCTC is necessary to reduce tobacco consumption. These include tax and price measures, comprehensive bans on tobacco advertising, promotion, and sponsorship, 100 per cent smoke-free environments, large and prominent pictorial health warnings on tobacco products, preventing and countering tobacco industry interference in TC policy development and implementation, and increasing public awareness about tobacco harms and tobacco industry interference. These are important for reducing the demand for tobacco and will drive the demand for tobacco cessation programs.

MPOWER package

The MPOWER package is a good summary of the main TC measures contained in the FCTC. It provides a good introduction to the FCTC for those who are new to tobacco control.

FCTC’s success

The FCTC has helped bring a global focus to the public health need to curb tobacco use, including the role of the tobacco industry in globalizing the tobacco pandemic. As an international treaty, it has prompted governments to seriously look at the tobacco burden in their countries and take action to reduce this burden. Progress has certainly been made by the FCTC Conference of Parties in adopting evidence-based international guidelines to assist State Parties in implementation of many of the FCTC demand reduction measures. However, implementation is not uniform across countries, such that there still remains much to be done to reduce the tobacco burden (diseases, disabilities, and premature deaths) across the world until prevalence rates reach the so-called “endgame” level of less than 5 per cent.

Worldwide industry interference

Tobacco industry interference has been growing more brazen and explicit. In the past, tobacco companies have been interfering behind the scenes, but in recent years, when governments pass effective tobacco control laws, these companies have been taking the governments to court in their own countries (e.g. Sri Lanka, Philippines, Thailand) as well as internationally by exploiting trade and investment agreements (e.g. Uruguay and Australia). The industry is also working hard to co-opt governments and non-governmental organizations, so as to improve the credibility of the industry, through claims of being a “legal” industry and a stakeholder that needs to be consulted in TC policy decisions (despite its inherently harmful/lethal products) and through CSR activities, which are only a cover-up for the industry’s harmfulness.

React to industry strategies

These (Corporate Social Responsibility) CSR activities need to be exposed for what they really are: fake CSR whose purpose is to cover up the harmful nature of the industry and to influence policy makers so as to weaken and delay effective industry regulation.

Parties to the FCTC are also advised under the Art. 5.3 Guidelines that they should reject any partnerships with the industry, including their so-called CSR activities, which are not only a form of tobacco promotion and sponsorship but also an instrument for tobacco industry interference in policy making. Thus, a government policy should be instituted that prohibits such CSR by the tobacco industry.

Are they liable?

Many tobacco users become addicted without fully understanding the consequences of tobacco use, most of them in their youth, when their brain is not yet fully developed and is more prone to addiction. Tobacco companies take advantage of this and do research focused on how to effectively attract new users among the youth. In addition, tobacco companies deliberately hide or downplay the harms of their products, and they oppose effective TC measures that can prevent uptake or promote cessation. Therefore, tobacco companies should be held liable for the harms brought about by their products.

Advice to TC activists

Be persistent, and don’t be discouraged. Continue to inspire and recruit other advocates, because this is a worthwhile cause that will benefit humanity for generations to come. Learning tobacco control isn’t rocket science, but generating and sustaining the passion for advocacy is necessary in this prolonged battle with the industry.

Guidance from a veteran

The largest obstacle to success in TC is the tobacco industry. It is thus imperative that more energy and resources should be spent on denormalizing this industry. Opium and the opium trade used to be unregulated, but the world has since decided on its very strict regulation. Tobacco is not like any other product and should also be taken down this path as soon as possible.