UNTIL THE MID-1980S, tobacco and the manufacturers of tobacco products had a tenacious hold on Canadian consumers. Canada has a tobacco-growing industry that is larger, on a per capita basis, than that of the United States. Ten years ago, Canada also had one of the highest levels of tobacco consumption in the industrialized world.
From 1983 to 1989, however, tobacco sales in Canada fell by 20 percent in total, and by 29 percent among the adult population. In 1989 alone, per capita tobacco sales in Canada fell by almost 7 percent (compared to 3 percent in the United States). And "the social change goes beyond sales declines," as Garfield Mahood, executive director of Canada's Non-Smokers' Rights Association (NSRA), told the Seventh World Conference on Tobacco and Health. "There are changed attitudes in Canada," Mahood stated. "The tobacco industry has become a social pariah. ... Tobacco executives have little credibility."
NSRA, along with a few other Canadian health organizations, has set international precedents in its campaign against the tobacco industry, pushing two of the toughest anti- industry laws ever passed through the Canadian Parliament. NSRA has become a leader in the anti-tobacco campaign by undertaking aggressive lobbying and public relations efforts that go far beyond traditional approaches to stemming tobacco use. What has made the organization so effective is its willingness to recognize and confront the root cause of tobacco-related death and disease - the manufacturers of tobacco products. Industry, not the consumer, has been the target of efforts aimed at curbing the leading form of preventable death in Canada.
Blaming the perpetrators
"Individuals don't create epidemics," Mahood says, yet health agencies have traditionally adopted a "blame the victim" strategy that tells individuals that it is their responsibility to quit smoking or to not start in the first place. But, as staff legal counsel David Sweanor wrote in a NSRA annual report, "the tobacco industry knows that unless there is a major intervention in the way it does business, more than enough youngsters will join the tobacco market than are needed to replace most of the older smokers who quit or die." Mahood says that the key to the tobacco epidemic - responsible for 35,000 deaths every year in Canada - is prevention, and the key to prevention is strict regulation of the tobacco industry.
Many health advocacy groups, however, are hesitant to shift funds to lobbying efforts aimed at regulation. Mahood says that because Canadian health organizations are controlled by the medical establishment, they tend to direct money to research and patient- care programs rather than to new policy efforts. NSRA also discovered that many Canadian health organizations were reluctant to adopt the aggressive, controversial approaches involved in tackling industry head-on for fear it would hurt their fundraising efforts. "Physicians don't like to offend people," says Kenneth Kyle, lobbyist for the Canadian Cancer Society.
The preventative approaches that these groups do advocate, therefore, do not usually focus on the root cause of tobacco-related death. Instead, they target individual smokers through efforts such as annual "no-smoking days." Mahood told the Conference on Tobacco and Health, "There were disproportionate resources being allocated to smoking cessation efforts and to research on cures for diseases compared to the resources allocated to health advocacy and to keeping young Canadians off of the tobacco market in the first place. The tobacco industry can live comfortably with the health community spending a generous portion of their resources on these special cessation events."
There were notable exceptions, however. A group of physicians who volunteered their services to the Canadian Ski Association (CSA) formed a group called Physicians for a Smoke-Free Canada to campaign against the CSA's decision to accept sponsorship from RJR-Macdonald , the manufacturer of Export A, a Canadian cigarette brand. While the CSA ultimately voted to retain the sponsorship, the campaign placed the issue on the national agenda and resulted in a severe blow against tobacco sponsorship of sports events: Canada approved a new federal government policy to deduct from federal sports grants an amount equivalent to what the grant recipients receive from tobacco company sponsors.
The most active of the Canadian health agencies has been the Canadian Cancer Society (CCS), which joined in the NSRA lobbying effort early on and has shown "world- precedent-setting leadership in health advocacy," according to Mahood. Kyle says that CCS moved into lobbying out of a belief that "a change in behavior" requires a "change in the environment." He asserts that regulations which discourage smoking and make cigarettes less available are far more effective than public education in lowering rates of tobacco-related cancer.
The NSRA and the CCS have lobbied vigorously to get laws passed (securing the active support of the Canadian Minister of Health was particularly important, Mahood says) and mounted an aggressive public relations campaign that turned public sentiment against smoking and, more importantly, against the manufacturers of cigarettes. Advertising and mass mailings played a huge role in the campaign.
One especially effective advertisement appeared on page three of the prominent Canadian newspaper, The Globe and Mail of Toronto, on the day that a bill which would become the Tobacco Products Control Act was going to committee for mark-up. In response to information that industry lobbyists were working to weaken the bill (for which government officials, including the Prime Minister, had expressed support), NSRA made public the relationship between Prime Minister Brian Mulroney and Bill Neville, an influential lobbyist and the head of the Canadian Tobacco Manufacturers' Council. Neville, a friend and advisor to Mulroney, had been in charge of setting up the Prime Minister's office. The headline of the advertisement read: "How many thousands of Canadians will die from tobacco products may be in the hands of these two men." Mahood told the Conference on Tobacco and Health, "With the issue now having been identified as a potential patronage issue before millions of Canadians, it was impossible for the government to weaken its resolve to pass a strong bill without being perceived as granting favors to friends." The bill came out of committee stronger than it had gone in.
A mass mailing to the households of over 30,000 constituents of Conservative Member of Parliament (MP) Ron Stewart similarly sought to make public his ties to the tobacco industry. Stewart was one of a number of pro-industry MPs who hoped to gut the proposed Tobacco Control Act in committee. The flyer, written by Mahood and signed by leaders of CCS, the Canadian Council on Smoking and Health and Physicians for a Smoke-Free Canada, pointed out that Stewart was a tobacco wholesaler and accused him of putting his financial interests ahead of the health of his constituents. Stewart withdrew from the committee reviewing the bill.
Reining in the tobacco companies
In 1988, NSRA's work paid off when Parliament passed the first laws regulating tobacco in Canada since 1908 - the Non-Smokers' Rights Act and the Tobacco Products Control Act. The Non-Smokers' Rights Act bans smoking in all federal and federally- funded workplaces, severely restricts smoking on public transportation and bans smoking completely on both domestic and overseas airline flights.
The Tobacco Products Control Act bans all cigarette advertising and promotion in newspapers and magazines and on billboards. Cigarette advertising at points of sale will be prohibited as of January 1993. The Act restricts brand-name tobacco promotion of arts and sports events, and prohibits distribution of free samples and the use of tobacco brand names on non-tobacco items such as t-shirts and hats.
The Control Act also requires that prominent health warnings cover at least 20 percent of both major faces of cigarette packaging. Mahood says that manufacturers have attempted to get around this requirement by printing the warning in colors that do not stand out against one another - such as white on gold. NSRA is working for a provision requiring that the warning be printed in black on white or white on black. The act further requires that the warning list toxic ingredients, and that manufacturers provide the government with data on toxins in tobacco and in tobacco smoke. Rather than reveal these additives, RJR-Macdonald stopped using them, and Philip Morris stopped selling its cigarettes in Canada.
While the two acts are far-reaching, Canadian anti-smoking advocates believe the high taxation of cigarettes in Canada has probably contributed the most to the decline in tobacco use. Since 1985, NSRA and the CCS have pressured the government to implement tax hikes on tobacco products, with considerable success. In a report on cigarette taxation in Canada, Sweanor writes that over the past six years Canada has "gone from having relatively low tobacco taxes to having the highest taxes in the world. In fact, the figures currently available to us indicate that among Canada's 10 provinces, two have higher tobacco prices than are found anywhere else in the world, and all 10 rank within the top 15 tobacco taxing jurisdictions in the world." With federal, provincial and sales taxes figured in, a pack of cigarettes in Canada costs somewhere between C$5.13 and C$6.43.
Critics charge, however, that "sin taxes" on products such as alcohol and cigarettes disproportionately affect low-income and minority communities. Ed Meyers of the Washington, D.C.-based Citizens for Tax Justice says that cigarette taxes are "very regressive" and fall "hardest upon those with the least ability to pay." Meyers says, "We're not convinced the tax code is the place to make social or health policy." And there does appear to be an irony in the Canadian policy - which emphasizes a focus on tobacco companies rather than individual smokers - relying heavily on consumption taxes.
But Mahood dismisses concerns about the regressive nature of high taxation of cigarettes. "I hardly think [it is] enlightened public policy ... to make tobacco more affordable for low-income people," he says, adding that the argument "taken to its absurd conclusion" would call for the distribution of free cigarettes in low-income communities. "There are other ways to assist the poor," he says, without encouraging tobacco use.
Mahood and other Canadian health activists justify their support for high cigarette taxes on the grounds that they are effective. They point, for example, to the Canadian experience between 1980 and 1984, when taxes raised the real price of cigarettes by 25 percent and Canadian per capita consumption dropped 10 percent. (The tax system was removed in 1984 as the result of industry efforts; NSRA first entered the tax campaign in 1985 in a fight to retain the tax.) Teenagers are especially price-sensitive, according to the NSRA and the CCS. If cigarettes are less affordable, "then kids don't start smoking," says Kyle.
The effectiveness of these taxes is blunted somewhat, however, by the ready availability of much less expensive cigarettes across the border in the United States. U.S. tobacco policies in general - far less stringent than those of Canada - obviously affect the success of Canadian efforts. Magazines with cigarette advertisements cross the border, as do television broadcasts of U.S. sports events sponsored by tobacco companies which are free to display their banners, names and logos on the playing field.
Mahood says, "There is no question that [the U.S.] failure to confront the tobacco industry head-on ... can hold us back." And while he is careful to point out that his direct experience involves only the Canadian health community, Mahood does suggest that "some [U.S. health organizations] might look to the Canadian Cancer Society as a model for greater involvement."
Current CCS efforts include lobbying the Canadian Parliament to encourage the U.S. government to implement higher taxes on cigarettes. The CCS is also working to raise the Canadian federal excise tax on tobacco products even higher and to equalize taxes between cigarettes and fine-cut tobacco. Loose tobacco, which is rolled by consumers into cigarettes, contains more tar than manufactured cigarettes and is usually smoked without a filter. Since taxes are lower on fine-cut tobacco, Kyle says "people are being encouraged to substitute a more lethal product" for manufactured cigarettes.
The CCS also hopes to get stricter measures passed that would discourage young people from starting to smoke. The organization is pressuring the Canadian government to raise the minimum age for buying cigarettes from 16 to 18 or 19, to impose huge fines on store owners who sell to minors and to ban cigarette vending machines, from which it is easy for underage smokers to purchase cigarettes.
Canada has had virtually unparalleled success in slashing smoking rates. Mahood notes, however, that for the most part, "the [international] health community has had ... an abysmal record in pursuing new initiatives to tackle the tobacco industry." While he thinks it would be "presumptuous" to tell anti-smoking forces outside of Canada how to run their campaigns, Mahood says he hopes the Canadian experience can serve as a model for other countries.