WHO's Tobacco Message
- posted by Jim Leitzel @ 10:39 PM

A couple weeks ago the World Health Organization issued a new report on the "Global Tobacco Epidemic" and what steps to implement to counter it. The toll that tobacco takes (and will continue to take in the future) on health is staggering, with more than 5 million tobacco-related deaths annually, supplemented by the threat that the tab will rise to more than 8 million by 2030. The cumulative impact over the course of the 21st century, according to the WHO, will be hundreds of millions of deaths, and (if that is not sufficient), the toll could be an attention-grabbing 1 billion tobacco-related deaths. (There are more than one billion smokers currently on planet earth.) Today, the New York Times picked up on the WHO report in a special Week in Review graphic, following an editorial earlier in the week calling for the US to submit the 2005 Tobacco Control Convention to the Senate for ratification.

The WHO offers six policies (read about them in this 19-page pdf) to try to stem the tobacco health cataclysm. My concern, of course, is that at least two of the WHO's suggested policies -- public smoking bans and high tobacco taxes -- do not meet standard Vice Squad precepts. (The higher taxes might be OK if the starting point is low.) Eventually, as I note in Chapter 3 of Regulating Vice, harm minimization (or health maximization) and vice policy robustness must always part company. Robustness accepts that there might be benefits available from vice consumption, but a strict harm minimization strategy ignores these putative benefits. There should be limits on how much an adult who chooses to smoke (or drink, or gamble, or sell/buy sex, or...) should be punished or inconvenienced, in the absence of harm to others.

Labels: Regulating Vice, robustness, smoking ban, taxes, tobacco, WHO

 
Cuba Joins the Public Smoking Ban Bandwagon
- posted by Jim Leitzel @ 3:38 PM

Cigarette vending machines have been banned, along with smoking in a variety of public venues -- but the Cuban government still rations subsidized smokes to those over 50.

Cuba has signed but not yet ratified the World Health Organization's Framework Convention on Tobacco Control. The Convention received its 40th ratifier in late November, so it will go into effect soon, 90 days after that 40th adopter signed. Vice Squad reported at the time that Peru had been the 40th ratifier, but that proved not to be the case, sort of. Seems that Syria had beaten the Peruvians to the punch, but they sent their notification to the WHO in Arabic, and it took awhile to get translated. See if you can figure out what happened, here -- Armenia and Ghana were involved in the contretemps, too.

Labels: smoking ban, WHO

 
Peru Proves Pivotal...
- posted by Jim Leitzel @ 7:25 PM

...in bringing the World Health Organization's international treaty, the Framework Convention on Tobacco Control (FCTC), into effect. The treaty needed to be ratified by 40 of the 168 signatories to take effect, and Peru became number 40 on November 30. From the WHO's press release:

The WHO FCTC will enter into force on 28 February 2005, in 90 days. From that date on, the 40 Contracting Parties will be legally bound by the provisions of the Treaty. These provisions set international standards on tobacco price and tax increases, tobacco advertising and sponsorship, labelling, illicit trade and second-hand smoke.

Pre-Peruvian ratifiers include Brunei Darussalam, Cook Islands, and Nauru. The US, like Iraq, Iran, and North Korea, has signed the treaty, but not yet ratified it. Here's the WHO website with the complete list of signatories and ratifiers; the Convention itself is available here.

[Update, February 7, 2005: the pronouncement of Peru's pivotal status was premature! Basically, there was mass confusion at the WHO: here's the amended word.]

Labels: tobacco, WHO

 
Swedish Alcohol Developments
- posted by Jim Leitzel @ 5:38 PM

Vice Squad has been tracking the possibility that Sweden will drastically cut its alcohol taxes, in the face of previous tax cuts in neighboring countries and EU rules that make importing for personal use easy. But not that easy: here's a story of a couple of fellows who ended up in jail when they couldn't explain the 2000 litres of alcohol that they were bringing into Sweden. It would be OK if it clearly were for personal use, or if they had other evidence that they were having a big party. But according to the article, "... it isn't acceptable to tell customs that "you're stocking up your reserves" or that it's been bought "for a large party"..." without supporting evidence.

The Swedish alcohol monopoly, enmeshed in a corruption scandal, is selling less because of the increased border trade -- another factor in making reduced taxes likely:

In September the Swedish Alcohol Retailing Monopoly recorded a 14.2 per cent drop in year-on-year sales. Sales of wine fell by 3.3 per cent, of beer by 4.7 per cent and of cider by 12.2 per cent. The drop in sales is most noticeable in Norrbotten and Skåne where consumers have the opportunity to buy cheap spirits in Finland and Denmark respectively.

Sweden is joining other countries (Finland, Norway, Iceland and Denmark) that have generally had tough alcohol policies and high taxes for negotiations with the European Union and the World Health Organization. Tight regulations do seem to work in terms of limiting consumption:

Norway, Sweden and Iceland, who charge the highest prices for alcohol, are also among the five nations in Europe with the lowest annual consumption of pure alcohol per person.

According to the WHO, people in Iceland annually consume just 4.41 litres of pure alcohol per person.

By contrast, Luxembourgers have the highest consumption with 14.47 litres per year per person, according to the WHO.

Norway, which is not a member of the EU, has the highest alcohol prices in Europe. But after Sweden lowers its taxes, Norway might feel pressure to follow suit, as the prospect of convenient, cheap imports will allow for avoidance of the high taxes.

Finally, the European Commission is coming after Sweden for taxing wine too highly, relative to beer. Why is the Commission sticking its nose into this business? Because most of the beer is locally produced, while most of the wine is imported, so the tax differentials might really be disguised protectionism -- which the Commission is tasked with fighting -- as opposed to a legitimate alcohol control strategy.

Labels: alcohol, EU, free trade, Norway, Sweden, taxes, WHO

 
The Obesity Contrarian
- posted by Jim Leitzel @ 10:41 AM

Today the World Health Organization decided to initiate a global campaign against obesity. Is this a good idea?

Until recently, increased average weight was beneficial for health -- undernourishment was a much more pressing concern than obesity from a public health perspective. This may still be the case in most countries today. In rich countries, however, undernourishment is no longer as severe, while obesity rates have risen. The US has seen major increases in obesity for 40 years, with the bulk of the increase occurring in the last two decades. In March, the US Centers for Disease Control and Prevention released a report claiming that some 400,000 deaths per year were associated with obesity. Surely such carnage should put obesity near the top of our public health concerns.

Or maybe not. Paul Campos, for one, isn't buying it, as indicated by the title of his recent book, The Obesity Myth. An edited excerpt appeared last month in The Guardian, and is available on-line here.

Campos suggests that the standard measure of obesity, the Body Mass Index (BMI), is itself quite flawed. The index is computed by taking your weight measured in kilograms and dividing it by the square of your height measured in meters. A BMI of 25 or more is generally interpreted as signalling an "overweight" condition, while BMIs of 30 or above are generally interpreted to signal "obesity". But as Campos points out, this crude measure leads to absurd results in individual cases: "According to the public health establishment's current BMI definitions, Brad Pitt, Michael Jordan and Mel Gibson are all 'overweight', while Russell Crowe, George Clooney and baseball star Sammy Sosa are all 'obese'." Campos also argues that the scientific evidence does not support the contention that a BMI above 25 is bad for one's health -- though those who are quite obese, with BMI's in the mid-30s and above, are at increased health risk. There is much more to Campos's critique, including a look at those parties (medical and pharmaceutical industries) that would seem to have a pecuniary interest in hyping the dangers of obesity, and the class origins of America's current anti-fat crusade: "The disgust the thin upper classes feel for the fat lower classes has nothing to do with mortality statistics and everything to do with feelings of moral superiority." I highly recommend The Guardian excerpt for those who would like to develop a fuller understanding of Campos's position.

Labels: obesity, WHO

 
Funding Drug Research: Paying the Piper and Calling the Tune
- posted by Jim Leitzel @ 8:42 AM

The Media Awareness Project (MAP) offers this article on the incentives facing drug researchers. The gist of the story is that government dominated funding of research into currently illicit drugs biases the types of studies that are conducted and publicized. In the US, the National Institute on Drug Abuse (NIDA) is the major funder of research involving illicit drugs. The MAP story takes as its point of departure the discredited NIDA-supported ecstasy study headed by Dr. George Ricaurte that helped to promote federal controls over raves: "In his now-retracted study, Dr. Ricaurte was trying to prove something -- that even one dose of ecstasy causes brain damage --which neatly fits drug-war ideology. Not surprisingly, NIDA covered the $1.3 million U.S. cost of the research. In fact, Dr. Ricaurte has been given $10 million U.S. by NIDA over his career. In exchange, NIDA consistently got what it wanted: Research that hyped the dangers of ecstasy."

A major source for the MAP article is Dutch drug researcher Peter Cohen: "In the early 1990s, the WHO asked a group of international scientists, including Cohen, to produce what it billed as 'the largest global study on cocaine use ever undertaken.' In 1995, the study was done. It concluded that most users consume cocaine occasionally, that occasional use usually does not lead to compulsive use, and that occasional use does little or no harm to users. It was a flat contradiction of the drug-war ideology, so the U.S. threatened to pull its funding if the report was released. The WHO buckled. The report was buried."

The problem that the MAP article addresses applies to social scientists working on drug policy, too, it seems to me. Imagine the incentives facing a young PhD in economics (or some other social science) interested in an academic or research career dedicated to drug policy research. It would be very hard for such a person to take a strong legalization position, when research funding is dominated by the National Science Foundation and other organizations that will not be anxious to be associated with what easily can be labeled (or mislabeled) a pro-drug stance. Such a person, sad to say, might even understandably be reluctant to start or participate in a vice policy blog that generally eschews the criminalization of adult vices!

Labels: drugs, ecstasy, WHO

 
World Health Organization Releases Substance Abuse Report
- posted by Jim Leitzel @ 10:21 AM

The World Health Organization has released Neuroscience of Psychoactive Substance Use and Dependence, which it describes in this press release as "an authoritative report summarizing the latest scientific knowledge on the role of the brain in substance dependence." It looks as if the report fully subscribes to the disease model of addiction. The report also re-emphasizes the well-known point that the addictive substances that cause the most health problems are the licit alcohol and tobacco, and not the currently illicit drugs. Of course, in itself, this observation says little about appropriate policy towards any of the potentially addictive substances.

Labels: addiction, WHO

 
Japan Next to Ratify WHO Tobacco Treaty?
- posted by Jim Leitzel @ 5:35 PM

The global tobacco control agreement (pdf version here, 23 pages) worked out by the World Health Organization will come into effect when 40 of the 91 countries who have signed it also ratify it. So far, nine have done so, and Japan appears to be headed to be number 10. The treaty looks to reduce smoking and exposure to smoke through a variety of means, including taxes, packaging regulations, and advertising controls.

Labels: Japan, smoking, tobacco, WHO

 
India to Curb Tobacco Ads
- posted by Jim Leitzel @ 9:25 PM

About 16 percent of India's adult population smokes cigarettes, though
the gender breakdown is amazingly uneven: 2.5% of the women and
29.4% of the men. (In the US, in contrast, more than 20 and less than
30 percent of both men and women (and older youths!) smoke.) The
Indian government now intends to eliminate most forms of tobacco
advertising, according to this BBC report. Sponsorship of sporting
events by tobacco companies is already verboten in India (and many
other countries): "...the new rules would ban tobacco advertisements
on television, radio and the print media."

A comprehensive ban on tobacco advertising has been called for by
the World Health Organization's Framework Convention on Tobacco
Control (pdf version). "With this ban, India will be the seventh
country to ratify the Framework Convention on Tobacco Control
which was adopted unanimously by the World Health Assembly four
years ago." The WHO's current list of parties to the convention only
lists five countries, however: Fiji, Malta, Norway, Seychelles, and
Sri Lanka.

Incidentally, per capita cigarette consumption in India is much, much
lower than in the US, well below what the difference in prevalence
rates alone would lead one to suspect. Indians on average smoke
129 cigarettes per year, while Americans smoke some 2,255. Data
on international tobacco comparisons are available here (pdf format).

Vice Squad, starved for material, has looked at tobacco advertising bans
in the past.

Labels: India, marketing, tobacco, WHO