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"Kobe Declaration" Calls for a Halt to the Tobacco Menace among Women and Children
Health experts and anti-tobacco activists have urged the World Health Organization to fully integrate "special needs" of women and girls into a proposed international treaty on tobacco control. The newly concluded Kobe Declaration was adopted by consensus by some 500 delegates who attended the four-day international conference on women and tobacco hosted by WHO in Kobe, Japan from November 14-18.
The Declaration demands that the Framework Convention on Tobacco Control (FCTC) "include gender-specific concerns and perspectives in each and every aspect" and states that "gender equality in society must be an integral part of tobacco control strategies and women's leadership is essential to success." "We have to work together to ensure the success of the framework convention which will be a powerful public health tool," said Dr Gro Harlem Brundtland, WHO Director-General. "It could encourage States Parties to take appropriate measures to protect children and adolescents from exposure to tobacco by including obligations related to advertising, sponsorships and labeling."
Dr Filomina Steady, Chairperson of the Declaration drafting group and professor of African Studies and Gender Studies at Wellesley College, MA, USA stressed the importance of drawing attention to the potential epidemic of tobacco use in women and girls. "This is the new target population in the developing world that is particularly being recruited in this phenomenon of nicotine addiction. This declaration will feed into the Framework Convention on Tobacco Control to ensure there is a strong gender-sensitive component and that it serves as a mobilizing tool to bring women, NGOs, leaders, politicians, activists and academics into this movement."
The Convention, targeted for adoption latest by May 2003, will be the first legally binding international instrument aimed at curbing the global spread of tobacco and tobacco products. Some of the measures being considered include a ban on advertising, promotion and packaging of tobacco products, raising tobacco taxes, tightening rules to stop smuggling and special anti-smoking education programs targeted toward young people. Dr Douglas Bettcher, Coordinator of the FCTC, acknowledged that more work needed to be done in clarifying and incorporating women's issues into the treaty. "The sorts of general principles outlined in the declaration could provide a guide to drafting aspects of the framework Convention. I think the recommendations and declaration will provide a very firm foundation in this process."
The Conference -- officially called the WHO International Conference on Tobacco and Health, Kobe - Making a Difference to Tobacco and Health: Avoiding the Tobacco Epidemic in Women and Youth -- examined ways to counter the tobacco epidemic among women and youth and focused particularly on the alarming rise in smoking among young women and girls in Asia. For example, a new survey by the Japanese Ministry of Health and Welfare shows that smoking among women aged 20-29 more than doubled between 1986 and 1999, from 10.5% to 23.2%. Of the 1.1 billion smokers in the world, 200 million are women. That figure is set to triple in the next 25 years. WHO has estimated that women account for 500,000 of the 4 million tobacco-related deaths that occur every year. If present smoking trends continue, WHO has warned that by the year 2025, 10 million people per year will die unnecessarily, 70 percent of them in developing countries.
"The greatest preventive potential for the epidemic in the 21st century lies in stopping increased smoking rates among the women of Asia and Africa in particular and among youth," said Dr Derek Yach, Project Manager of WHO's Tobacco Free Initiative. "Usually in public health, we focus where disease and death are the highest. In the case of tobacco, we know there's a lag of often decades between smoking and death rates. If we can stop the smoking rates rising, we know with certainty we'll prevent a massive epidemic in the 21st century."
Conference highlights
While the Kobe Declaration was the most tangible outcome of the conference, there were other highlights. Concentrating its programme around the major themes of prevalence and impact of tobacco on women throughout the life cycle and the determinants of tobacco use among women and young girl, the high points of the conference came at the beginning and the end.
The first highlight was the opening address by the WHO Director-General, Dr Gro Harlem Brundtland, who depicted the tobacco industry as Public Enemy #1. "The tobacco epidemic spares no nation and no people.four million unnecessary deaths per year, 11,000 every day." In the tobacco industry's "programmed trail of death and destruction,.a cigarette is the only consumer product which, when used as desired, kills its consumer."
Dr Shigeru Omi, WHO Regional Director for the Western Pacific, expressed concern over the situation in Asia. "The tobacco industry is turning to the Asia-Pacific region to recruit new cigarette consumers through tobacco marketing that characterizes tobacco use as socially acceptable, fashionable and glamorous," Dr Omi said. While only 8.6% of Japanese women smoked in 1986, that figure had risen to an estimated 13.4% by 1999. He further mentioned that the prevalence of lung cancer in the host country, Japan, had increased 14-fold over the past 40-years. "Last year, 50,000 Japanese people died from lung cancer, which is now the leading cause of cancer deaths," Dr Omi noted.
According to Dr Yach, this was WHO's first major international meeting in Asia since the launch of TFI and the first ever on women and tobacco in Japan. On expected outcomes, Dr Yach highlighted greater unity for the women's movement and the public health community to place tobacco squarely in the center of their agenda. He also drew attention to the fact that serious debate has started now about the government support for, and involvement in, tobacco manufacturing, distribution and sales.
During the conference, participants were given a thorough analysis of both the addictive properties of tobacco, including the deceptive "light cigarettes" - and the alluring properties of marketing which try to make smoking synonymous with slimness, sophistication and women's liberation from traditional stereotypes. Nancy Kaufman's presentation around "Media, fashion and promotion" drew animated audience response.
A substantive high point was Dr Rowena van der Merwe's presentation. Echoing a recent World Bank report, Curbing the Epidemic: Governments and the Economics of Tobacco Control, she presented a strong case for the economics of tobacco control, showing that smoking makes neither good sense - nor good cents. According to World Bank figures, in addition to the cost in lives, tobacco-induced disease and subsequent health care costs result in a global net loss of US$ 200 billion a year - more than the GNPs of Malaysia and Singapore combined.
"Few people now dispute that smoking is damaging to health," she said. It is also damaging to a country's economic well-being. The time is now ripe to "harness economic tools and logic to ultimately.reduce the toll of tobacco." Prevention is the "most effective and cost-effective policy" and will have the most dramatic effect on future trends. However, comprehensive measures to promote cessation are also needed.
The solution, Dr van der Merwe suggested, lies in robust taxation. "Higher taxes are the most potent tool available to balance young people's inadequate perception about the addictive nature of tobacco and their myopic behaviour in discounting the future health consequences of their consumption." She proposed raising taxes to 66 - 75% of the price of cigarettes and pumping these revenues back into such activities as tobacco-targeted health care and counter-advertising campaigns. This proposal was incorporated into the Declaration.
The final press conference, in addition to drawing statements from the conference leaders, featured statements by two very diverse young women tobacco-free advocates. Annika Dulkmark, Miss Sweden 1996, reported on the innovative use of beauty pageants as anti-smoking marketing tools. For example, all Miss Sweden contestants must be non-smokers and part of their responsibilities involves visiting schools as role models to educate 10-14 year-olds on the importance of not smoking. She said that France, Italy, Norway, Iceland, the Miss World and the Miss Universe Pageant (which involves 80 countries worldwide), all have either incorporated or are seriously considering including this tobacco-free advocacy approach.
Tanya Selvaratnam, board member of Third Wave, a foundation for young women, and also Sri Lankan actress, film producer and Harvard graduate in international legal history, offered a poignant personal account about losing her 54-year old doctor father to lung cancer. "We owe it to ourselves and to our young people to watch over them and make sure they don't stray," she said, capturing in that phrase the spirit of the conference and its forward-looking strategies.
Looking towards the future
After reporting on the results of the recent Singapore Consultation on Youth and Tobacco (28-30 September), the conference presenters several upcoming events, including:
- 11th World Conference on Tobacco or Health, 6-11 August 2000 in Chicago, IL, USA. (www.wctoh.org).
- Inter-Governmental FCTC working group, Geneva, 27-29 March 2000
- Beijing Plus Five, 5-9 June 2000, New York, NY, USA
- Millennium Assembly, 22-26 May 2000, United Nations Secretariat, New York.