[Intl-tobacco] Frenk Open Letter to the Global Tobacco Control Community

[robert weissman]

*From:* Matt Myers, Campaign for Tobacco-Free Kids

There have been a significant number of communications concerning Dr.
Julio Frenk, the Health Minister from Mexico, who is a candidate for the
position of Director General of the World Health Organization. Today I
received a letter from Dr. Frenk discussing his position on tobacco, the
FCTC, what has taken place in Mexico and that expresses his opposition
to voluntary agreements with the tobacco industry. A copy of the letter
is attached to add to that discussion for everyone's review and
consideration.
To the best of my knowledge, this is the first time that tobacco has
been a significant enough issue on the world health agenda that it has
risen to be a consideration in the criteria for the selection of a new
Director General. This is a very positive development. Hopefully, the
position of each candidate on tobacco, the priority to be given to the
FCTC at WHO and the need for strong legally enforceable legislation at
the country level to implement the FCTC will be among the issues that
every member considers when casting their vote.
----

October 30, 2006


Open Letter to the Global Tobacco Control Community:

I would like to outline tobacco-control policy in Mexico during my
tenure as Minister of Health and to unequivocally state my determination
to support and invigorate the Framework Convention on Tobacco Control
(FCTC) if elected Director-General of the World Health Organization.

I am firmly committed to the fight against tobacco. From 1998 to 2000 I
had the privilege of serving in the Cabinet of Dr. Gro Harlem Brundtland
at WHO and was therefore involved in many of the discussions around the
formulation and implementation of the Tobacco Free Initiative. This
experience helped me to make tobacco control one of the top priorities
when I was appointed as Minister of Health of Mexico in December, 2000.
In my first speech at a celebration of World No-Tobacco Day, on May 31,
2001, I launched a direct attack on the tobacco industry. Specifically,
I demanded from multinational companies that they observe the same rules
of behavior in Mexico as they have in their home countries (i.e., the
United States and Great Britain). Such language was unprecedented in my
country and signaled my determination to stand up to very powerful
interests.

That marked the beginning of several important measures that were
adopted even before the Framework Convention on Tobacco Control (FCTC)
was approved by the World Health Assembly in May 2003. Subsequently,
Mexico became the first country in the Americas to ratify the FCTC.
Throughout this process, I was able to implement key actions to address
the tobacco epidemic in my country, including the following:

1. Large increases in the taxation rates of tobacco products, amounting
to a 5-fold increase for unfiltered cigarettes (from an excise-tax rate
of 20.9% in 2000 to 110% in 2005) and a one-third increase for filtered
cigarettes (from 85% in 1999 to 110% in 2004);
2. since January 1, 2003, a total ban on tobacco publicity in the radio,
television and Internet, as well as major restrictions on printed media;
3. a substantial increase in the size of the warning label, from small
texts on the side face of cigarette packs to 50% of one of the frontal
surfaces;
4. a 7-fold growth in the number of smoking-cessation clinics, from 36
in 2000 to 250 in 2005;
5. restrictions on smoking in federal government buildings;
6. implementation of a program to strengthen prior norms on tobacco-free
schools, including a national health-education campaign on the dangers
of smoking directed to children and youth, greater limits on sales of
cigarettes near educational institutions, and a total ban on smoking
within school grounds;
7. prohibition of the sale of cigarettes in drugstores and to persons
under age 18;
8. on-going mass-media campaigns against tobacco which are reinforced by
health education undertaken throughout the national health system.

Although they must be taken further, this initial set of measures
reflects my full commitment to tobacco control and has begun producing
positive results, among them the following:

=95 Between 2000 and 2005, total cigarette sales decreased by 3.5%,
according to official figures from the Ministry of Finance.
=95 Between 2000 and 2005, the proportion of adolescent smokers decreased
from 9.2% to 7.6% (a 25% reduction in the proportion of adolescent male
smokers and a 20% reduction in adolescent female smokers) (data from the
National Health Surveys of 2000 and 2005, see www.insp.gob.mx).
=95 There was a decrease in the prevalence of smoking among adults (18 -65
years) between 2000 and 2005 (data from the National Health Surveys of
2000 and 2005, see www.insp.gob.mx).
=95 The voluntary certification of more than 800 government buildings as
smoke-free has benefited approximately 100,000 persons.

After the above=96mentioned measures had been implemented, an additional
levy was introduced in the form of an increase in the price per
cigarette package that is earmarked for health actions. This levy was
imposed on the tobacco industry through a limited agreement valid until
December 2006.

It is this agreement that has generated concern among several groups
committed to tobacco control. Let me say that I understand such
concerns. However, I would like to reassure the public health community
that the agreement responded to specific legal of my country,
particularly certain provisions that allow citizens and corporations to
contest in courts and therefore delay the adoption of any action by
government authorities.

Furthermore, it is important to mention that the agreement has a limited
duration (until the end of this year) and will not be renewed. The
Ministry of Health is currently preparing legislation to be submitted to
the Congress in order to further advance tobacco control through several
key actions, among them the following: the levy imposed by an earmarked
increase in price of cigarettes will be incorporated into the fiscal
law; all advertising will be banned with a defined phase-in schedule;
full disclosure of ingredients in cigarettes will be required; cigarette
pack label warnings will be increased to 100% of one of the frontal
surfaces along with pictograms. Thus, the agreement was never meant to
be a substitute for strong legislation, but rather a tactical move to
facilitate its adoption and enforcement.

In summary, Mexico entered into the agreement because of unique
circumstances in Mexican law, because it was strictly time limited, and
solely as a strategy to enable Mexico to then adopt a strong law that is
mandatory and fully complies with a rigorous interpretation of the
Framework Convention on Tobacco Control (FCTC), thus reinforcing
previously adopted legislation on the matter as explained above. I do
not believe the experience in Mexico can be generalized to any other
country, nor should it be seen as a precedent or as support for the use
of voluntary agreements with the tobacco industry.

The way ahead is clear. If elected Director-General of the WHO I will
strongly oppose any voluntary agreements with the tobacco industry. I do
not believe that such voluntary agreements comply with the requirements
or the spirit of the FCTC. As I have already stated in my platform, I
will make full implementation of the FCTC a major priority, and I will
increase technical assistance to governments in this crucial area of the
work of WHO.

As a proud and dedicated member of the public health community, it is
very important to me that there be no doubt about my full commitment to
our shared mission: the full control of tobacco use as the most
effective way of preventing the burden of death and disability caused by
smoking throughout the world.


Julio Frenk, M.D., Ph.D.
Minister of Health of Mexico