RIO DE JANEIRO, Feb. 22, 2006 (IPS/GIN) - Brazil, the world's leading tobacco exporter, cut smoking among its population by 13 percentage points over four years, thanks in large part to some grim advertising images depicting the effects of tobacco use on health.
A photo of José Carlos Marques Carneiro without his legs -- they were amputated in the early 1980s -- can be found on cigarette packages in Brazil with the text: "He is a victim of tobacco. Smoking causes vascular disease and can lead to amputation." The image was also licensed for anti-smoking campaigns in Britain, Japan and the United States.
Carneiro began smoking when he was 15 years old. Today, 44 years later, he is a symbol in Brazil's anti-tobacco fight.
"The first symptoms appeared in 1976, but it was a difficult disease to diagnose and only became evident in 1981, when I felt itching, clumsiness, cold toes, and the sole of my foot burned as if it were frostbitten," Carneiro told Tierramérica.
After several surgeries and gradual amputations, he became active in the anti-smoking effort. Since 2003 his image has been part of several campaigns, under contract with the Ministry of Health, which decided to use photos of "tobacco victims" in its warnings about the threats of smoking to health.
"My joy is knowing that my photo helps prevent children from having a life like mine. I celebrate every cigarette avoided," said Carneiro.
Brazil was able to reduce from 32 percent in 1989 to 18.8 percent in 2003 the proportion of smokers older than 15, thanks to disquieting images -- like the photos of Carneiro -- and to strict regulations imposed on cigarette sales in spite of resistance from the tobacco industry.
Cigarette advertising is limited to the shops where they are sold, non-smoking sites have been expanded, and it is prohibited to use adjectives like "light" on the products to suggest they are less harmful than other cigarettes.
An estimated 200,000 Brazilians die each year from tobacco-related causes.
"The most important victory in the anti-smoking movement was the elimination of social approval of tobacco," says Paula Johns, coordinator of the Zero Tobacco Network (RTZ), a civil society coalition of more than 100 non-governmental, medical and scientific organizations.
A decisive factor in this process was José Serra, minister of health from 1998 to 2002, says Johns. The civil society groups have only organized in the past few years, gathering strength to push for Brazil's ratification of the Framework Convention on Tobacco Control, of the World Health Organization (WHO). Brazil's Senate approved it just a few months ago, in October.
"Future advances depend on a government-civil society partnership," according to Johns.
Another RTZ leader, Paulo Cesar Correia, noted that doctors have played an important role in disseminating information. one standout is José Rosemberg, who in 1979 published the first scientific book about tobacco use as a public health problem.
But despite the important progress made so far, there are numerous challenges on the road ahead.
"Many shopkeepers violate the ban on sales to people under 18 years old, and smoking continues in non-smoking locations because of the lack of enforcement by municipal authorities," says Tania Cavalcante, coordinator of the national anti-smoking program promoted by the Ministry of Health.
Currently, the two biggest cigarette manufacturers in Brazil -- Souza Cruz, an affiliate of British American Tobacco, and Philip Morris -- recognize that their product is "associated with health risks" like cancer, emphysema, other "serious illnesses" as well as dependence on tobacco, justifying the government's right to regulate sales and advertising.
Both companies have taken up actions of social responsibility and harm reduction, and they don't hesitate to underscore that the tobacco industry generates 2.4 million jobs -- directly and indirectly -- in Brazil. An estimated 200,000 families grow tobacco in this South American country.
Crop substitution is one of the challenges Brazil faces, as do other tobacco-producing countries, although not in the short term, given the slowness in decline in demand for tobacco worldwide, say experts.
"The (crop substitution) problem will likely only arise in 25 or 30 years," Vera Costa e Silva told Tierramérica. She led the WHO's Tobacco Free Initiative (TFI) for five years and is now a consultant for Brazil's Ministry of Health.
One priority she stressed at the Conference of Parties to the Convention -- held Feb. 6-17 in Geneva -- is the fight against cigarette contraband. Thirty percent of the cigarettes consumed in Brazil are illegal, which makes the smoking habit cheaper. The tobacco industry has expressed its full support for the anti-smuggling initiative.
Tobacco crop substitution is difficult because "today there isn't anything as profitable as tobacco, especially for small farmers," says Adoniram Sanches Peraci, director of family farming finance and protection at the Ministry of Agricultural Development.
In southern Brazil, to earn the same profit as from two hectares of tobacco, a family would have to grow 10 hectares of maize. But more farmland is not readily available.
Nevertheless, the government is working with small farmers on alternatives, and for now is promoting other crops by offering low-cost credit, at three percent annual interest, compared to 8.75 percent interest on financing for tobacco farms.
Meanwhile, lawsuits against the tobacco industry continue. The Association for the Defense of Smokers' Health (ADESF) filed a class action suit in 1995 against Souza Cruz and Philip Morris in the name of "the victims of deceitful advertising."
ADESF legal director Luis Mónaco estimates that the case could cost the big tobacco companies 52.5 billion reals ($24.4 billion dollars) in restitution payments. "We won two sentences in our favor," he said, adding that the association is confident they will win the final legal victory.
But in the numerous individual lawsuits that ADESF is sponsoring throughout Brazil, the rulings have varied. In Rio de Janeiro a judge denied Carneiro compensation, despite the fact that the amputation of his legs forced his early retirement from work. The judge ruled that when Carneiro took up smoking there was no Brazilian law to protect the consumer.
"Now we will file an appeal in a higher court," said Carneiro, adding that he will never give up.
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