In rich countries, the Marlboro Man rode into the sunset long ago. But here in Cambodia, and in poor countries around the world, he still rides tall in the saddle.
Advertising campaigns like Philip Morris’ Marlboro Man have drawn the most controversy and debate as public health officials move closer to ratifying a global treaty that proponents claim would help Third World countries like Cambodia get a grip on a looming public health crisis.
Among other features, the Framework Convention on Tobacco Control would require countries to regulate tobacco advertising, forbid its sale to children, raise taxes on tobacco to keep it out of children’s hands and require warning labels on tobacco products. The 191 members of the World Health Organization, which drafted the treaty, are expected to ratify it by May 2003, officials say.
The question of advertising has been the hottest item of the framework, especially here in Cambodia, and it has reopened an old debate on whether or not smoking has a place in society.
On one side are public health officials and anti-tobacco activists, who say cigarette companies turn customers into victims by hawking a deadly product through slick ads like the Marlboro Man. On the other side are tobacco companies and advertisers, who say they are merely keeping their customers satisfied.
“The fact is, there are adults who like to smoke our product,” British American Tobacco spokesman Kin Lum said.
The stakes are enormous, and not just for Cambodia. Billions of smokers worldwide face risks of long, slow, painful-and expensive-deaths. But then, advertising is a multi-trillion dollar business worldwide and one of the few industries poor countries can develop on their own and immediately-since ads have to be done in native languages and local dialects.
Large tobacco companies do not oppose the treaty, but they say they want it to reflect “reasonable” goals that take broad factors into account and do not have a “one-size-fits-all approach,” Kun Lim said.
Other tobacco firms have voiced similar concerns.
“There are no easy answers to the problem of youth smoking,” the Philip Morris Web site states. “Our experience has taught us that no single approach or program can be executed on a global scale.”
A meeting of Asean officials in Bangkok earlier this month, which included five delegates from Cambodia, gave broad endorsement to the treaty, calling it a way of meeting “social obligations to place human health and general well-being as a top priority.” But the delegates refused to back the total ban on advertising that most anti-smoking groups have demanded, drawing fire from public health activists.
In a release issued the day after the meeting ended, the Framework Coalition Alliance, an umbrella group of hundreds of pro-treaty groups, called the Asean statement on ads “a step backwards.”
Ironically, the country who fought off the ad-ban plank was Singapore, which itself bans tobacco ads and has some of the strictest anti-tobacco laws in the world. Some critics have suggested Singapore bowed to pressure from Big Tobacco-the huge cigarette conglomerates, many of whom make Singapore their regional headquarters.
Banning ads could make a huge difference in Cambodia, the only Southeast Asian country not to regulate ads, a country with comparatively loose anti-tobacco legislation-and a country with what many say is a huge smoking problem.
“There are great opportunities to make strides in Cambodia because there’s been so little progress,” one WHO official said.
Though a relatively small country, more than 60 percent of Cambodia’s people smoke, Health Promotion Center Director Lim Thai Theang said.
“In a global sense, any country with such a high prevalence rate is going to be a priority,” the WHO official said.
Anti-tobacco campaigns have taken on urgency as smoking rates for Cambodia, and Asia, have continued to rise. According to statistics from the Framework Convention Alliance, the Asia-Pacific region was home to 35 percent of the world’s smokers in 1995. Today, the region accounts for nearly 55 percent of smokers worldwide. These figures represent a public health crisis waiting to happen, authorities say.
Cambodia’s smoking rate is already having an impact. More than 5,800 Cambodians die every year from smoking-related diseases, according to WHO figures. At least 24,000 people have died from smoking-one death every hour and a half-and a total 73,500 people will have died from smoking in the 10 years leading up to 2007, according to statistics from both the Advantage Development Release Agency and the WHO.
Yet, for all of that, the damage from smoking here is still relatively small, compared to deaths from diseases like malaria. The average Cambodian can expect to live around 54 years, according to government statistics. Smoking-caused diseases like heart disease, emphysema and lung cancer are not yet leading killers here because people simply don’t live long enough to die from smoking.
Anti-tobacco activists counter that the whole point of the treaty is to prepare Cambodia for the time when people will live longer and to give the country a jump-start on tobacco control.
“If we start phasing out advertising from next year, we can develop the young generation and get them to stop smoking,” Ministry of Information Undersecretary of State Pov Yada said.
The treaty gives a “grace period” for poor countries to adjust to the new pledges, but Cambodia has already promised to get in line. The government has ordered television and radio stations to rid themselves of tobacco ads by May of next year.
But some treaty critics say tobacco can’t be cast just in terms of public health, especially in a country still trying to pull itself out of three decades of civil war. As much as anything, some say, tobacco is an economic issue.
Nearly 45,000 people depend on all or part of their family income from British American Tobacco alone, Kun Lim said. The company has invested $25 million in Cambodia since 1996-even as foreign investment in the country has continued to decline in other sectors.
Tobacco also has ripple effects on the economy-for instance, the way it supports local advertising industries. A ban on ads, some critics say, would deny poor countries like Cambodia access to one of the few growth industries available to them immediately.
“If there’s no cigarette advertising, my television station will be in financial crisis. We don’t have partners from overseas to help us,” Bayon television General Director Thai Norak Satia said.
Television and radio executives around Cambodia have expressed dismay at the Ministry of Information directive banning tobacco ads by next year. Bayon alone stands to lose 40 percent of its revenues, Thai Norak Satia said. Other stations around the capital said they on depend on tobacco ads for between 10 percent and 40 percent of their income.
And then there are the low-level tobacco sellers, like Phnom Penh vendor Sok Ry, 46, who sells cigarettes from a small, wheeled case on Sisowath Boulevard. Her cigarettes go for between $0.05 to $1 per 20, and she needs that meager income. She’s afraid the treaty is designed to crush her business.
“If the government stops me from selling, I can’t survive. I’m very poor,” she said.
Pro-treaty forces have two responses to the economic argument. First of all, despite company claims, local people do not benefit from tobacco production, they say. According to the World Bank, Big Tobacco has tightened its grip on tobacco production, mechanizing jobs and taking control away from farmers worldwide, usually placing their growers in spiraling cycles of dependence.
“Far from growing rich from their work, many of those working in tobacco are facing multi-generational poverty compounded by illiteracy and poor health,” a statement from Canadian anti-tobacco group PATH said.
Moreover, tobacco may even make the poor poorer, some treaty supporters say.
Cambodians already spend between 8 percent and 11 percent of their income on tobacco, the WHO reports. In a country where the per capita income hovers around $284 per year, buying tobacco means not buying food, public health officials and activists say.
“It’s an issue of poverty,” the WHO official said.
Besides, using poverty in an argument about tobacco misses the point, anti-tobacco activists and officials say.
“The big point is this affects the health of kids. This affects public health overall. And it affects poverty,” the WHO official said.
Tobacco firms say they are not threatened by the treaty, but are worried about what they see as the imperious tones some anti-tobacco activists have used in pushing for ratification. Too many public health activists treat tobacco companies as enemies instead of potential partners, as tobacco companies see themselves.
For instance, British American Tobacco, like many large tobacco firms, has already implemented advertising controls that are “far ahead” of the proposed treaty and they deserve recognition for it, Kun Lim said.
“We’ve pulled down our billboards. We don’t advertise on TV. We are saying we are only targeting adult consumers,” Kun Lim said.
These efforts make a big difference, especially in the 114 WHO member countries which, like Cambodia, have little or no regulations on cigarettes, the Philip Morris Web site states.
For many health advocates, though, this is all too little, too late.
For generations, Big Tobacco, especially in the US, denied that their products killed people. They spent billions on deceptive advertising and public lobbying, tied up anti-tobacco legislation in courts and were accused by industry insiders and public health officials of lying about the dangers of cigarettes and giving false testimony in public hearings.
It took multi-billion dollar lawsuits from officials in various states in the US to get tobacco firms to admit, grudgingly, what most people had known for years: Cigarettes are addictive, and cigarettes are deadly. (Since 1999, most major firms, including Philip Morris and British American, have acknowledged the “risks” of smoking.)
So after years of poisoning both public debate and their customers, tobacco firms have lost their right to participate in treaty discussions-even if they claim to have repented, pro-treaty activists say.
“It’s the public health community that should be making public health decisions,” the WHO official said.
Tobacco companies say they have learned their lesson and now acknowledge the “risks” in using their products. Now they say they have much to offer the public health community-if only they are listened to.
“We believe and we understand the WHO’s job is to look after the health of the people. All we’re asking for is some kind of mutual discussion,” Kun Lim said.
Beyond the specifics of the treaty, another argument lies just beneath the surface. Increasingly, some have argued the anti-tobacco backlash has gone too far and has become a movement not to stop cigarette companies’ abuses, but a movement to stop smoking-even for those who actually enjoy it.
In Cambodia, after all, people have been smoking since long before Big Tobacco started bombarding the country with slick marketing, some have argued.
“People aren’t affected much by cigarette advertising, because Cambodian people have been smoking for such a long time,” Phnom Penh Municipal Television station Director Kham Poun Keomony said, adding his station is not threatened by the ad ban, since they get less than 10 percent of their revenues from cigarette companies.
And as long as people are aware of the risks of smoking, some critics say, all of the public health warnings and ad bans in the world won’t make a difference.
“I understand that smoking cigarettes can harm people’s health-but for me, I just sell. If people who buy the cigarettes don’t want to think about their health, that’s up to them,” Sok Ry said.
It is on the question of choice that much of the smoking debate hangs. To some, the issues are, first, whether or not people can actually enjoy smoking and second, whether those who do so are entitled to a place of their own. Yes, critics say, smoking is addictive. But it is also-for some-enjoyable.
“In our view, an informed decision to enjoy smoking while balancing that enjoyment against the risks is no more [open to] criticism than many other lifestyle choices we all make,” a British American Tobacco pamphlet states. “We will continue to support that right and to lawfully and responsibly conduct our business.”
But free speech applies to individuals, not to multinational corporations, the WHO official said. “Besides, smokers are certainly not in the minority in this country. We believe governments have the right to regulate tobacco.”
Fine, tobacco companies counter, so long as the goal is to protect public health and not to take cigarettes out of the hands of even those who want them. If the latter motive is driving some of the proposed regulations, it could have disastrous consequences, some treaty critics say.
For instance, calls for higher taxes on cigarettes could lead to smuggling in Cambodia, which would actually mean less regulation of tobacco, since market pressures force cigarette companies into international standards of quality control, British American executive Thierry de Roland Peel said.
As it stands, 30 percent of Cambodia’s tobacco market already consists of “hand-rolls”-homemade, cheap cigarettes of the kind vendors like Sok Ry sell, de Roland Peel said.
“What’s going to happen to all those responsible companies?” he asked.
The past sins of tobacco companies, treaty critics acknowledge, have handicapped them in the debate over whether smokers are to have a place in society.
Tobacco officials admit their industry’s record continues to cost them in public relations-but they insist times have changed and point to their internal advertising standards that include promises not to target young people, feature celebrities or make use of endorsements, as proof.
“Tobacco has been getting bad publicity for years. [But] we’re already ahead. We’re quite hard on ourselves” with new controls and codes of ethics, de Roland Peel said.
But as the death count from tobacco, here and abroad, continues to rise, that’s just not enough anymore, treaty proponents say.
“It’s not just an issue of adult choice,” the WHO official said. “Tobacco remains an addictive product. And once people are addicted, it’s no longer a choice.”