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AJPH First Look, published online ahead of print Oct 27, 2005
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December 2005, Vol 95, No. 12 | American Journal of Public Health 2120
© 2005 American Public Health Association
DOI: 10.2105/AJPH.2005.073353

LETTER

DISPARITIES IN GLOBAL TOBACCO HARM REDUCTION

Jonathan Nadel, BS, Vaughan Rees, PhD and Gregory N. Connolly, DMD, MPH

The authors are with the Harvard School of Public Health, Boston, Mass.

Correspondence: Requests for reprints should be sent to Vaughan Rees, PhD, Harvard School of Public Health, Landmark Bldg 3rd Floor E, 677 Huntington Ave, Boston, MA 02115 (e-mail: vrees{at}hsph.harvard.edu).

In "Origins of the WHO Framework Convention on Tobacco Control," Roemer et al. present a compelling argument for a unified global approach to tobacco control.1 However, the Framework Convention on Tobacco Control will not benefit nonsignatory countries, which tend to have few or no existing tobacco control measures in place. Indonesia is the only Asian country that failed to sign the treaty. Significantly, Indonesia is also one of the largest tobacco markets in the world, with smoking rates in excess of 60% for adult males and 20% for 10-year-old males.2 Altria, the parent company of US cigarette giant Philip Morris (PM), recently acquired Sampoerna, Indonesia’s second-largest cigarette manufacturer, and appears poised to exploit the virtual absence of tobacco industry regulation in that country.

In the United States, where more rigorous tobacco control measures are in effect, PM appears to be making some progress toward reducing the harms associated with tobacco use. Positive initiatives such as harm reduction, youth smoking prevention, and adult cessation programs are part of a strategy employed by PM in the United States in response to public health initiatives. PM recently announced plans to construct a US$300 million facility in Richmond, Va, to develop "reduced exposure" tobacco products and introduced Marlboro UltraSmooth, a cigarette with a carbon filter designed to reduce toxic gas phase smoke constituents, in test markets.

In Indonesia, more than 90% of cigarettes smoked are kretek, or clove cigarettes. These often unfiltered cigarettes contain a blend of ground clove buds and tobacco and deliver significantly higher levels of tar, nicotine, and carbon monoxide than a conventional US cigarette and much higher levels still than Marlboro UltraSmooth (Table 1Go).


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  		TABLE 1—— Smoke Chemistry Data for an Indonesian Kretek (Clove Cigarette), a Conventional US Cigarette, and Marlboro UltraSmooth
 
Unfortunately, it is difficult to reconcile PM’s expressed commitment to harm reduction with the company’s investment in a product with such questionable health implications in a country with little or no regulation of marketing and sales to minors. PM’s actions in Indonesia cast serious doubt on the company’s purported reforms. PM’s involvement in the Indonesian tobacco market emphasizes the need for public health advocates to pressure multinational tobacco companies to support the principles of the Framework Convention on Tobacco Control. We welcome this momentous initiative. Nevertheless, a truly unified global tobacco control treaty must also have the capacity to prevent transnational tobacco companies from continuing to undermine public health in the developing world.

References

1. Roemer R, Taylor A, Lariviere J. Origins of the WHO framework convention on tobacco control. Am J Public Health. 2005;95:936–938.[Abstract/Free Full Text]

2. Reynolds C. The fourth largest market in the world. Tob Control. 1999;8:89–91.[Free Full Text]

3. Malson JL, Lee EM, Murty R, Moolchan ET, Pickworth WB. Clove cigarette smoking: biochemical, physiological and subjective effects. Pharmacol Biochem Behav. 2003:74;739–745.[Medline]

4. Philip Morris USA. Product facts: tar and nicotine numbers. Available at: http://www.philipmorrisusa.com/en/product_facts/tar_nicotine/tar_nicotine_numbers.asp. Accessed June 29, 2005.





This Article
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95/12/2120    most recent
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Right arrow Articles by Nadel, J.
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Right arrow Articles by Nadel, J.
Right arrow Articles by Connolly, G. N.
Related Collections
Right arrow Public Health Practice
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Right arrow Other Tobacco
Right arrow Tobacco Control

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