Who could imagine Paris without its smoke-filled cafes? As it turns out, the French government can. For those who would dare smoke in Parisian establishments, the government has a startling new message: “Veuillez fumer dehors!” French smokers aren’t the only ones stepping outside, however. Smoke-free policies are sweeping the globe.
In 2004, Ireland became the first country to establish a national ban on smoking in all indoor workplaces, including restaurants and bars. Since then, more than a dozen countries have followed suit. For example, France enacted a ban in February 2007 covering offices, schools, and hospitals that will extend to all public establishments in January 2008. The European Union is considering comprehensive smoke-free legislation for all 27 member nations. Meanwhile, more than one-third of U.S. states have enacted smoke-free policies, most of them since 2005.
Connolly, an international ambassador for sweeping policies that safeguard the public against passive smoking, shuttles from one country to the next, conducting local research, coordinating anti-smoking media campaigns, and advising government officials. In many U.S. states and in countries that include Ireland, El Salvador, Greece, China, Taiwan, Philippines, Poland, Armenia, Israel, Thailand, and, most recently, the Mediterranean island nation of Cyprus, Connolly goads policy makers to adopt proven tobacco-control strategies.
“You have to build the capacity to do research locally, then add a heavy dose of aggressive anti-tobacco advertising to foster social change and build enough political will to raise taxes, ban smoking in public places, and offer people treatment for tobacco addiction,” he says, outlining key tactics in a nutshell (see also sidebar on at right). Covering a wall in his office is a world map studded with pushpins, each marking a site where research by HSPH faculty, alumni, and their collaborators is under way.
Connolly honed his approach while heading the Massachusetts Tobacco Control Program, the job he held before coming to Harvard in 2004. Under the leadership of Koh, at the time the state’s public health commissioner, and Connolly, Massachusetts cut cigarette consumption nearly in half. If anyone needed proof that comprehensive tobacco-control initiatives could reduce consumption, this was it. Now, Connolly, Koh, and their HSPH colleagues are increasingly focusing attention on developing countries, where smoking rates remain high and where multinational tobacco companies see enormous markets ripe for exploitation.
Philip Morris has begun a joint venture with the China National Tobacco company to produce Marlboros in the country, Connolly says. As the world’s largest producer of tobacco products, China National Tobacco supplies 1.7 trillion cigarettes to Chinese consumers annually. Warns Connolly: “Both companies stand to benefit from the partnership—at the expense of global public health.” Philip Morris will produce cheaper Marlboros by lowering its labor and manufacturing costs, he says, while China National Tobacco will be able to sell its own cheap brands through Philip Morris’s international distribution system.
By acquiring or linking up with national monopolies in developing countries, transnational tobacco companies are expanding their markets dramatically. “And that,” Connolly says, “is disastrous for the world.”
and children next
Koh stresses that smoke-free policies in developing countries face unique challenges, in part owing to the tobacco industry’s widespread influence. “The industry weaves its message into all segments of society, so initially people may feel powerless to voice their outrage,” he explains. “But fortunately, tobacco control is rapidly becoming a strong and vibrant concept internationally. The 21st century is witnessing a paradigm shift, once considered impossible, whereby entire countries are declaring themselves smoke-free in indoor public places. Mounting progress across the globe is making smoking history worldwide.”
Connolly sums up the key to successful tobacco control with one word: “KILLS—Keep it Loud and Local, Stupid,” he says with a chuckle. “You have to generate local debates, create local science, and empower communities.” Doing that requires a lot of legwork. In resource-poor countries, Connolly and his collaborators use sophisticated yet low-cost, effective technologies to gather baseline data on tobacco risk. Using portable air sampling devices, for example, they measure air quality, including childhood second-hand smoke exposures, indoors and in real time. With digital cameras with GPS tracking linked to Google Search, they can map cigarette advertising near youth-oriented schools, playgrounds, and other locations. They also scour health and economic data to quantify smoking’s death toll and financial impact. Many HSPH students set off to collect this data during the School’s 2007 Winter Session.
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Copyright 2007, President and Fellows of Harvard College