Fighting for Lungs and Minds in Asia
TOKYO â€“â€“ The residents of Japan's nursing homes received a special gift on Respect the Elderly Day--15 million cigarettes, distributed by the government-owned Japan Tobacco Co
That few here find the gesture misplaced--even in a country where cancer is the biggest killer--is a clue to why tobacco companies worldwide have targeted Asia as the biggest prize in the high-stakes market for cigarette sales.
But even in a region where up to two-thirds of men smoke and restaurants can be foggy with cigarette haze, tobacco companies are facing an unexpectedly agile anti-smoking movement that is using tools and strategies employed in the American anti-tobacco fight.
In South Korea and Japan, for example, opponents have filed lawsuits against tobacco companies, taking a page from successful litigation in the United States and using research gathered in U.S. courts.
Smoking opponents have pushed Asian authorities for tougher laws. In Thailand recently, the government banned smoking scenes on television. India this month tightened rules on tobacco sales to minors; Vietnam last month barred advertising and "cigarette girls" who hand out samples; while the Pacific Islands have passed strong tobacco control laws.
Even in China, home to a third of the world's smokers, the government has imposed tobacco advertising restrictions, created an Office of Smoking and Health, banned smoking in public places in 11 cities and been unexpectedly cooperative in helping draft an international anti-smoking plan.
"We don't underestimate the battle here; it's huge," said Stephen A. Tamplin, who coordinates much of the Asian anti-smoking efforts of the World Health Organization (WHO) from Manila. "But we're encouraged. We think there's renewed interest in tobacco control."
Stages of the anti-tobacco campaign that took so long in the West--such as marshaling proof of the health consequences of smoking--are moving here more quickly as smoking opponents busily translate the U.S. evidence for use in local campaigns.
"We have tried to overcome some of the awareness issues that took so long to overcome in the West," Tamplin said. Smoking opponents are becoming media savvy and are nurturing activism in non-smokers, techniques that helped sway the battle in the West.
"We have evidence on what strategies work and what works well" from the anti-tobacco campaigns in the West, said Annette David, a WHO technical adviser. Smoking opponents, for example, are demanding strong warnings on cigarette packs. In Thailand, one arresting label warns that "smoking reduces sexual ability." In Singapore, officials are considering putting gruesome pictures of diseased lungs and gums on cigarette packs.
Still, the trend is in favor of the tobacco companies. While cigarette use is dropping in the West, smoking is still on the rise in Asia, increasing faster than anywhere else in the world, according to the WHO.
Smoking rates for women are quite low--a national average of about 8 percent. In many Asian countries, the habit still is considered a stigma of "bad girls," but that is changing, and smoking rates among young women are skyrocketing. The prevalence of smoking among adult men has long been alarming--as high as 75 percent in Vietnam, 66 percent in China and South Korea, 54 percent in Japan and 40 percent in Thailand.
China's annual consumption of 1.7 trillion cigarettes makes it the world's largest tobacco market. "If the war is lost in China, it's lost in the world," said David. American, British and Japanese tobacco companies are jockeying with domestic producers for that market. Philip Morris is building a $300 million cigarette plant in the Philippines, while Japan Tobacco recently trumped American encroachment by paying $7.8 billion for the RJR Tobacco International Division, which sells Winston, Camel and Salem cigarettes in 70 countries.
"We see a good overseas market," said Japan Tobacco corporate spokesman Ryosuke Tsuji. "In some developed countries, sales may not grow dramatically, but we see good potential in undeveloped and underdeveloped countries."
Japan Tobacco, officially privatized in 1985, still is two-thirds owned by the Japan Finance Ministry, which earned $102 million in dividends last year--and another $8.5 billion in national tax revenues on Japan Tobacco product sales. (Excise taxes on tobacco in the United States generated an estimated $5.2 billion last year.)
Government involvement in the tobacco business in Japan, South Korea, China and elsewhere in Asia presents smoking opponents with special headaches. "Tobacco brings a lot of money to the government," said Lee Jakyoung, an environmental health activist in Seoul. "The Ministry of Health wants to promote anti-smoking education in Korea, but they are opposed by the other agencies because of the revenues."
Bae Keum Ja had to name the South Korean government in the lawsuit she and other volunteer lawyers brought on behalf of 31 cancer patients or their kin against the Korea Tobacco and Ginseng Corp., the majority owner of which is the government.
She saw the U.S. litigation unfold while she studied at Harvard Law School, and she got her degree in 1998 with a thesis on how to use American legal theories in her country. "American tobacco companies lied to smokers until 1994; the same thing happened in Korea," Bae contends.
The defendants say they are not worried. The plaintiffs must prove that smoking caused their cancer and that the company concealed known health risks, both of which it denies, said Park Ghyo Sun, one of the lawyers for Korea Tobacco. "And in the U.S., litigation is decided by a jury," Park noted. "Here it is decided by professional judges, who will determine the case on law, not emotions."
Cultural differences often complicate a direct transfer of of American legal tactics. The health advocates who brought suits in South Korea and Japan say it was difficult to recruit plaintiffs because litigation is frowned on in their countries and smokers are loath to face criticism for seeking damages for their decision to smoke.
"In Japan, smoking is still considered a matter of personal habit, not something that kills people. Families still put cigarettes in the coffin of a loved one so he has something to smoke," said Fumisato Watanabe, who helped launch a nationwide hot line to find seven cancer patients who would agree to sue Japan Tobacco two years ago.
Two of the plaintiffs have died since the suit was filed. There are no class-action suits to represent victims and no concept of punitive damages, so even if the plaintiffs persevere through the many years the case is expected to take, the potential reward is low. "We aren't filing for money. We want the Japanese people to know about smoking and the government to change the status quo," Watanabe said.
Even changing smoking etiquette requires cultural delicacy in a region where individual "rights" are valued less than avoiding offense. In Manila, for example, the WHO has launched a pilot program that it hopes to export elsewhere in Asia entitled "It's okay to say you mind."
"The logic is, it is not okay to confront people. But it's okay in a kind, Asian, polite way to ask someone not to smoke," said Tamplin. "It sounds silly, but the distinction is important."
It seems to work, he said. "Despite the cultural fears that saying something will break a relationship, if you say, 'Would you please not smoke' in a polite way, the response you get will not be anger or resentment, but more one of embarrassment, [such as] 'I'm sorry I bothered you.' "
No-smoking areas like those that have proliferated in the West are slowly gaining favor here. Many of the fancier restaurants have such areas, and in South Korea and Japan, even some coffee shops are starting to restrict smoking among patrons who sit elbow-to-elbow in small, crowded spaces. Work spaces, however, remain thick with smoke in many Asian countries.
"I think we're at the point the U.S. was many years ago," said Lee Jakyoung in Seoul. "Sooner or later this all will come."
But it is one thing to have rules, another to enforce them. In Japan, for example, the legal age to buy cigarettes is 20, but with a half-million vending machines on the streets of the country, the law is almost meaningless.
"There are not many people around Asia that are working on tobacco control; there's not the political will," said Varaborn Bhumiswasdi, a public health official in Thailand, which has been an Asian standout in enacting tough anti-smoking laws. This battle still has a long way to go."