Tobacco Control in Thailand
Vigilance and Diligence
Von Bung On Ritthiphakdee
Thailand is constantly being held up as an example to which the whole Asian region can aspire. It has implemented all of WHO's recommendations and, as a result, has seen an 11% drop in smoking prevalence since 1986. At times Thailand has offered a stark contrast to the rest of the region which is been stalked by the tobacco industry and fettered by distracted governments. Yet as the Action on Smoking and Health Foundation of Thailand enters its second decade of work new threats are emerging and the successes of the past are under threat.
Ten years ago almost sixty percent of Thai men and four percent of Thai women aged over fifteen were smokers. Despite the fact that smoking was largely a pastime of the poor, cigarettes were perceived to be a luxury product, and smoking was associated with wealth and modernity. Thailand was pegged by the industry as a fertile ground for future sales due to its economic growth. It was for this reason that it was one of the countries targeted by the tobacco industry in its bid to open Asian tobacco markets using US Trade law (the notorious Section 301).
The Section 301 case put Thailand's tobacco activists on the world stage and marked a significant turning point in the history of tobacco control in Thailand. Until then there had been no unified effort to combat tobacco use. Whilst a ban on the importation of tobacco together with the restraint shown by the Thai Tobacco Monopoly (TTM) had largely insulated Thais from the powerful marketing strategies of the Transnational Tobacco Companies (TTCs), smoking rates were still too high and the health effects of tobacco use were becoming increasingly common.
With the US cigarette makers' complaint, tobacco became a hot issue in Thailand. Suddenly tobacco was in the news every other day. Thais were enraged by the fact that US companies were trying to replace slipping US sales with greater Asian sales, despite the known risks associated with smoking and the enormous damage smoking had already caused. Since the Thai government defended its exclusion of foreign cigarette companies on health grounds, people began to see the trade dispute as a fight for their right to protect their own health. They began to see tobacco companies for what they are - organisations which profit from addiction and are indifferent to the dangers of tobacco use.
Technically the US tobacco industry won its fight at GATT. They were allowed to start selling cigarettes in Thailand from where they had once been banned. But the case gave Thai tobacco control activists the momentum with which they were able to lobby for the passing of two key pieces of legislation - the 1992 Tobacco Products Control Act and the 1992 Protection of Non-Smokers Act. It also saw the baptism by fire of the Action on Smoking and Health Foundation of Thailand, which had been founded only a few years before.
Today Thailand still leads the way in efforts to control tobacco through legislation, taxation and community education, but the uproar has subsided and tobacco is beginning to be shuffled to the sidelines as issues such as AIDS, and the so-called 'hard' drugs, take the spotlight away from smoking. This is despite the fact that smoking is one of the kingdoms leading causes of death. And the consequences of this are visible. There has been an increase in smoking prevalence amongst young Thais in the past three years. Young women are a particular worry. The upward trend was borne out in a 1997 study by Yuwala Khansa which showed that nearly 5% of female high-school and vocational students were smokers. This is double the national female smoking rate of 2.5%. Fears that this may be associated with the entry, and increased prominence, of foreign brands were attested to by the finding that nearly 70% of these young women indicated a preference for Marlboro.
The changing political climate in Thailand is not obvious. Thailand has just passed the ingredients disclosure amendment and new, stronger pack warnings, including the world's first warning that stated that smoking leads to impotence. But these movements do not disguise the fact that the Thai government has become complacent to tobacco control. The tobacco control budget, always meagre, has declined even further, government policy on tobacco is vague and shackled by often changing leadership and a lack of enforcement of the legislation already passed has become a major problem.
The non-government sector in Thailand plays an important role in tobacco control but it must work within a severely limited budget. The Action on Smoking and Health Foundation, which is often held up as an example of successful tobacco-control, runs its entire operation on less than US$ 100,000 per year. The economic crisis of the past year has put further strain on this tiny organisation. The funding restrictions shackle the organisation and inhibit its further growth. Many projects remain small scale despite their success.
Industry shifts to more insidious promotion
As can be expected from an industry known for its survival instincts, the tobacco industry is taking full advantage of this lapse in concentration. This time they are not overseeing a marketing blitz or a high profile court case, instead they are shrewdly shifting their game plan to a more insidious type of promotion.
A lack of knowledge about restrictions on point of sale advertising by shop owners, in conjunction with a lack of enforcement by public health officers, has meant that the amount of advertising in shops is increasing. This has been done by providing cabinets, emblazoned with distinctive brand colours (and sometimes graphics) and stickers. The cabinets are free and ensure a neat, eye-catching display for the cigarettes.
The amount of indirect marketing, particularly brand stretching, has been increasing markedly over the past 3 years. The most prominent example is Camel Trophy clothing. Camel Trophy clothes are sold in upmarket department stores and in separate Camel Trophy shops. The ubiquitous Camel Trophy sticker adorns almost every 4x4 sold in Thailand. The company's close connection with off-road activities extends to the promotion of Camel Trophy clothes through off-road magazines and ensuring a high profile at 4x4 events. So 'high' in fact that it is hard to believe that the relationship cannot be characterised as sponsorship. In this the TTC's are not only taking advantage of lax enforcement but also in legislative loopholes that do not forbid the use of minimally altered tobacco brand names and images.
One of Thailand's recent successes was the introduction of the new health warnings. Due to the 'newsworthy' nature of the warning (ie smoking causes impotence) the issue was given considerable media and public attention.
Thailand offers a timely reminder that tobacco control is only truly effective when it is able to effectively utilise every weapon at its disposal. It is not enough to pass legislation - you must enforce it, and it is not enough to merely have a grassroots campaign - you need to adequately resource it. And whilst national political support is indispensable, so too are international allies. Thai and international tobacco control advocates cannot allow admonition to restrict future progress. We need genuine, renewed government commitment to tobacco control and enough resources to allow government and non-government organisations to run effective campaigns.
*Ms. Bung On Ritthiphakdee is Director of the Thailand Action on Smoking and Health Foundation.