I. Introduction:

The Environmental Action Network is a public interest litigation group engaged in the regulation of tobacco. By the regulation of tobacco we mean that the smokers should be fully informed of the risks of their habit and should not be mislead by advertising. Non-smokers should be protected and those who want to quit should be supported. Further that our environment should be protected.

Smokers and tobacco growers are not the enemy. Too often smokers are as much victims as anyone else. Many struggle with addiction and want to quit. For tobacco growers they need to survive.

Regulation of tobacco is the regulation of an industry. It is necessary to curb the tobacco related death, disease and debility that is decimating mankind at the rate of 4.2 million people per year. It presents a unique challenge for unlike other disease control efforts, the disease vector here is a multi-billion dollar industry. The control of malaria would be a whole different prospect if mosquitoes started paying taxes. The tobacco industry has known far longer than anyone else, the dangers of their products. They have lied, distorted the truth and resisted any attempts at regulation.

This paper examines the tobacco industry tactics in Uganda. We will begin with an overview of Uganda's socio-economic circumstances, the status of tobacco control and then focus on the behaviour of the tobacco industry.

II. Uganda and tobacco:

Uganda is the smallest East African country with an area of 236,040 square kilometres and a population estimated at 24 million people. Our GDP is approximately $ 6.2 billion per year making a per capita GDP of approximately US.$ 260. Between 1990-1999, Uganda averaged an economic growth rate of 7.1% per annum. The percentage of the population in poverty fell from 55% in 1995 to 35% in the year 2000. Tobacco is our second largest cash crop, grown in over 16 of our 60 districts.

The history of the tobacco industry in Uganda dates back to the early 1920's and until recently that history has been the history of British American Tobacco having over 90% market share. BAT contributes approximately 8% of the taxes collected per annum, approximately US. $35 million and approximately 600,000 people are engaged in the industry. Following the divesture of the Government interest in it, BAT converted to a public company and is listed on the Uganda Securities Exchange.

In the last couple of years more players have been licensed to manufacture/import tobacco products in Uganda; Mastermind Tobacco Limited (manufacturer of Supermatch) and Taaba Limited (importer of Boss). The resultant competition in the purchase of raw leaf tobacco is said to have spurred Government to consider inviting yet another manufacturer.

Smoking prevalence amongst adults is estimated at 52% for males and 17% for females. Among the youth, 14-18 years it is estimated at 58%. Per capita consumption of cigarettes is approximately 150 units. The health warning on cigarette packets "cigarette smoking can be harmful to your health" perhaps best indicates that the health risks of smoking in Uganda are not well understood. A study completed last year at the main referral hospital found that 75% of the victims of oral cancer had a history of smoking with some having smoked as little as 2 years. Acute respiratory infections are the second leading cause of infant visits to health units and third commonest cause of infant deaths accounting for 8.2% of the infant deaths. Cigarette smoke is identified as one of the causes of acute respiratory infections.

Speaking on 7th April 2002, World Health Day, the Minister of Health noted an increase in non-communicable diseases such as asthma, diabetes, cancers, heart and cardio-vascular diseases, stroke and hypertension. No mention was made to the linkages of these diseases to tobacco and in keeping with the theme of the Day, the Honourable Minister prescribed more physical exercises for Ugandans.

Clearly the Revenue Authority keeps better records than do the hospitals and the Honourable Minster of Finance gets to announce them every year.

Our pro-investment President Yoweri Kaguta Museveni, has twice expressed doubt on the links between cancer and cigarette smoking. Not even his Senior Presidential Advisor who doubles as BAT Board member has whispered to him that BAT now admits that smoking comes with serious risks of lung cancer. His Excellency has defended cigarette makers and blamed Ugandans for copying European habits badly. He stated that the problem was not with cigarette but "how people smoke". He stated further;

"People should smoke, but they should not swallow the smoke. Smoking while swallowing the smoke is a European practice. May be the problem is with the way you smoke. Although I don't smoke you could possible hire me as a Consultant on smoking……."

More recently the President poured scorn on the tobacco-cancer link citing the case of his father who has smoked for over 70 years "but has never got cancer".

The President recently praised the revenue generated by BAT and saying that if he had 1,000 BATs his economic problems would be over! This is an opinion also expressed rather graphically by a 2nd Deputy Prime Minister who stated "BAT is the best milk producing cow in Uganda." On a separate occasion the same Deputy Prime Minister acknowledged the risks of smoking;

"Really nobody is forced to smoke. But if you do, then we welcome you because we shall get taxes from you. It is optional to smoke. Smoking is like drinking alcohol or travelling by air. Everything in this world is risky".

The 2nd Deputy Prime Minister hails from a District that derives 70% of its revenue from tobacco. In recent peace talks between a rebel group operating in the area and the Government, one of the demands by the rebels was for a cigarette factory. Guns or cigarettes, they will still be killing Ugandans.

On each occasion of such unfortunate utterances, the Uganda Medical Association has not responded. However they recently demonstrated their concern for public health by writing in the press on road safety issues!

The Framework Convention on Tobacco Control (FCTC), remains a quiet matter for the Ministry of Health and it is highly doubtable if it has even been discussed widely within that Ministry. Certainly no mention is made of tobacco at all in the recent donor approved 5-year health plan, nor was the FCTC mentioned in the recent World No Tobacco day speech, despite our suggestions.

This is the backdrop against which the fight for tobacco control is being waged. A lack of political commitment and a lack of data.

III. Tobacco regulation in Uganda

In addition to the Ministry of Health, the tobacco control lobby comprises a mix of lawyers, journalists, radio presenters, doctors, students, Uganda Medical Association and NGOs. There is no full-time tobacco control person in Uganda, even within the Ministry of Health. The Ministry of Health runs the Tobacco or Health Forum, which is intended to serve as a clearinghouse for tobacco control activities. It is a very loose alliance of persons interested in tobacco control. ToH activity peaks around World No Tobacco Day and slumps quite badly after that.

The tobacco control measures in place in Uganda have been arrived at mostly by concessions from the tobacco industry. The wording for the 14-year-old cigarette warning labels, "cigarette smoking can be harmful to your health" was proposed by BAT, who refused to accept a stronger warning on the grounds that they did not believe that cigarette smoking was harmful to health and further that stronger warnings would actually encourage youth to smoke.

In 1995, the Government prohibited its television and radio stations from carrying tobacco adverts. This restriction did not affect the more popular private radio and tv stations.

The Ministry of Health premises were declared smoke free in the year 2000. Those of us who work elsewhere are left wondering the Honourable Minister of health will deem us fit for protection from the dangers of secondhand smoke.

On the eve of World No Tobacco day in 2000, BAT launched the Courtesy of Choice programme in prime hotels and restaurants in Uganda. This entails a simple separation of smoking and non-smoking areas in public places.

Uganda is in its initial stages of a not too well conceived plan to prepare tobacco control legislation. While we are now moving to a second draft of the legislation, there is absolutely no documentation to assess the magnitude of the problem sought to be controlled in the legislation nor is there any documentation to support the measures prescribed in the draft legislation.

IV. Industry tactics;

The tobacco industry's deliberate use of manipulation, deceit and deception to advance their selfish quest for profit has been well documented using their internal documents. What we recount below is the industry behaviour in Uganda.

· Controlling the agenda

It is only to be expected that given its favourable position in the public and political eye in Uganda, BAT would seek to exploit this advantage to the full. "we have changed…. we are a responsible company…" was the rallying cry for the Corporate Social Responsibility programme.

In a series of meetings, chaired by a leading newspaper editor, BAT assembled top bureaucrats, politicians, opinion leaders, doctors and farmers for advice on how it should improve its image. By making token concessions and promising to launch a youth smoking prevention campaign, BAT emerged smelling of roses. Those of us who refused to attend the meeting were branded as extremists with a hidden agenda, while BAT positioned itself as taking care of the situation. The message was largely that there are other problems that Government should remain focused on such as malaria and AIDS. BAT is already handling the tobacco problem and there is no need for Government to spend its precious resources on that.

To understand the success of this strategy one has to know our bloody history. We have had many wars and many rebel groups. Peace talks and compromise have become a large part of our approach to conflict resolution and BAT is playing on this. We talk to rebels who have been killing innocent children and cutting of people's limbs, ears and noses. What could be so terrible about talking to a "responsible" and generous company, a leading taxpayer and employer, selling a legal product? Besides the meetings are held in plush hotels, at the company expense with an allowance for attendance.

· Influence peddling

TEAN has had a more personal taste of BAT's influence peddling. Last year, TEAN filed a suit in the High Court of Uganda, seeking declarations that smoking in public places violated non-smokers constitutional rights to a clean and healthy environment and to life. The suit was filed against the Attorney General and the National Environment Management Authority. BAT immediately applied to be joined in the suit. Gladly, the application was dismissed. The Attorney General then sought to have the suit dismissed on various technical points that bore remarkable similarity with arguments that we had heard before from the industry lawyers. That application was also dismissed. Then a smoker applied to join the suit claiming that his rights would be infringed by the orders sought by TEAN.

It came as a big surprise to learn that the smoker was an employee of BAT. He was using the same industry lawyers in Uganda and in England. Using a report by a renown BAT expert, he disputed the science on the dangers of second hand smoke and argued for smokers freedoms. At one stage of the proceedings we were told that the smoker had left his job and that his lawyer could not reach him. He was found when the Judge put down his foot.

We attempted to negotiate the matter and we were obliged to consult the smoker's lawyer. What we proposed were declarations that smoking in public places was a violation of non-smokers rights to life and to a clean and healthy environment and a simple list of public places in which smoking was to be banned. While the Attorney General and the Environment Authority were agreeable, the smoker's lawyers disagreed on almost each and every point. They were dead set against the declarations and came up with all sorts of reasons to oppose the smoking ban. Even in hospitals, they suggested that the sick patients should be allowed access to smoking rooms.

We chose to stick with the declarations and file the consent without mentioning the public places in which smoking was to be banned. However, the Court declined to enter it precisely on this ground that it did not go far enough to protect non-smokers. This allowed BAT to once again swing into action. After a series of meetings between BAT and the Respondents, we received a letter stating that the Respondents had withdrawn from the settlement. The case was immediately re-assigned to a more senior Government lawyer.

None of the media outlets would run our protest against the industry interference despite our best efforts. The Judge however was more resolute and he was brooking no interference. Pending a decision on whether or not the smoker be allowed to join the suit, the Judge directed the parties to hold a meeting and agree on the public places in which smoking should be banned. The Judge further directed that if no agreement were reached, he would reach his own decision on 20th June 2002.

· Voluntary measures

With the signing of the International Marketing Standards Agreement between the leading tobacco companies last year, BAT loudly announced that it was withdrawing from advertising on the electronic media and was pulling down its billboards to boot. Yes, most of the billboards came down. The neon signs for restaurants, shops, and bars, and the road signs, painted shop fronts are still up. In a recent promotion, thousands of posters were plastered in the suburbs on shop fronts. The campaign "Vaayo Gyoli" featured instant prizes for smokers of the "Sportsman" brand. The prizes include t-shirts, radios, flashlights.

True to form, BAT could not stay off the airwaves and the silver screen and was soon running radio and tv adverts to promote the Wicked & Wild Street Bash. This is a huge concert of youth groups performing live in a blocked off street outside a discotheque. BAT makes a point about the event being for only 18 year olds and over. Age verification is "randomised" and we lack any effective means to verify age. In the colonial period, age verification for tax purposes was done by counting teeth and for education, a pupil was expected to be able to reach over his head and touch his other ear. We understand BAT uses a rigorous interview process in which the subjects are expected to tell nothing but the truth.

Again while the billboards may be coming down, the attention is now shifting to indoor advertising. Many places of entertainment feature neon signs and other advertising gadgetry of tobacco companies. In one discotheque, BAT built a Benson & Hedges Bar and provided Bensons & Hedges branded sega motor racing consoles.

BAT is also preparing to launch its youth smoking prevention campaign. Following a BAT sponsored survey that found peer pressure to be the main cause of youth smoking full-page ads were run. The ads featured a lad up a tree holding a placard that read "smoking causes smelly clothes, yellow teeth and bad breath", hardly the stuff to discourage youth from smoking.

The Retail Access Programme (RAP) is another industry initiative aimed at introducing measures to prevent youth access to cigarettes. Again it is too late too late. One of the messages being tested is a cartoon with a cigarette saying "Noo!!! I will not be bought by children".

· Philanthropy

BAT's generosity is legendary! In addition to passing risks of serious diseases, they have also dished out large sums of money, from prizes to their contract farmers, refurbishing an Army Officers mess, donations to the Police Force and the Commonwealth Parliamentary Association, contribution to a roal wedding, to a donation to a non-governmental organization dealing with street children. The donation to this NGO, the Tigers Club was money and footballs marked "youth smoking prevention" said to keep youth from thinking about smoking.

BAT also runs a scholarship fund for its staff and farmers. The over 200 beneficiaries of this scheme are now lawyers, engineers and even medical doctors. One of the beneficiaries, now a Medical Superintendent of Arua hospital said in a newspaper article "I have been able to realise my dreams basically because of BAT". There is suggestion that BAT will be extending this scheme outside BAT environs. This story came out in the week after World No Tobacco Day at the time of children going back to school.

· Deceit and deception

In 1988, Bat wrote a letter to the Director of Medical Services stating that it would not go with strong warning labels because it did not believe that cigarette smoking was harmful to health. In their annual report of 2001, BAT stated that they have long accepted that smoking comes with serious risks of serious diseases such as lung cancer, respiratory disease and heart disease.

Quite a quantum leap in 14 years! When challenged on why BAT did not inform smokers directly on this position, the Company Head of Corporate and Regulatory Affairs stated that the Company was in a dilemma as to where to put the warning labels since most of the purchase of cigarettes in Uganda was done by stick and not by packets. His suggestion was that warning labels be printed on their already branded cars.

BAT claims to have abdicated its responsibility on new warning labels to the Uganda National Bureau of Standards. At our last check, the proposal was to change the warning to "cigarette smoking is harmful to health".

TEAN's response to this has been to file another lawsuit based on the proposition that BAT as the manufacturer of dangerous products has an obligation to inform the consumers of that product of its dangers and that their failure to do so is infringing the consumers right to life.

The suit does not seek damages or costs. It is simply an action in the public interest for the promotion of public health.

· Lobbying

BAT has been at the forefront of the Government efforts to curb smuggling. This at a time that BAT is under investigation in the United Kingdom for involvement in smuggling. The recently launched tax stamps were introduced amid a lot of fanfare by BAT, appearing quite often on awareness workshops held with the Revenue Authority. After the introduction of the tax stamps an ad was run suggesting that the tax stamp was also a guarantee of authenticity and freshness of the product. BAT's interest in curbing smuggling is apparently more directed at depriving their competitors of a well-known route to market access.

Last year following an 8% rise in excise duty on cigarettes, BAT cut back on production and predicted increased smuggling and loss of revenue to the Government. Sure enough at the end of the year BAT reported a fall in sales of 20%. The Uganda Manufacturers Association is now demanding a reduction in excise duties on cigarettes by 27%. Unspoken is that fact that Mastermind Tobacco Ltd. reported a 30% increase in revenue for the same trading period!

World No Tobacco Day is the one-day that the media are obliged to cover tobacco control issues. They are paid to do so by the Ministry of Health. BAT has use the eve of World No Tobacco Day for counter-publicity. This year was no exception, with BAT hosting journalists to a business lunch. Last year featured a visit by the President of the International Tobacco Growers Association, while the year before saw the launch of the industry programme Courtesy of Choice by the President of International Hotel and Restaurant Association. Once BAT had meeting in the same hotel as the Ministry of Health World No Tobacco Day event.

V. CONCLUSION:

The tobacco industry recognises that tobacco regulation is coming. They are desperately getting in line with all forms of half measures aimed at dissuading Governments from taking harsher measures. It is their clear intention to position themselves at the centre of tobacco regulation and to control this agenda by whatever means, whether by influence peddling, clouding the issues or outright deceit and deception.

What hope do we have? We have the massive support of the international tobacco control community. We have the ability to advocate and to litigate these issues. Possibly we will soon have a strong Framework Convention on Tobacco Control if we all continue to prioritise public health. On this note I would like to thank South Africa for the leadership it has demonstrated both at the country level and at the NGO level in pushing for a strong FCTC.

Lastly, I would like to appeal to you all to get more involved in tobacco regulation in your countries. It is the same business of protection and promotion of public health. When I speak to people about chronic obstructive pulmonary disease and emphysema they think three things; 1) I spent the whole night practicing how to say the words 2) I wouldn't recognise COPD even if I had it for lunch 3) if a lawyer is in it he is doing it for the money. It is of utmost importance that the health care providers lead the struggle for tobacco regulation and do so resolutely.

Counsel your patients! Do research! Talk publicly against tobacco! If you do smoke, please stop!

I thank the Conference sponsors and organizers for making it possible for me to be here and I thank you all for listening to me.

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