Smoke in your eyes

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Vietnamese lawmakers are all set to pass the country's first comprehensive tobacco control laws next month, but will they withstand opposition from the industry?

Sometimes, Vu Van Luong looks at the photo of his son's wedding in 2002 and fondly remembers the days when he was ruddy and fit, weighing nearly 60 kilograms. But then he looks at himself again in the mirror and reality crashes in: ten years later, he has lost almost 30 kg.

It has been ten years since Luong conquered the major addiction in his life: alcohol. But Luong, a 65-year-old former construction worker in Ho Chi Minh City's Binh Tan District, had been smoking two packs of cigarettes every day for the last 45 years, despite repeated attempts to quit.

It was not until May of last year that he was able to stop smoking. But the damage was already done. He has severe problems with his bronchial tubes, blood pressure, heart and prostate gland. He can barely eat and sleeps just a few hours every night. Three years ago, doctors surrendered and gave him only a few more years to live.

"Fortunately I'm still alive"¦ If only I had quit smoking earlier," Luong told Vietweek in a murmuring voice. His face looks pale and his hands can hardly hold a cup of tea tight for more than two minutes.

Luong said he had tried to stop smoking years ago but doing so is not easy particularly in Vietnam, where non-smoking sections are rare, cigarette advertising circumvents restrictions, and many consider lighting up an essential masculine trait. The Global Adult Tobacco Survey 2010, an international standard for systematically monitoring adult tobacco use and tracking key tobacco control indicators, shows that of the total population of 86 million, around 15.3 million people actively smoke in Vietnam and an estimated 46.8 million are exposed to secondhand smoke.

Still, changes are afoot. The National Assembly, Vietnam's legislature, is scheduled to pass a draft law aimed at upping the restrictions on smoking next month. But existing legal loopholes enable tobacco advertising to continue thriving and the influential tobacco industry lobby has reached high-level policymaking.

"Vietnam currently does not have very strong policies that can restrict tobacco marketing and industry expansion," said Anuradha Khanal, country coordinator for the Vietnam Programs of Campaign for Tobacco Free Kids, a Washington-based NGO that seeks to reduce tobacco use and its deadly toll in the US and around the world.

"The tobacco industry will do everything possible to undermine public health efforts. They will try until the very end," Khanal told Vietweek.

Fatal attraction

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Since Vietnam ratified the World Health Organization (WHO) Framework Convention on Tobacco Control in December 2004, it has banned all forms of tobacco advertising, increased taxes on cigarettes and, since 2008, added warning labels to packaging.

But cigarette images are still ubiquitous and dressed to hook a large audience.

"It's really difficult to resist the temptation of smoking as you can find cigarette images almost everywhere," said Nguyen Huu Nghia, a 54-year-old market vendor in District 7.

Nghia had been a chain smoker until last June, when he became determined to quit. But he said he could relapse "anytime soon."

"On the two-kilometer route from my home to the market, cigarette images are everywhere," Nghia told Vietweek.

Different studies have found mock cigarette packs and the logos and slogans pasted all over small shops in Vietnam, even though technically, these ads are just "displays" not advertisements under Vietnam's prevailing regulations. Tobacco companies have cashed in on these loopholes to promote their brands.

A two-year study by the Hanoi School of Public Health found that between November 2009 and April 2011, around 95 percent of 1,530 points of sale surveyed in 10 provinces and cities across Vietnam had tobacco advertising or promotion activities under various forms. The points of sale surveyed included tobacco and coffee shops, bars, karaoke parlors, supermarkets, tobacco-selling pushcarts, restaurants and grocery stores, said the study, released late last month at the 15th World Conference on Tobacco or Health in Singapore.

It blamed the violations on legal loopholes and poor enforcement of tobacco controls.

"So, right now, [with] a big population, growing economy and short of policies, [Vietnam] is a big and lucrative market for the tobacco industry," Khanal said.

Ban or bane?

Tobacco has killed 50 million people in the last 10 years, and tobacco is responsible for more than 15 percent of all male deaths and 7 percent of female deaths, the new Tobacco Atlas report, led by the New York-based health campaign group World Lung Foundation (WLF), said last month.

In the report, marking the tenth anniversary of its first Tobacco Atlas, the WLF and the American Cancer Society said if current trends continue, a billion people will die from tobacco use and exposure this century - one person every six seconds.

Smoking caused around 40,000 deaths in Vietnam in 2007, the WHO estimates. This figure could surge to 70,000 by the end of 2030 if drastic measures are not taken, the UN agency warned.

Vietnamese smokers, on average, spend more on cigarettes than they do on education or healthcare, both of which are subsidized by the government, said a study by HealthBridge Canada, an international health advocacy group.

Cigarettes were among the 10 industrial products that recorded highest growth in sales here in 2009, according to the General Statistics Office. The tobacco industry contributes approximately US$350 million annually to the state budget, and in this respect, it ranks second only to the petroleum industry, according to an August 2010 article published by Mondaq, an electronic resource that provides legal, regulatory and financial commentary and information.

The country's legislative body has been drafting a comprehensive tobacco control law since 2008 and is set to vote for it this May. The bill, the passage of which health advocates say has been thwarted by an aggressive tobacco industry lobby, envisages banning all forms of sponsorship by tobacco companies but does not completely prohibit philanthropic activities.

The bill is also looking to allow graphic warnings to occupy at least 50 percent of the cigarette pack and raise tobacco taxes.

Currently, health warnings are text-only and cover 30 percent of the front and back of the pack in Vietnam, meeting the minimum requirement of the WHO Framework Convention on Tobacco Control (FCTC). Cigarettes are taxed at 32 percent, with the most popular brand taxed at 42 percent of its retail price. The WHO says tobacco taxes in Vietnam fall below the World Bank's recommendation that they make up two-thirds to four-fifths of the retail price.

But many government officials and lawmakers have said at a number of meetings and conferences that if Vietnam allows graphic warnings to occupy 50 percent of the cigarette packs and raise tobacco taxes, it will cripple the [tobacco] industry.

However, Pham Hoang Anh, the Vietnam country director of HealthBridge Canada, said tobacco control would not mean the government should close the country's state-run number-one tobacco brand, Vinataba.

"Tobacco control is all about making life easier for smokers who want to quit and prevent younger generations from taking on it," Anh told Vietweek.

"Many lawmakers worry that if the tobacco control law is implemented, people will quit immediately and as a result, the tobacco industry will be damaged and tobacco-growing farmers affected. But I even don't think that can happen in five years.

"Our goal is to reduce the tobacco prevalence. As the population is growing, if we don't enforce the tobacco laws, the rate of smokers will increase. If tobacco controls are strong enough, the number of smokers will stabilize and that is our goal."

Meanwhile, until the law is passed, activists remain cautious.

"We can't really say how strong it is because there might be some changes in the end. We don't know until the very end," Khanal said.

Article 5.3 of the FCTC bans industry insiders from participating in any debate on the drafting of the tobacco control laws.

But perhaps this provision has been interpreted differently in Vietnam.

A July 2011 article on the Industry and Trade news website, the mouthpiece of the eponymous ministry which owns Vinataba, quoted deputy minister Nguyen Nam Hai as saying that his ministry supported the printing of graphic warnings on cigarette packs.

But instead of the proposed 50 percent "The graphic warnings should take up [only] 30 percent," Hai said.

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