Diffusion of the “Spanish model” in Latin America

Ernesto M Sebrié, MD MPHDepartment of Health Behavior, Roswell Park Cancer Institute

Buffalo, New York

ICO- WHO Symposia on Tobacco ControlBarcelona (July 5, 2012)

1. Current situation on smokefree policies in Latin America

2. The so-called “Spanish model” and its impact in Latin America.

3. Final remarks

OUTLINE

• During the 1980s & 1990s Latin American (LA) countries adopted either no laws or ineffective laws to regulate smoking in enclosed places.

• In 2001, the Pan American Health Organization

(PAHO/ WHO) launched the Smokefree Americas Initiative.

• In Feb. 2005, the adoption of the WHO Framework Convention on Tobacco Control changed the policy environment that led to substantial progress in LA.

INTRODUCTION

100% smokefree national

Comprehensive national

100% smokefree sub-national

Smoking designated areas or no restrictions

Regulation pending

• As of July, 2012

SMOKEFREE LATIN AMERICA

Sebrie EM et al Smokefree Policies in Latin America and the Caribbean: Making Progress Int. J. Environ. Res. Public Health (2012)

SMOKEFREE POLICIES

Indoor public places Indoor workplaces Public transportation Outdoor areas

Uruguay (2008) 100% smokefree 100% smokefree 100% smokefree Health care & educational institutions

Panama (2008) 100% smokefree 100% smokefree 100% smokefree Sports facilities

Guatemala (2008) Except 20% hotel rooms 100% smokefree 100% smokefree NS

Colombia (2009) 100% smokefree 100% smokefree 100% smokefree NS

Honduras (2010)100% smokefree Except cigars manufactures 100% smokefree Within 2 meters of public

places

Peru (2010) 100% smokefree 100% smokefree 100% smokefree Health care & educational institutions

Venezuela (2011) 100% smokefree 100% smokefree 100% smokefree NS

Ecuador (2011) Except 10% hotel rooms 100% smokefree 100% smokefree Health care & educational institutions (except

University)

Argentina (2011)* Except smoking clubs and tobacco stores

Except private enclosed workplaces without employees

and without services to the public

100% smokefree Health care & educational institutions (except

University)

Brazil (2011)* 100% smokefree 100% smokefree 100% smokefree NS

Costa Rica (2012)* 100% smokefree 100% smokefree 100% smokefree NS

* Regulation pending, NS: Not specified

Factors of Success

SMOKEFREE MODELS

• Uruguay • Panama • Colombia• Guatemala • Peru • Venezuela• Honduras • Ecuador• Brazil (*)• Argentina (*)• Costa Rica (*)

• Chile• Bolivia• Mexico

(national)• El Salvador• Nicaragua• Paraguay

(sub-national)

• Argentina• Mexico• Brazil(*) Regulation pending

Tobacco Industry Interference

7. Litigation4. Weakening of the law (“accommodation language”)

5. Amendment of the law

6. Preemption

1. Lobbying theexecutive authorities

2. Promoting aPresidential veto

3. Blocking or delay of lawregulation

• “Spanish Model” (2006)

• Mirror the Tobacco Industry’s “Courtesy of Choice” Program:• Accommodation

Cortesía de ElegirConvivencia en Armonía

• PMI & BAT: 1990s

Tobacco Industry Counter-model

Sebrie & Glantz "Accommodating" smoke-free policies: tobacco industry’s Courtesy of Choice programme in Latin America TC (2007)

These laws are characterized by the inclusion of one or more of the following exceptions:

• Smoking designated areas: completed isolated or not• Use of ventilation or air filtration systems• Smoking venues exclusively for adults• Owners’ authority to voluntary choose whether to become

smokefree or not• Smoking clubs• Tobacco stores for tobacco tasting

Tobacco Industry Counter-model

Chile Peru

- 2004 2005 2006 2007 2008 2009 2010 2011 2012

No legislationVoluntary accommodation

FCTC

Comprehensive smokefree

“Spanish model”

UruguaySanta Fe

PanamaGuatemalaMexico City

Spanish law

El Salvador

Bolivia

NicaraguaMexico

Colombia

HondurasPeru

Costa Rica

VenezuelaEcuadorArgentina

Brazil

new Spanish law

URUGUAY (2006)In 2006, shortly after Uruguay became the first 100% smokefree country in the region, the TI conducted an advertising campaign with the punchline “Spain and the freedom to choose“, implying that countries under that model would be more democratic and tolerant.This campaign unsuccessfully sought to overturn the adoption of the smokefree policy.

Schneider, Sebrie & Fernandez The so-called "Spanish model" - Tobacco industry strategies and its impact in Europe and Latin America BMC Public Health (2011)

Newspaper El País, Montevideo (July 7, 2006)

Montepaz requests to respect the “freedom” of choice

SANTA FE, ARGENTINA (2006)In July 2006, an amendment to the Santa Fe law was introduced to reintroduce smoking designated areas in bars, restaurants, discos, mini markets, convenience stores, and hotels that were “physically separated from the rest of the room, [with] ventilation to the exterior.” Sebrie & Glantz Local Smokefree Policy Development in Santa Fe TC (2009)

- Arguments used to support this amendment included claims of personal freedom, generation of social conflicts, and difficulty of implementing the law due to “Argentinean culture.”

- In the grounds of the bill, the legislators cited the Spanish and Chilean laws

A copy of the 2005 Spanish law was attached at the end of the bill to support the amendments

GUATEMALA (2008)

Muggli, ME et al Legislating tolerance: Spain’s national public smoking law Tob Control (2009)

PMI’s subsidiary submitted comments to the government of Guatemala proposing amendments to the smokefree bill to provide for exceptions included in Spain’s law in order to “allow business property owners to provide smokers with comfortable areas in which they can smoke.”

PMI’s proposed exceptions following the Spanish and Chilean laws:- Classification of restaurants, bars, cafeterias, and similar venues by size (big and small) depending on the service area (>or <100 m2)- Discos and night clubs only

for adults and alcohol sale

CONCLUSIONS

• Significant progress in the implementation of effective smokefree policies has been achieved among LA countries since the adoption of the WHO FCTC in 2005.

• As of July 2012, eleven LA countries (Argentina, Brazil & Costa Rica regulations pending) have adopted a comprehensive national smokefree policy, accounting for ~ 70% of the total population in LAC (573 million: WB, 2010).

CONCLUSIONS

• Both governments and civil society are defending the laws with strong arguments highlighting the rights to health, to life, to clean environment, of the child, and human rights guaranteed by their own constitutions and/or by international treaties (e.g., International Covenant on Economic, Social, and Cultural Rights; Convention on the Rights of the Child; American Convention on Human Rights) to which they are parties.

CONCLUSIONS• TI unsuccessfully used the “Spanish model” to block the Uruguay (1st national) and Santa Fe (1st sub-national) 100% smokefree laws in LA.

• Current challenges that the “New Spanish Model” is facing (e.g., threats to amend the law using accommodation language) might have a domino negative effect in Latin America.

• There is a need of collaboration between Spain and Latin America to protect the successful achievements (adoption of 100% smokefree legislation) and to effectively counter tobacco industry arguments and strategies aimed to overturn these meaningful policies.

ACKNOWLEDGEMENTS

Program project grant P01 CA138389 “Effectiveness of Tobacco Control Policies in High vs. Low Income Countries”.

Ernesto Sebrie, MD MPH ernesto.sebrie@roswellpark

.org

Roswell Park Cancer Institute