Q. The Bloomberg Initiative offers a wide window for comprehensive public health work related to tobacco control, with a global reach in the new century. How did this initiative take shape and what were the main determining factors to zero in on tobacco as against other public health issues? What were the main objectives, and after two years what progress have Campaign for Tobacco-Free Kids and the other partners in the Initiative observed?

Ans. The global tobacco epidemic is a leading cause of preventable death and work in this area has historically been significantly under-funded. The Bloomberg Initiative is focused on the tobacco epidemic because it stands out as being almost entirely preventable if a set of known interventions are implemented. These interventions - which include smoke-free laws, bans on advertising and marketing, large graphic health warnings, and increased taxes on tobacco products – are mandated by the Framework Convention on Tobacco Control.
Mayor Bloomberg and his public health staff have implemented a number of these policies in New York City, and a marked decline in tobacco use has resulted. The Mayor decided to donate his philanthropic funds to implement these approaches in low and middle income countries with high rates of tobacco use. In the two years that the Bloomberg Initiative to Reduce Tobacco Use has been up and running, the world has seen considerable progress in tobacco control, such as:
A smoke-free movement that is sweeping the globe, with countries as diverse as India, Turkey and Colombia recently passing smoke-free legislation.

For the first time in history, Indonesia’s Parliament has placed comprehensive anti-tobacco legislation on the National Legislation Agenda.
The tobacco-free Beijing Olympics helped galvanize a quickly growing tobacco control movement in China that includes smoke-free cities and improved health warnings.
Russia has acceded to the Framework Convention on Tobacco Control.
The World Health Organization has firmly embraced tobacco control as a top priority and is urging governments to implement a package of tobacco control policies called for by the Framework Convention whose effectiveness is documented in WHO’s MPOWER package of policy recommendations. 

Q. Over the years, faced with strong government legislations and public support for tobacco control measures in developed countries, the industry has gradually and quite successfully shifted its attention to developing countries. What strategies do the partner organizations in the Bloomberg Initiative exercise to curb industry operations in less rich countries?

Ans. Since one-half of tobacco users will eventually fall ill or die from tobacco-related disease, the industry devotes its considerable resources to getting new customers addicted to tobacco products in order to remain profitable. The culpability of the tobacco industry in spreading death and disease is why the Framework Convention clearly calls for a ban on tobacco industry advertising, marketing and sponsorship. The policies focused on under the Bloomberg Initiative are aimed at reducing tobacco use, thus undermining industry marketing efforts, and partners in the initiative are working with NGOs throughout the world to find creative ways to confront industry marketing tactics. Many of these industry tactics are aimed directly at women and children, populations that are experiencing a rise in rates of tobacco use in most developing countries.

Tobacco control advocates working in Mexico, the Philippines, and Indonesia have confronted the tobacco industry for sponsoring music concerts. In Mexico, this type of sponsorship is expressly against the law. In Indonesia, it is not against the law but if companies like Philip Morris have already agreed to stop marketing through concerts in other countries, why is it okay for them to keep doing it in Indonesia? With rates of smoking among youth rising in Indonesia, advocates in that country have aggressively confronted the industry for this type of corporate behavior and succeeded in having Philip Morris pull its sponsorship of an Alicia Keys concert.
With support from the Bloomberg Initiative, governments and NGOs are also unrolling paid advertising campaigns. These campaigns are meant to increase the visibility of tobacco use as a public health crisis and expand the recognition that tobacco use and exposure to secondhand smoke are deadly. In India, for example, TV ads, print ads, and billboards will be appearing more frequently in a government-supported effort to change perceptions of tobacco use and reinforce the policy-oriented work of our partners.

Q. How can global best practices and experiences of international organizations help in combating the tobacco industry in particular?   

Ans. One of the main objectives of the Bloomberg Initiative is to assist and enhance a global network of tobacco control advocates. By sharing information about successful strategies and providing technical assistance, pooling resources to collect data and undertaking cooperative projects, the Bloomberg Initiative has sought to enable organizations to learn and benefit from each others’ successes, and develop a set of best practices for implementing the policies we know will lead to reduced rates of tobacco use.

Q. What kinds of specific challenges come up while funding projects in developing countries?

Ans. Because tobacco control efforts must combat the tobacco industry in countries where smoking and other forms of tobacco use are deeply ingrained in social customs, tobacco control advocates face lots of challenges!
Challenges include the industry’s close ties to policy makers and its huge marketing budgets in many countries. Overcoming these challenges takes creativity and dedication, and it speaks well of our partners that they are making such strong progress in many countries. In some countries, the industry has even paid for the university educations of reporters and owns key media, making it harder to get good media coverage of anti-tobacco stories. But even this challenge can be overcome with a determined, disciplined effort to educate journalists and get the truth out.

In other countries – China is a good example – smoking is deeply ingrained in the culture. Cigarettes are frequently handed out as gifts at weddings or presented at celebratory dinners. In other words, they have become more than tools for delivering nicotine to a person’s lung, they have become symbols of civilization. The organizations working in China have begun to make inroads into this perception but their task is huge.

Another great challenge sometimes faced by tobacco control advocates is the lack of political will by those in power. Since the tobacco industry has often hidden behind its claims that it is an important economic asset to the country, or that certain sectors of agricultural workers or other tobacco workers will collapse if the tobacco industry is more carefully regulated, it can be quite difficult to convince government that regulating the industry will actually be a boon to their country in terms of lives and dollars saved. In cases like this, tobacco control advocates have their work cut out for them and rely heavily on the growing body of evidence being developed and shared by researchers and advocates around the world.

Q. Who are the main allies and what are the positive outcomes from programmes in these countries?

Ans. Support for tobacco control comes from many directions, some of them to be expected and some of them quite surprising. In many countries, associations of medical professionals, economists, restaurant owners, and others have rallied to the cause of reducing tobacco use based on their own sets of professional values. Powerful support like this is needed and cultivated by tobacco control advocates. But sometimes help comes from unexpected directions: popular music groups in Indonesia have recently made commitments that they will no longer have anything to do with tobacco companies.

Q. How do you evaluate the success and outcomes from the large number of projects funded? What have been the key learnings overall on the Bloomberg Initiative’s tobacco control journey in the last nearly three years?

Ans. The Bloomberg Initiative places a high priority on funding projects that embrace a solid set of measurable objectives, based on the most effective ways to reduce tobacco use on a population-wide basis.  Success and outcomes in the Bloomberg Initiative come at many levels and can be measured in as many ways. They include, for example, increased media attention to tobacco as a serious public health problem, the adoption of policies and programs contained in the Framework Convention and WHO’s MPOWER framework, more effective implementation of existing tobacco control policies and, most importantly, measurable changes in attitudes and behaviors related to tobacco.
Since the evidence demonstrates the powerful impact of policy change, any evaluation regime will have a focus on actual laws or regulations passed and rigorously implemented.

Q. In countries like India, where the tobacco issue is quite complex, weaved around tradition, huge burden of use and production and manufacture, how is this initiative going to bring about change? Are there any similar experiences internationally which can be used as learnings while implementing the programme in India?

Ans. In India we are indeed already seeing change. Observers in major cities are reporting a marked decline in smoking in all types of restaurants and bars after the smoke-free law took effect. Our partners in India are currently conducting tests in about eight cities to confirm that that indoor air quality is improving.
Civil society organizations in India and champions in government under the leadership of Minister of Health, Ramadoss are also trying to ensure that the health warning law goes into effect as scheduled, despite the attempts of others to dilute and postpone the law.
The lessons from around the world demonstrate that persistence in presenting the real facts about the health and economic burden of tobacco will eventually win out over the misinformation campaigns of the tobacco industry, and that strong will in government – reinforced by the voice of civil society organizations – are necessary to positive change.

Q. In India, where health is a state subject, how can smaller organizations and community groups at the grassroots level with very little resources be roped into the programme? What can be their defining role?

Ans. India has a tradition of powerful grassroots movements.  These movements have shaped the history and the future of the country. The Bloomberg Initiative will enable the anti-tobacco movement in India and elsewhere to gain momentum and force. We hope that in India grassroots organizations working on tobacco control will be better able to mobilize their constituents, speak and act from their own perspectives, and use their unique expertise to make a difference.

Q. How is the initiative working on making this a long term, sustainable programme?

Ans. The Bloomberg Initiative is now just two years old, and we have been joined by the Bill and Melinda Gates Foundation. It is our hope that, by bringing new resources to the global tobacco control movement and raising its profile, we will be joined by new sources of funding and technical expertise. As the tobacco control movement moves in new directions and picks up speed, we plan to be flexible enough to provide the right kind of technical support and resources to keep pace.