Brazil and Tobacco Use: A Hard Nut to Crack: Brazil Is Pushing to Enforce Smoking Bans and Backing Nicotine Replacement Therapies in an Attempt to Keep Chipping Away at Tobacco-Use Statistics. Raising the Price of Cigarettes Would Also Help

Article excerpt

Taxes on tobacco products generated income of around US$ 2.2 billion for the Brazilian government in 2008, but that doesn't mean the Brazilian government is going easy on the tobacco industry.

For the past two decades, Brazil has been at the forefront of global tobacco control initiatives. Vera da Costa e Silva, a public health specialist who advises the government on tobacco control, is proud to note that Brazil was the first country to ban the use of misleading adjectives such as "light" and "mild" from cigarette packages back in 2001. That move was in line with a law passed a year earlier requiring cigarette manufacturers to include pictorial health warnings covering at least 100% of one of the two main sides of a pack. These warnings often depict people in advanced stages of tobacco-related illness.

As a result of such initiatives, smoking prevalence has come down in the past two decades from 34% of the adult population in 1989 to 15% last year, according to the Brazilian Ministry of Health. But the declining trend has tailed off over the past few years as tobacco companies target new consumers, notably women. Meanwhile, 200 000 Brazilians die every year from tobacco-related diseases, according to the National Cancer Institute (INCA).

One area in which Brazilian tobacco control has faltered is in the enforcement of other key tobacco control measures, such as smoking bans in enclosed public places. Although Brazil ratified the WHO Framework Convention on Tobacco Control in 2005, requiring the country to pass laws to restrict tobacco, it has not done this. For that reason, many states and municipalities have taken matters into their own hands by passing their own laws banning smoking from public places with no separate places designated for smokers. However, these by-laws have been challenged as "unconstitutional" by the hospitality industry and could be overturned by the supreme court.

So far four states and eight municipalities have introduced smoking bans in a process that Costa e Silva characterizes as "a domino effect".

In August, a big "domino" went down when the state of Sao Paulo passed its own law banning smoking in enclosed public places. Previous attempts to ban smoking in Sao Paulo have failed as a result of weak enforcement and public apathy, but this time things may be different. Sao Paulo state health secretary, Luiz Roberto Barradas Barata, says that 99.5% of the state's pubs, restaurants and hotels are committed to upholding the law. "In the last month, we monitored 37 000 places and applied only 198 fines," he says. Establishments in breach of the ban are fined up to US$ 750 for a first offence, with the fine doubling for a repeat offence. A third breach entails closure of the business for 48 hours and a fourth shuts it down for 30 days.

Not everyone is happy about the bans. Alexandre Sampaio, president of the Pubs, Restaurants and Hotels Syndicate in the state of Rio de Janeiro claims that such initiatives are unconstitutional. He says that Riffs hospitality industry has suffered a 20% decline in visits to restaurants and bars as a result of the ban, which the state legislature passed into law but that has yet to come into force. He also argues that the government should be committing resources to informing the public, teenagers in particular, about the dangers of smoking, rather than restricting the spaces in which people can smoke. "In a few years we would have fewer smokers," he says.

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Of course, while banning smoking in public places protects the health of non-smokers, many smokers need more than bans to help them quit. On the cessation front, Brazil is throwing its weight behind nicotine replacement therapies--a move strongly endorsed by the World Health Organization (WHO), which in May of this year put nicotine replacement therapy on the Essential Medicines List (EML).

"This is a public health victory," according to Costa e Silva, who believes that this recent decision by WHO will encourage Brazil and other countries to see nicotine replacement therapy as equally important as any other drug used for prevention purposes and promote cheaper commercial forms of nicotine replacement therapies. …

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