A National Strategy

Appendix C

Denormalization of Tobacco Industry Products - Definition

• Normalize - to make normal or regular
• Normalization - the process of making normal or regular
• Denormalization - to remove, or steer away from, what seems to be normal

What is encompassed by denormalization?

Traditionally, anti-smoking social marketing efforts have been directed at making smoking a less socially acceptable behaviour without blaming the victim. Denormalization, in the context of social behaviour, aims to change attitudes toward what is generally regarded as normal or acceptable behaviour, including through social marketing. When attitudes change, behaviour will also change because humans generally want to act in ways that are acceptable to others.

There are many examples of how social behaviour has been "denormalized", for example:

• Failure to use safety belts and child restraints;
• Drinking and driving;
• Poop and scoop laws for dogs; and
• The shift away from corporal punishment for children.

There is clearly scope to consider further behavioural denormalization, particularly where it focuses on the consequences for others, rather than just the person smoking:

• Working to discourage smoking in enclosed public or private spaces where others could be affected by second-hand smoke, including children in the home;
• Working to discourage smoking by and around pregnant women.

However, consideration can be given to approaches to denormalization that go beyond the individual. Another possibility is promoting greater awareness of the effects of second-hand smoke on non-smokers' health, and to provide appropriate support for increased smoke-free areas. Additional

possibilities lie in creating greater awareness of the extent of criminal sales to children (50 million criminal sales per year), and the role the retail sector plays in displaying, promoting and selling cigarettes to children.

Secondly, rather than "smoking", increased focus can be placed on use of "tobacco products" and their effects.

Finally, denormalization activity can help draw attention to the way the tobacco industry operates. As the Federal Minister for Health stated in his speech of January 18, 1999, we need to look at "ideas that might help us in our work in the Canadian context to counterbalance the steady flow of images that make smoking seem natural and desirable when it is anything but. It's also going to be about informing Canadians of the marketing tactics used by the tobacco industry to recruit new smokers."

Denormalization could help build public support for tobacco control measures and public concern about the tobacco industry.

This type of denormalization activity can include:

• Deglamorizing the use of tobacco products;
• Combatting myths about tobacco products (for example, that light and mild products are safer or can help you quit);
• Drawing attention to the size and impact of tobacco industry advertising budgets, and the nature of their promotional activities.
• Drawing attention to the role of other industries and organizations in supporting the promotion and sale of tobacco.

Benefits of denormalization

Denormalization activities are important because they may help develop a set of values and behaviours that bring the whole community together to reinforce desirable behaviour and attitudes. It can help make tobacco use an issue of community concern, rather than just an issue for those using the products. Secondly, it can help ensure that people behave in appropriate ways--including making efforts to quit--without the need for a lot of policing or enforcement. Thirdly, it can help generate support for Government and broader defence of public health

policy in the face of industry challenges.

Examples of possible benefits of denormalization in the context of tobacco, could include:

• Any attempt to sell cigarettes to minors would be discouraged by attention from other shoppers;
• People using tobacco products in places where others were affected by smoke would attract adverse attention;
• Canadians would accept health advice relating to tobacco use and cessation from credible sources only; and
• Canadians would be sensitized to promotional techniques, particularly where they influence children.
• Corporations currently engaged in partnerships with tobacco companies (i.e., Banks, newspapers, advertisers, governments and other co-sponsors) would disengage from supporting tobacco promotion and sales.
• Governments would gradually cease their promotion and support of tobacco-promoting events (i.e., Co-sponsored festivals) and the promotion of tobacco production and sale (i.e., Trade missions which encourage tobacco exports).

Appendix D

International Framework Convention on Tobacco Control (FCTC)

In May 1996, the 49th World Health Assembly (WHA)--the highest governing body of the World Health Organization (WHO) composed at that time of the representatives of 190 Member States--adopted a resolution calling on the Director-General to initiate the development of an international framework convention for tobacco control in accordance with Article 19 of the WHO Constitution. It would be the first international convention adopted by WHO.

Canada has been a leading supporter of the development of a framework convention for tobacco control. We hosted the first (Halifax, 1997) and second (Vancouver, 1998) WHO meetings of public health and legal experts on the development of the framework convention, and continue to be a leading source of funds for the initiative.

What is an international framework convention?

It is a legal instrument in the form of an international treaty in which the signatory states agree to pursue broadly stated goals, and possible protocols, in this case, on tobacco control. The framework convention on tobacco control will represent a collective international response to common concerns related to tobacco.

How does a framework convention work?

Unlike other more detailed kinds of treaties, a framework convention does not try to resolve all substantive issues in a single document. Rather, Member States first adopt a convention that calls for cooperation in achieving broadly stated goals. Parties to the convention then negotiate separate protocols containing specific measures concerning each of the goals stated in the framework convention.

What could be the content of a framework convention on tobacco control?

The final answer to this question would be highly dependent on what the signatories would choose to include. Nevertheless, one broadly stated goal could be to move progressively towards implementation of comprehensive tobacco control strategies that include the measures referred to in previous WHA resolutions, as well as other appropriate measures. Separate protocol agreements would be more detailed in nature, focusing on specific elements, and developing separate plans and timetables for implementation. Member States could then choose to become signatories to those protocols, which if they agree, could be implemented in their country.

Member States can do most of these things on their own. So why is an international framework convention needed?

In practice, only a few Member States have actually implemented comprehensive tobacco control measures. The planning, scheduling and international information sharing that would accompany the development of an international convention would facilitate and encourage Member States to strengthen their own national tobacco control policies.

In addition, a framework convention is a useful tool for promoting international cooperation and coordination of international aspects of tobacco control. Because many elements of national tobacco control programmes can be affected by what is going on in other countries, international instruments can be used to move towards better international control--and greater public health effectiveness--with respect to a number of areas that are transboundary in nature. WHO has identified the following as possible areas for Protocols:

• Tobacco smuggling
  Currently, recorded world cigarette exports exceed imports by about 400 million cigarettes, implying that over seven per cent of world cigarette production is smuggled from one country to another to avoid cigarette taxes. It has been estimated that cigarette smuggling results in global losses of tax revenue totaling US $16 thousand million annually.
• Tobacco advertising
  Bans or restrictions on tobacco advertising in one country can be undermined by advertising spillover from other countries.
• Duty-free sales of tobacco
  Current international agreements on duty-free sales should be reconsidered in the light of the serious health consequences of tobacco use.
• Tobacco pricing and taxation
  International harmonization of tobacco prices and taxes at high levels would do much to discourage tobacco use and to ensure that high-price policies for tobacco products are not undermined by smuggling from nearby low-price jurisdictions.
• Reporting of production, sales, imports and exports of tobacco products
  Improved standards of international reporting of tobacco production and sales would facilitate international monitoring of this epidemic.
• Testing and reporting of toxic constituents
  Improved and more effective international standards for the testing and reporting of toxic constituents in tobacco products and tobacco smoke would facilitate the monitoring of the degree of hazards of tobacco products.
• Policy and programme information sharing
  More effective sharing of information among nations about the state of their national tobacco control legislation and programmes would help improve both national and international tobacco control.