Diffusion of the “Spanish model” in Latin America Ernesto M Sebrié, MD MPH Department of Health Behavior, Roswell Park Cancer Institute Buffalo, New York ICO- WHO Symposia on Tobacco Control Barcelona (July 5, 2012)
OUTLINE• Current situation on smokefree policies in Latin America• The so-called “Spanish model” and its impact in Latin America.• Final remarks
INTRODUCTION• 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.
• As of July, 2012100% smokefree nationalComprehensive national100% smokefree sub-nationalSmoking designated areas or no restrictionsRegulation pending
SMOKEFREE LATIN AMERICA SMOKEFREE POLICIES Indoor public places Indoor workplaces Public transportation Outdoor areasUruguay (2008) 100% smokefree 100% smokefree 100% smokefree Health care & educational institutionsPanama (2008) 100% smokefree 100% smokefree 100% smokefree Sports facilitiesGuatemala (2008) Except 20% hotel rooms 100% smokefree 100% smokefree NSColombia (2009) 100% smokefree 100% smokefree 100% smokefree NS 100% smokefree Except cigars manufactures 100% smokefree Within 2 meters of publicHonduras (2010) placesPeru (2010) 100% smokefree 100% smokefree 100% smokefree Health care & educational institutionsVenezuela (2011) 100% smokefree 100% smokefree 100% smokefree NSEcuador (2011) Except 10% hotel rooms 100% smokefree 100% smokefree Health care & educational institutions (except University)Argentina (2011)* Except smoking clubs and Except private enclosed 100% smokefree Health care & educational tobacco stores workplaces without employees institutions (except and without services to the public University)Brazil (2011)* 100% smokefree 100% smokefree 100% smokefree NSCosta Rica (2012)* 100% smokefree 100% smokefree 100% smokefree NS * Regulation pending, NS: Not specifiedSebrie EM et al Smokefree Policies in Latin America and the Caribbean: MakingProgress Int. J. Environ. Res. Public Health (2012)
SMOKEFREE MODELS• Uruguay • Chile• Panama • Bolivia• Colombia • Mexico• Guatemala (national)• Peru • El Salvador• Venezuela • Nicaragua• Honduras • Paraguay• Ecuador (sub-national)• Brazil (*)• Argentina (*)• Costa Rica (*) • Argentina • Mexico(*) Regulation pending • Brazil
Tobacco Industry Interference1. Lobbying the 4. Weakening of 7. Litigationexecutive authorities the law (“accommodation2. Promoting a language”)Presidential veto 5. Amendment of3. Blocking or the lawdelay of lawregulation 6. Preemption
Tobacco Industry Counter-model• “Spanish Model” (2006)• Mirror the Tobacco Industry’s “Courtesy of Choice” Program: • Accommodation Cortesía de Elegir Convivencia en Armonía • PMI & BAT: 1990sSebrie & Glantz "Accommodating" smoke-free policies: tobacco industry’sCourtesy of Choice programme in Latin America TC (2007)
Tobacco Industry Counter-modelThese 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
Comprehensive Venezuela smokefree Ecuador Honduras Argentina FCTC Peru Brazil Panama Uruguay Guatemala Santa Fe Mexico City new Spanish law Colombia Costa Rica- 2004 2005 2006 2007 2008 2009 2010 2011 2012No legislationVoluntaryaccommodation Spanish law Mexico Nicaragua El Salvador Chile Peru Bolivia “Spanish model”
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 supportthis amendment includedclaims of personal freedom,generation of social conflicts,and difficulty of implementingthe law due to “Argentineanculture.”- In the grounds of the bill, thelegislators cited the Spanishand Chilean laws
A copy of the 2005Spanish law wasattached at the endof the bill to supportthe amendments
GUATEMALA (2008) 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.”Muggli, ME et al Legislating tolerance: Spain’s national public smoking law Tob Control (2009)
PMI’s proposedexceptions following theSpanish and Chileanlaws:- Classification of restaurants,bars, cafeterias, and similarvenues by size (big andsmall) depending on theservice area (>or <100 m2)- Discos and night clubs onlyfor adults and alcohol sale
CONCLUSIONS• Significant progress in the implementation ofeffective smokefree policies has been achievedamong LA countries since the adoption of theWHO FCTC in 2005.• As of July 2012, eleven LA countries (Argentina,Brazil & Costa Rica regulations pending) haveadopted a comprehensive national smokefreepolicy, accounting for ~ 70% of the totalpopulation in LAC (573 million: WB, 2010).
CONCLUSIONS• Both governments and civil society aredefending the laws with strong argumentshighlighting the rights to health, to life, to cleanenvironment, of the child, and human rightsguaranteed by their own constitutions and/or byinternational treaties (e.g., International Covenanton Economic, Social, and Cultural Rights;Convention on the Rights of the Child; AmericanConvention on Human Rights) to which they areparties.
CONCLUSIONS• TI unsuccessfully used the “Spanish model” to blockthe Uruguay (1st national) and Santa Fe (1st sub-national) 100% smokefree laws in LA.• Current challenges that the “New Spanish Model” isfacing (e.g., threats to amend the law usingaccommodation language) might have a dominonegative effect in Latin America.• There is a need of collaboration between Spain andLatin America to protect the successful achievements(adoption of 100% smokefree legislation) and toeffectively counter tobacco industry arguments andstrategies 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, M D M PH ernesto.sebrie@ roswellpark.orgRoswell Park C ancer Institute