Brazil anti-tobacco forces score yet another victory but work is not yet done

ACT and their anti-tobacco coalition after an advocacy activity at the National Congress in Brasilia. Photo: ACT Promoção da Saúde

This was originally published on Global Health TV on May 30, 2018.

RIO DE JANEIRO, Brazil — This country has one of the best tobacco control programs in the world, resulting in a series of laws to protect non-smokers that the Brazilian government been put into place over 20 years. During this time, cigarette smoking has fallen by more than half.

And yet smoking is still a huge problem. Almost 15 percent of adult Brazilians still smoke, according to the Ministry of Health, causing 156,000 deaths per year. Every day, second-hand smoke kills seven Brazilians.

Though smoking has fallen dramatically among both men and women, there are still 21.5 million smokers in Brazil, which puts it in the top 10 countries in terms of number of smokers. And for every success achieved by the tobacco control movement – and there have been many – the cigarette industry fights back with all of the considerable resources at its disposal.

The latest victory for the anti-tobacco forces occurred on February 1^st, when the Supreme Court made a historic ruling that affirmed the authority of the Brazilian Health Regulatory Agency (ANVISA) to prohibit additives in cigarettes (including flavors like mint and cinnamon). Anti-tobacco groups believe these additives make the products more attractive to children and adolescents.

The vote was a close as it could be – a 5-5 tie. Under Brazilian law, a tie vote in the Supreme Court means the ANVISA regulation is constitutional. This ruling has made Brazil one of the first countries in the world to have a complete ban on additives.

This month I visited ACT Promoção da Saúde (ACT Health Promotion), founded in 2006, one of the organizations at the forefront of the war against tobacco at their offices here, a block from Copacabana Beach. 

Anti-tobacco work began two decades ago when Dr. Vera Luiza da Costa e Silva started a movement coordinating tobacco control for the Ministry of Health’s National Cancer Institute in 25 states and helped ban tobacco advertising in mass media in 1999. Dr. da Costa e Silva is now head of the secretariat at the World Health Organization’s Framework Convention on Tobacco Control.

In 2007, ACT and its civil society allies started work to enact a national law banning smoking in public places but got strong push-back from the tobacco industry, said Daniela Guedes, ACT’s director of campaigns and mobilization. So they regrouped and decided to focus on the state of São Paulo, the largest state in Brazil (with a 2018 population of 45 million). One of their first activities was to create a sign to promote smoke-free policies at companies and restaurants. 

ACT conducted a public opinion poll that showed that 88% of the population supported a smoke-free law in São Paulo state (the percentage was almost as high among smokers). Polling is an important part of ACT’s work – it helps attract the attention of the media and lawmakers.

Their initial advocacy efforts focused on then-São Paulo Governor José Serra, a former minister of health. He wanted more evidence before joining their forces, said Guedes, and anti-tobacco advocates gave it to him. Their strongest evidence was the seven people who die from second-hand smoke every day (one of the slogans of an early campaign was “He who doesn’t smoke is not obliged to smoke”). One month later, Serra proposed a ban on public smoking in São Paulo state. Despite massive resistance from the tobacco industry, the bill was passed.

This created a “cascade effect,” said Guedes, prompting many other states and municipalities to pass similar bans. And it stimulated much discussion of this issue in local and national media.

ACT and its allies then set their sights on a national smoke-free law. After much resistance from the tobacco industry, the ban was passed and signed by of then-President Dilma Rousseff in 2011. It took another three years for the law to be implemented, with the tobacco industry fighting back every step of the way. But the public smoking ban became the law of the land across Brazil.

Lately, ACT and its allies have been working against the tobacco industry’s efforts to make cigarettes seductive to children and adolescents. For example, this TV spot, makes the case against adding flavors to cigarettes and displaying them alongside of candy. On the second day it was aired, the largest Brazilian tobacco company sued ACT, asking for damages of 500,000 reales per day. The tobacco company lost and the TV campaign continued.

The number of adult smokers has decreased from 35 percent in 1989 to 15 percent in 2013, according to National Health Surveys of the Ministry of Health (scroll down to first table here). So the fight against tobacco in Brazil, despite these many triumphs, is not yet finished.

“We still have more work to do,” said Guedes. “We need to fully implement the additives ban and ban point-of-sale displays that still show cigarette packaging. This is why it is so important to pass a law mandating plain packaging – cigarette packaging is still so attractive, especially to youngsters.”

In 2015, José Serra – who by then had become a senator from São Paulo – proposed another national tobacco control bill to ban additives, advertising at point of sale, smoking in cars with children and mandate plain packaging. These steps represent the next steps in tobacco control. After three years, this bill is still going through the legislative process.

ACT is still very much engaged in the ongoing fight against tobacco but three years ago they took on another one of the risk factors of non-communicable disease – overweight and obesity. In Brazil, 25 percent of girls and 26 percent of boys are overweight, according to World Obesity.

See more details of tobacco in Brazil on the Brazil page of the 2018 Tobacco Atlas.