1.8. Tobacco control policies and their implications

Tobacco advertising was banned in 1992 by “Principles of the Legislation of Ukraine on Health Protection” and in 1994 by the President’s Decree. Unfortunately, the enforcement of these acts was insufficient. The issue was to be clarified in the law on advertisement. The tobacco and advertising lobby persuaded the Parliament Commission on Mass Media to write a law with fewer restrictions on tobacco advertising. The lobby was financed by Philip Morris and other tobacco transnationals. They even prepared a document called «Questions and answers on banning the tobacco advertising in Ukraine, prepared for the members of parliament in Ukraine by the Associations of independent advisers for the development of the Ukrainian tobacco industry». It stated that if tobacco advertising in Ukraine were banned, the country would lose $400,000,000. There were, in fact, no grounds for this figure. Michael Parsons, a spokesman for Philip Morris International in Lausanne, Switzerland, later acknowledged the company’s authorship (Washington Post, 19.11.1996). The Alcohol and Drug Information Center (ADIC) checked the Association’s calculations in the document and concluded they are incorrect and misleading. For example, the Association assumed that there would be a four-fold increase in the size of the Ukrainian tobacco crop. In fact, recently there have been decreases in crop size (see Table 1.5). The ADIC distributed an analysis to members of parliament about the economic and other effects of the advertising ban. When the law was finally discussed in the parliament in March 1996, the health lobby was stronger and the parliament voted for banning. However, the tobacco lobby spent immense amounts of money for an anti-law campaign and managed to persuade the President of Ukraine to issue a veto. The final decision, adopted in July 1996, was a compromise: tobacco advertising is banned on radio and TV but allowed in printed media and billboards.

Presently, there is significant direct advertising on billboards and in print, as well as indirect advertising on T-shirts, plastic bags, cafe umbrellas and little private shop lights - even trolley cars. Philip Morris, JTI, Reemtsma and BAT are among the top on the list of billboard advertisers, spending a combined $53 million on billboard campaigns in 1997-2000 (30% of all billboard advertising expenses). While tobacco advertising is banned on TV, the ban is often ignored, for example one TV channel has a special youth musical program called «Camel rock.» Tobacco ads for Marlboro, Parliament and Vogue remain common in women’s magazines. According to a nation-wide survey in November 2000, 49% of the respondents support a total ban of tobacco advertising and only 5% believe that is necessary to permit tobacco advertising on radio and TV.

Health warnings

Cigarette packs are obliged to carry a health warning. This rule was adopted in Soviet times and has not been changed by the new Ukrainian legislation. Most cigarettes packs produced in Ukraine carry the following health warnings: «The Ministry of Health warns: smoking is dangerous to your health», «Smoking is dangerous to your health», «Smoking is dangerous to health», and «Smoking makes life shorter». The warning is printed on one side of the pack in small letters 1x1 mm or 2x2 mm sometimes in contrast colours (black and white), sometimes not (gold on red).

Restrictions on smoking

Smoking is banned in all means of transport (subway, buses, etc.), in cinemas, theatres, covered sport arenas, school buildings, and in some work places and government offices. Partial restrictions apply to international flights (smoking is restricted to a designated area). Since April 1997, smoking has also been banned in all treatment and prevention institutions. Since August 2001, smoking has been banned in the administration building of the President of Ukraine.

Some places obey the law, even though enforcement is mostly informal.

Youth access restrictions

According to the regulations on retail tobacco sale (issued in August 1996), it is prohibited for people younger than 18 years old to buy and sell tobacco.

Unfortunately, there is no enforcement of these regulations.

Cigarette vending machines do not exist in Ukraine.

The nicotine and tar content of cigarettes

The Ministry of Health issued an order in July 1997 that set a maximum permissible level for the tar and nicotine content of cigarettes. The tar content of filter cigarettes sold in Ukraine should not exceed 15 mg per cigarette. Non-filter cigarettes are allowed a maximum of 22 mg tar per cigarette. The nicotine content limits are 1.3 mg and 1.5 mg per filtered cigarette and per a non-filter cigarette, respectively. This is an improvement from the former 1991 standards adopted by the former Soviet Union, when the maximum level of tar was 25 mg and the maximum level of nicotine was 1.5 mg per cigarette.

Other regulations

A license is required in order to sell tobacco products. According to the regulations of retail tobacco sale (issued in August, 1996), the following is prohibited: to buy and sell tobacco to people under the age of 18; to sell tobacco in youth, educational, health, and sport settings, and other places identified by local authorities.

Cessation programs

Smoking cessation programs are not available in primary health care facilities. It is private institutions and non-governmental organizations (like the «QUIT-Center» in the city of Kiev) that provide most of them. Nicotine replacement therapy is available only in the form of chewing gum, and it is not accessible to most of the population due to its cost (the price of 30 pieces of gum with 2 mg of nicotine each is about 5 $US; a pack of cheap local cigarettes could be 0.1 $US).

According to a national survey in November 2000, only 2% of smokers applied to medical professionals for help quitting, and only 5% of them used medicine for smoking cessation.

According to Pharmacia data in 2000, the market of Nicorette gum was 59,000 $US and for other cessation drugs – 14,000 $US.

The Coordinating Board on Tobacco Control

The severity of problems caused by tobacco use show the need to establish an intersectoral coordinating committee for tobacco control. The Ministry of Health initiated the establishment of such a committee. On November 12, 1997, the Government issued a decree and established a governmental Coordinating Board on Tobacco Control. The Minister of Health heads the Board. There are three deputy chairpersons: the First Deputy Minister of Health, the Deputy Minister of Finance, and the First Deputy Head of the Consumers Protection Committee. Representatives of the following ministries and departments are members of the Coordinating Board: the Ministry of Interior, the Ministry of Education, the Ministry of Defence, the Ministry of Youth and Family Affairs, the Ministry of Culture and Arts, the Ministry of Science and technology, the Sports Committee, the Occupational Health Committee, and the State TV and Radio Company. There will also be representatives from some voluntary organizations (the Red Cross, the Movement for Healthy Lifestyle, and the Alcohol and Drug Information Centre) and the Parliament Committee on Health.

The recent development of a tobacco control policy

To support the development of a strong tobacco control policy and to counteract tobacco industry activities, some NGOs have established the Coalition for Tobacco Free Ukraine in September 2000.

In the year 2000, the First Deputy Minister of Health and the Deputy Head of the Board, Dr. Olga Bobyleva, initiated the development of the Tobacco Control and Health Protection Law. In the year 2001, a draft of this law was discussed by all relevant ministries and supported with exception of the Ministry of Agriculture.

However, in March 2001, some members of the parliament presented a draft of the Law on Smoking Restrictions, and because of this the government could not present the Tobacco Control and Health Protection Law. In June, the Law on Smoking Restrictions was adopted by the parliament at the first reading. Although it was a rather weak law, all of the tobacco factories except Philip Morris attacked it, stating that it served interests of only one tobacco company. For example, it had severe tar and nicotine limits, which small factories could not follow, while these limits have no value for public health. During a discussion of this law in the Parliament Public Health Committee, most propositions including public health proponents were ignored, and the version of the law presented to the parliament in November was not comprehensive: tobacco advertising issues were not included, the smoking restrictions would be hard to enforce, and there should be 6 health warnings with the tobacco industry being able to choose only one of them. On December 13. only 109 members of the parliament voted for this law, while 226 were needed in order for it to be adopted.

The government in June 2001 adopted the Conception of the Governmental Tobacco Control Policy. It includes some good intentions, like a tax increase and an advertising ban, but has no real terms or obligations.