London School of Hygiene & Tropical Medicine

A paper in today’s British Medical Journal reveals for the first time how British American Tobacco actively undermined and eventually overturned groundbreaking legislation that would have served to protect the health of the Uzbek population.

In 1994, Uzbekistan’s tobacco industry was privatised and BAT established a production monopoly in a joint venture with the Uzbek government, led by the President Islam Karimov. Having observed just one electronic billboard in the country during a visit in July 1993, BAT noted in a marketing report that Uzbekistan was ‘unique in the world in terms of its singularly unexploited advertising and promotional environment’, with advertising costs that were ‘cheap enough to allow multinationals almost unrestricted market spend’. The company aimed to exploit this environment, projecting a 45% increase in annual cigarette consumption between 1993 and 1999.

This would clearly require freedom to advertise and when BAT learned that the Uzbekistan’s Chief Sanitary Doctor had issued ‘Health Decree 30’, a potentially highly effective piece of tobacco control legislation that was unprecedented in the region, it responded immediately. The decree banned tobacco advertising and smoking in public places, including schools and universities, and introduced health warnings. Within 24 hours of learning about the decree BAT had co-ordinated arguments aimed at countering each section of the degree, and depicting it as jeopardising broader foreign investment in Uzbekistan. They refuted the health impacts of smoking that had been accurately described in the decree even going so far as to state “smoking has not been proven to actually cause” diseases and denied evidence that advertising would increase consumption.

BAT fought to have the degree withdrawn or amended. When the chief sanitary doctor refused to concede to BAT’s demands, the matter went straight to President Karimov and BAT ultimately achieved their desired amendments. The intended total ban on advertising was replaced with a voluntary code. The ban on smoking in public places was replaced with a ban confined to institutions dealing with health and children, specifying that elsewhere smoking areas would be provided. Despite BAT’s claims that it does not intend to encourage young people to smoke, the original ban on smoking in colleges and universities was specifically removed.

Until now, the only information available on these events was a self-serving report by BAT that failed to mention the existence of the original decree, implying instead that BAT had instigated the development of the new code, and attempting to present the code as an example of ‘the company’s responsible attitude to its advertising practices’. Today’s paper reveals the real story of the code’s development, based on detailed analysis of BAT corporate documents released following litigation in the United States, and held at BAT’s Guildford Depository in the UK. The findings were corroborated by individuals who cannot be named for their own safety as those who have been involved in tobacco control in Uzbekistan have been subject to harassment and torture.

With the proposed legislation blocked, and in the absence of any effective checks, tobacco advertising in Uzbekistan became ubiquitous from the mid-1990s. Reports from this highly secretive state suggest that tobacco consumption has increased by between 7% and 8% each year, primarily among young people, and cigarette sales rose by 50.5% between 1990 and 1996. By 1999, BAT had achieved a market share of over 70%.

Dr Anna Gilmore of the London School of Hygiene & Tropical Medicine, the report’s leading author, comments: ‘Between 1992 and 2000 BAT’s investment accounted for over a third of total foreign direct investment into Uzbekistan. The Chief Sanitary Doctor was powerless next to BAT. There can also be little doubt that BAT’s behaviour has condemned the Uzbek population to suffer far higher rates of tobacco related diseases than would otherwise have occurred.’

She continues: ‘In the light of these and other, similar revelations, the International Monetary Fund needs to reconsider its support for tobacco industry privatisation which is clearly fraught with danger for the population’s health. But if privatisation goes ahead, or has already happened, we need to protect public health by ensuring that there is greater openness, and less potential for corruption and lobbying by tobacco interests’.

Dr Gilmore urges those states participating in the Framework Convention on Tobacco Control (which do not include Uzbekistan, one of the few countries to have neither signed nor ratified the treaty), whose first Conference of the Parties is currently taking place in Geneva,1 to help prevent this degree of policy influence being exercised in other countries. ‘Given the ease with which BAT influenced policy in Uzbekistan, we need to prevent this happening elsewhere. The Framework Convention on Tobacco Control, the World Health Organization’s first international health treaty, provides such an opportunity but binding protocols will be needed alongside support for low-income countries to help them develop effective tobacco control policies.’