Philippe Boucher's Rendez Vous: Giacomo Mangiaracina

Rendez-vous with Giacomo Mangiaracina

President of the Societą Italiana di Tabaccologia, Roma, Italy
By Philippe Boucher

Tuesday, April 18 2000

Thank you Giacomo for accepting our rendez-vous.

May I ask you to introduce yourself?

I am 50, have two daughters, one with a college degree in psychology and the other in sociology and Argentine wife. I am a doctor, specialized in Cardiovascular Diseases and Preventive Medicine. I worked as a public health manager in Sicily in 1977, in a very difficult situation because of the Mafia and corruption of political environment. So, after five years, I resigned. In the following years, I worked in prevention of cardiovascular diseases and also in scientific journalism. In 1985, I moved to Rome with my family where I started the "big project" of my life, prevention and treatment of tabagism. In 1973, I attended the first Seventh-Day Adventist's "Five-Day Plan" when it first came to Italy. I had been a careful observer and from that date my pioneerism with "the tobacco adventure" started. I began to collaborate with the "Vita e Salute Association," organizing smoking cessation programs all over Italy, in Italian Switzerland and among the Italian community in Germany. Until now, I have coordinated over 600 smoking cessation programs in which more than 30.000 smokers attended. I also formed 450 operators and group-trainers. In 1986, the Italian League against Cancer asked for my collaboration in creating a new form of stop smoking group therapy. Ten years later the Health Ministry appointed me as scientific consultant and member of the first Italian Commission for Tobacco Control. However, I continued in charity work because of exasperating delays and omissions. The most important results date from 1997. The national press and TV interviewed me about my stop-smoking programs and so many hospitals in Rome asked me to help create services for patients who are smokers. The public office of the City of Rome appointed me as technical consultant for tobacco programs for the OMS Smoke-Free Cities project. In 1999, I was elected president of SITAB, Societą Italiana di Tabaccologia.

First question: Italy is often presented as plagued with cigarette smuggling. Can you tell us what the situation now is?

Four-fifths of Italy borders on the sea, so we have two big problems: clandestine immigration and smuggling. The former presents more difficulties considering that the economy of some cities in the south, such as Naples and Bari, is sustained by cigarette smuggling. Last March, three policemen died during a shoot-out in an anti-smuggling operation. The government then proposed to give economic help to the families of repentant smugglers. We assume that their only goal was to calm public opinion. These criminal organizations in Italy produce illegal income of about 500 million dollars per year. This money is then invested in other criminal activities. Every day a swarm of little speedy boats cover the 12-mile stage between the big Yugoslavian and Albanese ships towards about 8.000 km of Italian coast.

Information from the Italian Finance Police indicates that one Italian in four smokes smuggled cigarettes, for 3.500.000 daily consumers. This constitutes a big profit for crime and a loss of about 100 million dollars per year for the government, with an average of 8.000 tons of imported cigarettes. The repression grows; its costs are high compared with the benefits. The problem still exists.

2. Philip Morris has been accused in the past of cheating on taxes in Italy. Is this case still pending? What are now the relationships between the State and the big multinationals?

In a country with 1.200 tax-evaders and 9.500 million dollars of tax evasion per year, the sin of PM is readily absolved. The strategies of advertising promotion of PM in Italy are very successful. They recently launched social and cultural initiatives such as "Progetto Cinema" and "PM Award" at the Luiss University in Rome. This year the jury awarded a prize to "Hag Coffee," produced by Kraft-Jacobs Suchard, owned by PM!! ... It is also clear that PM's goal is to reach young people and unfortunately, we have very few possibilities to counter these strategies. On several occasion we have been successful with a team of lawyers specialized in litigation (Codacons). The Government is totally absent in these matters. We receive awards and acknowledgements for our work, but no monetary help or facilities.

3. You have started a website ( ), can you tell us about the organization(s) you work with, what your main ongoing projects and objectives are?

Five years ago, given the silence of national institutions in tobacco control, I founded GEA Progetto Salute, a non-profit organization with a team of doctors, psychologists, teachers, sociologists in order to create projects and services where the Government is not present. In the last three years the most important results:

1. Smoking cessation services in six hospitals in Rome.

2. Formation stages for operators, physicians, psychologists, and nurses.

3. The first "pregnancy without smoking" service at Policlinico Umberto I University Hospital, in Rome.

4. The first Italian network of organizations and professionals on tobacco control.

5. Creation of SITAB (societą italiana di tabaccologia), the first Italian scientific society in tobacco-related problems.

6. "Internet No Smoke", a controlled self-help, step-by-step smoking cessation program, via Internet. We monitor about 40 smokers per year, and think this figure will increase.

7. "GEA News", an e-newsletter on Tabagism that we send monthly to about 1.100 addresses which includes all the Italian organizations involved in tobacco services and research.

8. The first Italian nonsmokers e-group:

Now, our first objective is doctors. In Italy 35-50% of medical doctors are smokers. This huge problem reduces the social impact of prevention and treatment of tabagism. We need to organize a Secretariat on Tobacco Control and Smoking Prevention. On several occasions, I asked governmental institutions for funds and facilities, with no results. Our programs are still self-supported, but we can not develop them on a big scale. It is a shame that a non-profit organization is doing the work that a Health National Office should be doing. Once again, I received an invitation from the National Institute of Health to lecture about GEA, its activities, and strategies, on May 31, during the world no-tobacco day. Health Minister Rosy Bindi will be present. Other than this, there have been no initiatives by the government agencies.

4. Latin countries sometimes have very tough laws in the books that are -unfortunately- largely unenforced. They are often very good on general political declarations while not providing any adequate funding for implementation of the stated excellent intentions. This is my personal experience with... France. What is the government really doing in Italy to promote tobacco control? Is there an office of smoking and health? How many people work on this issue, with what budget?

The first Italian law in tobacco control was promulgated in 1973. It is still a good law which forbids smoking in public workplaces, hospitals, schools, cinema... but it is still largely unenforced. Here we have another situation of volunteer intervention: three years ago volunteers made surprise visits to some public offices in Rome, reporting to the police all violations of the law. The most important newspapers covered the event and debates were televised. We now have more public attention on this problem, is very difficult to stop people from smoking in Italian hospitals! We don't know how the situation is in other Latin countries, but here we need stronger strategies, involving non-smoking staff on the workplace. I consider the work in this field to be very difficult, requiring many operators. The government is doing nothing. The National Health Secretariat has an office for "Drug Dependencies and Tobacco," but it does not work as it should on Tobacco. If you contact them by phone (0339-06-5994), the director of this office, Mrs. Daniela Galeone, will tell you that there are no funds for tobacco control. Fines against smokers feed the fund. Since it seems that Italian smokers are usually not fined, the national fund is almost at zero. So, no institutional taskforce against tobacco and no budget. This is enough for us to expect nothing good in the near future.

5. The EU Commission is now headed by Romano Prodi. Do you have any idea where he stands as far as tobacco control is concerned? What about the rest of the Italian political leaders? Are some of them concerned?

I would like to know what Prodi's ideas are for tobacco policies and interventions. We know for sure that the Italian "tobacco case" is a dirty matter. It seems that political leaders consider it not-a-real problem. Tobacco kills 90.000 Italians each year, alcohol 30.000 and heroin 1.000. Our political leaders seem unable to evaluate these figures. They always act as if nothing is happening. On the contrary, the most popular expressions are: "No prohibition," "No American intolerance", "ex-smokers are the worse pain in the ass".

So, in the last seven years we have had a progressive increase of smoking among teenagers. This is due to the few and low-quality projects in prevention. Who can help us?

Thank you Giacomo for taking the time to be with us today.

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