Philippe Boucher's Rendez-vous with . . . Heather Selin
Tobacco control advisor with the Pan American Health Organization(PAHO)
Rendez-vous with . . . Heather Selin
Washington DC, USA
By Philippe Boucher
Tuesday, March 13 , 2001
PB: Thank you Heather for accepting our rendez-vous.
May I ask you to introduce yourself?
Heather Selin: I was born and raised in Saskatchewan in western Canada and did undergraduate studies in Saskatoon before moving to New York City to pursue a masters degree in psychology. I moved to Ottawa in 1990 to work for a member of parliament.
I started working in tobacco control in 1992 when I answered a newspaper ad calling for an "advocate" for the Canadian Council on Tobacco Control. I guess that is what I've become: I went on to work for the Non-Smokers' Rights Association in Ottawa, then for the Office on Smoking and Health at the US Centers for Disease Control and Prevention. I joined PAHO as its tobacco control advisor in 1999. Having the combination of governmental and NGO experience, as well as "hands on" experience with some tough national campaigns, has been good preparation for international work.
Q1. Can you explain what PAHO is and what it does in tobacco control?
HS: Established in 1902, the Washington-based Pan American Health Organization (PAHO) provides technical cooperation to its Member States (governments of countries in North America, the Caribbean, and Latin America) to address various public health needs. PAHO is also the WHO Regional Office for the Americas and the specialized health agency of the Organization of American States.
PAHO works with its country offices (29 in total) to identify the technical cooperation needs of Member States, provides a political voice to promote tobacco control policies, and promotes linkages between various players in tobacco control.
As well as myself, the tobacco control team in Washington consists of Dr. Armando Peruga, regional advisor on tobacco, alcohol and drugs, Ms. Maritza Rojas, consultant epidemiologist, and Ms. Tania Pereyra, program assistant. We also collaborate with other PAHO units on various projects.
Q2. What is the working language? do you feel there are cultural differences in the approaches toward tobacco control between Spanish speaking countries vs English speaking countries? what about Brazil?
HS: Spanish and English are working languages at PAHO headquarters, and these as well as Portuguese and French are PAHO's official languages. Of course the working languages of each country are their native languages.
There are definitely stylistic differences between Latin American and English-speaking countries that affect message delivery and communication styles, however this does not translate into vastly different approaches. In fact what I find remarkable is that in most countries, the questions and challenges that come up are more similar than different: questions about evidence, and the challenges of addressing industry arguments and influence.
Q3. If we look at central and south American countries how different can the tobacco situation be from one country to the other? are there big tax/prices differences? important differences as far as regulations/legislations are concerned? or are the countries rather similar in many aspects?
HS: There are significant differences in smoking prevalence. The highest rates - between 32 and 40% -- are in the Southern Cone: Chile, Argentina, Uruguay and Brazil. In these countries women's smoking rates are nearly as high as men's. Prevalence is relatively high in the Andean countries especially among men, somewhat lower in Central America, and there is great variation in the Caribbean, for example less than 10% prevalence in Barbados but nearly 30% in Trinidad.
Unfortunately, most countries are similar in the lack of progress in tobacco control. Measures largely consist of scattered public and school education efforts, limited partial restrictions on smoking and on tobacco promotion, invisible health warnings on packages, and virtually no support for smoking cessation. Affordability is an issue in most countries, even though two or three countries have high tax incidence. We are seeing signs of change, however, and the challenge will be to move the region into the next phase of tobacco control with stronger and more comprehensive policies.
The good news is that Brazil, despite being the world's largest tobacco exporter, has taken a leadership role in tobacco control by passing comprehensive restrictions on tobacco promotion, by building municipal infrastructure for tobacco control, and by strongly supporting the Framework Convention on Tobacco Control.
In addition, some Caribbean countries are very concerned about tobacco promotion and have indicated an interest in banning tobacco promotion. We hope to see some regional precedents set in the next couple of years, and we think the Framework Convention process will assist in this.
Q4 . Do the PAHO countries face certain specific challenges that would be different from other parts of the world? what do you see as the main issues now?
HS: I don't know whether the challenges in the Americas are unique, but I would summarize them as lack of data and research infrastructure, scarcity of nongovernmental organizations working in tobacco control, and lack of funding to change the situation.
We have research institutions that are well equipped to do surveys of tobacco use, however capacity for and interest in econometric and evaluation research is limited outside of the larger countries like Mexico and Brazil. For this type of evidence we rely primarily on data from the US, Canada and Europe. This is the age-old problem of not having local data. The local data usually confirms what is already known about what works, but decision makers insist on having it before acting. We hope that Brazil will provide good evaluation data that is more relevant to policy makers in the region.
There are virtually no funded NGOs working on tobacco. Most tobacco control coalitions are made up of governments and related institutions, with NGOs relying on volunteer representatives such as practicing physicians. Smoking rates among doctors are still high in many countries, so medical groups are not as strong as they might otherwise be. There is some interest among medical students' groups, and of course Latin America has been the source of very strong human rights movements tied to religious, women's and other networks. If the strength of these movements can be harnessed, tobacco control efforts will be given a great boost. However, significant movement is unlikely without funding.
Many traditional significant funding sources for international tobacco control are focused on Asia because of the large population and health implications. Although this priority is definitely justified, some funding needs to be distributed to all regions to try to achieve at least one or two precedent-setting initiatives per region that can serve as models to be emulated.
Q5. What is your general assessment of the situation now? Is the tobacco industry more powerful? is tobacco consumption on the rise? or are public health interests substantially gaining ground?
HS: Going back to the need for more data, we have very little systematic information on tobacco industry activities, such as expenditures on promotion. However, we have enough information to know that industry strategies are not substantially different from other parts of the world: aggressive marketing, youth targeting, distribution patterns that take advantage of smuggling networks, and political connections.
The industry is still powerful in many countries both because of the tobacco agricultural base (eg. Cuba, Dominican Republic, Honduras, Argentina), and because public opinion is not strongly or overtly against the tobacco industry. Although people may be concerned about marketing techniques, the industry does not have the same status of "rogue industry" that it has in the US, Thailand and the UK. Associating with the industry is less of a public relations problem. One reason may be that countries have not been flooded with the information from industry documents that has helped change public opinion in other countries. Part of the barrier is that the documents are in English. Document research published in Spanish would be a great help.
Are we gaining ground? Well, even though prevalence hasn't been going down, it doesn't seem to be going up. However, we are fearful of a rise in women's tobacco use since this is an untapped market in many countries and therefore an attractive one for tobacco companies.
I would say that the ground is slowly being laid for progress. We are starting to address all of the challenges I have mentioned to some degree. We are gathering more data on tobacco use and mortality and on legislation. We have some potential funding sources for econometric research. We are supporting research on industry documents related to Latin America and the Caribbean. The World Bank report is now widely disseminated and is starting to change thinking about tobacco. The FCTC is providing a mobilization platform both for governments and for NGOs.
We will soon be launching a new smoke free environments initiative that we hope will provide another focus and rallying point for tobacco control efforts in the region. The secondhand smoke issue is politically palatable, provides a tangible goal for governments and communities, ties into existing health priorities like health municipalities and maternal/child health, and will build support for other tobacco control measures. Stay tuned.
PB: Thank you Heather for taking the time to be with us today.
Rendez-vous is supported by a contract from the Robert Wood Johnson Foundation
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