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While attending the 11th World Conference on Tobacco or Health from Aug. 7 in Chicago, I was very impressed by the enthusiasm of participants seeking tighter controls on smoking. The first conference, hosted by the American Cancer Society, was held in New York in 1967. The latest conference was hosted by the same society and supported by the American Medical Association and the Robert Wood Johnson Foundation. About 4,500 people took part in the conference, up from 2,500 at the Beijing conference in 1997 and the 400 who attended the first conference, as antismoking campaigns have spread worldwide.

Participants in the Chicago conference included government health workers, researchers, clinicians, public-policy officials and tobacco-control advocates. Also present were U.S. and Canadian prosecutors and lawyers who were handling litigation against tobacco companies. The gathering of government and private-sector officials and academics discussed smoking problems from political, economic, social, medical and educational viewpoints.

One of the main topics of discussion was the prevention of tobacco smuggling. In today’s borderless world, international cooperation is essential to control smuggling. However, Japanese participants were mostly clinicians and included no lawyers or representatives from the Health and Welfare Ministry or other government departments. This shows the lack of Japanese interest in tobacco problems.

The World Health Organization played a leading role in the Chicago conference. In an address to the conference, WHO Secretary General Gro Harlem Brundtland called for international cooperation to implement the Framework Convention on Tobacco Control, the first international treaty on public health, the drafting of which will begin in October.

The convention will set international standards for restricting tobacco ads, preventing tobacco smuggling and promoting information exchanges. To promote the treaty, conference hosts and sponsors urged 200 tobacco-control advocates in more than 100 countries — mostly developing countries — by giving them full financial scholarships. Spending on scholarships this year exceeded the total of such spending over the past 10 years.

At the conference, attention focused on Canada’s new tobacco-labeling regulations, which are scheduled to take effect next January. Under the regulations, cigarette packages will carry the world’s largest warning label on smoking, with a color photograph covering half of the surface. Health-information messages will be printed inside the package. There will be 16 rotated warning messages inside and outside the package.

In panel discussions on the regulations, the health minister, a lawmaker and a representative of a nongovernmental organization from Canada praised one another for their roles in adopting the regulations. Canada’s federal Parliament unanimously approved the legislation that enacted the regulations.

This would be inconceivable in Japan, where bureaucrats and politicians attach greater importance to the interests of cigarette manufacturers and retailers than to public health. I hope that Japanese bureaucrats and politicians will learn from the coordinated campaigns of the Canadian government and industries to tighten controls on smoking.

Japan’s halfhearted smoking controls stirred little debate at the conference. But in a workshop debate I attended, there were some exchanges concerning Japan Tobacco Inc.’s marketing territories. Last year, JT became one of the “Big Three” multinational cigarette companies — along with Philip Morris and British American Tobacco — when it bought the international tobacco-business division of RJR Nabisco Holdings Corp. In video demonstrations at the conference, Mild-Seven (JT) and Marlboro ads were shown prominently. JT is likely to face severe criticism from nonsmokers worldwide in the coming years for going against international tobacco controls.

I noticed at the conference that nicotine-replacement therapies that used gums and patches were attracting increasing attention. Two major pharmaceutical manufacturers joined the conference sponsors in expectation of growing business opportunities regarding the therapies.

A Japanese medical doctor said it was unreasonable that nicotine-replacement therapies were not covered by public health insurance while treatments for alcohol dependency were.

The conference impressed upon me just how far Japan is lagging behind other countries in smoking controls.

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