WHO Internatioanl Conference on Tobacco and Health—Making a Difference to Tobacco and Health: Avoiding the Tobacco Epidenic in Women and Youth in Kobe, Japan, November 1999
The Kobe Declaration
Women the next wave of the tobacco epidemic – an overview
Dear colleagues
and friends representing almost 50 countries, it's great to meet you.
And to the organisers many thanks for inviting me to this very important meeting.
| When
the Irish born American femme fatale Lola Montez had her portrait taken
at a Boston studio in 1851, I am absolutely sure that neither she or
anyone else could have foreseen the future symbolic value of the cigarette
as a symbol of emancipation for women, or the tragic development that
we are now facing, with women as the next wave With the
dress and hairstyle Lola Mendez is wearing in the photograph
she could actually pass for a lady, if it wasn’t for the
cigarette which stands out particularly effectively against her black
gloved hand. Used as the focal point of this picture,
the cigarette was certainly intended to provoke us. Ladies
in 1851 did not smoke and the very notion that women and girls might
Instead women during this period, like in the US, played a central role in battling against the cigarette. Among other things they urged for restrictions of sales of cigarettes to women. A total ban on sales to women was actually not far away in the US as late as in 1921. Lola Mendez 1851 with permission from Benedikt Taschen Verlag, Köln |
But
today the number of women smokers is increasing rapidly in most parts
of the world, not only because women are the  fastest growing population in the world, but also because smoking is still fostered and encouraged world wide for commercial gain. With their huge marketing resources the tobacco companies have successfully encouraged women to smoke by promoting its social acceptability. They have even managed to make the cigarette a symbol of new roles and expectations of women’s behaviour. From the beginning, the cigarette represented power, authority and independence for men. But for women it had and still has quite different symbolic values, signaling values such as rebelliousness, independence, glamour and sexuality. Anyone who has seen Laureen Bacall asks Humphrey Bogart for a light knows how closely sexuality and smoking are linked. Tobacco advertisement with Laureen Bacall and Humphrey Bogart |
| Since
the 1920īs when the sad tobacco history started among women in the US,
the transnational tobacco companies have invaded country after country
in trying to get women hooked on tobacco. For the tobacco industry it
is all about creating the right image of women as smokers by creating
needs and desires and about manufacturing their products as a tool to
fulfil our needs and desires.
By wrapping in their seducing messages in gold and purple the tobacco companies have very cleverly hidden the truth that tobacco is nothing else than a killer. Instead the tobacco companies are promoting their deadly product by exploiting our ideas of: |
be
experimenting with cigarettes was certainly not confronted publicly.
|
Glamour: |
Emancipation: |
Power: |
 But
perhaps even more cynical and misleading is the tobacco companies promotion
of the cigarette to women as a fat-free way to satisfy our hunger, appealing
to women’s desire to be slim. I must say I canīt find a more selling
argument aimed at a target group which has a tendency to like themselves
even better the less there are of them!
|
 The
World Health Organisation has estimated that the number of smoking women
will almost triple over the next generation, to more than 500 million.
Of those 500 million women more than 200 million will die prematurely
from tobacco induced diseases. And donīt ever forget that these women
are not just faceless statistics, but are the girls and women of today.
Allow me to use the Scottish painter Andrew Geddeīs painting from the beginning of this century to illustrate my own feelings about this almost totally preventable epidemic! Painting by Andrew Gedder from the National Scottish Gallery in Edinburgh |
|
In
the developed nations, there are many projections of the dire trends
of smoking among women, but in developing nations we can only begin
to make estimates as data on Estimates by WHO 1997 and Alan Lopez 1997 |
I
wish I could be more optimistic about the future but unfortunately experience
in developed countries suggests that  smoking
habits among women in developing countries will soon become similar to
those among men. WHO estimates that in 2020 the prevalence of women smokers
in developing countries will be the same as in developed countries, namely
20 per cent. In
developing countries, where the epidemic is growing rapidly, especially
in urban areas, there are of course considerable variations. |
In the African region data are available from less than 30 per cent of the countries and itīs estimated that about 4 per cent of African women smoke. In Latin America and the Caribbean countries smoking is as common as in developed countries, with an average of 22 per cent. In South East Asia the prevalence of cigarette smoking is still very low among women and only 4 per cent smoke manufactured cigarettes. But other forms of tobacco use among women are very common and in many rural areas of India as many as 50-60 per cent of women chew tobacco. In the Western Pacific the overall smoking rate among women is 8 per cent. But even here there are big variations, from 30 per cent in some population groups in Fiji to 3 per cent in Singapore. I guess many of you are sharing my problem with visualising statistics but if I tell you that the 4 per cent of women who smoke in China means as many as 20 million Chinese women of today. Also that of these 20 million almost 10 million will die prematurely from tobacco related diseases. Then I am sure that all of you will understand the scope of the problem. And who can better describe the importance of combating the smoking epidemic among women in China at an early stage of the development than our exellent chair at this meeting Professor Judith Mackay when she ones said; "The greatest single opportunity for prevention of non-communicable diseases in the world would be to prevent a rise in smoking among girls and women in China"! Something that certainly could be true for most developing countries today! In the Eastern Mediterranean region smoking among women is still often considered vulgar, improper and immoral. But despite that about 4 per cent of women smoke in this Region. Finally in Central and Eastern Europe where several countries certainly should be regarded as developing countries, the smoking rates among women are now similar to those in Western Europe which is about one quarter. In many of the Eastern European countries, the increase has been quite dramatic during the last years. For example in one of Sweden’s neighbour countries Lithuania, only very few women, 10 %, used to smoke until the beginning of the 1990īs. But in the last five years the proportion of women smokers has doubled! In the younger age groups the increase has been almost 500 per cent during the same period! In Sweden it took almost 20 years to double female prevalence. |
Advertisement from Lithuania 1997 |
| I
must say that for me the value of getting women to quit smoking in the
US or in Sweden is neutralised if other women at the same time take
up smoking in Lithuania, If the depressing smoking trends are not enough to inspire us to further action, we also have strong medical arguments, which clearly demonstrate that: Women who smoke like men will also die like men and perhaps also when they are even younger.This is the message that all of us have to bring to the public.
Poster from the Netherlands. A girl in a coffin. |
| But
unfortunately in many countries there is still a perception that smoking
is mainly a male problem and that women seem to be more resistant to tobacco
than men. This in a way isn’t very surprising as only in a few countries
like the US, UK and Canada, where women have smoked for decades now, have
smoking related diseases among women become common. Tobacco is now a leading
killer of America and European women. Already in 1987 in the US, lung
cancer a direct result of smoking –surpassed breast cancer as the
number one cancer killer for women. At present as many as half of the total number of women killed by tobacco every year are in the US which has only 5 per cent of the worldīs female population. This is a fact that clearly demonstrates the magnitude of the smoking epidemic among women. And what is even worse; it is not only that women will die from the same tobacco related diseases as men there are also those unique risks for us women related to our reproductive function. Except that women who smoke suffer from an increased risk of cervical cancer, infertility, menstrual problems, early menopause, increased risk of osteoporosis, smoking is also a major risk for poor outcome in pregnancy. Finally if this is not enough to inspire us to strong actions we have also learnt during the last years that the as with alcohol, women seem to be even more sensitive to tobacco than men. In Sweden, which is now one of the few countries in the world where more women than men are smoking, women are now the main lung cancer victims among people under 50 years. The challenge is daunting and it is easy to be pessimistic, but don’t forget that the deaths and diseases among women who use tobacco are almost 100 % preventable. Also the solution is very simple; We just have to do more, and the sooner we act the sooner we will start we will get results. I must say after been working with tobacco control more than 20 years now I have actually realised that besides the tobacco industry there is also a second enemy which is peopleīs luck of concern for the tobacco problem. So please donīt forget that nothing happen unless we take action, Also there is no time to wait for others to take the initiative. And I can promise you while we are hesitating to take action the transnational tobacco companies will expand into new markets with women as their prime target. I have a dream that this Conference will mark the start of a worldwide women’s campaign against smoking and also soon as a direct result of our efforts we will be able to build consensus around a specific protocol on women in the WHO Framework Convention. |
As
the President of the International Network of Women Against Tobacco I
hope you will now accept my invitation to become a member of our forces
and act as women leaders in the tobacco control movement. Welcome to join
me on the barricades 
INWAT is today a network of almost 600 members in 60 countries. Our main objectives are
The International Network of Women Against Tobacco, established in 1990 |
|
Like the medieval woman Joan of Arc, from the 15 century who led the French army in many battles during the Hundred Years War my wish is to see many more women having leadership in the tobacco control movement all over the world. Right now we are engaged in what is more than a hundred years war against tobacco disease, a war that is being fought on many fronts therefore we will need many more of you to work with us. Joan of Arc from the 15 century By promoting women’s leadership I am convinced that we will dramatically increase the available pool of expertise and knowledge. After all it is not only that we women are half of the worlds population we are also strongly represented in healthcare, teaching and other profession in the front line of tobacco control. Dear colleagues welcome to join our world wide forces. By working together we can prevent the tobacco industry from getting women hooked on tobacco in developing countries. The future must be our hands and not in the hands of the tobacco industry. And really it does not necessarily need to get worse before gets better! |
And
today there seem to be no limits for the tobacco companies in their
eagerness to get women hooked on tobacco. The same marketing techniques
that have been used to promote smoking among women in developed countries
are now being applied to women and girls in developing countries. And
I guess that anger is too mild to describe my own feelings when I look
at this advertisement from Lithuania. The caption says: "Nobody
can take the cigarette away from me( says this woman), not even if I
get hurt". 
China,
Brazil or South Africa. 
