World Heart Federation: Tobacco control in Colombia

APRIL 2010

TOBACCO CONTROL IN COLOMBIA: RESOUNDING VICTORY FOR HEART HEALTH

In July 2009, Colombia became a regional leader in public health when it enacted a strong, comprehensive law on tobacco control. The Colombian Society of Cardiology, working closely with policymakers, non-governmental organizations and health officials, played a key role in this public health victory. Through its 2009 Award for Leadership and Excellence in Smoke-free Policy, the Global Smokefree Partnership has recognised the Society, along with other key advocates, politicians, institutes and officials for this remarkable achievement.

Winning recognition

Global Smokefree Partnership is multi-partner initiative formed to promote effective smokefree air policies worldwide; each year, it gives awards for leadership and excellence in smokefree policy. The award was presented to Colombian advocates in Baltimore at the congress of the Society for Research on Nicotine and Tobacco (SRNT) held in February. Along with the Cardiology Society, other Colombian recipients named were Vice-Minister Cuervo, Senators David Name and Dillian Francisca Toro, the National Cancer Institute, Corporate Accountability International, the Bogota Bar Association, the Cancer League, and the Colombian public, who support and comply with the law. Other winners in 2009 were: Mr Murli S. Deora (India), Davao City Anti-smoking Task Force (Philippines), Turkish National Coalition on Tobacco or Health, and Guatamala (multiple sectors).

Getting past the influence of the tobacco industry

For years the advocates fighting for tobacco control in Colombia were thwarted by the pervasive influence of the tobacco industry. “Over the past 15 years some 20 tobacco control bills have been introduced in our legislature,” recounted Jaime Calderon, President of the Colombian Society of Cardiology. “One bill after another was defeated, as each year over 20,000 Colombians continued to die from tobacco-related illness – including heart disease. Colombia has many problems that are more visible and immediate: crime, internal conflict, displacement, drugs, poverty” he continued “so it was hard for media, politicians, or citizens to focus on problems whose impact, while enormous, is less visible.” Indeed, Colombia was one of the last countries in Latin America to sign the Framework Convention on Tobacco Control (FCTC), the world’s first public health treaty.

Regional support

Colombia acceded to the FCTC in April 2008. The InterAmerican Heart Foundation (IAHF), long-time leader in tobacco control, helped local tobacco control partners mobilise support by bringing in regional expertise and attracting international funding for their activity. Within days of a high-profile World No Tobacco Day event organized by IAHF and its local partners, Carlos Ignacio Cuervo, who had just become Vice-Minister of Social Protection, announced a sweeping smoke-free decree. The ban was aligned to FCTC standards and made Colombia the largest country in Latin America with nationwide 100% smokefree policy. Dr Calderon, speaking for the Cardiology Society, immediately declared support for the ban in the nation’s leading paper.

Working together to defend the ban

The victory was fragile because it could be changed by legislation. In no time, new, weaker bills were proposed for debate. With funding and technical support from the Campaign for Tobacco Free Kids, Beatriz Londoño, a former public health official teamed up with Colombian lawyer Yul Francisco Dorado Mazorra, who had long worked with Corporate Accountability International to support strong tobacco control. Together, they mobilised a coalition to protect the ban and ensure that any new legislation enacted was aligned with evidence-based measures outlined in the FCTC.

Sharing science with policymakers

Claudia Anchique, a cardiologist from Duitama, joined the coalition on behalf of the cardiology society. Working with Diana Rivera of the National Cancer Institute, she spoke with Senators and Congressmen about the health impact of secondhand smoke, testifying before legislative commissions and speaking to the media. “We explained how strong, clear and comprehensive tobacco control law would protect Colombians’ health”, she recalled that “One thing that really helped was when we commissioned a poll about the ban: it showed that 91% of the population were glad about it. This was a lot of help with politicians: we said the people want this smoking ban and they are watching to see how you protect their health. That made them listen”.

She emphasised that “We also talked a lot about youth. In Colombia, tobacco companies were still hiring models to hand out cigarettes in bars, concerts…they sponsored football teams and many cultural events, and vendors could sell cigarettes as “single sticks” that make it easier for children to afford. A lot of people think there is nothing you can do to change smokers, so it’s a lost cause. But when you show them all the actions they could take to help keep their children from getting addicted, they begin to realize why you need a clear law: if there is anything we care about more than business, it is our children. One congresswoman introduced a weak bill for debate and after we talked to her she changed her mind: in the end she gave important support to the strong law and really helped it pass”.

Mobilising public support

In parallel to this work with policymakers, the Colombian Society of Cardiology worked with other advocates to mobilise public support for strong tobacco control. They worked with youth and communities and leveraging events like World Heart Day to get the message across. Dr Anchique continued “We also went to talk to groups like the football association and the trade groups, to make them understand what we were doing. When finally the law came up for vote, we organized medical societies to join together to put a full-page letter of support in the top newspaper. In the plenary on the day of the vote, the room was full of medical students wearing tee-shirts that demanded smoke-free air”.

Making the law work

The law requires that all indoor workplaces and public places be smoke-free. It prohibits tobacco advertising, promotions and sponsorship and requires large, pictorial health warnings on tobacco packaging. It also mandates public education programmes on the deadly effects of tobacco use. Since it passed, the coalition has worked to develop the broad support and enforcement needed to make any law come off the paper into reality. “We are also working towards getting support for increasing taxes,” said Dr Anchique, “that is an important and effective measure that was left out of the law”.

Stepping beyond science

When asked how she has been changed by her involvement in action to change health policy, Dr Anchique replied: “We cardiologists are thinking in technology most of the time; many of us have the idea that prevention is important, but often don’t really see it as our job. For me this was the first time to step outside of science, of clinical work, congresses and journals and to talk with lawmakers. It was a big, big step, but you have to do it. Before, I was waiting for the politicians to do something, blaming them for not caring about health. But we cannot sit around and wait for a different world …..we will die waiting! We have to go to the politicians, to confront them, convince them to take health seriously; after all, we cannot expect them to have our knowledge unless we give it to them. This is our reality and no one else will change it for us – we can’t expect it to happen on its own”.

Working with youth

“The other thing I learned was to work with youth. As we developed campaigns and events we worked with ACOME, the medical students’ association. It was the first time we had included students in our activities, and we were really surprised to learn what good speakers they were, with fresh ideas. They learned from us, too. Now we are working in the universities with students, ensuring good implementation of smoke-free policy, increasing content on tobacco and cessation in medical school curricula….if what you want is change, youth are a big help”.

Stirring things up

The Cardiology Society’s active engagement in tobacco control grew through its involvement with the World Heart Federation Colombia Model Youth Project. Project Manager, Dr Londoño and a number of youth who returned from the Global Youth Meet in India in 2007 developped tobacco control advocacy activities. In February 2008, Dr Londoño and a handful of these youth attended the Colombian Society of Cardiology Congress to develop informal exchange on tobacco control with congress participants. They got the Minister of Social Protection, who was visiting the Congress, to take his first public stand on the issue. On the day before the ban first took effect, the award ceremony for the project’s youth media and graffiti contest gave youth a prominent place in media coverage about the ban, sending the message nationwide that smoke-free policy was something that youth demanded, not something imposed by authority. “When we started the youth project”, Dr Londoño recalled, “Colombia had just declared that it would become party to the FCTC, but it seemed like nothing was happening. We picked tobacco as our focus for the project because that is what the youth we were working with were interested in. We hoped they could help stir something; they have definitely been part of the equation of change”.

Finding the time

Dr Anchique is the only cardiologist in Duitama. Asked how she found the time to combine lobbying and organizing with her work and family life, she laughs. “It was not easy! Sometimes I would get a call and had to drive three hours to get to Bogota by 10:00 am to speak before the legislature…..and would not get home until late at night. My specialty is rehabilitation, so the centre could arrange things with the patients but my little girl – a toddler – was not so easy. Some days I hardly saw her and that was tough, but now I don’t regret it because now she has a healthier world for her to grow up in. Last week when we went out of Colombia on vacation she noticed how many people were smoking and didn’t like it…she was not used to the smoke!”.