Japan's Incredible Anti-Public Interest Tobacco Policy

Daniel P. Dolan (Principal, Communication Japan)

"Japan not only lags behind other countries in terms of tobacco regulation, it remains primitive in its thinking"
--Eitaka Tsuboi, president of the Japan Medical Association.

Smoking in Japan often seems to be as natural as breathing, but how many Japanese citizens know that the Minister of Finance is the major shareholder in Japan Tobacco, with 66.77% of issued stock?

If the idea of a government agency actually promoting consumption by its citizens of a proven cancer-causing product borders on criminally foolish, the travesty is only magnified by the fact that the Ministry of Finance must do so by law. The 1984 Tobacco Industry Law (Tabako Jigyo Ho) mandates "sound development of our nation's tobacco industry….to ensure stable fiscal revenues". Indeed, Business Week reports that in fiscal year 2000 the Ministry of Finance made more than $US 400 million in profit from tobacco sales in Japan. But a government panel in 1999 estimated that smoking costs the Japanese economy $US 34 billion each year in the form of illness, accidents and premature deaths. If these numbers are even close to being accurate, the policy is economically unsound. As University of Hawaii Law Professor Mark A. Levin has noted in an excellent essay on Japan's tobacco policy, "the evidence reveals the sacrifice of public health for the benefit of fiscal and economic interests".

A particularly close relationship between the Ministry of Finance and Japan Tobacco helps to implement national tobacco policy as smoothly as possible. The powerful Ministry of Finance keeps on the sidelines the agency that logically should regulate tobacco - the Ministry of Health, Labour and Welfare - and Japan Tobacco allegedly has made efforts to disrupt international tobacco control initiatives. In a February 18, 2002 address to the WHO European Ministerial Conference for a Tobacco-Free Europe, WHO Director-General Dr. Gro Harlem Brundtland revealed that "UK journalist, Roger Scruton, has recently been exposed for receiving payment from Japan Tobacco International to place articles criticizing WHO and tobacco control, revealing a concerted campaign against the global treaty you are now negotiating."

Japan also has been singled out-together with the US, Germany and the UK-for systematically attempting to derail the recently completed WHO-coordinated Framework Convention on Tobacco Control (FCTC). The treaty includes international rules on tobacco taxation, smoking prevention and treatment, as well as illicit trade, advertising and promotion, and product regulation. But in October 2003 Japan was the only nation among 192 member countries not to endorse the treaty's goal of reducing the consumption of tobacco worldwide. Japan's consistent efforts to de-rail the treaty won Japan the Marlboro Man Award in February 2003 from the Network for Accountability of Tobacco Transnationals. A spokesperson for the group complained that "throughout these negotiations Japan has also blocked progress toward a comprehensive ban on tobacco advertising, promotion and sponsorship, seen by most countries as at the heart of the FCTC."

In addition, Japan Tobacco also has in the past made agreements with U.S. biotechnology companies to develop lung cancer vaccines, prompting some observers to blast Japan Tobacco for attempting to benefit from tobacco sales to persons who might assume that access to vaccines could protect them from lung cancer. One example is Japan Tobacco's December 1998 agreement with Cell Genesys to collaborate on development of such drugs.

Japan's Comfortable Relationship with Tobacco

So just how big a problem is tobacco consumption in Japan? Here are three indicators:

• In Japan 52.8% of adult males smoke, according to 2002 data by the World Health Organization (WHO). Japan Tobacco puts the number at 49.1%.
• In 1998 lung cancer became the leading cause of death in Japan with 51,000 deaths. The number has grown to 56,000 deaths in 2002.
• The top three magazine advertisers in 1999, according to Magazine World, were (in millions yen):
  Kao: 5,664
  Shiseido: 5,337
  Japan Tobacco: 5,060 (approximately $US 42 million)

Japan is the only industrialized country listed in the WHO data with greater than 50% smoking rates by males. Other countries in the same league include Mongolia, Guinea, North Korea, Indonesia, Kenya, Panama, Armenia, Cambodia, Namibia, Kazakhstan, Georgia and Djibouti. Interesting company for the world's second largest economy. Doctors in Japan could of course educate patients who smoke on the dangers of the habit, but 1990 WHO data show that even 24.8% of physicians in Japan are smokers. Perhaps more alarming are the results of a 2001 survey by Mainichi Daily News that found that 30% of high school students in Japan smoke regularly.

Smoking 101: The Facts

Although smoking is the most preventable cause of death in most industrialized countries, tobacco prevention education in Japan is sadly lacking. Probably due in large measure to permissive tobacco advertising regulations and the many role models in Japan who smoke on television or in movies, many Japanese of all ages seem to believe that tobacco use is similar to drinking caffeine in that moderation is harmless ("look, I smoke and I'm still alive"). Yet many years of scientific studies show that any amount of tobacco consumption is harmful to health. Moderate caffeine or alcohol consumption is in an entirely different category of risk. Smoking is responsible for drastically reducing the quality of life for millions of people around the world. Here are three alarming facts from the American Cancer Society:

But quitting smoking at any time provides health benefits. Smokers may in fact be alive, but they are considerably less healthy than they would be if they did not smoke. In September 1990, the US Surgeon General outlined the benefits of giving up tobacco:

• People who quit, regardless of age, live longer than people who continue to smoke.
• The risk increases steadily with the number of cigarettes smoked per day. In those who smoke 40 or more cigarettes a day (2 or more packs), the risk of lung cancer is nearly 20 times the risk in nonsmokers.
• Smokers who quit before age 50 have half the risk of dying in the next 15 years compared with those who continue to smoke. Those who quit by age 35 avoid 90% of the risk attributable to tobacco.
• Quitting smoking substantially decreases the risk of cancer of the lung, larynx, pharynx, esophagus, mouth, pancreas, bladder, and cervix.
• Benefits of cessation include risk reduction for other major diseases including coronary heart disease, lung diseases, and cardiovascular disease.

Citizens Groups Should Force Permanent Policy Changes

Can Japan extricate itself from backward government complicity in pushing tobacco? A bit of good news for cost-conscious smokers in Japan is that Japan Tobacco has announced that it will raise tobacco prices 10-30 yen per pack effective July 1, 2003. This small increase, however, probably will not have significant impact on smoking rates. More importantly the Health Promotion Law enacted July 2002 by the Ministry of Health, Labour and Welfare has lead to a May 1, 2003 passive smoking law that requires shops, hotels, restaurants, bars, schools, bus terminals, railway stations and other public places to "make efforts to take necessary measures" to reduce second-hand smoke.

Although it might seem that the new law could go far toward increasing the health of Japanese citizens, as is typical in Japan the Ministry has not put into place any kind of enforcement mechanism. Japan Railway has therefore decided that its version of "making efforts" to curb smoking is a ban at only six heavily trafficked stations for only two hours in the morning.

Another unpromising sign occurred in May 2003 when the Ministry itself abandoned a plan to remove all tobacco vending machines from its Tokyo headquarters after strong objections from factions within the Ministry. In an apparent compromise four vending machines were left for the convenience of tobacco-addicted health officials.

With these woefully late but hopeful signs of sincere concern by the Japanese government in the physical health of the nation, citizens groups should quickly gain momentum and rally to the cause of pressuring the two Ministries to truly act in the public interest. This will be no easy task in Japan, where NGOs and citizen organizations have always been under-funded and routinely ignored by mass media and government officials. The battle against government support for smoking will require successful consolidation of the efforts of the few existing anti-smoking groups in Japan, in what certainly will be a long struggle against arrogant and entrenched Ministry bureaucrats and other tobacco interests.

One example of the bumpy road ahead for tobacco policy reformers was reported by the Japan Times in 1999, when the newspaper learned that Japan Tobacco planned to give free boxes of cigarettes to senior citizens in Japan in honor of the country's annual Respect for the Aged Day. The Times added that in 1998 Japan Tobacco sent 15 million cigarettes to nearly 5,000 senior citizen homes.

Tobacco Policy Action Points

In the face of government and tobacco interest claims that tobacco profits are critical for the economy, this Faustian bargain should be exposed and denounced as a shortsighted and unconscionable attack on the present and future health of the nation. Here are some among many possible action points for concerned citizens:

• Protest government ownership of Japan Tobacco shares and call for abolishment of the Tobacco Industry Law that mandates this ownership. Also demand that the Ministry of Finance transfer total responsibility of tobacco issues to the Ministry of Health, Labour and Welfare, which should campaign strongly and systematically against tobacco consumption in the public interest.
• Pressure the Ministry of Finance and Japan Tobacco to remove from public access all of the country's approximately 630,000 tobacco vending machines. This is particularly important for reducing smoking among youths.
• Lobby for the creation and systematic introduction in elementary schools nationwide of tobacco education programs based on internationally recognized research by organizations such as WHO.

A cornerstone tenet of democratic nations is that their governments are "for the people". Japan's current tobacco policies run counter to this ideal.