Foundation for a Smoke-Free World: How it Frames Itself

From TobaccoTactics
Share/Save/Bookmark
Jump to: navigation, search

Framing Itself, Its Science and those Who Oppose It

Since its inception in 2017, the Foundation for a Smoke-Free World’s (‘the Foundation’ or ‘FSFW’) primary argument has been to convince people that it is both legitimate and independent, despite receiving all of its funding from Philip Morris International (PMI). In order to try and build credibility within the debate on tobacco and health, considerable effort has been spent establishing and re-enforcing this idea. Further arguments have been put forth by the Foundation, such as negative framing of some parts of the public health community.

The Foundation has attempted to frame itself as:

  • A legitimate creator of independent research
  • A supporter of FCTC (including Article 5.3)
  • A supporter of social justice issues (empathetic to the smoker, empathetic to farmers and LMICs)
  • A supporter of measured regulation (i.e. harm reduction approach to tobacco regulation)

The Foundation has framed some of the public health community and tobacco control measures in these ways:

  • Negative characterisation of the public health community
  • Negative characterisation of public health measures such as taxation

The following table provides examples of the above and presents some counter evidence which questions the Foundation’s characterisations of itself and others. This table does not represent an exhaustive list of the arguments the Foundation has made, nor an exhaustive list of counter-arguments.


Ways in which the Foundation is framing itself and its role within science and public health Counter claims/evidence
1. As a legitimate creator of independent research
The Foundation repeatedly asserts that it acts independently from the tobacco industry, for example:
  • In October 2017, Derek Yach, the President of the Foundation assured readers that there were “stringent safeguards in place to assure the tobacco industry has zero influence over the Foundation’s agenda or research;”[1]
  • Yach went on to state that “The Foundation is an independent legal entity separate and distinct from the tobacco industry, with independent governance, a peer-reviewed research agenda and strict protections against conflict of interest;” [2]
A McCabe Centre analysis of the Foundation’s constitutive documents outlined here has highlighted several ways in which it appears that PMI would be able to influence the Foundation’s research agenda and practice.[3]
The Foundation used Cohen et al.’s criteria which stipulate the circumstances under which industry-funded models of research may be appropriate,[4] stating that “The Foundation has put those principles and criteria into practice”[5][6] However, Cohen et al. themselves have since been clear that the Foundation does not meet the criteria as set out in their paper, “the claim…[that the Foundation addresses their eight criteria]…is incorrect in several instances”, concluding that “due to lack of independence, the potential for conflicts of interest, and clear public relations gains, the Foundation does not represent a tobacco industry-supported funding model that should be acceptable to the research community” [7]

The Foundation’s very first research output, their ‘State of Smoking’ study was conducted by a public relations firm, Kantar, which has been criticised for its history of working with the tobacco industry whilst simultaneous working for governments and health charities. [8]

The Foundation attempted to establish itself as a legitimate tobacco control organisation, through its statement in support of Bloomberg’s Philanthropies 2018 STOP initiative:

“Because of the tobacco industry’s decades of deception, the Foundation for a Smoke-Free World wholeheartedly supports the Bloomberg Foundation's Stopping Tobacco Organizations and Products (STOP) campaign. We applaud the effort to monitor for public deception and "junk science" designed to cover up or mislead the public about the dangers of smoking or alternative products. We encourage independent review of all tobacco control science – including our own—and we encourage all tobacco control researchers to make their raw research data publicly available for secondary analyses, as the Foundation requires of its researchers”[9]

However, Kelly Henning from Bloomberg Philanthropies made it clear that the new global tobacco industry watchdog was needed exactly because of organisations such as the Foundation for a Smoke-Free World:

“What we face over and over again is this ceaseless pushback by the very well-funded tobacco industry against our work. Most recently, Philip Morris’s newly funded Foundation for a Smoke-Free World, announced not too many months ago, demonstrated how the tobacco industry uses every imaginable tactic to push back. That announcement made us stop and think that maybe there is more we should be doing to try to counter the tobacco industry’s interference with tobacco control. That was really what led Bloomberg Philanthropies to launch this effort.”[10]

The Foundation has likened itself to the Truth Initiative:

“The Foundation’s bylaws, certificate of incorporation and funding agreement are unprecedentedly rigid and establish the Foundation as a completely independent organization, akin to the Legacy Foundation (now Truth Initiative).”[11]

The Truth Initiative is a non-profit tobacco control organisation which was established as part of the 1998 Master Settlement Agreement between the tobacco industry and US states.[12]

As such, its funding came from successful litigation against the tobacco industry.[13] In contrast, Philip Morris was instrumental in developing the Foundation along with Derek Yach (the Foundation “arose out of extended discussions with Philip Morris International”) and in the middle of 2018 was its sole funder.[14]

In 2018, the Foundation outlined its plan to fund research centres:
  • “Through the support of Centers of Excellence for science-based tobacco control research at academic centers around the world, the Foundation aims to develop the next generation of leaders and institutions to accelerate the end of smoking.[15]
  • And in an open letter from January 2018, Yach stated that “the Foundation shares your enthusiasm for a “centres-of-excellence” approach to our grant making. We anticipate the bulk of our funding will support such centres” [5]
The tobacco industry has a history of founding research centres within universities, such as the PMI-funded Duke Center for Nicotine and Smoking Cessation Research (CNSCR) at Duke University in North Carolina and the Centre for Corporate Social Responsibility at the University of Nottingham funded by British American Tobacco.[16]

The tobacco industry has also created non-university-affiliated research groups in efforts to build reputability around industry-funded science, such as the Council for Tobacco Research, which was formed in 1954 by US tobacco companies in an attempt to maintain uncertainty around the health harms caused by smoking[17]

2. As a supporter of the FCTC
The Foundation has framed itself as a supporter of (and indeed, champion of) the WHO’s Framework Convention on Tobacco Control:
  • In October 2017, Yach stated “I was quite surprised when the World Health Organization (WHO) recently issued a statement mischaracterizing the mission of the Foundation for a Smoke-Free World, and wrongly suggesting the Foundation doesn’t comply with Article 5.3 of the Framework Convention on Tobacco Control (FCTC). As someone deeply involved in the development of the FCTC as a cabinet director and executive director at WHO, I know a bit about the FCTC. And it is clear the goals and objectives of the Foundation for a Smoke-Free World are squarely in line with the FCTC and especially Article 5.3”. [2]
  • In the same blog post, Yach continued “Furthermore, the Foundation plans to eventually apply for WHO Non-State Actor designation as a philanthropic foundation. The Foundation and WHO have a shared objective – to rid the world of cigarettes and dramatically reduce smoking-related disease and death” [2]
  • In January 2018, Ehsan Latif (on the Foundation’s Board of Directors) claimed that the Foundation “will support the FCTC by filling the gaps in the FCTC that have received inadequate attention or funding” and outlined these as Article 14 (cessation support), Article 17 (supporting tobacco farmers) and Article 18 (protect the environment) among others.[18]
Although the Foundation purports to be a supporter of the FCTC, its funding is provided by Philip Morris International which, according to a 2017 Reuters report, is “running a secretive campaign to block or weaken treaty provisions that save millions of lives by curbing tobacco use” and who describe the FCTC as a “regulatory runaway train” driven by “anti-tobacco extremists.”[19]

The Reuters report argues that specifically, PMI is attempting to undermine Articles 13, 15, 16, and importantly Article 5.3 which outlines the necessity for tobacco control research to be conducted away from the undue influence of the tobacco industry.[19]

In September 2017, the WHO outlined that given that Article 5.3 of the FCTC “obliges Parties to act to protect public health policies from commercial and other vested interests of the tobacco industry…[and that]…Governments should not accept financial or other contributions from the tobacco industry or those working to further its interests, such as this Foundation”

The WHO continued by saying that “there are many unanswered questions about tobacco harm reduction, but the research needed to answer these questions should not be funded by tobacco companies….when it comes to the Foundation for a Smoke-Free World, there are a number of clear conflicts of interest involved with a tobacco company funding a purported health foundation, particularly if it promotes sale of tobacco and other products found in that company’s brand portfolio. WHO will not partner with the Foundation. Governments should not partner with the Foundation and the public health community should follow this lead” [20]

Further, research suggests that the tobacco industry has used the idea of having common goals with the public health community to its advantage. For example, the concept of harm reduction has been used to “facilitate access to, and dialogue with scientists, public health experts, and policymakers, presenting themselves as ‘partners, rather than adversaries’ who share a common goal”[21]

3. As a supporter of social justice
In several of its blog posts the Foundation emphasises that it is on the side of the smoker:
  • “Our focus is on the smoker – not the concept of the “smoker”, but on the individual. We believe the experience of smoking is multifaceted and deeply personal. Indeed, the State of Smoking Survey findings reinforce our view that smoking is deeply integrated into most smokers’ daily lives, so quitting means more than just giving up cigarettes” [22]
  • “We can easily forget what tobacco control is about when we only focus on data and laws. What matters is the real people, struggling every day. From a smoker trying to quit a habit they know is going to harm them, or a farmer wondering where their next pay check will come from” [23]
  • Further, Yach uses quotes from recently published book ‘Natural Causes’ (Ehrenreich, 2018) to state that “to be a smoker is to be a pariah” and “as more affluent people gave up the habit, the war on smoking…began to look like a war against the working class” and that smoking could be seen as “a kind of self-nurturance” [24]
Tobacco kills more than 7 million people per year, yet, industry and industry-funded bodies have long since portrayed themselves on the side of the smoker.

For example, the tobacco industry has marketed cigarettes to marginalised groups as a kind of empowerment (for example, marketing menthol cigarettes to African American men “framing blacks’ dignity with their right to consume products and services of quality and creating intersecting agendas by linking smoking to meanings of fairness and upward mobility”[25] and cigarettes conceptualised as symbols of emancipation and ‘torches of freedom’ for women.[26])

The tobacco industry is known to use front groups to befriend smokers – one tobacco-industry front group FOREST calls itself the ‘voice and friend of the smoker’ [27]

However, as the WHO pointed out in 2017, “PMI engages in large scale lobbying and prolonged and expensive litigation against evidence-based tobacco control policies such as those found in the WHO FCTC and WHO’s MPOWER tobacco control, which assists in implementation of the WHO FCTC. For example, just last year PMI lost a six year investment treaty arbitration with Uruguay, in which the company spent approximately US$ 24 million to oppose large graphic health warnings and a ban on misleading packaging in a country with fewer than four million inhabitants.” [20] Such aggressive tactics seem at odds with the idea of a PMI-funded Foundation being on the side of the smoker.

In several of its blog posts, the Foundation emphasises that it is on the side of the tobacco farmer, and that one of its priorities is to ensure the economic security of low- and middle-income countries:
  • “The issues facing the smallholder farmer are complex and intertwined. At the Foundation for a Smoke-Free World, we will aim to solve those issues with a holistic approach that puts the farmer first. A new deal is needed for the smallholder tobacco farmer. Here our journey begins putting the farmer first” [28]
  • “Consequently, the additional effect of losing significant foreign exchange earnings from export sales of tobacco will virtually cripple countries like Malawi, which relies on tobacco exports for 81% of its foreign exchange earnings.”. [28]
  • In March 2018, the Foundation launched its Agricultural Transformation Initiative in Malawi [29]
In the past the tobacco industry has created front groups, (such as the International Tobacco Growers Association) that appear to represent the needs of worldwide tobacco growers, but are in fact intended to be industry lobbying groups.

Tobacco companies such as BAT are members of the Child Labour in Tobacco Growing Foundation (ECLT), however, research suggests that tobacco industry involvement in trying to tackle child labour only supports their corporate social responsibility agendas, rather than affecting any real change, and appears to be used to distract public attention away from the low wages and low tobacco prices that the industry pays in countries such as Malawi.[30]

4. As supporter of measured (rather than onerous) regulation
The Foundation also frames itself as a supporter of reasonable levels of regulation:
  • In a blog in April 2018, David Janazzo wrote: “Regulatory regimes…must be properly aligned with the risk/benefit trade-off of combustible and other products. We believe this is particularly important for the poor smoker. Therefore, we support policies that tax combustible cigarettes at substantially higher rates than lower risk products”).[31]
  • In the same blog post, Janazzo also argued that ‘light-touch’ regulation means industry can flourish, which in turn means that consumers are the ’winners’.[32]
  • Janazzo went on to say that “pricing regimes not reflective of the risk profile, as well as negative perception and poor knowledge of product benefits versus risks based on the science, could hamper consumer confidence and thereby adoption at this stage. Bottom line, more research is needed quickly such that…regulators can place the appropriate protections around the products based on relative risk”. [32]
Here the main message appears to be that ‘lower-risk products’ should be regulated less heavily than combustible cigarettes, and that minimal regulation is favourable for all. In the past, the tobacco industry has worked to frame itself as a supporter of measured regulation and has often lobbied for “pre-emptive legislation that protects its own interests”[33]

The Foundation’s statements echo PMI’s own views on a ‘common-sense approach’ to regulation. On PMI’s website they state that ‘sensible, risk-based regulation of smoke-free products, combined with further restrictions on cigarettes, can help address the harm caused by smoking more effectively - and faster - than plain packaging and other traditional regulatory measures”[34]

The Foundation also appears to frame itself as a knowledge broker, in order to support cross-industry drives for regulatory change:
  • “The Foundation is ready to foster a discussion on this…[using, rather than banning technology]…and draw upon and help bring leaders from oil, gas, transportation and agriculture to give their views about how some future regulatory systems could more rapidly support innovation and detect potential threats” [23]
The tobacco industry, in the past, has been adept at recruiting other industries (often through the use of third-party groups, such as the Risk Assessment Forum) to gain support for changes to regulatory architectures. For example:
  • British American Tobacco worked with the chemicals, fossil fuels and pharmaceuticals industry to create and implement industry-friendly standards of evidence in policymaking in the EU, under the banner of ‘reducing red tape’ within the ‘Better Regulation’ agenda. [35]
  • PMI worked in the US to establish and implement industry-friendly standards of evidence around assessing health risks (e.g. through the Data Quality Act in the US and ‘good epidemiology’ in the EU. [17]
Ways the Foundation is framing the public health community and public health measures Counter claims/evidence
1. Negative characterisation of the public health community
The Foundation uses several arguments to negatively frame those who question its legitimacy and the effectiveness of harm reduction technology:
  • Framing those who oppose the Foundation as also opposing public health goals: “there are organizations who, rather than joining forces to tackle this major health crisis in a collaborative, productive spirit, are choosing to oppose the Foundation and its goal of helping smokers quit by advancing the science of tobacco control. This opposition runs counter to the goals of many of these institutions and their leading scientists: to advance public health…” [11]
  • Framing those who oppose the Foundation as inhibiting free speech: ””Despite what we believe are reasonable measures to assure our independence, WHO’s FCTC secretariat issued a premature view that we are not independent and that there is little evidence to support harm reduction. On that basis, they recommend parties to the FCTC not interact or engage with us. Their statement has been used to justify additional measures, including refusing WHO health and medical journals to publish work by FSFW-supported scientists, and banning those who are associated with the Foundation from attending the [2018] World Conference on Tobacco or Health being held in my home city of Cape Town. WHO is based in Geneva..” [23]
  • Framing those who do not embrace tobacco harm reduction strategies as opponents of technological progress: “disruptive technology disrupts the status quo and stirs deep emotions that can undermine progress if poorly managed…every time a technology disruption occurs, people get upset: the Luddites of the 18th century, reactions to GMOs, concerns about driverless cars. What happens first is fear. “Ban it” is the natural response” [23]
  • Framing early refusals to work with the Foundation as knee-jerk emotional responses: “Most of the disruption I’m seeing in the early phase is coming from the traditional tobacco control core. Deep emotional issues related to even considering engagement with the tobacco industry…have led to early reactions. These reactions are compounded by WHO’s views on excluding harm reduction from tobacco control” [23]
The tobacco industry often attempts to shift arguments towards more emotive ones such as framing public health advocates as the enemy of industry and free enterprise, and denigrating members of the tobacco control community.

For example, attempts to discredit non-industry scientists who produce unfavourable research have been documented, such as academics being professionally attacked for speaking up about second-hand smoke[36] and others labelled ‘scientific extremists.[37]

2. Negative characterisation of public health measures other than harm reduction strategies
The Foundation appears to frame policy interventions which restrict the activity of the tobacco industry and act at a whole population level as ineffective:

“we have created smoke-free environments, mandated bigger health warnings, made cigarettes more expensive, and restricted advertising and marketing. Yet still, one billion people continue to smoke … there seems to be a disconnect between the development of policy and the benefit many smokers receive from policy” [38]

The tobacco control measures that the Foundation cites as ineffective here (smoke-free environments, health warnings, regulations on advertising, higher taxes) are known to be effective [39]

Also, the Foundation fails to acknowledge here that the tobacco industry have actively and aggressively fought against such policy interventions. These factors appear to explain why, of the estimated 8.3 million tobacco-related deaths occurring by 2030, 6.8 million will be in low- and middle-income countries (where the tobacco industry is successfully fighting tobacco control policies). [40]

The Foundation also appears to frame taxes on tobacco products as discriminatory:
  • “Cigarette taxes are regressive…a recent article regarding sin taxes describes them as designed to punish the poor.” [41]
  • “we argue that the effectiveness of incremental tax increases in many cases will likely be subject to diminishing marginal returns – with the costs being borne unfairly by the poorest among us.[41]
The article referenced by the Foundation in this blog post[42] was written by Christopher Snowdon, member of the tobacco industry-funded, right-wing think tank, the Institute of Economic Affairs.

This is an example of the Foundation amplifying tobacco industry-funded voices without being transparent about their industry ties. Although the Foundation posits that taxes are discriminatory, tobacco itself is a health inequality issue, and socioeconomic inequities in tobacco consumption in Europe, for example, are “large and widening”.[43] Further it appears that the tobacco industry has actually purposefully targeted working class young adults, seeing them as a “critical market segment to promote growth”[44]

An increase in taxes is a proven method for reducing harms associated with tobacco use since “tobacco tax increases are the most effective and inexpensive way of reducing tobacco smoking prevalence, consumption initiation and inequalities in smoking”.[45]



TobaccoTactics Resources

TCRG Research Blog

Relevant Link

Notes

  1. D. Yach, Why this, why now?, Foundation for a Smoke-Free World, News & Views, 12 October, 2017, accessed 23 May 2018
  2. 2.0 2.1 2.2 D. Yach, Clearing up myths and misperceptions, Foundation for a Smoke-Free World, News & Views, 17 October 2017, accessed 23 May 2018
  3. J. Liberman, The new Philip Morris-funded Foundation for a Smoke-Free World: independent or not?, McCabe Centre for Law & Cancer, A WHO Framework Convention on Tobacco Control Secretariat Knowledge Hub, 30 January 2018, accessed February 2018
  4. J. E. Cohen, M. Zeller, T. Eissenberg et al, Criteria for evaluating tobacco control research funding programs and their application to models that include financial support from the tobacco industry 2008, Tobacco Control, Special Communication,18 (3) 228-34, accessed 23 May 2018
  5. 5.0 5.1 D. Yach, An open letter on the Foundation’s independence and governance, Foundation for a Smoke-Free World, News & Views, 11 January 2018, accessed 23 May 2018
  6. Foundation for a Smoke-Free World, Eight criteria from Cohen et al for accepting tobacco industry funding, compared to the governance of the Foundation for a Smoke-Free World, accessed 23 May 2018
  7. J. Cohen, T. Eissenberg, Criteria not met for tobacco industry-supported Foundation, Johns Hopkins Bloomberg School of Public Health Institute for Global Tobacco Control News and Media, 20 December 2017, accessed 30 May 2018
  8. D. Yach, The State of Smoking 2018 Global survey findings and insights, Foundation for a Smoke-Free World, Press Conference Presentation, 19 March 2018, accessed 17 May 2018
  9. D. Yach, Statement on the Bloomberg STOP initiative, Foundation for a Smoke-Free World, News & Views, 7 March 2018, accessed 23 May 2018
  10. D. Kerecman Myers, Wanted: A watchdog to STOP Big Tobacco in its tracks, John Hopkins Bloomberg School of Public Health, Global Health NOW, 2 May 2018, accessed 23 May 2018
  11. 11.0 11.1 D. Yach, Collaboration: It is time to join forces, Foundation for a Smoke-Free World, News & Views, 26 January 2018, accessed 23 May 2018
  12. The Truth Initiative, About us: Who we are and what we do, accessed May 2018
  13. The Truth Initiative, Master Settlement Agreement, accessed May 2018
  14. D. Yach, Building a Foundation to accelerate an end to smoking, 23 January 2018, BMJ opinion blog, accessed February 2018
  15. Foundation for a Smoke-Free World, Our Work. Support global research: Addressing knowledge gaps, accessed May 2018
  16. K.Maguire, University accepts blood money, 5 December 2000, The Guardian, accessed May 2018
  17. 17.0 17.1 L. Bero, Late lessons from early warnings: science, precaution, innovation, EEA report, 23 January 2013, accessed May 2018
  18. E.Latif, The FCTC, MPOWER and FSFW: Holistic tobacco control, Foundation for a Smoke-Free World, News & Views, 12 January 2018, accessed May 2018
  19. 19.0 19.1 Reuters Investigates, https://web.archive.org/web/20180523154033/https://www.reuters.com/investigates/section/pmi/dropdown.html?v=1527090000000 The Philip Morris Files], 2017, accessed May 2018
  20. 20.0 20.1 World Health Organization, WHO statement on Philip Morris funded Foundation for a Smoke-Free World, 28 September 2017, accessed May 2018
  21. S. Peeters, A. B. Gilmore, Understanding the emergence of the tobacco industry’s use of the term tobacco harm reduction in order to inform public health policy, Tobacco Control, 2015,24, 182-9
  22. D. Janazzo,Thoughts on “why are the poor blamed and shamed for their deaths?”, Foundation for a Smoke-Free World, News & Views, 10 April 2018, accessed May 2018
  23. 23.0 23.1 23.2 23.3 23.4 D. Yach, Designing the future of tobacco control, A report adapted from a Keynote Address to the Food and Drug Law Institute Annual Conference in Washington, DC, 17 October 2017, Foundation for a Smoke-Free World, 2018, accessed May 2018
  24. D. Yach, WHO: Comments on the first draft report of the WHO independent high-level commission on non-communicable diseases, Foundation for a Smoke-Free World, Blog, 18 May 2018, accessed 23 May 2018
  25. M. Kohrman, P Benson, Tobacco, The Annual Review of Anthropology, 2011, 40;329-44
  26. J. Lee, Big Tobacco’s spin on women’s liberation, New York Times City Rooms Blogs, 10 October 2008, accessed May 2018
  27. Forest, Message from our Director, April 2015, accessed May 2018
  28. 28.0 28.1 J. Lutzweiler, A new deal for the smallholder tobacco farmer, Foundation for a Smoke-Free World, News & Views, 27 November 2017, accessed 23 May 2018
  29. J. Lutzweiler, Back to the fundamentals, Foundation for a Smoke-Free World, News & Views, 19 March 2018, accessed 23 May 2018
  30. M. G. Otañez , M. E. Muggli , R. D. Hurt et al, Eliminating child labour in Malawi: a British American Tobacco corporate responsibility project to sidestep tobacco labour exploitation, Tobacco Control, 2006, 15(3);224-30
  31. D. Janazzo, Reduced-Risk Products, Foundation for a Smoke-Free World, News & Views, 10 April 2018, accessed 24 May 2018
  32. 32.0 32.1 D. Janazzo, Have we seen this before?, Foundation for a Smoke-Free World, News & Views, 3 April 2018, accessed 23 May 2018
  33. Y. Saloojee, E. Dagli, Tobacco industry tactics for resisting public policy on health, Bulletin of the World Health Organization, Tobacco, 2000, 78(7),;902-10
  34. Philip Morris International, Our views. Regulation: A common sense approach, accessed May 2018
  35. K. E. Smith, G. Fooks, J. Collin, Is the increasing policy use of Impact Assessment in Europe likely to undermine efforts to achieve healthy public policy? JECH, 2010, accessed May 2018
  36. M. Fernández Pinto, To Know or Better Not to: Agnotology and the Social Construction of Ignorance in Commercially Driven Research, Science and Technology Studies, 2017, 30 (2):53-72
  37. T. Grüning, A. B. Gilmore, M. McKee, Tobacco industry influence on science and scientists in Germany, American Journal of Public Health, 2006,96(1);20-32
  38. E. Latif, Why I’m joining the Foundation for a Smoke-Free World, Foundation for a Smoke-Free World, News & Views, 27 November 2017, accessed May 2018
  39. Framework Convention on Tobacco Control Secretariat, WHO Framework Convention on Tobacco Control, World Health Organization, 2005, accessed May 2018
  40. A. B. Gilmore, G. Fooks, J. Drope et al, Exposing and addressing tobacco industry conduct in low-income and middle-income countries, The Lancet, 2015, 385(9972);1029-43
  41. 41.0 41.1 D. Janazzo, Smoking:thoughts on “why are the poor blamed and shamed for their deaths?”, 10 April 2018, Foundation for a Smoke-Free World, blog, accessed May 2018
  42. C. Snowdon, Don’t believe the propaganda – sin taxes are designed to punish the poor, 4 April 2018, Health Spectator, News and Analysis, accessed May 2018
  43. B. Loring, Tobacco and inequalities:Guidance for addressing inequities in tobacco related harm, World Health Organization regional office for Europe, 2014, accessed May 2018
  44. E M Barbeau, A. Leavy-Sperounis, E. D. Balbach, Smoking, social class and gender: what can public health learn from the tobacco industry about disparities in smoking?, Tobacco Control, 2004,13;115-20
  45. R. Hiscock, J. R. Branston, A. McNeill et al, Tobacco industry strategies undermine government tax policy: evidence from commercial data, Published Online First: 09 October 2017. doi: 10.1136/tobaccocontrol-2017-053891