Chile-Country Profile

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Background

The Republic of Chile is a high-income country, according to the World Bank classifications [1], situated along the western seaboard of South America which shares borders with Argentina, Bolivia and Peru. Chile is a representative democratic republic, which major political parties include the political coalition ‘Chile Vamos’ composed by four centre-right parties and the Partido Socialista de Chile [2]

Tobacco Control Legislation

Chile became a Party to the WHO Framework Convention on Tobacco Control (FCTC) on September 11, 2005. [3] To comply with the FCTC, Chile’s tobacco control law underwent different amendments with the latest version agreed in 2018.[4] The amendments were aimed at strengthening the tobacco law by incorporating the ban on the use of additives, plain packaging, the ban on the display of tobacco products at points of sale and the strengthening of the health authority. [5] [6] Despite approval by the Health Commissions of the Senate and the Chamber of Representatives, the amendments have faced delays while with the Agriculture Commission of the Chamber of Representatives. Meanwhile President Sebastian Piñera began his second term in office in March 2018. [7]Dr. Jaime Mañalich returned as Chile’s Minister of Health in June 2019. He set tobacco control as one of the priorities in the Chilean public health agenda as well as addressing the aggressive tobacco industry interference taking place in the country.[8] [9] Piñera’s second term in government has seen a complicated political situation with often low levels of public approval and an increase in social protests. In October 2019, the Chilean Government’s repression of social protest reached global media outlets and leaving the political scenario unstable. [10]

Smoking in Chile

Chile’s has implemented several tobacco control policies with a reduction in the prevalence of tobacco use seen in both the general population and young people. Between 2010 and 2016 there was a decrease of 6.5% in the consumption of tobacco overall. [11] Even so, Chile continues to have one of the highest prevalence rates of smoking in the Americas region, [12] with one in three people over 15 years old currently smoking. [13] Furthermore, one in five children aged 13-15 years old smokes and the average age they start is 13.7 years.[11]There has been a strong market penetration of menthol cigarettes, those flavoured with capsules (40% of the market) and extensive marketing of electronic cigarettes. [14] In Chile, two out of every three children under the age of 18 smoke menthol cigarettes and 44% start smoking with this type of tobacco. Half of menthol cigarette smokers belong to the lowest socioeconomic levels [15] Every year more than 16,000 people die in Chile due to pathologies caused by or associated with tobacco consumption.[11] According to the Institute of Clinical and Health Effectiveness, smoking costs the Chilean government more than 1 billion Chilean pesos a year in direct costs alone (treatments, hospitalizations, surgeries, medicines).[16]. This is equivalent to 0.8% of the annual GDP and 30% more expenditure than that collected from tobacco taxes each year.

Roadmap to Tobacco control

Chile ratified the Framework Convention on Tobacco Control in June 2005. To comply with the FCTC, the Chilean government has adopted several tobacco control policies. A study conducted in 2015 by the School of Public Health of the University of Chile and the Pan-American Health Organization, demonstrated the positive effect of plain packaging to discourage tobacco use in adolescents. Regulations in Chile establish up to 50% of the packaging has to be covered by health warnings, with rotating images and messages and avoiding misleading language such as “low tar”. This is a measure that has been proven highly effective and that does not affect local trademark rights or infringe the Chilean Constitution [17].

Tobacco Tax

In early 2019, the Chilean parliament began discussions on a new tax reform with senators of the health commission (Girardi and Goic) as well as civil society (Foro Nacional de Cáncer, Mesa Ciudadana Tabaco or Salud) pushing for an increase in taxes on tobacco and alcohol. [18] It has been proposed that the increase would be a source of funding for the National Cancer Law enabling prevention policies and treatments, which has been sanctioned but has no allocated budget. Senator Goic, one of those pushing for this tax increase, has been one of the strongest promoters of the National Cancer Law. [19]

A study conducted in Chile in June 2019, concluded that

“higher prices and the tobacco control policies enacted in 2006 were associated with lower hazards of starting smoking. Our results add to the increasing evidence that higher cigarette prices are associated with reduced hazard of starting smoking in LMICs” [20]

E-cigarettes and HTP in Chile

Electronic cigarette consumption has grown from 3.6% in 2014 to 6.5% in 2016 amongst those aged 12-65 years. [21] The highest prevalence of electronic cigarette consumption has been consistently observed in younger age groups (15-24 years) [11] particularly in the Metropolitan Region (Greater Santiago) where the consumption of electronic cigarettes among those aged 13-15 years was 12.1% in 2016 [22] The marketing on electronic cigarettes has resulted in a significant increase in awareness, from 46.9% in 2014 to 66.5% in 2016. [23]

A Decree of the Institute of Public Health (ISP) regulates e-cigarettes as a pharmacological product. The National Agency of Medicines, ANAMED, as the governing body of the certification of medicines in Chile, authorized some of these products to be marketed as pharmaceutical products, when it could have been regulated by existing regulations on tobacco.[24]

In September 2019, a new bill was sent to Parliament proposing to regulate e-cigarettes and heated tobacco products as tobacco products. Under this proposed bill, these next generation products would be regulated by the tobacco law enacted in 2013, resulting in a ban on advertising and promotion, on the sale to minors, on smoking or vaping in enclosed spaces and they would need to include health warnings as traditional cigarettes. [25] The health minister, Dr. Mañalich, told the media that "the industry has shifted and it is offering the same toxic product, the same poison, in different ways and with an extraordinarily aggressive form of marketing”[25]The industry has been making public statements about their disagreement with the new regulation bill, arguing that these regulations would not make a difference. British American Tobacco’s main arguments are based on the need to differentiate e-cigarettes from traditional cigarettes, grounded on their scientific evidence on harm reduction. [26]

Tobacco Industry Interference

The tobacco industry has played a strong role in undermining the public health efforts on tobacco control in Chile for many years. Senators, members of the Ministry of Health and the Minister of Health himself have publicly exposed the aggressive lobbying that the tobacco industry has been carrying out. [27] [28] A range of tobacco industry tactics have been used, including:

  • To delay and postpone the debating of the tobacco law that is currently sitting at the agriculture commission. [28]
  • Philip Morris International has managed to engage in high-level hearings with Ministers and senior officials of Finance, Economy, Health, Parliamentarians and Consumer Public Service (SERNAC) and Taxation (SII) in a number of opportunities.[29]
  • Inviting journalists to travel to Europe to promote their new products, which subsequently resulted into articles and reports in the media promoting their products as 'low-risk alternatives'. Articles including bronchopulmonary physicians in the media endorsing these products as smoking cessation therapies. [30] [31]
  • Organising meetings and events addressed to doctors and funded by PMI to promote their new products.[32]
    Invite to PMI funded event in Chile May 2019
  • sponsorship of a pre-meeting event in the framework of the Asia Pacific Economic Cooperation Forum (APEC) leaders meeting in Chile, called "APEC 2019 CEO Summit" that will be held from November 14 to 16 2019 in Chile. The Heads of State meeting (presidents of the participating countries) will be held on November 16 and 17. Philip Morris International will be a platinum sponsor of the event. [33]
  • spreading misinformation, including the over-estimate the numbers on illicit trade in the country, arguing a 386% increase in the last five years [34] [35] while the government official numbers show a trend of less 10% in the last 14 years. [36]

TobaccoTactics Resources

Relevant Link

Acknowledgement

With thanks to Sonia Covarrubias, Nancy Ortiz, Pamela Morales and Maria Teresa Valenzuela Schmidt from Chile libre de Tabaco and Lidia Amarales from RespiraLibre who contributed to this page. Final editorial decisions were made by the Tobacco Control Research Group.

References

  1. World Bank, Classification of countries by income,2019, accessed October 2019
  2. Chilean Government, Political System of Chile, 2017, accessed October 2019
  3. WHO FCTC, Chile FCTC, 2008, accessed October 2019
  4. CTFK, Chile Tobacco control summary, 2019, accessed October 2019
  5. Chamber of Representatives of Chile, Tobacco law has been shifted to agriculture commission, 30 January 2018, accessed September 2019
  6. Anton, Emma, Amendments to the tobacco law, “La Hora”, 10 January 2018, accessed September 2019
  7. Forbes Billionaires, Sebastian Piñera & family, “Forbes”, 18 September 2019, accessed September 2019
  8. Ministry of Health of Chile, Dr. Jaime Mañalich takes office, 13 June 2019, accessed September 2019
  9. CNN Chile, Minister of Health exposes aggressive tobacco industry lobby and threats, “CNN Chile”, 06 September 2019, accessed September 2019
  10. Reuters, Approval rates of Sebastian Pinera, “Reuters”, 01 June 2019, accessed September 2019
  11. 11.0 11.1 11.2 11.3 Ministry of Health of Chile, National Health Survey 2016-2017], “Ministry of Health of Chile”, 2017, accessed September 2019
  12. Pan-American Health Organization, Chile is still leading the prevalence in tobacco use in the Americas “PAHO”, 29 August 2018, accessed September 2019
  13. Tobacco Atlas Chile, Tobacco Atlas on Chile, “Tobacco Atlas”, 2019, accessed September 2019
  14. John Hopkin University, Technical Report on Flavored Cigarettes at the point-of-sale in Latin America, “Institute for Global Tobacco Control”, June 2017, accessed September 2019
  15. Ministry of Health of Chile, National Health Survey Chile 2016-2017, 2017, accessed September 2019
  16. Institute of Clinical and Health effectiveness,Deaths, disease and costs due to tobacco use in Chile, 2014, accessed September 2019
  17. University of Chile,Study on plain packaging in Chile and the effects on teenagers, University of Chile, 06 June 2016, accessed September 2019
  18. STEP, Tax reforms in Chile, 16 January 2019, accessed September 2019
  19. Girardi, Guido, Tax Reform Senator Guido Girardi, 23 March 2019, accessed September 2019
  20. Guindon GE, Paraje GR et al, Association of Tobacco Control Policies With Youth Smoking Onset in Chile, 10 June 2019, accessed October 2019
  21. Ministry of Health of Chile, Global Survey on Tobacco use in Youth 2016 Chile, October 2017, accessed September 2019
  22. Ministry of Health of Chile, Global Survey on Tobacco use in Youth 2016 Chile, October 2017, accessed September 2019
  23. Ministry of the Home affairs and public security of Chile, National Survey on drugs and tobacco use Chile, 01 December 2017, accessed September 2019
  24. Ministry of Health of Chile, Decree of the Institute of Public Health of Chile. File is available, 20 October 2010, accessed September 2019
  25. 25.0 25.1 Ministry of Health of Chile, Ministry of Health sends bill regulating vapers and electronic cigarettes, 03 September 2019, accessed September 2019
  26. Public Statement BATBAT public statement on new regulations,“Diario Financiero”, 05 September 2019, accessed September 2019
  27. El Mostrador, Senator exposes tobacco industry interference in Chile, 14 July 2017, accessed September 2019
  28. 28.0 28.1 CNN Chile, Minister of Health exposes tobacco industry interference in Chile, “CNN Chile”, 06 September 2019, accessed September 2019
  29. Ley del Lobby, Record of meeting with PMI and high level officials, May 2018, accessed October 2019
  30. Raide, M, Journalist travels to BAT office in London, 8 May 2019, accessed October 2019
  31. Canal 13 Chile, Journalist travels to Switzerland to PMI’s headquarters, 02 December 2018, accessed October 2019
  32. Image 1: received by TobaccoTactics by informant, Tobacco Tactics database, August 2019, accessed October 2019
  33. Price Waterhouse Coopers, Philip Morris International is a platinum sponsor of APEC meetings, 15 July 2019, accessed October 2019
  34. British American Tobacco Chile, Illicit trade in Chile, BAT, September 2017, accessed September 2019
  35. La Tercera, Illicit trade increase in Chile, 01 February 2017, accessed September 2019
  36. Ministry of Health of Chile, Impact of Tobacco use on health in Chile, September 2015, accessed September 2019