Steadfast in action for a smoke-free country

I

Activities of the Youth Smoking Prevention Foundation

S T E A D FA S T

IN ACTION

FOR A SMOKE-FREE COUNTRY

CONTENTS

1

Preface

3

Aims To rid society of tobacco

6

Facts 200 new smokers every day

9

Tools Two lung specialists against the tobacco industry Self-help book for a smoke-free existence A successful policlinic for stopping smoking Prize-winners Youth Smoking Prevention Foundation Manifesto on Tobacco Prevention Media appearances TabakNee unmasks the lobby Reactions to TabakNee Smoke Alarm mobilizes children and parents Five popular short films Laying the blame where it belongs

11 13

17 22 24

27

Next The battle against the killer industry continues Campaign aimed at politics The State on trial

32

Board of Youth Smoking Prevention Foundation

33

Committee of Recommendation

1

PREFACE

As doctors, we want to treat our patients as best we can. We do all in our power to offer them every chance of surviving, but for most of our patients there is unfortunately no cure. What we can do, however, is make the quality of their remaining life as good as possible.

And that involves trying to convince patients, with increasing urgency, to quit smoking. Already diseased because of tobacco, our patients find quitting so difficult that it underlines the importance of preventing others from starting to smoke. We must encourage smokers to stop and, more importantly, ensure that children don’t start smoking.

That is why we try to make as many people as possible aware — through the Youth Smoking Prevention Foundation, the TabakNee website and the Smoke Alarm campaign — of the damage caused by tobacco and of the vile methods that the industry employs to get people hooked and keep them hooked.

We do not do this alone, but with a team of scientists, journalists, researchers and lawyers, and with our secretary Frits van Dam as the driving force. This book offers an overview of the work of the Youth Smoking Prevention Foundation since its beginning in 2009. We hope that you will support us financially so that we can continue our work. Help us to make tobacco a thing of the past.

Pauline Dekker

Lung specialist, Red Cross Hospital, Beverwijk Wanda de Kanter

Lung specialist, Antoni van Leeuwenhoek Hospital, Amsterdam

2

one main aim

RID SOCIETY OF TOBACCO

3

AIM

Given all that we now know, would tobacco be allowed on the market today if it weren’t already there? Of course it wouldn’t. A highly addictive and poisonous substance that, if used as intended, is ultimately lethal, wouldn’t stand a chance of being allowed onto the shop shelves.

But tobacco is already on sale in shops, and its legal status is the most important argument made by manufacturers and some politicians to keep tobacco on sale. For the government too, 20,000 deaths a year from smoking are apparently no reason to ban tobacco, or at the very least impose greater restrictions on it than are currently in place.

The Youth Smoking Prevention Foundation has one clear aim: to rid society of tobacco and make smoking a thing of the past. The only way to achieve this aim is to ensure that nobody starts smoking. The foundation is therefore urging the government to adopt a number of measures to create an effective prevention policy:

•

substantial increase in sales tax to put tobacco out of the reach of children A packet of cigarettes should cost at least 10 euros so that most children cannot afford to buy them.

•

tobacco-free school playgrounds Smoking in and around schools should no longer be allowed.

4

•

effective enforcement of the age restriction for buying tobacco It should effectively be impossible for persons under 18 to buy tobacco.

•

reduction in the number of points of sale With some 60,000 points of sale, tobacco is far too easily available, and enforcing compliance with the age restriction is impractical. Tobacco should be removed from supermarkets, chemist’s shops and bookshops, and should only be sold from special licensed tobacco outlets.

•

tobacco products should not be visible to customers at points of sale A wall filled with packets of cigarettes is a tobacco advertisement.

Tobacco advertising is illegal, and tobacco products should therefore no longer be visible in shops.

OTHER COUNTRIES HAVE SHOWN THE WAY

More and more countries are proving that these measures are not uncommon. Countries such as Australia, New Zealand, Norway, Finland and Ireland have implemented strict anti-smoking policies.

Cigarette vending machines are illegal in England, and since April 2012 cigarettes are no longer allowed to be displayed in ordinary shops. The same is true in Finland.

Anybody found to have sold cigarettes to a person under the age of 18 in Finland can receive a half-year prison sentence.

Australia, New Zealand and Iceland are considering the introduction of a total ban on cigarette sales.

Ireland aims to be smoke-free by 2025.

In the interests of our children’s future, the Netherlands should join this list as soon as possible.

5

200 NEW SMOKERS A DAY

200

70 35

Some 200 children under 18 start smoking in the Netherlands every day. 126 of them will start smoking daily, 70 will remain smokers for the rest of their lives, and 35 of them will die from its effects.

6

FACTS

20,000

Some people die each year of diseases caused by smoking. Half of those people are younger than 65.

Half of all people who smoke throughout their life die from the effects of tobacco, on average to years before the age at which they would otherwise have died.

10 15

87% of all new cases of lung cancer are caused by smoking. The figure for COPD (chronic obstructive pulmonary disease) is 85%, for acute heart attacks 31%, and for strokes 20%.

In 2013 the percentage of smokers among Dutch people aged 15 and older was % (26% men, 25% women, rounded).

25

30

In 2013, % of Dutch youths aged from 15 to 19 had smoked within the past four weeks.

200

Some children under 18 start smoking in the Netherlands every day. 126 of them will start smoking daily, 70 will remain smokers for the rest of their lives, and 35 of them will die from its effects.

7

65

In 2013, % of smokers aged 15 and older in the Netherlands admitted they had made a serious attempt to stop smoking. If they could live life all over again, almost % of smokers would not start smoking.

90

4 to 10% of smokers aged 15 and older in the Netherlands who tried to stop smoking in 2011 had not smoked a single factory-made or hand-rolled cigarette one year (in 2012) after stopping.

Each year the Dutch state collects in tax on tobacco sales.

2,4 billion euros

In 2012 Dutch people bought a total of 12.2 billion cigarettes, which cost them euros.

3,3 billion

Sources: National Public Health Compass; Continu Onderzoek Rookgewoonten; Roken Jeugd Monitor; International Tobacco Control Netherlands Survey; AC Nielsen; Ministry of Finance.

8

Two lung specialists against the tobacco industry

9

TOOLS

In 2007 Pauline Dekker and Wanda de Kanter have had enough. The two lung specialists at the Red Cross Hospital in Beverwijk see that almost everybody in their waiting rooms sit there as a result of smoking. And the diseases in question, mainly lung cancer and COPD, are incurable.

When Dekker and De Kanter realize that there’s no substance more addictive than nicotine, they no longer want to stand by and watch. Instead, they decide to take action. So together the two doctors write the book Nederland Stopt! Met roken (‘The Netherlands Stops Smoking!’), which they present in May 2008. The presentation coincides with the centenary of NVALT, the Dutch society of lung specialists, and the introduction on June 1 of the smoking ban in cafes and restaurants in the Netherlands.

The timing can’t be better, and thanks in part to the unflinching efforts of both doctors, the book receives plenty of media attention. Ever since, Dekker and De Kanter succeed in reaching the media whenever tobacco is in the news.

SELF-HELP BOOK FOR LIFE WITHOUT TOBACCO

Nederland stopt! Met roken is a practical and effective manual for stopping smoking. The book reveals and explains many issues related to smoking and what makes quitting so difficult.

It discusses the myth of addiction, the tactics employed by the tobacco industry, the health advantages for those who stop, and the dangers for those who don’t.

Featuring a ‘step-by-step guide to stopping’, the book helps readers to prepare properly for

10

stopping, which is essential for maximising the chances of success. In addition, the book discusses the various methods for stopping smoking: cold turkey, with and without supervision, with and without nicotine substitutes or medicine.

Moreover, medical specialists tell of the effects of smoking in their area of expertise. The book also translates the latest scientific insights into everyday life.

That makes Nederland stopt! Met roken a comprehensive manual for a smoke-free existence.

Scores of readers express how helpful the book was to them. Here are some of their comments:

‘The step-by-step guide to stopping shows you just how bad your situation is. The book is not the slightest bit aggressive in tone, but written so you can see the facts for yourself.’

‘For me as a social worker the book has become a real bible!’

‘The good thing about this book was that I was prepared for difficult moments, especially those moments when I didn’t want to stop.’

‘I am now a non-smoker thanks to your book.

I really have been rescued. MY DEEPEST GRATITUDE TO YOU!’ ‘The book includes a letter from a woman who was diagnosed with lung cancer within one week.

Her lung specialist asked her to write a letter to

11

her children. While reading the letter I stood up, cut my remaining cigarettes in two, and I haven’t touched a cigarette ever since.’

A SUCCESSFUL POLICLINIC FOR STOPPING SMOKING But the lung specialists also continue to highlight the disastrous effects of smoking in the news. In Beverwijk they open a Stop Smoking Policlinic, which proves extremely successful within a few years. According to a survey it conducts, half of the participants hadn’t smoked one year after treatment. That high percentage is in part the result of a method adopted from England called ‘motivational interviewing’ (MI) and, allied to that, a strict selection of motivated participants. Asking the right questions makes patients feel they are taken seriously, but they also have to face up to the peculiar reasoning they follow to justify their unhealthy habit. In 2010 Dekker and De Kanter write a second book devoted to this method entitled Motiveren kun je leren (‘Motivation can be learned’), specially intended for people working in health care. The book helps medical professionals to discuss healthier behaviour with patients in a more effective manner.

Both books are successful, with print-runs of 40,000 and 10,000 copies respectively. A tear-off calendar and an audio-book based on Nederland stopt! also prove popular.

On top of all that, Dekker and De Kanter set off on a lecture tour in which they explain to 10,000 doctors, dentists and pharmacists in the Netherlands why it is so important to advise patients to stop smoking and how they should do that.

12

PRIZE-WINNERS

Thanks to all their activities and success, in 2012 the Dutch Foundation on Smoking and Health (Stivoro) proclaims Dekker and De Kanter as the best practitioners treating tobacco addiction in the Netherlands, and the news makes the front page of De Telegraaf newspaper. In the same year they receive the 38th Professor Muntendam Prize from the Dutch Cancer Society ‘for their innovative approach to the treatment of tobacco addiction and their tireless battle for a no-smoking country’.

On May 31, 2013, the lung specialists earn another accolade when, within the framework of World No Smoking Day, they receive the Gerbera Award 2013 from Stivoro on behalf of the Dutch Cancer Society, the Dutch Heart Foundation and the Lung Foundation.

According to the jury report: ‘The lung specialists Wanda de Kanter and Pauline Dekker deserve all support and admiration for their tireless efforts to put the problem of smoking on the political and social agenda. They are motivated in those efforts by their concern for the health damage caused by tobacco that they see in their daily work.

And like few other people they have the courage to take on the tobacco lobby in their crusade. Pauline and Wanda are part of a long tradition of doctors with the courage to highlight social issues with the aim of creating a healthier society. A doctor on the barricades fighting for a cause: that’s something the sector should be extremely proud of!’

In late October 2013, both lung specialists receive distinctions abroad, this time the Roy Castle

13

Lung Cancer Foundation Prize for their TEDx performance entitled ‘Replacement smokers’. The prize of 500 pounds is awarded during the 15th World Conference on Lung Cancer in Sydney.

In their contribution to TEDxNijmegen in April 2013, Dekker and De Kanter gave their presentation the form of a biting role play in which they denounce the involuntary nature of tobacco addiction, the shame felt by patients for their ‘self-inflicted’ disease, and the shameless greed for profit in the tobacco industry.

YOUTH SMOKING PREVENTION FOUNDATION As Dekker and De Kanter immerse themselves more deeply into the subject, they realize that all efforts to help people stop smoking are ultimately futile as long as new smokers continue to join the ranks of those already smoking. All the information that reaches them from the literature and from their international network teaches them to see through the devious methods employed by the tobacco industry to recruit new smokers among young people. So to offer resistance, they set up the Youth Smoking Prevention Foundation in 2009. The aim of the foundation can be summarized succinctly: to make smoking a thing of the past.

That aim can be achieved through a number of related measures: heavy increase in sales tax to put tobacco out of the reach of children creation of tobacco-free school playgrounds increase in the minimum age for buying tobacco in combination with an effective age control drastic reduction in the number of sales points concealment of cigarettes from view at points of sale

• • • • •

14

The foundation’s advisory council is made up of leading figures from the medical and academic worlds and other prominent figures. Foreign members of the council are: Robert N. Proctor, professor of the History of Science at Stanford University and author of Golden Holocaust; Professor Robert West, University College London, Smoking Cessation Institute; and Dr Jeffrey Wigand PhD, whistleblower from the tobacco industry and founder of Smoke-Free Kids, Dekker and De Kanter express their views at every possible opportunity, and the Dutch Clean Air Foundation (CAN) proclaims them to be the 2009 Non-Smokers of the Year.

Soon afterwards, the foundation’s ranks are strengthened with radiation therapist Lukas Stalpers, secretary of the Dutch Oncology Society, and Frits van Dam, Emeritus Professor of Psychology and former researcher at the Dutch Cancer Institute. Van Dam is appointed foundation secretary and Stalpers becomes a member of the Committee of Recommendation. Around the same time, the Dutch Cancer Society decides to support the foundation financially.

That support is vital, because the political climate takes a turn for the worse in the autumn of 2010 when Edith Schippers is appointed as the new Minister for Health, Welfare and Sport. Very quickly she reverses a number of measures in the area of tobacco policy. She lifts the ban on smoking in small cafés, halts information campaigns, and takes remuneration for stopping smoking out of basic health insurance policy.

Dekker and De Kanter decide to respond and draw up a Manifesto on Smoke Prevention in which they call on the minister ‘to do all in her power to make tobacco addiction a thing of the past for future generations and to limit its damage to current generations’. Some 1000 physicians,

15

MANIFESTO

Based on their knowledge of and responsibility for sustainable public health, the undersigned call on the new Minister for Health to do what is necessary to make tobacco addition a thing of the past for future generations and to limit its damage on present-day smokers. Specifically: 1 To greatly increase the cost of tobacco products (a doubling of the price) 2 To remove tobacco products from view at points of sale (‘wall of fame’ in supermarkets) and reduce the number of points of sale 3 To ban smoking in or near schools (smoking is contagious) 4 To raise the age at which people can buy tobacco to 18 5 To enforce the ban on smoking in cafes and pubs and to balance the legislation from the viewpoint of prevention for youths

16

academics and prominent figures sign the manifesto. After much perseverance Dekker and De Kanter are allowed to present their manifesto to the minister on 19 January 2011.

In her reply, Schippers asserts that she too wants to prevent children from taking up smoking, but has decided to use other means to achieve that aim.

Even so, the media devote plenty of coverage to the appeal by the doctors to the minister. The current affairs TV programme EenVandaag reports on the presentation made to the minister and gives Dekker and De Kanter amply opportunity to explain what should be done.

Later that year, in October 2011, the investigative TV programme Zembla, with help from the Youth Smoking Prevention Foundation, convincingly shows how short the lines are between Minister Schippers and the tobacco industry. No wonder that she is rightly known as the ‘Minister for Tobacco’. The programme does not go unnoticed. The authoritative medical periodical The Lancet devotes an editorial to the subject entitled Can the Dutch Government really be abandoning smokers to their fate? (Volume 379, issue 9811, p. 121) and the programme is screened at international congresses with English subtitles.

Questions raised in parliament after the programme prompt the decision to relieve Schippers of responsibility for tobacco policy and put it in the hands of state secretary Martin van Rijn.

Longartsen hekelen ‘minister van tabak’ Door een onzer redacteuren Amsterdam. Twee longartsen van het Rode Kruis Ziekenhuis in Beverwijk hebben een website opgezet waarop zij mensen veroordelen voor banden met de tabaksindustrie. Zij noemen onder meer oud-senator en oud-minister van Defensie Hans Hillen (CDA), die betaald advies gaf aan sigarettenfabrikant British American Tobacco en emeritus hoogleraar Irene Asscher, moeder van de vicepremier en commissaris bij sigarettenfabrikant Philip

Morris. Minister Schippers (Volksgezondheid, VVD) wordt wegens veronderstelde contacten met de tabaksindustrie neergezet als ‘minister van Tabak’.

De longartsen, Wanda de Kanter en Pauline Dekker, voeren al jaren actie tegen roken. Volgens hen overlijden jaarlijks 23.000 mensen aan de gevolgen. Hun voornaamste doel is te voorkomen dat jongeren ermee beginnen. Voor het naming and shaming op hun website ‘Tabak Nee’ baseren ze zich deels op het werk van

onderzoeksjournalisten.

Volgens een woordvoerder van Schippers zijn de aantijgingen op de website „nergens op gebaseerd”. Als minister in het kabinet-Rutte I verhoogde zij juist het budget voor antirookvoorlichting aan jongeren, stelt hij.

Wel beëindigde Schippers de dure televisiecampagnes via Postbus 51, omdat voorlichting via de sociale media effectiever zou zijn.

Inmiddels valt het ontmoedigingsbeleid voor roken onder staatssecretaris Martin van Rijn.

17

MEDIA APPEARANCE

Pauline Dekker and Wanda de Kanter appear frequently in the media after the release of their book Nederland stopt! They give scores of interviews and contribute to all national and regional newspapers, consumer magazines from J/M to Opzij, and professional journals such as the Nederlands Tijdschrift voor Geneeskunde, Medisch Contact and Arts en Auto. In addition, they appear regularly on popular radio and TV programmes such as De Wereld Draait Door and Nieuwsuur.

The Youth Smoking Prevention Foundation also actively campaigns through social media. Since 2008 the www.nederlandstopt.nu weblog is updated weekly with all activities from the past week. More than 10,000 contacts receive daily news and updates via Facebook, Twitter (@ Wdekanter) and LinkedIn about matters relating to tobacco and the fight against tobacco.

TABAKNEE UNMASKS THE LOBBY De Zembla documentary shows just how far the tentacles of the tobacco industry extend into society and politics and teaches us the effect of exposing that. The foundation therefore decides to continue its investigative journalism and to unmask the tactics and tools employed by the tobacco industry on a separate website. The TabakNee site publishes profiles of current and former politicians and other public figures who, directly or indirectly, work for the tobacco industry.

18

When the TabakNee website goes online on March 11, 2013, it provokes an unprecedented media explosion. All newspapers, radio stations and TV programmes highlight this unusual form of ‘naming and shaming’ by a website. Politicians and others linked to the tobacco industry by the website are furious and the press rubs its hands with glee.

In its first year TabakNee makes numerous revelations about the lobby of ‘the tobacco industry & its cronies’. In addition to its own publications, the team behind the website works in various ways with established media channels. For example, two of those who work for TabakNee, Stella Braam and Ivo van Woerden, make a series of four stories for the weekly Vrij Nederland magazine about the lobby and the network of the tobacco industry. The first story, about the powerful support from the Confederation of Netherlands Industry and Employers (VNO/NCW) for the tobacco industry, appears in July 2013 and comes as a bombshell. Many other media report on the subject and the revelations lead directly to questions in parliament.

Articles on the website itself highlight a PR advisor who works for both the tobacco industry and the health care sector, so-called independent research that turns out to be funded by the tobacco industry, the powerful lobbying by the VNO/NCW on behalf of the tobacco industry, the work of small tobacconists and café owners on behalf of the tobacco lobby, academics who dance to the tune of the tobacco industry, the heavy lobby in the European Parliament, and the interweaving of the tobacco lobby in the political arena.

Many articles result in questions in parliament. On at least five occasions, members of parliament put questions to responsible ministers as a result of information from the TabakNee website, which operates with its own editorial charter and independent editorial office, and posts more than 250 articles in less than a year. Visitor numbers grow steadily

19

20

and increase even more rapidly after the launch of a twoweekly newsletter.

In late 2013 TabakNee receives internal documents from Philip Morris concerning the tobacco manufacturer’s lobbying in Brussels. The documents disclose in detail how Philip Morris tries to influence members of the European Parliament who have to decide about revisions to the European Tobacco Product Directive. These internal documents form the basis for a series of stories on TabakNee published after December 2, 2013. In late February 2014, current affairs programme EenVandaag airs a TV report based on the same documents and on additional research.

That collaboration illustrates once again the added value of TabakNee. The investigative journalism of TabakNee forms a welcome addition for editors of current affairs programmes such as EenVandaag. In this way, TabakNee works beyond its own website to disseminate information about the tactics employed by the tobacco industry and to make people understand that implementing measures against smoking is essential.

REACTIONS TO TABAKNEE

Immediately after the launch of TabakNee, politicians and other figures in positions of authority are asked to respond. They have two choices: they are either for or against the website.

The Dutch Labour Party (PvdA) and Socialist Party (SP) issue statements in which they express support for TabakNee. Myrthe Hilkens (PvdA) tells NOS news: “The tobacco industry sells outdated nonsense and this is about public health. We should be concerned about the health of young people, and smoking is always bad. If people work with the tobacco industry, it is good we are aware of that.”

21

NRC Handelsblad newspaper observes that this comment increases tensions between the parties in the coalition cabinet, the PvdA and the Liberal Party (VVD).

Former minister for health Els Borst (D66) is also pleased with the site. “It is the only thing that the tobacco industry listens to. People who sit on the board of directors of a tobacco manufacturer should ask themselves if they would be better off spending their time doing something more useful,” she tells the AD newspaper.

There is less enthusiasm from the VVD and CDA NTAA R E M M s parties. VVD member of parliament Arno Rutte CO l: 18 plu o h o c l a n is angry about his own profile on the site. “We Tabak e should conduct the discussion on the basis of E serious arguments. For me that means showing the arguments for and against. And if I take tobacco manufacturers seriously, surely that is d doesn’t immediately mean I’m a lobbyist? The o ro b z’n De een z’n dood, de ander en op stang VVD is also concerned about the increase ts jaagt ar in the number of smokers,” he says in de Volkskrant newspaper.

In an editorial article NRC Handelsblad newspaper writes: “Luxury goods industries should be able to handle some rough treatment. After all, they know exactly what they’re doing when it comes to making tobacco and alcohol appeal to children and inventing an effective ‘lifestyle’ to go with it. [...]The doctors who have to clean up the mess are the whistle-blowers. Take them seriously.”

Trouw newspaper describes the efforts of Dekker and De Kanter outside their surgeries er grip kan maar be ht. De ac aakvol, even sm worden opgebr iek van het wel l voor de klin t we eft ui ag t m he n ter alitei . Kinal artse oholdok en. De rauwe re en aant radicaliseren en rts of alc rd zij de longa bat gevoeld wo moet tely, al jar gehad: onie n der Le in het de delenindustr Zij weet Nico va oholmisbruik derarts id . tegen alc , zei zondag in genotm kunnen et: hoe ze je uw ot to en sto Op in aar is”. derjarig gen een ecies wat ze do k voor pr der min t dat het „nu kl aalfjaritw immers alcohol op smaan effectieBrandpun liniek worden meisterer tabak en brengt en er ee ineken He zijn polik en met een Jäg agen. De nderen ki er verzint. te zijn. dr nd ge ki en bij ge t tyle’ bij ng binn alengte vive ‘lifes hans denkt da igi om ift rg olc ve Het indi lde alcoh Dat was is cool, alt g doet de rest. gemidde is nu drie uur. j denkt in nr door.

Verslav hi en s rte er Al . ko nd alcoholi er ki minuten ng van en indu leeft ig va nt om ge m en ne Ernst eren ne rs ge roke bij kind cidenten e. Het aantal jonbinet onttussen toeneens. Ieder ka lige preha groeit ev nieuw grootsc ders, bewerpt op nen waarin ou ‘samen’ er lan ventiep n en overheid tsen daar ar ve en. Dat drijfsle te begrijten kom uit moe mee raken, valt rlijks n ld ers jaa dasse vervee en imm et longkanet strop n verlp he „m j n eanne eraa pen. Zi nd burgers m aan de m bouwen die hi ull”. lang mog . ze an ge inde zo tiendui een pitb levense t gaat tegensta in hoge eword ik se longartsen ker hun ellen. Da dienen, t uiteind verwijk website lijk uitst rs hebben he het was Twee Be aandag met de al op ke – n ro De edaa nv oenm elf aang Aangem opende e frontaal de aa dere mean lijk zichzviduele keuze. ekiende Tabak Ne stuurders en tineverslatg hún indi elokt door ui niemand , be politici tg n de nico n willen digd, ui g, dat zeker. En er de risitse tigen aa deplich strie. Deze ar evoelens ov tin rd ke ee n. mar du aamteg op hun gevolge geïnform vingsin d- en sch is nog on wetend over de dividu en de schul kankerpatiënt sseren. in co’s of on k behoort dat , zeker ca van hun r niet meer in preventie Tegelij md te worden verbod er ok spreekuu stichting Rook beurt?’) ro sch n be Ee . ns ek ook ve rjarigen Hun lie oek je een spre .nl grof ftijdsgre de minde n, een rooklee ingen ee dr Jeugd (‘Z www.TabakN stevige et op schole n verder terug t ligt alet is nu m al. Dat gaat m ier zoon ee he W van 18, gelegenheid – een vernv minem. voor de in de aa als ho ok t ro ad Ne n en ava ch de. retoriek is maar zelf to rken of in de re g van alcoholm e lemaal herpin artsen di minister dustrie blijft we nker dere verscor de jeugd. De n de klokka tabaksin ervaring met tegentiging vo el opruimen, zij us. wie privé r weigert tabak onderuit rie m se m ro ze t de aa rs. Neem heeft m worden, krijg gepast of te kenluide s stander t is niet steed Da de zak.

22

as exemplary. “Against their better judgement, manufacturers have for years denied that smoking causes cancer. Now they finally acknowledge the risk, but they still do everything they can to get young people everywhere on earth smoking. That is not only in bad taste and offensive but also life threatening.”

Columnists from everywhere join in the discussion.

“Everybody support TabakNee!” writes Max Pam in de Volkskrant. Frits Abrahams in NRC Handelsblad writes: “I wish the campaigners lots of success. Their mission deserves it.” His colleague Bas Heine comments: “The website by the two lung specialists is therefore justified, because it rationally exposes an accepted form of hypocrisy.” And Youp van ’t Hek puts it succinctly the following Saturday: “Keep it up, ladies! Full speed ahead.”

SMOKE ALARM MOBILIZES CHILDREN AND PARENTS In the meantime, the foundation works to reach parents through their children in the battle against tobacco. In collaboration with ad agency Pool, it launches the Smoke Alarm campaign to fan the flames of indignation among parents concerning the tactics of enticement employed by the tobacco industry and the lazy attitude adopted by the government in response.

At the core of the Smoke Alarm campaign are a number of short films in which primary school children gradually expose the power field around tobacco. The films are shared on social media platforms like Hyves – later continued on

23

Facebook – and Smoke Alarm attracts 40,000 followers.

The films then form the raw material for a new documentary aimed at adults entitled ‘The Replacers’, which appears in 2015. The aim of the film is to motivate parents to make their opinions known to people in politics.

FIVE POPULAR FILMS

The riddle of group 8 from 3 April 2013 – 69,184 views One thing that all children in group 8 know for certain: they are never going to smoke. But five years later a third of them do, because in puberty they forget everything they now consider important. This video shows how that happens.

The proposal from group 8 from 30 May 2013 – 41,952 views All cigarette manufacturers say they don’t want children to start smoking. Even so, they design pretty packaging and add flavours to cigarettes that children find appealing. Because of this, Group 8 tries to help manufacturers to find an alternative.

Get it at AH from 5 September 2013 – 32,674 views Why do supermarkets sell cigarettes? They should not do that because many children enter supermarkets. That is why over half the children in the final year of primary school know about cigarettes largely from supermarkets. In this film the children ask Albert Heijn to stop selling tobacco.

24

AH has it all from 11 September 2013 – 299,058 views Albert Heijn supermarket puts cigarettes on display so that many children know exactly what’s for sale. A serious pastiche on the AH commercials on TV. Group 8 in The Hague from 30 May 2014 - 8,252 views Laws are made in The Hague. Pupils in their final year of primary school visit politicians and ask them to take action. If not, the pupils plan to go to court.

2837 petitions signed Figures per April 2015

LAYING THE BLAME WHERE IT BELONGS In early 2014 a DVD is released containing nine interviews with lung cancer patients and/or surviving relatives. Made by film and television maker Frans Bromet and entitled ‘You have to die of something’, the films are produced with money that Dekker and De Kanter receive for the Muntendam Prize. The films are also circulated through the Dutch Cancer Society website and on YouTube.

‘With these films we want to let patients have their say,’ says Wanda de Kanter, who now works as a lung specialist at the Antoni van Leeuwenhoek Hospital. ‘Mostly we don’t hear them in the discussion, because their disease usually develops rapidly and they die quickly. Even so, we want to make these patients more visible and give them a voice.

25

These portraits are about empowering patients. At the same time, they are intended to lift the sense of guilt that patients feel about their smoking behaviour. After all, that guilt lies squarely with the tobacco industry, which makes people addicted to a product that kills if used as intended.’

The series of portraits prompts the Nieuwsuur TV programme to air a report on 31 January 2014 entitled ‘The invisible cancer’. It asserts, among other things, that the relative invisibility of lung cancer is the reason why so little money is allocated to research into this disease.

An article in De Correspondent also covers this subject under a headline that reads: ‘The deadliest form of cancer has a major marketing problem’. The article quotes Paul Baas, lung specialist at the Antoni van Leeuwenhoek Hospital: ‘There is a form of cancer, says lung specialist Paul Baas, that claims so many victims and that could be tackled easily through focused government intervention. After all, the tax on tobacco could be channelled directly into research. “A new incentive fund, an extra euro charged on each packet of cigarettes, intended solely for research,” says Baas. ‘But maybe the government itself is just as addicted to the tax collected from cigarette sales as the smokers are to smoking. This year it is allocating 5 million euros to tobacco prevention, while some 2.5 billion euros are collected annually through tax on tobacco sales. “That’s why I had such mixed feelings when I saw the Minister for Health Edith Schippers appear on the Stand Up Against Cancer programme,” says Baas.’

The films are screened by the Dutch Cancer Society on February 4, 2014, World Cancer Day, in the presence of those featured and who, it must unfortunately be stated, are still alive.

26

The battle against the killing industry continues

27

FOLLOW-UP

Since its establishment, the Youth Smoking Prevention Foundation has achieved much, particularly in raising awareness. With the support of the Dutch Cancer Society, the Foundation has been able to distribute a lot of information, through its own publications and through the press, about the harmful effects of smoking, the powerful influence of the tobacco industry, and the measures that will genuinely help to protect young people from tobacco addiction.

It is no surprise, therefore, that in early 2015 Wanda de Kanter, the Foundation’s chairwoman, won the Woman in the Media Award 2014. The prize from media platform VIDM.nl and speakers agency ZijSpreekt is awarded in recognition of the woman who has been most successful in presenting herself as an expert. Today the media knows how to find Wanda de Kanter and Pauline Dekker when it wants a response to smoking-related issues. The prize also shows that the Foundation has succeeded in keeping the issue of smoking on the agenda, prompting lobby expert Erik van Venetië in late 2014 to praise the Foundation’s efforts as a ‘fine example of successful lobbying for a good cause’.

28

LEGAL ACTION AGAINST THE STATE

In 2014 the Foundation was very successful in generating publicity with its legal action against the Dutch State, which will be heard on 8 September. Representing the Foundation, lawyer Phon van den Biesen (Van den Biesen Kloostra Advocaten) has taken the action on account of the excessively close ties between the government and tobacco industry. These ties are a contravention of Article 5.3 of the international anti-smoking convention of the World Health Organization (WHO), the Framework Convention on Tobacco Control (FCTC). Article 5.3 states that in setting and implementing their public health policies, governments shall act to protect these policies from the interests of the tobacco industry. In other words: governments must erect a firewall against the tobacco lobby and strictly limit contact with the tobacco lobby to matters concerning the technical implementation of policy that has already been adopted.

Hundreds of documents acquired through an appeal to the Government Information (Public Access) Act reveal the complete absence of such a firewall from the perspective of the Dutch government. An extensive analysis of the documents shows that various ministries, in particular Finance and Health, maintain extensive contacts with the tobacco industry about matters that could influence policy. In the run-up to the case, TabakNee is publishing a series to expose the most significant breaches of Article 5.3 FCTC. The website maintains a logbook that records the progress of the court case.

EXPOSED BY TABAKNEE

TabakNee exposed more in 2014. Internal documents from

29

Philip Morris reveal the tobacco company’s lobby strategy in relation to the revision of the European Tobacco Production Guideline (TPD). The series ‘De Frontsoldaten van de Tabak’ charts the links between smokers’ interests groups and the tobacco industry. Another series of stories exposes the serious conflict of interest hidden behind Postbus 262 in Leidschendam, where a syndicate made up of the tobacco industry, supermarkets and other interest groups have banded together to resist any move to limit the number of sales outlets for tobacco products, even though a reduction in the number of sales outlets is one of the most effective ways of tackling youth smoking.

TabakNee also challenges the sponsoring of local authorities by tobacco companies and criticizes the investments in tobacco products made by pension funds, among them ABP, the fund for employees in the government, public and education sectors. By the end of the year, TabakNee had attracted 1.1 million views since the start. Every two weeks the TabakNee newsletter reaches 1500 people, among them all politicians, public officials and journalists who cover the subject.

COMPLAINT AGAINST DEFENCE

Another issue that TabakNee is challenging is the policy through which the Ministry of Defence actually encourages rather than discourages smoking among military personnel.

TabakNee has reported on the price reductions on tobacco products enjoyed by Dutch military personnel at NATO bases, where cigarettes can be also be sold to employees from the age of 17. Because the ministry has refused to respond, the Foundation has submitted a complaint to the National Ombudsman about this remarkable state of affairs, which is totally at odds with the national Tobacco Act.

30

HELPING HAND

Wherever possible, the Youth Smoking Prevention Foundation takes action not only with a clenched fist but also with a helping hand. For example, in November 2014 the foundation met for the first time with Niek-Jan van Kesteren, the director of the Confederation of Netherlands Industry and Employers (VNO-NCW), recognized as one of the most powerful lobby groups acting on behalf of the tobacco industry. That position will not change, but the two parties are working together in a joint effort to combat smoking among young people.

The Foundation also met with Van Rijn, State Secretary for Health, to discuss the legal action against the State.

ROOKALARM

Spring sees the release of the film ‘De Vervangers’, the final instalment in the Rookalarm campaign. In a good 50 minutes the film shows the effectiveness of marketing and lobbying by the tobacco industry in recruiting new smokers to replace smokers who die from the effects of their addiction.

The film convincingly shows how the tobacco industry, though it maintains otherwise, entices children and youths to start smoking. The film also shows the helpless plight of people who, usually at a young age, become addicted to cigarettes. No matter how much they want to, they cannot kick the habit and are eventually punished with lung cancer and other deadly sicknesses.

At the same time, the film shows the ineffectual response from politicians to the facts. ‘Of course it’s rubbish, junk,’ says Minister-President Rutte in a talk show, but we’re not going to do anything about it, he then implies.

‘De Vervangers’ is inescapable and should convince parents and politicians once and for always that the tobacco industry has far too much influence on youths.

31

ADDICTION IS NOT VOLUNTARY

The Youth Smoking Prevention Foundation is continuing to exert political pressure. Politicians and public officials need to be talked out of the notion that smoking is a free choice, and people should not be patronized.

But free will is not involved when it comes to addiction to nicotine, the most addictive substance on earth.

The only choice is that made by a child who decides whether or not to start smoking. In puberty the brain pays no heed to bans or sensible decisions, however.

Because of the harm caused by its own product, and forced as a result to solicit new customers, the tobacco industry cleverly exploits that brain weakness. Its product is made deadly addictive, knowingly and intentionally. In the words of historian Robert Proctor: ‘Deadly by design’. That is what politicians must realize and why they must protect the public. That is not patronizing, but protecting.

It is time to decide that the cigarette, a stealthy but ready murderer, has no place in today’s world. The Youth Smoking Prevention Foundation pursues that goal tirelessly. Help us wherever possible to make smoking a thing of the past.

32

BOARD OF YOUTH SMOKING PREVENTION FOUNDATION

Wanda de Kanter lung specialist, Antoni van Leeuwenhoek Hospital, author of Nederland stopt! Met roken (chairwoman) Emeritus Professor Frits van Dam psychologist, University of Amsterdam, former staff member of Antoni van Leeuwenhoek Hospital (secretary) Rob Giebels econometrician, former advisor financial affairs and risk management for the City of Amsterdam (treasurer) Professor RenĂŠ Bernards molecular biologist, Utrecht University, Antoni van Leeuwenhoek Hospital, member of Royal Netherlands Academy of Arts and Sciences (KNAW) Barbara van den Broeke child and youth psychologist/psychotherapist Geertje Creijghton LL M administrative lawyer, Baarn Pauline Dekker lung specialist, Red Cross Hospital, author of Nederland stopt! Met roken Professor Jacques Wallage honorary professor transition in public administration, University of Groningen

33

COMMITTEE OF RECOMMENDATION

Rob Barnasconi MSc dentist Dr Renee Bittoun adjunct associate professor of Medicine, head of Smoking Cessation Institute, University of Sydney Emeritus Professor Piet Borst former scientific director of Netherlands Cancer Institute Professor Paul Brand child lung specialist Isala Clinics Zwolle Professor Jan Willem Coebergh public health physician and epidemiologist Gert van Dijk medical ethicist KNMG Ireen van Ditshuyzen documentary maker Professor Marjolein Drent professor of interstitial lung diseases, Maastricht University, president World Association for Sarcoidosis and Other Granulomatous Disorders (WASOG) Benedicte Ficq LL M criminal lawyer Bas van Goor former volleyball player, Director Bas van Goor Foundation

34

Pauline Haasbroek stop smoking coach Miriam de Kleijn general practitioner-epidemiologist Emeritus Professor Caro Koning radio therapist Professor Willem J.M. Levelt former president of the Royal Netherlands Academy of Arts and Sciences Professor Angela Maas professor of female cardiology, UMC St Radboud Nijmegen Professor Johan Mackenbach professor of public health and chair of the Department of Public Health, Erasmus MC Rotterdam Emeritus Professor Bob Pinedo oncologist, VU University Amsterdam Professor Dirkje Postma professor of Pulmonology, University of Groningen Robert N. Proctor professor of the History of Science, University of Stanford Lukas Stalpers radio therapist Academic Medical Center

35

Professor Robert West health psychologist, Director of Tobacco Studies, University College London Nout Wellink former president De Nederlandsche Bank Professor Michiel Westenberg developmental psychologist, Leiden University Professor Marc Willems professor of Tobacco Control Research, University of Maastricht Professor Rudi Westendorp geriatrician, Leiden University Professor Reinout Wiers developmental psychopathologist, University of Amsterdam Jeffrey Wigand tobacco industry whistle-blower, founder of Smoke-Free Kids Inc.

36

SUPPORT THE YOUTH SMOKING PREVENTION FOUNDATION

The members of the board of the Youth Smoking Prevention Foundation receive no remuneration for their work for the foundation. A number of professionals do receive remuneration for various activities of the foundation.

The funding for that remuneration comes from a limited number of financial supporters, among them the Dutch Cancer Society. We ask for your support to give the Youth Smoking Prevention Foundation a more solid basis and to ensure that it can continue its work.

SUPPORT US WITH YOUR DONATION

Make a donation to us, big or small, so that we can continue to expose the tobacco industry and make smoking a thing of the past.

You can support us by sending your donation to the Youth Smoking Prevention Foundation in Amsterdam, bank account number NL11 TRIO 0390 186 511.

The Dutch Tax and Customs Administration recognizes the Youth Smoking Prevention Foundation as an Institution for Public Benefit. This means that private donations to the foundation are tax deductible at a rate of 125% of the donated sum.

For more information, please contact Frits van Dam, +31 6 20 61 67 43

CREDITS TabakNee Final editing: Frits van Dam Journalists:

Stella Braam, Bas van Lier, Broer Scholtens

Design:

Wiebe de Wolf

Logo design: Nathalie Soetens www.tabaknee.nl Smoke Alarm Campaign:

Pool Worldwide, Amsterdam

www.rookalarm.nl 'You have to die of something' Bromet & dochters www.bromet.nl

COLOFON Text:

Bas van Lier, Amsterdam

Translation:

Billy Nolan, Amsterdam

Design:

Philip de Josselin de Jong, Haarlem

Printing:

Kapsenberg van Waesberge, Rotterdam

Š 2015 Youth Smoking Prevention Foundation, Amsterdam

The Youth Smoking Prevention Foundation has one clear aim: to rid society of tobacco and make smoking a thing of the past.

The only way to achieve this aim is to ensure that nobody starts smoking. The foundation is therefore urging the government to adopt a number of measures that together create an effective prevention policy.

This publication gives an overview of all the activities the foundation deploys to reach this goal.

www.stichtingrookpreventiejeugd.nl