On June 10, 2008, at the House of Representatives, the health committee’s technical working group (TWG) was set to meet on House Bill (HB) 3364. Congressmen flocked to Room 14 of the Ramon V. Mitra Building, where the meeting was being held, going against their known practice of leaving technical guys alone to fine-tune bills and just discussing them in the plenary.
 
The bill, however, was not an ordinary bill; a lot was at stake, at least as far as the 34 congressmen who sat in were concerned.
 
The proposal being taken up was for “An Act to Effectively Instill Health Consciousness Through Picture-based Health Warnings on Tobacco Products.” Should it become law, HB 3364 will require tobacco companies to put on their product wrappers photographs of diseases or disabilities caused by smoking, as a form of warning buyers what they may be getting.
 
Lobby money
 
Based on Newsbreak’s interviews with lawmakers privy to the meeting, most, if not all, of their colleagues who showed up at the technical meeting were intent on killing the graphic health warning bill. Insiders confirmed that lawmakers who argued against the proposal received cash from a colleague for their efforts.
 
A lawmaker, who gave the interview on condition of anonymity, said lawmakers in the meeting were given P20,000 each to register opposition to the bill. The money was handed by a colleague, but it wasn’t clear to who the real source of the money was.
 
“It is rather cheap but that’s how it goes,” the lawmaker said.
 
A source, who admitted getting P20,000, said money was not the main consideration in opposing HB 3364. “It is about pakikisama.” The source said a lawmaker sides with colleagues “whose constituents may be affected by the bill” so he or she can, in turn, count on the support of these colleagues when he or she is pushing for another bill.
 
“It is how the system works in the House,” the lawmaker said.
 
Why graphic warnings
 
The use of graphic health warnings is recommended by the World Health Organization Framework Convention on Tobacco Control (FCTC), to which the Philippines is a signatory.
 
Article 11 of the FCTC requires that signatory-countries adopt effective health warnings on tobacco products by September 2008. A month after the deadline, the Philippines was among the Southeast Asian countries that had not complied. Around the world, about 15 countries have introduced pictorial health warnings on tobacco products.
 
The House and the Senate were both aware of the September 2008 deadline for adopting the graphic health warning measure under the international framework convention on tobacco control. Senator Pia Cayetano scheduled hearings on Senate Bill (SB) 2377, or the “Picture-based Warning on Cigarette Package” bill, while Northern Samar Rep. Paul Daza filed a counterpart measure.
 
While a number of senators are known to be smokers—among them Senators Rodolfo Biazon, Francis Escudero, and Jinggoy Estrada—SB 2377 did not meet strong resistance in the chamber. The measure is being deliberated on second reading in the plenary. While a recent leadership change in the Senate caused a reshuffle in committee chairmanships, the bill is still expected to be approved. Cayetano has yielded the heath committee panel to Senator Loren Legarda.
 
Parochial politics
 
The parochial politics of some congressmen, however, proved to be a stumbling block.
 
Thirty-four congressmen, including party-list representatives, came to the TWG meeting on June 10; oppositionists outnumbered the bill’s sponsors.
 
Deputy Speaker and Ilocos Sur Rep. Eric Singson sought to delete the title of the bill, a move that could virtually kill the bill. Legislators from Northern Luzon, where tobacco farming in the country is concentrated, were present and supported Singson’s manifestation. Lawmakers from the Visayas and Mindanao backed them up.
 
While HB 3364 is basically a health bill, a transcript of the proceeding showed that those opposed to the bill focused their arguments on the economic issues. They cited alleged disastrous effects on the livelihood of tobacco farmers if it is passed.
 
Their logic was: if consumers are frightened by the graphic health warnings, the sales of tobacco products would go down, and the demand for tobacco harvested in the provinces will decline as well.
 
Iloilo Rep. Janette Garin argued that the tobacco sector has problems that would have economic implications, and the graphic health warning bill is not addressing them.
 
Leyte Rep. Trinidad Apostol said that the current text warnings on cigarette packs are sufficient, and anything beyond that, as the bill proposes, would run counter to government efforts to promote livelihood.
 
Deputy Speaker and Cebu City Rep. Raul del Mar quibbled on issues like the kind of pictures that will be placed on cigarette packs, which of these pictures will be displayed more constantly, and who will design the warnings.
 
The critics also raised questions on the truthfulness of the proposed graphic warnings. Garin, a medical doctor, said the diseases to be depicted on cigarette packs are not necessarily caused by tobacco smoke.
 
Albay Rep. Al Francis Bichara said that many lifestyle-related deaths could be attributed to high cholesterol levels and not to smoking. He noted that many smokers die of old age, while there are non-smokers who die early.
 
DOH  reprimanded
 
Their attacks extended to a resource speaker at the TWG meeting. Dr. Franklin Diza of the Department of Health’s National Center for Disease Prevention Control, said he “got scolded and reprimanded” by congressmen when he argued for the passage of the bill.
 
The opposition that lawmakers demonstrated on June 10 was a surprise to Diza. He noted that most of those who showed up at the TWG meeting never attended the four committee hearings before that.
 
“But when they found the bill was gaining support, the congressmen from the North and their supporters attended,” he observed.
 
Diza acknowledged that aside from the Northern Luzon bloc of lawmakers, the lobby of the tobacco industry “is also strong.” He said the “tobacco industry has friends in Congress.”
 
We sought to interview three of the congressmen who openly objected to the passage of the graphic health warning bill—Eric Singson (2nd district, Ilocos Sur), Ronald Singson (1st district, Ilocos Sur) and Roque Ablan (1st district, Ilocos Norte)—but they begged off.
 
Same opposition group
 
Maricar Limpin, executive director of the Framework Convention on Tobacco Control Alliance Philippines, noted that those who are opposed to HB 3364 were also the ones who objected to the bill that proposed text health warning on tobacco products a few years ago. The text warning bill, however, encountered less resistance.
 
Packaged as a trade bill, that measure took only more than a year to be passed, Diza noted. One factor the measure faced smooth passage was that “they believed it (text warning) would not be effective anyway.”
 
The bill, adopted in 2003, became Republic Act 9211 or the Tobacco Control Act. It sets guidelines and regulation for the packaging, sale, distribution, and advertising of tobacco products. Among others, it mandates the printing on the package or wrapper—in English or Filipino—texts that warn of the ill-effects of smoking.
 
Text-only warning has no impact
 
But five years of the law’s implementation showed text warnings to have little effect in discouraging tobacco consumption.
 
“The text-only warning has no impact,” said Limpin. She cited a global youth survey, conducted by the World Health Organizatioin (WHO), which showed that the prevalence of smoking among Filipino youth even increased from 15 percent in 2003 to almost 22 percent in 2007.
 
The increase in smoking prevalence shows that “we are not winning the war.  We have to institute drastic measures to curb the tobacco epidemic,” she said.
 
Limpin said the text warning should be printed on the front and back of the package to be more effective, but the law requires that for only one side of the panel or package.
 
Besides, says Diza of the health department, the text warnings are in English, alienating the poor who do not understand the language.
 
Pictorial warnings shock
 
Even then, by the time RA 9211 was passed in 2003, the provision on text warning was considered outdated. Studies conducted by the Canadian Cancer Society as early as 2001 established that pictorial warnings were more effective in discouraging smoking. Around that time, Canada and Brazil had adopted pictorial warnings, while other nations had begun similar moves.
 
In one study, half of the 2,031 Canadian adults who were surveyed, said the new health warnings increased their motivation to quit smoking. Among the smokers, 21 percent who were tempted to have a cigarette decided not to because of the graphic warnings.
 
The survey also showed that the most effective graphic warnings were those depicting a diseased mouth and a lung tumor.  Canada was the first country to use graphic health warnings on tobacco products.
 
The Association of European Cancer Leagues stressed that visual images on the negative effects of smoking “convey shock, immediacy and empathy” as “smokers tend to favor ‘shock’ images that are disturbing or unpleasant to look at.”
 
Shocking images a threat
 
The preliminary findings of an about-to-be-released study conducted among Filipino youth in 2008, a copy of which was obtained by Newsbreak, boosts this contention. Majority of the respondents said they found visual warnings more effective in making them realize the dangers of smoking. The graphic design, Filipino youths said, had better ability to convey the health risks related to smoking and some said it actually stopped them from buying cigarettes.
 
The effectiveness of visual warnings may not be felt among longtime smokers, but this definitely poses serious threat on creating new markets for the tobacco industry, Limpin said. To sustain its market, the tobacco industry, she noted, has been aggressively promoting cigarette use among the youth.
 
“The industry knows that the introduction of graphic warnings threatens its future market,” Limpin said.
 
But with ardent allies in the House, the tobacco industry need not worry in the meantime.
 
—with research assistance by Lilita Balane (Newsbreak)