by Dr. Marilyn Lorenzo

 
INTRODUCTION

       The battle to abate the tobacco epidemic is not being won and a major concern is the escalating transfer of the epidemic from big income countries to poorer and developing countries. In response to these global conditions, the World Health Organization (WHO) launched in July 1998, the Tobacco-Free Initiative (TFI) that aims “to coordinate an improved global strategic response to tobacco as an important public health issue.” The long-term goal of the global tobacco control is “to reduce smoking prevalence and tobacco consumption in all countries and among all groups, and thereby reduce the burden of disease caused by tobacco.” An important component of TFI is the Framework Convention on Tobacco Control (FCTC). The FCTC will be the international legal arm “that will circumscribe the global spread of tobacco and tobacco products (WHO 1998).”

             In the Philippines, more recent initiatives aimed at crafting a national tobacco control program have been instituted. Among these are the series of multisectoral consultative meetings and workshops initiated by the Department of Health to craft a Plan of Action for Tobacco or Health. In line with the Department’s mission, the National Institute of Health of the University of the Philippines Manila are spearheading five roundtable discussions this year with technical and financial support from WHO. The discussions will focus on strategic themes that will set directions for tobacco control.

 TOBACCO CONTROL MEASURES

              Historical tobacco control measures have been instituted in the Philippines, such as control on tobacco products, protection for nonsmokers, and health education. In 1988, a National Coalition on Tobacco Control was established by the Philippine Medical Association, the Tri-Chest Societies, and the Philippine Heart Foundation, which advocated the institution of measures against smoking. In the same year, the government-owned Philippine Airlines introduced a nonsmoking policy on all its domestic flights (WHO 1997). Henceforth, all domestic flights of other airlines in the country applied the same policy.

              Among the many bills on tobacco control, the Consumer Act of 1992 was passed into law, requiring health warning effective 1994. In the Philippine Clean Air Act of 1999, Section 24 of Article 5 prohibits “smoking inside a public building or an enclosed public place including public vehicles and other means of transport or in any enclosed area outside of one’s private residence, private place of work or any duly designated smoking area.” This provision of the Act will be implemented by the Local Government Units. 

              There are no laws prohibiting the sale of cigarettes to minors. In fact, retail vending of cigarettes are by street vendors, who are mostly children. Tobacco advertising in all media is freely allowed and even sponsorship of arts, sports, and cultural events abounds. In 1991, it was mandated that all public and private educational institutions become smoke-free. There are some work places where voluntary measures are being instituted. Smoking is also prohibited in medical conventions and school campuses. There were unsuccessful legal attempts to require tobacco multinationals to abide by the same rules and standards in the Philippines as in their own countries, such as health warnings, and limited cigarette advertisements on television. 

  Health education projects with media coverage on tobacco use have taken place. In 1992, the Philippine Medical Association started smoking cessation workshops. Considered a highly successful antismoking campaign in 1994 was the “Yosi Kadiri,” implemented by the Department of Health (WHO 1997). An appraisal of health education interventions made in Western countries on the options of national targets for the reduction of teenage smoking revealed that interventions aimed primarily at youth are likely to have delaying effect only, and sophisticated school programs, through potentially valuable, have proved difficult to implement effectively on a large scale. The appraisal also revealed that priority should be given to broad-based interventions aimed at the community  as a whole, including mass campaign for all age groups, fiscal policy, restrictions on smoking, and bans on advertisement (Reid et al., 1995). 

              The only recorded litigation taken against the tobacco industry is one that has been filed by the widow of a jeepney driver from Caloocan City who died of lung cancer in July 1998. The lawsuit was filed at the Regional Trial Court of the National Capital Region, Branch 222, Quezon City last December 1998 (Excerpts form the Office of the Clerk of Courts, Quezon City). 

              Senate Bill No. 1554, “an act regulating labeling, sale, and advertising of cigarettes and other tobacco products and prohibiting smoking in public conveyances and enclosed places” was introduced by Senator Juan Flavier et al. in the first regular session of the eleventh congress in 1999. 

              In the House of Representatives, House Bill Nos. 1198 and 4244 were introduced by Congressman Heherson Alvarez and Congressman Magtanggol Gunigundo, respectively in the first regular session of the eleventh congress. House Bill 1198 is the lower house version of Senate Bill 1554. House Bill 4224, on the other hand is “an act banning advertisements of tobacco products; prohibiting its sale to minors; regulating its production and manufacture; and establishing a trust fund thereof to ensure a smoke-free Philippines.”  

              As of this time, the said bills have not yet to be passed, while smoking continues to be taken up by an ever increasing number, exacting its toll on human health and on the quality of life of the Filipinos.         

  MAGNITUDE OF THE TOBACCO EPIDEMIC 

  Tobacco Production and Consumption 

              It has been reported that in the Philippines, 63,258 hectares were harvested for tobacco, up from 50,490 hectares in 1985 while 1.4% of all arable land is used for growing tobacco in 1990 (WHO 1997). In 1997, records show that some 51,800 hectares have been planted with tobacco, producing 65,000 metric tons of unmanufactured tobacco with a value of P2,929.4 million (Bureau of Agricultural Statistics 1998). The significant regions in the country where tobacco has economic roots are the Ilocos Region (Region I) and the Cagayan Valley (Region II) in the north. 

              Among the world’s 25 leading producers of unmanufactured tobacco in 1994, the Philippines ranked 19th with 50,898 metric tons of tobacco, dry weight, or about 0.9% share if the world’s total. In the same year, the Philippines imported 26,641 metric tons of unmanufactured tobacco, while our exports stood at 14,404 metric tons. The imports and exports of unmanufactured tobacco put the Philippines in the 14th and 22nd of the world’s 25 leading importers and exporters, respectively (U.S. Department of Agriculture). In 1997, the country exported 17,000 metric tons of unmanufactured tobacco amounting to US$29 million, while the import amounted to about US$67.3 million. The major market for flue-cured Virginia tobacco export in Western Europe, particularly Germany while for native leaf exports, 40% were brought to Spain (Dy et al., 1991). 

              In terms of manufactured cigarettes, the Philippine has manufactured 73 billion cigarettes in 1994, occupying the 15th leading producers of cigarettes. The country has imported some 13.98 billion cigarettes, thus occupying the 12th place among world’s leading importers. However, the nation was not among the 25 leading exporters of manufactured cigarettes. In 1990, two transnationals, through their subsidiaries, controlled 67% of the local market of manufactured tobacco. 

              According to the report of the Center for Research and Communication, now University of Asia and the Pacific (Dy et al., 1991), the contribution of the tobacco industry to the country’s gross domestic product (GDP) in 1990 was about P6.5 billion, or about 0.6% to the GDP. For the same year, it was estimated that 573,311 persons are employed in the industry with the majority (488,580) engaged in farming, followed by trading (47,214), manufacturing (20,108) and processing (15,840). With respect to tax collections, the industry paid in 1990 approximately P7.1 billion in excise taxes. It was estimated that if other taxes would be included, some P11.5 billion  would be the entire revenue from the tobacco industry. 

              Among the 25 leading countries in 1994, in terms of apparent tobacco consumption of manufactured cigarettes, the Philippines ranked 15th with some 85.36 billion cigarettes or about 1.6% of the world’s total (WHO 1997). The annual average per capita adult (age 15 and above) consumption in 1970 to 1972 was estimated at 2,010 manufactured cigarettes. This peaked to 2,110 in 1980 but dropped to 1,770 in 1992. 

              With respect to relative cost of cigarettes, smokers of 20 cigarettes a day spent 17% of their median household income for local cigarettes and 35% for imported brands in1989 (WHO 1997). 

              In terms of tar content of cigarettes, it is reported that in 1987, tar levels ranged from 19.1 mg to 39.7 mg (average of 38.2 mg) while that of nicotine content was from 1.00 mg to 1.79 mg (average of 1.35 mg). Ninety five percent of cigarettes produced in 1994 were filter-tipped. 

  Smoking prevalence 

              In terms of tobacco consumption, WHO estimated in 1998 that one-third of the global population, or 1.1 billion people aged 15 years and over are smokers. Sadly, 800 million of these are in developing countries (WHO 1998). From the same report, the global smoking prevalence of 47% among males and 12% among females were noted. 

              In the Philippines, the results of the National Smoking Prevalence Survey of the Department of Health in 1995 indicated that among 3,264 adults (aged 18 years and over), 46% once smoked while 33% are current smokers (DOH 1995). From the same survey, it was reported that smoking was three times prevalent among men than in women, that 70% of the current and ex-smokers had finished only elementary or high school education, and that majority belong to the low-income levels. The survey results also showed that among 3,244 youths aged seven to 17 years old, 10% of them once smoked while 4% were current smokers, and the mean age of current and ex-smokers was 12 years old (DOH 1995). 

              In the monograph of cigarette smoking in the Philippines (Dans et al., 1999), the smoking prevalence was derived from the Fifth National Nutrition Survey composed of 4,541 individuals aged 20 years and over in 1999. They reported a smoking prevalence wherein 33% of adult Filipinos are current smokers while 13% are ex-smokers. From the same monograph, it was reported that smoking prevalence among children, as derived from small surveys, is about 30% in urban areas with majority of them smoking from the time they were 13 to 15 years old. 

              According to a 1987 to 1988 survey among population subgroups, 63% of males and 37% of female physicians were smokers. Thirty-eight percent of respondents said they smoked in front of their patients, and only 59% advised patients on the ill effects of smoking (WHO 1997).   

  Health consequences of smoking 

              In terms of health consequences of tobacco use, WHO estimates that globally, 4 million deaths are caused by smoking. This is expected to increase to about 10 million by the year 2030, which will be more than the total number of deaths from communicable diseases such as malaria, tuberculosis, and maternal and childhood conditions combined (WHO 1999). 

              WHO predicted that with the current smoking trends, tobacco will be the leading cause of disease burden worldwide, causing one in eight deaths. The report added that 70% of these deaths will occur in developing countries.  

              The World Bank reported in 1999 that half of the long-term smokers will eventually be killed by tobacco, and of these, half will die during productive middle age losing 20 to 25 years of life. WHO and the World Bank also cited nicotine addiction as one of the adverse health consequences of smoking. In a US study among children and youths in 1991, it was reported that majority of nicotine addiction occurred in those who started smoking at age 13 to 17 (WHO 1999). 

              In another study among US high school students, only less than 40% who believed that they will quit within five years, actually do quit. In high-income countries, individual attempts to quit smoking have been reported to have low success rates to those who try without the assistance of cessation programs, 98% will have started again within a year. Quitting is rare in low- and middle-income countries (World Bank 1999). 

              In the monograph on cigarette smoking in the Philippines, it is reported that in 1999, some quarters of a million Filipinos will be suffering form lung cancer. chronic obstructive pulmonary disease, coronary artery disease, and cerebrovascular disease caused by smoking (Dans et al., 1999). It further noted that 80% of these Filipinos will be among males of productive age and 5% of these cases will die. 

              A study on the cumulative incidence of bronchitis and pneumonia among infants in Metro Manila indicated that a significant risk factor for the incidence is cigarette smoking of a household member (Torres and Subida, 1996). Another study of a community around an industrial plant has shown that children belonging to households with smoking mothers were 2.3 times more likely to have lower predicted pulmonary function as compared to their counterparts belonging to households of nonsmoking parents (HSMECInc, 1999). 

  Economic costs of smoking 

              According to the World Bank report, the economic costs of tobacco exceeds its estimated benefits, such that smoking-related health care accounts for 6% to 15% of all annual health care costs in high-income countries. It  further elucidated that a 10% increase of real price of cigarettes would cause 40 million smokers alive in 1995 to quit and prevent a minimum of 10 million tobacco-related deaths (World Bank, 1999). 

              In a preliminary estimate made in the Philippines in 1999, approximately P27 billion will be spent of health care, P1 billion for productivity loss due to illness, while P18 billion will arise from productivity loss due premature death or an annual total of P46 billion for those suffering from smoking-related diseases (Dans et al., 1999). 

              While these preliminary estimates provide us with some ideas about the magnitude of the tobacco epidemic in the Philippines and elsewhere, more definitive and precise information is necessary to guide future tobacco-free initiatives. 

  APPROACHES TO DEVELOPING NATIONAL PLANS OF ACTION 

              Among the key strategies, WHO recommended national plans of action for comprehensive tobacco control that relates to legislative action: 

  •  Tobacco taxes that increase faster than price and income growth

  • Portion of tobacco taxes to be used to finance tobacco control measures and to sponsor sports and cultural events 

  • A ban on all forms of tobacco advertising, promotion and, sponsorship 

  • A legal requirement for strong, varied warnings on cigarette packages 

  • Restriction of access to tobacco products, including a prohibition on the sale of tobacco products to young people 

  • Limitations on the levels of tar and nicotine permitted in manufactured tobacco products 

  • Strategies to provide economic alternatives to tobacco agricultural workers (WHO 1998). 

         Legislation is critical to comprehensive tobacco control. The range of legislative measures should necessarily be broad, given the number of things that must be done in order to achieve effective control of the tobacco epidemic in any country. It is necessary to take the position followed by many governments when dealing with other drugs. It is preferred to have a single piece of legislation giving broad regulatory control over all aspects of tobacco manufacturing, importation, marketing, and use. If this is not possible, alternatively, it may be necessary to pass several different laws. In any case, the relevant laws should give priority to the following legislative provisions: 

  1. The accessibility of tobacco products should reflect the gravity of harm associated with their use. This effort should include: 

  • A taxation law that reduces affordability 

  • An end to tobacco sales in vending machines and from self-service displays 

  • The effective elimination of tobacco sales and distribution to children 

  1. There should be full and free consent among users and potential users of tobacco products. This would entail the following: 

  • An end to all direct and indirect forms of tobacco advertising because tobacco advertising is inherently misleading 

  • An end to the misleading messages conveyed on tobacco labeling and packaging 

  • Prominent, detailed, and frequently updated health information on (and possibly in) tobacco packaging and at point of sale 

  • Full public disclosure of all product toxins and additives 

  • Mandated public health education efforts, including efforts to educate the public about the role of the tobacco industry 

  • Guaranteed assistance to those who wish to cease using tobacco products and assistance to tobacco users seeking compensation for their harm 

  1.   There should be protection for health, rights, and well-being of those who do not use tobacco products. This include: 

  • A guarantee of smoke-free spaces, workplaces, and public transit 

  • Guaranteed and simplified methods of redress for those harmed by environmental tobacco smoke 

  • Legislated protection from (or compensation to) fires and other environmental hazards caused by tobacco products 

  1. The legislation should control the product itself and should include: 

  • The ability to ban specified categories of any nicotine delivery products 

  • Control over the additives which can be ingredients found in tobacco products 

  • Control over the additives which can be ingredients found in tobacco products 

  • The ability to require modification in tobacco products 

When some countries are not able to adopt truly comprehensive legislation in a single step, these countries may require a series of steps to attain this same goal. However, to avoid passing numerous small pieces of legislation, it is often better to pass broad laws. The limits of what is politically feasible at any point in time should be accounted for in the drafting of these laws. Some worthy strategies to explore are: 

  • Some requirements can be stipulated to come into force at a later date; 

  • If some current activities promoting tobacco cannot be stopped, they might be phased out and new activities prevented; 

  • General requirements can contain regulatory authority allowing for further health protection measures to be developed by regulation or ministerial order 

These latter provisions are components of a comprehensive legislative approach to tobacco control. For example, large and prominent health warnings, covering  10% or more of the package face, are now required in Africa and Thailand (WHO 1990).

ECONOMIC APPROACHES TO TOBACCO CONTROL 

              The main purpose of tobacco taxation policy is to make tobacco products less affordable and reduce compensation. Often this requires increasing prices beyond what is necessary to surpass inflation. This is because income growth can also stimulate the demand for tobacco, a problem in some developing countries with rapidly growing economies. 

              Increase tobacco taxes, above the rate of inflation, and earmarking a proportion of the proceeds to finance other tobacco control measures that comprise the comprehensive national tobacco control program, are highly recommended by WHO. Adoption of such measures will make all tobacco control measures both effective and self-financing. This is especially important in developing countries where financing of new public health initiatives could be difficult.  

              In order to estimate the links between consumption and price, it is necessary to employ economic techniques. Many studies have done this, and consistently show that for every 10% increase in the real “inflation adjusted” price, there will be a drop in consumption ranging from 2% to 8%. Young people and low-income people have been found to be more price-sensitive than others. 

              Producing this sort of information can show strong associations that can lead to changes in the perceptions of various tobacco control tools. These associations can also be powerful persuaders of governments. Some may argue that tobacco tax increases will reduce the consumption so much as to reduce overall revenue, but mere presentation of past graphical data will show the opposite to be the case. 

              Another fiscal measure that can be used is to limit the preselling prices of tobacco products. This compensates for the extremely high profits tobacco companies could otherwise obtain due to the industry’s  monopolistic nature and allows increased tobacco tax revenue without additional changes in retail prices. 

              The key objective of health oriented tax policy is to reduce the harm from tobacco consumption. there are many ways that this can be done. These include:

  •  Putting a “floor” on the price of tobacco products, to keep price sensitive consumers out of the market. This may be effective in preventing nonsmokers (such as children and poorer adults) from ever starting to smoke. 

  • Causing to rise regularly to cover normal inflation; to ensure that tobacco products do not become more affordable as incomes rise; and to give existing smokers increasing incentive to quit. 

  • Ensuring that the price-differential between different tobacco product more adequately reflects the health risks involved and prevents mere substitution of one product for another, such as when taxes are much lower on “roll-your-own” tobacco than on manufactured cigarettes.

  There are two basic methods of tobacco taxation:   

  1. Nominal or specific taxes, which are based on a set amount if tax per cigarette or gram of tobacco. These taxes will be particularly effective at putting a floor on the price of tobacco products. Unless they are automatically linked to inflation, the government will have to increase them each year in order to ensure that the effect of the tax is not eroded by inflation. While this form of taxation can prevent inexpensive manufactured tobacco products from being on the market, it can also give advantages to the brands of big multinationals which prefer to compete on brand image rather than price. 
  2. Ad valorem taxes, which are levied as percentage mark-up on the price of tobacco products. This method of taxation has the advantage of providing mechanism for automatic tax increases in line with price changes. A disadvantage is that price differences between high –and low priced brands of cigarettes and accentuated. 

For health purposes, specific taxes are likely to be more effective, as long as they are increased regularly to compensate for rising prices and incomes and provided other methods can prevent  marketing inroads by the multinationals. Linking the tax  automatically to the index of consumer prices will ensure that the tax is not eroded by inflation. It will be better still if the tax rises annually by more than the increase in incomes, to reduce affordability. 

        For some countries, a combination of specific and ad valorem taxes would be most appropriate, but the end result of making tobacco products less affordable really is the bottom line.

ECONOMIC AND AGRICULTURAL ALTERNATIVES TO TOBACCO 

        Given the powerfully addictive nature of tobacco, only slow and gradual changes in tobacco consumption can be expected, even in the best of circumstances. This means that there will be time for smooth economic adjustment as displaced tobacco workers move to alternative forms of economic activity. 

        Effective long-range and strategic planning can anticipate long-term declines in the tobacco industry. Addressing economic alternatives for tobacco workers can also be a good strategy. It can dissuade departments of agriculture, tobacco agricultural workers, and other from opposing tobacco control plans and encourage support for a comprehensive national tobacco control strategy. 

        Part of Canada’s successful comprehensive tobacco control strategy included subsidies to tobacco farmers to take up alternative forms of economic activity. One-time cash payments were also made to tobacco farmers who agreed to retire from the tobacco business. In one decade, tobacco consumption dropped by 40% in Canada, the number of tobacco farmers fell by half, and the tobacco-growing regions of the country experienced strong economic growth, as new forms of economic activity opened up. Other countries including Brazil, Malaysia, and the Philippines, are looking into economically feasible alternatives to tobacco. 

        In Bangladesh, a successful community demonstration project in a tobacco-growing region succeeded in not only reducing rates of tobacco consumption in the community but also converting a large number of farmers from tobacco to food production. Also, in this region, food production was shown to be more lucrative than tobacco production. 

        In the Philippines, acceptable alternatives to address deeply entrenched tobacco crops especially in Regions 1 and 2 must be studied and pursued. While the production of tobacco in the Philippines seems to be minute. its economic contributions to the country in terms of excise taxes have often been cited. Furthermore, we must be careful in instituting changes in agricultural production in these places because many farmers in the tobacco growing regions are subsistence farmers and are heavily dependents of the economic gains and incentives that they derive from the present tobacco crops. There are viable substitutes to tobacco crops such as garlic and onions that are similarly of high value and are suitable to the soil and climatic conditions of the tobacco growing regions. However, because this is a demand-driven industry, corresponding changes must also emanate from these changes. Agricultural alternatives are possible in the long run if these are intelligently pursued (Dy & Lorenzo, 1991) 

  WHERE DO WE GO FROM HERE? 

        Present efforts are directed in assisting DOH and its partners in launching an effective and meaningful tobacco-control campaign. A proposal to develop a comprehensive National Tobacco-Free Initiatives Program has been approved in principle. External funding agencies such as WHO have been approached to support the present initiatives. 

        This effort consists of researches and other related activities that will yield valuable information that will drive national-free initiatives in the Philippines. The project aims to establish evidence that will accurately characterize the magnitude of health related effects of smoking. The information that will be systematically pieced together will be the foundation of an effective national tobacco control strategy that will be in place by the year 2001 and would have been pilot-tested for replicability by the year 2003. 

        Specifically, the project aims to: 

  1. Undertake the research that will yield critical baseline information about the current status of tobacco use, behavioral determinants of smoking and its health and health-related effects in the country through the following: 

  • Meta-evaluation of national and international tobacco control efforts in the country; 

  • Review of records on what has already been done in tobacco control efforts in the country; 

  • Identification of key stakeholders and their roles in the proposed tobacco control; and 

  • Identification of effective tobacco control strategies within the Philippine context. 

2.      Determine critical programmatic variables or factors that must be incorporated into an effective national tobacco control program.   

3.      Identify policy alternatives, directions, and instruments that will facilitate the implementation of an effective and feasible tobacco control program. 

  NATIONAL TOBACCO ELEMENTS AND METHODS 

              In order to achieve the project objectives, the proposed tobacco control project  will contain but not be limited to the following elements and methods: 

  A.     Policy Research:  at the national and local levels, analyze and evaluate public policy on restricting tobacco use (e.g.  restricting access to minors, limiting areas where smoking is allowed), tobacco taxation, tobacco smuggling, regulating nicotine as a drug, and tobacco advertising bans among others. This will also entail evaluation of the effects of current policy initiatives on tobacco control and determination of which policies will be effective in achieving the goals of a tobacco-free initiative. 

  B.    Health Research: at the national and local levels, this entails collecting evidence on health effects of smoking as such: determining smoking prevalence by sex, age groups, by educations level, by geographic area, and by income groups; collecting mortality and morbidity data among different high-risk groups; determining social aspects of smoking “addiction”; segregating the effects of indoor air pollution from smoking and identifying the effects of smoking on children’s and women’s health. 

  C.    Health programs development and testing:  at the national and local levels, identify and pilot-test effective smoking cessation and prevention program elements that may be integrated into current health programs; monitor smoking trends and evaluate the effectiveness of national tobacco control strategies. 

 D.    Advocacy and health promotion:  at the national and local levels, determine useful methods of information dissemination on health effects of smoking and educational programs that will deter smoking among the general population; development of educational materials and conduct for educational activities appropriate for different age groups in a variety of settings that will highlight how to achieve tobacco-free lifestyles. 

  E.     Economic policy instruments and other related policies development:   at the national and local levels, determine which types of economic policies will be useful in curbing access to tobacco products with focus on pricing and taxation; determining appropriate use of tobacco tax revenues, economic alternatives for dislocated tobacco farmers, agricultural alternatives to tobacco crops, economic effects of tobacco control strategies, advertising bans and how to deal with issues such as tobacco smuggling, and tobacco manufacturing related regulation. 

 F.     Capacity-building of key stakeholders in the tobacco control program:  this entails organization and maintenance of national and local core groups that will stimulate, support, and coordinate tobacco-control activities. Ensuring adequate funding, staffing, and strong networking capabilities of these groups will be an important focus. Essential training programs for tobacco control program staff and their counterparts in nonhealth organizations will be developed and tested. Training materials and curricula for these people will likewise be developed.  

  PROJECT PARTNERS 

              The Department of Health has conducted a series of meetings and workshops since April 1999 aimed at identifying specific strategies and mechanisms in the preparation of the National Plan for Tobacco Control. four subcommittees were formed namely, the Strategy Committee, the Scientific Committee, the Social Mobilization Committee, and the Advocacy Committee. A steering committee sets the directions for these subcommittees. 

              The Institute of Health Policy and Development Studies of the National Institutes of Health of the University of the Philippines Manila has conducted a preliminary consultative meeting last July 2, 1999 to identify areas for discussion on August 11, 1999 where the various project partners will participate in the round table discussion on tobacco control. 

              The proposed project will be undertaken in collaboration with the following partners: 

  Government Sector   

Department of Agriculture (DA) to provide technical assistance in identifying alternatives to tobacco farming, other uses of tobacco 

Department of Trade and Industry (DTI) to assist in developing guidelines for tobacco export and importation 

Department of Finance-TESDA to identify employment alternatives for those involved in tobacco farming, trade, and manufacturing 

Department of Finance-EIIB to implement programs that will abate tobacco/cigarette smuggling 

Department of Education, Culture, and Sports to develop programs for tobacco control in school curricula and guidelines for banning sponsorship of sports events by the tobacco industry 

Department of Interior and Local Government to provide technical assistance to LGUs in the development of local ordinances, policies, and programs on tobacco control 

Department of Science and Technology to provide technical support in the conduct of research such as nicotine replacement therapy and other smoking cessation alternatives 

Local Government Units particularly in Regions I, II, and CAR to facilitate and support consultation with tobacco farmers re: the project 

League of Mayors and League of Governors to support the Tobacco-Free Initiatives of the National Government 

Congress and Senate to introduce and pass appropriate initiatives resolutions, bills that will support tobacco-free initiatives