[Intl-tobacco] Political economy of tobacco control in Thailand (fwd)

[Robert Weissman]

Political economy of tobacco control in Thailand
Tob Control 2001;10:48-54 ( Spring )
by Sombat Chantornvonga, Duncan McCargob
Source: Tobacco Control, Wednesday, 2/28/01

a Faculty of Political Science, Thammasat University, Bangkok 10200, Thailand,
b Institute for Politics and International Studies, University of Leeds, Leeds
LS2 9JT, UK

Correspondence to: Dr McCargo d.j.mccargo@leeds.ac.uk

Received 24 March 2000; Revision received 23 August 2000; Accepted 27 October
2000

	  Abstract

Thailand has some of the world's strongest anti-tobacco legislation. This
paper examines the political economy of tobacco control in Thailand,
emphasising the identification of forces which have supported and opposed
the passage of strong anti-tobacco measures. It argues that while a
powerful tobacco control coalition was created in the late 1980s, the
gains won by this coalition are now under threat from systematic attempts
by transnational tobacco companies to strengthen their share of the Thai
cigarette market. The possible privatisation of the Thailand Tobacco
Monopoly could threaten the tobacco control cause, but the pro-control
alliance is fighting back with a proposed Health Promotion Act which would
challenge the tobacco industry with a hypothecated excise tax dedicated to
health awareness campaigns.

(Tobacco Control 2001;10:48-54)

Keywords: anti-tobacco legislation;  political economy;  Thailand; 
transnational tobacco companies

	  Introduction

Thailand is a constitutional monarchy. The military and the bureaucracy
have traditionally held considerable power, but recently political parties
and elected parliamentarians have become the leading political actors.1
The Thai political process is characterised by vote buying and other
illegal electoral practices that undermine the integrity of the political
order. However, a new and more liberal constitution was inaugurated in
1997 to combat flaws in the electoral system. The result is a heady mix of
pluralism and structural corruption, leading to a remarkably open but
somewhat dysfunctional system.

These general characteristics are also evident in Thai tobacco control. As
in other areas of public policy, public health issues are driven by
constantly changing coalitions of support formed by competing interest
groups.2 Thailand constitutes an important case study, given the potential
implications of its tobacco control successes for other developing
countries seeking to curb tobacco consumption.3

	  The Chatichai government and the tobacco issue

The 1988-91 Chatichai Choonavan government saw apparently contradictory
developments on tobacco control: the Thai cigarette market was opened to
foreign competition, yet tobacco control legislation was also approved in
principle. It was during this time that transnational tobacco companies
(TTCs)  made their first move to penetrate the Thai cigarette market.
Despite the existence of a total ban on foreign cigarette sales (the
Thailand Tobacco Monopoly (TTM) enjoyed a monopoly on cigarette
manufacture and sales), during the period from January 1988 to February
1989 the TTCs reportedly spent well over 17 085 100 baht on advertising in
Thailand, in order to generate a demand for their products and thus a
favourable climate for the opening of the Thai market.

	  Emergence of the tobacco control movement

By 1988, an anti-smoking movement spearheaded by non-governmental
organisations (NGOs) such as the Thai Anti-Smoking Campaign Project
(better known as ASH Thailand)founded in 1986was already making its impact
felt throughout the country.4 Through active social marketing, activities
using media specialists and involving key figures from just about every
walk of life, NGOs turned the anti-smoking movement into a form of social
mobilisation which had a lasting impact on the consciousness of the whole
society concerning the subject matter of smoking control. The pay-off in
terms of anti-smoking measures was considerable. In 1988 the cabinet first
issued an executive decree banning TTM from advertising, and a total ban
was imposed on all forms of foreign cigarette advertising, both direct and
indirect. In 1989 tobacco products were placed under the category of
"harmful products" making this cabinet decree a fully fledged law. In the
same year the National Committee for Control of Tobacco Use (NCCTU) was
established, with the task of formulating official policies on the tobacco
industry

	  US pressures to open the Thai market

Late in 1988, the US government began to increase pressure on Thailand to
open up the domestic tobacco market. The pro-entry alliance comprised
TTCs, the US government and embassy, the Finance Ministry, sympathetic
politicians (especially from the Social Action Party), and TTC agents and
surrogates. The anti-entry alliance was composed of: ASH and health
activists, sections of the media (especially newspapers), NCCTU, (part of
the Ministry of Public Health), sympathetic politicians, mainly from the
Democrat Party, health minister Chuan Leekpai, urban voters, TTM, the TTM
union, the Tobacco Growers' Association, and small farmers' groups.

By siding with organised anti-smoking campaign groups and seizing the
moral high ground on the tobacco issue, Chuan and his party received the
spotlight of media attention, and so stood to reap considerable political
benefits, no matter what the outcome. The public outcry heard through all
channels of the mass media forced the finance minister grudgingly to back
down on its strong support for opening the tobacco market. Prime minister
Chatichai (using his constant catch phrase "no problem") typically played
down the issue, commenting that it was not especially important.
Government policy on tobacco was apparently not to have any definite
policy.

	  Threat of US trade sanctions

In April 1989, the TTCs called upon the US Trade Representative to impose
trade sanctions under section 301 of the 1974 US Trade Act, if Thailand
continued to disallow market access to American cigarettes. The TTCs
accused Thailand of using unfair trade practices against them, and
demanded a completely free and open market, freedom to establish their own
marketing and distribution system, abolition of the high tax regimen and
discriminatory taxation, complete freedom to advertise and promote
cigarettes through the press, radio and television, and the right to
sponsor sports and other events.

The US Trade Representative then initiated an investigation to determine
whether or not Thailand was engaged in unfair trading practices. The
strategy of the anti-smoking coalition was not to allow the US-Thai
cigarette dispute to be viewed simply as a trade conflict. The two most
prominent Thai anti-smoking activistsDr Hatai Chitanondh and Dr Prakit
Vateesatokitjoined the three member Thai delegation to the US Trade
Representative hearings, and sought maximum media publicity for their
cause. The Thai case was supported by US, Asian, and international health
activists and NGOs, and the anti-tobacco coalition recruited leading
public figures and senior monks to support their cause.  However, Thai
exporters came out in strong support of the Ministry of Commerce's
position that import of foreign cigarettes should be allowed.5

	  GATT adjudication

In late 1990, with the outcome of the bilateral talks between Thailand and
the USA still inconclusive, the USA took the dispute to the General
Agreement on Tariffs and Trade (GATT).6 The USA petitioned GATT, arguing
that Thailand's import ban and excise tax system were inconsistent with
GATT rules. The US position was that the dispute was a "national treatment
issue, not a health issue". Therefore, Thailand should be ordered to
remove unfair and discriminatory trade barriers that made it difficult for
US products to compete with domestic products. Thailand's position was
based on the health consequences of the market opening for cigarettes.
Health personnel were present in the Thai party but not the US team. The
Thai delegation persuaded the GATT panel to consult the World Health
Organization. The WHO team supported Thailand, arguing that foreign
cigarette imports would have severe adverse health consequences.7

The GATT panel subsequently ruled that although Thailand's taxes on
cigarettes were consistent with GATT, the import ban was nevertheless
illegal. However, GATT also ruled that the ban on cigarette advertising
was legal, and that Thailand could impose strict non-discriminatory
labelling and ingredient disclosure regulations on cigarettes.

	  Drafting the tobacco control legislation

Tobacco control advocates had successfully mobilised health concerns about
cigarette imports, drafted wide support from different sections of the
community, and made the issue of foreign cigarette imports a matter of
national pride and "face". Thus when Thailand was forced by GATT to open
up the cigarette market, the anti-tobacco coalition was able to push for
various measures as a quid pro quo. A very tough tobacco control bill
based on the Canadian Tobacco Products Control Act was drafted, and the
Office for Tobacco Consumption Control (OTCC) was established within the
Ministry of Public Health, with a 32 million baht budget (US$1.28 million
updated to current rate)  for its first year. Ensuring that draft
legislation makes its way onto the statute books in Thailand is no easy
matter; parliamentary sessions are short, legislative procedures are
cumbersome, and the Thai political process is characterised by structural
corruption. It is highly questionable whether or not under normal
circumstances the Tobacco Products Control Bill would have become law.

	  The 1991 coup and the fate of anti-tobacco legislation

A military coup in February 1991 saw the Chatichai government replaced by
an unelected government, with a cabinet of technocrats led by former
diplomat Anand Panyarachun. In this new political scenario, anti-tobacco
groups had direct access to deputy health minister Athasit Vejjajiva, one
of the founders of ASH. Athasit and other health advocates had direct
access to leading power holders, including de facto coup leader general
Suchinda Kraprayoon.8 Suspension of the normal political process curtailed
TTC capacity to derail the legislative process. At the same time, the
anti-tobacco lobby could play on nationalist sentiments among cabinet
members and the military to press forward on tobacco control. At one
point, two of the most important sections of the bill (a ban on
advertising and the mandatory disclosure of ingredients) were almost
removed. Evidence that similar measures had been adopted in the USA and
Canada was crucial in swaying the government to retain these provisions.9
Guilt feelings or anxieties by cabinet members concerning the doubtful
legitimacy of their government may have spurred them to support "good"
legislative measures.10 The National Assembly passed both the Tobacco
Products Control Act and the Non-Smokers' Health Protection Act without
any amendment on 13 March 1992, two weeks before the end of the Anand
government's term in office.

The Tobacco Products Control Acts bans all forms of cigarette advertising,
cigarette promotions and free samples, advertising of other products where
a brand of cigarettes is part of the logo, sales of cigarettes to under
18s, and cigarette vending machines. Cigarette manufacturers are further
required to devote at least 25% of total package space to printing a
health warning in black and white. Manufacturers and importers of tobacco
products are also obliged to inform the Ministry of Public Health of the
composition of their products before they can be sold. The Non-Smokers'
Health Protection Act essentially bans smoking in public buildings.
Technically speaking, the victory seemed a complete one.

	  Continuing contestation: obfuscation and delay

With each new government following the end of the Anand government in
March 1992, the tobacco multinationals sought to win back lost territory.
They appeared to be best placed when dealing with the elected politicians
who took turns assuming control of the Ministry of Public Health,
typically seeking to delay or water down regulations. Late in 1992, the
cigarette companies narrowly failed to reduce the size of the health
warning.

The tobacco lobby did win some battles. Dr Hatai was removed from his key
position as the secretary of the NCCTU in 1993, a move he attributes to
press leaks claiming that a key minister had received bribes from the
tobacco industry.11 Successive cuts were made in the budget of OTCC (later
the Institute for Tobacco Consumption Control (ITCC)), from 32 million
baht in 1992 to only 15 million baht in 1999,12 which was followed by the
transfer of ITCC from the centrally placed office of the permanent
secretary of the Ministry of Public Health to the Department of Medical
Science.

The TTCs' biggest fight against the anti-smoking groups in Thailand,
however, centred around the requirement stated in article 11 of the
Tobacco Products Control Act that cigarette firms must disclose the
ingredients of their products. TTCs sought to obstruct or delay its
implementation by all possible means. After years of delay, the TTCs
finally gave in, and the ingredient disclosure law came into effect in
late 1998. However, the law only requires that the Ministry of Public
Health is informed of the ingredients, not consumers.

	  Tax policy and tobacco control

The US Trade Representative continued to press the Thai government for a
reduction in cigarette taxes, and the Ministry of Finance consistently
argued that a tax increase would force cigarette traders to raise their
prices, leading to more smuggling as the gap between legal imports and
contraband became wider. The NCCTU, chaired by the minister of public
health, had always advocated increasing excise taxes on tobacco products,
but most politicians were not very enthusiastic about the plan, fearing
that the idea might antagonise smokers,13 not to mention fellow
politicians in charge of the Ministry of Finance.

Despite strong objections from the deputy minister of finance in charge of
the TTM, new health minister Dr Arthit Urairat managed to convince the
cabinet to approve raising the excise tax from 55% to 60% in mid
1993. Subsequently, sales of TTM cigarettes declined by 2.8%, while sales
of imported cigarettes continued to grow by 7.24%. Yet while revenue from
the sales of cigarettes went down, the excise tax actually brought more
net income to the government. It has been estimated that increases in
excise tax may have caused up to 200 000 young smokers to quit.14 There
have been regular subsequent increases in cigarette excise taxes, most
recently on 12 October 1999 (when taxes were raised to 71.5%), and as
smoking has become less and less socially acceptable in Thailand,
increasing cigarette taxes has become an increasingly easy option in
political terms.

Cigarette smuggling remains a serious problem in Thailand; especially in
Chinatown and parts of central Bangkok, foreign cigarettes bearing neither
excise stamps nor health warnings are freely available. Large scale and
open illegal sales of this kind could suggest the collusion or
participation of law enforcement agencies. Nevertheless, despite
predictions from the tobacco lobby that increased taxes would lead to a
growth in smuggling, legitimate sales seem now to be substantially
outstripping sales of smuggled products, and there is evidence that both
the profitability and volume of cigarette smuggling has peaked. Reasons
for this include15: the continuing robust growth in sales of legitimate
duty paid foreign cigarettes; the impact of the economic crisis; the
transformation of retail outlets away from small family stores and towards
large chains; some improvement in law enforcement; and a decline in the
prevalence of smoking. The most important reason appears to be the first
oneTTCs have pursued a strategy of price cutting, bringing prices of their
legally sold products quite close to the price of TTM products.

	  Political economy of TTC activity in Thailand

Transportation costs and tax increases ought to hurt the TTCs very badly.
TTCs have acted by relocating their production to countries near Thailand,
thereby cutting down on the crucial cost insurance freight price of
cigarettes. Most foreign brands are produced in Malaysia. Malaysian
produced cigarettes enjoy preferential tariffs under the ASEAN free trade
agreement of only 22% compared with tariffs as high as 60% for those
imported from outside ASEAN (Association of South East Asian Nations).6
The prices of these imported cigaretteseven after all tariffs and taxes
are appliedbecome competitive with TTM's brands.  TTCs offer greater
profit margins to their sales agents than TTM, a factor which has
contributed to their steady increase in market share. Thanks to policies
of price cutting and use of retailer incentive programmes, TTC market
share reached 15.4% by the end of 1999, as earlier predicted by TTM.16

TTM's responses have included offering higher profit margins to its own
agents, and launching its own low cost brand of American blend cigarette.
The situation may become even worse if in the future producers of
international brands should decide to move manufacturing facilities from
Malaysia to cheaper cost countries like Indonesia or the Philippines. Then
the lower cost of production would allow the TTCs to reduce prices, and
the TTM would eventually lose its present competitiveness.

	  Advertising and marketing restrictions

TTC activity in Thailand has been greatly curtailed by the extensive
advertising and marketing restrictions, and TTCs continue to press for
"the real opening". Having failed to gain the right to advertise, foreign
cigarette companies have since tried instead to circumvent the law.
Various forms of "indirect" advertisements of foreign cigarettes
continue.17 Camel Trophy and Marlboro Classic goods, as well as bumper
stickers with foreign cigarette logos, are widely available. Though
illegal, point-of-sale advertising of foreign brands is widespread, and
despite some of the strictest tobacco control laws in the world, the
implementation is spotty. More often than not, it is the tobacco control
groups and the media that help keep the TTCs in check. A 1996 purchase
survey showed that 97% of 15 year olds who had tried to purchase
cigarettes had been successful. In 1997 it was reported that during the
past five years there was no record of anyone being fined for smoking in
prohibited areas. TTCs are also engaging in "nicophilanthropy" by
sponsoring arts, sport, and cultural activities wherever possible. In
1992, the TTCs offered technical and financial assistance to the Ministry
of Public Health for an anti-smoking campaign.18 TTCs have won significant
support from sports writers who favour tobacco sponsorship. In 1994 Philip
Morris even obtained an audience with the King of Thailand by donating a
substantial sum of money to one of his charitable foundations; the same
company has provided support for scientific research, including recruiting
a leading Thai doctor and former president of the Asian Association for
Occupational Health to work on research on indoor air pollution.19

The government often lacks a clear position on the whole tobacco issue.
This was graphically illustrated when Metha Ua-apinyakul, an MP from
Phrae, himself a prominent tobacco producer, was appointed to the
committee of the NCCTU in 1994.20

	  Future of TTM: privatisation?

The uncertain future of TTM as a state owned enterprise presents new
opportunities to the TTCs. When Thailand's economy crashed following the
calamitous currency devaluation of 2 July 1997, the country was forced to
ask the International Monetary Fund to bail it out. In order to obtain
much needed loans, the Thai government pledged to privatise state owned
enterprises, including TTM. Health groups, led by Dr Hatai,21 have
strongly opposed the idea, arguing that TTM privatisation would allow
foreign tobacco firms to market their products more aggressively, thus
resulting in an increase in smoking rates among women and the young, and
paving the way for TTCs to set up manufacturing bases in Thailand for
export to its neighbours. TTM executives, on the other hand, appear to be
very receptive to the idea of some form of joint venture, arguing that a
partnership would be necessary to make TTM more competitive. After all,
competition from foreign products will be even more intense after
2003 when ASEAN cuts import taxes to between 0-5%.

Until very recently the TTM State Enterprise Employees' Association joined
forces with health groups in opposing privatisation, fearing that it would
result in at least half of the association's members losing their jobs.
Lately, however, it appears that TTM executives have succeeded in
persuading leaders of the employees's association to agree with them.

Various TTCs have showed keen interest in securing licensing arrangements
with TTM to sell foreign brand name cigarettes, and in establishing
cigarette making joint ventures with TTM. For TTCs, a deal with TTM could
offer an ideal way to build sales, and a means to avoid import duties,
making their products even more attractive in the market. Nevertheless,
prospective buyers and joint venture partners who have explored deals with
TTM remain extremely wary, because of the monopoly's outdated equipment,
questionable management practices, well organised workers, and chronic
overstaffing. These factors combine to make TTM unattractive, certainly in
the short term. Whether TTCs will be able to establish successful joint
ventures with TTM, or whether an ad hoc anti-privatisation coalition led
by anti-tobacco groups will be able to block a viable deal, remains
unclear.

	  Lessons of the past

Prakit identified eight main practical "lessons" learned from the Thai
case.22 These included the importance of stressing to policy makers that
the objective of tax increases was preventing children from taking up
smoking. Another lesson was that gaining Ministry of Finance cooperation
in using taxation as a tobacco control measure relied on convincing
officials that revenues would thereby increase.

To Prakit's list might be added some more down-to-earth, political
observations based on the Thai case:

* nationalist, populist, and culturalist sentiments can sometimes be
usefully employed to counter the image building efforts of TTCs;

* unlikely allies may be useful in countering TTC activity, including
tobacco producers and other powerful vested interests;

* in order to ensure that anti-tobacco policies are adopted, it may be
desirable to allow bureaucrats and politicians to claim credit for new
initiatives;

* personal connections may be invaluable in helping secure desired policy
outcomes;

* aim to pass legislation wherever possiblegovernments come and go, but
repealing or revising already enacted legislation is time consuming and
costly.

A striking feature of the Thai case has been the success of anti-tobacco
campaigns led by doctors. In the Thai context, many prominent doctors are
able to present themselves as government officials, academics and/or NGO
activists, depending on the situation (it should be noted that doctors in
public hospitals and lecturers in state universities are civil servants in
Thailand). This flexibility of approacha reflection of the pluralism and
relative openness of Thai societyis often crucial for the purpose of
alliance building, since leading doctors are able to command respect and
support from a wide range of organisations and social groups. Tobacco
control advocates have often enjoyed a creative tension in their relations
with government, working in close partnership with the state, while also
publicly denouncing government actions at crucial junctures.23

	  Current positions of the main players

DOMESTIC TOBACCO PRODUCERS

Those involved in the production of tobacco and the manufacture of
cigarettes in Thailand are currently in some disarray. Whereas during the
early 1990s they formed a tacit alliance with the health lobby to oppose
foreign penetration of the Thai market, the producers are now somewhat
demoralised and their position lacks coherence. Some tobacco growers
continue to oppose privatisation of TTM, believing that any joint venture
between TTM and foreign companies will ultimately weaken the system of
high price tobacco quotas which provides them with significant income.
Meanwhile, it appears that members of the TTM board and even leaders of
the labour union have accommodated themselves to the possibility of
privatisation taking place at the state monopoly, arguing that TTM cannot
continue in its present form in a globalised economic order. While some
elements of the tobacco production lobby could still form tactical
alliances with the anti-tobacco movement, the scope for substantive
collaboration now seems limited. The emergence of an alliance between any
TTC and TTM would pose a serious challenge to the Thai anti-tobacco
coalition.

TRANSNATIONAL TOBACCO COMPANIES

The TTCs would like to portray themselves as good corporate citizens,
misunderstood and unfairly pilloried by the anti-tobacco lobby in
Thailand.  They claim that they are working according to the spirit as
well as the letter of the law, and face numerous difficultiesparticularly
the comprehensive advertising and marketing restrictions that are in
force. Indeed, it could well be argued that Thailand (or at least Bangkok)
has become an anti-smoking society, and a generally hostile environment
for TTCs. The economic crisis has triggered a rise in populist nationalist
sentiment, creating a difficult business environment for US tobacco
companies in particular.

At the same time, TTCs are able to use their considerable financial
resources to build up increased political leverage. There is anecdotal
evidence that TTCs or their distributors regularly shower government
officials with generous hospitality, including sponsored "study tours"
abroad. Internal TTC documents talk of the need for "alliance building" in
target markets such as Thailand.  Minnesota archive documents show that as
early as 1984, Philip Morris made an attempt to lobby then supreme
commander general Arthit Kamlang-ek. Most recently, the same company has
started a tobacco cultivation venture with the politically powerful
Wongwan family. Aware of the fact that the anti-tobacco movement has
formed strong ties with the media, TTCs are seeking to create their own
parallel networks of sympathetic reporters and columnists, partly by
sending them on junkets to overseas factories in the USA and Malaysia.
While TTCs have yet to make really big inroads into the Thai cigarette
market, they are taking a softly softly, long term approach, slowly
increasing market share and making friends in high and low places. They
are dedicated to eliminating all obstacles to their business activities.
The key to this goal is clearly a strategy of localisation: by becoming
"Thai" rather than foreign, TTCs can seek to work within the local system.
Localisation is a comprehensive strategy, which could include: placing
highly credible Thai nationals in key positions;  forming alliances with
influential and powerful Thais; sponsoring high profile events and
activities; sourcing more tobacco from within Thailand; and establishing
joint ventures with TTM. The more effectively they can localise, the more
effectively TTCs will be able to weaken and block the regulation and
control of tobacco. TTCs have already achieved a considerable degree of
success in gradually increasing market share, and clearly pose a very
substantial threat to the gains made in terms of tobacco control over the
past decade in Thailand.

GOVERNMENT

Factionalism and clientelism underlie the actions and behaviour both of
Thai bureaucrats and their political masters. The system of unruly
coalition administrations, in which competing parties control rival
ministries and vie openly for the spoils of office, makes for a messy
process of policy formation.  Identifying the government's policy stance
on a particular issue at any given moment is no easy matter. Tobacco
control cuts across the interests of various departments, including the
Ministry of Public Health, the Ministry of Finance, the Ministry of
Commerce, and the prime minister's office.

While bureaucrats often seem primarily concerned to defend turf,
politicians rarely spend more than a couple of years in any ministerial
post (often less), and so typically have a minimal grasp of complex policy
issues such as tobacco control. Ministers in Thailand are therefore
particularly susceptible to lobbying of all kinds, ranging from media
savvy health campaigns to straightforward financial inducements. The
tobacco control victories of the Chatichai, Anand, and Chuan governments
generally reflect a combination of sympathetic ministers (Chuan, Athasit,
Arthit), progressive, liberal and resourceful enclaves within officialdom
(Hatai, Prakit), external lobbying by "NGOs" actually run by civil
servants, strong media support, and providing useful opportunities for
political grandstanding. By seizing the moral high ground, the
anti-tobacco movement offered an excellent platform from which politicians
could score points at the expense of their rivals. Support for increased
tobacco taxes in the 1990s also reflected an accurate assessment by the
Ministry of Finance that higher taxes would increase government revenues.

Nevertheless, government support for anti-tobacco measures in Thailand is
not particularly robust. Even the present Thai government can scarcely be
said to have any clear policies on anything; in any case, Thailand in
2001 is on its ninth government since 1991. Government in the Thai context
is simply not a reliable or consistent factor, and there is no certainty
whatever that future administrations will continue to support tobacco
control measures.

ANTI-TOBACCO MOVEMENT

The anti-tobacco movement in Thailand is relatively small, yet highly
effective. One of the key figures behind the movement is Dr Prawase Wasi,
who enjoys extraordinary influence as a "senior citizen" with a hotline to
virtually every governmental and non-governmental sector in Thailand.
Other key figures are former deputy health minister and Mahidol University
rector Dr Athasit Vejjajiva, former deputy secretary general of the
Ministry of Public Health, Dr Hatai Chitanondh, and Mahidol medical
faculty dean Dr Prakit Vateesatokit. It is striking that all these key
figures are senior physicians whose main careers have been within
government service, but who have also established NGOs to lobby the
bureaucracy from without. Thus the anti-tobacco movement currently has
three main components, neatly straddling the govenmental/NGO divide: ASH
(Action on Smoking and Health Foundation), the Institute for the Promotion
of Thai Health, and two closely linked bodies operating under the umbrella
of the ministrythe Institute for Tobacco Consumption Control (ICCT), and
the NCCTU.

ASH is an NGO established in 1986 under the auspices of the Rural Doctors'
Association (but has been independent since 1996), and partly at the
instigation of Dr Prawase. Dr Prakit serves as executive secretary, while
Dr Athasit was until recently chairman. ASH has around 12 full time staff,
and an annual budget of roughly $100 000 a year, which derives from public
donations.24 The main strategy of ASH is networking through the media to
promote anti-smoking messages, and to campaign in support of tobacco
control measures.

The operations of the Institute for Promotion of Thai Health are much
smaller, and embrace other issues besides tobacco control: at the same
time, it seems fair to say that tobacco control is its principal policy
goal. Dr Hatai Chitanondh, who heads the NGO, works through his media and
bureaucratic connections to highlight critical issues, and is particularly
concerned to discredit initiatives by TTCs to counter or undermine tobacco
control measures.

The ICCT acts as secretariat to the NCTTU, and carries out various
functions in support of anti-tobacco legislation. However, in recent years
tobacco producers have gained entry on to the NCTTU, and the budget of the
ICCT has been cut, thereby limiting its effectiveness. The ITCC is now
only a small unit with a staff of seven, including the director herself.
In the eyes of some, the ITCC has since been completely "neutralised" by
questionable politicians and inept bureaucrats, and so can no longer
readily play the leading role it previously assumed.25

The anti-tobacco movement in Thailand emphasises networking and
collaboration with the media; these form key aspects of the work of the
NGO sector. The movement also receives support from international NGOs and
external actors such as WHO. Despite limited resources, the movement has
built up very considerable public sympathy and support through
exceptionally effective alliance building.  At the same time, the
anti-tobacco movement relies heavily on advertising and marketing
restrictions in order to ensure that it remains a dominant voice in the
Thai media. If these restrictions were successfully undermined by TTCs,
the anti-tobacco coalition would be dramatically weakened.

	  Future agenda: the proposed Health Promotion Act

At present much of the agenda for the future for anti-smoking advocates
still centres around familiar themes: intensifying the campaign on the
danger of smoking, enforcing both the 1992 Act on controlling tobacco
products and the 1992 Act on health protection for non-smokers.

Since 1999, considerable effort has been invested in ensuring that the
Health Promotion Fund Bill becomes law. This bill, which was approved by
the cabinet on 19 October 1999, proposes the creation of a new public fund
with the aim of discouraging the consumption of alcoholic beverages,
cigarettes, and tobacco products, and of promoting good health among the
people; it is to be managed by a public organisation under the prime
minister's office, and to be financed by an extra 2% of taxes collected
from producers and importers of alcoholic drinks and cigarettes. It has
been estimated that such a law will bring in 1400 million baht a
yearenough to focus more resources on the prevention of health problems,
rather than their cure.

But the Health Promotion Fund Bill is currently only a piece of draft
legislation, and will be strongly opposed by the TTCs and their allies,
who include leading cigarette importers and distributors, around 300 000
cigarette retailers nationally (80 000 in Bangkok alone), and the liquor
importers, distributors, and retailers. For their part, public health
groups seek alliances with the media, international health organisations
such as WHO, international health and anti-tobacco NGOs, and public
opinion in order to press for the passage of the bill. Little has been
heard about the measure since it was approved in principle.

The stance of TTM stakeholdersboth the executives and the workers as well
as local tobacco growersremains unclear. How these players will act may
depend on the situation at the moment for example, whether or not TTM has
already made a deal with the TTCs. Prospects for the passage of the bill
remain unclear, and various objections have been raised in cabinet. The
health minister has called for the fund to be supervised by Ministry of
Public Health. Others argue that the fund will be duplicating the
anti-drug campaign run by the Ministry of Education; it still remains
unclear how far key officials at the Ministry of Public Health will
welcome the birth of this new and independent body whose responsibilities
seemingly duplicate those of their ministry.

In a way, the status of the Health Promotion Fund Bill and the situation
facing these doctors and their allies today closely resembles that of the
smoking control legislation and its supporters back in 1992. It remains to
be seen if the anti-tobacco movement can cap earlier legislative
breakthroughs, which were described at the time as "something just short
of a miracle".

	  Acknowledgments

This study forms part of a WHO funded project entitled "Global analysis of
the political economy of tobacco control in lower and middle income
countries, phase II: case studies in Thailand and Zimbabwe", administered
by the London School of Hygiene and Tropical Medicine. The authors would
like to thank fellow team members for all their support: Jeff Collin,
Richard Dodgson, Kelley Lee, David Seddon, Patrick Vaughan, and Godfrey
Woelk. In particular, Jeff Collin spent many hours patiently editing the
report version of the study. We would like to thank all those people in
Thailand who helped provide information for this study, especially Dr
Hatai Chitanondh, Dr Prakit Vateesatokit, Dr Varabhorn Bhumisawasdi, and
Bung-orn Ritthipakdee. We are also very grateful for the research
assistance provided by Vikit Suksamran, Sunee Sarakkhot, and Narumon
Thirawat. We are pleased to acknowledge the support and funding that the
study received from the Tobacco Free Initiative of the World Health
Organisation, Geneva, and we warmly acknowledge the personal support given
by Derek Yach, Douglas Bettcher, and Roberta Walburn. However, the views
expressed here are the sole responsibility of the authors and do not
necessarily represent those of WHO.

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