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Heather Wipfli: Global War on Tobacco

Reviewed by Prof. Dr. Uwe Helmert, 2015-10-01

Cover Heather Wipfli: Global War on Tobacco ISBN 978-1-4214-1683-0

Heather Wipfli: Global War on Tobacco. The Johns Hopkins University Press (Baltimore, Maryland 21218-4363) 2015. 240 pages. ISBN 978-1-4214-1683-0. 32,65 EUR.

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The Tobacco Industry has capitalized on numerous elements of globalization – including trade liberalization, foreign direct investment, and global communication – to expand into countries without effective tobacco control programs. As a consequence, tobacco is currently the leading cause of preventable death in the world. Amid evidence of an emerging pandemic, a committed group of public health professionals and institutions sought in the mid-1990s to challenge the tobacco industry´s expansion by negotiating a binding international law under the auspices of the World Health Organization. The WHO Framework Convention on Tobacco Control (FCTC) – the first collective global response to the causation of avoidable chronic disease – was one of the most quickly ratified treaties in United Nations history. In this book Heather Wipfli tells the story of the FCTC, from its start as an unlikely civil society proposal to its enactment in 178 countries as af June 2014.


Dr. Heather Wipfli is a political scientist and the associate director of the University of Southern California Institute for Global Health.


  1. A World Connected by Cigarettes and Disease
  2. One Hundred Years in the Making
  3. Those Who Want and Those Who Do Not Want:The FCTC Negotiations
  4. With Force: The First Decade of FCTC Implemention
  5. The FCTC in Thailand: In Search of Solidarity
  6. The FCTC in Uruguay: Igniting a Global Leader
  7. The FCTC in Germany: An Island of Resistance
  8. The FCTC in China: The „Responsible“ Resistor
  9. Conclusions

… and Selected Topics

Chapter 1

Our modern world is defined by connectivity. Instant transnational communication is central to modern globalization defined by deepening global integration, which occurs as capital goods, people, and ideas diffuse across national boundaries. Although communication and markets are global, regulation and norms are not. The global tobacco epidemic provides one of the illustrations of the challenges and oppurtunities that globalization presents to providing and protecting health within our fragmented international system. The successful transnational tobacco industry has used numerous elements of globalization, including trade liberalization, foreign direct inverstment, and global communications, to expand its markets to low- and middle-income countries where effective tobacco-control programs are not in place. As a consequence, global health has been substantially diminished. Tobacco related deaths, a complete manmade epidemic, have become the leading cause of preventable death in the world. In 2013 alone, tobacco killed nearly six million people. More than five million of those deaths resulted from direct tobacco use, whereas more than 600,000 were the result of non-smokers being exposed to secondhand smoke. Approximately 80% of all tobacco related deaths occur in low-and middle-income countries.

As the industry’s global ambitions became clear and the evidence of a growing pandemic emerged, a committed group of individuals and organizations sought to challenge the tobacco industry’s expansion and to control tobacco use. They used modern communication technologies and virtual networks to spread information, coordinate activities, and elicit responses from local, national and international authorities. The global response included the first ever negotiation of a binding international law under the auspieces of the World Health Organization (WHO) and the WHO Framework Convention on Tobacco Control (FCTC).This book tells the FCTC story as an unlikely civil society proposal in the mid-1990s to it entry into force in 178 countries as of June 2014. In doing so, the books seeks to advance our understanding of how non-state actors and international institutionalization can impact global governance of health. The FCTC is a double-sided story. On the one hand, the FCTC is a singular tale of an international effort to develop a new instrument in global health governance. On the other hand, the FCTC is made up of nearly 2000 individual stories about how new international legal norms were understood, negotiated, and translated into domestic legislation.

Chapter 5, 6 and 8

These chapters provide qualitative descriptions and analyses of how the FCTC intersected with political, economic, and legal forces influencing tobacco control in Thailand, Uruguay and China. The country case studies selected in this book represent three of the four major categories of countries that partcipated in the FCTC. Thailand represents the handful of middle-income countries that had strong tobacco laws going into the FCTC but looked to the treaty to help institutionalize its past tobacco control succes and gain solidarity in its efforts to keep the transnational tobacco companies at bay. Uruguay represents the larger number of low-income countries that had little domestic tobacco control prior to the launch of the FCTC and needed the FCTC as a foundation upon which to stand up to the forces that had successfully hindered tobacco control for decades. China represents countries that were home to large tobacco companies and that fought against a strong FCTC. The group of high-income countries that had already instituted comprehensive tobacco control programs domestically and that helped initiate the FTCT process (Canada, Australia, Norway) are left out, as their stories had been told elsewhere.

Chapter 7: Germany

In the early twentieth century, Germany led the world in tobacco-related science. In 1909, German scientists first coined the term „secondhand smoke“, and in 1929 Fritz Lickint published the first formal statistical evidence linking tobacco and lung cancer. German scientists continued to make substantial contributions to the tobacco and health evidence throughout the 1930s, thanks to a substantial investment in cancer research by the Weimarer Reepublic and the Nazi regime. During this time, the Nazi doctrine of „social hygiene“ was implemented for the sake of „racial health“. Specifically, the regime focused on cancer prevention and initiated national campaigns against the hazards of smoking. Smoking was presented as an „un-German habit“ and as hazardous to the German „social body“. The Nazi government also issued sanctions against smokers, prohibited smoking in hospitals and public offices, demarcated special compartments for nonsmokers in trains, and restricted certain forms of cigarette advertising. Despite these control effects, smoking during the war years was pervasive, nearly 80% of German males smoked. At the end of the war, the newly created West Germany was an easy target for a massive invasion by American tobacco companies. Against the backdrop of a country in ruins and a destroyed economy, imported cigarettes, notably Camel were used on the black market in lieu of the inflated offical currency. Germans widely considered smoking to be one of the basic human needs, and they idealized it as „the last tiny bid of dignified life“.

It was at this time that the modern German tobacco industry began to take shape.The Verband der Cigarettenindustrie (VdC), the German trade association of cigarette manufacturers, was founded in in 1948. Between 1954 and 2007, the VdC comprised German ans Austrian tobacco companies, among others Reemtsma, Brinkmann, Austria Tabak, Philipp Morris, RJ Reynolds, and British Tobacco. Much of what is known about the activities of the VdC and transnational tobacco companies in Germany over the past half cenury comes from the tobacco industry´s own confidential documents realeased to the public as a result of litigation in the United States. The documents detail decades of scientific manipulation and public deceit. In the 1960s, transnational, (primarily American) firms began actively supporting the VdC´s research in Germany. American companies were particularly interested in their ability to use the VDC structure to conduct research at an arm´s length, thereby protecting themselves from litigation. While the scientific community elsewhere in the world grew to reject tobacco industry funding and sought to mitigate its influence on science, many German scientists failed to do so.

It wasn’t until the 1990s that public health became a recognized speciality in German medicine. The first school of public health in the German speaking region of Europe opened at Bielefeld University in 1994. Reflecting back on his time as the first chair of the university’s Department of Public Health Medicine, Alexander Krämer noted that he and his colleagues „faced severe opposition from faculty, the university administration, and particularly reviewers of public health research grants when, pushing for tobacco prevention programs. These obstructions“, Krämer argued, signaled that as of the mid-1990s, doctors and public health professionals in Germany were not yet ready to recognize the need to fight smoking. The industry’s influence on German policymakers and the public was especially great because of the lack of other credible sources of tobacco information. One exeption was the Medical Action Group on Smoking or Health, which was founded 1971 by Ferdinand Schmidt, a medical scientist and director of the Research Center for Preventive Oncology in Mannheim. In 1974, the action group organized the first German Nonsmokers Conference. The tobacco industry responded to the group’s activities by framing the work of Schmidt as „peculiar“. The industry’s attacks continued into the 1990s and were successful at marginalizing Schmidt in the eyes of scientists and government health administrators.

Since the early 1970s, the European Union has attempted to exert control over tobacco in its member states. Early EU efforts focused on harmonizing tobacco taxes throughout the market. These efforts were met with a great deal of resistance from many member states, including Germany, which feared being deprived of a crucial source of income. However, in subsequent years, Germany has often stood alone in its refusal to accept EU promotion of tobacco control policies throughout the region. Throughout the negotiations for the FCTC, Germany was infamous for its oposition to a strong treaty. Along with the United States, China and Japan, Germany fought to weaken obligations contained in the convention and consistently acted to protect tobacco industry interests. The first case in which Germany aggressively tried to stop EU regulation of tobacco came in 1989, when tte EU passed a directive requiring that specific health warnings – such as „Cigarette smoking is hazardous to your health“ and „Smoking causes cancer“ - be included on all cigarette packages and advertisements. The tobacco industry challenged the EU directive in the German Federal Constitutional Court, arguing that the legally required warnings were violations of the tobacco companies constitutionally protected commercial speech, which emanated from freedom of speech under the Basic Law for the Federal Republic of Germany. During the period leading up to the court’s decision, politicians, legal scholars, and the tobacco industry critizised the EU directive for restating the opinion of cancer experts who based their judgment on „questionable statistical“ data provided primarily by the US Surgeon General. During the debate at the European Commission, the German minister of health pushed to modify the warnings by including the word „may“ in „Smoking causes cancer“. The commission rejected the intervention, emphatically stating that such a conditionally modification was scientifically incorrect. In 1997, the German Federal Constitutional Court finally confirmed the conditionality of the aforementioned warnings. However, based on the German case, national and EU ministers of public health did revise the warnings to clarify, that the ministers, not the companies, were the authors.

Germany’s resistance to the FCTC process began as early as 1996, when it voted against iniating work on the convention (World Health Assembly resolution #49.17). At the 1998 World Health Assembly , Germany described the roosed convention as „an unnecessary distraction from the work of the WHO an not likely to be very effective“. Germany included a representative from the Federal Ministry for Economics on its delegation, making it one of the few countries to send a non-health representative at this point in the process. As the negotiations went on, Germany developed more specific arguments against key elements of the treary, pariticularly in regard to the advertising restrictions, youth acces, and language prioritizing free trade before health. Germany also joined the United States and Japan in arguing unsuccsessfully for prioritizing trade over health in the language of the convention.

At the end of the FCTC negotiations in February 2004, Germany (along with the United States) opposed the treaty’s final text, arguing that the German constitution prevented it from introducing a comprehensive ban on tobacco advertising, promoting, and sponsorship. Until the very last minute of debate, other EU countries believed the only way to overcome German opposition to the treaty was to introduce reservations to the treaty. However, hours before the start of the WHO Assembly, a German official announced in Geneva that Berlin had decided not to challenge the agreement. The reasons for the German turnaround are unknown and cause for much speculation. On December 16, 2004, Germany ratified the FCTC, making it just short of being in the initial group of 40 ratifications required to make the treaty enter in force.

With few exceptions, most tobacco control measures in Germany remain largely voluntary in nature, adopted by the tobacco industry to prevent formal legislation. Their implementation is often weak and often nonexisting. Youth access to tobacco is one example of such measures. There are more than 800,000 cigarette vending machines in Germany – one for every 30 smokers. A study conducted in 2005 found that 61% of all cigarette vending machines were located in areas where there was little to no control of youth access. Despite the weakness of of the revised youth access laws, youth smoking decreased between 2001 and 2008. This decrease is likely a consequence of Germany´s multiple tobacco tax increase since 2000. Between 2002 and 2010, the average tobacco tax increased by 75%.

The scientific community in Germany continues to lack a code of ethics regarding tobacco industry funding disclaimers. It has grown increasingly difficult for German scientists to publish research studies that challenge the scientific status quo regarding active and passive smoking. In 2000, top medical journals in Germany published studies that showed no association between secondhand smoke and disease. However, outrage among some medical professionals expressed in letters to the editors appears to have convinced journal editors that such studies should no longer be accepted for publication.

Overall, Germany’s approach to the FCTC was largely consistent with its historically weak tobacco control policies and repeated opposition to EU tobacco control legislation. Its positions reflected widespread influence of the tobacco industry on German policymaking. Germany is still one of the few industrialized nations in which the tobacco industry remains a legitimate force in buisiness, government, science, and society at large. Consequently, Germany continue to have one of the highest smoking rates in Europe, was 38.9% of German men and 30.6% of German women smoking. Even more troubling, 20.6% of German women continue to smoke during pregnancy. As the global norm of tobacco control is further diffused throughout the international system and confirmed by states and societies, Germany will be under increasing pressure to conform, even in the absence of formal harmonization or diffusion efforts by the European Union or WHO.


This book clearly demonstrates that Germany´s Tobacco Prevention Policies are still very weak in comparison with other Western Eeuropean countries. The number of cigarette vending maschines (about one per 30 smokers) is still one of the highest worldwide. This reflects the traditionally widespread influence of the tobacco industry on German policy making. Thus, Germany continues to have on of the highest smoking rates in Western European countries. A positive trend is that youth smoking has decreased between 2001 and 2008 significantly. But public health experts argue in this context that the decrease is mainly due to the fact that tobacco tax increased in this time period by 75%.

Target Groups

Researcher, lectures and students of Public Health and acteurs in the field of health promotion and tobacco control.


The book „Global War on Tobacco“ by Heather Wipfli tells the story of the WHO Framework Convention on Tobacco Control (FCTC), the first collective global response to the causation of avoidable smoking-related diseases – from its start as an unlikely civil society proposal to its enactment in 178 countries in June 2014. It gives broad evidence that Germany´s anti-smoking policies are still one of the weakest in West European countries.

Review by
Prof. Dr. Uwe Helmert

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Uwe Helmert, 2015. Review of: Heather Wipfli: Global War on Tobacco. The Johns Hopkins University Press 2015. ISBN 978-1-4214-1683-0. In: socialnet Reviews, 2015-10-01. ISSN 2190-9245. Retrieved 2023-10-03 from

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