Ernesto Sebrié Roswell Park Institute ICO-WHO Symposium 2012

1. Diffusion of the “Spanish model”
in Latin America
Ernesto M Sebrié, MD MPH
Department of Health Behavior, Roswell Park Cancer Institute
Buffalo, New York
ICO- WHO Symposia on Tobacco Control
Barcelona (July 5, 2012)

2. OUTLINE
• Current situation on smokefree policies
in Latin America
• The so-called “Spanish model” and its
impact in Latin America.
• Final remarks

3. INTRODUCTION
• During the 1980s & 1990s Latin American (LA)
countries adopted either no laws or ineffective
laws to regulate smoking in enclosed places.
• In 2001, the Pan American Health Organization
(PAHO/ WHO) launched the Smokefree Americas
Initiative.
• In Feb. 2005, the adoption of the WHO
Framework Convention on Tobacco Control
changed the policy environment that led to
substantial progress in LA.

4. • As of July, 2012
100% smokefree national
Comprehensive national
100% smokefree sub-national
Smoking designated areas or no restrictions
Regulation pending

5. SMOKEFREE LATIN AMERICA
SMOKEFREE POLICIES
Indoor public places Indoor workplaces Public transportation Outdoor areas
Uruguay (2008) 100% smokefree 100% smokefree 100% smokefree Health care & educational
institutions
Panama (2008) 100% smokefree 100% smokefree 100% smokefree Sports facilities
Guatemala (2008) Except 20% hotel rooms 100% smokefree 100% smokefree NS
Colombia (2009) 100% smokefree 100% smokefree 100% smokefree NS
100% smokefree Except cigars manufactures 100% smokefree Within 2 meters of public
Honduras (2010)
places
Peru (2010) 100% smokefree 100% smokefree 100% smokefree Health care & educational
institutions
Venezuela (2011) 100% smokefree 100% smokefree 100% smokefree NS
Ecuador (2011) Except 10% hotel rooms 100% smokefree 100% smokefree Health care & educational
institutions (except
University)
Argentina (2011)* Except smoking clubs and Except private enclosed 100% smokefree Health care & educational
tobacco stores workplaces without employees institutions (except
and without services to the public University)
Brazil (2011)* 100% smokefree 100% smokefree 100% smokefree NS
Costa Rica (2012)* 100% smokefree 100% smokefree 100% smokefree NS
* Regulation pending, NS: Not specified
Sebrie EM et al Smokefree Policies in Latin America and the Caribbean: Making
Progress Int. J. Environ. Res. Public Health (2012)

6. Factors of Success

7. SMOKEFREE MODELS
• Uruguay • Chile
• Panama • Bolivia
• Colombia • Mexico
• Guatemala (national)
• Peru • El Salvador
• Venezuela • Nicaragua
• Honduras • Paraguay
• Ecuador (sub-national)
• Brazil (*)
• Argentina (*)
• Costa Rica (*)
• Argentina
• Mexico
(*) Regulation pending • Brazil

8. Tobacco Industry Interference
1. Lobbying the 4. Weakening of 7. Litigation
executive authorities the law
(“accommodation
2. Promoting a language”)
Presidential veto
5. Amendment of
3. Blocking or the law
delay of law
regulation 6. Preemption

9. Tobacco Industry Counter-model
• “Spanish Model” (2006)
• Mirror the Tobacco Industry’s “Courtesy of Choice”
Program:
• Accommodation
 Cortesía de Elegir
 Convivencia en Armonía
• PMI & BAT: 1990s
Sebrie & Glantz "Accommodating" smoke-free policies: tobacco industry’s
Courtesy of Choice programme in Latin America TC (2007)

10. Tobacco Industry Counter-model
These laws are characterized by the inclusion of one
or more of the following exceptions:
• Smoking designated areas: completed isolated or not
• Use of ventilation or air filtration systems
• Smoking venues exclusively for adults
• Owners’ authority to voluntary choose whether to become
smokefree or not
• Smoking clubs
• Tobacco stores for tobacco tasting

11. Comprehensive
Venezuela
smokefree Ecuador
Honduras Argentina
FCTC Peru Brazil
Panama
Uruguay Guatemala
Santa Fe Mexico City new Spanish law
Colombia Costa Rica
- 2004 2005 2006 2007 2008 2009 2010 2011 2012
No legislation
Voluntary
accommodation Spanish law Mexico Nicaragua
El Salvador
Chile
Peru Bolivia “Spanish
model”

12. URUGUAY (2006)
In 2006, shortly after Uruguay
became the first 100% smokefree
country in the region, the TI
conducted an advertising
campaign with the punchline
“Spain and the freedom to
choose“, implying that countries
under that model would be more
democratic and tolerant.
This campaign unsuccessfully
sought to overturn the adoption
of the smokefree policy.
Schneider, Sebrie & Fernandez The so-
called "Spanish model" - Tobacco
industry strategies and its impact in
Europe and Latin America BMC Public
Health (2011)

13. Newspaper El País, Montevideo (July 7, 2006)
Montepaz requests to respect the “freedom” of choice

14. SANTA FE, ARGENTINA (2006)
In July 2006, an
amendment to the Santa
Fe law was introduced to
reintroduce smoking
designated areas in bars,
restaurants, discos, mini
markets, convenience
stores, and hotels that
were “physically
separated from the rest
of the room, [with]
ventilation to the
exterior.”
Sebrie & Glantz Local
Smokefree Policy
Development in Santa Fe TC
(2009)

15. - Arguments used to support
this amendment included
claims of personal freedom,
generation of social conflicts,
and difficulty of implementing
the law due to “Argentinean
culture.”
- In the grounds of the bill, the
legislators cited the Spanish
and Chilean laws

16. A copy of the 2005
Spanish law was
attached at the end
of the bill to support
the amendments

17. GUATEMALA (2008)
PMI’s subsidiary submitted
comments to the
government of Guatemala
proposing amendments to
the smokefree bill to
provide for exceptions
included in Spain’s law in
order to “allow business
property owners to provide
smokers with comfortable
areas in which they can
smoke.”
Muggli, ME et al Legislating tolerance: Spain’s national public smoking law Tob Control (2009)

18. PMI’s proposed
exceptions following the
Spanish and Chilean
laws:
- Classification of restaurants,
bars, cafeterias, and similar
venues by size (big and
small) depending on the
service area (>or <100 m2)
- Discos and night clubs only
for adults and alcohol sale

20. CONCLUSIONS
• Significant progress in the implementation of
effective smokefree policies has been achieved
among LA countries since the adoption of the
WHO FCTC in 2005.
• As of July 2012, eleven LA countries (Argentina,
Brazil & Costa Rica regulations pending) have
adopted a comprehensive national smokefree
policy, accounting for ~ 70% of the total
population in LAC (573 million: WB, 2010).

21. CONCLUSIONS
• Both governments and civil society are
defending the laws with strong arguments
highlighting the rights to health, to life, to clean
environment, of the child, and human rights
guaranteed by their own constitutions and/or by
international treaties (e.g., International Covenant
on Economic, Social, and Cultural Rights;
Convention on the Rights of the Child; American
Convention on Human Rights) to which they are
parties.

22. CONCLUSIONS
• TI unsuccessfully used the “Spanish model” to block
the Uruguay (1st national) and Santa Fe (1st sub-
national) 100% smokefree laws in LA.
• Current challenges that the “New Spanish Model” is
facing (e.g., threats to amend the law using
accommodation language) might have a domino
negative effect in Latin America.
• There is a need of collaboration between Spain and
Latin America to protect the successful achievements
(adoption of 100% smokefree legislation) and to
effectively counter tobacco industry arguments and
strategies aimed to overturn these meaningful policies.

23. ACKNOWLEDGEMENTS
Program project grant
P01 CA138389
“Effectiveness of
Tobacco Control
Policies in High vs. Low
Income Countries”.

24. Ernesto Sebrie, M D M PH
ernesto.sebrie@ roswellpark.org
Roswell Park C ancer Institute