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Smoking in Russia: What Do Stalin and Western Tobacco Companies Have in Common?

1995; Elsevier BV; Volume: 70; Issue: 10 Linguagem: Inglês

10.4065/70.10.1007

1942-5546

R. Douglas Hurt,

Global Public Health Policies and Epidemiology

In January 1994, while participating in a week-long humanitarian aid mission to St. Petersburg, Russia, I was discouraged to see the presence of Western tobacco companies on almost every street. This situation is at a time when Russia is struggling economically and politically, and unmet needs for basic services are obvious everywhere. Because few cars are available and most of the people rely on public transportation, bus stops are prime advertising spots, most of which display Western tobacco company advertisements (Fig. 1). Billboards are in many places throughout the city, but the kiosks are the most prevalent (Fig. 2); they seem to be on almost every street and at the entrance of every subway station. The most prominent product being sold in the kiosks is cigarettes, and Western tobacco company brands predominate. Western tobacco companies are taking advantage of the unstable political and economic situation in Russia to promote their products, despite the efforts by the Russian government to prohibit mass media tobacco advertising. Instead of a decrease in the mass media promotional efforts, an increase has actually occurred in such cities as Moscow, despite the law passed by the Supreme Soviet of the Russian Federation in 1993 that prohibits such advertising.1Kholmogorova GT Prokhorov AV West goes east: the new tobacco situation in Russia.Tobacco Control. 1994; 3: 145-147Crossref Google Scholar In addition, neither the advertisements nor the Western cigarette packages have health warnings. The cigarettes exported from the United States have messages such as "U. S. tax exempt, for use outside U. S." or "Tax exempt, for export use." In addition to observing firsthand the invasion of Western tobacco products into Russia, I also learned about Russian history and, in particular, about the effects that the reign of Joseph Stalin had on Russia. Unfortunately, the effects that Western tobacco companies will have on the Russian people are similar.Fig. 2Tobacco kiosk in St. Petersburg.View Large Image Figure ViewerDownload (PPT) Propaganda Versus Marketing.—Stalin was a ruthless dictator who caused the death of millions of Russians.2Kort M The Soviet Colossus: A History of the USSR. Scribner, New York1985Google Scholar, 3Lewis J Whitehead P Stalin: A Time for Judgement. Pantheon Books, New York1990Google Scholar, 4Hingley R A Concise History. Thames & Hudson, New York: Russia1991Google Scholar Although his reign of power lasted for more than 25 years, it had a finite duration and was confined to the 20th century. The death and disability that will be caused by the use of Western tobacco products in Russia are just beginning and will continue for many decades. Stalin may have intentionally ordered many of his victims to be killed, but most died as a result of his policies, which were intended to accomplish strategic and political goals.5Solzhenitsyn AI An Experiment in Literary Investigation. Harper & Row, The Gulag Archipelago, New York1974: IIIGoogle Scholar For Western tobacco companies, death is simply the most pronounced by-product of the use of their tobacco products. The potential suffering and death that will be inflicted on the Russian people who smoke Western cigarettes goes well beyond that perpetrated by Stalin. From 1965 to 1989, the number of cigarettes imported into Russia doubled to more than 73 billion per year. Russia is now the largest importer of tobacco products in the world.6European Bureau for Action on Smoking Prevention. Test the East: The Tobacco Industry and Eastern Europe; The BASP Report. Publiset and Associates, 1991 Feb: 1-16Google Scholar As they expand their market share among current smokers and establish new markets among youth and females, Western tobacco companies will most likely further increase the number of cigarettes exported to Russia while they build factories to increase the number of cigarettes that they will produce in Russia. Although Stalin had a sophisticated propaganda machine for its time, the tobacco industry is using the most advanced technology available to produce a 21st-century propaganda effort. Stalin's methods were perceived as cold and calculating, but those of the tobacco industry are smooth and subtle. The marketing plans are prospective, with the result of pervasively infiltrating all facets of Russian life.1Kholmogorova GT Prokhorov AV West goes east: the new tobacco situation in Russia.Tobacco Control. 1994; 3: 145-147Crossref Google Scholar Although Western tobacco companies are not dictators in the governmental sense, they will likely influence the destiny of millions of Russians. The latest marketing and advertising technology is being used to cause Russians to become addicted to nicotine and to continue the spread of America's 20th-century plague. Invasion of Western Tobacco Companies Into Russia.—Ironically, during the 1980s and early 1990s, the US government was instrumental in opening the Asian markets for American tobacco companies, despite pleas from health officials within the administrations.7Mackay J Battlefield for the tobacco war.JAMA. 1989; 261: 28-29Crossref PubMed Google Scholar One such official said, "Cigarettes become a health problem only when you combine addiction with greed—greed on the part of the tobacco industry and the advertising industry, who are willing to exchange dollars for the lives of others."8Sesser S Opium war redux.The New Yorker. 1993 Sep 13; 69: 78-89Google Scholar Such policies are from the United States, a country that prides itself on its worldwide humanitarian and health-related projects. Unfortunately, the number of lives that will be lost as the smoking epidemic spreads "totally outweighs and overwhelms what we have accomplished in the humanitarian field."8Sesser S Opium war redux.The New Yorker. 1993 Sep 13; 69: 78-89Google Scholar The major difference in the opening of the Russian market in comparison with the Asian situation is that effective resistance from the Russian government has been minimal. Thus, the tobacco companies have not needed the assistance of the US government. The invasion of the Russian market by traditional American brands of cigarettes, such as Marlboro, L & M, Camels, More, and Lucky Strike (among many others), has been enhanced by new brands that glamorize the Western way of life. These brands include Hollywood, advertised with the slogan "Go for It," and West, advertised by the slogan "Test the West." Even the joint ventures between the American and Russian space programs are depicted in the brand Apollo Soyuz (Fig. 3), a partnership between Philip Morris and the Moscow Yava Tobacco Factory. As in Asia, the sophisticated Western marketing techniques depict Western models and lifestyles that create glamorous standards to emulate.8Sesser S Opium war redux.The New Yorker. 1993 Sep 13; 69: 78-89Google Scholar The smoking rate among Russian women (as among Asian women) is extremely low in comparison with that in men.9Zaridze DG Dvoirin VV Kobljakov VA Pisklov VR Smoking patterns in the USSR.in: Zaridze D Peto R Tobacco: A Major International Health Hazard. International Agency for Research on Cancer, Lyon (France)1986: 75Google Scholar, 10Tchachenko GB Riazantsev VK Description of the Situation in the Russian Federation. WHO Regional Office for Europe, Copenhagen1993 NovGoogle Scholar This discrepancy presents a new market opportunity that is more easily exploited than is convincing existing smokers to change brands. The entrance of Western tobacco companies into Russia has dramatically changed the dynamics of cigarette marketing and will likely change the demographics of the smoking population, especially among youth and females. This situation occurs at a time when the Russian people need enormous amounts of assistance to bring order and a better quality to their daily life, not more sophisticated tools to increase the smoking rate among the citizens. The invasion of Western tobacco companies and their advertising partners is unfolding throughout eastern Europe and the former Soviet Union. This expansion prompted the World Health Organization to develop a Tobacco-Free Europe Action Plan,11Tobacco-Free Europe Action Plan. WHO Regional Office for Europe, Copenhagen1993Google Scholar and the hope is that, with active intervention, the tide can be tempered. Because of the enormous financial stake, however, the Western tobacco companies have been extremely aggressive in the promotion of their products.1Kholmogorova GT Prokhorov AV West goes east: the new tobacco situation in Russia.Tobacco Control. 1994; 3: 145-147Crossref Google Scholar This approach was best exemplified during the Russian economic crisis of 1990 when cigarette production from Russian tobacco factories plummeted. In order to miss no opportunity to penetrate the market, R. J. Reynolds (RJR), Philip Morris, and the British American Tobacco Company made "emergency" shipments of an estimated 38 billion cigarettes to Russia.12Prokhorov AV Smoking in Russia. WHO Regional Office for Europe, Copenhagen1993 JulGoogle Scholar Prevalence of Smoking in Russia.—For the adult population of the Russian Federation, the prevalence of smoking has increased from 53% in 1985 to 67% in 1992.10Tchachenko GB Riazantsev VK Description of the Situation in the Russian Federation. WHO Regional Office for Europe, Copenhagen1993 NovGoogle Scholar Overall, the prevalence among Russian females is much lower than among Russian males; however, the smoking rate among the Russian population varies from region to region. In industrial areas, the smoking rate in 1986 was 78.6% for men and 13.7% for women; in Moscow, 49% of men were smokers in comparison with 9.2% of women, and in Siberia in 1992, the smoking rate was 69.4% for men and 7.9% for women.12Prokhorov AV Smoking in Russia. WHO Regional Office for Europe, Copenhagen1993 JulGoogle Scholar Among women, an unusually high prevalence of smoking (24.9%) was reported from St. Petersburg in 1991. Of concern for the Russian National Research Center for Preventive Medicine is the upward trend from 1986 to 1991 of smoking among adolescents; daily smoking among males 11 to 16 years of age has increased from 12.4 to 21.6% and among females, from 2.7 to 6.6%.12Prokhorov AV Smoking in Russia. WHO Regional Office for Europe, Copenhagen1993 JulGoogle Scholar Most recently, a study showed that in Moscow 42% of boys and 24% of girls 15 to 17 years old were smokers in 1993.10Tchachenko GB Riazantsev VK Description of the Situation in the Russian Federation. WHO Regional Office for Europe, Copenhagen1993 NovGoogle Scholar Tobacco-Related Diseases.—Since the disintegration of the Soviet Union, determining the extent of tobacco-related diseases in Russia has been difficult. Statistics through the early 1980s, however, indicate a substantial increase in the incidence of lung cancer and other tobacco-related cancers, especially among male Russians.13Zaridze DG Gurevicius R Lung cancer in the USSR: patterns and trends.in: Zaridze D Peto R Tobacco: A Major International Health Hazard. International Agency for Research on Cancer, Lyon (France)1986: 87-101Google Scholar The number of newly diagnosed lung cancer cases increased from 40,200 (31,400 in men and 8,800 in women) in 1965 to 91,700 (75,000 in men and 16,700 in women) in 1984 and is expected to exceed 100,000 by the end of the century. For most developed countries, large nationally representative studies of smoking and mortality are not yet available to provide tobacco-attributable proportions for main causes of deaths. Therefore, these proportions are estimated indirectly on the basis of a large recent study by the American Cancer Society of smoking and mortality among more than 1 million US adults.14Garfinkel L Selection, follow-up, and analysis in the American Cancer Society prospective studies.Natl Cancer Inst Monogr. 1985; 67: 49-52PubMed Google Scholar Its results, combined with US smoking patterns, have been used by the US surgeon general to estimate that tobacco was responsible for about one-fifth of all deaths in the United States in 1985.15Centers for Disease Control Reducing the Health Consequences of Smoking: 25 Years of Progress; A Report of the Surgeon General. US Government Printing Office, Washington (DC)1989Google Scholar This method and the absolute lung cancer rate of a particular population have been used to provide a conservative estimate of tobacco-related mortality in other countries.16Peto R Lopez AD Boreham J Thun M Heath Jr, C Mortality from tobacco in developed countries: indirect estimation from national vital statistics.Lancet. 1992; 339: 1268-1278Abstract PubMed Scopus (1094) Google Scholar In 1995, an estimated 45% of the deaths of middle-aged Russian men will be tobacco related, whereas the rate for Russian women will be 7%, a difference that reflects the lower smoking rates among women.16Peto R Lopez AD Boreham J Thun M Heath Jr, C Mortality from tobacco in developed countries: indirect estimation from national vital statistics.Lancet. 1992; 339: 1268-1278Abstract PubMed Scopus (1094) Google Scholar On the basis of current rates, approximately 5 million tobacco-related deaths will occur in Russia from 1990 to 1999, a number that is likely to grow because the annual smoking rates are projected to increase. With the current smoking patterns, 20% of the current 150 million Russians will eventually die of tobacco-related diseases.16Peto R Lopez AD Boreham J Thun M Heath Jr, C Mortality from tobacco in developed countries: indirect estimation from national vital statistics.Lancet. 1992; 339: 1268-1278Abstract PubMed Scopus (1094) Google Scholar If Russia is to emerge from the scourges of the 20th century, when millions of people died as a result of civil war, revolution, Stalin's policies, and World War II, it can ill afford the burden of an increase in tobacco-related diseases. In fact, every effort should be made to reverse this trend. The Belomorkanal.—Another interesting connection exists between the devastating consequences of the Stalin regime and the breakthrough of Western tobacco companies into the Russian tobacco market. As part of the First FiveYear Plan, Stalin ordered the building of a series of canals to connect the Baltic and White Seas to enable the Russian Navy to reach the White Sea and not be trapped if outlets from the Baltic Sea were closed by hostile forces17Dallin DJ Nikolaevskii BI Forced Labor in Soviet Russia. Yale University Press, New Haven (CT)1948Google Scholar. The overall project was known as the Belomorkanal. The project was undertaken with great vigor by the State Political Administration (OGPU), which was the secret police arm of Stalin's government and a predecessor of what would later be called the KGB.18Riasanovsky NV A History of Russia. 5th ed. Oxford University Press, New York1993Google Scholar In addition to domestic espionage, the OGPU was responsible for overseeing the large network of forced labor camps in the Soviet Union.17Dallin DJ Nikolaevskii BI Forced Labor in Soviet Russia. Yale University Press, New Haven (CT)1948Google Scholar The forced labor camp system was used to punish and control those who opposed Stalin's policies, as well as to incarcerate ordinary criminals. The system also provided a huge and relatively inexpensive workforce that could be used to complete major projects at little cost to the government. The administration of the camps was ruthless, and it is estimated that millions of Russians died in the camps because of disease, starvation, and brutal physical punishment. Construction of the canal was begun in 1931 and was completed less than 2 years later. No heavy equipment was provided for the workers because of the lack of hard currency. Thus, the canal was built with picks, shovels, and human muscle (Fig. 4). Researchers have estimated that, at any time, more than 300,000 men and women worked on the canal and that between 100,000 and 250,000 workers died building the canal.2Kort M The Soviet Colossus: A History of the USSR. Scribner, New York1985Google Scholar, 17Dallin DJ Nikolaevskii BI Forced Labor in Soviet Russia. Yale University Press, New Haven (CT)1948Google Scholar Stalin and his subordinates were concerned that the enormous toll in human life sacrificed to build the canal might seriously detract from what they perceived to be the importance of this work. Therefore, they undertook a propaganda campaign to promote the Belomorkanal as a "great social triumph." The Russian literary giant Maksim Gorky was chosen to help publicize the social attributes of this work. He and 120 other writers, artists, and musicians were taken on a carefully orchestrated tour of the Belomorkanal, during which time the human suffering and deplorable conditions were concealed by the OGPU. The actual picture of the working and living conditions was hidden, much as Prince Potemkin hid the true plight of the peasants' lives by erecting fake villages along the route during the visit of Catherine the Great to the Ukraine and Crimea in 1787.20Smith H The Russians. Ballantine Books, New York1977Google Scholar The concept of "Potemkin villages" was used by the czars and is still used in modern Russia, although now it is termed "pokazukha" (that is, "for show"). Gorky, along with 34 other authors, wrote a beautifully illustrated book with many photographs (Fig. 4) that presented the grim enterprise as a triumph for progressive penology.19Gorky M Auerbach L Firin SG Baltiisko-Belomorski Kanal imeni Stalina. The State Publishing House, 1934Google Scholar, 21Gorky M Auerbach L Firin SG Belomor: An Account of the Construction of the New Canal Between the White Sea and the Baltic Sea. Harrison Smith & Robert Haas Inc., New York1935Google Scholar In essence, they created a Potemkin village behind which the horrors of the Belomorkanal were hidden. In their book, the authors heaped praise on Stalin and the OGPU administrator Genrikh Yagoda. Within a few years, the book was withdrawn from the public because many of the leaders glorified in the text and pictures were declared enemies of the state.5Solzhenitsyn AI An Experiment in Literary Investigation. Harper & Row, The Gulag Archipelago, New York1974: IIIGoogle Scholar The Belomorkanal Cigarette.—Shortly after the canal was completed, a new Russian cigarette, Belomorkanal, was introduced and became one of the most popular brands in Russia. Belomorkanals are a traditional Russian papirossi cigarette constructed with about 3 to 4 cm of tobacco and a long paper cylinder holder. Papirossi cigarettes have no filter and have a high tar content. Before World War II, papirossi cigarettes were practically all that was available to Russian smokers. Since the mid-1970s, traditional Westerntype cigarettes have been consumed at a higher rate than papirossi cigarettes, and this trend is increasing in the 1990s.9Zaridze DG Dvoirin VV Kobljakov VA Pisklov VR Smoking patterns in the USSR.in: Zaridze D Peto R Tobacco: A Major International Health Hazard. International Agency for Research on Cancer, Lyon (France)1986: 75Google Scholar During the difficult economic times of the 1990s, however, Belomorkanal and other papirossi cigarettes are affordable for most Russians. In July 1992, the American tobacco company R. J. Reynolds bought controlling interest in the Uritsky Tobacco Factory in St. Petersburg and formed the RJR-Petro Tobacco Factory. Other Western tobacco companies have also recently invested heavily in St. Petersburg tobacco factories Rothmans, $80 million, and Philip Morris, $100 million. The RJR venture has special importance, however, because the Uritsky Tobacco Factory produced the Belomorkanal cigarette brand. The cigarette that evokes images of the hundreds of thousands of Russians who died carrying out Stalin's edicts now proudly has the insignia RJR stamped on the back of each package (Fig. 5). This legacy of Stalin will be brought into the 21st century by the American tobacco company RJR. Thus, for the Russian people, the Potemkin village of the 1990s will be the Madison Avenue venue advertising technology that shows smokers as healthy, beautiful, and youthful, a facade behind which is hidden the death and disability caused by the product being advertised and promoted. The Connection.—What do then, do Stalin and Western tobacco companies have in common? Both have central roles in the death and suffering of countless numbers of Russians—Stalin in the past, Western tobacco companies in the future. I appreciate the assistance of Dr. Tapani Piha, World Health Organization Regional Office for Europe, Copenhagen, Denmark; Sergei Albert, St. Petersburg, Russia; Dr. John Slade, University of New Jersey, Robert Wood Johnson School of Medicine and Dentistry; Dr. R. Jeffrey Goldsmith, University of Cincinnati; Dr. Thomas P. Houston, American Medical Association; and Dr. Alexander V. Prokhorov, University of Rhode Island.