27 Apr 2016
President Dr Tabaré Vázquez, an oncologist, is rightly credited for pushing Uruguay’s tobacco control agenda to the forefront globally, but 10 years ago inspiration was provided by a variety of sources inside and outside the country – with civil society leading – likely boosted by Uruguay’s tiny size, which made it easier to ‘spread the word’, and a surprisingly receptive public.
Today I am proud to have participated in this agenda-setting campaign, which has had a major impact on public health in my country. In the early 2000s, Uruguay had one of the highest rates of smoking in Latin America and the highest rate of male deaths caused by lung cancer. In the region, young Uruguayans faced among the highest rate of exposure to tobacco smoke indoors.
A 1996 decree banned smoking in government offices and all enclosed premises, but it included designated smoking areas, which we now know are ineffective. No matter – the regulation was not enforced nor monitored.
Encouraged by ongoing negotiations on the WHO Framework Convention on Tobacco Control (FCTC) and by a SF regional initiative of the Pan-American Health Organization (PAHO) in 2001, some Uruguayans began imagining a smoke-free country.
In March 2003, PAHO held a capacity-building workshop in Jamaica. Three Uruguayans attended as observers: Dr Diego Estol (Director General of the Ministry of Health [MoH]), myself (representing the National Medical Association) and Dr Adriana Blanco (from the Municipality of Montevideo). There, the idea of Uruguay becoming Latin America’s first smoke-free country was born.
In December 2003, PAHO held a SF workshop in Uruguay. There, representatives of the MOH and civil society organizations – united in the National Tobacco Control Alliance (ANCT) – agreed on a project aimed to make government, health and educational facilities 100-percent SF in two years.
In January 2004, a MoH decree banned smoking in education and health facilities, but there was only moderate enforcement and compliance. Also in 2004, a national SF network (RULTA) was launched.
On 24 August 2004, a new non-smokers’ association (FPU) organized the first 100-percent SF dinner-dance, which attracted over 400 people. A few weeks later, the Uruguayan Society of Cardiology (SUC) held its first congress, also with a SF dinner-dance. These events were “pilot projects” to prove that smokers would respect a ban.
In September 2004, Uruguay ratified the FCTC, and later that year the MOH created a tobacco control advisory commission (that included civil society).
On 1 March 2005, Dr Vázquez took office as President. Later that month, the advisory commission advised the Minister of Health on measures for implementing the FCTC.
Shopping malls go SF
Things began to move quickly. On 31 May the President issued various decrees, including one regulating smoking in indoor places. In July, two shopping malls surveyed their customers: only 3.6 percent of them said they would stop visiting if the malls completely banned smoking. They chose to go 100-percent SF. That same month, MOH banned smoking in all government facilities.
On 5 September, President Vázquez issued a new decree, establishing a complete smoking ban from 1 March 2006.
Media campaigns played an important role. In 2004, the National Resource Fund (FNR), a wealthy and well known public institution, got involved in SF, launching a media campaign to increase public awareness of the risks of smoking and second-hand smoke.
Thanks a million
In late 2005, supported by PAHO, the civil society alliance, ANCT, conducted another campaign to increase awareness about the health risks of second-hand smoke. And in February 2006, President Vázquez launched Thanks a million – a campaign aimed at involving smokers themselves in the movement and at preparing the ground for the coming complete ban.
Thanks a million attracted 1.3 million participants, who thanked smokers for not lighting up indoors. In November 2006, an opinion poll showed that 94 percent of Uruguayans supported SF workplaces.
Ten years later, what has been the impact of Uruguay’s SF campaign?
Two international studies compared indoor air contamination levels, and nicotine levels, before and after the smoking ban. They found a roughly 90-percent reduction in both.
A 2010 national study revealed a 22-percent drop in admissions to hospitals for heart attacks after the ban came into force.
Following Uruguay´s lead, in less than 10 years 12 other Latin America countries have become SF.
What’s next for SF Uruguay?
Despite this impressive record, Uruguay should not relax but continue building on these achievements. For example in 2010, 81 percent of smokers who had a family car reported that smoking was “never allowed” when children were in the vehicle; that number grew to 84 percent in 2012. Also in 2012, 88 percent of smokers said they would support a law banning smoking in vehicles carrying children.
Uruguay should also consolidate and deepen its SF policy by:
- Conducting periodic awareness media campaigns;
- Improving enforcement of SF workplaces;
- Banning smoking in areas next to access doors to educational , health facilities and restaurants.
* FCA Director, Americas region and President, Tobacco Epidemic Research Centre of Uruguay (CIET)
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