Paula Johns

Paula Johns is systematically addressing the question of tobacco control in Brazil by framing it as a sustainable development and public health issue, as opposed to an issue of individual choice. Paula is buiding a citizen-led movement to make the government and the tobacco industry accountable for the systemic problems related to tobacco production and consumption, with a strong focus on defending the rights of Brazil’s most vulnerable populations.

Paula created the first citizen organization (CO) to effectively take on the issue of tobacco control in Brazil, a field that has traditionally been dominated by short-term government-led initiatives. She established the Alliance on Tobacco Control (ACT) in 2003 in order to push the Brazilian government to sign on to, and implement the international Framework Convention on Tobacco Control (FCTC). Through Paula’s work she has tranformed the field from one that is uniquely focused on individual health issues related to tobacco use to one that is intricately linked to broader sustainable development and public interest questions.

Paula focuses on four main strategies. To begin, she is influencing government policies regarding tobacco control. Additionally, she is broadening the focus of tobacco control activities to include considerations for human rights, gender, race, economic development, and environmental protection, among others. Paula is also building research and communication tools to counteract the power of the industry’s lobby with scientific data and to change perceptions around tobacco use among the general population. Finally, she is creating alliances with small producers to ensure that with decreased tobacco consumption they will continue to have a secure source of income while ensuring greater well-being.

Some of Paula’s most impactful work has been around mobilizing the citizen sector to influence public policies on the issue of tobacco control. For example, her ACT has led an effort to elaborate and implement the first state laws transforming enclosed public spaces into non-smoking spaces. ACT has also led policy debates that have resulted in the implementation of stricter advertizing regulations for the tobacco industry and has disseminated influential public opinion research about second-hand smoke. Her initiatives are already reaching a national level. However, she has her sights set on much bigger goals. That is why she is actively participating in regional tobacco networks throughout the Americas and has become a member of the Framework Convention Alliance through which she has helped create similar citizen sector alliances to her own in Mozambique, Ecuador, and Argentina.

According to the Brazilian Institute of Geography and Statistics (IBGE), about 24.6 million Brazilians aged 15 and up are smokers. This accounts for more than 17 percent of this age group, more than half of whom say they want to quit. As a result of this addiction and second-hand smoke, approximately 200,000 Brazilians die from tobacco-related diseases every year. Agricultural workers who produce tobacco are also a forgotten segment of the population. The consequences of manipulating large amounts of chemical on a daily basis and their poor working conditions are often debilitating for their health and general well-being. All in all, tobacco puts a heavy burden on public health systems but despite the size of the issue, the Brazilian government invests an average of US$8M per year on anti-smoking activities, in comparison, it spends US$400M yearly on combatting HIV/AIDS.

A step forward in addressing the effects of second hand smoke came when Brazil ratified the World Health Organization FCTC—the first international public health treaty of its kind. When Brazil signed on, it committed to adopting the recommended measures, including making smoking prohibited in enclosed public spaces and in the workplace. Although a few states have made advances, the federal legislation on second-hand smoke has yet to be implemented in the majority of the country. This is to say that there have been sporadic attempts by the Government of Brazil to control tobacco use. For years it was the only entity active on this issue. However, as the industry grew, the government quickly lost interest. As a result of the government’s previous leadership on tobacco related issues, the citizen sector has been far behind much of the world and slow to take up the cause. The power of the industry has made most citizen sector work in this field ineffective, until very recently.

Brazil is now the second largest exporter of tobacco in the world, after China. Looking out for its bottom line, large companies regularly oppose any regulation aiming to decrease tobacco consumption. The industry yields much of its power by financing political campaigns and lobbying the higher echelons of government thus pointing to a clear lack of transparency and accountability. This multi-billion dollar industry therefore has a considerable amount of influence on public policies and is currently challenging state laws regulating smoking in enclosed public spaces.

In addition, Brazil does not yet have effective public controls on tobacco advertizing. The marketing departments of tobacco companies operate like well-oiled machines in order to increase tobacco consumption. For example, though youth cannot legally be targeted by tobacco ads, large cigarette producers often sponsor hip university events and very little is done to stop them. By keeping the price of cigarettes extremely low consumption increases; and when prices go up, illegal trade rises with it. Youth, low-income populations, women, and black populations are among the most affected by the effects of cigarette use.

It is important to change Brazilian perceptions of smoking as an individual choice, and disregard the effects it has on the rest of society. Tobacco consumption is a sustainable development issue. It affects the environment, the livelihood and well-being of small farmers, human rights, issues of race and gender, as well as the health of individuals.

At the end of the 2003, Paula led an initiative—while she was still working at Redeh (Brazil’s National Network of Human Development)—that brought together citizen sector and governmental organizations from seven Brazilian states to create the ACT. She used the development of the international FCTC as a mobilizing force to begin a citizen-led movement in Brazil. Paula started by establishing a multi-disciplinary team of doctors, sociologists, psychologists, lawyers, and marketing professionals to systemically address issues related to tobacco production and consumption. She initially partnered with Health Bridge and the Canadian International Development Agency to get her organization off the ground. ACT is now an independent organization. It is currently headquartered in Sao Paulo, and has an office in Rio de Janeiro and representatives in Salvador, Brasilia, and Porto Alegre.

By increasing access to information on issues related to the tobacco industry and facilitating the creation of citizen-led networks, ACT is building avenues for civic participation in activities relating to tobacco regulations and their implementation. One of ACT’s primary functions is to monitor and advocate for the development and implementation of the FCTC; compare annual analyses on progress made with regards to anti-tobacco legislation; highlight the government’s commitment, or lack thereof, to the ratified treaty; and even monitor the tobacco industry’s interference with such processes. Members of ACT are able to strengthen their strategies, including lobbying, as a result of this new flow of information, but also thanks to the contacts and campaign materials developed by Paula’s organization. They are thus making both the government and the tobacco industry increasingly accountable and transparent, with the ultimate goal of shifting public opinion nationwide about the need for tobacco control.

ACT is also giving a voice to citizens and raising awareness among society-at-large about the inner workings of the tobacco industry as well as the effects of second-hand smoke. Paula’s organization is building popular support for stronger tobacco control regulations and creating the transparency and accountability mechanisms necessary to increase the political will to act on these issues. Many studies have been conducted in partnership with Instituto Datafolha, one of the most respected research institute in the country. The information obtained guides ACT’s strategies, both in terms of communication and legislation.

ACT dedicates a significant amount of its resources to educating the segments of the population that have been found to be most likely to take up smoking. In addition, ACT led a campaign with its pro bono partner Neogama—a communications business—entitled, “Any enclosed space is too small for smoke.” The campaign included the dissemination of information through pamphlets, billboards, radio, and television ads. ACT also reached out to a number of COs throughout Brazil with this information. In 2009, ACT and INCA received funding from the World Lung Foundation to create a similar national campaign.

As a result of this work, and using public opinion research as one of its main data points, ACT has successfully influenced the state of Sao Paulo to pass the country’s first law stipulating that people are to be prohbited from smoking in bars and restaurants. It is also working on getting a bill approved in the Senate to turn any enclosed space into non-smoking spaces. Following the passing of Sao Paulo’s anti-smoking law, ACT established a partnership with Johns Hopkins Bloomberg School of Public Health to quantify the amount of nicotine pollution in bars and restaurants in the city of Sao Paulo before and after the law passed. The study showed that nicotine levels detected in the air of bars and restaurants had dropped by 72 percent, on average; thus signalling general compliance with the law and an improved environment for clients and workers alike.

Chief among Paula’s goals is to address sustainable development issues related to tobacco production and consumption. She is particularly cogniscent of the affects of the tobacco industry on marginalized populations, such as low-income communities, women, and tobacco producers. Paula pays close attention to the issue of race relations as well. ACT, for example, established a partnership with organizations that work on gender relations in 2009 to better understand the relationship between tobacco consumption and gender, and disseminate those findings. These efforts led to the publication of four scientific articles on the topic and guides her organization’s strategies. With regard to tobacco producers, Paula has created strong alliances with their associations to understand their concerns with the new tobacco legislation, to document the effects of cultivating tobacco on their health, and to gradually develop alternatives to tobacco production.

Paula has established strategic alliances with some of the sector’s most important actors, both nationally and internatoinally. ACT is a member of the Framework Convention Alliance, composed of 350 organizations in more than 100 countries, whose mission is to promote the implementation of the treaty. Paula’s organization also participates in the State Committee for the Promotion of Smoke-Free Spaces, an organization that brings together 40 governmental institutions, COs and student-led groups. It has participated heavily in advocating for Sao Paulo’s Anti-Smoking Law in 2009.

The impact of Paula’s work is clearly becoming apparent. Brazil’s population is increasinly aware of the negative effects of smoking and second-hand smoke, and a number of laws are now going into effect to regulate smoking in public spaces throughout Brazil. In addition, ACT’s member organizations are now better equipped to work along with legislators and government officials on influencing and implementing public policy.

ACT is now getting ready to replicate the law passed in Sao Paulo in ther states and municipalities, putting a strong emphasis on the health of restaurant and bar employees. In the medium term, Paula will continue to work on policy change to increase the price and taxes imposed on cigarettes, as well as enforce stronger restrictions on advertizing by the tobacco industry in order to reduce consumption levels. She realizes however, that with rising prices, illegal trade will likely go up as well. This is an issue she has already begun to address with partner organizations in Uruguay, Paraguay, and Argentina. Paula is also determined to develop a strong strategy with tobacco producers to ensure they also benefit from the new tobacco legislation in which she advocates.

Paula was born in Sao Paulo and developed an interest early on in learning about different cultures. As a teenager, she travelled to Denmark and studied at a boarding school out of an interest to learn in an foreign environment. She was quite shy and her inability to speak Danish at first made her integration all the more difficult. As Paula felt the need to socialize with her peers, she took up the habit of smoking and remained a smoker for 18 years.

Upon her return to Brazil, she worked for five years in the Consulate of Denmark in Rio de Janeiro. A few years later she returned to Denmark to pursue undergraduate and masters degrees in the social sciences and international development. Her studies allowed her to do field research in Guiné-Bissau where she realized that she needed to contribute in one way or another to social change. Paula came to the conclusion that she would be much more “useful” if she worked in Brazil where social needs were higher and where she identified more deeply with the culture. She was always struck by the level of injustice and inequalities in Brazil despite growing up in a privileged environment.

After giving birth to her first daughter and finishing her degree, Paula returned to Brazil a second time to work with Redeh: The Network of Human Development. Through her work at Redeh, she began to examine the question of tobacco control for the first time as a result of a project she coordinated there between 2001 and 2003. The objective was to increase the amount of information on health issues related to tobacco consumption, organizing seminars for organizations throughout Brazil. By the end of the project, she realized that she had created a network of organizations who were now aware of and passionate about the issue of tobacco control. However, if she stopped leading this work, her efforts would have been in vain. Paula also understood that given the citizen sectors’ dismall contribution to this issue in the past, there was a real need to keep them involved and engaged.

From the beginning, Paula has followed the negotiations of the FCTC, at a time when the National Cancer Institute was particularly active on this issue in Brazil. However, it had never managed to include citizen-led efforts in developing its policy strategies. It was also quite vulnerable to political changes. This is how Paula decided to create the ACT and three years later, in 2006, she began to gain recognition in the sector for her leadership. She was invited as the keynote speaker at an event where Bill Gates and Michael Bloomberg announced joint investments in combatting the global pandemic caused by tobacco. Since then, Paula has actively participated in political decisions regarding tobacco in Brazil.