France: An Ambivalent War Against Smoking

The contradiction became subject to increasingly intent scrutiny after publication of a proposed law to limit tobacco use, presented by twenty-seven members of the National Assembly, which said, "The state is pursuing a shortsighted policy, and cannot reconcile the tax revenue from tobacco with the health and social cost."

France's cigarette manufacturer and distributor, called SEITA (for Societe d'Exploitation Industrielle des Tabacs et Allumettes), has the sole right to manufacture cigarettes within the country, and controls the distribution of almost all imported cigarettes. It belongs wholly to the government. SEITA generated 31 billion francs ($5.48 billion) in 1990 tax revenues--some 2.3 percent of the national budget--plus an operating profit of $66.7 million.

The annual cost to the country for health care related to smoking is estimated at $8.8 billion, plus some $2.6 billion in lost production, for a total social cost per year of $11.4 billion.

Each year some 61,000 French men and women--almost the equivalent of the entire population of Cannes--die of ailments related to smoking. An authority on smoking in France, Professor Jean Marsac, the head of the pneumology department at Paris's Cochin Hospital, calls cigarettes "the most deadly addiction epidemic of the twentieth century." Cigarette consumption doubled in France in the thirty-five years from 1950 to 1985, and although it has stopped increasing and has even declined slightly in recent years, heavy smokers are much more numerous today than they have been in the past: 23.5 percent of male smokers consumed more than a pack a day last year, as compared with 16 percent in 1977. Overall, 38 percent of people in France smoke, as compared with 29 percent in the United States, and smoke lies heavy almost everywhere in the land.

The nation's young people are hardest hit by the effects of smoking. They are the most suggestible, the most vulnerable to the seeming glamour of a once-forbidden adult habit. The earlier a person starts smoking, some specialists say, the more damaging the habit will be--and 10 percent of the smokers in France are under twelve. Sixty percent of all eighteen-year-olds are smokers.

Those French who smoke do so with avidity, and even light up between courses at meals, a practice once universally condemned. Watching students outside lycees or universities in France as they try to master the rituals of veteran smokers is amusing, although also depressing. Here one sees a latter-day Humphrey Bogart taking a deep pull on a Camel and throwing his head back dramatically to blow out the smoke; there a would-be John Wayne takes a hard-bitten draw on his Lucky Strike, eyes half-closed with menace. The moment they emerge from class, students light up their Gitanes, Philip Morrises, and Gauloises, and they carry their cigarettes before them woodenly as though they were fetishes.

Valerie Nicoly, twenty-eight, an assistant television director who studied at the demanding Institut d'Etudes Politiques de Paris, explains the lure of smoking: "It has to do with the American image from World War Two, with the U.S. soldiers in Europe and their parachuted supplies of cigarettes, with the Far West, heroes, cowboys, films, adventure. All this makes smoking seem glamorous." She adds that Andre Malraux and other French intellectuals were usually seen as smokers, and many students aspire to become intellectuals. Students also spend a lot of time in cafes, she notes, establishments traditionally hazy with a mantle of blue-gray Gauloise smoke; this reinforces the habit.

A more clinical view is taken by Guilhem Boutan, twenty-five, a graduate of the school of management at the University of Paris, Dauphine campus. "Stress leads people to smoke," he says, drawing deeply on a Marlboro, "and students are under a lot of stress. There is a lot of competition, a lot of pressure, in the French educational system." Boutan's view is confirmed by the weekly Nouvel Observateur, which conducted a study of smoking and concluded that "the major factor responsible for smoking seems to be 'le stress.'"

Of course, those who find relief from stress through cigarettes are feeling the effect of nicotine. Nicotine makes its way through the system quickly, reaching the brain in about seven seconds, and has what many smokers describe as a soothing effect. Nicotine, however, is also used as an insecticide, and a dose of as little as fifty milligrams will kill a human being within a few minutes.

Curiously enough, in view of its present reputation, tobacco was thought to be a panacea by those who introduced it in Europe. It came from the Americas, a precursor of other American imports, benign and malign, from democracy to jazz, fast food, the samba, and graffiti. Around 1560 Jean Nicot, France's ambassador to Portugal, sent some tobacco to Catherine de Medicis, the queen mother and regent of France, in hopes that the plant might help relieve her migraine headaches, and he won the debatable honor of having the psychoactive substance in tobacco named after him. Moliere extolled the wonders of tobacco fulsomely in Don Juan, saying, "There is nothing like tobacco.... Not only does it rejuvenate and purge the human brain, but it instructs souls with virtue...." James I of Scotland, more prescient, condemned it as "repugnant to the eye, detestable to the nose, dangerous for the brain, appalling for the lungs." In Russia, Czar Alexis Romanov ordered that smokers' noses be cut off.

The ambivalence of these views on tobacco is reflected in the French language, in which tabac can be used idiomatically to mean either a beating or a huge success. Whether tobacco was good or bad did not much matter to the French fiscal authorities, who in 1674, during the reign of Louis XIV, created a state monopoly controlling its sale. They sought to generate tax revenue, which the King knew all too well how to spend. The government's monopoly was briefly interrupted after the Revolution but was renewed under Napoleon, and has been preserved ever since.

Under today's regulations, cigarettes are sold only in designated stores, called debits de tabac, whose owners net six percent on every pack sold. The stores also sell stamps, candy, chewing gum, and other oddments, and many are operated in conjunction with newsstands or cafes. The rules help impose some limits on smoking among youths, because cigarettes are sold only over the counter, not from machines. Of course, underage smokers still find ways to obtain cigarettes.

France first moved to impose restrictions on smoking in the early 1970s, with limits on smoking in public places such as hospitals and schools. Then, in 1976, came the milestone "Loi Veil," which limited the advertising of tobacco products. The bill was named after Simone Veil, the Minister of Health at the time. Critics of France's efforts to curb smoking claim, however, that a Latin disinclination to enforce such laws has weakened their effect. Nonetheless, smoking has been prohibited on commuter trains and domestic French airline flights, and new rules protecting nonsmokers in workplaces and restaurants are due to come into effect this year.

Today France is suddenly conscious of both the effects of smoking and the effects of inhaling secondary smoke. Programs to help smokers stop abound; there are ad campaigns, seminars, smokeless days, nosmoking signs in cabs, and a variety of counseling services. A few employers offer salary bonuses to employees who don't smoke, but the practice is not widespread. An increasing amount of snarling occurs between smokers and nonsmokers.

The growing tension between the two camps burst into the open last year when SEITA launched a new brand of cigarettes under the name Chevignon, a maker of expensive jackets and other garb favored by the young moneyed set in Paris. Antismoking militants denounced the merchandising tactic as a lure to get young people to smoke, and demanded the withdrawal of the cigarettes from the market. The controversy actually shook the Cabinet. Ministers responsible for health vigorously disagreed with those responsible for the governance of SEITA as their duties put them on a collision course. Health won: the Chevignon brand was withdrawn after four months, and has not resurfaced.

Many people in France regard the new furor over smoking warily, having read horror stories about the antismoking hostilities in America, which are reported gleefully in French magazines and newspapers. The conflict in the United States is sometimes portrayed as a form of civil war. Journalists tell of fights, and write about smokers being made to feel like outlaws, or being ostracized in business.

Some look beyond the quarrels to what they fear may eventually be a loss of liberty, a prospect few French will entertain gladly. A Paris paper, Le Quotidien, whose editor is probably a smoker, reported somberly on new antismoking rules imposed in New York and observed that "this revolution puts the fundamental liberty of every citizen in danger."

Indeed, the record so far shows that the controversy surrounding smoking can provide delicious opportunities for argument among a people known for their contentiousness. Anecdotes abound. A bus driver near Marseille was set upon by a woman professor, furious because he had an extinguished cigarette in his mouth. He applied for six weeks' leave from work to recuperate. Tobacco dealers in Besancon, angry at a vigorous new municipal campaign to reduce smoking, put up posters everywhere that said DON'T SMOKE! DON'T DRINK! DON'T MAKE LOVE! DON'T DRIVE YOUR CAR! YOU COULD DIE FROM IT! When the management of a Hewlett-Packard branch in France sought to impose smoking restrictions for health reasons, staff members threatened to barricade the company restaurant and keep fat people out, on the grounds that more food would be bad for their health.

Some other responses have been exaggerated too, like those of the antitobacco leader Jean Tostain, who denounces tobacco profits as "nicodollars" and equates smokers with Nazis. Another militant, Bertrand Schmitt, confronts smokers in public places and hectors them priggishly. He even goes so far as to claim that smoking interferes with lovemaking. The moralizing of such activists, who are often reformed smokers themselves, is probably encouraging smokers to persist. Mort Rosenblum, an Associated Press correspondent who has covered France for years, calls them "health Fascists." To counter such tactics and unsettling allegations, efforts have begun to create a smokers' rights movement, but with unimpressive results.

The potential for violent disagreement over the use of tobacco helps explain why the tobacco lobby in 1987 began a major $530,000 advertising campaign emphasizing tolerance and courtesy between smokers and nonsmokers. The ads and posters showed engaging-looking people, presumably smokers, saying, "Let's ensure that life together remains a pleasure. Liberty works both ways."

This clever, low-key campaign generated a good deal of positive response, chiefly because it seemed nonpartisan but nevertheless upheld smokers' rights.

France has no bearded prophet like the redoubtable C. Everett Koop, the former U.S. Surgeon General, to lead an anti-smoking campaign and galvanize public opinion, but several vigorous private groups and forces in the government are striving to reduce the toll of smoking. Their aims, enunciated in reports and at public forums, include raising the price of cigarettes, reducing or eliminating cigarette advertising, putting bolder warnings on packages, creating more no-smoking areas, and lowering tar content.

They have made some discernible progress: cigarette prices were increased by five percent last September and will go up 10 percent more this year; advertising is being reduced by government order and will be eliminated by 1993; and SEITA is bringing the tar content of its cigarettes down to the 15-milligram level agreed on by the European Community for 1993. And a new, bolder legend now appears on the front of cigarette packages, announcing: NUIT GRAVEMENT A LA SANTE ("Seriously endangers health"). Other ominous messages are printed on the package backs, warning that smoking is harmful to others, is dangerous for unborn children, and causes cardiovascular diseases and cancer. The earlier, more modest warning said only ABUS DANGEREUX, and appeared in type approximately a sixteenth of an inch high.

But problems--of politics, price, and publicity--persist. "France is a somewhat peculiar country," says Dominique Lefebvre, an official in the Ministry of Culture and Communication. "You can't coerce people here." Speaking of the 1980s, he adds, "The political class did not show the political courage needed to make progress."

Raising cigarette prices, now the third lowest in Europe and half those in many other European countries, will reduce smoking, but it will also, from the politicians' point of view, adversely affect France's cost-of-living index. Surprisingly, 1.8 percent of that index is made up of tobacco products. When the index goes up, salaries and wages escalate along with it, increasing inflation and generating political problems. Anti-smoking forces demand a cost-of-living index that omits tobacco, so that cigarette prices can be raised without causing index escalation.

The publicity problems arise because advertising agencies have become critical to political campaigns and political fund-raising. Lefebvre says pointedly that the agencies "open whole boulevards of influence." The prohibition on advertising for cigarettes may also lead to curbs on ads for alcoholic drinks, and all this is highly hazardous to politicians' financial health.

Nevertheless, the government senses the changing climate and the desire for action. It is aware that 76 percent of French people believe that smoking shortens life. Accordingly, it plans to increase the pressure to reduce smoking. SEITA, which has already announced plans to reduce its work force by 245, is introducing cigarettes made with lighter tobacco and is expected to diversify, perhaps into food-related businesses. And a new cost-of-living index omitting tobacco may be adopted.

Such measures will be steps, but only steps, toward resolving the present-day policy contradiction in France, which is described by Albert Hirsch, a leading researcher on smoking damage, as "a major paradox, an incoherence." In fairness, the paradox is grounded in history. It was logical in the seventeenth century to impose taxes on tobacco. It was logical in the twentieth century to provide a national healthcare system. Some observers critical of the present arrangement recall the French Finance Minister of some years ago who was reminded that his treasury paid out three francs in health costs for every franc it took in from tobacco sales. He replied, "I get the one franc. It is my successor who will have to pay out the three francs."