The evolving fight against tobacco

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The evolving fight against tobacco

• Clive Bates
• Director
• Action on Smoking and Health

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3 layers of understanding

• Smoking and disease
• Impact of passive smoking
• Addiction to nicotine

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Understanding of smoking

• 1. Smoking and disease

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Deaths attributable to smoking (1995)

• Main causes of death attributable to smoking (UK)

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Other conditions associated with smoking

• Angina risk 20 x risk
• Buergers disease
• Cataracts 2 x risk
• Crohns disease
• Depression
• Duodenal ulcers
• Chronic rhinitis
• Fertility 30 lower
• Graves disease
• Hearing loss
• Immune system impaired
• Decreased lung function
• Ocular Histoplasmosis

• Optic neuropathy 16 x risk
• Menopause 2 years early
• Sudden Infant Death syndrome
• Osteoporosis
• Peripheral vascular disease
• Psoriasis 2 x risk
• Rheumatoid arthritis
• Reduced sperm count
• Tuberculosis
• Macular degeneration 2 x risk
• Low child birth weight 4 x risk
• Vocal chord polyps
• Increased sperm abnormalities

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Contribution of different risks factors
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Smoking in overall decline
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Disease follows
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Consequences

• Defeats the harmless pleasure argument
• Justifies state intervention
• Main response
• Marketing controls
• Warnings
• Public education
• Taxation

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Understanding of smoking

• 2. Passive smoking

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Passive smoking the effects

• Fatal risks
• Several hundred lung cancers (UK)
• Several thousand heart disease cases
• Non-fatal impacts
• Lung function, cough, wheeze, phlegm
• Asthma aggravation
• Children
• SIDS, middle ear infection, lung disease
• 17,000 under-5s
• Other effects

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Passive smoking evidence Hackshaw et al.

• compelling confirmation that passive smoke is a
  cause of lung cancer
• Excess risk of lung cancer 24
• Corresponds to 100s of deaths in the UK annually

Risk of lung cancer non-smoking women living
with smoker compared to non-smoker
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Attitudes to passive smoking
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Consequences

• Defeats the freedom argument
• Others are harmed
• Justifies measures to control passive smoking
• Workplace
• Public places
• Home

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Consequences
Public Places
Home
Work
Health and Safety at Work Act
Charter and market forces
Campaigns and culture
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Understanding of smoking

• 3. Addiction to nicotine

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Comparison
Nicotine is highly addictive, to a degree
similar or in some respects exceeding addiction
to hard drugs such as heroin or cocaine
Royal College of Physicians of London, 2000
Nicotine Addiction in Britain
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2. Addiction to nicotine
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Addiction to nicotine
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Addiction to nicotine

• Defeats the choice argument
• 83 of UK smokers would not start if they had
  their time again
• Policy implications
• Justifies treatment of tobacco dependence
• Explains why lights do not work
• Product regulation and harm reduction

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UK policy
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UK Policy

• Ban tobacco advertising, sponsorship
• Raise tobacco taxes
• Tackle smuggling
• Fund national education programme
• Smoking cessation services and drugs
• Passive smoking at work
• Passive smoking in public places
• Consumer protection measures (labelling etc)

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Policy drivers

• Smoking and disease
• Impact of passive smoking
• Addiction to nicotine