Britain is Quitting Smoking. Can our Success Inspire the Rest of the World?
By Jamie Doward
From Monday, small UK shops will be forced to hide cigarettes, but big tobacco is exploiting huge new markets in China, India and Pakistan
Dev sees it as a war on the little guy. It wont stop people smoking, he says. Its just more red tape. He may not like it but from Monday, like all small retailers, Devs newsagents, off the Holloway Road in north London, will no longer be allowed to display cigarette packs behind its counter.
If he breaches the ban, the shop owner faces a maximum fine of £5,000 in the magistrates court and up to six months in prison, two years if he ends up in the crown court.
The demise of the power wall, as it is dubbed by wily cigarette manufacturers who for years crammed it with row upon row of their brands, deprives the tobacco industry of one of its last means of advertising. Like smoking in pubs and public buildings, it is now consigned to history, destined to become a retail curiosity.
Health campaigners believe the ban is a significant step forward. Two-thirds of smokers start before the age of 18, so it is vital that everything is done to put tobacco out of sight to protect future generations, said Hazel Cheeseman, policy director at Action on Smoking and Health (Ash).
Introduced for larger stores in 2012, the ban is the latest in a series of wins against big tobacco. This autumn will see the introduction of a ban on smoking in cars carrying children. From next year, cigarette companies will be forced to sell their products in unbranded packs. Then there is the forthcoming EU ban on the sale of menthol-flavoured tobacco and packets of 10 cigarettes both popular with younger people.
And there could be more to come. The chief medical officer, Professor Sally Davies, has backed proposals from London mayor Boris Johnsons health commission for 20,000 acres of parks in the capital to go smoke-free. A number of playgrounds up and down the country have already imposed voluntary bans. Smokers talk of being under siege.
On its website, the tobacco industry-funded campaign group, Freedom Organisation for the Right to Enjoy Smoking Tobacco (Forest), carries a quote from the playwright and screenwriter, Sir Ronald Harwood, who observes: Tobacco is not an illegal substance, yet the government is persecuting a minority. How much of a minority has only started to become evident in the past five years. Smoking, once a rite of passage to adulthood, is now far from the norm among the younger generations. Figures from the Health and Social Care Information Centre suggest that, between 2003 and 2013, regular smoking fell from 9% to 3% among 11-to-15-year-olds.
The older generation are turning their backs, too. In 2007 a quarter of all British adults smoked. Today it is barely 18%. Similar declines in other western countries are feeding into the zeitgeist. The days when film stars and celebrities were pictured James Dean-style, a cigarette drooping from their lips, seem to belong to a different era. The film industry itself, so long the promoter of smoking cool, has woken up to this phenomenon. Last month Disney announced a ban on smoking for all of its PG 13-rated films.
The death of the smoker is bad news for Dev: according to a report by the Office of Fair Trading, tobacco accounts for 30% of all sales in the average newsagents. But it is potentially much worse for big tobacco, not because it sees the UK as an important market, but because it is frightened that what happens here will be exported around the globe. The UK, along with the likes of Norway, Finland, Ireland and New Zealand, has taken a lead in tobacco control that is being studied closely by other countries. For the global tobacco giants, such as British American Tobacco (BAT), Philip Morris, JTI and RJ Reynolds, the prospect that other countries will adopt UK-style health policies is a concern. While the industry can afford for smaller, developed countries to introduce health reforms, it cannot afford for this to happen in fast-growing nations such as China and India. Global smoking prevalence fell from 41% to 31% in men and from 11% to 6% in women between 1980 and 2012, but the number of smokers has increased steadily from 720 million 30 years ago to almost 1 billion, mainly because of population growth.
The tobacco industry can rely on its massive profits in the west to subsidise its expansion and lobbying activities in low-income countries, said Professor Anna Gilmore of the University of Baths department for health. In the latter they sell cheaply now to get people hooked. These cheap prices, heavy tobacco marketing and population expansion enable the tobacco companies to get millions hooked on their product. Then as these economies develop, they ramp up prices and profits.
The industry is not, however, having it all its own way in these developing markets. Almost 180 countries have signed up to the World Health Organisations framework convention on tobacco control that requires signatories to curb the power and influence of cigarette companies.
While manufacturers are skilful in finding ways around it, the framework can be a weapon in the hands of the health lobby. Only last week there was an outcry among health charities around the world after it emerged that Britains high commissioner to Pakistan had been part of a BAT delegation lobbying the countrys finance and health ministers in an apparent breach of the framework. It is clear that diplomats do not understand the purpose of the guidelines and need to seek advice from experts within the Department of Health before responding to any request for help from the tobacco industry, said Deborah Arnott, chief executive of Ash.
A week after the BAT delegation met with officials, Pakistan delayed the introduction of large-scale graphic health warnings on cigarette packets, a move that has reinforced fears that tobacco control is becoming highly polarised along socioeconomic lines.
A recent paper in the medical journal The Lancet suggested that less than 1% of the population of low-income and middle-income countries live in areas with a high probability of achieving tobacco control targets, compared with 36% of the population of high-income countries. For this reason, leading health organisations are now throwing their weight behind calls for a turbocharged approach to tobacco control that could see the global promotion of initiatives such as doubling the price of cigarettes, cutting the number of retail outlets selling tobacco, and the encouragement of vaping as a nicotine substitute.
If these measures were implemented, experts believe a tobacco-free world defined as a world where less than 5% of the population smoke is achievable by 2040.
It sounds fanciful, but already several countries, notably New Zealand, have committed to stamp out smoking by 2025, and there is pressure on the UN to issue a landmark resolution on tobacco, similar to that it introduced a decade ago against diabetes. It starts building a movement in the same way we saw with HIV/Aids, said Dr Derek Yach, executive director of the Vitality Institute, a body set up to promote health and disease prevention, and one of the physicians pushing the 2040 target.
Yach points out that there was similar scepticism when the WHO revealed its goal to ensure 3 million people with Aids received treatment by 2005, and when it unveiled plans to eradicate polio. But huge question marks hang over whether cash-strapped countries would welcome the loss of a major tax generator and an industry that creates tens of thousands of jobs.
Significantly, last month both the Gates Foundation and Bloomberg Philanthropies announced they were to increase funding of tobacco control programmes, seen by some experts as a tacit acknowledgement that development agencies, NGOs and governments are failing to allocate sufficient resources for tackling an addiction that kills six million people a year.
Ultimately, even if their goal of a tobacco-free world fails, those backing the campaign believe it will have served its intended purpose. They have studied their UK history. In 1962 the Royal College of Physicians in the UK first alerted the world to the dangers of tobacco, Yach said. Within months many people started quitting. This was not because of taxes or legislation. It was because of the debate around the dangers of tobacco.
GOING UP IN SMOKE
? Smoking peaked in the UK in 1948, with 82% of men and 41% of women smoking.
? On 1 July 2007 the smoking ban was introduced in England making it illegal to smoke in almost all enclosed and substantially enclosed public places and workplaces. Scotland introduced the ban in March 2006, with Wales and Northern Ireland following in April 2007.
? The price of tobacco in the UK increased by 80.2% between 2003 and 2013.
? The use of e-cigarette among adults in Britain tripled between 2012 and 2014, from an estimated 700,000 to 2.1 million.
? In 2014, a 20-a-day smoker of a premium brand would have spent about £2,900 on cigarettes.
? The World Health Organisation estimates that tobacco kills half its users, and that six million people die each year from both the direct and indirect effects of smoking.
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