Posted on Sep 25, 2013 by Michael Loftus
In a world where every opinion has at least a handful of contrary views, there is now a remarkable degree of consensus with regard to smoking. That is, it is simply very bad for you. Even those few organisations and people that remain pro-smoking make their case largely on the grounds that it is a freedom of choice issue and that, in effect, you have the right to condemn yourself to the increased risk of cancer, heart disease and some fifty other conditions if you so choose.
However, despite the medical (and general public) consensus regarding smoking, it is still a habit in which a substantial minority still indulge in. The proportion of the UK population who smoke fell from almost 50% forty years ago, to a third twenty years ago and now, the figure lingers around 20%. The existence of this persistent minority does raise some questions about the effectiveness of anti- smoking campaigns, specifically as to whether in recent years these campaigns have lost their edge in some way.
The history of these anti-smoking campaigns is a fascinating topic in its own right, especially when considering the evolution of such campaigns. For example, in the 1940’s, cigarette advertisers were claiming that smoking their brand ( as opposed to a competitor’s) was the best way of getting rid of a smokers cough!
Through the 1950’s however, research was drawing increasingly robust associations between smoking and lung cancer in particular. In the UK, the watershed event was probably the publication of a report in 1962 by the Royal College of Physicians which initiated a wholesale change in public attitudes, linking smoking and poor health and causing it to pave the way over the decades towards the public unacceptability of the smoking habit.
In 1965, television advertising of cigarettes was banned by the UK Government. In 1970, a World Health Organisation report proposed a range of other limitations on smoking including an end to all forms of cigarette advertising and promotion. 1971 saw the establishment of Action on Smoking and Health (ASH) with its fundamental goal of making non-smoking the social norm.
Through the seventies, eighties and nineties, obligations on manufacturers to carry health warnings on cigarettes packs became more exacting while restrictions on advertising and sponsorship by cigarette brands became more restricted and smoking on planes, trains, and some workplaces was increasingly curtailed.
In 2003, after a long process of resistance by manufacturers, the phases of a complete ban on cigarette advertising in the UK began to take effect with the disappearance of advertising on billboards, in print media, via direct mail and through the internet . Then in 2007, the Health Act passed into law meaning that all workplaces and enclosed public places in England were smoke free – Scotland , Wales and Northern Ireland had already adopted similar proposals.
Such campaigns have been made a success through programmes which support the people who have been convinced by the campaign arguments and actually want to give up the habit.
However, the effectiveness of the personal support measures for people giving up smoking has been put under scrutiny by an examination of the programmes in the UK. The unstated target for the efforts in England is that half of the people who seek help should give up smoking in the short term for at least 4 weeks.
The sad fact is that, at first glance, this unofficial target has never been achieved. Back in 2001, the number of quitters was 35% while for the most recent year, it was 34%. It is also the case that of those who do give up smoking, maybe 80% who stick with it till the four week mark will relapse at some point.
However, the programme is in fact very highly regarded with the Health Service and is seen as something of a beacon of success – particularly in terms of cost effectiveness. The cost of each intervention is some £300 but in terms of the imputed benefits to the health service, the benefits are some five times as much. Furthermore, the programme also has a highly impressive reach with contact being made with 8% of smokers.
The real goal of public health is to discourage children and young people from taking up the habit; supporting the long term smokers who do try to give up and recognising – grimly – that mortality itself may be the factor that makes the greatest inroads into the final 20% who ignore the facts and continue with this unfortunate habit.