Feature

So much done – and so much still to do

With tobacco advertising finally banned in the UK, health activists are celebrating by turning their attention to the next steps in the long campaign against smoking, explains Amanda Sandford

Now that the tobacco advertising ban has finally been enacted, the public could be forgiven for thinking that the pressure is finally off the government with regard to tobacco control. Nothing could be further from the truth. Both nationally and internationally, tobacco politics is now centre stage and the success or failure of tobacco reduction strategies rests largely with politicians and civil servants.

The first stage of the 2002 Tobacco Advertising and Promotion Act came into force on 14 February. Not surprisingly, this was preceded by a last minute flurry of adverts in the print media by tobacco companies desperate to keep their brands firmly fixed in the minds of smokers and would-be smokers (i.e. children). Although tobacco advertising in the print media and on billboards is now consigned to history, regulations determining the limits on advertising at point of sale are still to be published.

One major weakness of the act is that it allows promotion at the point of sale. Despite warnings that the tobacco industry would exploit this glaring loophole, the government appears unconcerned. The regulations are subject to approval by the European Union which may result in a six month delay before they are published and a further delay before they can be implemented.

Meanwhile, an EU directive to ban tobacco advertising won approval by the council of health ministers last December and is expected to come into force shortly. Ironically, the EU directive is considerably weaker than most national legislation as it only covers trans-border advertising and sports sponsorship, but the fact that the European Commission set a deadline of July 2005 for implementation by member states meant that the UK government was forced to bring forward by a year its preferred date for ending tobacco sponsorship of Formula One motor racing. The political fall-out from Bernie Ecclestone’s £1m donation still lingers over Westminster.

Despite these uncertainties over point of sale advertising, indirect advertising, and the promotion of tobacco via Formula One for another two years, the government estimates that the advertising ban will result in a 2.5 per cent reduction in tobacco consumption, which means that eventually around 3,000 lives a year will be saved.

The next big challenge is unquestionably the drive to get smoke-free public places established as the norm. ASH has been leading the campaign to persuade the government to adopt an ‘approved code of practice’ which would effectively ban smoking in virtually all workplaces. This does not require new legislation yet would, at a stroke, mean that the vast majority of workplaces and public places (which are nearly always someone’s place of work) would become smoke-free. Sadly, the government has failed to accept the rationale for this, leaving health campaigners to press for stronger measures, namely new legislation. ASH is spearheading a new campaign – the Clear the Air Coalition – which calls on the government to make a smoke-free workplace a basic right.

Some might argue that the UK has made great progress in establishing smoke-free policies and it is true that, compared with 20 or even 10 years ago, many more offices, shops, and places of entertainment have taken steps to reduce people’s exposure to tobacco smoke. But this voluntary approach means that some businesses – typically small to medium sized enterprises – have simply ignored best practice, and surveys suggest that some 3 million employees in Britain are still forced to breathe colleagues’ tobacco smoke on a daily basis. This is totally unacceptable.

If the carcinogens found in tobacco smoke were leaking from a pipeline they would be dealt with immediately, but in the form of tobacco smoke they seem to be beyond anyone’s control. By contrast other countries, such as Norway and New Zealand, are actively planning to legislate to provide greater protection from environmental tobacco smoke.

One area of policy where the British government can claim credit is in smoking cessation measures. The provision of stop-smoking services across the country and the introduction of reimbursable nicotine replacement therapy has made Britain a world leader in smoking cessation. And the investment appears to be bearing fruit: the NHS funded services are reporting four-week quit rates of around 50 per cent. But, not content with setting national targets, the government is demanding that each primary care trust meet stringent – if not impossible – cessation targets locally. This creates an unnecessary burden on already overstretched trusts. A further problem is that money for cessation is not ring-fenced and may be diverted to meet other health targets.

The other strand to the national smoking cessation programme is a mass media campaign urging smokers to quit. For the first time, the government has involved major health charities and an initial £15m is being allocated to the British Heart Foundation and Cancer Research UK to produce new, hard-hitting campaigns. These should have more impact now that the health message is no longer undermined by advertising.

The success or otherwise of other tobacco control measures such as tackling smuggling, and consumer protection issues including health warnings, are governed to a great extent by international controls. Although the UK has had a laudable policy of maintaining a high rate of taxation on tobacco for many years, the impact has been limited by the government’s inability to halt smuggling. Some progress has been made in reducing cross-Channel bootlegging – the Treasury estimates that this form of illicit trade has been cut by about three-quarters over the past two years – but Customs have yet to make headway with the big smuggling operations run by criminal gangs, which account for around 80 per cent of the illegal trade.

The EU is now a major determinant of tobacco control policy. In addition to the tobacco advertising directive, health warnings and information about ingredients are covered by a separate EU directive which became effective last December. This means that new stocks of cigarettes reaching supermarket shelves should now carry bold heath warnings and misleading terms such as ‘light’ and ‘mild’ will disappear from packs over coming months.

In addition to national and European law, the UK may soon be bound by an international tobacco control treaty which has just completed the final stages of negotiation in Geneva. This World Health Organisation initiative should be ready for adoption at the World Health Assembly in May. Countries which sign up will have to implement comprehensive tobacco control programmes and co-operate internationally to tackle smuggling. This will raise the profile of tobacco control and add to the gradual de-normalisation of tobacco as a consumer product. It will be a long, slow process but – in the developed world at least – Marlboro Man is finally becoming persona non grata.