Public health officials used to believe that we’d never manage to get the rate of adult smoking below 25%, according to a recent article by Clare Wilson in New Scientist (free, but registration required). Now, in a number of richer markets, it is well below that level: in the UK, it’s 16%, in the US, 15%. New Zealand plans to get its adult smoking levels below 5% by 2025, Finland by 2030 (this is a more aggressive target, since it includes chewing tobacco and e-cigarettes.) At its peak, in the mid-20th century, half of American and British adults smoked.

Keeping it legal

The reasons for the decline aren’t hard to find, and they suggest that when public health interventions aren’t watered down as a result of governments caving in to aggressive commercial lobbying, they can be very effective. It is ten years since the England banned smoking in enclosed workplaces, including bars and restaurants. The combination of limiting the places where people can smoke, increasing costs through taxation, restricting sales outlets, publishing health warnings and banning advertising and other forms of promotion and endorsement turns out (who knew?) to reduce demand.  

The only country to ban smoking outright is Bhutan, which is culturally very different and where smoking rates were already very low. Public health officials would rather tobacco were legal: Deborah Arnott, of the UK anti-smoking group ASH, is quoted as saying, “You’re much more effective at regulating products if they’re legal.”

E-cigarettes

New anti-smoking strategies continue to be proposed. Tasmania debated raising the minimum age for smoking each year; some have suggested requiring that cigarettes are more alkaline, which would deter deep inhaling of the smoke. But these both create black markets, for younger smokers or for illicit milder cigarettes. Better approaches might be to continue to raise costs and discourage media and movies from showing people smoking (a significant cause of teenagers trying it.)

One curiosity: there’s a split in the public health community as to whether e-cigarettes help people to quit or not. The US and Australia regard them as being almost as dangerous as ordinary cigarettes, while Martin Dockrell of Public Health England notes that they are 95% safer than smoking, and there’s no evidence of harm to bystanders. In the UK, the article notes, “vaping took off around 2010, and since that time the rate of decline in smoking has, if anything, slightly steepened.” But smoking rates are also falling in the US and Australia, where policy on vaping is less tolerant. 

Either way, Stanton Glantz of the University of California suggests that we’re close to the point where smoking might no longer be “a public health problem of consequence.”

Losing credibility

The New Scientist article doesn’t draw wider conclusions, but I will. The first is that the long war of denial and obfuscation waged by the tobacco companies in the face of increasing evidence of harm may have shored up their profits for a while (a classic “Horizon One” response to change), but meant that they had lost all credibility and no influence once the public health evidence reached a critical mass. 

The second is that public health strategies can work to reduce public harm. Obviously, neo-liberalism would ignore such concerns, since it is effectively a political and economic strategy in which the state manages markets so that companies can extract profits. But in an age where neo-liberalism is discredited and political parties are moving beyond it, public health and public harm should be back on the political agenda. Denial and obfuscation will not be as effective as they used to be. 

The image of Ronald Reagan promoting Chesterfields comes via the Stalin’s Moustache blog and is used with thanks.