Determinants of Policy on Smoking and Health

Smoking cigarettes is arguably the greatest public health hazard in developed countries and may become so in much of the developing world. The International Agency for Research on Cancer (IARC) identifies some 30 diseases or groups within ICD rubrics as being positively associated with smoking, most causally.1 'Excess deaths' attributable to smoking run into tens of thousands every year in the UK alone. Faced with this scourge governments have appeared to act with an almost uniform timidity: 'paltry and hesitating' even in the measured language of the Royal College of Physicians. 2 Many critics however do not understand the factors which government weigh in formulating policies. In this article I try to describe simply these often competing determinants, and government's response to them, since the results of the early case-control studies on lung cancer and cigarette smoking3"9 became parliamentary currency in 1951.'° I deal exclusively with the UK where I have been concerned in the government's principal scientific advisory machinery as a member, and from 1981 chairman, of the Independent Scientific Committee on Smoking and Health. Comparison with practices in other countries would be instructive but is beyond the scope of this review. THE VIEW FROM GOVERNMENT The mounting evidence during the early 1950s incriminating cigarette smoking in lung cancer set difficult problems for government, the tobacco industry, the medical profession, and (not least) the smoker. The critical factors were seen to be: (i) smoking was widespread: in 1950, 77% of men and 38% of women smoked, mostly (in the case of women exclusively) cigarettes," (ii) smoking was not a passing fad but a widely accepted and growing habit, 3 Strangford Avenue, Belfast BT9 6PG, N Ireland, UK. (iii) tobacco products were advertised without restraint and lawfully marketed to all over 15, (iv) the public favoured strong, non-filtered cigarettes,12 (v) the irritant properties and alien aroma of tobacco smoke were offensive, but not harmful to non-smokers, (vi) death rates from lung cancer were increasing sharply, especially in men; and