In a recent piece in the London Review of Books, Ross McKibbin, commenting on the intellectual capacities of the current British government, observed that ‘the present cabinet has become the most lightweight in living memory. Some of its members are so lightweight they shouldn’t be in the cabinet at all…’ And nowhere is this absence of intellectual heft more apparent in the government’s new anti-tobacco strategy, announced this week.
The centrepiece of the strategy is a ban, to begin in 2011, on the retail display of tobacco products in shops. UK health secretary Alan Johnson, defending the government’s move on BBC Radio 4’s Today programme, claimed that there is ‘overwhelming evidence’ supporting such a ban as a way to prevent children smoking. ‘When they [children] see a point of display and as a result of seeing it they take up smoking… it’s the key evidence as to why 200,000 11- to 15-year-olds are smoking.’
Unfortunately, Johnson’s comments say more about the way in which tobacco policy today is driven by inappropriate emotion (it’s ‘for the sake of the children’) and inexcusable ignorance than they do about sensible policies for reducing tobacco use. There are three central problems with the government’s new policy.
First, Johnson’s claim about ‘overwhelming evidence’ is simply wrong. There is in fact no good or compelling evidence that children begin to smoke because they see tobacco displayed in shops. The Department of Health relies on three studies to support its claims that seeing tobacco in shops leads children to smoke. One study (by Henriksen et al, 2004) is not even about tobacco displays but about tobacco advertising in California, which has little relevance to the UK.
A second study (by Wakefield et al, 2006) refutes the government’s key contention that seeing cigarette displays leads to smoking. In this study, which showed students pictures of stores filled with tobacco displays, there were no statistically significant differences in approval of smoking between students who saw stores filled with cigarette displays and those who viewed stores with no tobacco displays.
The third study (by Wakefield et al, 2008), in itself a highly limiting factor for this research since it is not independently replicated, found that younger smokers were not significantly more likely to notice tobacco displays than older people. More crucially, daily exposure to tobacco displays was not associated with impulse purchases of tobacco. So not only is the evidence not overwhelming, it doesn’t support Johnson’s crucial claim that 200,000 kids are smoking because they see cigarettes in shops.
Second, the government claims that other countries, such as Canada and Iceland, that have implemented bans on cigarette displays, have experienced impressive reductions in youth smoking as a result. But again, this is simply not true. For example, the Canadian province of Saskatchewan banned tobacco displays in March 2002. The ban was in effect for 18 months until overturned by a court decision. During that 18-month period, youth smoking prevalence rates in the rest of Canada declined from 22.5 per cent to 22 per cent. But in Saskatchewan youth smoking prevalence increased from 27 per cent to 29 per cent. In the neighbouring province of Manitoba – which had no display ban – youth prevalence declined from 28 per cent to 23 per cent. Moreover, the comparative youth prevalence data from Canada shows that in 2006 there were no statistically significant differences between those provinces with display bans and those without. Clearly, display bans have not made a difference in Canada.
And what of Iceland? According to the government of Iceland’s official numbers, produced by Statistics Iceland, in 2000 – the year before Iceland’s display ban – prevalence amongst male adolescents (aged 15-19) was 12.5 per cent. In the year the display ban began it was 19.1 per cent and the year following that it was 22.5 per cent. Again, this is hardly supports the contention that display bans have reduced youth smoking.
The final problem with the government’s anti-smoking ‘strategy’ is that while focusing on tobacco displays, which have no connection with smoking uptake by young people, one of the real sources of youth and adult smoking is completely ignored.
In 1994, about 36 per cent of women in the lowest socio-economic group in the UK smoked. According to the British Household Panel Survey, a longitudinal survey of about 9,000 households in the UK, 28 per cent of female smokers aged 18 to 49 had low-skilled manual jobs, 40 per cent lived in social housing, and 30 per cent were dependent on means-tested benefits. The most recent figures from National Statistics found little change in smoking prevalence amongst these women over the past 14 years (1).
Professor Hilary Graham of Lancaster University, who first wrote about these women in the late 1990s, observed that among women in the 18-to-40 age group who leave school without qualifications, 46 per cent are smokers. Within this group, of those whose current or last job was a semi-skilled or unskilled one, 50 per cent are smokers. When social housing was added to these two exposures, prevalence rose sharply to 67 per cent. When the additional disadvantage of living on means-tested benefits was included, prevalence rose to 73 per cent. The greater a women’s exposure to various forms of disadvantage – whether educational, occupational, social or economic – the greater the likelihood of her becoming a smoker. Similar risks are to be found for young people. The more likely they are to be from poor homes, and do badly in school, the more likely they are to be smokers.
The implications of such statistics for tobacco control policy are significant. Even a cabinet room filled with lightweights should be able to grasp that preventing smoking, both in the young and the not so young, lies in addressing these sorts of socio-economic factors which predict smoking uptake. Policies designed to keep children in school, and that allow them to be successful at school, policies to pull people up the socio-economic ladder, as well as to vastly improve the services upon which they are disproportionately dependent, such as public transport and subsidised housing, offer some of the most practical steps towards tackling high smoking rates.
As Martin Jarvis and Jane Wardle observe about smoking and socio-economic position: ‘Improvements in housing, education and employment would target the underlying social conditions which foster high levels of smoking. There is little doubt that substantial progress in this direction would greatly facilitate reductions in smoking, as well as contributing to the wider adoption of other desirable health behaviours, such as an improved diet.’
But instead of addressing the root causes of smoking among those with the highest smoking rates in the UK, the lightweights in the cabinet propose to ban displays of tobacco in the shops. Which is why, today, a majority of socially disadvantaged British women and their children will still be smoking.
Patrick Basham and John Luik are co-authors, with Gio Gori, of Diet Nation: Exposing the Obesity Crusade, a Social Affairs Unit book. (Buy this book from Amazon(UK).)
(1) Socio-economic inequalities in smoking: an examination of generational trends in the Great Britain, Davy, 2007