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Winning the war on tobacco

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Tobacco, according to Michael Daube, an eminent advocate for tobacco control in Australia, accounts for the deaths of one million Australians since 1950. Tobacco is surely one of humanity’s great follies.  Yet recently, the UK government declined to introduce plain packaging of cigarettes.  The tobacco war is by no means over yet.

My research interest in tobacco goes back to 1970s.  In 1974-5, I worked with eminent epidemiologists John Colley and Walter Holland at St Thomas Hospital in London examining the effects of parental smoking on the respiratory health of children aged 0-5 years.  This was a rare privilege: both men had already raised the likely effects of parental smoking in a paper in The Lancet. My task was to work with them and other colleagues to refine the estimates of effect and to separate it from the consequences of cough, induced by smoking and other factors, in the parents.  

This we were able to do with the help of expert statisticians.  In consequence we were able to publish the first dose-response relationship – the more the parents smoked the greater the risk to the child – linking parental smoking to serious respiratory illness in young children.  The work has been hugely amplified since then and the health effects of secondary smoke are widely appreciated.  Concerns about passive smoking have motivated tobacco control strategies in many countries and have become important motivators to reduce tobacco consumption, not for the sake of the smoker alone, but also of those around them.

Strong advocacy in relation to tobacco, involving a mighty army of people of talent, goodwill and concern for the health of the nation, led by public health giants such including Nigel Gray, David Hill, Simon Chapman, Mike Daube, Rob Moodie, Michelle Scollo and the late Konrad Jamrozik, has positioned Australia at an eminent position in the tobacco war, with population prevalence of around 17 per cent.  As Simon Chapman wrote in a paper that addressed the value of individual components of the anti-tobacco campaign, it is not possible to say whether prohibiting advertising or upping the tax or advocacy groups defacing billboard ads for Marlboro had a quantifiable effect of tobacco consumption, but we know that the composite of these efforts, operating in complex ways, is profound. 

In a recent editorial on tobacco control over the past 40 years in Australia in the Australian and New Zealand Journal of Public Health, Mike Daube, who comes from the Public Health Advocacy Institute at Curtin University in Western Australia, paid tribute to health groups such as the Public Health Association of Australia, Cancer Councils, the Heart Foundation and the AMA that have ‘worked well as coalitions…both Labor and Liberal governments around the country have supported action on tobacco.  The recent moves to introduce plain packaging showed us politicians at their best…including Nicola Roxon’s outstanding leadership with Dr Mal Washer’s unequivocal statements [of support].” 

Daube makes the further point that though average population levels of smoking have fallen, 15 per cent of Australians still smoke and that disadvantaged groups are disproportionately represented.  Among those most at risk are psychiatric patients and our Indigenous population, where smoking prevalence rates remain high and life expectancy is a decade or more less than average.  Plain packaging of cigarettes has been a distinctly Australian victory.  E-cigarettes, Daube suggests, pose a special hazard because of the ability of tobacco companies to market them by circumventing national limitations on advertising, price and packaging.

Can we anticipate a day when tobacco will be gone?  Let’s hope so.  Nor should we, Daube argues, take 40 more years for ‘serious action on the remaining big [two] epidemics – obesity and our modern drinking culture.’ 

This is a good-news story with holes.  But we can take courage from the achievements and promote new ways of achieving better health – for all Australians.