UK fight for tobacco control

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Published: 14 Nov 2013
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Prof Linda Bauld - University of Stirling, Stirling, UK

Prof Bauld talks to ecancertv at the UK's National Cancer Research Institute ( NCRI ) 2013 meeting about the ‘end game' for tobacco control in the UK, and key priorities for science and policy to reduce smoking

Smoking prevalence in the UK has declined steadily in recent years but one in five adults still smoke. A current focus for tobacco control science and policy is to work towards reducing prevalence to 5% or less in the coming decades.

The session she chaired focussed on new evidence about the key drivers for prevalence reduction including: using price measures to counteract the activities of the tobacco industry; addressing smuggling; the EU tobacco products directive and evidence on health warnings and standardised packaging; point of sale interventions; and priorities for reducing the uptake of smoking amongst young people. The session was for preventative medicine, behavioural science and public health researchers, practitioners and policy makers.

We have a session this afternoon on tobacco control and the importance of moving towards a smoke-free society in the UK and in other countries. The main reason why we’re doing that at this conference is because tobacco is still responsible for one in four cancer deaths and one in five cases of cancer in the UK and it’s the most preventable cause of cancer. What we tend to find is that people have a good understanding of the links between tobacco and some forms of cancer, like lung cancer, for example, but there’s still a general lack of understanding not only amongst the public but even amongst clinicians, other professionals, about the links between other types of cancer and smoking. So we know that smoking is directly linked to over a dozen forms of cancer.

So the session really is thinking about looking forward and asking what have we achieved? The smoking rates in the UK have reduced significantly, they’ve reduced by half since the 1970s but we’ve still got one in five adults in the UK who smoke, there are ten million smokers, and we know that about 200,000 young people start smoking every year still in the UK. So it’s not something that we’ve tackled. So the session really looks at four things. It looks at where we are in relation to smoking rates and who smokes because smoking is increasingly concentrated in more disadvantaged groups in society and those are the groups we need to target and work with. It then looks at the international context for where the UK is; we’ve got a colleague, Professor Geoff Fong from the University of Waterloo in Ontario in Canada, who has come across to talk about the International Tobacco Control Survey which compares where the UK is in relation to other countries and we’ve done some things well and we’ve done other things not so well.

What are the goals?

We have four countries in the world now that have set targets for a tobacco-free society and that really means 5% or less smoking prevalence. Scotland has done that, our government has said that we aim for that by 2034 and Ireland has just come out with their own plan. We don’t have one for England and Wales yet in terms of a target, or Northern Ireland, but Cancer Research UK and others are working with UK governments to try and persuade them for the need for that. Targets are useful because they focus the mind and they encourage us to think about evidence-based interventions, which is what those of us in the research community are interested in promoting in relation to tackling smoking.

What happened to the plain packaging?

We’re still hopeful on the plain packaging front. The Scottish government is committed to introducing it if Westminster doesn’t but the UK government are now looking again at it. We hoped that they would make a commitment to it already but they haven’t. We’ve now got an amendment to the Children and Families Bill in the House of Lords that’s going through. We did a systematic review at the University of Stirling a number of years ago for the Department of Health and we’ve also done work for Cancer Research UK on this looking at all the evidence around standardised or plain packaging and essentially it would do three things: it reduces the appeal or the attractiveness of smoking in the pack because the pack is really the only remaining form of tobacco advertising. It also takes away from the confusion that smokers have about the harm from cigarettes because most smokers believe that not all cigarettes are the same and the pack can convey less risk, like lighter cigarettes, for example. And also if you remove the branding and the imaging from the tobacco pack, you make those visual health warnings, the picture of a diseased lung or a baby in an incubator, much more salient. We’ve done experimental research with smokers which shows that they pay much more attention to those visual health warnings if it’s a plain pack. So that’s why it’s a policy that we think is evidence based and we hope the government will move forward with it.

What is standing in the way?

Political will is a big issue. I think you can have all the evidence in the world conducted by rigorous studies, good quality research teams but unless the government is willing to take action we’re in a difficult place, so that’s the first thing. The second thing is that we have to focus the minds of organisations that are doing research on cancer and others towards prevention. If you look at the broad spectrum of research in this area, for example, on cancer, you see that most resources are directed towards treatment whereas actually we could achieve much more if we could stop people from developing cancer in the first place, and that’s really what our session is all about.

From a political point, is the problem the deficit that could occur with regards to tax on cigarettes?

The bottom line is really that we’re dealing with a huge powerful multinational set of organisations, the tobacco industry, which is often called the vector of smoking related diseases, and their ability to lobby government, whether it’s at UK level, you may be aware of some of the recent media coverage on that, or also at European Union level which is very important for UK tobacco policy. So you’ve got vested powerful corporate interests who really are interested in continuing to sell a product that kills so we need political will but we also need a government that’s willing to recognise that the needs of the public and public health are more important than the needs of those corporations and we don’t currently at the moment, perhaps; that’s not the place that we’re in.

We have some countries that are quite courageous, Finland for example, New Zealand are looking much more but really ambitiously. New Zealand, for example, is looking at making tobacco unavailable for sale in the country or phasing it out. So there are those kinds of policies which are really quite dramatic and would actually achieve real change. On the treatment side, as well, I think there are many countries, the UK has actually not been bad on this front, where we can make effective treatment more widely available for people who are trying to stop smoking. We could do much more in that area and again that’s a priority for research.