Tobacco Control
Encyclopedia
Tobacco control is a field of public health
science, policy and practice dedicated to controlling (i.e. restricting) the growth of tobacco use and thereby reducing the morbidity and mortality
it causes. Tobacco control is a priority area for the World Health Organization (WHO
), through the Framework Convention on Tobacco Control.
In Britain, a response to the still new habit of smoking met royal opposition in 1604, when King James I wrote A Counterblast to Tobacco, describing smoking as: "A custome loathsome to the eye, hateful to the nose, harmeful to the brain, dangerous to the lungs, and in the black stinking fume thereof, nearest resembling the horrible Stigian smoke of the pit that is bottomeless." His commentary was accompanied by a doctor of the same period, writing under the pseudonym Philaretes, who as well as explaining tobacco's harmful effects under the system of the four humours ascribed an infernal motive to it's introduction, explaining his dislike of tobacco as grounded upon eight 'principal reasons and arguments' (in their original spelling):
Later in the seventeenth century, Sir Francis Bacon identified the addictive consequences of tobacco use, observing that it "is growing greatly and conquers men with a certain secret pleasure, so that those who have once become accustomed thereto can later hardly be restrained therefrom" .
Smoking was banned in Berlin in 1723, in Königsberg in 1742, and in Stettin in 1744. These bans were repealed in the revolutions of 1848. New smoking restrictions were imposed by the German government during the second world war, sometimes cited by those opposed to tobacco control as suggestive of 'Nazi' origins, although they were in practice not consistently implemented.
in the UK, who first identified the causal link between smoking and lung cancer
in 1952. Partial controls and regulatory measures eventually followed in much of the developed world, including partial advertising bans, minimum age of sale requirements, and basic health warnings on tobacco packaging. However, smoking prevalence and associated ill health continued to rise in the developed world in the first three decades following Richard Doll's discovery, with governments sometimes reluctant to curtail a habit seen as popular as a result - and increasingly organised disinformation efforts by the tobacco industry and their proxies (covered in more detail below). Realisation dawned gradually that the health effects of smoking and tobacco use were susceptible only to a multi-pronged policy response which combined positive health messages with medical assistance to cease tobacco use and effective marketing restrictions, as initially indicated in a 1962 overview by the UK Royal College of Physicians and the 1964 report of the US Surgeon General.
and government policy initiatives. Progress was initially notable at a state or national level, particularly the pioneering smoke-free public places legislation introduced in New York City in 2002 and the Republic of Ireland in 2004, and the UK efforts to encapsulate the crucial elements of tobacco control activity in the 2004 'six-strand approach' (to deliver upon the joined-up approach set out in the white paper 'Smoking Kills' ) and its local equivalent, the 'seven hexagons of tobacco control' . This broadly organised set of health research and policy development bodies then formed the Framework Convention Alliance
to negotiate and support the first international public health treaty, the World Health Organization Framework Convention on Tobacco Control, or FCTC for short.
The FCTC compels signatories to advance activity on the full range of tobacco control fronts, including limiting interactions between legislators and the tobacco industry, imposing taxes upon tobacco products and carrying out demand reduction, protecting people from exposure to tobacco smoke in indoor workplaces and public places. regulating and disclosing the contents and emissions of tobacco products, posting large health warnings upon tobacco packaging, removing deceptive labelling (e.g. 'light' or 'mild'), improving public awareness of the consequences of smoking, prohibiting all tobacco advertising, provision of cessation programmes, effective counter-measures to smuggling of tobacco products, restriction of sales to minors and relevant research and information-sharing among the signatories.
WHO subsequently produced an internationally-applicable and now widely recognised summary of the essential elements of tobacco control strategy, publicised as the mnemonic 'MPOWER' . The six components are:
.
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
science, policy and practice dedicated to controlling (i.e. restricting) the growth of tobacco use and thereby reducing the morbidity and mortality
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
it causes. Tobacco control is a priority area for the World Health Organization (WHO
Who
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
), through the Framework Convention on Tobacco Control.
The prehistory of tobacco control
The first attempts to respond to the health consequences to tobacco use followed soon after the introduction of tobacco to Europe. Pope Urban VII's thirteen-day papal reign included the world's first known tobacco use restrictions in 1590 when he threatened to excommunicate anyone who "took tobacco in the porchway of or inside a church, whether it be by chewing it, smoking it with a pipe or sniffing it in powdered form through the nose". The earliest citywide European smoking restrictions were enacted in Bavaria, Kursachsen, and certain parts of Austria in the late 17th century.In Britain, a response to the still new habit of smoking met royal opposition in 1604, when King James I wrote A Counterblast to Tobacco, describing smoking as: "A custome loathsome to the eye, hateful to the nose, harmeful to the brain, dangerous to the lungs, and in the black stinking fume thereof, nearest resembling the horrible Stigian smoke of the pit that is bottomeless." His commentary was accompanied by a doctor of the same period, writing under the pseudonym Philaretes, who as well as explaining tobacco's harmful effects under the system of the four humours ascribed an infernal motive to it's introduction, explaining his dislike of tobacco as grounded upon eight 'principal reasons and arguments' (in their original spelling):
- First, that in their use and custom, no method or order is observed. Diversitie and distinction of persons, times and seasons considered.
- Secondly, for that it is in qualitie and complexion more hot and drye then may be conveniently used dayly of any man: much lesse of the hot and cholerique constitution.
- Thirdly, for that it is experimented and tryed to be a most strong and violent purge.
- Fourthly, for that it witherete and drieth up naturall moisture in our bodies, therby causing sterrilitie and barrennesses: In which respect it seemeth an enemie to the continuance and propagacion of mankinde.
- Fiftly, for that it decayeth and dissipateh naturall heate, that kindly warmeth in us, and thereby is cause of crudities and rewmes, occasions of infinit maladies.
- Sixtly, for that this herb is rather weeed, seemethe not voide of venome and poison, and thereby seemeth an enemie to the lyfe of man.
- Seventhly, for that the first author and finder hereof was the Divell, and the first practisers of the same were the Divells Preiests, and therefore not to be used of us Christians.
- Last of all, because it is a great augmentor of all sorts of melancholie in our bodies, a humor fit to prepare our bodies to receave the prestigations and hellih illusions and impressions of the Divell himselfe: in so much that many Phisitions and learned mean doe hold this humour to be the verie seate of the Divell in bodies possessed.
Later in the seventeenth century, Sir Francis Bacon identified the addictive consequences of tobacco use, observing that it "is growing greatly and conquers men with a certain secret pleasure, so that those who have once become accustomed thereto can later hardly be restrained therefrom" .
Smoking was banned in Berlin in 1723, in Königsberg in 1742, and in Stettin in 1744. These bans were repealed in the revolutions of 1848. New smoking restrictions were imposed by the German government during the second world war, sometimes cited by those opposed to tobacco control as suggestive of 'Nazi' origins, although they were in practice not consistently implemented.
The origins of modern tobacco control
Tobacco control as a scientifically-based approach originates from post-war epidemiology, and notably the work of Richard DollRichard Doll
Sir William Richard Shaboe Doll CH OBE FRS was a British physiologist who became the foremost epidemiologist of the 20th century, turning the subject into a rigorous science. He was a pioneer in research linking smoking to health problems...
in the UK, who first identified the causal link between smoking and lung cancer
Lung cancer
Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
in 1952. Partial controls and regulatory measures eventually followed in much of the developed world, including partial advertising bans, minimum age of sale requirements, and basic health warnings on tobacco packaging. However, smoking prevalence and associated ill health continued to rise in the developed world in the first three decades following Richard Doll's discovery, with governments sometimes reluctant to curtail a habit seen as popular as a result - and increasingly organised disinformation efforts by the tobacco industry and their proxies (covered in more detail below). Realisation dawned gradually that the health effects of smoking and tobacco use were susceptible only to a multi-pronged policy response which combined positive health messages with medical assistance to cease tobacco use and effective marketing restrictions, as initially indicated in a 1962 overview by the UK Royal College of Physicians and the 1964 report of the US Surgeon General.
Comprehensive tobacco control
The concept of multi-pronged and therefore 'comprehensive' tobacco control arose through academic advances (e.g. the dedicated Tobacco Control journal), not-for-profit advocacy groups such as Action on Smoking and HealthAction on Smoking and Health
Action on Smoking and Health is the name of a number of autonomous pressure groups/charities throughout the world which seek to publicize the risks associated with tobacco smoking and campaigns for greater restrictions on cigarette and tobacco sales....
and government policy initiatives. Progress was initially notable at a state or national level, particularly the pioneering smoke-free public places legislation introduced in New York City in 2002 and the Republic of Ireland in 2004, and the UK efforts to encapsulate the crucial elements of tobacco control activity in the 2004 'six-strand approach' (to deliver upon the joined-up approach set out in the white paper 'Smoking Kills' ) and its local equivalent, the 'seven hexagons of tobacco control' . This broadly organised set of health research and policy development bodies then formed the Framework Convention Alliance
Framework Convention Alliance
The Framework Convention Alliance , also called the Framework Convention Alliance for Tobacco Control, is a confederation of over 350 organizations from more than 100 countries which banded together to support the negotiation, ratification and implementation of the Framework Convention on Tobacco...
to negotiate and support the first international public health treaty, the World Health Organization Framework Convention on Tobacco Control, or FCTC for short.
The FCTC compels signatories to advance activity on the full range of tobacco control fronts, including limiting interactions between legislators and the tobacco industry, imposing taxes upon tobacco products and carrying out demand reduction, protecting people from exposure to tobacco smoke in indoor workplaces and public places. regulating and disclosing the contents and emissions of tobacco products, posting large health warnings upon tobacco packaging, removing deceptive labelling (e.g. 'light' or 'mild'), improving public awareness of the consequences of smoking, prohibiting all tobacco advertising, provision of cessation programmes, effective counter-measures to smuggling of tobacco products, restriction of sales to minors and relevant research and information-sharing among the signatories.
WHO subsequently produced an internationally-applicable and now widely recognised summary of the essential elements of tobacco control strategy, publicised as the mnemonic 'MPOWER' . The six components are:
- Monitor tobacco use and prevention policies
- Protect people from tobacco smoke
- Offer help to quit tobacco use
- Warn about the dangers of tobacco
- Enforce bans on tobacco advertising, promotion and sponsorship
- Raise taxes on tobacco
International collaboration
The tobacco control community is internationally organised - as is its main opponent, the tobacco industry (sometimes referred to as 'Big Tobacco'). This allows for sharing of effective practice (both in advocacy and policy) between developed and developing states, for instance through the World Conference on Tobacco or Health held every three years. However, some significant gaps remain, particularly the failure of the US and Switzerland (both bases for international tobacco companies and, in the former case, a tobacco producer) to ratify the FCTC.Reception
Now an accepted element of the public health arena, tobacco control polices and activity are seen to have been effective in those administrations which have implemented them in a co-ordinated fashion; England, for instance, met its target to reduce its adult smoking prevalence to 21% or lower by 2010 through such an approach. Direct and indirect opposition from the tobacco industry continue, for instance through the tobacco industry's efforts at misinformation via suborned scientists and 'astroturf' counter-advocacy operations such as FORESTFOREST
FOREST is a United Kingdom political pressure group that campaigns from a pro-smoking perspective, opposing measures to reduce tobacco consumption on the grounds of defending a perceived right to smoke tobacco...
.