1. The evolving fight against tobacco Clive Bates Director Action on Smoking and Health

2. 3 layers of understanding • Smoking and disease • Impact of passive smoking • Addiction to nicotine

3. Understanding of smoking 1. Smoking and disease

4. Deaths attributable to smoking (1995) Main causes of death attributable to smoking (UK)

5. Angina risk 20 x risk Buerger’s disease Cataracts 2 x risk Crohn’s disease Depression Duodenal ulcers Chronic rhinitis Fertility 30% lower Graves’ disease Hearing loss Immune system impaired Decreased lung function Ocular Histoplasmosis Optic neuropathy 16 x risk Menopause 2 years early Sudden Infant Death syndrome Osteoporosis Peripheral vascular disease Psoriasis 2 x risk Rheumatoid arthritis Reduced sperm count Tuberculosis Macular degeneration 2 x risk Low child birth weight 4 x risk Vocal chord polyps Increased sperm abnormalities Other conditions associated with smoking

6. Contribution of different risks factors

7. Smoking in overall decline

8. Disease follows

9. Consequences • Defeats the ‘harmless pleasure’ argument • Justifies state intervention • Main response • Marketing controls • Warnings • Public education • Taxation

10. Understanding of smoking 2. Passive smoking

11. Passive smoking – the effects • Fatal risks • Several hundred lung cancers (UK) • Several thousand heart disease cases • Non-fatal impacts • Lung function, cough, wheeze, phlegm • Asthma aggravation • Children • SIDS, middle ear infection, lung disease • 17,000 under-5s • Other effects

12. Passive smoking evidence – Hackshaw et al. • “compelling confirmation” that passive smoke is a cause of lung cancer • Excess risk of lung cancer 24% • Corresponds to 100s of deaths in the UK annually Risk of lung cancer: non-smoking women living with smoker compared to non-smoker

13. Smoking status Percent agreeing that smoking should be restricted… Current smoker Ex-smoker Never smoked All adults …at work 73 88 92 86 …in restaurants 73 92 94 88 …in pubs 28 59 65 53 Attitudes to passive smoking

14. Consequences • Defeats the ‘freedom’ argument • Others are harmed • Justifies measures to control passive smoking • Workplace • Public places • Home

15. Consequences Public Places Home Work Charter and market forces Health and Safety at Work Act Campaigns and culture

16. Understanding of smoking 3. Addiction to nicotine

17. Comparison • “Nicotine is highly addictive, to a degree similar or in some respects exceeding addiction to ‘hard’ drugs such as heroin or cocaine” • Royal College of Physicians of London, 2000 Nicotine Addiction in Britain

18. 2. Addiction to nicotine

19. Addiction to nicotine

20. Addiction to nicotine • Defeats the ‘choice’ argument • 83% of UK smokers would not start if they had their time again • Policy implications • Justifies treatment of tobacco dependence • Explains why ‘lights’ do not work • Product regulation and harm reduction

21. UK policy

22. UK Policy • Ban tobacco advertising, sponsorship • Raise tobacco taxes • Tackle smuggling • Fund national education programme • Smoking cessation services and drugs • Passive smoking at work • Passive smoking in public places • Consumer protection measures (labelling etc)

23. Policy drivers • Smoking and disease • Impact of passive smoking • Addiction to nicotine