Firefighting?

This week ASH Scotland launched Beyond Smoke-free, an ambitious, far-reaching set of proposals for a strategic approach to continuing to reduce tobacco harm in Scotland. These recommendations were formed after consultation with academics, NHS workers, service users and with inputs from an expert advisory group. They take account of research findings and international strategic thinking. Funding from Cancer Research UK made it possible for us to undertake this work, and to highlight the fact that tobacco is the largest preventable killer we face in Scotland. It is an epidemic we cannot afford to ignore.

Beyond Smoke-free covers smoking prevention, cessation, reducing exposure to tobacco smoke, and makes recommendations on Government, society and industry. There are 33 robust yet achievable proposals for the short and medium term, with a longer term vision for progress. I hope that all our political parties will use these to inform their thinking about Scotland’s future public health, and commit to a new comprehensive strategic approach to tackling tobacco.

One of the recommendations – to support speedy progress towards EU standards for fire safer cigarettes while ensuring the negotiations are not exploited by tobacco companies – seems especially relevant this month as new statistics were released on fire deaths in Scotland. Of the 49 fatal casualties in accidental dwellings fires in 2008-09, smoking materials were the cause of 22 of the deaths. Those most at risk of fire deaths tend to be older people living alone. Alcohol or drugs can be a factor, making it less likely that people will react in time to the danger. In many cases, fire investigators find warning signs that could have alerted people to the potential for tragedy, such as burn marks on carpets, furniture or clothes.

Fire safer cigarettes (or RIP, reduced ignition propensity) cigarettes are designed to go out rather than keep smouldering when not being puffed. They were first introduced nationally in Canada, and in 2010 were mandated throughout America, in Finland and Australia. Undoubtedly they save lives but like any other tobacco control measure this is not something that can be done in isolation. They reduce but cannot completely prevent fires. They do nothing to prevent the diseases caused by tobacco. So we also need accessible smoking cessation services, targets to reduce illicit tobacco, work to engage young people with smoke-free choices, and a continuing vigilance towards tobacco industry promotional activities. We need a new ambitious and comprehensive national tobacco control strategy and a commitment to continuing Scotland’s success in acting to reduce the impacts of tobacco on our nation’s health and prosperity.

Illicit tobacco is not a victimless crime

This week I took part in the first Scottish National Summit on Illicit Tobacco, which brought enforcement organisations, the Scottish Government, retailers, health organisations and community representatives together to discuss the problems of illicit tobacco in Scotland and how to tackle them.

Illicit tobacco is not a victimless crime. Cheap cigarettes or tobacco undermine people’s attempts to stop smoking and make it more likely that tobacco, a lethal product, will get into the hands of children. The cost to the public purse in lost taxation runs into billions, money that is much needed to fund our public services.

Tackling illicit tobacco is one of the few areas of concern we in public health currently share with tobacco companies. But it is a late consensus. For the tobacco companies, smuggling became a high profile issue only when the outcry over non duty paid goods led to new arrangements that penalised their own involvement in alternative retail distribution routes.

Criminal gangs then moved in to profit from the continuing demand for illicit tobacco supplies, and we heard that the same gangs that are involved in bringing drugs and weaponry into communities now count tobacco amongst their commodities. People buying cheap cigarettes or rolling tobacco from a fag house or car boot sale are unknowingly funding serious criminal activities, and in some cases terrorist activities.

Meantime, funding for the Scottish Government’s Enhanced Tobacco Sales Enforcement Programme which brings local authorities into partnership with HM Revenue and Customs to tackle illicit tobacco comes to an end in 2011, and the UK Border Agency which is charged with detection and confiscation at points of entry into the UK is said to be withdrawing funding for three posts at Stranraer Port.

Tobacco whether fake, smuggled or duty-paid, kills. The tobacco epidemic claims one in four of the adult deaths in Scotland ever year and can’t be ignored. We need decisive action to reduce smuggling and continued action to tackle tobacco; because the cost of inaction is unbearable

Inspiring women

I’m fortunate that my work brings me into contact with many inspiring people, people who generously engage their hearts and minds towards envisioning and striving for a brighter future. This month I’d like to mention two of the inspiring women whose paths have crossed mine in the past few weeks.

The first is Dr Judith Mackay. Judith made time during her annual holiday visit to Scotland and in her packed calendar to come in and catch up with our work and to update me on steady progress in tobacco control in Asia. Judith was for long years a lone campaigning voice on tobacco in Asia, labouring unpaid and in the teeth of ferocious opposition to raise awareness of the harm tobacco does. She argued successfully for measures to reduce its malign influence, and she continues to put her energy into making progress towards smoke free. She co-authored the Tobacco Atlas and was a chief architect of the Framework Convention on Tobacco Control, the first international public health treaty designed to tackle the tobacco epidemic worldwide.



Dr Judith Mackay accepting BMJ award

In recent years, Judith’s commitment and influence have been recognised, twice by Time magazine as one of the Time Asia Heroes in 2006 and in the Time 100 in 2007. She was awarded an OBE in 2008, and her work was recognised by the BMJ readership with their lifetime achievement award in 2009. Meeting Judith is always inspiring because she shows unstinting passion and courage in continuing to challenge Big Tobacco’s predations, and because she has made and continues to make such a positive difference in so many people’s lives.

My second inspiring woman is Ailsa. Ailsa was a smoker for 35 years, quitting just before her 60th birthday. It wasn’t her first quit attempt, and this time it was concern for her cat that motivated her to seek help. Ailsa had mental health problems, and she found she smoked more when she was in hospital because she felt frightened and insecure. Some people had told her she shouldn’t stop, that the timing wasn’t right.

For Ailsa, stopping smoking was a positive choice. With advice and group support she ditched tobacco and now she feels so much better. She can taste food, she isn’t breathless, and quitting smoking has given her new self confidence. Best of all, quitting smoking has meant her medication could be reduced, so her mind is clearer and she feels good that she has fewer chemicals in her body. Sparky her cat appreciates it too! Ailsa made a video to share her story, with photos and her own commentary. It is quirky and moving, and entirely her own. I hope she will decide to share it more widely, as I think many people will find something to identify with in her story.

Cigarettes are often presented as an adult or lifestyle choice. The reality is they are a highly engineered, highly toxic product that is sold on the image but is rooted in addiction and habit. Tobacco is a grim epidemic, although as someone pointed out, unlike other epidemics there is an added dimension. Malaria kills people, but mosquitoes don’t have PR agencies and expensive promotions budgets.

The tobacco industry use their vast profits to develop tactics that aim to challenge policies to reduce smoking.

I’ve been thinking about the tobacco industry recently. Not that unusual, but more specifically, I have been angered at how they use their vast profits to develop tactics that aim to challenge and derail policies and legislation to reduce smoking.

Imperial Tobacco – the fourth largest tobacco company in the world – is currently taking legal action against the Scottish Government’s Tobacco and Primary Medical Services (Scotland) Act, challenging the legislative competence of the Holyrood parliament. This Act, which aims to reduce youth smoking by reducing the attractiveness and availability of tobacco, has a number of measures that are due to come in over the next few years. These include registering tobacco retailers, bringing in tougher penalties for those who sell tobacco to under 18s, introducing new offences of buying tobacco underage or for under 18s. It will also close down the retail display of tobacco and ban the sale of cigarettes through vending machines. It is these last two measures which Imperial Tobacco is challenging. The court proceedings have ended and we await the written decision of the judge, Lord Bracadale.

The tobacco industry claims legal action is a last resort, but the facts show otherwise. Philip Morris is seeking to overturn the recently introduced bans on retail tobacco displays in both Norway and Ireland. In England, British American Tobacco, Japan Tobacco, and Imperial Tobacco, are seeking a judicial review against the display ban due to come into force in 2011. In addition, Imperial Tobacco’s subsidiary cigarette vending machine company Sinclair Collins is seeking a judicial review of the English ban on tobacco vending machines also due to be introduced next year.

In Canada where an Act of Parliament mandated larger graphic warning labels on cigarette packets, Imperial Tobacco, Rothmans, Benson & Hedges, and JTI-Macdonald all took to the courts claiming the legislation was an infringement of their rights. In Australia, as soon as the federal government announced they were bringing in legislation to introduce standardised packaging with no branding, colours, or logos, Imperial Tobacco and British American Tobacco both said they would take legal action against such a move. When a tobacco control strategy for England stated it would consider the evidence surrounding plain packaging, Imperial Tobacco immediately responded by threatening a legal challenge.

Going to court is part of big tobacco’s continuing strategy of seeking to dilute, delay or derail legislation to reduce tobacco addiction and harm.

In April, Imperial Tobacco announced global sales of £13.4 billion and pre-tax profits of £974 million in the six months to 31 March. It is these huge profits made from selling its lethal products in more than 160 countries that are being ploughed into challenging the actions of governments around the world to use legislation to reduce the major harm caused by smoking to their citizens’ public health.

Earlier this year, the Office of Fair Trading fined Imperial Tobacco £112.3 million for unlawful tobacco pricing saying there was an understanding that the price of some brands would be linked to rival brands in order to limit competition. It is the largest fine ever handed out by the OFT for anti-competitive practices. However for Imperial, whose profits reached nearly a billion pounds in just six months, this is a drop in the ocean.

So that is what those of us trying to work for public health are up against. The vast profits tobacco companies make at the expense of people’s lives and wellbeing are ploughed back into more and more sophisticated marketing and recruiting practices, and into pursuing costly legal action against policies and legislation designed to reduce the deaths, diseases and anguish caused by tobacco.

In Scotland’s case tobacco accounts for a quarter of all adult deaths each year. I believe the health of our nation and our future generations is well worth fighting for.

h/t sheila duffy