Tobacco control

The tobacco control field comprises the activity of disparate health, policy and legal research and reform advocacy bodies across the world. These took time to coalesce into a sufficiently organised coalition to advance such measures as the World Health Organization Framework Convention on Tobacco Control, and the first article of the first edition of the Tobacco Control journal suggested that developing as a diffusely organised movement was indeed necessary in order to bring about effective action to address the health effects of tobacco use.[2]

The tobacco control movement has also been referred to as an anti-smoking movement by some who disagree with its aims, as documented in internal tobacco industry memoranda.[3]

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".[4] In this restriction, tobacco was sentenced to excommunication, not so much because it harmed health, but because its use within the Churches was intolerable because it ruined the atmosphere of the masses. Thus, these sentences would not be made against tobacco per se (whose individual consumption was not penalized as long as it was moderate), but rather for its improper use in places considered sacred and public. The condemnation of improper use remains intact in Catholic doctrine today.[5]

The earliest citywide European smoking restrictions were enacted in Bavaria, Kursachsen, and certain parts of Austria in the late 17th century.

In Britain, the still-new habit of smoking met royal opposition in 1604, when King James I wrote A Counterblaste 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 its introduction, explaining his dislike of tobacco as grounded upon eight 'principal reasons and arguments' (in their original spelling):

1. First, that in their use and custom, no method or order is observed. Diversitie and distinction of persons, times and seasons considered.
2. 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.
3. Thirdly, for that it is experimented and tried to be a most strong and violent purge.
4. Fourthly, for that it witherete and drieth up naturall moisture in our bodies, thereby causing sterrilitie and barrennesses: In which respect it seemeth an enemy to the continuance and propagacion of mankinde.
5. Fiftly, for that it decayeth and dissipateh naturall heate, that kindly warmeth in us, and thereby is cause of crudities and rewmes, occasions of infinite maladies.
6. Sixtly, for that this herb is rather weeed, seemethe not voide of venome and poison, and thereby seemeth an enemy to the lyfe of man.
7. Seaventhly, 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.
8. 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".[6]

Smoking was forbidden in Berlin in 1723, in Königsberg in 1742, and in Stettin in 1744. These restrictions were repealed in the revolutions of 1848.[7] In 1930s Germany, scientific research for the first time revealed a connection between lung cancer and smoking, so the use of cigarettes and smoking was strongly discouraged by a heavy government sponsored anti-smoking campaign.[8][9]

After the Second World War, the German research was effectively silenced due to perceived associations with Nazism. However, the work of Richard Doll in the UK, who conclusively identified the causal link between smoking and lung cancer in 1952, brought this topic back to attention. 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 British Royal College of Physicians[10] and the 1964 report of the U.S. Surgeon General.

In the United States, the 1964 report of the Advisory Committee to the Surgeon General represented a landmark document that included an objective synthesis of the evidence of the health consequences of smoking according to causal criteria.[11] The report concluded that cigarette smoking was a cause of lung cancer in men and sufficient in scope that “remedial action” was warranted at the societal level. The Surgeon General report process is an enduring example of evidence-based public health in practice.[11]

Now an accepted element of the public health arena, tobacco control policies and activity are seen to have been effective in those administrations which have implemented them in a co-ordinated fashion.

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.

Direct and indirect opposition from the tobacco industry continue, for instance through the tobacco industry's efforts at misinformation via suborned scientists [23] and 'astroturf' counter-advocacy operations such as FOREST.

• Chapman, Simon (2007). Public Health Advocacy and Tobacco Control: Making Smoking History. Wiley-Blackwell. ISBN 9781405161633.
• Tate, Cassandra. Cigarette wars: the triumph of" the little white slaver" (Oxford University Press, USA, 2000) online.

• Young, T. Kue (2005). Population Health: Concepts and Methods. Oxford University Press. ISBN 0-19-515854-7.

• Tobacco Control journal
• Tobacco Policy