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The evolving fight against tobacco. Clive Bates Director Action on Smoking and Health. 3 layers of understanding. Smoking and disease Impact of passive smoking Addiction to nicotine. Understanding of smoking. 1. Smoking and disease. Deaths attributable to smoking (1995).

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The evolving fight against tobacco

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the evolving fight against tobacco

The evolving fight against tobacco

Clive Bates


Action on Smoking and Health

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

1. Smoking and disease

deaths attributable to smoking 1995
Deaths attributable to smoking (1995)

Main causes of death attributable to smoking (UK)

other conditions associated with smoking
Angina risk 20 x risk

Buerger’s disease

Cataracts 2 x risk

Crohn’s disease


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


Peripheral vascular disease

Psoriasis 2 x risk

Rheumatoid arthritis

Reduced sperm count


Macular degeneration 2 x risk

Low child birth weight 4 x risk

Vocal chord polyps

Increased sperm abnormalities

Other conditions associated with smoking
  • Defeats the ‘harmless pleasure’ argument
    • Justifies state intervention
  • Main response
    • Marketing controls
    • Warnings
    • Public education
    • Taxation
understanding of smoking10
Understanding of smoking

2. Passive smoking

passive smoking the effects
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
passive smoking evidence hackshaw et al
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

attitudes to passive smoking

Smoking status

Percent agreeing that smoking should be restricted…

Current smoker


Never smoked

All adults

…at work





…in restaurants





…in pubs





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

Public Places



Charter and market forces

Health and Safety at Work Act

Campaigns and culture

understanding of smoking16
Understanding of smoking

3. Addiction to nicotine

    • “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
addiction to nicotine20
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
uk policy22
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)
policy drivers
Policy drivers
  • Smoking and disease
  • Impact of passive smoking
  • Addiction to nicotine