Old moralism in new packaging

There is little to say about the plain packaging of cigarettes that wasn’t said by Sir Humphrey in Yes, Prime Minister: ‘Something must be done. This is something, therefore it must be done.‘ Every year, the Action on Smoking and Health (ASH) PR machine whirrs into action demanding that politicians take ‘bold steps’ based on ‘overwhelming evidence‘. Every year, the policies get more surreal. Graphic health warnings didn’t work? Put the cigarettes behind shutters. Shutters won’t work? Ban colourful packaging. What next year’s campaign will be is anyone’s guess, but if events in Australia are any guide it might involve forcing smokers to register for a license.

One obvious question is never asked – does this strategy of hyper-regulation and ‘denormalisation’ actually work? By one measure, the answer is a resounding ‘yes’. In 2006, the anti-smoking movement created a ‘Tobacco Control Scorecard’, a hit parade which Britain and Ireland have consistently topped thanks to uncompromising smoking bans, sky-high tobacco taxes and retail-display bans. Plain packaging should help the UK maintain the top spot next time the list is compiled.

Trebles all round, then? Not quite. After declining steadily for years, Britain’s smoking rate has been flatlining since 2007, while Ireland’s eye-wateringly high cigarette prices have made the Emerald Isle the capital of black-market tobacco in Western Europe. If stigmatising smokers and annoying the tobacco industry is the aim of tobacco control, our two countries reign supreme, but if the goal is to improve public health we should take a lesson from the country that comes a mediocre ninth on the scorecard: Sweden.

According to the most recent EU statistics, the smoking rate is just 16 per cent in Sweden, compared to 28 per cent in the UK and 23 per cent in Ireland. (Figures vary significantly across datasets, but Sweden has been consistently shown to have the lowest rate in Europe.) Unsurprisingly, Sweden also has the lowest rate of lung cancer in the EU. Why, then, does it sit in mid-table obscurity on the tobacco-control scorecard? It receives black marks for having exemptions to its smoking ban, allowing advertising of smokeless tobacco and having more affordable cigarettes than our own. The Swedish government also chooses not to subsidise nicotine-replacement therapy and doesn’t put pictures of tumours on cigarette packs.

But if it flunks so many tests, why does Sweden have the lowest smoking rate in Europe? Firstly, because the criteria used by the anti-smoking movement in its scorecard do not reflect best practice, but merely reflect the obsessions of its leadership, such as the belief that smoking bans lead to mass abstinence and that massive, gruesome warnings succeed where simple, evidence-based warnings fail. Neither of these articles of faith stands up against the facts and – crucially – there is no correlation between high Tobacco Control Scale scores and low smoking rates. In other words, when it comes to reducing the smoking rate – the only measure that counts – the orthodox tobacco-control model simply does not work.

An evidence-based approach would look at what the countries with the lowest smoking rates are doing and incorporate their policies into a model of best practice. With tobacco, as with drugs, harm reduction works better than prohibition, but harm reduction is the age-old enemy of zealots and moral entrepreneurs because it confounds the tidy certainties of the good-versus-evil battle they believe themselves to be fighting. Sweden’s approach is essentially a harm-reductionist one. The key to Swedish exceptionalism lies in the opt-out it secured from the EU’s ban on oral tobacco when it joined the union in 1995.

Traditional Scandinavian smokeless tobacco products had been banned by the EU three years earlier because anti-smoking groups assumed them to be carcinogenic. They aren’t and the European Commission has since accepted that this belief lacks scientific foundation, but the ban remains in place. Per capita tobacco consumption in Sweden is much the same as any other European country when measured by weight, but most of it is taken in the form of ‘snus’ (oral snuff) and, as a result of the market shifting to a product which is 99 per cent safer than cigarettes, their smoking and cancer rates have fallen dramatically. Last month, a study published in Nicotine & Tobacco Research found that 32 per cent of Norwegian ex-smokers had used snus to quit, compared with just 14 per cent who had used nicotine-replacement therapy (being outside the EU, Norwegians are able to legally obtain snus). A study published in the European Journal of Epidemiology in 2004 found that if the rest of the EU adopted the Swedish model, 200,000 premature deaths could be prevented every year.

Unintended consequences do not get much more negative than this. In the name of public health, a virtually harmless nicotine product was banned, leaving smokers with the choice to quit or die. Numerous public-health experts have questioned the wisdom of the ban, including the Royal College of Physicians and former ASH director Clive Bates, but the neo-prohibitionists seem to have prevailed. As I have written before on spiked, some even want to see the prohibition of electronic cigarettes on the basis that they are addictive (as are nicotine patches, as is methadone etc. The use of low-risk substitutes for addictive drugs is central to harm reduction.)

By spending hundreds of thousands of pounds campaigning for empty gestures like plain packaging, the government has nailed its colours to the neo-prohibitionist mast, exhibiting the same faith in over-regulation as its predecessor. If it put the same resources into supporting the Swedish government’s campaign to get the EU ban on snus overturned, it might achieve its stated goal of improving the health of the nation. That, however, would require the tacit admission that bans are not always desirable and are sometimes counterproductive, a concept entirely alien to British politics in the twenty-first century.

Chris Snowdon is the author of The Art of Suppression: Pleasure, Panic and Prohibition Since 1800 (Buy this book from Amazon(UK)).

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