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.