Tobacco regulation: saving lives vs personal freedom
The UK’s Department of Health (DoH) has announced an ambitious new strategy for reducing smoking in the population from 21% currently, to 10% by 2020.
In 2007 the Government brought in a ban on smoking in virtually all enclosed public and work places. This move added to earlier regulatory controls including the restrictions on displaying tobacco products, prominent graphic health warnings on packaging, raising the age access limit, and progressive increases in tax. These came on top of bans on all forms of tobacco advertising, and historic increases in investment in public education of smoking health risks. Combined, these measures are widely seen as having contributed to a substantial reduction in smoking across the population since the 1970s.
Transform has supported these policies, including the ban on smoking in enclosed public places, that have demonstrably delivered positive health outcomes without the need to resort to criminalisation of users or abdication of market control to criminal profiteers, quite the opposite in fact. For more discussion see our recent submission to the DoH 2009 consultation on tobacco policy.
Along with a raft of new public health measures (such as extending tobacco cessation treatment provision) The DoH is now considering extending tobacco regulation further. Policies that are being consulted upon include:
Plain packaging - removal of all logos/branding
Ending the sale of tobacco from vending machines (a significant source of tobacco for young people)
Promoting smoke-free homes and cars
Reviewing whether to extend legislation from enclosed public places and workplaces to areas like entrances to buildings
Plain packaging in particular seems like a good idea, and one with a strong evidence base that can hardly be seen as restricting user freedoms. One suspects that it wont happen in the short term at least, with a tokenistic ban on smoking around entrances, that wont serve any real purpose being the move that is actually enacted. Some countries are already going further. Finland, which outlawed tobacco advertising as far back 1976, aims to make smoking in a car carrying anyone under the age of 18 illegal by this summer.
Other countries, such as the US, are lagging behind in many of these moves, at least at Federal level (some states such as California have introduced very restrictive controls on smoking in public places). Last year Barack Obama signed the Family Smoking Prevention and Tobacco Control Act. This legislation, which was passed by the House of Representatives by a vote of 307 to 97 and the Senate 79 to 17, granted the Food and Drug Administration (FDA) extensive new authority to regulate tobacco products. It means that the FDA would regulate the content of tobacco products, prohibits the use of the terms “light,” “mild,” and “low” on packaging and in advertising and mandate dramatic changes in the nature and strength of cigarette warnings, which by 2012 would have to cover the top 50% of both front and rear panels of cigarette packages. And it also stipulates that the FDA must reissue its 1996 regulations, which, among other things, would prohibit outdoor advertising of tobacco products within 1000 ft (305 m) of a school or playground, limit advertising in publications with a “significant youth readership” and ban brand-name sponsorship of sporting and cultural events.
To most Europeans, none of this seems new or radical. However in America such stipulations are frequently seen as a threat to the First Amendment of the Constitution – in other words they contradict commercial freedom of speech. Opposition to these policies comes not only from the tobacco manufacturers but also the American Civil Liberties Union (ACLU).
The ACLU sent a letter to senators arguing that,
‘… regulating commercial speech for lawful products only because those products are widely disliked — even for cause — sets us on the path of regulating such speech for other products that may only be disfavored by a select few in a position to impose their personal preferences.’
This idea that tobacco advertising controls are an unacceptable infringement on freedom of speech seems mistaken, when it has been recognised the world over that tobacco, specifically smoked tobacco, is not a 'normal' commercial product in that it causes direct and serious measurable health harms (around 50% of smokers will die prematurely as a result of their use) even when used as directed. This sets it aside from even alcohol.
The WHO has estimated that, at current global rates, there will be 1 billion tobacco related deaths during this century. Even the ACLU accepts there are must be some limits on freedom of speech. If the prospect of a billion deaths is not enough not justify some restrictions (not on use remember, just marketing) you have to wonder what would.
What is of more interest to Transform, however, is the policy disconnect that exists between tobacco policy and drug policy more generally. Most governments have acknowledged that using tobacco is hugely damaging to health and that stricter regulations are proven to reduce levels of use relative to prevalence patterns that emerged during the unregulated commercial tobacco promotion of earlier in the last century.
In the developed world, tobacco has been falling since the 70's, As a result of improved regulation, the reigning in of commercial marketing and increased public health education. This is in stark contrast to use of most illicit drugs.
If increased regulation and public health education has been proved to successfully contribute to a reduction in tobacco use and health harms, it is follows that these same policies might also be successful in reducing the harms associated with other – currently illegal – drugs. Unfortunately, we cannot even begin to explore the options for better market regulation whilst drugs are subject to rigid blanket prohibitions that mean no such market interventions are possible, default control falling to criminal profiteers and the economic dynamics of a completely unregulated illegal market.
TRANSFORM DRUG POLICY FOUNDATION WEBLOG
EMILY C, 03/02/2010