Fifty years since Smoking and health - Royal College of Physicians

Lessons from 50 years of tabacco control in the UK
(6) informing purchasers of the tar and nicotine content of the smoke of cigarettes
(7) investigating the value of anti-smoking clinics to help those who fi nd giving
up smoking diffi cult.
The report was truly innovative, not only in its content but also in how it was promoted.
The RCP hired a PR consultant to orchestrate the launch, and for the fi rst time ever held a
press conference. 5 The report received widespread publicity and had a signifi cant impact in
driving down smoking prevalence. 6 Sadly, the government did little to implement the RCP’s
recommendations.
However, the RCP has adhered to the principle ‘if at fi rst you don’t succeed, try, try again’
– with great success. Charles Fletcher, the TV doctor behind the 1962 report, went on to be
co-author on a report on ‘The limitation of smoking’, presented to the World Health Assembly
in 1970. This recommended a range of actions, including an end to cigarette advertising
and promotion, and was endorsed by the second RCP report on smoking published in 1971.
Recognising that it could not succeed in changing government policy without continued
advocacy, the RCP also set up Action on Smoking and Health (ASH) in 1971.
Such advocacy continues to be necessary as the tobacco industry evolves to survive. In line
with the RCP recommendation, TV advertising was banned in 1965, but developing sports
sponsorship enabled the tobacco industry to promote its products even more widely on the
BBC as well as on commercial channels. In 2002 legislation was passed to end advertising,
promotion and sponsorship, but still left packaging and display as potent promotional tools
for the tobacco industry. In England, tobacco displays will be removed from large shops in
2012 and from small shops in 2015. Australia is enforcing plain, standardised packaging from
December 2012, and the UK is consulting on the possibility of following suit. The industry
will continue to fi nd new ways to promote its products, so must be required to publish data
on all its sales and promotional activities so that public policy can keep up with tobacco
industry practice.
Although based on little hard evidence at the time, other recommendations that have
passed the test of time include the use of tax to decrease the affordability of cigarettes, 7
which has been widely proven to be an effective population strategy to reduce cigarette
consumption, as long as the illicit market is properly controlled. 8 The pilot anti-smoking clinics
that sprang from the RCP’s 1962 recommendation have matured into one of the most
cost-effective health interventions, free at the point of delivery to all smokers. 9 Mass media
campaigns motivating and encouraging smokers to quit, backed up by earned or unpaid
media, are now a core part of a comprehensive strategy, which between 1998 and 2008 was
accompanied by more rapid declines in youth smoking than adult smoking. 8
However, other recommendations have had to be revised in the light of the evidence.
In 1962 it was believed that ‘more education of the public and especially schoolchildren
© Royal College of Physicians 2012 5