Looking ahead to a new tobacco control strategy for Scotland
“It didn’t just change the lives of nonsmokers by not having to put up with smoke in restaurants and bars and other public places, but also has encouraged smokers to give up by making it a little bit more difficult for them and not making it the social norm to smoke… It has been such a radical change in public life and I think it has been one for the good,” says the Scottish Liberal Democrat Leader.
The Scottish Government will soon publish its new tobacco strategy in which it will set out its commitment to go a step further and make Scotland smoke-free. The CPG was briefed on a draft version of the strategy late last year and Rennie says that while he is encouraged by the ambition within it, there were concerns about the lack of detail.
“You can go for a smoke-free Scotland, which is technically below 5 per cent. But you need to have the policies that detail how you are going to get there.”
He continues: “It is easy setting targets; it is much more difficult doing it, as we’ve found out with the climate change targets. You really need the detail as to how you are going to achieve these things.”
Sheila Duffy, chief executive, ASH Scotland, says the Scottish health community eagerly awaits the new strategy on tobacco and health.
She points out that the current strategy, A Breath of Fresh Air for Scotland, has been “highly successful”.
“Although at the time it was written it seemed at the leading edge and quite visionary and hopeful, by the time we got to the end of it, I think people were surprised by how far we’d come and how much had been accomplished and how normal it had become to have things like smoke-free public places.”
Duffy would now like Scotland to broaden its vision and consider the lessons from further afield, pointing to Australia where standardised packaging for tobacco products was introduced at the beginning of December last year, and New Zealand, which recently decided in principle to introduce plain packs following a public consultation.
A UK-wide consultation on the topic closed six months ago, however, the UK Government is yet to respond. Rennie supports the move and says he has been speaking to Liberal Democrat health minister, Norman Lamb MP about this.
“I explained the logic of the argument and he wasn’t unsympathetic. He obviously has to convince the other members of the Coalition as well. But I think because smoke-free public places were so successful — quite radical at the time — but so successful, I think we will be able to convince them as well that there are merits in doing so.”
Duffy worries that with around 40 young people taking up smoking each day, further delay may cost lives.
“I think the worry with tobacco control measures is if you delay or if you deflect, it costs lives. And in this case what we are talking about is the number of young people that are becoming addicted to tobacco, who are starting to use it. The tobacco companies have a 40-a-day habit in Scotland. So we think it is really important that strong action is taken to close down that pipeline of new recruits to tobacco and we are urging the Scottish Government to bring out a very strong strategy to do that,” says Duffy.
Ben McKendrick, senior policy and public affairs manager, BHF Scotland, argues that while smoking rates have fallen, they still stand at around 23 per cent of all adults aged 16 and over, and are significantly higher in deprived communities. He says it is “crucial” that we get these rates down.
“For someone who smokes, the most important thing they can do to improve their heart health is to quit or not start in the first place. Tobacco remains a key risk factor for heart disease and continuing to drive down smoking rates will, arguably, be the most significant thing that governments can do to continue to improve heart health and cut the rate of deaths from heart disease.”
He believes we are at an important moment in tobacco control and shares Duffy’s determination to see standardised packaging introduced across the UK.
“I think it is certainly something that is worth fighting for. It is clearly the case that the pack is one of the last, if not the last, bastions of advertising of this product. As well as fairly clear evidence suggesting that standardised plain packaging would reduce the attractiveness of these products, I think there is also quite an important principle there that something that is highly addictive, that kills half of the people who use it, should not be allowed to be marketed in a way that seeks to attract people, particularly younger people.”
Dr James Cant, Head of BLF Scotland and Northern Ireland, concurs it is the next logical step in denormalising tobacco use: “Buying fatal substances in a supermarket is not normal. That danger shouldn’t be disguised by fancy, designer packaging. Plain packaging will expose tobacco as the dangerous substance it is.”
The previous smoking ban forced us all to take tobacco very seriously, he argues, and says he would now like to see Scotland build on its successes by sharpening its focus on the dangers posed by second-hand smoke, particularly for children.
“We recognise these dangers and we’re protecting office workers or those who work in bars — yet we’re still allowing children to be exposed on a daily basis. A child in the back seat of a car, where an adult is smoking, is exposed to incredible levels of SHS. If the equivalent concentration was experienced outside, the Government would be warning people to stay indoors and avoid physical activity.
“This is something that must be addressed if the Government is serious about building on the success of its previous strategy. Children don’t always have the power to remove themselves from the source of second-hand smoke so we’d like them to receive the same amount of protection from that the rest of us are enjoying.”
Duffy, McKendrick and Rennie all support a debate around smoking in cars to raise awareness as an initial step, pointing out that while the car is a semi-private space it is one that is already regulated, for example, through the mandatory use of seatbelts and a ban on driving while using a mobile phone. However, Cant goes a step further and insists that legislation on smoking in cars is required.
“Legislation would send a clear message that this practice is dangerous and unacceptable. Without that, it will take a lot longer to change individuals’ attitudes and behaviour. We’re concerned about the amount of children who will be damaged in that time.
“Exposure to second-hand smoke in childhood leaves children at a higher risk of many conditions such as asthma, glue ear or even meningitis. It also makes them more vulnerable to respiratory disease in adulthood, such as COPD or lung cancer. I don’t think that’s the sort of legacy we want to leave our children. In terms of health impacts, cost to the NHS and days lost from work, I don’t think we can afford not to legislate.”
However, Simon Clark, director of the smokers’ lobby group Forest, says that a ban on smoking in private vehicles containing children “would set a dangerous precedent because the next step is a ban on smoking in the home” and he believes legislation would be “an unnecessary and heavy-handed response”.
Looking ahead to a new strategy, he argues that the concept of a smoke-free Scotland is “disturbingly illiberal and intolerant”.
He continues: “To reduce smoking rates to single figures, for example, can only be achieved through legislation that will seriously intrude on people’s lifestyle and private space.”
Tobacco is a legal product and those adults who choose to smoke deserve “far greater consideration” from politicians, he argues.
“Sadly, the state sponsored health lobby never knows when to stop. The same tactics that are being used to tackle smoking are now being used to target alcohol, fizzy drinks and fast food.
“When will they get it into their heads that people have a right to make informed choices about smoking, eating and drinking without being bullied, coerced or patronised?
“Life is not risk free and people should be free to take risks, within reason, without undue interference from politicians and unelected mandarins in Holyrood or elsewhere.”
And yet through its lengthy fight to fend off legal challenges to its Tobacco and Primary Medical Services (Scotland) Act, the Scottish Government has demonstrated its determination to stamp out smoking in Scotland and earlier this month it was able to announce that Scotland’s long-awaited ban on the open display of tobacco products and selfservice tobacco vending machines will finally be introduced on 29 April.
Duffy says she is delighted that the measures have survived successive legal challenges and commends Matheson for taking a strong stance on point of sale legislation. While Scotland has lagged behind other countries in terms of the time it has taken to introduce these measures because of the legal challenges, Duffy says that as a result of Matheson refusing to compromise, the permitted display area in Scotland will be around a tenth of the size of the permitted display area in England and Wales.
She adds: “I think there probably hasn’t been enough awareness of that, that our public health minister maintained the intention and the spirit of the legislation. I think Westminster compromised in the face of retail lobbying motivated by tobacco industry scaremongering.
“Our public health minister stayed strong on the regulations and maintained the smaller permitted display area in order to keep the intention and the spirit of these measures and I think he is to be commended for that.”