Motsoaledi’s anti-smoking crusade is not about public health
- Ivo Vegter
- 06 Jun 2016 10:34 (South Africa)
Everyone agrees that smoking is bad for you, and most people – including many smokers – dislike smoke-filled places. So it’s an easy win for public health officials: crack down on smokers, and claim that everyone who quits is a victory for your progressive public health policy. As an added bonus, you score brownie points with the United Nations.
The problem is, the link between public policy and smoking trends is not at all clear. Nor is it obvious that smoking is a national public health crisis. According to the HSRC’s latest National Health and Nutrition Examination Survey, 18.2% of South Africans smoke. This isn’t particularly high, and puts us in the best third of all countries for which the World Health Organisation (WHO) has data. A more recent survey, also by the HSRC, puts SA’s smoking prevalence at an even lower 17.6%. The earlier health survey also says only 2.6% no longer use tobacco, which is a startlingly low quit rate, considering that smoking prevalence was over 30% only 20 years ago, and there seems to be no shortage of finger-wagging ex-smokers around.
Unlike higher excise taxes and prohibiting smoking in public places, the latest salvo in the government’s war on tobacco flatly ignores or even contradicts available evidence. Health minister Aaron Motsoaledi says he will present a bill in Parliament that will mandate plain brown packaging for tobacco products, prohibit in-store displays and vending machines, and bring e-cigarettes into the tobacco regulation fold.
Here’s the problem: although the WHO Framework Convention on Tobacco Control recommends plain packaging, there is little evidence that it works. Most available research involves perception studies, which – not surprisingly – find that people think plain brown paper packaging is less attractive.
The quantitative data that exists is based on the experience of Australia, which introduced plain packaging in 2012. Two studies, one focused on adults and one on minors, both find that there is no evidence that the introduction of plain packaging for cigarettes had any effect on smoking prevalence.
These studies are certainly not the final word on the matter, but considering that the government is proposing the effective expropriation of valuable brand assets of companies that sell a legal product, one would expect the standard of evidence to be rather higher than mere speculation about a marginal impact based only on marketing perception studies.
Motsoaledi follows a long line of moral busybodies who profess to impose rules on us for our own good. As Daily Maverick’s Marelise van der Merwe put it: “The argument is generally that smoking is bad enough that any means to fight it is legitimate; and that the fundamental rights of citizens to life may trump the rights of companies to sell their products.”
But that is quite a scary proposition. There are many bad habits, and once you grant government virtually unlimited powers to combat them, you’re signing away a great deal of freedom for only very limited safety.
This isn’t only about the rights of tobacco companies to market their wares, but also about the right of people to make informed choices about the risks they are willing to accept for the sake of pleasure. Alcohol will probably be next. Considering all the talk of a sugar tax, imagine if sweets were packed in plain brown paper packaging, with only a text description on the label, and perhaps some gory photographs of grossly obese people with limbs lost to diabetic neuropathy. Does the fact that some proportion of the population over-indulge in sweets and snacks justify such an intrusive, draconian intervention?
If the government is of the opinion that people make the wrong choices, the correct approach would be to mount an information campaign. The government has prohibited cigarette companies from advertising their products as “light” or “mild”, for example, but few know why it did so. The official explanation is that such phrasing – as well as lighter-coloured packaging – misleads some consumers into believing that milder cigarettes are healthier than full-flavoured alternatives with darker-coloured branding.
The thing is that only a small minority of smokers actually believes this to be true, and ironically, that minority would be correct. Lower-tar cigarettes are less harmful than their heavier counterparts. The idea that it isn’t is sheer propaganda that relies on the absurd assumption that a milder cigarette will result in a commensurate increase in the number of cigarettes smoked. Presumably, instead of 20 full-strength smokes with 12mg tar, it is expected someone will smoke 60 ultra-lights with 4mg tar. If you are this free to fiddle with the numbers, you can prove anything.
This sleight-of-hand reveals the real problem: neither the anti-smoking lobby nor the government cares much about successful harm-reduction efforts. It isn’t about public health, but about putting tobacco companies out of business. There is no relative merit, to their minds, in people smoking less, choosing lighter cigarettes, or switching to less harmful alternatives. Nothing short of complete cessation is good enough for the moral busybodies.
For evidence, look no further than a debate in the South African Medical Journal, between Yussuf Saloojee, executive director of South Africa’s National Council Against Smoking, on one hand, and Derek Yach, executive director of the Vitality Institute – the health- and fitness-promoting programme associated with Discovery Health – and David Sweanor, an epidemiologist from Canada, on the other.
Yach in particular has a significant interest in people’s actual health, since ill health costs insurance companies real money. Yach and Sweanor argued in favour of harm-reduction measures, such as e-cigarettes. Saloojee dissented. Although he explicitly acknowledges that e-cigarettes are less toxic, he argues – without any evidence to that effect – that they are merely a means for tobacco companies to dissuade smokers from quitting.
Motsoaledi, too, wants to bring e-cigarettes into the tobacco-control fold. This, too, goes against the available scientific evidence. Small and disputed studies exist with findings either way, but the consensus view is that e-cigarettes are significantly less harmful than cigarettes, pose no threat to the health or comfort of bystanders, and are effective as a means to quit smoking cigarettes.
A comprehensive report by the Royal College of Physicians in the UK has recommended that smokers switch to e-cigarettes, both as an aid to quit and as a means to reduce harm. In particular, it found that e-cigarettes are far more popular than traditional nicotine-replacement therapies sold as medicine, and that the potential hazard to health is unlikely to exceed 5% of the health hazard of smoking tobacco. There is no evidence, it found, that they renormalise the act of smoking, act as a gateway to smoking in young people, or are simply being used as a temporary addiction crutch for times when smokers are not permitted to light up.
“The available evidence to date,” it says, “indicates that e-cigarettes are being used almost exclusively as safer alternatives to smoked tobacco, by confirmed smokers who are trying to reduce harm to themselves or others from smoking, or to quit smoking completely.”
Perhaps the government feels threatened by an anti-smoking revolution that originated in the free market, rather than in the offices of the morality bureaucracy. It seems to want to suppress e-cigarettes by either treating them as equivalent to tobacco or forcing them out of conventional shops and into pharmacies. This isn’t science, nor is it concern for public health.
Suspiciously, only big tobacco companies and big pharmaceutical companies are threatened by e-cigarettes. Public health would probably benefit from their use. Add plain packaging and a ban on retail displays to the mix, and the incumbent tobacco monopoly – British American Tobacco supplies the vast majority of South Africa’s market – will become unassailable by competitors. Nobody will be able to create awareness of a new brand. The only competitive criterion will become price, and with lower price, inevitably, comes lower quality.
Why the government is pursuing policies that will only benefit big business and will not achieve significant public health benefits is left as an exercise for the reader. But even if the policies did work, they would not justify the expropriation of brands from companies that sell a legal product, nor would they merit curtailing the free choice of tobacco users.
The celebrated author, theologian and ethicist C.S. Lewis once wrote: “Of all tyrannies a tyranny sincerely exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience. They may be more likely to go to Heaven yet at the same time likelier to make a Hell of earth. Their very kindness stings with intolerable insult.”
Few people sympathise with smokers, but these draconian laws set a very dangerous precedent about the right to make private choices in a free market, and the property rights of companies that sell legal but disfavoured products. Citizens ought to have the right to make free choices about their own money, health, and pleasure, provided they do not infringe on the rights of others. Instead of protecting the rights of others, however, the government prefers to treat us like children, who need to follow strict rules and regulations for our own good. If you’re okay with such a paternalistic, authoritarian view of the role of the state, you don’t deserve the rights and liberties of an adult. DM