While we were recognising the work of an absent Javed Khan by awarding him a well-deserved ‘Nanny’ (above) for ‘services to the nanny state’ at the Forest Summer Lunch last week, something else was happening.
Clive Bates, the former director of ASH, was busy writing a critique of Khan’s ‘independent’ tobacco control review.
I don’t always agree with Clive but I respect his opinions and I admire his campaign skills, especially his ability to forensically analyse reports and papers like the Khan review in an easily digestible, matter-of-fact way.
The problem I have always had is that, to the best of my knowledge, there is not a single anti-smoking law currently in place in the UK that Clive does not support.
From the smoking ban to plain packaging, every measure has had the Bates’ seal of approval, privately if not publicly. Alternatively he’s largely kept shtum, not wanting (perhaps) to criticise anti-smoking legislation.
I was surprised then to read that the Khan review includes ‘far too much punishment and coercion’. In fact, according to Clive:
Too much of Khan’s proposed agenda involves measures to hurt, restrict or humiliate smokers and to press them to stop smoking in response. The punitive agenda includes, for example, brutal tax increases, outdoor smoking bans, making purchasing more time-consuming, and new warnings designed to stigmatise and humiliate. For those who do not stop, these measures become policies that just add to the negative welfare effects and harms of smoking. Experience and good government suggest that major objectives need to be achieved as far as possible with the consent and support of those most directly affected. It is not the job of the government to batter citizens into behaviour change and it will fail if it relies too heavily on this approach.
For once I am in total agreement with the great man so it seems churlish and a bit petty to find fault elsewhere.
As it happens I agree with most of Clive's analysis but the fundamental difference between us is that, regardless of how it is achieved, I don't accept that the Government should target a ‘smoke free’ future at all.
As I told guests at the Forest Summer Lunch, the problem with having a ‘smoke free’ target is that it inevitably invites coercion and punishment, as Khan's report and Clive's critique clearly demonstrate.
If you’ve read the 'The Khan review: making smoking obsolete' you’ll know that his 15 recommendations include extending the smoking ban to more outdoor areas, banning smoking in social housing, and increasing tobacco duty by a whopping 30 per cent.
In response Clive has come up with 20 recommendations of his own:
1. Lift the EU-imposed ban on snus
2. Remove the 20mg/ml limit on the strength of nicotine e-liquid
3. Replace excessive and inappropriate warnings on vaping products
4. Replace excessive and inappropriate warnings on non-combustible tobacco products
5. Replace partial bans on vape advertising with controls on themes and placement
6. Replace blanket bans on advertising of low-risk tobacco products with controls
7. Limit plain packaging to combustibles but control themes on smoke-free packaging
8. Require NHS inserts in cigarette packs to encourage switching to smoke-free products
9. Allow commercial inserts in cigarette packs to promote smoke-free products
10. Amend the leaflet requirement in vaping products
11. Drive motivation to switch with improved risk communications
12. Eliminate pointless restrictions on tank and refill container sizes
13. Take a principled approach to flavoured smoke-free products
14. Introduce consumer protection regulation for modern oral nicotine pouches
15. Use fiscal policy to support the transition to smoke-free alternatives
16. Allow use of smoke-free products in public places
17. Impose well-designed age restrictions
18. Strengthen healthcare and public health system response
19. Allow prescribing of e-cigarettes on a trial basis and engage with vape shops
20. Use science and evidence to underpin the strategy
I don’t have a problem with most of those (although 'Impose well-designed age restrictions' is a bit opaque) but I also think it’s naive to think that these recommendations alone will enable the Government to ‘meet the 2030 smoke-free target’.
Worse, the hugely optimistic view of vaping as some sort of silver bullet that will achieve a ‘smoke-free’ society ignores one very important point that I have been banging on about for years.
In short, however much you incentivise smokers to switch to vaping, a substantial number will still not want to switch and the reason is very simple.
Despite everything (including the well-published health risks and multiple laws designed to denormalise smoking and restrict people's consumption of cigarettes), a significant number of adults (confirmed and social smokers) continue to enjoy and get pleasure from smoking.
How hard is that to understand, recognise and defend? Many smokers have tried vaping and they don’t like it as much as smoking. Some don’t like it at all.
Unfortunately, as much as Clive criticises Khan for advocating policies designed to force smokers to quit, he rarely if ever defends an adult’s right to smoke.
Instead he highlights the difference between ‘tobacco free’ and ‘smoke free’ making it clear that he supports the latter but not the former.
Clive is right to stand up for smokeless tobacco products like heated tobacco and snus but we either defend the use of all nicotine products (combustible and non-combustible) or we go home because everyone knows (or should know) where this is heading – not a smoke or tobacco-free world but a nicotine-free world.
By effectively accepting the Government’s smoke-free 2030 ambition, all Clive is really doing is arguing over the means to achieve it.
Meanwhile, though I’m grateful that he has finally come round to opposing policies designed to 'hurt, restrict or humiliate' smokers so they will quit, it's worth repeating something Chris Snowdon wrote only a week ago (‘How the smoking ban ruined Britain’):
The government could have allowed smoking rooms. It could have allowed some pubs and clubs to allow smoking while having a general rule against it. Instead we got one of the most draconian, unforgiving and petty smoking bans in the world.
To the best of my knowledge Clive fully supports the smoking ban so while his opposition to further coercive measures is welcome, forgive me when I say that it's arguably 20 years too late.
That ship sailed when the Labour Government (which was in office when Clive left ASH to work as a civil servant in the Cabinet Office) imposed a comprehensive smoking ban on every pub and club in the country, against the wishes of the majority of the public who supported exemptions and separate smoking rooms.
Nevertheless I recommend you read his critique of Khan's recommendations in full.
The irony is that the Khan review may be toast already. The man who commissioned it, Sajid Javid, is no longer health secretary (he's not even in government at the moment) and whoever his long-term successor is (Steve Barclay currently has the job) may have other priorities.
The same applies to the new PM, whoever that is, but I'll save a discussion about government priorities – based on a recent Forest poll – for my next post.