Tobacco control is a field of public health science, policy and practice dedicated to controlling (i.e. restricting) the growth of tobacco use and thereby reducing the morbidity and mortality it causes. Tobacco control is a priority area for the World Health Organization (WHO), through the Framework Convention on Tobacco Control.
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The first attempts to respond to the health consequences to tobacco use followed soon after the introduction of tobacco to Europe. Pope Urban VII's thirteen-day papal reign included the world's first known tobacco use restrictions in 1590 when he threatened to excommunicate anyone who "took tobacco in the porchway of or inside a church, whether it be by chewing it, smoking it with a pipe or sniffing it in powdered form through the nose".[1] The earliest citywide European smoking restrictions were enacted in Bavaria, Kursachsen, and certain parts of Austria in the late 17th century.
In Britain, a response to the still new habit of smoking met royal opposition in 1604, when King James I wrote A Counterblast to Tobacco, describing smoking as: "A custome loathsome to the eye, hateful to the nose, harmeful to the brain, dangerous to the lungs, and in the black stinking fume thereof, nearest resembling the horrible Stigian smoke of the pit that is bottomeless." His commentary was accompanied by a doctor of the same period, writing under the pseudonym Philaretes, who as well as explaining tobacco's harmful effects under the system of the four humours ascribed an infernal motive to it's introduction, explaining his dislike of tobacco as grounded upon eight 'principal reasons and arguments' (in their original spelling):
Later in the seventeenth century, Sir Francis Bacon identified the addictive consequences of tobacco use, observing that it "is growing greatly and conquers men with a certain secret pleasure, so that those who have once become accustomed thereto can later hardly be restrained therefrom"[2].
Smoking was forbidden in Berlin in 1723, in Königsberg in 1742, and in Stettin in 1744. These restrictions were repealed in the revolutions of 1848[3]. New smoking restrictions were imposed by the German government during the second world war, sometimes cited by those opposed to tobacco control as suggestive of 'Nazi' origins, although they were in practice not consistently implemented[4].
Tobacco control as a scientifically-based approach originates from post-war epidemiology, and notably the work of Richard Doll in the UK, who first identified the causal link between smoking and lung cancer in 1952. Partial controls and regulatory measures eventually followed in much of the developed world, including partial advertising bans, minimum age of sale requirements, and basic health warnings on tobacco packaging. However, smoking prevalence and associated ill health continued to rise in the developed world in the first three decades following Richard Doll's discovery, with governments sometimes reluctant to curtail a habit seen as popular as a result - and increasingly organised disinformation efforts by the tobacco industry and their proxies (covered in more detail below). Realisation dawned gradually that the health effects of smoking and tobacco use were susceptible only to a multi-pronged policy response which combined positive health messages with medical assistance to cease tobacco use and effective marketing restrictions, as initially indicated in a 1962 overview by the UK Royal College of Physicians[5] and the 1964 report of the US Surgeon General.[6]
The concept of multi-pronged and therefore 'comprehensive' tobacco control arose through academic advances (e.g. the dedicated Tobacco Control journal), not-for-profit advocacy groups such as Action on Smoking and Health and government policy initiatives. Progress was initially notable at a state or national level, particularly the pioneering smoke-free public places legislation introduced in New York City in 2002 and the Republic of Ireland in 2004, and the UK efforts to encapsulate the crucial elements of tobacco control activity in the 2004 'six-strand approach' (to deliver upon the joined-up approach set out in the white paper 'Smoking Kills' [7]) and its local equivalent, the 'seven hexagons of tobacco control'.[8] This broadly organised set of health research and policy development bodies then formed the Framework Convention Alliance to negotiate and support the first international public health treaty, the World Health Organization Framework Convention on Tobacco Control, or FCTC for short.
The FCTC compels signatories to advance activity on the full range of tobacco control fronts, including limiting interactions between legislators and the tobacco industry, imposing taxes upon tobacco products and carrying out demand reduction, protecting people from exposure to tobacco smoke in indoor workplaces and public places. regulating and disclosing the contents and emissions of tobacco products, posting large health warnings upon tobacco packaging, removing deceptive labelling (e.g. 'light' or 'mild'), improving public awareness of the consequences of smoking, prohibiting all tobacco advertising, provision of cessation programmes, effective counter-measures to smuggling of tobacco products, restriction of sales to minors and relevant research and information-sharing among the signatories.
WHO subsequently produced an internationally-applicable and now widely recognised summary of the essential elements of tobacco control strategy, publicised as the mnemonic 'MPOWER'.[9] The six components are:
The tobacco control community is internationally organised - as is its main opponent, the tobacco industry (sometimes referred to as 'Big Tobacco'). This allows for sharing of effective practice (both in advocacy and policy) between developed and developing states, for instance through the World Conference on Tobacco or Health held every three years. However, some significant gaps remain, particularly the failure of the US and Switzerland (both bases for international tobacco companies and, in the former case, a tobacco producer) to ratify the FCTC.
Now an accepted element of the public health arena, tobacco control polices and activity are seen to have been effective in those administrations which have implemented them in a co-ordinated fashion; England, for instance, met its target to reduce its adult smoking prevalence to 21% or lower by 2010 through such an approach[10]. Direct and indirect opposition from the tobacco industry continue, for instance through the tobacco industry's efforts at misinformation via suborned scientists [11] and 'astroturf' counter-advocacy operations such as FOREST.
Tobacco Control is also the name of a journal published by BMJ Group (i.e. the publisher of the British Medical Journal) which studies the nature and implications of tobacco use and the effect of tobacco use upon health, the economy, the environment and society. Edited by Simon Chapman,professor of Public Health and Public Policy at Sydney University, it was first published in 1992.