Tobacco Control Playbook

KEY MESSAGE: Tobacco is uniquely harmful, requiring unique approaches. There are some similarities with other preventable health problems and harmful behaviours, but also differences. Action on tobacco recommended by health authorities is evidence-based, proportionate to the magnitude of the problem and will prevent millions of unnecessary deaths.

What is the issue?

The tobacco industry and its allies claim that action on smoking is the first step on a slippery slope that will affect many other products, industries and behaviours.

What is the evidence for concern?

• From very early days, the tobacco companies have argued that any action on smoking is just a start, and that other products and industries will follow ^[1].

• They also argue that restrictions on smoking will extend to other behaviours ^[2].

• They claim that public health campaigners, organisations and authorities see tobacco as a testing ground, and the model for further action and restrictions, and even that advocacy groups for tobacco control are "health fascists" and "nicotine Nazis" ^[3][4].

• It is claimed that exactly the same arguments and objectives are used for other areas in public health as for tobacco ^[5][6].

• The Legacy/Truth industry documents show several thousand references to the "slippery slope". These include not only discussions and lobbying documents, but also even press and television advertisements using the "slippery slope" as an argument against action on smoking ^[7].

• As part of the "what's next?" case, examples used to worry other industries (and the public) are advertising bans, tax increases, health warnings and plain packaging ^[8][9][10].

• The tobacco industry has strong links (often including co-ownership and common board membership) with other industries such as alcohol and junk food. Tobacco companies seek to enlist the support of such companies on the basis that action on tobacco brings action in their areas one step closer ^[11]. They further, however, express concern that some organisations involved in action on tobacco also press for action on other health issues such as alcohol ^[12].

• Tobacco companies and their supporters regularly use slogans such as "nanny state" as part of their argument that there is a broader, more sinister agenda ^[6][10][13].

• Tobacco industry and allies also claim that while campaigners and health organisations claim their approaches to tobacco and other issues are not identical, these denials cannot be believed - today it's tobacco, tomorrow it may be cars, sporting goods or chocolates ^[8][10].

• The essence of these claims is that in reality action on smoking is part of a prohibitionist, anti—industry push.

What is the reality?

• Tobacco is unique. It is the only product which, when used precisely as intended, kills half of its consumers ^[14].

• The action on tobacco recommended by health authorities is evidence-based ^[15].

• Action recommended to reduce smoking is proportionate to the magnitude of the problem, and will save millions of lives ^[16].

• There are some similarities between tobacco and other health problems, but also differences. Some of the same approaches may indeed be appropriate, but each issue needs to be taken on its merits ^[17].

• It is entirely appropriate that organizations concerned for the public's health, such as the World Health Organization, national medical and public health associations, cancer and heart charities and indeed governments should be involved in addressing not only tobacco but also major health and social problems such as those related to alcohol and obesity.

• The ultimate objective for tobacco is to end all use of the product. The same objective does not apply in areas such as alcohol or obesity ^[17][18].

• It is simply untrue to claim that tobacco control is part of a broader anti-industry push. It is reasonable that people working on other issues should learn from the tobacco example (including dealing with harmful industries and misleading arguments). It is also not surprising that other harmful industries seeking to oppose effective action believe that they can learn from the tobacco experience.

• Terms such as "nanny state" are meaningless clichés, used by those without substantive arguments. Any civilised society recognises that states have a responsibility to protect their communities. This is particularly the case in relation to public health, where objections to action aimed at reducing smoking have no more validity than opposition centuries ago to ensure safe food and water, or more recently to action that protects the community in areas ranging from immunisation to road safety ^[10][13].

• The aim of public health authorities is to benefit and improve public health, which in the case of tobacco control entails seeking to prevent the seven millions tobacco-related deaths that occur annually ^[19].

• Suggestions of a dark, prohibitionist, anti-industry agenda are a fabrication.

Key messages

• Tobacco is uniquely harmful, requiring unique approaches.

• There are some similarities with other preventable health problems and harmful behaviours, but also differences.

• Action recommended by health authorities is evidence-based, proportionate to the magnitude of the problem and will prevent millions of unnecessary deaths.

• There is no prohibitionist, anti-industry agenda. Any such claims are fabrications.