The death of smoking: how tobacco will be eradicated for good

Smoking rates have been slowly falling in Western countries for decades. Soon, the habit could be wiped out, without even having to ban it.

By Clare Wilson

MOST of us in the West are an unhealthy lot: we eat junk food, drink too much alcohol, exercise too little and generally ignore medical advice designed to help us live longer.

But there is one thing we are listening to our doctors about. Smoking rates have been slowly falling, year on year, in most Western countries for decades. This month saw the 10-year anniversary of England’s ban on smoking in enclosed workplaces – including bars and restaurants – a change that once would have seemed inconceivable. The UK government is due to announce new tobacco control strategies for the next few years.

The decline of smoking is emboldening some public health officials to plan for what is sometimes called the tobacco endgame – stubbing out smoking completely. But several strategies to reach this goal have potential pitfalls, and some could even be counterproductive. So is a smoke-free future ever going to happen, and what could we do to bring it about?

Smoking was a minority pursuit until the late 19th century and the arrival of one of the deadliest inventions in history: industrially produced cigarettes. Their popularity soared during the first world war, as soldiers were given cigarettes with their rations. Celebrities, athletes and even doctors endorsed the habit. At its peak in the mid-20th century, around half of all adults in the UK and the US smoked.

But the evidence was building that smoking causes lung cancer, as well as heart attacks, strokes and other diseases. The risks were denied by tobacco companies for decades, but the tide of public opinion was turning. As governments brought in an increasing array of tobacco control measures, from health warnings on cigarette packs to advertising bans and restrictions on where people can light up, smoking rates have slowly declined.

A long-standing fear, however, has been that the fall would stop because of a hard core of smokers impervious to all health advice. “People always used to say you can never get below 25 per cent,” says Martin Dockrell of Public Health England.

But this hasn’t happened. In the UK, adult smoking rates are now down to about 16 per cent, in the US, 15 per cent. So how long could this trend continue?

Some think there is practically no limit, including Stanton Glantz at the University of California, San Francisco, a long-time tobacco control crusader. He says that while smoking will never be completely wiped out, the habit could be eliminated “as a public health problem of substantial consequence” – in other words, smoking rates could be reduced to just a few per cent.

Some countries already have this goal in sight. New Zealand, which has long had some of the world’s strictest tobacco control laws, aims to get adult smoking down to below 5 per cent by 2025. Finland is aiming for this by 2030, including the use of chewing tobacco and e-cigarettes.

A plan to ban

But is this goal enough? Despite all the health warnings, some argue that people assume cigarettes can’t be that bad if you can still buy them everywhere. Perhaps a full ban is the only way to get the message across.

To date, only one country has dared go this far. In 2004, the Himalayan nation of Bhutan outlawed the sale of all cigarettes and chewing tobacco. People can buy them legally abroad, but there is a limit on what they can bring into the country.

Western nations probably shouldn’t look to Bhutan’s ban as a guide, though, as even before it came in, the country’s smoking rate was estimated at just a few per cent. It is also very different culturally. The main religion is Tibetan Buddhism, which encourages people to keep a clear mind so they can meditate, says Michael Givel at the University of Oklahoma. “Tobacco hasn’t been as big a cultural thing as elsewhere.”

Aside from the question of whether it is ethical to stop people doing something they enjoy, this kind of ban may also backfire. History tells us that prohibition fuels criminal suppliers. This happened in the 1920s when alcohol sales were banned in the US, and still goes on today with illegal recreational drugs such as heroin.

“There are all sorts of scary unintended consequences that could come along with prohibition,” says Dockrell. Use could even increase, he says, as illicit cigarettes would be much cheaper and lack health warnings.

“You’re much more effective at regulating products if they’re legal,” says Deborah Arnott of UK anti-smoking group Action on Smoking and Health.

It’s hard to know the effect of the ban in Bhutan as there is no reliable data, but seizures of smuggled tobacco in the country rose more than three-fold between 2005 and 2008. “If anyone claims they can get rid of smoking based on the