Simon Chapman: Tobacco industry targeting poor

Every year about 40 per cent of smokers make a serious attempt to quit. Photo / Bloomberg

Opinion

Plain packing has been a reality for Big Tobacco in Australia for three months now; New Zealand announced last month it will follow suit; and at least four other nations, including India, are also considering plain packs. So just how bad do things look for the tobacco industry?

The answer here depends on where you are talking about.

Let's take Australia first. Thirty-five years ago when I started my career, around 45 per cent of men and 30 per cent of women smoked. Today 16.4 per cent of men and 13.9 per cent of women in Australia smoke daily. Every survey in the past 20 years has seen smoking rates heading south.

Teenage smoking rates are also at an all-time low: in 1996, 28 per cent of 17-year-old boys smoked, and 34 per cent of girls. Today it's 16 per cent and 13 per cent. And that's been achieved without "targeting" teenagers, which evidence suggests is about the worst thing you can do. Teenagers smoking has fallen away dramatically by stealth: they see the quit campaigns targeted at their smoking parents, have grown up since 1992 with a total ban on tobacco advertising and sponsorship, and live in a society where smoking has become denormalised.

But what about the smokers who remain? Are they a "hard core" of thoroughly addicted smokers who either can't or don't want to quit?

In fact, they're anything but. It's not just the light smokers who have quit: many very heavy smokers have too, and if it was mostly only heavy smokers left smoking, average daily consumption would be rising, which it's not.

A 2002 study of 8000 smokers from four countries, including Australia, found the experience of regret at having started smoking was nearly universal: 90 per cent of smokers agreed or strongly agreed with the statement, "If you had to do it over again, you would not have started smoking". I've never met a smoker who lived in hope that their own children would take up smoking, even as adults.

So with 15.1 per cent of Australians smoking daily today, that leaves just 1.5 per cent who smoke and who have no regrets. For every 200 people, just three will be smokers who are happy about it.

Every year about 40 per cent of smokers make a serious attempt to quit. Smokers around the world shell out US$1.8 billion ($2.1 billion) on quit treatments. They are not doing this to make a charitable donation to the pharmaceutical industry. They smoke, desperately wish they didn't and want to stop. Can there be any product in the history of commerce where the customer base feels so bad about consuming it?

Many studies have shown large proportions of smokers welcome restrictions on where they can smoke, tax rises, and ghoulish pack warnings. They know these things help them regulate their smoking. Only one in 10 smokers now smoke inside their own homes and 58 per cent of Victorian smokers believe the sale of cigarettes should eventually be banned.

But what about other parts of the world?

I have reviewed a yet-to-be-published study from a rural tobacco-growing province in China where 89 per cent of illiterate males smoke. Big Tobacco's planners eye their world maps and salivate over large, poorly educated populations, ideally with corrupt officials.

Tobacco websites touchingly now "agree" that smoking causes health problems, and they cynically promote new reduced harm products, spinning the ever-so-responsible line that they hope that smokers will switch to these less risky products.

For the world's largest and poorest nations, the worst tobacco promotion is yet to come.

All the while they continue to virulently oppose any policy that threatens to actually reduce smoking. Their dream is of "dual use" where as many people smoke as much as they can, whenever they can, while using smokeless nicotine products during the hours or settings where smoking is banned, to keep blood-nicotine levels high.

The good news is 176 nations have now ratified the legally binding World Health Organisation's Framework Convention on Tobacco Control, obligating them to introduce the sort of policies we have had in Australia for decades. The only nations which haven't are tobacco states such as Malawi, Zimbabwe, Haiti, Cuba and the tobacco industry paradise of Indonesia, where Western rock and pop acts still assist to promote smoking at music festivals.

Today's epidemic of tobacco-caused disease started about 120 years ago with the invention of the safety match, the mechanisation of cigarette manufacturing, the efforts of the advertising industry and the tobacco industry's addiction chemists. In many nations the death toll is now on the wane. But for the world's largest and poorest nations, the worst is yet to come.

Simon Chapman is a Professor of Public Health at the University of Sydney.