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January is traditionally a time to focus on our health, and on the steps we can take to improve it.

But what about the health of the nation overall? One of the biggest factors affecting the UK’s health is the gap between rich and poor – an important factor that affects rates of diseases like cancer.

More than eight in 10 cases of lung cancer in the UK are a result of smoking, and our research shows that, because of differences in smoking rates, social deprivation leads to 11,000 people dying unnecessarily from lung cancer every year in the UK.

It’s therefore vital that information about the link between smoking and health inequalities is scientifically analysed.

So, we were alarmed by a recent report, published in the BMJ’s Tobacco Control journal, that showed how the tobacco industry has misrepresented scientific evidence on health inequalities to the Government.

This continues the industry’s pattern of misinformation and deceit. Let’s look at what the report found.

What did the researchers do?

In 2008, the Department of Health invited organisations and the public to give their views to help inform its policy on tobacco control (known as a consultation).

The tobacco industry and allied organisations made several submissions.

The BMJ report, written by David Clifford from the University of Bath’s Tobacco Control Research Group, and Dr Sarah Hill and Professor Jeff Collin from the University of Edinburgh’s School of Social and Political Science, analysed seven of these submissions in particular for arguments relating to health inequalities and smoking.

Why is it important?

The tobacco companies who submitted evidence are responsible for nine out of every 10 cigarettes sold in the UK.

And their views were striking, if unsurprising. Despite the clear impact of deprivation and inequality on lung cancer, all seven submissions argued that these inequalities meant that the government should tackle inequality by relaxing policies aimed at reducing smoking.

Their underlying point appears to be that smoking is merely a ‘symptom’ of a wider problem that causes inequality, and so tobacco control policies are a wasted effort, as they don’t get to the root of this.

Government, they feel, should cast its efforts elsewhere, rather than treating the mere ‘symptoms’ of inequality.

The graphic below disproves this by showing how smoking rates have changed as tobacco control policies have come in, and how that’s affected lung cancer rates over the same period:

Lung-IncVsSmo

Let’s look at the tobacco industry’s specific points.

Blame

According to the report, the tobacco industry’s submissions tried hard to shift the blame for inequalities onto others, and refused to accept its own role in creating them.

One submission from FOREST, a campaigning group funded by the tobacco industry, even attacked the Department of Health’s work on tobacco control for “help[ing] to stigmatise people on low incomes”.

But the fact is the tobacco industry has directly contributed to worsening these inequalities.

Keeping you hooked

The researchers also found the tobacco industry arguing that increasing tax on cigarettes “burdens the poor communities” and “exacerbates health inequalities”.

But this goes against published evidence, which suggests that increasing the price of cigarettes is one of the most effective ways to reduce smoking-related health inequalities, by providing a price incentive to quit smoking.

And, when faced with past tax increases, some tobacco companies have actually lowered their prices to absorb the tax hike.

Another related argument they used is that raising the price of tobacco furthers inequalities; according to the tobacco company Philip Morris: “the widespread availability of cheap smuggled and counterfeit cigarettes [is] accessible to public and minors alike”.

This is a key argument used again and again by the industry. But when you look at the statistics, official figures show that the size of the illicit trade market has more than halved since its peak, from 21 per cent in 2001 to 10 per cent in 2013/14, and is set to continue to do so.

The industry’s argument here doesn’t stand up.

Protecting our next generation

The report uncovered one submission that claimed that children don’t take up smoking because of advertising, displays and packaging of cigarettes, but “rebelliousness and risk-taking” instead.

This is important – rates of smoking among kids from socially deprived communities can be well above the average.

But childhood mischievousness is highly unlikely to be the cause.

As we’ve blogged about before, and as this video highlights, an independent review of the evidence has shown that tobacco marketing can appeal to children, and that plain, standardised packaging reduces their appeal:

This is why we’re calling on the government to introduce standardised packaging ahead of the next General Election.

All of this, on top of their usual box of tricks

We’ve blogged before about the tactics of big tobacco. And in addition to demonstrating a new effort to target health inequalities, this research also confirmed the well established tactics of the tobacco industry to undermine effective tobacco control policy:

  • Calling for ‘reduced risk’ tobacco products? Check.
  • Misrepresenting scientific evidence? Check.
  • Arguing that tobacco regulation breaches individual liberties? Check.

As a final example mentioned in the report, this from British American Tobacco (BAT) was particularly striking. Its submission to the Government referenced an article by Sir Michael Marmot, to claim that “health inequalities are not associated with a single factor such as smoking, but with many differences in the circumstances in which people live and work.”

Let’s read what Sir Michael Marmot actually wrote. Despite the importance of smoking to inequalities we’ve discussed, BAT conveniently neglected to mention the conclusion of his article, which explicitly recognised the need to address smoking rates to tackle health inequalities:

“Reduction of the health disadvantage of those in lower social positions will require action to improve those circumstances throughout the life course […]. If, however, at least half of social differences in adult mortality are the result of differences in smoking, the conclusion might be to forget social conditions, neighbourhood deprivation, employment conditions, early childhood and subsequent adult disease; just focus on getting the smoking rates down in people of low status.” [emphasis ours].

Selective reporting? You betcha.

Yet more misleading information

This report demonstrates the lengths the tobacco industry will go to try and twist the facts.

It has repeatedly tried to undermine measures to reduce the number of smokers – its lifeblood – in the UK. And the industry is still at it, providing misleading information about health inequalities and absolving itself of any responsibility for its actions.

It’s crucial that messages about the relationship between smoking and health inequalities are clearly communicated and based on scientific evidence.

The fact that the tobacco industry is making misleading arguments in public to argue for reduced tobacco control is bad enough.

But it’s inexcusable when those arguments are presented to the Government as ‘evidence’ when, as we know, the evidence points in the opposite direction.

Dan Hunt is graduate trainee in the policy department at Cancer Research UK

Reference

  • Clifford, D., Hill, S., & Collin, J. (2014). Seeking out ‘easy targets’? Tobacco companies, health inequalities and public policy Tobacco Control, 23 (6), 479-483 DOI: 10.1136/tobaccocontrol-2013-051050

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