Waiting for the Domino Effect: This Month, Landmark Legislation Comes into Force in Australia, Making It the First Country to Ban Branded Cigarette Packaging. Mike Daube Talks to Fiona Fleck about How Public Health Campaigning Has Come a Long Way since the 1970s

By Fleck, Fiona | Bulletin of the World Health Organization, December 2012 | Go to article overview

Waiting for the Domino Effect: This Month, Landmark Legislation Comes into Force in Australia, Making It the First Country to Ban Branded Cigarette Packaging. Mike Daube Talks to Fiona Fleck about How Public Health Campaigning Has Come a Long Way since the 1970s


Fleck, Fiona, Bulletin of the World Health Organization


Q: When did you start campaigning for tobacco control, and why?

A: I started working on tobacco in the United Kingdom of Great Britain and Northern Ireland in early 1973, as the first full-time director of Action on Smoking and Health, so--a long time ago. Recently, an American researcher working on the early days of tobacco control phoned and said excitedly, 'I've just discovered that you're still alive!' In those days there was no tobacco control advocacy as we now know it. I saw tobacco as a massive public health problem that was barely being addressed and that needed a different approach. There was overwhelming evidence on the magnitude of the problem and concern in the medical establishment, but very little was actually being done. It was a campaign crying out to be fought.

Q: What was it like campaigning in those days?

A: It's difficult to describe how tough it was. Things were so different. Misconceptions were rife. The media thought that every time someone spoke about the dangers of smoking, "balance" required someone from the industry to deny the evidence. A leading health reporter told me in 1973, "you're never going to find anything new to say about smoking". The tobacco companies were powerful and respectable: their leaders got knighthoods and peerages. Respected medical researchers worked with and took funding from tobacco companies. The Royal College of Physicians invited comments and amendments on its reports from the tobacco industry, until I got them to stop. At my first ASH meeting in the Royal College of Physicians in 1973 some of the country's most distinguished doctors, frustrated by the lack of progress, debated for two hours what they could do to make the government quake in its boots. Eventually they had the answer: they would write a letter to the Lancet.

Q: Why was there so little understanding of tobacco control?

A: Most people didn't understand the magnitude of the problem and just how ruthless the industry was and, in those days, we didn't have access to confidential industry documents now available following the US Master Settlement Agreement. There was no real peer group in the country, and only a few colleagues outside the United Kingdom. There was very little money for campaigning. Once I had to deliver media releases to the newspaper offices around Fleet Street on foot in a thunderstorm! The first time I bought shares in tobacco companies so that we could ask questions at their annual general meetings--such as "How many deaths were the company's products responsible for in the last year?"--I didn't dare to tell the ASH board. But after the first one, they all wanted to join in the fun! I am amazed, in retrospect, at how generous the medical hierarchy was to a young man with long hair and a penchant for purple suits, who wanted to turn ASH into a real pressure group. I was unbelievably privileged to work with some of the great figures in the United Kingdom's public health history: Charles Fletcher, Sir George Godber, Keith Ball, Lord Platt, David Player and Sir John and Eileen Crofton, as well as wonderful international colleagues including Nigel Gray, Kjell Bjartveit, Michael Pertschuk, Stan Glantz and Matt Myers. A real joy of later decades has been working with Simon Chapman, Mela nie Wakefield, Maurice Swanson and other terrific colleagues in Australia and elsewhere.

Q: What were the early successes?

A: We got tremendous media and community interest. Some superb journalists in all media made crucial contributions, along with support from journals such as the BMJ. Tobacco companies reacted angrily to our work. Governments responded to the media attention, with action in areas including advertising controls, tax and public education. One year we got eight cigarette brands withdrawn from the market (two, named "Rapier" and "Stiletto", by pointing out how appropriate it was to name them after lethal weapons); the Chancellor of the Exchequer (finance minister) made the case for tobacco tax increases as a health measure; there were further curbs on tobacco promotion; we ended some appalling forms of promotion; and doctors and health professionals got increasingly interested in campaigning. …

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Waiting for the Domino Effect: This Month, Landmark Legislation Comes into Force in Australia, Making It the First Country to Ban Branded Cigarette Packaging. Mike Daube Talks to Fiona Fleck about How Public Health Campaigning Has Come a Long Way since the 1970s
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