You may now NOT smoke: are we heading for a ban?
Rumours suggest Rishi Sunak may announce a New Zealand-style restriction on tobacco products, aiming to make us smokefree, but it is too high a price to pay
Smoking is bad for you and smoking cigarettes will damage your health and may kill you.
I know, all right? I know smoking kills. My grandfather died of smoking-related throat cancer (and that’s giving “related” a massive holiday, given his intake), both my parents were smokers but gave up in their thirties, and I don’t smoke (cigarettes; cigars, different story). I will tell anyone who’s interested how appallingly—fatally—the tobacco industry misled the public over the effects of tobacco smoking, how early they knew that it was bad for you, how deep was their perfidy in concealing the evidence from the public. I even went to a talk by Jeffrey Wigand once. What do you people want?
This is not an advertisement for smoking. It is not a defence of smoking, but then again, nor is it an apology for it. I want to explore smoking as an issue of rights and freedom, and how society and the government should manage that issue, given that smoking engages conflicting rights and the responsibility of government towards public health. I write this now because it is suggested, quite strongly, that Rishi Sunak’s speech to the Conservative Party conference in Manchester today will include an announcement that smoking will gradually be banned, along the lines of the New Zealand approach.
First, what does that mean? In 2021, the government of New Zealand decided that it would move towards a smoke-free society by making tobacco products more difficult to obtain. Last December, the New Zealand Parliament passed the Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Act 2022, and it was given Royal Assent by the governor general, Dame Cindy Kiro, on 15 December. (Ironically enough, Dame Cindy was formerly a professor of public health.) The act does three things, two of them unremarkable enough for a piece of legislation intended to deter people from smoking, the third much more striking.
The two ho-hum measures are, first, that the number of retail outlets licensed to sell “smoked tobacco products” is restricted, and they must apply for permission to the director general of health, who is also the chief executive of the Ministry of Health, the equivalent of the permanent secretary here. (Coincidentally, the incumbent, Dr Diana Sarfati, who took office only a fortnight before the new legislation was given Royal Assent, is another public health expert, her specialism being disparities in cancer outcomes.) The second provision is that “smoked tobacco products” will have their nicotine content reduced, the level being prescribed by the minister of health. Nicotine, a stimulant, is of course what makes tobacco products addictive; it is reckoned to be only slightly less habit-forming than opioids.
Those are both fairly obvious measures. If you want to discourage people from doing something, make it less convenient and its effects less potent. Where the Kiwis have gone slightly off the reservation is in the third provision of the act, which prohibits the sale of tobacco products to anyone born on or after 1 January 2009. That prohibition is complete and permanent: if you fall into that group, you will never legally buy tobacco products in New Zealand. The government hopes that this will create a generation, the oldest of whom will turn 15 in a few months, which is smokeless. They will not start smoking, they will not be tempted to try smoking and they will not damage anyone else’s health by smoking, because they will simply not have the opportunity to do so legally. There will then come a time when the last person in New Zealand born on 1 January 2009 dies, after which buying tobacco products will simply be illegal.
A few words on context. These are some of the most stringent restrictions in the world, and they are being applied to a country where the prevalence of smoking is already low. Last year eight per cent of adults smoked daily; in the US, the rate is about 11.5 per cent, in the UK it is around 13 per cent, but the global rates are much higher and vary significantly by gender—more than 37 per cent of men smoke, while the rate for women is under nine per cent. This variance is so large that a global average is effectively meaningless.
The minister of health, Dr Ayesha Verrall, explained the benefits of a smokefree lifestyle to Parliament:
Thousands of people will live longer, healthier lives and the health system will be $5 billion better off from not needing to treat the illnesses caused by smoking, such as numerous types of cancer, heart attacks, strokes, amputations.
However, another important factor is an attempt to reduce the disproportionate prevalence of smoking in Māori and Pasifika communities. Verrall hopes to close the life expectancy gap for Māori women by 25 per cent and men by 10 per cent.
These are all very worthy aims, intended to prolong and improve the quality of life as well as reducing pressure on health providers.
I think the law is a monstrous piece of state control, an imposition on freedom of choice and action, the absolute epitome of the nanny state and I would oppose fiercely attempts to introduce similar provisions here.
Let me be clear on a few things. The damage smoking does to your health is not in dispute. We are now at a stage at which the provision of information is so broad that no-one can credibly say they did not know the habit was harmful when they took it up, and so they have made a choice in the full knowledge that the course of action they have chosen elevates their risk of developing one (or more) of 50+ serious health conditions, of which cancer is the most obvious but which also include heart disease, stroke and gum disease. (One website lists “tobacco odour” in the hair, which I feel begins to look like unnecessary clutching at straws: the serious risks are quite enough.) Whatever the risks of these diseases, however much you smoke, however long you smoke for, whatever you smoke, you take up the practice in any form in the knowledge that you are placing your health at risk.
And, in principle, that is not only your choice but your right. Something like 1.3 billion people use tobacco products around the world. Humans have been smoking for around 7,000 years, starting with the use of tobacco in shamanist rituals in central and south America. (Cannabis has existed in Eurasia for about as long, but it was rarely smoked until tobacco was brought to Europe from the Americas in the 16th century.) So to ban smoking is to remove from our society entirely a practice which is extraordinarily ancient: we are talking about an era when some of our ancestors still had not developed agriculture, relied on stone tools, often wore animal skins and lived in small tribes. Antiquity on its own is not a justification for allowing something, but it ought to give us pause for thought.
People sometimes argue, and I have done so mostly in jest myself, that of smoking was invented tomorrow, it would quickly be banned because of its dangers. The same is true of alcohol were discovered. We apply very different and more stringent criteria to new substances or practices, not least because they are still at a stage at which they have not become widespread. As a wry reflection on the myriad inconsistencies and quirks of human existence, it is quite true. But smoking will not be invented tomorrow. It is a thread running through our culture at least as old as farming. We know countless facts and stories about it, it appears in our collective memories.
This is all about freedom, really. The ability to inhale the smoke of burning tobacco leaves may not seem much when we think about the enormous challenges facing the world today, but how we treat small matters says a great deal about how our instincts will lead us to treat greater ones. We need principles to live by, and a presumption of freedom, the freedom to do as you wish without harming others, the freedom to live without arbitrary restraints, is a fundamental principle. It governs how we will order our world, how we will live together, how we will behave. For me, the government must have an extremely powerful case to say to us, you may not do this. That case may not be complex: you stop at traffic lights so that pedestrians may cross in safety. I’m not so drunk on the concept of freedom that I think every Belisha beacon should indicate a free-for-all, where we take our chances and the cunning and swift survive. I’m not proposing we substitute Atlas Shrugged for the Highway Code.
Nevertheless, tobacco products are currently legal to buy and consume, with some restrictions. To say that that state of affairs should cease, that the government should say, we have decided that, in your own best interests, we will take away this freedom, small though it may be, is not to be tolerated.
I acknowledge restrictions. Although my instinct was to oppose it and to see it as a restriction which was unjustifiable, I came to support the ban on smoking in public places, which we introduced in the UK between 2006 and 2007 (Scotland, then Wales, then Northern Ireland, then England). The case of rights versus responsibilities was intricate and long argued, but reframing it made the bans as they were proposed easy to accept: second-hand smoke is a toxin. We can argue about the degree of har, but, in this particular respect, it doesn’t really matter. It exists, and it is not negligible. That being the case, it has to be eradicated from workplaces, which were the main target of the smoking bans in this country. It is simply unacceptable, in health and safety terms, for an employer to be aware of a recognised and easily eradicable workplace toxin, and to do nothing. So restaurants, pubs, bars, offices, shops, taxis, hospitals, schools—if smoking was not already prohibited in places like these, it had to stop. I can still do little better than refer you to the report by the House of Commons Health Committee, published in December 2005, which looked at the proposed legislation in context and made various recommendations (most of which the government accepted). It was sober, evidence-based policy making. And its case was overwhelmingly powerful.
Of course there are instances where competing rights will clash, or where rights will rub up against responsibilities. If you are sitting outside a café, where smoking is not prohibited, you are exercising your freedom. Someone at the next table may object, and they have. a theoretical case that not only may you be making their surroundings unpleasant, but doing them some small harm. Even so, their right not to be exposed to harm is not underpinned by a right to sit at a specific table. If they don’t like it, they may leave. Otherwise, your freedom is the deciding factor. In the real world, very few, if any, rights are absolute, and there will always be cases where a balance must be struck. It should be decided in favour of the most important freedom, but deciding what that is may not always be easy.
As it happens, I also object to the notion that actors or performers or celebrities should not be shown smoking, because they are “role models” and this may encourage people to smoke. I suppose it may: but if we start regulating the behaviour of public figures on the basis of what they may encourage people to do, where is the end point, except drawn arbitrarily? Should no film ever include a car chase, because it may encourage someone to break the speed limit or drive recklessly? Clearly not. Ultimately we have to put people’s destinies as much as possible in their own hands, and that requires us all, every one of us, to accept a greater degree of personal responsibility than, I sense, we take on at the moment. Freedom, as the great Toby Keith tells us, don’t come free, and like many superficially trite lyrics in American country music, it contains a simple but essential truth. Freedom in some senses is a responsibility: it is the responsibility to look after ourselves. Not everyone will discharge that responsibility well or wisely, but it does not then follow that it should be taken from us all.
(In case anyone is working themselves up, this is not a gateway drug to saying there should be no public provision of health, or no welfare, because we must look after ourselves. That is not a logical or necessary extension.)
It may not be wise to smoke. It is almost certainly not healthy. It is expensive, and it may not be popular with your friends and family. But, bearing in mind the restrictions which are already placed upon it, I can see no justification for moving us, however slowly, inexorably towards a prohibition. There may be practical objections: will it simply fuel the black market? Will enterprising souls find some other vice, just as injurious or perhaps more so? Perhaps so, but those things do not need to be true.
The Covid-19 pandemic gave us a window into a world in which we abdicated a great deal of responsibility for our health and well-being to the state, allowing ourselves to be placed under extraordinarily stringent controls. Some were valid. Some were clearly mistaken. Some may have been wrong but undertaken for the best of reasons. In any event, I cannot see the world of lockdown as some kind of utopia, much more a warning, a premonition of what society is like if we infantilise ourselves, holding our arms out for reassurance like toddlers. We need, in my view, not only to undo the small tyrannies of those years, but turn the ratchet further, become a freer, more open but more responsible society. And that, I submit, will not be achieved by Rishi Sunak telling is that, as time goes on, citizens will lose the right to be able to buy cigarettes or cigars or pipe tobacco. Know the risks, of course, and consider them like an adult; do not harm others where it is easy to avoid it; but, ultimately, it’s your choice. And that is a state of affairs to which a government should always aspire.