International Flights to be Smoke-Free

Federal Transport Minister Laurie Brereton has announced that flights between Australia, Canada and the USA will be totally smoke-free from 1st March 1995, under a treaty signed between the three countries on 1st November. Smoking will be banned on all Australian international flights from 1st July 1996. This last is in keeping with a resolution proposed by Canada and seconded by Australia at the International Civil Aviation Organisation (ICAO) last year, which called for smoke-free flights by 1st July 1996, so Mr Brereton is not going a day earlier than he has to. Incidentally, Qantas is in the High Court in Sydney defending a suit by a non-smoker on 21st November. Now lets end duty-free cigarettes!

NSW Quit Ad Killed

The TV advertisement that was to have spearheaded the 1994 NSW Quit campaign was stopped the day before it was due to be filmed. The ad was against passive smoking and featured a child being led into a gas chamber and the door being shut. Quit director Martin Palin had done market research into public reactions to the ad, and had undertaken considerable consultation with other health groups. It seems he had not sufficiently persuaded the public relations general manager in the Health department. She, a smoker with young children, despite the research, stopped the ad.

The cancellation cost the NSW Health department $150,000 and Palin was publicly castigated in the Sydney Morning Herald. How the Health department expects to get its staff to use their initiative, when staff go through the correct methods but have their superiors stop their work on a personal whim is not explained. Some ads were adapted from Victoria to fill the TV advertising time.

Money Buys Votes

Two new studies, one in US congress and one in the Californian state parliament have both shown what everyone has believed for years, 'The more tobacco money that a member of congress received, the less likely he or she was to support tobacco control issues'. The tobacco industry contributed to 83% of current US senators and 68% of lower house members. Source: JAMA 19/10/94

Australian political party donations have fallen since funding disclosure legislation came in, and our politicians are asking for increased public funding of election campaigns. Given the corruption in Italy and Japan with political donations, Clinton's troubles with the Whitewater real estate scandal and these latest tobacco revelations, a bit of public political funding might be the lesser of two evils.

Weak Action on Kids' Access

The NSW Health Department has done another survey that shows kids as young as 12 are finding it easy to buy cigarettes, with 80% of underage smokers being sold cigarettes without question. 72% of 13 year olds and 61% of 12 year olds reported no difficulty. Yet the legal age was raised to 18. Half of the teen smokers started by age 13. A police prosecutor hired a year ago to educate health inspectors has also made little difference. The problem is under the current law, kids have to give evidence, and parents and police are reluctant to involve them. The law needs to be changed.

Meanwhile Health Minister Phillips is huffing and puffing about 'proof of age cards' and Philip Morris is launching yet another 'retailer education program'. Members may recall Minister Phillips letter of 25th August (quoted in Update 2) "prosecutions are not always seen as the most appropriate.. a high level of compliance is achieved through the use of alternative methods....It is of great concern to the Department that the NSMA assumes that as there have been no Departmental prosecutions to date that there has not been increased compliance...it is my view that prosecutions should be seen as an act of last resort.. success should be judged on compliance..". This certainly looks a bad joke now, and reveals the fob-off letter for what it was. Western Australia has had prosecutions of hundreds of dollars. NSW seems lost in the 1930s.

Action Point 1.

Call a talkback radio station or write to a newspaper about children buying cigarettes. The NSW Parliamentary term is almost over and they will not sit again till after the election.

Philip Morris Challenges Ad Ban

On 6th June Philip Morris challenged the Federal Tobacco Advertising (Prohibition) Act in the High Court, asking that it be declared invalid as it denies normal commercial freedom of speech. The Commonwealth Health department is defending the case. A hearing date is not yet set.

Smoking Increases in Kids Films

The NSW Cancer Council and the National Heart Foundation have criticised cigarette advertising by 'product placement' in films. A voluntary code in the USA has been shown to be a complete farce. Australian and US films have smoking in a positive or bravado/risk taking situations. Examples are Reality Bites, the Specialist, and Muriel's Wedding. What is needed is a new policy with mandatory disclosure of any tobacco money received, as well as merely classification changes.

Action Point 2

Write to Federal Health Minister Carmen Lawrence, Parliament House, Canberra 2600 or Frank Marzic, Office of Film and Literature Classification, Level 1, 255 Elizabeth St., Sydney 2000

Obituary- Peter Wilenski

Non-smokers were saddened to hear of the death of one our most distinguished members, Peter Wilenski at the age of 55 of lymphatic cancer. Peter was a 'Renaissance man'. Foreign Minister Gareth Evans called him, 'a remarkable combination of compassion, intellect, vision, energy and effectiveness'. He believed in the human spirit, and distinguished himself as a public service reformer, before becoming Australia's representative at the United Nations. As head of the Federal Public Service Board in 1987 he made it smoke-free. There was no fuss, no problems, in fact it was not even mentioned in most of his obituaries in the popular press. Yet it proved what could be done and how easily. If only more people lived by his example.

Paris Conference Report

The 9th World Conference on Smoking or Health was held in Paris from 10-14th October. Dr Chesterfield-Evans represented the Movement there, and presents his report.

First some reflections, then the real news. Paris is a great city. The food is excellent, and not necessarily expensive. The first thing that strikes a 'health person' is that there are almost no fat people in Paris apart from tourists. People dress well and eat non-fattening foods. The conference was at 'La Defence' on the outskirts of Paris. The venue was somewhat impersonal. There was little tea or coffee and few places to sit, which made networking harder. However, the lack of free coffee was said to help to have paid for the 20% of delegates from developing countries who were helped to attend. Delegates were invited to the magnificent Town Hall by Jacques Chirac, the Paris mayor and presidential hopeful. Chirac was not there himself, and was replaced by another official, a snub which offended some French non-smokers, but was not actually noticed by most delegates.

The news on smoking in France is not so good. The smoking rate is 42%, and almost all adolescents smoke, having been converted to US brands. They now smoke Marlboro or Winston, rather than Gitanes or Gauloises. There is successful ban on advertising and sponsorship. There is a ban on smoking on the Metro and there are compulsory smoke-free areas in all cafes. The Metro ban is not entirely observed in the stations, but it is in the trains. In cafes there is always a non-smoking section, but it often ignored, though at times the offer is made. Things are a lot better than they were.

The World Scene

There was some good news and some bad news. The good news is that health groups around the world are becoming more sophisticated, and recognise that it is a political war. The papers were on how legislation was achieved, what rates there are in each country, far more than just the medical aspects that used to be covered. There are better links than ever and more camaraderie around the world. The World Bank will no longer fund tobacco projects in the developing world.

But there is also a lot of bad news. Britain, Germany and Holland have held out in the European Parliament and the advertising ban that was suggested has been defeated. It does not look like rising again in the medium term. In the USA President Clinton's health bill, which was going to raise tobacco tax and introduce a universal health insurance scheme has been defeated, so US tobacco taxes will remain low. The failure of the Clinton bill has had wider implications. The low tax US has forced the Canadian government to lower their tax (despite the efforts of health campaigners), because of the amount of smuggling across the US border. The Democrats are also expected to lose their majority in the US Congressional elections, so the chance of a similar tobacco and health bill getting through next year is slim.

In Asia the multinational tobacco companies are replacing national monopolies and as they are far more aggressive in their marketing, tobacco consumption is rising sharply, and is likely to increase 30% by 2000. In Eastern Europe the situation is similar, but there is such a breakdown in the government control of some countries so that it makes little difference what the law is. It is not implemented.

Overall per capita consumption in the developed world in the years 1990-2000 is forecast by the World Bank to fall by 17% in the 35 most developed countries and to rise by 12% in the 180 developing countries. Overall world consumption is still rising, and is currently killing 3 million people a year, but this will rise steeply.

British Doctors' Study Results

Probably the most significant paper at the conference was the presentation by Richard Peto of the latest results of the study of smoking and death rates in British doctors which was started in 1951. When Richard Doll found the link between smoking and lung cancer in 1950, he wrote to all doctors registered in the UK and asked them to record their smoking habits. 40,000 replied and he set up a study to measure their survival. 10,000 died in the first 20 years of the study and 20,000 have died in the second 20 years. The death rate of smokers in the age group 45-64 is about 3 times as high in smokers as lifetime non-smokers, and this is in diseases caused by smoking. The risk of dying is higher than was formerly thought and it is now estimated that approximately half of regular smokers will be killed by their habit. Diseases that were commoner in smokers were: cancers of the lung (15x more common than in non-smokers), oesophagus, stomach, urinary bladder and pancreas.

Lung problems of chronic bronchitis, emphysema, asthma, and pneumonia were commoner, as were the circulatory problems of pulmonary heart disease, aortic aneurysm, ischaemic heart diseases (coronary disease) and cerebrovascular disease (strokes). The difference in deaths from ischaemic heart disease between smokers and non-smokers is 1.76:1 after standardisation for alcohol consumption. (Interestingly, drinking a few alcoholic drinks per day seems to prolong life). It is pointed out that the death rate from heart attacks and strokes in smokers is double that of non-smokers, but because these deaths are earlier or follow periods of long-term disability from middle age, their significance is even greater. Peptic ulcer is 3x and cirrhosis of the liver is 5x commoner in smokers, though this last may be because smokers tend to drink more heavily.

Parkinson's disease is less common in smokers, but Doll and Peto speculated whether this may not have been a health effect, but merely that the tremor of the disease meant that its sufferers have difficulty smoking, hence become 'former smokers'. There was not much difference in Alzheimer's or senile dementia in smokers and non-smokers, though it was pointed out that not many people actually die of these conditions. As the smoking and non-smoking groups reached later middle age the differences between them increased. There were also deaths due to fires caused by smoking in bed. Pipe and cigar smokers are intermediate between cigarette smokers and non-smokers.

The big message is that half of lifetime smokers will be killed by tobacco and half of these (i.e. a quarter of all smokers) will die in middle age (35-69), losing an average of 20-25 years of life compared to a non-smoker. Because of the large number of people killed by tobacco, just over half of deaths in middle age are caused by tobacco. More than twice as many deaths are caused by cardiovascular disease than cancers. The effect of quitting even in middle age is to reduce the death rate, so 'its never too late to quit'. BMJ Vol 309, 8/10/94, p 901-10

Smoking Increases Hip Fractures

Dr Takeshi Hirayama released a major study on the effect of diet and smoking on the rate of hip fractures. 265,000 people over 40 had been followed for 17 years. The results were that smoking men have 2.45 times the fracture risk of non-smoking men, and women smokers 2.3x the risk. Vegetables, fish and milk also reduce fractures, meat and alcohol make no difference.

A recent Australian study by Professor Sambrook of the Garvan Institute in Sydney found that the bone density of smokers is much less than non-smokers. The bone density is 0.93gm/square cm in non-smoking men, 0.91 in ex-smoking men, and 0.86 in smoking men. In women it is 0.79 in never smokers, 0.78 in ex-smokers and 0.73 in smokers. Hence the higher rate of hip fractures.

Two significant books were released at the conference.

Mortality from Smoking in Developed Countries 1950-2000 by Richard Peto, Alan

Lopez, Jillian Boreham, Michael Thun, and Clark Heath jr. This paperback of 553 pages is a collaboration of a great number of sources, especially the World Health Organisation. It is an expansion a Lancet article (1992 Vol.339:1268-78). The data collected up to 1990 has been analysed by the authors, then extrapolated to the year 2000. The purpose of the book is to point out the size of the epidemic, and to help readers communicate it to the world in general, so that governments and individuals can be persuaded to take action. It has a lot of large and simple full-page tables and graphs that are deliberately designed to be made into overhead transparencies. Express permission to do this is given.

Rates of death have been compared to US non-smokers, who are presumed to have a reasonable standard of health and are thus the reference population. The format is simple and the explanations clear. Death rates are compared to non-smokers, and the data for all ages and middle age (35-69) are expressed separately. Countries are compared, with their smoking caused deaths clearly shown in different years. (Australia has improved from the middle of the pack in 1975 into the top quarter in 1995). The international comparisons are interesting, but not of routine use, and the problem with such a comprehensive book with so many countries in it is that Australian graphs and data are only 6 pages of overhead-type graphs and six pages of detailed tables of smoking attributable deaths divided by age, sex and diagnosis. The book is useful in comparative terms but if all that is needed is some Australian data, there may be simpler ways of getting it, with the new manual from ASH due shortly.

Why not have an input to Update?

Our Address is:

Non-Smokers' Movement of Australia,

Box K860, Haymarket NSW 1240.

The Fight for Public Health, Principles and Practice of Media Advocacy,

by Simon Chapman and Deborah Lupton.

Simon Chapman has for many years been an important link between the academic and activist groups. It has been a slightly lonely position as activists have tended to regard him as an academic, and academics as an activist. But he has persisted in his cause, and both groups have benefited from his efforts. This book is about how to actually get public health measures implemented. After an introductory chapter 'What is Public Health Advocacy?', it is divided into two parts. It has 106 pages of relatively academic writing co-written by Deborah Lupton analysing news coverage, with case studies to illustrate the elements of advocacy.

The second half of the book is an A to Z of advocacy, written in a more 'down to earth' style, but still well referenced, on how to actually run such a campaign. All the major points are there, and having read the A-Z, the reader will have a good idea how to get on with running a campaign. It is to be hoped that this book will add to the academic respectability of health advocacy, so that it can become an integral part of university public health training. Chapman's book will be a worthy first textbook in the area. BMJ Publishing softback 270p $45.95.

Action Point 3

Write to Warwick Hough, Restaurant and Catering Assoc. 121 Alexander St., Crows Nest 2065. Ask that they advocate Smoke-Free indoor air legislation, not just air conditioning controls. Give examples of a problem that you personally have had in a restaurant.