Public Health Advocacy and Tobacco Control: Making Smoking History Review & Ratings

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Public Health Advocacy and Tobacco Control: Making Smoking History Review

From: British Medical Journal October 2007
"He takes up some of the hottest issues in contemporary tobacco control worldwide and shows us their ethical, political, and policy complexities. Chapman's chapter on harm reduction and product regulation is one of the most nuanced pieces I've ever read on this contentious topic, which threatens to seriously divide the tobacco control movement.
Situating the issue within the history of industry product engineering, he reminds readers of the "lights" debacle, from which tobacco control advocates still have much to learn. The tobacco industry developed so called light cigarettes that delivered less tar and nicotine, as measured by machine. However, it was determined only much later (after millions of smokers switched to lights, thinking they would be safer) that lights were no safer at all, because people covered the specially engineered ventilation holes that allowed the lower levels measured by machine, and they "compensated" by smoking more and more deeply--facts that the industry knew all along. Given the recent interest by major multinational companies in acquiring manufacturers of smokeless tobacco products, Chapman argues for a strong regulatory regime. Under such a regime the amounts of specific, known harmful constituents in all tobacco products would be reduced and product distribution would be curtailed, but he warns that such tinkering should not divert tobacco control from its primary focus.
Chapman's book is serious scholarship, but don't mistake it for some spiritless tome that only academics will want to slog through. Anyone remotely interested in public health advocacy, ethics, and policy--not only related to tobacco--will find it a rewarding read. Chapman blends history, policy, ethics, and advocacy in a witty, engaging, and accessible way. Discussing Australia's laws on smoke-free areas, for example, he observes: "For a time in Australia, you could not smoke within two metres of a bar, this being deemed sensible to protect bar staff from harm. But at 2.01 metres, the idea was that they can breathe easy. There was the small problem that everyone forgot to tell the smoke it had to keep back. Anyone with an IQ a point higher than it takes to grunt understood that something was very wrong here."
Chapman sees informed advocacy as part and parcel of public health, and the second half of the book is an A to Z of advocacy, focusing on tobacco but packed with useful gems for advocates in any area of health and drawn from his own long experience with advocacy at many levels. Perhaps it's not quite the Sistine Chapel ceiling, but Chapman--who began his artistic career as an advocate defacing cigarette billboards with witty counter-phrases--knows how to think strategically about the best ways to move from symbolic gestures to genuine policy change. This book should stimulate many productive actions towards ending the holocaust."
Professor Ruth Malone, University of California, San Francisco

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