Marketing Health: Doctors, Public Health, and the Smoking Ban

By Kirsty OUP-UK

On Sunday 1st July 2007 a ban on smoking in public places came into effect in England. Similar bans have already been in place in the rest of the United Kingdom for some time. Virginia Berridge, Professor of History and Director of the Centre for History in Public Health, London School of Hygiene and Tropical Medicine, is the author of Marketing Health: Smoking and the Discourse of Public Health in Britain, 1945-2000. Below, Professor Berridge talks about how, while we are now used to doctors and government officials telling us what is good and bad for us, this development has only come about in the last 50 years.

“Parents should be prosecuted if they give alcohol to their children before the age of 15”
Medical evidence says it’s dangerous – and it’s the government’s duty to intervene.

“Eat your five portions of fruit and vegetables each day”
‘It’s good for you,’ says the Chief Medical Officer.

In 2007, we are used to headlines like the ones above – and to the alliance between doctors and government on which they are based. It may be the individual citizen’s duty to adopt a healthy lifestyle – but healthy living is founded on advice from doctors and scientists and it seems that behaviour is becoming increasingly regulated by government. Regulation takes different forms and the smoking ban implemented in England on 1 July, 2007 is the latest example.

For doctors to advise about individual habits and behaviour is a relatively new development, and even the government had qualms about it initially when the change of approach came onto the agenda. The change of attitude developed in the 1950s and 1960s thanks to new styles of communication with the public, and changes in the patterns of disease. Until the 1950s, public health doctors had traditionally dealt with epidemic diseases, but now chronic diseases were beginning to come to the fore. Doctors had been wary about speaking publicly on health matters because of fear that this could be seen as contrary to professional standards. In the 1950s and 60s that began to change.

Smoking and the connection with lung cancer and heart disease ultimately changed the orientation of public health and communication between the medical profession and the public. The use of modern methods of mass communication was to be part of a new partnership, and so too was the use of risk factor epidemiology, a new science for public health that emphasized long term risk in the population from current health habits, such as smoking. Two events in the 1960s typified these changes. The first was the publication of the 1962 Report on smoking of the Royal College of Physicians (RCP), and the other was the 1964 report of the Cohen committee on health education.

The RCP report was very popular with the public. Originally the College had only wanted 5,000 copies printed and when Charles Fletcher, secretary of the committee, insisted on double that number, the College required that the committee to pay for any copies which were unsold. But the report sold out within days and a second printing was needed. By the autumn of 1963 the report had sold over 33,000 copies in the UK and over 50,000 in the US. It was followed the next year by Fletcher’s Common Sense About Smoking, which symbolically linked the medical evidence with a chapter on economic effects, as well as others on social implications and how to give up.

Meanwhile, the Cohen committee argued for a greater degree of publicity for health matters, using campaigns that encouraged people to change their habits, and social surveys, as well as strengthening the new profession of health educators. Its recommendations led to the establishment of the new Health Education Council in 1968, which mounted habit-changing campaigns on smoking.

These events began a process that has led ultimately to today’s smoking ban. Sometimes people are surprised that the ban wasn’t on the agenda in the 1950s, but such action by government then would have been unthinkable. Politicians, like doctors, were wary of advising the public to change their personal habits: they thought this was not a proper activity for government. In addition to this, smoking was a widespread social habit which all classes of society indulged in and supported. Even Austin Bradford Hill, one of the researchers who discovered the connection with lung cancer, kept a box of cigarettes in his office to offer visitors; it would have been considered impolite not to. The government even provided tobacco tokens to pensioners.

A huge social and cultural change has occurred since the 1950s, and some researchers are now asking whether the ‘smoking story’, with its history of cultural and policy change, offers a model for other substances, such as alcohol, which are now more centrally on the policy agenda.

If you want to read more about smoking then, as well as Professor Berridge’s book, there is also an interesting chapter on smoking and what we knew about it in the 1950s in Bad Medicine by David Wootton. To read about smoking and how it’s related to drinking culture then have a look at Binge Britain by Martin Plant and Moira Plant. Finally, in November 2007, we have a book for professional therapists: Smoking Cessation by Bonnie Spring. A client book will also be available.