Local choice and democracy: normal life versus tobacco control

How local is democracy? This question arises in relation to the news that elections to local health boards will not now occur, as reported by columnist Lesley Riddoch here. (Her recently published book Blossom covers similar arguments.)

She talks about how to make Scotland blossom: how to arrange matters so that far more of its population can access its natural resources. One major point of comparison is that 'local' in Scotland is fairly meaningless, considered in the example of, say, Strathclyde or the Highland Region, where populations under regional administration are vast, as is the area covered. 

Every way you measure it, Scotland is doing badly. In Norway, with genuinely community-sized, tax-raising municipalities of around 14,000 people, election turnouts range from 70-82 per cent and one in 80 Norwegians stands for election. In Scotland, community councils have a tiny average annual budget of £400 and no statutory clout and services are provided instead by large council bureaucracies for an average 162,000 people. These “local” councils receive most of their cash from central government. Turnout in the 2012 elections was 38 per cent and one in 2,071 Scots stood for election.

I am just reading another book about how multiparty democracy and proportional government make for a greater diversity of political parties, and the paragraph above goes some way to explaining why this doesn't seem to happen in Scotland. More centralised administration yields fewer parties, lower political participation, and lower living standards generally. Scotland is far from being the worst governed country in the world, but it seems to have much to learn about increasing democratic participation.

If Scottish democracy is characterised by a shortage of public representatives below regional council level, ASH Scotland represents a stark contrast in its flow chart illustrating the Scottish Tobacco Control Alliance. This is top-down stuff, but they are organising the whole country into tobacco control groups at all levels. (All right, not quite the whole country.) Topic groups, smoking cessation groups, working groups, member organisations, overseen by the SCTA, ASH Scotland, and further up the tree the European Union, the UK government, the Framework Convention on Tobacco Control (FCTC), and overall the Scottish government 'involving the tobacco control community in developing and implementing policy'.

It's an impressive level of networking, but it should not be top-down, and is crushingly narrow in its outlook. We have huge problems in our country of chronic ill health, poverty and under-representation, but the answer seems to be – just don't smoke.

Even people who do support certain tobacco control initiatives should worry about the centralised nature of this drive for greater tobacco control which is entirely centre funded, has tentacles throughout and beyond all health boards and is mirrored by the absence of any real local democracy.

Scottish national tobacco control strategy – for tobacco control eyes only

Minutes from the August meeting of the Scottish Tobacco Control Alliance state that the next stage of national tobacco control in Scotland will not go out to public consultation, but only to tobacco control advocate groups.

On the bright side they will be putting on a ceilidh in the spring for fundraising purposes, according to the section on funding. Expect fewer free summits in the future.

H/tip to Jay and Eddie for the link.

More on ASH Scotland's alliances

As if the Scottish Coalition on Tobacco were not enough, ASH Scotland also coordinates the Scottish Tobacco Control Alliance.

They also support what they call local alliances. The thoroughness of their briefings must be considered in light of their 27 staff (just take a look at their media briefing for the Lothians).

The resources put into attempting to reorder everybody's priorities so as to blame smoking for all ills, deaths and inequalities (who wants to live forever?) are significant. However, page 3 of SCTA's 2010 annual report shows that of the 119 or so member organisations involved with it, the largest groups are involved with NHS smoking cessation and NHS health promotion. It's a career move, rather than a popular cause.

SCTA holds events, has members and topics groups, produces a bulletin and annual report (all accessible from here), and has gained a grant from Cancer Research UK towards the formulation of what has become Scotland's tobacco control strategy. Their output includes a discussion of the new mental health guidelines, Smoke-free mental health services in Scotland – Implementation guidance at a meeting for mental health professionals in Glasgow in June (you get Learning Outcomes for attending too – all free of charge). Never mind that the then Scottish Government specifically exempted mental health services from the smoking ban when it was passed in 2005, and no reason has been offered for any change from this position, nor has any such change been endorsed by the public.

Sheila Duffy's latest (comments-free) blog post urges all parties to support a new tobacco control strategy (while announcing that most of the parties have promised this already). She had a column in today's Scotsman (20 April) that appeared as 'Platform' beside the editorials, claiming that tobacco control still had to eradicate the differences in mortality rates between Scotland's rich and Scotland's poor, and that continued support for Scotland's tobacco control was essential.

Impressive although all this networking is on one level, it's hard to see how it helps resolves any of the difficulties that face most Scots these days. Sheila Duffy's conclusion to her opinion piece in the Scotsman today concludes:

The challenge for our politicians is to reduce the health inequalities gap caused by smoking ...

An interesting economic analysis, that such inequalities are caused by smoking. Duffy is right to point out that higher mortality exists in more deprived areas. But this is not simply because people smoke: even if smoking is a factor, so is chronic unemployment, homelessness, anxiety and all the other consequences of being at the bottom of the economic heap. It's as if the powers that be are saying to the deprived: societal problems are too complicated to work out. But your problems will be marginally less severe if you don't smoke. So don't do it. You know it makes sense.

It's a top-down analysis. It's taken committed smokers out of 'polite society' too: they can no longer relax with peers and be seen to enjoy themselves in public places. It's made it harder for many smokers to assume positions of leadership, because the act of smoking has been so deliberately stigmatised. In the end it distorts all experience to the single plane of whether or not people smoke (see the discussion of the young mother on page 4 of the annual report).

It does all this very largely on government funding and with the blessing of all the main political parties in Scotland.

Learning Outcomes to be awarded at anti-smoking conference

The Scottish Tobacco Control Alliance (ASH Scotland) announces a conference on smokefree homes and cars, to be held in March in Dundee.

Two things stand out: one is that the problem of secondary smoke in the home seems to be the preserve of people from 'poorer backgrounds'. Does this mean that the list of alleged ill effects are also related with being poor?

More than half of babies and young children from poorer backgrounds are regularly exposed to SHS in the home, compared with less than a fifth of UK children from families with a professional background.  Exposure to SHS in childhood is associated with reduced lung function, middle ear disease, an increased risk of respiratory symptoms and a higher incidence of respiratory tract infections.  SHS exposure has also been shown to be a cause of cot death.

The second is that this event seems to have been set up to 'qualify' relevant personnel in talking people out of smoking at home, by the award of Learning Outcomes in the National Health Service 'Knowledge and Skills Framework'.  The link 'Learning Outcomes' on the page linked above sets out the details in a Word document.

This conference (thanks to NHS Scotland funding) is free of charge. Magnificent: Scottish national certificates in attempting to convert stubborn smokers in deprived areas ... whatever will they think of next?

Arguing with ASH on packaging

Today I continued an argument with Action on Smoking and Health that started last week, on an article published by the European Parliament. The article described how addiction could be eliminated by simply banning branding and forcing tobacco companies to sell their wares in plain packaging:

Karine Gallopel-Morvan, a lecturer at Rennes university in France, found that a plain pack design with health warnings would deter almost all non smokers from taking up smoking and would reduce the desire amongst smokers to take a cigarette from the pack.

Does this work better than patches? A delegate from Stirling, Crawford Moodie (well known in tobacco control circles) was also present:

Moodie, of the institute of social marketing at Stirling university in Scotland, conducted an online survey, which found that almost one in three young people admitted to choosing a certain brand of cigarettes because they were attracted by the pack's appearance.

This is very far from proving that young people wouldn't start smoking without the visual cues found on brand packaging. Deriving certain impressions from cigarette packaging is surely inevitable, but it doesn't demonstrate that the product wouldn't have a market without the branding.

What I was arguing with Action about was the claim in the article by Leon Joosens that "Unique codes and invisible ink along with the quality and packaging will indicate whether the cigarettes are illegal, ...So there is no reason to suggest it will increase illegal trade". I pointed out that invisible and ink and unique codes wouldn't be much use to customers trying to avoid counterfeit tobacco. Action said that provided customers bought tobacco from shops they would be safe from the danger of counterfeit products. It took me precisely ten seconds to find a story of illegal cigarettes (not necessarily counterfeit ones) being seized by officers in a shop. Already shops are handling illegal products.

ASH wouldn't accept that producing counterfeit cigarettes would be any easier to produce and distribute if branding were banned, but tried to convince me that branding was aimed at kids and was effective in 'making' them smoke. One of the articles it/he/she posted declares that 'perception is everything':

"Cigarettes have created a brand for every personality trait," Hanewinkel says. "If you are looking to project independence and masculinity, think of the lonely cowboy in the Marlboro ads. On the other hand, if you're looking to project a desire for romantic relationships, and friendships are playing a role, then you will choose Lucky Strike if you are a man and Virginia Slims if you are a woman."

Generalisations are all very well, but how can they project that demand for these products will disintegrate in the absence of branding? Or that customers will reach the right conclusions about which cigarettes are the most addictive?

They don't know. They can only hope.

Meanwhile the Scottish war on tobacco continues with an interesting article in the Press & Journal that describes progress over the last ten years:

Since the launch of a strategy to stop tobacco smuggling in 2000, more than 14 billion cigarettes, worth £4 billion, have been seized, more than 350 criminal gangs have been broken up, and £35 million has been collected through confiscation orders.

Three hundred and fifty gangs is a lot of people and one wonders how many more got away. The articles were published following a press release from ASH Scotland reporting the publication of the recommendations of a conference on illicit tobacco held in September 2010 in Perth. To its credit, the Press & Journal quoted Chris Ogden from the Tobacco Manufacturers Association, which was not invited to take part in last September's conference (he pointed out that high taxes were not helping the situation regarding illegal tobacco).

I find it odd that the people who have seized the initiative on illicit tobacco control in Scotland are those (the Scottish Tobacco Control Alliance) who appear to want to blur the distinction between legal and illegal tobacco, and wouldn't dream of advising you to support your local shop by buying the legitimate product, because they don't want you to buy the product at all. They are against the product and will not deal with industry representatives, but seek to protect legitimate trade in the product – while planning an attack on industry brand identity. What a mixed bag of aims and motives.