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Should we set a date for a tobacco-free Australia?

It’s been 100 years since the first medical textbook identified a link between smoking tobacco and lung cancer. So how strange is it that in 2012 we can walk into Coles and Woolworths and buy cigarettes…

New Zealand wants to largely be tobacco free by 2025; Finland has set 2040 as its target date. Iago A R

It’s been 100 years since the first medical textbook identified a link between smoking tobacco and lung cancer. So how strange is it that in 2012 we can walk into Coles and Woolworths and buy cigarettes? Are we living in some kind of twilight zone in which the world’s weirdness detectors have been turned off?

Retail tobacco sales in Australia cause 15,000 preventable deaths each year. A ban on retail tobacco sales would make almost every other public health intervention in Australia a trivial sideshow. It’s time to set a date for a tobacco-free Australia.

It’s weird that Coles can trumpet its ethical credentials in animal welfare while selling 2.3 billion cigarettes each year – enough to kill more than 1,600 Australians. That equates to around $30,000 profit on each life lost to cigarettes. Meanwhile, Coles' cigarette sales contribute to tobacco-related medical costs of over $300 million a year.

Weirder still is the Cancer Council Australia’s decision to hook up with Coles to promote its annual cancer fundraiser, Daffodil Day. Coles slings the Cancer Council a paltry A$2 million a year to offset its cancer footprint.

The government doesn’t seem to think it’s wrong that retailers sell cigarettes. But it would be wrong to sell confectionery cigarettes and chewing tobacco, which are both banned: chewing tobacco because it can cause cancer; confectionery cigarettes because they encourage children to smoke.

It’s weird that real cigarettes laced with chemically engineered nicotine do a lot better job of both encouraging smoking and causing cancer but they’re not banned. I called to ask the Australian Competition and Consumer Commission (ACCC)’s Product Safety Australia why cigarettes aren’t banned. They don’t know. Under the new Australian Consumer Law of 2010, however, they’re happy to receive reports of any consumer product that causes harm. Doctors – are you listening?

Retailing tobacco is the act performed by people with high socioeconomic power. But many smokers lack any political or financial power and do not respond to government regulations with lawsuits. So it’s easier for government regulations to focus on the act of smoking, not selling. There are bans on smoking in many public places, in cars with children, in some private apartment blocks, and on hospital grounds.

Television advertisements paid for by the government focus on de-normalising smoking. But the collateral damage is the de-normalisation of smokers themselves, leading to stigmatisation. Again and again they are reminded by the government, which taxes them heavily but does not ban the source of their addiction, that they could die an early disfiguring death and never see their children grow up. That’s some tough love.

When will we finally reach the logical conclusion that banning tobacco is much more compassionate than squeezing smokers with more and more painful stigmatisation?

A ban on cigarette sales isn’t the same as a ban on nicotine, which would still be available. Skywalker

We cannot assume that a black market will flourish with a retail ban. This assumption stops dead the discussion we must begin. Even at the current high tobacco tax levels, only tobacco-funded studies are able to identify a significant black market. Independent studies suggest that less than 5% of current smokers have ever used illegal or “chop chop” tobacco regularly.

A comparison to the days of alcohol prohibition are not entirely relevant as this is not a ban on the substance desired by smokers – nicotine, which will still be available – but a ban on its most deadly form of delivery: retail tobacco sales. It’s important to remember that modern nicotine replacement therapies can markedly ease the withdrawal process.

Some public health experts envision a future in which increasing tobacco taxes will chip the smoking rate away to nothing without the need for a ban. But this may not be realistic. Imagine just 5% of Australians smoking in 2025 – that’s still over one million people who are at risk of tobacco-related illness. And it will be one million desperate people if they are paying $30 or $50 per packet of cigarettes.

The times are changing and the public is ready for a total retail tobacco ban. A 2005 New South Wales survey found that 56% supported a move towards a total ban on the sale of tobacco within ten years – that’s almost double the support for the ban on smoking in hotels (28.3%) and licenced clubs (30%) in 2000.

Bhutan banned the sale of tobacco in 2004; New Zealand has set a target of 2025 for their tobacco end game (defined as less than 5% of the population still smoking and extreme difficulty buying tobacco); and a coalition of health and related NGOs have launched Smoke Free Finland 2040.

A target date for banning retail tobacco would be a game changer in the Commonwealth government’s negotiations with tobacco companies. It would say – you are on borrowed time and your every threat to flood our market with cheap tobacco and waste our money in court cases only strengthens our resolve to make your product illegal.

Let’s set the date.

Craig Dalton’s article Banning retail tobacco sales: Time to start the discussion is published today in the Drug and Alcohol Review.