SEARCH

SEARCH BY CITATION

By Simon Chapman . Published by Blackwell Publishing , Oxford , 2007 . Paperback, 336 Pages. RRP $72.50. ISBN 9781405161633 .

Reviewed by Mike Daube

Health Policy, Curtin University of Technology, Western Australia

Tobacco control is one of Australia's great public health successes. Smoking is declining in adults and children, except among Aboriginal people, where it is a major contributor to the life expectancy gap. Globally, however, tobacco companies are still on the rampage. Five million people die each year because they smoked, and the tobacco industry's ruthless targeting of developing countries is projected to double this total to 10 million a year within 20 years. Governments around the world, including our own, are as culpable as the tobacco companies: they could act to prevent tens of thousand of deaths, but are failing their communities.

One of the heroes of both the Australian and global campaigns on tobacco is Simon Chapman, now a highly respectable Professor of Public Health at the University of Sydney and editor of the authoritative journal Tobacco Control, but 30 years ago active in BUGA UP (Billboard Using Graffitists Against Unhealthy Promotion). The world of tobacco control owes him an inestimable debt: campaigner, researcher, author, editor, speaker, and, thanks to the wonders of e-mail and constant travel, mentor to thousands of campaigners. He has also played a prominent role in other public health campaigns, not least gun control.

Chapman's new book, Public Health Advocacy and Tobacco Control: Making Smoking History, is in reality two books. The first half is an account of tobacco control advocacy and a bluffer's guide to tobacco control issues in the 21st century; the second is an ABC of advocacy, with a focus on working through the media, influencing governments and demonising the opposition. It will gain an automatic place on public health reading lists, but should be required reading for anyone who wants to know how to make a difference in their community.

Chapman's style is lively, sometimes quirky, always forthright. He is rightly intolerant about those who pursue approaches known to be ineffective (school health education for smoking, high-intensity smoking cessation programs as an alternative to the mass campaigns that achieve so much more) and of doctors who do not advise their patients to quit despite 30 years of evidence that this works. He is critical of campaigners who go beyond the evidence, or who risk alienating their communities. He is not afraid to tell his own war stories about battles with tobacco companies. He queries why surgeons such as the late Victor Chang, whose remarkable skills saved the lives of individuals, attract a demigod status that is denied to the mere mortals among us whose work has prevented hundreds of thousands of deaths – perhaps more. He outlines issues in tobacco control, with a lengthy and important discussion of the tobacco companies’ persistent efforts to maintain sales by kidding the community that they are developing less harmful alternatives. He predicts a continuing decline of smoking in Australia and speculates that we may even end up with a world in which smokers are licensed to buy this remarkable product that will kill one in two of them.

Some of Chapman's judgements will generate debate even among those who share his passion for public health. His libertarian perspective does not let him support action to take smoking out of movies. Some (myself included) would argue that there is a greater liberty to be found in doing all we can to protect children from paid promotion by tobacco companies. He also directs heavy criticism at the World Health Organization for its decision not to employ smokers, arguing that while smoking at work is inappropriate, how people act in their private lives is their own business. This is a little harsh on WHO, which has recently at least tried to head in the right directions after years of strong reports and recommendations but little action. (Another leading figure in tobacco control once memorably described WHO's tobacco staff of previous decades as “people who speak nine languages but think in none of them”.)

In 1905, the great physician William Osler advised doctors not to “dally with the Delilah of the press”. Public health advocates do not have access to the billions of dollars that enable tobacco, alcohol or fast food companies to promote their products, but they do have access to media and can pressure and embarrass governments into acting. There is a long way to go even in Australia while smoking still kills 16,000 people every year and governments fail to act and to spend as they should. But who would have dreamed 30 years ago that Australia would be free of tobacco advertising and sports sponsorship, that grisly pictures would dominate cigarette packs, and that smoking would be banned from pubs, clubs and workplaces? Anyone who wants to know how Australia came to be a world leader in tobacco control, where we should go next, and simply how to run any sort of campaign should read this splendidly entertaining and informative book. Buy it, recommend it, put it on your reading lists, and if you can hack into your colleagues’ reading lists put it on those, too!