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BMJ. 2007 October 27; 335(7625): 890.
PMCID: PMC2043470
Review of the Week

The art of tobacco control

Reviewed by Ruth Malone, professor of nursing and health policy, University of California, San Francisco

Controlling the tobacco epidemic is no mean task—although some authors are better at navigating the complexities than others, Ruth Malone finds

If public health advocacy is an art, as I think it is, then comparing these two recent books on the state of tobacco control is a bit like comparing a wild, colourful finger painting done on butcher's paper with the Sistine Chapel ceiling. Not to disrespect the first—the energy and passion of which may lure many a young person towards artistic self expression—but it just can't quite compare with the skill, control, and discipline of an experienced artist.

Ending the Tobacco Holocaust is a 400 page splatter of outrage about the continuing epidemic of deaths related to tobacco use, which the World Health Organization projects will soon reach some 10 million a year. The book by the University of California, Los Angeles, psychiatrist and researcher Michael Rabinoff could be a fair read for lay readers unfamiliar with the topic, smokers wanting to reinforce their decision to quit, or high school students writing reports. Rabinoff brings an evangelical fervor to his topic, urging each of us to help create a better world. Who can fault this aim?

He does provide a lot of details on the tobacco industry, the biology of tobacco addiction, the role of movies in reinforcing tobacco use, and some of the politics of tobacco regulation. However, his righteous outrage—the spittle fairly flying from the pages—is not matched by sophistication about tobacco control, and here the book falls flat. Earnestly he argues that the answer to the tobacco epidemic is “simple”: we all just have to stop buying products from tobacco companies, boycott movies that display smoking, and boycott shops that sell to children, among many other things. To his credit, he points the finger primarily at the vector of the epidemic: the tobacco industry. However, his primary solutions are naive in light of recent and very well organised boycotts against the tobacco industry, which suggest that this tool is limited in its utility, easy for the industry to turn to its own advantage, and difficult to sustain in the long term.

For Chapman, professor of public health at the University of Sydney, who has been working in tobacco control advocacy for decades, the answers are not quite so simple. 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 that Rabinoff so earnestly—but less effectively—decries.

Chapman takes up some of the hottest issues in contemporary global tobacco control and shows us their ethical, political, and policy complexities

Notes

Ending the Tobacco Holocaust: How the Tobacco Industry Affects Your Health, Pocketbook and Political Freedom—and What You Can Do

Michael Rabinoff

Elite Books, £12.40, pp 452

ISBN 978 1 600700125

Rating: *

Public Health Advocacy and Tobacco Control: Making Smoking History

Simon Chapman

Blackwell Publishing, £19.99, pp 344

ISBN 978 1 405161633

Rating: ****


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