UK anti-smoking policies ‘comparable with sanitation reform in 19th century’

Public health initiatives on smoking in the UK are comparable in scale with the interventions made regarding clean water and sanitation in the 19th century, a leading expert has said.

Sir Richard Peto, emeritus professor of medical statistics and epidemiology at the University of Oxford, worked alongside the scientist Richard Doll, who uncovered a direct link between smoking and cancer 70 years ago on Wednesday.

Peto said the current landscape regarding smoking in the UK had changed significantly since he began his career in the 1960s, when the dangers of smoking were not taken seriously.

Since that time smoking has led to the deaths of about 9 million people in the UK, and is responsible for nearly one-fifth of new cancer cases every year.

“Throughout the 1950s and 1960s cigarette consumption in Britain was rising at one point,” Peto said. “You’d see a group of four people sitting smoking, and think that on average, one of the four is going to get killed before 70.”

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He added that at the time it had seemed the warnings regarding the dangers of smoking that Peto and other researchers made did not get through to the public. “The general population didn’t believe it, even lawyers and architects didn’t. Many journalists didn’t take tobacco seriously in the 1970s,” Peto said. “Even in the headquarters of Britain’s Medical Research Council there were ashtrays all around the committee rooms.”

He added: “Even in the 1990s, public opinion polls showed half the UK population agreed with the statement that smoking couldn’t be all that dangerous otherwise the government wouldn’t let it be advertised.

“The 1997 election was a turning point. Labour pursued an EU-wide advertising ban, after which both major parties have been serious about reducing tobacco deaths.”

Peto compared the scale of interventions against smoking in the UK with “great revolutions in public health, such as in regards to sewage and clean water”.

“Going back to the 19th century, sanitisation and sewers were one of the big public health interventions. That was an extraordinary change,” he said.

Peto also emphasised that public health initiatives regarding smoking should be a worldwide effort.

“Ninety-nine per cent of the world is not British. In Britain we have 6 million smokers, China has around 300 million,” he said. “The UK has had about 10 million tobacco deaths since 1950, but it’s not just a UK story. Worldwide, there were about 100 million tobacco deaths in the 20th century and there will be about a billion this century if the world keeps on smoking as now, with about half the young men and 10% of the young women starting, and most not stopping.”

But he cautioned that prevention efforts may be hindered by the fact tobacco deaths have become normalised, with the harmful effects of smoking being widely known, in comparison with a novel illness such as Covid-19.

“If we look at the coronavirus pandemic, it was new so it became news. We had 200,000 coronavirus deaths in this country due to the pandemic,” Peto said. “At the same time we have 300,000 tobacco deaths and nobody mentioned it as it’s not news … we are desensitised to it compared to coronavirus.”

Commenting on the significance of the anniversary since the link between tobacco and cancer was revealed, Dr Ian Walker, Cancer Research UK’s executive director of policy, said: “[Smoking] is still the biggest cause of cancer in the UK, and the single biggest driver of health inequalities. Research shows that nothing would have a bigger impact on reducing the number of preventable deaths than ending smoking.

“History shows that smoking rates decline with government action. That’s why it’s vital that the next government re-commits to legislation to raise the age of sale of tobacco products in the first king’s speech. This is a once-in-a-generation opportunity to save lives, alleviate pressure on the NHS and leave a lasting legacy.”