Three members of the Smoking Interest Group (including myself, Andrew Russell and Sue Lewis) have been in Singapore to attend the 15th World Conference on Tobacco or Health. This is a huge three-yearly conference bringing together 2600 delegates working in all aspects of tobacco control – from youth workers to academics to public health clinicians – from a total of 124 countries. It is a rather oddly named gathering – ‘tobacco or health’ – but the reason for this was immediately apparent from the opening speeches.
We were welcomed Ang Hak Seng, Chief Executive Officer of Singapore’s Health Promotion Board, who gave us a very upbeat report on how Singapore has managed to get its smoking prevalence down to a remarkable 14.3% (the UK’s is on average around 20%).
This was followed by a rabble rousing speech by Dr Margaret Chan, Director General of the World Health Organisation whose opening line was ‘Let’s rid the world of a killing addiction’ as she reminded us all that smoking is the world’s number one preventable cause of death.
I was at the conference to give a paper explaining the development of SIG and the rationale behind it: that we need to widen our sources of understanding of the experience of smoking (to include, among others, the literary arts) in order to encapsulate a more complete picture of why people smoke. I wished to emphasise the messiness of human experience and the lack of consistency in people’s actions depending on context, quoting Byron Good’s notion that the medical world is ‘only one of several worlds or “subuniverses” in which we live’ and have our being (an idea deriving ultimately from William James). I was there to quote research that shows how people lapse in and out of smoking, how they derive pleasure from it, and how, for some, it seems in a way to constitute part of their sense of themselves. Ultimately, I wanted to deliver a message that the field of tobacco control might benefit from de-medicalisation to allow a re-humanisation of the stigmatised smoker and a focus on the real culprits in sustaining smoking prevalence: the tobacco companies and the tax policies of governments.
It was a bit scary standing up to say this in a context where smoking and its consequences are almost universally described as a ‘non-communicable disease’ and regarded as an ‘epidemic’ requiring the most aggressive approaches at local and global public health levels to tackle it. But I did find an ally from an unlikely source. The first paper I attended was given by Simon Chapman, Professor of Public Health at the University of Sydney and a feisty campaigner for plain packaging in Australia. He was speaking on ‘the neglect of unassisted cessation in tobacco control’, and pointed out that research shows that the vast majority of smokers who quit do so by themselves without medical assistance. He ended his talk referring to Peter Conrad’s book, The Medicalisation of Society, and calling for a de-medicalisation of the smoking problem so that people who smoke can be encouraged to feel they have it within themselves to give up and don’t need to rely on nicotine replacement or counselling. I went off to give my paper feeling that it might be possible to speak out after all!