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Smoking out the tobacco industry

Updated Friday 11th April 2014

With plain packaging now looking a certainty, experts from the OU's Institute for Social Marketing explore the future for the UK tobacco industry.

An Australian cigarette package, where branding has been removed to make room for health warnings Creative commons image Icon Jack Greenmaven under CC-BY-SA licence under Creative-Commons license Australian 'plain' cigarette packaging Last year, the British Government launched an independent review into tobacco advertising which asked whether forcing cigarettes to be sold in plain packaging might be effective at preventing young people from taking up smoking. The controversial proposals have provoked some accusations that the iron fist of the ‘nanny state’ is at work, depriving the public of the right to make free, rational lifestyle choices around their smoking habits.

The Institute for Social Marketing (ISM), a joint venture between The Open University and The University of Stirling, has been instrumental in influencing government policies around tobacco consumption over the last 30 years by gathering compelling research around the marketing of tobacco and its influence on the uptake and continuation of smoking. The ISM’s research contributed to the eventual ban on tobacco advertising in the UK and introduction of smoke-free public places.

In this thought-provoking interview, Gerard Hastings (Professor of Social Marketing at the Open University Business School and former Director of the ISM) and Professor Linda Bauld (the Institute’s current Director) argue that introducing regulations around plain packaging will disarm the marketing capabilities of tobacco companies, prevent future generations of young people from becoming slaves to carcinogenic tobacco products, and potentially save thousands of lives. They also discuss how the recent rise in the popularity of e-cigarettes is presenting anti-smoking campaigners with fresh challenges.

OpenNews:
What role has the Institute for Social Marketing played in influencing the Government’s policies around tobacco advertising?

Gerard:
We’ve been working on public health policy around tobacco for 30 years now. We started in the 1980s, when the big issue was tobacco advertising. We’ve worked on helping to build up the evidence base around the relationship between tobacco advertising and children’s attitudes towards smoking. In 1997 the Labour Government came into power on a promise to introduce a ban on tobacco advertising. There were problems surrounding the Government’s proposals to exempt Formula One from the ban on tobacco sponsorship in sport. The ban was eventually introduced in 2004. We were subsequently involved in debate, discussions and research surrounding the advertising of tobacco at ‘point of sale’ displays in stores, which were excluded from the original advertising ban. Our work was extremely influential in the UK Government taking action to remove cigarette packs from sight at the point of sale. That’s happening now in large supermarkets and smaller shops will follow shortly. One of our major studies which contributed to the plain packaging debate has been a survey of teenagers, their attitudes to smoking and what has driven their decision whether or not to smoke. That has been going on for more than 10 years now, funded by Cancer Research UK.

OpenNews:
How will introducing plain packaging for cigarettes help to discourage people from smoking and improve public health?

Linda:
In recent years the last remaining form of tobacco advertising in the UK is the packet. The tobacco industry has millions of pounds to spend on promotion and advertising. Now that all other means of advertising their products have been taken away, companies have channelled their marketing budgets into creating innovative and attractive packaging, which has a particular appeal to young people.

Inside every cigarette packet you’ll find that the cigarettes themselves are largely the same in most cases. They might taste slightly different, but they are virtually the same product. The only thing that really differentiates them is the packaging. People are often willing to pay significantly more for the more expensive brands, but what they are essentially purchasing is a more attractive pack and not necessarily a superior cigarette. So the introduction of plain packaging deprives the tobacco industry of an additional profit opportunity. The more cigarettes they are able to sell in the UK, the more able they are to continue to market their products in the developing world, for example, where smoking rates are rife.

Over the past few years we have seen some quite amazing innovations in cigarette packs; from the launch of slim packages that resemble lipstick cases and appeal particularly to young girls; to the slide-back packet from Benson & Hedges which was a market leader. Outside the UK, some companies have begun to exploit digital technology, using QR codes fixed to the packets to direct users directly to their websites. That’s why we were asked by the Department of Health to carry out a systematic review of the effect that cigarette marketing in the form of the packet has on young people.

OpenNews:
How did you become involved in the Government’s recent proposals to introduce plain packaging for cigarettes?

Gerard:
It began three or four years ago when we were approached by the Government. [The Institute for Social Marketing] is part of a collaboration involving universities working alongside the Department of Health, known as the Public Health Research Consortium. Through that mechanism we were asked to carry out a systematic review of studies which had been conducted around cigarette packaging as a marketing tool and its influence on existing or potential smokers, particularly young people. This entailed carrying out a thorough review of all the research that had been carried out in these areas, whether it had been formally published or was what we call ‘grey literature’ sitting in a report somewhere. This body of research had to be acknowledged and checked to ensure that it was of suitable quality, identifying what the outcome of that research had been.

The eventual outcome was the development of in-depth documentation which summarised the evidence base and identified exactly what was going on. In terms of the debate around plain packaging, we compiled compelling evidence in three areas. Firstly, plain packaging makes the health warnings which adorn the packets much more prominent. Secondly, it reduces the danger of miscommunication and deceitful messaging which has previously conveyed the impression that low tar cigarettes are safer than ordinary ones, for example. Thirdly, plain packaging removes the branding, which we know has been an effective marketing tool for the tobacco companies and has been particularly instrumental in young people taking up smoking.

Linda:
The fact that the review was systematic meant that those methods could be replicated by other research teams, which was important. It was published in 2012 in parallel with the UK Government announcing a public consultation on plain packaging. So they essentially said: “We’re seeking the views of you, the public, on this potential policy and to inform your decisions here is the report carried out by researchers at the University of Stirling through the Public Health Research Consortium which provides the evidence for the potential impact that plain packaging will have.” So it was influential because it enabled the public to engage in an informed debate. Once the Government had received the responses, they indicated that the policy would go ahead. Then, in late 2013 the Prime Minister essentially changed his mind, citing a lack of compelling evidence and stating that the Government wished to hold back and assess how the policy has been received in Australia, where plain packaging was introduced in late 2012. When that happened, we decided to undertake an update to the review, which was published on our website in September 2013. We put forward a further 17 studies which underlined the potential impact of introducing the policy.

OpenNews:
Some commentators believe that the introduction of plain packaging for cigarettes would constitute a ‘nanny state’ at work. Could the new legislation be a threat to individual freedom of choice?

Gerard:
I want ordinary people to have the opportunity to make unfettered, free choices about how they live their lives, and I see the marketing of tobacco, and marketing more widely, as impinging on that. People often think that they are making free choices when in fact they aren’t. Take the example of our major supermarkets. The notion that people go into a store and always make an empowered decision about what they are going to buy is revealed as nonsense when you consider the fact that 80% of people make impulse purchases every time they walk into a supermarket. The concept of ‘freedom of choice’ is invoked on many occasions, yet it is often revealed to be nothing more than chimera. So for me it’s about getting people to understand how the forces of corporate marketing are influencing their everyday decision making. I want people to understand what’s going on so that they are empowered to make their own decisions about what to buy. I don’t want to make judgements about whether those decisions are ultimately right or wrong, but I do want people to make their own decisions. It’s important that universities are driving research into the effects of tobacco and tobacco advertising, so that policy decisions are based on scientific evidence rather than being influenced by corporations with a vested interest.

Linda:
Another body of work that the ISM has done is around studies on effective ways to help people to stop smoking. Over the past 15 years I have been involved in lots of studies where we have spoken to current smokers about their habits. Crucially, I have rarely, if ever, met a current smoker who would want their own child to take up the habit. You hear time and time again how much smokers regret the fact that they are nicotine dependant and that they ever became smokers in the first place. So that provides us with the motivation to help influence government policies around smoking based upon solid evidence.

OpenNews:
The tobacco industry has argued that the introduction of plain packaging will lead to a surge in sales of illicit tobacco, because the new packets will allegedly be much easier to counterfeit. How would you respond to these suggestions?

Linda:
Every time the UK has introduced a new tobacco control policy over the last decade or so, the industry’s automatic response has been to complain that such moves will lead to an increase in sales of illicit tobacco. It’s a frequent refrain from the industry. It’s a bit of a red herring which the tobacco companies keep putting forward as an argument. They express concern that fake cigarettes might contain dangerous substances. This is deeply ironic, because real cigarettes are known to kill one in every two people who are regular users. Governments need to crack down on illicit trade through proper law enforcement and cross-border sales management. However, there isn’t any real evidence that the introduction of plain packaging will lead to increased sales of illicit tobacco. A colleague in Belgium recently carried out a study around this issue and found that it is already relatively quick and easy to counterfeit the existing packaging, which would suggest that introducing plain packaging will make little difference to illicit trade. It’s important that the public health community is able to counter their claims with real evidence.

OpenNews:
Can you envisage plain packaging for cigarettes being introduced in the near future?

Linda:
There is a further review underway at the moment. The Government has appointed a Paediatrician, Sir Cyril Chantler, to have a final look through all the supporting evidence. It’s going to be very unfortunate if the UK Government decides not to proceed with this policy. They have already put the legislative framework in place which will allow the plain packaging laws to be approved. Of course, they will be faced with legal challenges from the tobacco industry, who will attempt to delay the process. So for the moment it’s difficult to suggest a firm date when the proposals are likely to become law. But all the indications suggest that it will eventually go ahead.

OpenNews:
How has the policy been received in Australia since plain packaging for cigarettes was introduced in late 2012?

Gerard:
It’s too early to say, as detailed research isn’t available yet. We’ve got to guard against falling into the trap of trying to establish a direct link between each piece of tobacco control legislation and human behaviour, when in fact there are numerous factors influencing people’s decisions to smoke or not. That said, the anecdotal evidence in Australia is that there have been no practical problems in implementing the policy.

Linda:
Some of our earlier studies might prove to be a useful indicator of the effect that plain packaging has on people’s behaviour. The ISM carried out a study in Glasgow where we instructed a sample of young female smokers to use plain packaging for two weeks. The women felt very uncomfortable using the packs; they regarded them as unattractive and it made them feel more anxious about their smoking. They thought about quitting more often and some consequently reduced the number of cigarettes that they smoked. So that’s an early indication and it tallies with the early surveys we’ve seen coming out of Australia. What’s more, telephone calls to the Australian ‘Stop Smoking Quit Line’ telephone service increased by 78% after the policy was introduced. That doesn’t necessarily mean that those people will go on to stop smoking altogether, but we’re beginning to see indicators that are consistent with the evidence we compiled for the systematic review.

OpenNews:
To what extent do you believe that people’s everyday lives are shaped by the forces of marketing?

Gerard:
Marketing in the commercials area has changed the world beyond all recognition. From my grandparents’ day to today, the difference is astonishing. Arguably, Coca-Cola and Marlboro did more to open up China than did President Nixon. These companies had a massive impact, and it’s clear that marketing can be a powerful force for change. We should be looking to see how we can use that powerful force in a way that is positive for individuals, communities and indeed as a species.

What drives a lot of political decision making in a lot of instances are the forces of consumption and the huge drive to get people to buy stuff. The companies who are selling these goods have become hugely rich and powerful on a worldwide scale. So now ExxonMobil, the international oil and gas company, is richer than Sweden. Apple is richer than Poland. You have to consider that countries have long-established democratic systems in place to guard against the abuses of power that can happen when someone is elected to office. In contrast, many Chief Executives are wielding enormous power and influence despite having no democratic mandate whatsoever.

What commercial marketing companies do is invoke the idea of consumer sovereignty and looking after the needs of the people. The most successful businesses are those who listen to consumers first and then give them what they want. That’s the marketing mantra. However, there is a fundamental deceit in this premise, and tobacco is an obvious example. How could it possibly be in the best interests of a teenager to take an addictive carcinogen into their bodies?

OpenNews:
What is ‘social marketing’ and how can the concept be used to change the world for the better?

Gerard:
The concept of ‘social marketing’, which pre-dates big business and international global corporations, is vital. It states that human beings are more successful when we co-operate, exchange and collaborate. These ideas of habitual empowerment are vital and can be harnessed for the greater good. These concepts might have been purloined and promoted across the business sector, but they have a role throughout society. Social marketing is about helping people to realise their own potential, not in terms of hollow corporate slogans but through a genuine sense of respecting the individual and recognising that everybody has something to contribute and something of value to say. Humans will function more successfully when we become better at incorporating these values into the ways that we run our societies.

OpenNews:
How has the recent growth in the popularity of e-cigarettes, which followed the banning of smoking in public places, impacted upon efforts to dissuade people from smoking?

Gerard:
From a medical and public health perspective, e-cigarettes are good news because they provide a cleaner way of ingesting nicotine and it’s one method that smokers can use to withdraw from tobacco consumption. For non-users of tobacco products, however, e-cigarettes are not a good idea. They provide no medical benefit and they risk becoming a cause of addiction. They could serve as a gateway into tobacco consumption for young people. E-cigarettes also undermine smoke-free ordinances, such as the banning of cigarette smoking in public places, which have inspired people to quit.

Linda:
Clean nicotine, such as that found in nicotine replacement therapy, is relatively safe. It has been around since the 1970s and there’s lots of solid evidence that it is not harmful. Of course, it’s much better for the individual if they give up smoking and nicotine use altogether rather than spending their money on nicotine replacement patches and suchlike forever. E-cigarettes are a different proposition. They may well help people to stop smoking, but we don’t yet have reliable evidence which confirms that. E-cigarettes are problematic because, although they are safer than conventional cigarettes, they may appeal to young people and others because of the significant advertising and promotion that has driven their sales.

Gerard:
A colleague and I were recently involved in a study where we audited the marketing of e-cigarettes. It’s clear that they have become a profit-making opportunity for many companies, for whom profit conquers all. The people who produce them have no concern for public health, and arguably they have no obligation to care. Their motivation is to create companies, generate wealth and reward their shareholders. But once you let the ‘profit genie’ out of the bottle, madness ensues. You see it in the coffee houses avoiding tax, the horse meat scandal and the banks being fined for mis-selling services to people. That’s because we are asking people to do the impossible: to strive for profit but be ethical at the same time. But it’s very difficult to serve these two masters. Profit tends to come out on top in this battle. That’s what we’re seeing with the market for e-cigarettes, which has gone frenetic. Over our 12-month audit we’ve recorded 121 different patents for new e-cigarette products coming onto the market.

One real concern is that tobacco companies will use their promotion of e-cigarettes as a means of also promoting tobacco. The marketing of e-cigarettes is very akin to the advertising of tobacco products in yesteryear. There has been a ban on tobacco advertising for some time. This led to the tobacco companies channelling their marketing efforts into point-of-sale displays, which were exempt from the ban. They began to make their displays as elaborate, colourful and appealing as possible. Once plain packaging is introduced, the tobacco companies will have been deprived of their entire marketing arsenal.

However, with the rise of e-cigarettes, these companies suddenly have a platform from which the idea of nicotine ingestion is being openly promoted. If you were to show an advertisement for e-cigarettes to a 10-year-old who has never seen a tobacco advert, then I doubt that they would recognise the difference. They would, however, see that there is something interesting and enticing going on; something adult and forbidden.

Linda:
I do think it’s far better for a young person to try an e-cigarette than tobacco. All the evidence suggests that they are much safer, but we don’t know if they will actually encourage youngsters to progress to real cigarettes. The other concern is that some of the organisations manufacturing e-cigarettes are tobacco companies, so the profits generated from sales of e-cigarettes are underpinning the continued manufacture of tobacco. It’s a complex situation.

Gerard:
It’s very early days in the e-cigarette market. Even in the UK, where they have been a relatively big success, the tobacco companies are making infinitely more money out of conventional tobacco than they are from e-cigarettes. The latter may be used to encourage people to continue smoking and enable them to bypass the restrictions imposed in smoke-free public places. Where people do want to quit, then there’s an alternative way for the tobacco companies to continue to make money out of people. Once people start using these highly addictive products, it becomes difficult to stop using them. In a consumer society that prides itself on choice and consumer sovereignty, that’s an issue. There are also moral implications around encouraging poorer people to purchase these addictive products. There is a direct correlation between the incidence of smoking and socio-economic status. In short, the wealthier you become, the less likely you are to smoke. With e-cigarettes we have a product on the market which, although it’s a better option than tobacco, still indentures people to buy a product that they can ill afford. That in itself has public health implications.

OpenNews:
What are the ethical implications around the addictive nature of e-cigarettes?

Linda:
One of our concerns with e-cigarettes is that no health professional can currently prescribe them. Where someone wishes to stop smoking they can be prescribed a nicotine patch alongside professional advice and support which can help them to stop using the patch eventually. We don’t currently have a system where an e-cigarette can be offered as a medical device. That would be a step forward.

OpenNews:
Can you envisage a time in the future when smoking addiction becomes almost non-existent?

Gerard:
There is a very active debate about what has become known as the ‘endgame’ for tobacco. In a couple of generations I can imagine people looking back and saying “What on Earth were we doing?” with regards to the widespread consumption of tobacco. That will have been the result of sustained efforts to deprive tobacco firms of their marketing collateral, preventing their use in public spaces and introducing controls on how they can be sold and promoted. E-cigarettes are a real game changer, however. If we don’t restrict the provocative advertising that has fuelled their popularity, and introduce similar restrictions on marketing and points of sale, I predict that in a few years’ time we could soon see a flourishing market in recreational nicotine, dominated by the tobacco and pharmaceutical companies, who may well have amalgamated by that stage.

The real danger of e-cigarettes is that they are normalising the practice of nicotine self-medication. Instead of sending out a firm “Don’t smoke” message, they convey that there is both a safe and a dangerous way of consuming nicotine. The result is a rather ambiguous message and could lead to a very active market in nicotine consumption. Of course, from a commercial marketer’s perspective, nicotine is a fantastic product because of its addictive nature. Look at how many millions the major supermarkets invest in cultivating customer loyalty. For nicotine this ‘loyalty’ – due to its highly addictive nature – is ‘built in.’

Linda:
We are unlikely to see any real restrictions on the marketing of e-cigarettes for a few years to come, so the status quo will remain for now. In some non-European countries, such as Canada, governments have made e-cigarettes containing nicotine illegal. However, enforcement is incredibly difficult because of the ease of ordering these products from abroad over the internet.

Gerard:
Restricting e-cigarettes to private sales between individuals over the internet is much more preferable to having them advertised provocatively on billboards in the high street and in supermarkets. They would still be deprived of a significant proportion of their marketing. So we might see some interesting global developments around the marketing of e-cigarettes which could suggest a model that might work in the UK.

OpenNews:
Do you take a lot of personal satisfaction from the fact that your work is directly influencing public policy and, by discouraging people from smoking, saving lives?

Gerard:
We’re involved in dangerous work and get challenged aggressively. A couple of years ago we faced a legal challenge from Phillip Morris [the global cigarette and tobacco company], which was immensely threatening. If they had won they day we would have been out of business. We would have had to surrender our data. No-one would have funded us or collaborated with us again on the basis that they wouldn’t ever have allowed us to feed the marketing intelligence of a large multinational tobacco company.

Gerard:
Our eventual triumph was largely down to the public outcry that followed. There was a huge furore, especially in Scotland, which culminated in a wonderfully supportive editorial in The Daily Record. They asserted that our researchers shouldn’t have been harried in this way; that the Government shouldn’t give away our data to companies who would kill more of our children.

Linda:
We received a huge amount of support from the public. The media support was instrumental in helping to turn back the tide against a large multinational corporation.

Gerard:
We take enormous pride in our successes. The team at the Institute for Social Marketing has recently received a Queen’s Award in recognition of our work over the past 30 years which has helped to influence the policies of successive governments around the marketing of tobacco, alcohol and food. Our proposals have been very radical and provoked fury from the big tobacco, food and alcohol firms. We have had to kick and fight to get our voices heard, but the establishment heard us and we have begun to have a sustained impact on public policy.

Please note: the views expressed in this interview are personal and are not necessarily the views of The Open University.

 

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