Smoking: 60 years of kicking the habit

The need to tackle unhealthy lifestyles is by no means a new concept. Even 100 years ago it was recognised that Britain was generally an unfit nation with few young men fit for active service.

An inter-departmental committee report produced in 1904 described the physical deterioration of Britain and said "diseases of affluence", such as cancer and heart disease, were beginning to take hold.

So the smoking ban in England, introduced in 2007, is clearly a turning point for public health when we reflect on how attitudes to smoking have changed in the 60 years since the inception of the NHS.

Ingrained habit

With the introduction of mass cigarette production at the turn of the 20th century, the war years had led to smoking becoming an ingrained social habit in England. 1950 saw the publication of pioneering research that reported a link between smoking and lung cancer.

This did not, however, receive the immediate acclaim it deserved. Health minister Ian McLeod famously chain-smoked his way through the first government press statement on smoking in 1954.

Although he acknowledged an association between smoking and lung cancer, it was decided that more research was needed. Subsequent health ministers also refused to mount a campaign against smoking, saying no ill-effects had actually been proven.

In the 1950s, the only perceived problem with smoking was the uncomfortable "throat scratch" that several cigarette manufacturers claimed to guard against. Cigarette advertisements depicted sultry film stars such as Rita Hayworth and Rock Hudson. There were encouraging messages enticing people to try delicate tobacco flavours "for those with keen, young tastes".

In fact, it was postulated that "the thorough test of any cigarette is steady smoking... see how well they agree with your throat". Decreasing the irritant quality of smoke so you could smoke more seemed to be the priority.

Attitude shift

By the 1960s, however, attitudes were changing. The Royal College of Physicians report Smoking and Health, which illustrated the significant effects of smoking on health, gained widespread public interest. In addition, the Cohen report in 1964 changed the approach to health education and stressed that greater publicity was needed to encourage total behaviour changes.

Television and journalism were used to elicit behaviour change. The rest of the decade saw the banning of cigarette advertising on television and the introduction of smoking cessation adverts.

Anti-smoking campaigns really took off following research in the 1970s highlighting the deleterious health effects of passive smoking. Aggressive shock campaigns have depicted dying cancer patients, blackened lungs and vulnerable children as the victims of passive smoking.

Nowadays, cosmetic and social effects of smoking seem to have more impact on the public, with women anxious about developing "smoker’s face" (facial lines and grey skin) and men deterred by erectile dysfunction.

The real turnaround in public opinion came in 2004, when public health leapt up the political agenda with the publication of the white paper Choosing Health. The paper specifically identified problems resulting from leading unhealthy lifestyles, including smoking, and measures for managing behaviour change such as smoking cessation services.

This, along with continued lobbying from pressure groups such as Action on Smoking and Health and persistent multi-disciplinary work led by public health professionals, culminated in the ban on smoking in enclosed public areas in England and Wales.

Sixty years have therefore seen major changes in attitudes to smoking and unhealthy lifestyles in general. A once illustrious tobacco advertising market has been emphatically banned and public health measures include a strong focus on preventive medicine, with organised health promotion strategies helping people pursue healthy lifestyles.