Transform submission to the DoH consultation on tobacco control

Transform's have made a submission to the Department of Health's consultation on the future of tobacco control. The complete pdf of Transform's submission is available here, the introduction and one of the discussion points, on the wider implications of tobacco control policy, are copied below.

Introduction

Transform welcomes this consultation as timely, thorough and thoughtful, and hope that it will allow us to build on the recent achievements made in tobacco policy with more appropriate targeted regulation based around evidence of effectiveness on key public health indicators.

• Following a dialogue with Action on Tobacco and Health (ASH) Transform fully endorse ASH’s detailed submission (1) to this consultation and its answers to the individual questions posed.
  
  
• Transform also fully endorse the World Health Organisation’s framework convention on tobacco control (2) signed by the UK in 2003

In addition to this endorsement of the ASH submission we include some additional comments on overlooked elements of issues relating to tobacco harm reduction that are relevant to Question 17 (3) in the consultation document.

Transform would also like to present some additional discussion points not directly addressed in the consultation document regarding:

• Possibilities for a more radical restructuring of tobacco market regulation
  
  
• Discrepancies between alcohol and tobacco policy development
  
  
• The wider issues raised around drug policy and how to regulate drugs

The wider issues raised around drug policy and how to regulate drugs

All drugs, whether currently legal or illegal, need to be subject to the optimum level of regulation such that harms, both to individual users and the wider community are minimised and wellbeing maximised. Better regulation of tobacco is now delivering positive public health benefits, and as we argue above, it is hoped, and indeed seems likely, that these lessons will soon be translated into more effective regulation of alcohol markets.

However, it is hard to ignore the fact that such regulatory interventions, on price, packaging, availability, ingredients/strength, marketing etc, and the positive outcomes they can demonstrably deliver are entirely beyond the reach of government when it comes to drugs covered by the Misuse of Drugs Act. Responsibility for control of illegal drug markets was abdicated to criminal networks and unregulated street dealers when they were subject to absolute prohibitions against their production, supply and use, enforced with criminal law.

The distinction between legal and illegal drugs is not based on any rational evaluation of harms, but rather is a quirk of our political and cultural histories over the last 200 years. Indeed a recent Lancet paper (4) ranked alcohol and tobacco as more harmful than many illegal drugs.

The disjuncture between how we approach legal and illegal drugs is entirely illogical, and the case for all drugs to be regulated within a single regulatory framework, by a single regulatory agency, using a consistent set of evidence-based public health principles/tools seems overwhelming. Why are alcohol and tobacco the primary concern of the DoH, whereas over 200 illicit drugs are covered by the Home Office? It is a quite bizarre and untenable situation. Even the Advisory Council on the Misuse of Drugs, the body of experts appointed to advise Government on drugs issues recently argued that:

"As their actions are similar and their harmfulness to individuals and society is no less that that of other psychoactive drugs, tobacco and alcohol should be explicitly included in the terms of reference of the Advisory Council on the Misuse of Drugs (5)"

Transform argues that the sorts of questions being asked about appropriate levels of legal regulation and state intervention in the tobacco and alcohol consultations are precisely those we should be asking for currently illegal drugs. The current anomalous legislative framework however, completely denies us this opportunity and there is a striking and depressing contrast between the public health pragmatism of these DoH documents and the shallow politically-driven criminal justice posturing that characterised last year’s disgraceful drug strategy consultation (6). The DoH should unambiguously assert that drug policy is primarily a public health issue and is should therefore be the primary responsibility of the DoH and relevant public health authorities.

No credible calls have been made for an outright ban on tobacco, or for it to criminalised and brought within the Misuse of Drugs Act. Indeed, when the then Home Secretary, John Reid, was asked on the Jeremy Vine radio show (BBC Radio 2, 11.11.04) if he supported such a ban he replied:

“Prohibition doesn’t work, as the US found out many years ago.”

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[1] http://www.smokefreeaction.org.uk/news/ASH_DH_Consultation_tobacco_control_final.pdf

[2] http://www.who.int/features/2003/08/en/

[3] Do you support a harm reduction approach and if so can y9ou suggest how it should be developed and implemented.

[4] Development of a rational scale to assess the harm of drugs of potential misuse . The Lancet , Volume 369 , Issue 9566 , Pages 1047 - 1053 D . Nutt , L . King , W . Saulsbury , C . Blakemore.

[5] Pathways to Problems 2006 http://drugs.homeoffice.gov.uk/publication-search/acmd/pathways-to-problems/Pathwaystoproblems.pdf

[6] Discussed in more detail in the submissions from Transform: http://www.tdpf.org.uk/Policy_General_DrugStategyConsultationSubmission.htm and the Drugs and Health Alliance: http://drugshealthalliance.net/documents/consultation_submission.php