Friday, 1 July 2011

Smoking – How can you change behaviour?

This week, the British Medical Association has called for a ban on smoking in cars, recommending tougher legislation. The main rationale behind this request is that research has shown that toxicity from smoking in cars is 27 times higher than in the home and young passengers are particularly at risk from passive smoking.

The  government has responded with  a call for a balance between legislation and partnership on improving public health. And there is the crunch. How do change people’s behaviour when they are indulging in activity or habits that are clearly damaging to themselves and those around them?

I have been enjoying the recent TV ‘docu-drama’ mapping  John F Kennedy’s brief and tragic spell in power. Love it or hate it, this series provides a fascinating snapshot of life in the early 1960’s. There is a shocking image of Katie Holmes, playing a heavily pregnant Jackie Kennedy writing a letter while smoking a cigarette. This would chill the blood of most reasonable observers today, but forty years ago it was unknown that smoking could seriously harm the unborn child. Yet now – through information, public pressure and maybe the passage of time, although it is not illegal to smoke while pregnant, it is far less socially acceptable. In the UK, following many public information campaigns and possibly pressure from family and friends, approximately 50% women now give up smoking while pregnant. We seem to be ahead of the US, where only about 20% pregnant women are estimated to give up and 17% of teenage mothers continue to smoke throughout their pregnancy.

There are other good reasons to discourage smoking in cars. Many years ago, I had just arrived for a business trip in Turkey and as my taxi driver was driving me to the hotel, he suddenly stopped the car, leaped out and removed his trousers! As all sorts of scenarios started to play out in my head and then I realised, with relief that his trousers had actually caught fire as he had dropped his cigarette in his lap!

Controlling the smoking habits of a population is potentially one of the biggest public healthcare challenges a nation can face. We know that, apart from the human loss and suffering, smoking costs the NHS and estimated £2bn a year.

In New York a few weeks ago, a smoking ban was introduced in parks and beaches. But this is supposed to be a ‘self-enforced’ ban and during a recent visit to the big apple I saw many a cigarette being smoked in Central Park and Union Square.
The smoking ban in public places in the UK has been pretty successful, partly due to the threat of prosecutions for corporate owners but also due to public pressure by non smokers. I would have no compunction in complaining to a restaurant owner of someone was smoking inside the facility.

So how does a government get a public health message not only to register with its audience but to convert that audience to make the required changes and to encourage those changes in others?

Celebrity culture is undoubtedly a powerful force to be harnessed for good. Tragically in 1991, a very well-known UK TV presenter, Anne Diamond lost a baby, Sebastian, to SIDS (Sudden Infant Death Syndrome). She stated a campaign highlighting the simple actions required to reduce the risk of SIDS, which included laying an infant on their back rather than face down, which many of our mothers used to recommend. The effect of this, and subsequent campaigns has been stunning. In 1990, there were 1.77 infant deaths per 1000 live births. In 1991, this was dramatically reduced to 0.61 per 1000. The figure is now dramatically 70% lower than before Anne’s terrible loss.

So let’s keep the pressure up on smoking. We shouldn’t demonise those who smoke but society should certainly censure those who put others at risk through their behaviour.

I hope the coalition can come up with some creative ways to not just educate the public, but to ‘engage’ them, and to encourage them to take more responsibility for themselves and those around them. David Beckham, Kim Kardashian, Justin Bieber? I don’t care who it is, as long as they get the right message across.


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