The British Medical Association voted last month to recommend a ban on the sale of cigarettes to anyone born after 2000. They are now lobbying government in this regard. While the frustration that motivated this vote is understandable, the proposal is unwise and would prove very counterproductive if implemented.
Smoking is a scourge on health. About 7,000 people die annually from smoking-related diseases in Ireland. Smoking causes about one in five deaths, and one out of every two persistent smokers will die of a smoking-related illness. Smoking causes about 90 per cent of all lung cancers, but can cause cancer almost anywhere in the body. About 1,850 people die of lung cancer annually in Ireland. Smoking also increases the risk of coronary heart disease and stroke by two to four times.
The incidence of smoking is on the decline in Ireland. In 1997, 33 per cent of adults smoked, but this has dropped to 21.5 per cent in 2013. There has been a 7 per cent reduction since the ban on smoking in enclosed public places was introduced in 2004. Smoking incidence is highest among the poorest. For example, in 2007, 56 per cent of 18-29-year-old women in the poorest social classes smoked, compared with 28 per cent in the highest social classes (CSO).
Smoking exacts a massive financial cost on the State. It is estimated that the health services will spend €23 billion over the next decade on tobacco-related diseases. About half of this cost is recouped from tax on cigarette sales, but the rest comes from the public purse.
The horrendous medical and economic cost of smoking, coupled with the perceived difficulties of achieving further reductions in smoking, is prompting medical authorities to propose draconian measures to deal with the problem. In Ireland, the former minister for health, Dr James Reilly, had proposed doubling the price of cigarettes. I believe that such harsh methods are counterproductive for several reasons. These include the opportunity for black-market cigarettes that such measures would create, the "forbidden fruit" syndrome, and the poor prospects that these measures would reduce the incidence of smoking.
The criminal classes must be fervently hoping that the proposed ban on selling cigarettes will be introduced, or, failing that, a penal tax increase on cigarette prices. In either event, the black market in the sale of smuggled cigarettes would boom and turf wars between competing criminal gangs would likely follow. The British Medical Association believes that the proposed ban on selling cigarettes to people born after January 1st 2000 would stop young people from taking up smoking. This is unrealistic. Selling cigarettes to under-18s is already illegal, but this does not prevent young people from obtaining cigarettes: they persuade older pals to buy cigarettes for them or they buy them on the black market. Also the stronger the legal anti-smoking sanctions, the greater the attraction of the illicit pleasure to be derived from breaking the rules. However, the incidence of smoking among teenagers has fallen: it was just about half in 2010 (11.9 per cent) what it was in 1998 (Irish Cancer Society).
I disagree with one argument frequently heard against the introduction of draconian anti-smoking measures. This argument says that people have a natural right to do as they please with their own bodies. This principle is also involved in supporting a natural right to euthanasia, abortion and suicide. I believe that this principle must be highly qualified. Each of us has responsibilities as well as rights. We all have social responsibilities to our families, relatives, loved ones and the general community. Deliberately harming oneself by smoking contradicts these responsibilities. We also have responsibilities to ourselves, including responsibilities to our future selves. If you freely decide to play fast and loose with your health today by smoking, your future self will almost certainly regret this decision later if lung cancer develops.
The incidence of smoking is on the decline, and, although further decrease will be hard won, there is no compelling reason to think that the downward trend will halt. One improvement that needs to be made in the campaign to combat smoking is to target the black market in cigarettes much more aggressively – according to the Irish Tobacco Manufacturers Advisory Committee, 28.3 per cent of all tobacco sold in Ireland today is on the black market. The massive efforts that have been made to combat smoking are paying off. We must hold our nerve.
William Reville is an Emeritus Professor of Biochemistry at UCC. understandingscience.ucc.ie