Post B – Plain Impact: Australian Tobacco Control

Smoking tobacco is one of the most self-inflicted causes of death and disease in Australia to date. Despite having implemented a range of tobacco control policies since 1973 and being one of the first nations to announce the implementation of the tobacco plain packaging laws. 2010 introduced a packaging policy funded by the Australian government, implementing tobacco packaging requirements demanding all tobacco goods to display visual health warning images on 75% of the front surface area and 90% of the back surface area (Freeman, 2019). Specified for no company logos, trademarks or brand colours to be incorporated into packaging design, creative or branded aspects of company branding were replaced by product and brand descriptions identified in a grey standardised typeface and size (Freeman, Chapman and Rimmer, 2008)

Promotional Poster released by the World Health Organisation inspired by the Australian plain packaging requirements. Source: Freeman (2019)

An area of public health where the ultimate intentions and aim of targeted campaigns and policies are not so complex and nuanced like some other areas of public health. The clear intentions of protecting non-smokers, supporting smokers to quit, and reducing the numbers of new smokers, tobacco control in Australia has successfully achieved the desired results. Statistics confirm the decline in daily smokers between 1995 and 2017-18 to have decreased from 23.8% to 13.8% (4364.0.55.001 – National Health Survey: First Results, 2017-18, 2019). Further studies have also proved that connections between the execution of the plain packaging in Australia and smoking Quitline calls, resulted in a 78% increase of calls to Quitline referred to the plain packaging initiative (Magnusson, 2014).

A definite public health campaign success story the initiative holds many positives, however, the unsettling fact that ‘there is simply no other legal product sold openly on the market today that has [the] same devastating human toll’ as smoking tobacco evokes my common sense as raises the question why (Freeman, 2019). Why aren’t we doing more to raise awareness and prevent smokers from choosing to slowly kill themselves?

Today, plain packaging laws have created their impact but it is now time for more action. As society has become accustomed to the unpleasant images and warnings, new campaigns or systems need to be implemented to re-create a new impact and deter smokers. I present this opinion based on my own personal observations and relationship as smoking seems to be even more relevant than not. Whether friends are social smokers or smoke routinely, knowledge of the ugly consequences of smoking is definitely identified, however, excused by the youth factor of being young and invincible or the idea that smoking is a means to socialise. 

Living in the 21st century in Australia the health effects and dangers of smoking are predominantly well known. And although consequences are known, the act of quitting and overcoming tobacco addiction requires a strong will and defiant extra push. However, I am a strong believer in the idea small changes create a larger impact so maybe the change we are waiting for is just around the corner!

References

11A.1 Plain packaging as a solution to the misleading and promotional power of packaging – Tobacco in Australia 2018, Tobaccoinaustralia.org.au. viewed 16 November 2019, <https://www.tobaccoinaustralia.org.au/chapter-11-advertising/indepth-11a-packaging-as-promotion/11a-1-plain-packaging-as-a-solution>.

4364.0.55.001 – National Health Survey: First Results, 2017-18 2019, Abs.gov.au. viewed 16 November 2019, <https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2017-18~Main%20Features~Smoking~85>.

Freeman, B. 2019, Thinking outside the box: Tobacco plain packaging and the demise of smoking, Successful Public Policy: Lessons from Australia and New Zealand, pp.303-326,.

Freeman, B., Chapman, S. and Rimmer, M. 2008, The case for the plain packaging of tobacco products, Addiction, vol 103, no 4, pp.580-590,.

Magnusson, R. 2014, The association between tobacco plain packaging and Quitline calls, Medical Journal of Australia, vol 200, no 6, pp.314-315,.

Voon, P. 2018, Big tobacco vs Australia’s plain packaging, Pursuit. viewed 16 November 2019, <https://pursuit.unimelb.edu.au/articles/big-tobacco-vs-australia-s-plain-packaging>.

Post C: Religion and Smoking

In Ambon, the population is composed of 59% Protestant, 39% Muslim and 2% Catholic displaying a clear division among the people (Ansori et. al., n.d.). In each village, their religious building is the most beautiful structure and displays a great amount of wealth which is highly juxtaposed with their homes. I had the opportunity to sit down with a local doctor, Anastassia (Tasya) and discuss the role religion plays within Ambon society. Tasya explained, “the people will give all their money to the church even if they don’t have much,” she continued by saying, “Ambonese culture is strong in religion, their daily life is wired on religion” (2019, pers. comm., 26 January).

The riots in 1999, showcased a division among the Ambonese people, the main factor separating and identifying them is their religion. Although all religions in Ambon live in harmony today, people still identify by their ethno religion and showcase this by living in distinct Christian or Islamic villages (Al Qurtuby, 2013).

Islam is based on five key principles, one in which is the ‘protection of the individual’, therefore any products or forms of consumption that jeopardise the health or life of an individual is considered against the teachings of Islam (WHO, 1999). This explains why alcohol is prohibited and although tobacco did not exist in the time of revelations, by analogy tobacco is one of those products that causes harm. Similarly, Christianity preaches “your bodies are temples… therefore honour God with your bodies” (1 Corinthians 6:19-20) (Holy Bible, n.d.).

In Indonesia 2017, a joint press conference was held of religious leaders representing Islam, Christianity and Hinduism and economic experts to denounce smoking and branded it forbidden in their respective religions (Jakarta, 2017).

In Ambon, religion is a high priority, the tobacco culture has an inescapable presence that even religious teachings have not had an effect. With a disregard of their beliefs, 67.4% of males and 4.5% of females in Indonesia smoke (WHO, 2018); underscoring that in theory, there is a relationship between smoking and religion but the smoking culture is strong in Ambon. In a qualitative study carried out in Indonesia, 2015, some non-smokers said their religion reinforced their non-smoking behaviour (Byron et al., 2015) Tasya explains that religion may persuade individuals not to smoke on a personal level, but not on a community level (2019, pers. comm., 26 January).

Reference List

Al Qurtuby, S. 2013, Peacebuilding in Indonesia: Christian–Muslim Alliances in Ambon Island, Islam and Christian–Muslim Relations, vol 24, no 3, pp.349-367,.

Ansori, M., Sukandar, R., Peranto, S., Karib, F., Cholid, S. and Rasyid, I. n.d., Post-conflict segregation, violence, and reconstruction policy in Ambon,.

Byron, M., Cohen, J., Gittelsohn, J., Frattaroli, S., Nuryunawati, R. and Jernigan, D. 2015, Influence of religious organisations’ statements on compliance with a smoke-free law in Bogor, Indonesia: a qualitative study, BMJ Open, vol 5, no 12, p.e008111,.

Holy Bible n.d., .

Jakarta, C. 2017, Religious leaders in Indonesia come together to say that smoking is forbidden, urging for higher tobacco taxes | Coconuts Jakarta, Coconuts. viewed 29 January 2019, <https://coconuts.co/jakarta/news/religious-leaders-indonesia-come-together-say-smoking-forbidden-urging-higher-tobacco-taxes/&gt;.

World Health Organisation 1999, Meeting on Tobacco and Religion, viewed 30 January 2019, <http://www.who.int/tobacco/media/en/religioneng.doc&gt;.

World Health Organisation 2018, Tobacco Control in Indonesia, viewed 30 January 2019, <http://www.who.int/tobacco/about/partners/bloomberg/idn/en/>.

POST B: Snus and the Swedish Experience

Portioned-snus

Above image: (General Original 2018)

Sweden has the lowest level of tobacco related mortality for men, and the third lowest overall in the EU (Shapiro 2018, 50) with 5 and 11% respectively of men and women smoking. This makes Sweden unusual; it’s one of the only countries in the world where women smoke more, and this trend has been widely attributed to the rise in popularity of Snus amongst men.

Screen Shot 2018-11-30 at 7.16.09 pm copy

Above image: (WHO 2012)

After dropping to its lowest consumption levels in 1967, Swedish moist snuff or Snus as it is referred to in Sweden, has been more popular with male nicotine users than traditional cigarettes since 1996. Made of dried ground tobacco, salt, water and  flavourings, it’s an oral product placed between the gum and upper lip.

Multiple sources cite increases in advertising in the 1960’s onwards, but primarily the development of new pasteurised products by the country’s primary Snus manufacturer Swedish Match (IARC 2007, chapter 1.1.2; Shapiro 2018, p. 48). This new process meant the product was air dried and free of chemicals similar products on the market had, and it proved an effective selling point to a market that was increasingly aware of the effects of smoking on the human body (Henningfield 2001).

Gender disparity suggests social and cultural factors were also at play, with male oriented marketing efforts and other societal notions influencing behaviours, a trend that also tends to ring true for cigarette smoking (WHO 2010).

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Above image: (Ramström 2018)

Nowadays, Swedish Match like many of its competitors openly represents it’s products as a harm reduction strategy (2018) targeting smokers who would like to quit. Studies on effective quitting methods tend to suggest that the use of Snus is in fact more effective than other products such as nicotine chewing gum and patches (Lund, McNeill & Scheffels 2010).

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Above Image: (Camel Snus Ads 2011)

The above commercials from tobacco company Camel aired in 2011 and promoted Snus as a healthier alternative to cigarettes in the lead up to the government sponsored Great American Smokeout. While it might be less harmful overall, various studies including one facilitated by the International Agency for research on Cancer in 2007 conclude that Snus is still a group 1 carcinogen capable of causing oral, oesophageal and pancreatic cancers (IARC, chapter 5.5).

Whether Snus and other smokeless products are effective harm reduction strategies is a debated topic. Governments are reluctant to endorse these products due to commercial interests a company has in transferring nicotine addiction instead of allowing cessation to occur (Henningfield 2001). Some studies also suggest similar products in the United States may have contributed to escalated smoking rates among youths and young adults in the 1990’s by fostering nicotine addictions that were then translated into cigarette use.

Patterns of nicotine use are influenced by complex factors and the Swedish Phenomenon may be open to interpretation for a while yet. That being said, there can be no one-size-fits-all solution so while there is value in learning from individual case studies, it should not be taken as a recommendation for application in other contexts.

 

References

Camel Snus Ads, 2011, Camel, USA, viewed 30 November 2018, <http://camelsnus.com>.

ENVIRON International Corporation 2013, Review of the Scientific Literature on Snus, ENVIRON International Corporation, Arlington, Virginia.

General Original, 2018, Swedish Match, viewed 30 November 2018, <https://www.swedishmatch.ch/en/buy-snus/general/general-original-portion/>.

Henningfield, J. 2001, Swedish Match Company, Swedish Snus and Public Health: A Harm Reduction Experiment in Progress?, Pinney Associates, Maryland, USA, viewed 30 November 2018, <https://tobaccocontrol.bmj.com/content/10/3/253>.

Lund, K. McNeill, A. Scheffels, J. 2010, ‘The Use of Snus for Quitting Smoking Compared with Medicinal Products’, Nicotine & Tobacco Research, vol. 12, no. 8, pp. 817–822.

IARC, 2007, Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines, NCBI, Lyon, France, viewed 29 November 2018, <https://www.ncbi.nlm.nih.gov/books/NBK326503/>.

Ramström, L. 2018, Sweden’s pathway to Europe’s lowest level of tobacco-related mortality, Poster, World Conference on Tobacco or Health, South Africa.

Shapiro, H. 2018, No Fire, No Smoke: The Global State of Tobacco Harm Reduction, Knowledge-Action-Change, London.

Swedish Match, 2018, Our Standpoint, Swedish Match AB, Stockholm, viewed 30 November 2018, <https://www.swedishmatch.com/Snus-and-health/Our-standpoint/>.

WHO, 2010, 10 Facts on Gender and Tobacco, World Health Organisation, Switzerland.

WHO, 2012, Global Report: Mortality Attributable to Tobacco, World Health Organisation, Switzerland.