2 in 3 smokers wish they could stop and 9 in 10 wish they had never started. Photo: Getty
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Why we should ban the sale of cigarettes to people born after the year 2000

Someone who starts smoking at age 15 is three times more likely to die of tobacco related cancer than someone who starts in their mid-20s.

Humanity has never developed anything more deadly than the cigarette. The combination of its addictive power and devastating health effects, coupled with historical social norms and powerful advertising campaigns, killed 100 million people in the twentieth century. The World Health Organisation predicts that this continuing epidemic will kill a billion more in the twenty-first. Tobacco products cause the death of 50 per cent of their users and, for each death, 20 other people suffer from a smoking related disease. Allowing this cycle of addiction, suffering and death to continue is unconscionable.

One solution is to prohibit the sale of cigarettes to people born after the year 2000. As this generation reach 18 in 2018 they would be prevented from buying cigarettes for their lifetime in a move that would progressively phase out cigarette sales. This would have the effect of de-normalising smoking for an entire generation of children and slowly begin to reduce the harm caused by tobacco. Evidence published today in the Lancet shows the incredible effects that smoke-free legislation has had on child health, including reducing premature births and hospital attendances for asthma attacks. It’s time to apply the lessons from this evidence to the population as a whole.

This move may be unpopular among people who view banning the sale of cigarettes as a restriction of personal freedom. However, starting to smoke predominantly takes place in childhood and adolescence, as 80 per cent of smokers start in their teens. This decision is heavily influenced by peer pressure and a desire to appear more adult, rather than being dependent on rational choice. Almost 99 per cent of people think adolescents should be prevented from taking up smoking and to achieve this smoking must become socially unacceptable. This is particularly important as someone who starts smoking at age 15 is three times more likely to die of tobacco related cancer than someone who starts in their mid-20s. By the time smokers reach adulthood, the majority continue smoking to relieve the unpleasant sensation of nicotine withdrawal, rather than to gain any pleasurable effect from the nicotine itself. Addiction, by definition, cannot be an expression of free will. This is reflected in the fact that 2 in 3 smokers wish they could stop and 9 in 10 wish they had never started. If smoking were a true choice, there would be far fewer smokers in the world.

The inevitable comparison of this policy with alcohol prohibition in the 1920s is hard to ignore. However, substantial differences exist between the nature of alcohol and the nature of tobacco. Most people who smoke are nicotine addicts responding to withdrawal symptoms who wish they could stop. In contrast, the majority of people who drink alcohol do so recreationally for its pleasurable effects. Alcohol is substantially less addictive than nicotine and so a much smaller proportion of drinkers become alcoholics. If 90 per cent people who drank became alcoholics there would be total public outrage. In recognition of the harms caused by tobacco, over time there has been a supportive public response to tobacco legislation, including health warnings, advertising bans, smoke-free public places and preventing smoking in cars with children. It would be surprising to suddenly see a large proportion of the population take up clandestine smoking in response to this kind of ban, particularly as current smokers would be able to continue buying cigarettes without hindrance.

While smoking is still seen as socially acceptable in daily life and believed to be an expression of free will it is unlikely that there will be sufficient political will to call for an outright ban. However, this policy presents an opportunity to intervene for the generation who have not yet started smoking to prevent them from perpetuating the cycle of misery and suffering caused by nicotine addiction. It’s time to play the tobacco endgame and begin building the first smoke free generation.

Dr Tim Crocker-Buqué is a Speciality Registrar in Public Health Medicine

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How to end the Gulf stand off? The West should tell Qatar to reform its foreign policy

Former defence secretary Geoff Hoon on the unfolding crisis in the Gulf. 

Only one group stands to benefit from a continuation of the crisis in Gulf: The Quartet, as they are now being called. Last week, The United Arab Emirates foreign minister tweeted that Qatar and its Gulf Cooperation Council neighbours are heading for a "long estrangement". We should take him at his word.

The European political establishment has been quick to dismiss the boycott by Saudi Arabia, the UAE, Bahrain and Egypt as naïve, and a strategic mistake. The received wisdom now is that they have acted impulsively, and that any payoff will be inescapably pyrrhic. I’m not so sure.

Another view: Qatar is determined to stand up to its Gulf neighbours

Jean-Yves Le Drian, France's foreign minister, was in the region over the weekend to see if he could relay some of his boss’s diplomatic momentum. He has offered to help mediate with Kuwait, clearly in the belief that this is the perfect opportunity to elevate France back to the top table. But if President Emmanuel Macron thinks this one will be as straightforward as a Donald Trump handshake, he should know that European charm doesn’t function as well in the 45 degree desert heat (even if some people call him the Sun King).

Western mediation has so far proceeded on the assumption that both sides privately know they will suffer if this conflict drags on. The US secretary of state Rex Tillerson judged that a Qatari commitment to further counter-terrorism measures might provide sufficient justification for a noble reversal. But he perhaps underestimates the seriousness of the challenge being made to Qatar. This is not some poorly-judged attempt to steal a quick diplomatic win over an inferior neighbour.

Qatar’s foreign policy is of direct and existential concern to the other governments in the Gulf. They will not let Qatar off the hook. And even more than that, why should they? Qatar has enormous diplomatic and commercial clout for its size, but that would evaporate in an instant if companies and governments were forced to choose between Doha and the Quartet, whose combined GDP is almost ten times that of their former ally. Iran, Turkey and Russia might stay on side. But Qatar would lose the US and Europe, where most of its soft power has been developed. Qatar’s success has been dependent on its ability to play both sides. If it loses that privilege, as it would in the event of an interminable cold war in the Gulf, then the curtains could come down.

Which is why, if they wanted to badly enough, Le Drian and Tillerson could end this conflict tomorrow. Qatar’s foreign policy has been concerning for the past decade. It has backed virtually every losing side in the Arab world, and caused a significant amount of destruction in the process. In Syria, Libya, Egypt and Yemen, Qatar has turned a blind eye to the funding of Islamic revolutionaries with the financial muscle to topple incumbent regimes. Its motives are clear; influence over the emergent republics, as it had in Egypt for a year under Mohamed Morsi. But as we review the success of this policy from the perspective of 2017, it seems clear that all that has been achieved is a combination of civil unrest and civil war. The experiment has failed.

Moreover, the Coalition is not going to lift sanctions until Doha suspends its support for the Muslim Brotherhood. When Western leaders survey the Gulf and consider who they should support, they observe two things: firstly, that the foreign policy of the Quartet is much more aligned with their own (it doesn’t seem likely to me that any European or American company would prefer to see a revolution in Dubai instead of a continuation of the present arrangement), and secondly, that Qatar would fold immediately if they applied any significant pressure. The Al Thani ruling family has bet its fortune and power on trans-Atlantic support; it is simply not credible that they would turn to the West’s enemies in the event that an ultimatum was issued. Doha might even welcome an excuse to pause its costly and ineffective programmes. Even if that involves some short term embarrassment. It is hardly going to lose support at home, with the highest GDP per capita in the world.

It would be necessary to make sure that the Coalition understands that it will have to pay a price for decisive Western intervention. The world will be a more dangerous place if our allies get the impression they can freely bully any smaller rival, knowing that the West will always come down on their side. That is however no great hurdle to action; it might even be a positive thing if we can at the same time negotiate greater contributions to counter-terrorism or refugee funding.

Unfortunately the reason why none of this is likely to happen is partly that the West has lost a lot of confidence in its ability to resolve issues in the Middle East since 2003, and partly because it fears for its interests in Doha and the handsome Qatari contributions in Western capitals. This cautious assessment is wrong and will be more harmful to Qatar and the aforementioned interests. The Quartet has no incentive to relent, it can’t afford to and will profit from commercial uncertainty in Doha the longer this drags on. If the West really wants this to end now, it must tell Qatar to reform its foreign policy or face sanctions from a more threatening ally.

Geoffrey Hoon was the UK defence secretary from 1999 to 2005.