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

European People's Party via Creative Commons
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Ansbach puts Europe's bravest politician under pressure

Angela Merkel must respond to a series of tragedies and criticisms of her refugee policy. 

Angela Merkel, the Chancellor of Germany, is supposed to be on holiday. Two separate attacks have put an end to that. The first, a mass shooting in Munich, was at first widely believed to be a terrorist attack, but later turned out to be the actions of a loner obsessed with US high school shootings. The second, where a man blew himself up in the town of Ansbach, caused less physical damage - three were seriously injured, but none killed. Nevertheless, this event may prove to affect even more people's lives. Because that man had come to Germany claiming to be a Syrian refugee. 

The attack came hours after a Syrian refugee murdered a pregnant Polish woman, a co-woker in a snack bar, in Reutlingen. All eyes will now be on Merkel who, more than any other European politician, is held responsible for Syrian refugees in Europe.

In 2015, when other European states were erecting barriers to keep out the million migrants and refugees marching north, Merkel kept Germany's borders open. The country has resettled 41,899 Syrians since 2013, according to the UNHCR, of which 20,067 came on humanitarian grounds and 21,832 through private sponsorship. That is twice as much as the UK has pledged to resettle by 2020. The actual number of Syrians in Germany is far higher - 90 per cent of the 102,400 Syrians applying for EU asylum in the first quarter of 2016 were registered there. 

Merkel is the bravest of Europe's politicians. Contrary to some assertions on the right, she did not invent the refugee crisis. Five years of brutal war in Syria did that. Merkel was simply the first of the continent's most prominent leaders to stop ignoring it. If Germany had not absorbed so many refugees, they would still be in central Europe and the Balkans, and we would be seeing even more pictures of starved children in informal camps than we do today. 

Equally, the problems facing Merkel now are not hers alone. These are the problems facing all of Europe's major states, whether or not they recognise them. 

Take the failed Syrian asylum seeker of Ansbach (his application was rejected but he could not be deported back to a warzone). In Germany, his application could at least be considered, and rejected. Europe as a whole has not invested in the processing centres required to determine who is a Syrian civilian, who might be a Syrian combatant and who is simply taking advantage of the black market in Syrian passports to masquerade as a refugee. 

Secondly, there is the subject of trauma. The Munich shooter appears to have had no links to Islamic State or Syria, but his act underlines the fact you do not need a grand political narrative to inflict hurt on others. Syrians who have experienced unspeakable violence either in their homeland or en route to Europe are left psychologically damaged. That is not to suggest they will turn to violence. But it is still safer to offer such people therapy than leave them to drift around Europe, unmonitored and unsupported, as other countries seem willing to do. 

Third, there is the question of lawlessness. Syrians have been blamed for everything from the Cologne attacks in January to creeping Islamist radicalisation. But apart from the fact that these reports can turn out to be overblown (two of the 58 men arrested over Cologne were Syrians), it is unclear what the alternative would be. Policies that force Syrians underground have already greatly empowered Europe's network of human traffickers and thugs.

So far, Merkel seems to be standing her ground. Her home affairs spokesman, Stephan Mayer, told the BBC that Germany had room to improve on its asylum policy, but stressed each attack was different. 

He said: "Horrible things take place in Syria. And it is the biggest humanitarian catastrophe, so it is completely wrong to blame Angela Merkel, or her refugee policies, for these incidents." Many will do, all the same.