Health Education Research, Vol. 16, No. 3, 384-385,
June 2001
© 2001 Oxford University Press
BOOK REVIEW |
Tobacco Control in Developing Countries
Prabhat Jha and Frank Chaloupka (eds) Oxford University Press, Oxford, 2000 490 pp. ISBN 0-19-263246-9 (pb)
Primary Nurse, South Leeds Community Unit Day Hospital,Community & Mental Health Services, Leeds
This scholarly, informative and demanding book is published on behalf of the Human Development Network, the World Bank and the Economics Advisory Service, WHO. With such a pedigree one would expect a study of considerable depth and importance. It is rewarding to note that this book does not disappoint.
Comprehensively charted and illustrated, the most chilling statistics are served up in the dedication: `...to the approximately 100 million people who have died in the twentieth century as a result of smoking. It is our hope that lessons learned from their deaths will help to avoid many of the 1 billion deaths expected to occur in the twenty-first century, on current smoking patterns'.
The sheer magnitude of the issues—economic, practical, philosophical and ethical—has empowered the Editors to elicit reports from 37 contributors. In the Foreword the telling point is made that tobacco is in some ways a unique threat to civilization. As smoking cigarettes was, for many years, synonymous with glamour, adventure and sophistication, particularly in Hollywood, a seismic shift in education is needed worldwide to radically reduce the alarming statistical projections. Not only are cigarettes `demanded by consumers ...[and] form part of the social custom', they are also `extensively traded and profitable commodities', which only serves to emphasize the enormity of the debate about tobacco control.
Despite the overwhelming concerns, the importance of optimism is maintained by the assembled writers throughout the five sections of the book. The format covers `tobacco use and its consequences', `analytics of use', `demand', `supply' and, in the concluding three chapters, `policy directions'. The overview, by the Editors and (Phyllida) Brown, offers a candid summary of the chapters' contents, which is a handy pointer for prospective readers. A thumb through a few pages may also prove beneficial—this is not a book to tempt those who find algebraic statistics daunting.
Littered with references to `the susceptible population size' (p. 31), for whom tobacco use begins at an early age (p. 110), the book moves inexorably towards the plight of the passive smoker. Damned almost from birth, a core of children have no voice in whether their parents smoke (p. 161) or in their home circumstances—but that is equally the case in other deprived situations. The expectation seems to be that children may rebel against the smoking habits of parents, given time. How susceptible are children to peer pressures? How important is the tacit approval given to smoking by the famous and influential?
Anyone who lived through the 1960s will be aware of the reputation of the Rolling Stones—the children fathered out of wedlock, the urinating against garage walls and the smoking on television. Opinions change, but the outcry that followed all five band members chain smoking on BBC TV, as guests on Juke Box Jury, made front page news. However, most publicity photographs of Leonard Bernstein, Charlie Chaplin, Pablo Picasso and even Gustav Mahler suggest an interest in nicotine.
Kenkel and Chen consider two questions in Chapter 8: (1) are consumers well-informed about the consequences of smoking and (2) can public policies to improve consumer information reduce tobacco use? They dauntingly summarize that as a potential cause of death, smokers rarely consider statistical risks affect them personally and young people underestimate the addictive properties of tobacco (p. 177).
The clean indoor-air laws and youth access restrictions are discussed by Woollery, Asma and Sharp. Their allocated space may be brief (11 pages, excluding references) but they conclude that the debate continues, as does the increased move towards litigation. Similarly, an uneasy alliance appears to exist between the tobacco industry and education and health advocates in America. Earlier this year it was reported that pressure groups were unhappy about the designs used for school book covers, fearing `that the design contained subliminal messages promoting smoking to children'. The covers, bearing the slogan `Don't wipe out. Think. Don't smoke', were being sent to 43 000 schools, as part of the $200 billion agreement between the tobacco industry and 46 states of the USA in 1998 (The Independent, 11 January 2001).
For many years governments worldwide have been trying to balance health and wealth issues when considering the economics of tobacco control. Jha and Chaloupka's Preface states that over 40 years' worth of `epidemiological studies...have removed any doubt that smoking is damaging global health on an unprecedented scale' and this book argues, with considerable conviction, for a radical shift in opinion.
Education about the issues will not be sufficient and the arguments here are not merely being used to preach to the converted. What comes across in the writing is a passionate concern for millions of individuals, for whom profit equals hardship and loss could mean loss of life. Oxford University Press have published a book that clearly demonstrates the power of taxation to influence behaviour. Having used our democratic right to elect the government, they should not now renege on the undertaking.
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