Background
Methods
Interviews
Primary sector | Professional disciplinary approach to tobacco control | Total | ||
---|---|---|---|---|
Economics / Law | Public Health | Other | ||
Academia | 6 | 3 | 0 | 9 |
Public sector | 0 | 4 | 3 | 7 |
Third sector* | 1 | 1 | 5 | 7 |
Private sector | 1 | 0 | 0 | 1 |
Total | 8 | 8 | 8 | 24 |
Discussion groups
Analysis
Results
What is the potential value of implementing the PPP?
“There’s some sort of nice symmetry about money from the tobacco industry being used to improve or solve some of the problems it creates.” (P05, third sector, public health)
“I think it’s a slam dunk. I don’t think there can be any question about that. The polluter pays phrase was the one thing that got into the government’s Green Paper [Advancing our health: prevention in the 2020s] on this. So, while they…you know, calling it an industry levy didn’t wash, they did say they were willing to look at ways of making the polluter pay.” (P18 public sector, public health)“I think that’s how you’d sell it to the public, and that they are essentially polluting, so the whole polluter pays thing, you know, so, you know, evocative, emotive language is probably so so, you know, tobacco industry is a polluter”. (P15, third sector, other)
“We’d need to be very, very careful in the communications about this, particularly in relation to who is the polluter. Because at the very beginning of this I suppose it is possible for someone to put out misinformation that would say they’re after you because you’re putting the tobacco smoke into the air by smoking, so you’re the polluter. […] You can find some references to polluter pays and public health but not very many. It’s mainly people shouting saying we should have a polluter pays principle for public health but there’s not much to say that’s happening. So, I think we’d need to really educate people what we mean by it and communicate by it.” (P11, third sector, other)
“I think it’s problematic, maybe this is just the lens that I look through it, but to me when you talk about polluter pays, you’re talking about the person who creates the negative consequences pays for the negative consequences. And I think one of the things that industry is moving towards is this harm reduction, harm minimisation narrative. And so as soon as you start defining something based on the outcomes, they will argue with you a lot and they will try and dispute any evidence base and they will try to create their own evidence base.” (P05, third sector, public health)
What are the potential industry arguments?
“You would get fierce opposition to anything that would restrict their operation and particularly anything that would incur additional costs, so yeah, you get the idea, it’s not something they would embrace without a fight.” (P05, third sector, economist)
“Well the bigger the noise the better because it shows that they’re bloody scared of it.” (P08, third sector, other)
“The big card they always play is the fact that we raise more in taxes than we spend on dealing with the harm which we dispute. But it doesn’t matter if you dispute it or not, if they say it, it becomes the narrative.” (P16, public sector, other)
“If you worked in the tobacco industry you might say well, drinking, because drinks can kill you, can’t they? And eating unhealthy food can kill you, and stuff, as well, so, are we all polluters.” (P14, public sector, public health)
Who should oversee implementation?
“I don’t think I would have a strong view as long as […] it was a transparent body that both industry and [academic] researchers and the government had trust in to operate transparently and fairly and not be unduly influenced by any stakeholders, by researchers, by industry, by government, you just need to make it an independent body.” (P05, third sector, public health)
“There are many players in tobacco control. So there’s local Government, there’s ASH, there’s Public Health England, as it is at the moment, NHSE, Department of Health and Social Care, there’s quite a few. And the reality is you probably need input from a variety of stakeholders, but there is a worry that there might be too many cooks…too many cooks spoil the broth.” (P16, public sector, other)
“At some points in that one country might be further ahead than the other one, so we might need to spend the money more differently, you know, so there’s quite a lot of different changes. So for example in England the cessation services are provided by local authorities. In Scotland they’re provided by the NHS, so there are unique, kind of, structures in place, so I think it might be quite difficult if one organisation decides where the money’s being spent in all those devolved administrations because they might not have the on the ground feel for where it’s needed.” (P11, third sector, other)
“Is the industry the retailer or is it distribution, or is it the importers or is it, you know, the overseas owners? […] I would imagine where people who produce or distribute will find legal barriers to put up to avoid information sharing that’s potentially confidential because of its, you know, economic nature, so I would suggest retail or distribution maybe are ways to tackle that.” (P16, public sector, other)
“I’ve always said that if you want to raise money from the tobacco industry then you need to go after the companies themselves which means a charge on their profits.” (P09, academic, economics)
How should funds be disbursed?
“The bit that we struggle to fund is the preventative work. You know, people pitching up with COPD or lung cancer, for example, are getting treated; that isn’t a problem in a UK context, whereas actually we are struggling with preventative funding. So it feels to me that that’s why I would argue that very, very strongly.” (P22, public sector, public health)
“The danger is that politicians think this is just another way to fill the bottomless pit that is the NHS with more money, and the point is that it’s smokers…the money is coming from smokers, because the profits come from smokers. Current smokers. And, therefore, that money should go in helping those smokers quit, and that’s what tobacco control is about. It’s not about treating them once they’re sick, it’s about supporting them to quit and preventing youth uptake.” (P23, third sector, other)
“[One] argument would be, well it should go for the National Health Service. And that of course turns on how you do the calculations for the damage charge or whatever you’re calling it. To the extent the calculations are based on cost to the National Health Service, the logic is very strong that the money should go to the National Health Service.” (P02, academic, law)
“I think the primary uses would be to support cessation for existing users, use that to support cessation counselling, cessation products, and then to use some of it for prevention purposes.” (P04, academic, economics)“I would have thought smoking cessation services would be a good place to start given that I know some funding for those have been cut back.” (P09 academic, economics)
“[A healthcare professional may] say you need to spend all of the money on smoking cessation services, because they are just so chronically underfunded, as is a lot of the NHS. But that does a different thing which is that it helps people stop smoking where we missed the boat, we didn’t prevent them taking it up, so that doesn’t solve the long-term problem of tobacco use and you’re still potentially getting uptake.” (P05, third sector, public health)
“I think using some of the funds to try to deal with illicit trade in tobacco products is a good idea, step up enforcement efforts and things like that, use some of the funds to deal with under-age sales, sales to under-age kids would be appropriate.” (P04, academic, economics)
“I would rank [combating illicit trade] way down the bottom because I am aware of quite an extensive literature demonstrating that this is basically a small issue blown up into a large issue by the industry and that they deliberately exaggerate the scale of the problem.” (P03, academic public health)
“We’ve done minimal around the school programmes and yet we’ve got the lowest youth smoking prevalence because we’ve absolutely focused our policy efforts on changing the adult world. […] I’m not saying that there isn’t a role for education in schools if it’s linked in to kind of really robust personal, social, citizenship-y kind of education, but the tobacco industry would love us to just go and run education sessions in primary schools.” (P08 third sector, other)“So it’s like doing a school-based education on not smoking, which really doesn’t work. So these like evidence-based policies for youth prevention. And the best actually, the best youth prevention, is reducing the consumption among adults.” (P12, academic economics)