From Linda Bauld [1]:

Although evidence on the health effects of smoking began accumulating over 200 years ago, it was not until the 1950s that any real attention was paid to this evidence. In 1950 five case control studies were published illustrating the link between lung cancer and smoking, including Doll and Bradford Hill‟s study. It took a further decade before the role of government in addressing smoking was acknowledged and a policy framework was proposed. In the UK, this framework was set out in the 1962 Royal College of Physician‟s report on Smoking and Health. This report set out recommendations for policy in six areas:

• the provision of public education on harm from smoking;​

• restrictions on sales of tobacco to children;​

• restrictions on advertising; restrictions on smoking in public places;​

• increasing tobacco taxation; providing information on cigarette packs about tar and nicotine content; and,​

• investigating the value of „anti-smoking clinics‟.

However, it would be almost half a decade later until all these measures were in place in the UK. Progress was achieved slowly. In 1965, television advertising of tobacco products was banned and in 1971 the first health warnings appeared on cigarette packs, followed by tar and nicotine yields in 1973. Also in the 1970s tobacco taxes were raised above inflation.

However, during the 1980s and early to mid 1990s relatively little policy progress took place. Instead, advocacy efforts escalated, led by Action on Smoking and Health (ASH) the tobacco control strategy established by the RCP in 1971. International tobacco control efforts also increased during this period and World No Tobacco Day was launched by the WHO in 1988. In 1993, Doll and Peto published results from the British Doctor‟s study that showed the extent of premature death due to smoking, with one in two smokers dying from smoking-related diseases13. This and other evidence persuaded the incoming New Labour government in 1997 to begin developing a package of policies that were outlined in the 1998 White Paper, Smoking Kills18. The policies in combination represented a comprehensive approach to tobacco control and included:

• An advertising ban (introduced in stages from 2002 to 2005)
• Tax increases (above the rate of inflation to 2001)
• Action on smuggling (increased from 2000)
• Mass media campaigns
• Enforcement of underage sales
• Better access to stop smoking medications
• The establishment of NHS stop smoking services

The policies set out in Smoking Kills did not include smokefree legislation but this was eventually introduced in England in 2007 following Scotland, Wales and Northern Ireland. Thus by 2007 all of the policies originally recommended in the RCP report were in place. Further progress, including the introduction of visual health warnings on packs (2008), raising the age of sale from 16 to 18 (2007) and the commitment to a point of sale display and vending machine ban (2009, not yet implemented) was made more recently.

What factors explain this progress, particularly in the past 10-15 years?

Key ingredients include:

• A sound scientific evidence base
• Authoritative reports from key organisations setting out action needed 
• A central point to lead advocacy and campaigning
• Coalition building Public support for policies and interventions
• Political support for policies and interventions

The evidence for tobacco control began with studies on the impact of smoking but now includes a considerable body of research setting the rationale for, and impact of particular policies and interventions. This evidence has been invaluable in persuading planners and policy-makers to invest in tobacco control measures.

Key organisations such as the RCP and the British Medical Association (BMA) have used this evidence to produce authoritative reports that have made the case for policies and interventions, underpinned by international developments such as the implementation of the World Health Organisation Framework Convention on Tobacco Control (FCTC) from 2005.

The existence of ASH as a central point for advocacy and campaigning has also been crucial, and ASH has been able to act as a focus for coalition building. The Smokefree Action Coalition, for example (with its roots in earlier coalitions, this partnership was formed to advocate for smokefree legislation) is centred around ASH but includes a wide range of charities and other organisations that are advocates for tobacco control.

Their actions combined with the evidence (often communicated through mass media campaigns) have helped to shape public opinion in favour of measures to address smoking. These measures have built up over time, assisting in denormalising tobacco use which has further contributed to public support.

New Labour‟s support for tobacco control undoubtedly contributed to the rapid progress observed in reducing smoking between 1998 and 2008 in particular - a steady decrease of 0.5% each year. It remains to be seen to what extent the change in government at Westminister in 2010 will affect tobacco control, and smoking prevalence, in the longer term.