Since the 1970s, the UK has shown a sharp declining trend over the prevalence of smoking amongst its population. A striking fact, given that in the year 1950 the UK was amongst the 7 nations with the largest cigarette smoking rates per capita (Pampel, 2019). In fact, the country has made astounding progress over time, as it started in 1974 with a relatively high tobacco consumption level (45,6%), and by 2018, it had reduced its smoking prevalence to 16,6%. This meant a reduction of 63, 6% over a 44 year period. That is a bigger reduction than France on the levels of smoking prevalence both in comparative and absolute terms.
During the 1970s, the W.H.O. drafted several reports that highlighted the dangers of smoking on human health, and recommended the prohibition of the use of advertising for encouraging tobacco consumption. These reports had an enormous effect on the British Government and population at the time, which led to the Government to take an active anti-tobacco stance and engage in tobacco control policies. This compromise was translated into Government agreements with the tobacco industry, which included the guarantee that all cigarette packages would include health warnings (Schraer and D’Urso, 2018).
A culture which repudiated smoking was slowly being built, as the British Parliament passed laws that banned cigarette advertising, and society celebrated days like ‘National No Smoking Day’. All this widespread rejection of tobacco from society was heard by members of the government, who reacted to population’s demands for more control on tobacco.
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During the 1990s, there was a considerable reduction in the smoking prevalence. While in the 1980s it had reached an average of 38%, it was reduced to 27% by 1994. That same year, the Department of Health set specific policies targeted at improving the health education of the population and at reducing the prevalence of smoking in society. In 1995, the Government rose the taxes on tobacco cigarettes to 78% of its retail price, and funded educational programs held at schools to increase the awareness on the danger of tobacco use.
In fact, in the year 2003 the country passed a tobacco Advertising and Promotion Bill (which banned any form of tobacco ads in the UK) and by 2007, the UK had passed legislations that guaranteed smoke free workplaces and public places. Since 2012, the UK holds a mass-event in which British smokers are challenged to quit smoking during the month of October. The National Health Service (NHS), organizes the program, and provides support and information on the health challenges posed by smoking, and on the benefits of quitting smoking. Moreover, the NHS also offers a program in which they provide help for free to all tobacco smokers who would like to quit smoking. In regards to Article 22 of the Convention (which deals with international cooperation), the UK Government showed its commitment to the fight against tobacco when it made a donation of £15 million to provide aid to FCTC members to implement the provisions of the Convention and reach the goals set for 2030.
In summary, all the elements mentioned above, in particular having one of the strongest legislations on tobacco control and a culture that has taken an anti-tobacco stance since the 1970s, have contributed to the massive decline that the UK has experienced over the second half of the twentieth century, a decline which still very much continues nowadays.
Despite the similarities in development, geographical location and population levels, France and the United Kingdom have shown drastically different trends in regards to tobacco prevalence over time. For instance, since the 1970s, the UK has experienced a sharp decline in smoking prevalence, while in France they massively increased in the 1970s and remained high until the 2000s, when they began to steadily decline.
The reasons which explain the differential paths followed by each countries can be found in the prevalence of an anti-tobacco cultural movement promoted by society itself (Bonnie and Lynch, 1994), and in the compliance with W.H.O. programs (the latter being featured in the compliance assessment above). These differential tobacco consumption paths are showcased in the following figure:
In the case of the United Kingdom, it is clear that both of these conditions were heavily present, which has led to a massive decrease in smoking in the country. On the other hand, the anti-tobacco efforts of France began in the 1990s, and while they have had a positive impact, it does not have the momentum that the anti-tobacco societal stance has in the UK. On top of that, as the compliance assessment showed, France´s compliance with W.H.O. measures has not been as exemplary as the United Kingdom’s.
However, despite the different levels of achievement in the matter of reducing tobacco consumption, it is important not to underscore the considerable effort both countries have put in reducing smoking in their respective societies.
For starters, between 1974 and 2018, both countries managed to reduce their smoking prevalence levels: the UK reduced it by 63,6%, and France by 23,4%. Moreover, France and the UK followed the MPOWER initiative, which in 2018 declared both nations amongst the highest achieving nations in raising taxes on tobacco, anti-tobacco media campaigns, monitoring the prevalence of smoking rates, and ensuring health-warning labelling of tobacco products. For the period of 2012-2013, both countries made significant voluntary donations to ensure the implementation of the FCTC: France contributed with 711,417 USD and the UK with 767,311 USD, 7.8% and 8,4% of the total donations made, respectively.
France’s scores on the compliance assessment are lower, and its smoking prevalence trends have not declined at massive rates, but it has been achieving considerable (yet slow) progress. In particular, the country has raised its taxes on tobacco (currently applies a tax higher than the one that the UK applies), and is particularly remarkable in monitoring bans on direct and indirect advertising on tobacco consumption. On the other hand, the UK government and competent authorities have shown a deep commitment to reducing smoking levels in the nation, and it has gone hand in hand with a popular society which supports said actions.
The British nation currently applies incredibly high tax levels on the retail price of tobacco cigarettes (even though it is mildly lower to that of France), and the National Health Service programs provide free and full coverage of the programs to help people quit smoking. That means that France and the UK have put significant resources and effort into applying these measures, as they consider reducing smoking as a priority for the betterment of their respective societies.
That being said, since 2004 (when both nations ratified the FCTC), France and the UK have followed wildly different paths. In 2004 the smoking rates of UK were 24,6% and France’s was 30%, which entailed a 5,4% difference. But since then, they have had almost opposite trends. The UK continued to consistently reduce its smoking rates (a 32,5% reduction between 2004 and 2018 levels), while France’s rates oscillated between 30-34%, never quite managing to reduce its levels. In fact, between 2004 and 2018, France had a 6,25% increase in its smoking prevalence. Overall, the UK has been more successful than France in reducing its smoking rates, as the French nation has struggled to reduce its strikingly high rates of tobacco smoking.
Both countries implemented W.H.O. measures (to a larger or lesser degree), but saw significantly different results, which highlights the fact that compliance with W.H.O. policies is not the only element affecting smoking rates, although fully committing to such programs can significantly help (like in the case of the UK, since France’s compliance was not entirely satisfactory on all fronts, as the compliance assessment showed). This provides important evidence on the extent of the impact of W.H.O. policies on the paths followed by each country.
After analyzing the smoking patterns and their evolution in the countries of interest, I conclude that the initial hypothesis is satisfied, since the W.H.O. policies have positively contributed to the reduction of smoking rates in the United Kingdom and in France since the year 2004. As the compliance assessment showcased, larger levels of conformity with W.H.O. policies have led over time to lower rates of tobacco usage prevalence. For the two analyzed states, they both applied the W.H.O. policies, but the UK implemented them with higher levels of compliance, which is why its tobacco consumption levels decreased considerably more.
In addition, it is also important to account for alternative explanations which might have also contributed significantly to the reduction of smoking rates. In particular, the prominence and long existence of an anti-tobacco stance in society (or lack thereof), have considerably affected the smoking rates on both countries. More specifically, they contributed to the sharp declines in the United Kingdom, where the anti-tobacco movement started in the 1970s (20 years earlier than in France). The momentum of a societal movements which takes a clear stance against tobacco is key to ensure a successful reduction of smoking rates.
In summary, the main causes of the differential paths followed by each countries identified by this research can be found in the existence of an anti-tobacco cultural movement promoted by a country’s government and its society, as well as in the compliance with the programs endorsed by the World Health Organization.
