By Holly Jarman, University of Michigan
The government's disappointing U-turn over plain packaging of tobacco has dealt a blow to campaigners and shows a government attempting to subvert its own consultation process.
The Conservative party's chief strategist Lynton Crosby has come under fire for suggesting that the party should focus on core issues such as the economy and immigration rather than public health measures such as plain packaging and minimum alcohol pricing.
But Crosby's lobbying firm Crosby Textor Fullbrook (CTF) has served the tobacco industry since the 1980s and currently provides advice to tobacco giant Philip Morris. Crosby may have chaired a meeting in London this year in which tobacco companies discussed how to stop plain packaging.
Health Secretary Jeremy Hunt announced that the government had "decided to wait until the emerging impact of the decision in Australia can be measured". Although he didn't say it outright, it's looking more and more likely that the policy is dead in the water.
Many early Conservative initiatives on health, climate, and social policy have been abandoned for a harder nosed industry-friendly approach; it should not surprise us that public health and evidence-based policymaking have now been sacrificed.
Subverting the evidence
The Department of Health has emphasised that the "UK is known the world over for its comprehensive, evidence-based tobacco control strategy". It's a sharp irony, given that the the government is now doing the opposite through an explicit decision to put the demands of tobacco manufacturers and retailers before the health of the public and reducing costs to the NHS from treating smoking-related illnesses.
The new Australian cigarette packages are not exactly "plain". They are deliberately designed to look unappealing - so much so that they were nominated for a Design of the Year Award by London's Design Museum. The packages show the brand name in a standard font with no swathes of colour or logos, and carry warning messages and mandated images which show some of the effects of smoking.
But plain packaging is not the radical new policy that some critics make it out to be. A cigarette package is a powerful form of advertising: portable, eye-catching and a constant reminder to smokers of their habit.
Cigarette packets send a lot of subtle messages. They can be labelled or colour coded as "mild", or "light", misleading smokers into thinking that they are less harmful than regular brands, when scientific studies show that this is not the case.
And they can be targeted at particular audiences. Cigarette packets that look like designer perfume bottles have been created that are intended to appeal specifically to women, for example.
Tobacco companies aren't above "predatory" marketing. For years, they have targeted adverts for menthol cigarettes at young African Americans. There's evidence to suggest that tobacco firms have lowered the price of menthol cigarettes and increased special promotions in shops near Californian high schools with larger populations of those students.
An open letter written by more than three dozen health specialists in the UK went so far as to accuse tobacco manufacturers of targeting children to replace the 100,000 people killed each year in the UK from smoking related disease.
Countries around the world, from the richest states in Europe and North America to less developed nations in Africa and Asia, have already chosen to regulate tobacco advertising, based on solid evidence that it promotes smoking, and a desire to limit the harmful effects of tobacco products on both smokers and non-smokers. They have banned hoardings, television commercials, print ads, and special promotions, and limited the space available on tobacco packaging for promotion by adding large warning labels. Plain packaging is an incremental step that builds on this series of policies.
An independent Systematic Review - commissioned by the government as part of its consultation - makes the evidence base for plain packaging quite clear. The authors note the consistency in the findings of research on plain packaging, stating that there is "strong evidence" that plain packaging helps to reduce smoking rates, reduces the appeal of tobacco products, increases the visibility of health warnings, and reduces the use of misleading design techniques.
It also points out a key dilemma common to many new policy measures: before plain packaging is implemented, it is impossible to know exactly how it would work in that particular location.
This prompts the question: what exactly is the standard of evidence required and who sets the standard if consensus among public health professionals is considered inadequate?
The evidence base for plain packaging is arguably better than that for many other policies currently being pursued by the government, of which the ill-conceived "bedroom tax" is just one example.
Split along predictable lines
The final report from the government's plain packaging consultation shows that responses were split along predictable lines. Local authorities and NHS organisations are strongly in favour of plain packaging, while tobacco companies and retailers are strongly opposed.
The Department of Health's decision to stall plain packaging is therefore an explicit decision to favour the economic interests of one industry over public health. What lies behind the government's U-turn is also predictable.
On one side, worldwide lobbying efforts by the tobacco industry have been intense. In Australia, when lobbying failed to prevent plain packaging from being introduced, tobacco companies challenged it in the high court.
Philip Morris went further, initiating a dispute using international investment law. And tobacco firms have admitted that they are providing legal support to countries that are challenging Australia's plain packaging policies through the World Trade Organization.
On the other side, we see an increasingly unpopular government that is becoming more receptive to the lobbies as it looks towards the next election. The UK Independence Party, which competes with the Conservative party for votes, supports a repeal of the ban on smoking in pubs.
Economics does matter, but so does our health and the amount we spend on dealing with problems caused by smoking. Crosby's conflict of interest raises questions about the ability of big companies to influence the highest level of government. The government must prove to voters that it can be brave and principled enough to make the evidence-based policy it claims to want by mandating plain packaging for tobacco products.