"Health or Smoking?" Report

HL Deb 13 June 1984 vol 452 cc1120-57

3.3 p.m.

Lord Henderson of Brompton rose to call attention to the follow-up Report of the Royal College of Physicians entitled "Health or Smoking?" published in November 1983; and to move for Papers.

The noble Lord said: My Lords, it is an honour for me to open a debate that has attracted a member of the Royal Family, His Royal Highness the Duke of Gloucester, to make his maiden speech, well placed from the Cross-Benches. The noble Duke's speech today will, I am sure, be a subject of wide comment in the press and on the radio and television. I only hope that after today the noble Duke will be encouraged to make further speeches, perhaps on architecture, on which he is an acknowledged expert. That might, indeed, induce his noble and royal kinsman the Prince of Wales to take part as well, since he has recently expressed an interest in that subject. That would be a double plus.

This Motion calls attention to the latest in a series of reports on smoking by the Royal College, beginning in 1962. I should like to start by paying tribute to the Royal College for its pioneering report in 1962, when Sir Robert Platt, later Lord Platt, was chairman of the Royal College.

I should like to say at once that I accept the findings of the Royal College, and have ever since 1962, and I accept the findings of the Surgeon General of the United States as well. However, I have certain reservations about some of the recommendations, though I must congratulate the Royal College on the report's appendix, on "Giving up Smoking", where I detect a slightly more flexible attitude than hitherto.

This is a highly complex, intractable and difficult subject. One would have thought that it would be so simple; that it ought to be, as the Royal College hoped in 1962, equivalent to cholera. The House may remember that in the early 1850s cholera was attributed to dirty water, and by 1875 Disraeli had on the statute book his great Public Health Act. Within 25 years, despite a certain amount of opposition, with great persistence he achieved that magnificent Act. But—and this is a huge "but"—no one was addicted to dirty water; no companies made billions of pounds out of dirty water. Dirty water did not provide billions of easily-collected revenue for governments, nor did dirty water, unlike cigarettes, provide hundreds of thousands of jobs. Indeed, it was Disraeli's Act that provided jobs for workers in the water industry. Nor was dirty water, as cigarettes are, an important factor in our balance of payments.

Those are just some of the reasons—psychological, social, financial and political—why, after more than 20 years of certain knowledge that smoking—not tobacco as such, but smoking—is poisonous, no government in the world, except perhaps those of Finland and Norway, have succeeded in tackling successfully what the United States Surgeon General, in his report of 1982, called, the most important public health issue of our time". Another illustration of the difficulty of this subject is that almost every idea, however well-intentioned, to combat smoking, seems to be counter-productive in some way. For example, by putting the price up the odds are that the addict will smoke his cigarette to the hitter end. If he stubbed it out earlier, it would be safer. But it is the last bit of the cigarette that is the most dangerous. So by pushing up the price, inadvertently, one is increasing the health hazard.

Let us next take the ban on television advertisements. That led directly to the sponsorship of sporting and cultural events, thereby vastly increasing, at small cost to the manufacturers, public awareness of brand names. That was quite contrary to the intention.

The Government health warning, which we surely all applaud, is, alas, privately welcomed by the manufacturers because if consumers sue the manufacturers for damages, they can no longer claim ignorance. In that highly litigious society, the United States, no product liability case against cigarette manufacturers has so far been successful.

In spite of all these difficulties, there has been some progress. In the great debate which was held in the House in 1962 the present Lord Chancellor (then Viscount Hailsham, Lord President, and Minister for Science) answered for the Government and robustly, and I think courageously at that time, supported what he called the, overwhelming body of scientific opinion". He also neatly encapsulated the attitude of the tobacco industry when he said that it was one of "agnosticism bolstered by scientific doubt".

Incredibly, that attitude is still the attitude of the tobacco manufacturers. But by entering into voluntary agreements, which they did very soon after that 1962 report and debate, they have implicitly acknowledged scientific evidence, whatever the official attitude may be. So, in a sense, that is a gain.

Again I quote the present Lord Chancellor, this time speaking as Mr. Quintin Hogg, in 1964, in the House of Commons. He said: I am a smoker speaking in a Parliament of smokers and in a Cabinet of smokers and with an electorate of smokers". As to Parliament now, I think the House will agree that it is a matter of common observation that those who smoke are the exception. Moreover, I am reliably informed that there is now only a single smoker in the Cabinet. So it is a single smoker in a Cabinet of nonsmokers, which is exactly the reverse of the case in 1964. That must be counted as progress, and what a good example it is to the country. If only all public figures would show such a good example, as well as the teachers and those in the health care professions, as recommended in the Royal College report!

In the electorate there are eight million fewer smokers than there were in 1962, and the habit is becoming socially unacceptable. I agree with the Royal College that the aim must be to create a society in which non-smoking is the norm.

But against those considerable gains, it is, sadly, true to say that in 1981 as many cigarettes were smoked as were smoked in 1962, when the Royal College first reported. Further, I am afraid that many more women smoke now than did in 1962. There is grave concern about smoking by the young and about the huge increase in smoking in the third world countries, rightly drawn attention to by the Royal College; so there is no cause for complacency.

What can he done? I shall leave to other speakers such important topics as the Government health warning, sales to under-developed countries, passive smoking and the special problems of women smokers. I should like to confine myself to a few questions to the Government, and to concentrate on advertising and alternatives. I would ask the noble Lord the Minister: what is the response of the Government to the joint survey by the SSRC and the MRC into the psychological and social pressures that encourage and reinforce the smoking habit? I believe that that joint survey was due to be published in 1981. At any rate, I should like to know what is the official attitude to it. I am very glad to see that one of the recommendations of the Royal College is for more—far more, they say—research into the nature of tobacco addiction.

I now come to advertising. 1 understand that the Government's policy is still one of control by voluntary agreement. I see the noble Lord, Lord Aberdare, here, in a different capacity from that in which he was when speaking for the Government 13 years ago, in 1971. He then said that control by voluntary agreement was their policy "at present". Does "at present" mean "indefinitely"? I do hope not. I would further ask the Minister whether the Government have considered using Section 108 of the Medicines Act 1968. I believe there is a question of its being ultra tires; but I should like to know whether use of that section would be ultra tires, or whether the Government have just failed to use it for political reasons and would still wish to adhere to voluntary agreement rather than to resort to any kind of statutory sanction.

For myself, I should like to see a three-pronged attack on advertisements: first, by voluntary agreement, if voluntary it must be, through the Advertising Standards Authority to restrict or totally ban all advertisements of cigarettes and of sponsorship that relates smoking to sport, sex, travel and culture. Secondly, I should like, as the Royal College says, the budget of the Health Education Council to be increased. The Royal College characterised their budget as "miniscule". Actually, it is £3 million a year. Just compare that with the manufacturers' budget for advertising in this country of £100 million per year. It is £2 billion globally. But if the Health Education Council's budget is miniscule by comparison with the advertising expenditure of the manufacturers, it is even more miniscule by comparison with the "take" of the Chancellor of the Exchequer, which, after the recent increase in the last Budget, is now £5 billion a year. All I am asking the Government to do is to "up" the expenditure on the anti-smoking campaign from 0.06 per cent. of their revenue of £5 billion to 2 per cent. I do not call that asking much. That is what is called "the fairness doctrine", which has been tried in the United States with varying success. I do not see why it should not be tried here. And if the advertisers start to cut their expenditure, so much the better.

Thirdly, I would urge the Health Education Council to change their style. For myself, I think that grim warnings and horror stories about health have had little effect. The Royal College now says that the public was deeply disturbed by television programmes recently on asbestosis. No doubt, and quite rightly, they were; but asbestosis is as irrelevant to this problem as cholera. The emphasis, to my mind, should be on how to kick the habit: to make it easier for those who want to do so; and, above all, to make it fun. and not to make people feel guilty. I should like to see leading figures of sport and television, popular heroes, taking part in these programmes. They might even give their services free. I do not see why not. Also, encouragement might be given at local level for members of the public, smokers. to join what could be called "smokewatchers", rather like the very successful weightwatchers' clubs. At all events, if one could only engage the goodwill and attention of popular heroes, one might try to get over to the country that not to smoke is manly, not to smoke is glamorous, not to smoke is sporty, and so on.

I should like to have talked for some time about alternatives to cigarette smoking, but I cannot do so because my time is running out. All I can do is to welcome the change of heart (as I see it) in the Royal College report, because they, I think, make life very much easier for all those who are afflicted with this habit and who have not been able to change. I should like to end by endorsing what Mr. Partick Jenkin said in 1980 in another place—and I think that that was the last time that this matter was discussed in Parliament. He was the responsible Minister; and he said that. it is the duty of the Government to reduce the toll of disease and premature death", and that this is "fully in the tradition of Conservative Governments". Thereby, he refuted those who harp on the "nanny state". I hope that we shall not hear those "nanny" and "governess" arguments in the debate today. My Lords, I beg to move for Papers.

3.18 p.m.

The Duke of Gloucester

My Lords, as I stand here before your Lordships for the first time, I am very conscious that I follow in the path of my ancestors. Many of them took their place here, as I do, and just a few spoke from the Throne. I am aware that the last Duke of Gloucester to speak here frequently battled with his brother-in-law, the Duke of Sussex, over the matter of slavery. The victory eventually went to Sussex, perhaps with a little help from Wilberforce and his friends. I hope today to restore some balance to the honour and prestige of the title that I am privileged to use in this Chamber.

Succeeding generations will regard the issue that we are to discuss with the same disdain we would now reserve for the policy and practice of slavery. Your Lordships may well know that in the 19th century epidemics of cholera decimated parts of the population and that the cause of the problem—polluted water supply—was identified by statistical analysis, enabling Parliament to pass the necessary legislation that totally eradicated the problem. Inevitably this process took much longer than necessary due to ill-informed opposition and vested interest.

This debate has been called to take note of the 1983 Royal College of Physicians' report, Health or Smoking? As your Lordships have heard, the first report was published in 1962, and it was as a consequence of that report that ASH was set up—ASH standing for Action on Smoking and Health. It is an organisation of which I am privileged to be the patron. The second report was in 1971, and the third in 1977. All of them have been written by the most eminent and knowledgeable experts in this field, reporting in a straightforward fashion the statistics and the experience of the consequences of the smoking habit. Each subsequent report has amplified the findings of its predecessor and the gaps in the overall picture slowly filled in—a picture which has also been revealed in every other country where similar research has been undertaken. although sadly I must emphasise that this country has suffered the effects of tobacco more than any other, due to our history of high consumption.

The depressing fact remains that virtually none of the recommendations in the reports have been carried out fully, even though everyone now accepts the figures as accurate.

My Lords, this volume may induce in its readers a sense of déjà vu: but this repetition is necessary because of the slowness of the response by the public and its legislators. The reports chart the consequences of the tobacco habit nationally; like a leaky bath tap left unrepaired, the current stain on the tub is inevitably larger and more distinct than that of 1962. If I may quote one statistic from the report, if you take 1,000 young smokers who smoke one pack a day, statistically one will be murdered, six will die on the roads, hut 250 will die prematurely from any of the following smoking-induced diseases: lung cancer, coronary heart disease, chronic bronchitis, emphysema, cancer of the oesophagus, of the mouth, of the larynx, of the bladder, of the pancreas, or strokes brought about by the fact that the human body is not designed to absorb chemicals inhaled through the respiratory system.

The conclusion that the Royal College draws is very plain. Smoking is the single most important cause of preventable ill-health, disability and premature death in Britain today. This will continue to be so for many decades unless there is a much greater change in the rate of consumption. On logical grounds there is a clear case for the total ban of such poison, but there are practical and humanitarian reasons for not doing so. Sixteen million people still smoke regularly, many of whom started when it was still considered a socially acceptable habit. The identification of it as a self-destructive practice came too late for many who were already addicted.

Addiction is an aspect of tobacco smoking that puts it in a very special category. We learn from Government surveys that 60 per cent. of people who smoke wish to give up, and that 70 per cent. have tried to at least once. The power of addiction to nicotine is shown by one dramatic statistic: even after undergoing major lung cancer surgery 48 per cent. of patients (if they survive) start smoking again. For such addiction it is impossible to legislate a ban.

What is possible is to concentrate on non-smokers, particuarly the young, and make sure that they are fully aware of the consequences of smoking—first to their health, and secondly the strength of the addiction.

It is still fashionable to mention "freedom" when anyone from the health professions tries to take action about smoking. A moment's thought would show that the freedom argument belongs not to the tobacco industry but to the health professions, as most smokers begin smoking when they are children—not a free adult choice by definition—and when as adults they try to give up they encounter unexpected problems.

The new government report on children smoking shows that secondary school children spend nearly £60 million per annum on cigarettes—setting them on an expensive path. In the fifth year, 27 per cent. are already regular smokers. Research shows that these people will experience much greater risk of serious or lethal medical problems than those who start later in life.

It would seem that not only smokers become addicted but also Governments. The tax on cigarettes brings in almost £5,000 million per annum, representing 3.7 per cent. of total revenue. There is no argument I can put to diminish the significance of this figure. The National Health Service only wastes £170 million alleviating those suffering tobacco-induced disease: but then for so many it can do so little to help. The cost to the economy is estimated at 50 million working days due to smoking-induced illness—more than 10 times the number lost to strikes.

Clearly any Government can be persuaded that they need this tax just as badly as many smokers need their nicotine, but there is clear evidence that the Government can raise the tax considerably higher before total revenue begins to fall. I congratulate this Government on raising the tax a further 10 per cent. in the last Budget and for declaring that this was for health reasons. In real terms cigarettes are much the same price in relation to the cost of living as they were after the war. The promise of regular large annual increases could become a plausible disincentive to new smokers.

From the very beginning the College of Physicians' report called for effective public information on the risks of smoking to he disseminated to everyone. Clearly this process is far from complete—for the large majority of smokers grossly under-estimate the risk they run. If you do not believe me, try asking them. Ideally it should be part of every school curriculum for people to be educated about how the human body works and how to treat or mistreat it—regrettably, many schools regard exams as more important.

For more than 10 years now we have had the benefit of the Government health warning. At the time this seemed a major advance, but in retrospect it seems merely to have protected, ethically and legally, both the industry and governments from the consequences of their inaction. Any warning has to be much stronger to respond to the reality of smoking. "Can seriously damage your health" sounds like. "One day you may get a headache, or a bad cough"! What would be more appropriate would be a variety of messages—as adopted in Scandinavia—that actually state facts about death, disease and addiction, prominently displayed on the pack.

The tobacco industry spends £100 million a year on advertising. It claims that it does not do so to woo new smokers but to encourage smokers to change brands. But yet in countries where they have monopolies they advertise just as much. Countries like Norway, where they have banned all advertising, have discovered that adult smoking decreased somewhat but that the dramatic consequence was a sharp fall in children's smoking. There is every reason to believe that the same thing would happen here, provided that all tobacco sponsorship was banned as well. Currently the tobacco industry spends around £6 million on sport sponsorship, but it gets fantastic publicity from this—hundreds of hours of television exposure and a marked effect on children's brand loyalty and awareness.

If this advertising could be phased out the results to the media and the various sports involved need not he drastic. Tobacco represents less than 3 per cent. of the total national advertising expenditure. I am sure other companies could take their place, and should, for no other product or service can he compared in any way to tobacco for the damage it causes. To those who fear the loss of their tobacco subsidy I suggest they consider the ethics of persuading people, however indirectly, to do something so clearly identified as harmful.

My Lords, I have ventured on to the uncomfortable question of moral considerations, not just to consider what we as individuals should do but also how others should or should not behave. This report has one chapter that breaks new ground. It reveals the extent that this country is in the forefront of exporting all these problems—medical, ethical, fiscal and social—to third world countries, eager to appear sophisticated but least able to pay in the long term for the short-term advantages brought by tobacco. The battle against international slavery is not yet quite finished, it would seem!

Cholera is a disease that our forbears put behind them through the power of Parliament. On this very day more people are dying of an unnecessary preventable disease than died during the era of cholera. Will indifference, ignorance and vested interest continue to kill off that section of our society that cannot or will not save itself?

3.30 p.m.

Lord Boyd-Carpenter

My Lords, it is a very great privilege and a very great pleasure to be able to be the first to convey to the noble Duke the congratulations of the whole House on a very remarkable, very impressive, and enormously interesting maiden speech. It is characteristic of the noble Duke's high sense of duty, which he has shown in many directions over recent years, that for the occasion of his maiden speech in this House (which all of us know is a somewhat nerve-racking occasion) he selected not one of those anodyne subjects in which we all, with easy consciences, denounce sin, but a highly relevant and very important public issue, not free from controversy. I think we are particularly indebted to him for making that very brave choice. I know that I speak for the whole House when I say that we profoundly hope that, having broken the ice this afternoon, His Royal Highness will give us the pleasure of hearing him on many occasions in the future.

Noble Lords

Hear, hear!

Lord Boyd-Carpenter

The noble Duke spoke with great vigour about smoking, but his language was quite moderate when compared with that of his forbear, His late Majesty, King James I, who made an oration on the same subject. His late Majesty observed that the habit of smoking was, loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black, stinking fume thereof nearest resembling the horrible Stygian smoke of the pit that is bottomless. Those observations point in the same direction as the noble Duke's speech, but the noble Duke will not mind my saying that they express these truths even more vigorously.

We are greatly indebted to the noble Lord, Lord Henderson of Brompton, for introducing this highly important subject. If I may make one comment, I would say that to some of us it has not been unamusing to see the quiet figure, with the cynical smile, at the Table transformed into one of the most vigorous and articulate Members of your Lordships' House; and we are greatly indebted to him for this.

On the subject itself, I want to say only two things. The noble Duke referred to the role to be played in dealing with the tobacco menace by taxation. I had some experience of this at the Treasury on two occasions: and, indeed, on three occasions we increased the duty on tobacco. It is not unamusing to reflect that on all those occasions—the increases being due, of course, to a desire to raise revenue, rather than to deal with the habit—the learned men in Customs and Excise who advised us said that we were going too far, that the demand would drop and the yield from the tax would drop. For a fortnight, they were right, on all three occasions. But after the fortnight had elapsed the curve of consumption went up again. That confirms what the noble Duke has said to us about the strength of this habit.

Nonetheless, I would suggest that a really swingeing increase in taxation could certainly do no harm and would be morally justified on the basis that it would be a contribution from smokers to the additional cost which they bring upon the National Health Service.

I very much agree with what I think was the theme of the noble Duke's speech and that of the noble Lord, Lord Henderson; namely, that what we have to do is to try to give opinion a lead, in particular opinion among the young.

I can quote one encouraging example from my own experience. Ten years ago, when I was chairman of the Civil Aviation Authority, I took it upon myself to suggest to the airlines that there was a case for having non-smoking sectors in civil aircraft. I was told, as people in my kind of position dealing with trains always are, that I knew nothing about it, that passengers wanted to smoke, that they wanted to have cigarette smoke puffed over them all night, and that, indeed, the airlines did very well out of distributing free cigarettes to them. Nevertheless, one had certain powers, and upon some amount of gentle pressure being applied the airlines, though on a very small scale, started introducing no-smoking areas for perhaps half a dozen seats.

Those of your Lordships who travel, particularly long distance, will know that nowadays half the aircraft, or more, is marked as "non-smoking". It has always intrigued me that that small shove, kick, or whatever you like to call it, which I was in a position to administer to the airlines, has produced so large a bruise and that now it is possible to travel about the world without having someone blowing cigarette smoke down your face all through the night.

I suggest that this is an example which might be followed further by those responsible for places of public assembly. More and more it should be laid down that if frequenting public places of one kind or another, that large body of people who do not want to breathe tobacco smoke should not be compelled to do so by the more selfish people who do. 1 am sure that pressure should be put on public authorities of all types, including Government and perhaps local government—I hardly dare mention that after Monday's debate—to induce them to make areas of public assembly and places of entertainment non-smoking areas.

This House can, I believe, set a very good example by holding this debate. I believe, too, that, like all our debates, it w ill have an influence on public opinion, in particular that public opinion which matters: that of the media, the Civil Service, the teachers and the academics—all the people who themselves form opinion. Our debates do, we know, influence them; and I hope this debate will do that and that this House will once again give a lead to public opinion. From the presentational point of view, in this context we have one advantage over another place: we do not have a smoking room.

3.38 p.m.

Baroness White

My Lords. I should like to join in the very warm congratulations already proffered by the noble Lord. Lord Boyd-Carpenter, on behalf of all of us in the House to His Royal Highness the Duke of Gloucester. I do so as a very early member of ASH, which I joined soon after it had been instigated by the Royal College of Physicians in the early 1960s. We have been delighted to have the noble Duke as our patron, but I think that even in our most optimistic moments we did not expect that he would not only choose this particular subject for his maiden speech in your Lordships' House, but would speak so forcefully and felicitously. We are indeed very grateful to him.

We are also grateful to—on this occasion perhaps I might be permitted to say, "my noble friend"—the noble Lord, Lord Henderson of Brompton, for the admirable way in which he introduced the subject. I think one must reiterate how grateful we are to the Royal College of Physicians, because there are very few august bodies of that nature which, over two decades and more, have pursued medical truth, in season and out of season, with the pertinacity which the college has shown in this matter. This, at least, is an area of public concern where there is no need to cry, "Physician, heal thyself'. Medical men have led the way not only in research, but by personal example on the part of the great majority of doctors, who either do not smoke or have successfully given up the smoking habit.

As some noble Lords know, my own direct interest in the issues before us arose from my talks with the then chief thoracic surgeon at St. Bartholomew's hospital way hack in 1968, after he told me that my husband, then aged 57, had only a few months to live. He said to me that, while the exact causal connection had not been fully proved, he himself—the surgeon; a very senior and experienced man—had no doubt at all that smoking had been a primary element in my husband's condition.

One aspect of the continuing argument with certain sections of the tobacco industry still sickens me. That is their continued assertion, in the face of all the circumstantial evidence, that because medical research into the causes of lung, throat or mouth cancer and other smoking-related illness has not vet enabled us to describe with precision the way in which certain causal elements work, therefore the industry are justified in claiming that they need accept no moral or ethical responsibility.

I quote from an annual report of one of the largest American companies, who stated that "no conclusive medical or clinical proof has been discovered". They were commenting on the 1979 report of the United States Surgeon-General, who for the last two decades has been even more outspoken than our own Royal College of Physicians. But I suggest that one does not need even O-level qualifications in physics or chemistry to know from experience that fire burns, even if one is not capable of describing the physical or chemical process by which it occurs with perfect scientific accuracy.

Research over the past three decades has established beyond all reasonable doubt a causal connection between smoking cigarettes and certain forms of illness, of which lung cancer is the most dramatic but not the most prevalent or necessarily the most costly to the community, however tragic it is to those men and women cut off in their prime. So I hope that we shall have no more hypocrisy of the "no conclusive clinical proof" variety, because this attitude is at the basis of much of the justification given by the great tobacco moguls for their expenditure on advertising, on sport, on culture sponsorship and so on.

The most difficult matter to resolve is not a medical one, although one hopes that further progress will be made in that field. The real problems are economic and fiscal—problems of a great, complex, multinational industry and its relations with governments. I would remind your Lordships that three of the six major international companies in this area are based in the United Kingdom.

The complexities of these relationships, including the political undercurrents in certain parts of the world, are admirably described in this book The Smoke Ring by Peter Taylor, which is sub-titled The Politics of Tobacco. It was recently published by The Bodley Head—a very reputable firm whose lawyers, I know, spent many weeks checking and cross-checking the references the book contains to make certain of their accuracy. It is not sensationally written—it has no need to be; the facts speak for themselves. But I am told that it has been little noticed in our own national or professional press, possibly because—I have no proof of this, but I surmise—newspapers and journals depend very largely on the advertising that they receive from the tobacco and cigarette manufacturers for their financial survival. Nevertheless, to any student of political affairs I commend this book as an extremely interesting one.

I confess that the repercussions of tobacco growing and manufacture in United States politics through the strongly-organised tobacco interests are of a dimension that I had not grasped until I read this hook. In Britain, we do not grow tobacco commercially. Some of our European Community partners do, but not on the scale which, so it is suggested, assisted President Reagan to victory and helped to push Jimmy Carter down the road to defeat.

Tobacco is big business and it is not only the great companies who know where their money comes from. Preceding speakers have already mentioned the immense amount of revenue which accrues to our Treasury, and no doubt to the Treasuries of other countries, from the tobacco industry and hence the understandable schizophrenia of Chancellors of the Exchequer. As I myself discovered some years ago when I tackled the then Chancellor. Mr. Roy Jenkins, on the subject, money can talk louder than health even to the most highly principled ears.

But the frightening prospect for the future lies not in Europe, North America or the more developed parts of the world, where there is perhaps just a grain of validity in the notion that people may choose their own fate. It is to some degree their own fault if they do not realise what they are doing. When I say that, I am in no way unsympathetic to the need suggested by the noble Lord, Lord Henderson of Brompton, for more persuasive methods of dealing with people who have succumbed to the addiction, which are very desirable indeed.

No, my Lords, the really frightening area is the third world, as the noble Duke indicated. Although the great companies are diversifying very considerably into other areas-1 may say that I sold out my Eagle Star shares before they were taken over by BAT—they know how important is their tobacco revenue. Because they recognise that there is some success, at any rate in the more sophisticated world, in persuading people to diminish or give up the smoking habit, they are turning to unsophisticated people. They are advertising in third world countries in a way which I find completely unprincipled.

I believe it is true to say that they have ceased to sell in those countries at a higher level of nicotine and tar content named brands which are sold contemporaneously at lower levels in other parts of the world. No, my Lords, what they are doing is to distribute brands named and advertised to suit the psychology of the counties concerned.

My time is already almost up and I can give only the one example of Nigeria, where I have seen the most persuasive arguments at the lower end of the market for "Bicycle" cigarettes, because bicycles are the aim and ambition of youngsters in the less developed parts of those countries. There are "Varsity" cigarettes to appeal to the up-market, the more sophisticated young man. The caption reads, "King-sized cigarettes for the man of the future", who is depicted as a very handsome young gentleman on his way up in the world.

Much as I should like to pursue this, I can make only one further reference, which is from a letter that I had three years ago today, on 13th June 1981, from the British American Tobacco Company's chief officer here in London, in which he referred to a speech that I had made on development aid policy, with some rather detrimental remarks about the tobacco industry. He said: For a number of countries, revenue from BAT is one of the larger elements in the national tax income. We are a good employer of labour and a source of trained technicians and managers. Our companies arc directed and managed almost entirely by local people. By successfully providing for the needs of domestic markets, we help to reduce imports and the assistance we give to exports helps increase foreign currency reserves. Every word of that, I am certain, is true. Would they say the same if the crop were opium poppies? Would they say the same if they were trading in heroin? The difference is only one of degree. Over the long term they are selling substances, advertising substances, distributing substances which can be equally damaging, equally destructive to the health and happiness of the people in the countries of the third world. Many of us were shocked that the Queen's Award for Exports should have been given to one of the three great tobacco companies in this country. What were they exporting? They were exporting sickness and premature death for very many people.

3.51 p.m.

Lord Gisborough

My Lords, I should like to add my congratulations to His Royal Highness for what was undoubtedly a thoughtful speech. It was well researched, constructive and a delight to listen to. I am also very grateful to my old friend Lord Henderson of Brompton for initiating this debate.

The damage to health by smoking is not in dispute. Bronchitis, heart disease, cancer are but three results. There is also the awful thought that pregnant women can damage their unborn infants. His Royal Highness's statistic, that of every 1,000 adults, 250 are killed by tobacco-related diseases, while six are killed in road accidents and one by murder, was interesting. It may be thought that, if people wish to commit suicide by smoking, so he it, so long as they are warned, but the illnesses caused must be a heavy burden on the National Health Service, quite apart from the balance of payments implications because of the cost of tobacco. I thoroughly support the plea for an increase in taxes on tobacco. However, what is so unpleasant about smoking is that others have to share it. At any meeting where there are a great number of people in one room, of whom several are smoking, the non-smokers have to put up with the smell and the damage, and in the morning they have to hang out their clothes to get rid of the smell that has got into them.

The report is vague about sidestream inhalers—that is, those who have to inhale other people's exhaust fumes. Damage or no, it is extremely unpleasant. The worst occasion is at a restaurant, when one sits down for a special occasion and the man at the next table lights a cigar. One has to eat in a cloud of spent fumes. As this cannot be hygienic, I believe that there should be more local authority or Government encouragement of restaurants to prohibit smoking, as in our own dining room.

There is also the question of smoking at work. I can think of several workmen at home who, over the years, often took a moment off to light their cigarettes. During the course of the day a lot of time was lost, and their ability to keep going was severely impaired by their lack of breath. I remember one local farmer who was reputed to stand at his potato riddle, look at each potato, light his pipe and then look at the next one. I am afraid that he died young, and he is very sadly missed. But the result is that now I am surely not alone in giving high precedence to the employment of nonsmokers. If this is so, surely smoking must be detrimental to finding a job.

Undoubtedly far fewer people smoke now than was the case a few years back but, peculiarly, it seems that the lower the income the greater the likelihood of a person being a smoker. It seems to me to be amazing that a person who is struggling on a low income should just burn a considerable part of that income in a tube in his mouth, even at the cost of being short when providing for his family.

What can be done? We already have non-smoking compartments in public transport and cinemas, and they are very popular, but all too often they are not large enough. This applies in particular to aeroplanes. In addition to the health hazard notices issued by the Government, the Government should run a publicity scheme to highlight the anti-social effect of smoking on others and the economic stress caused by those who indulge in smoking. In particular, however, the Government should bring this matter to the urgent notice of the young in our schools.

3.55 p.m.

Baroness Masham of Ilton

My Lords, I add my congratulations to the noble Duke. Perhaps I may say that I thought His Royal Highness sounded most at home in your Lordships' House; and I should like also to thank the noble Lord, Lord Henderson of Brompton.

Anyone who knows me well would be surprised if I did not say a few words to welcome this honest report, Health or Smoking? Ever since I can remember, as a very young child, I have been against smoking. I considered it then, as I still do now, as disturbing, unnecessary, dangerous and dirty. There are few things so unattractive as a pile of old cigarette ends.

I had a mother and a father who smoked. I always found a smoky atmosphere most uncomfortable and did my best to escape from it. If one does not smoke but wants to live in harmony with others who do, one has to try to tolerate something which one's natural instinct tells one is wrong. If people say to me, "Do you mind if I smoke?" I tell a white lie and say, "No", but I add, "It will damage your health".

Smoking helped to kill my father at 51. He was a heavy smoker, he coughed in the mornings and he died of coronary thrombosis. We all make mistakes in life. We all take risks. That is what living is about. But why do so many people continue to take the slow road to suicide? The odds are so high that they will damage their health if they are heavy smokers.

I congratulate the Royal College of Physicians on this report. As doctors, they are telling society of the dangers related to smoking and of the risk that mothers are inflicting on their babies.

Yesterday I attended the memorial service for the late Lord Glenkinglas. He used to come to stay with us and I used to try to get him to realise how dangerous his smoking habits were to his health. His lungs were deteriorating fast. Once when he came he had stopped smoking. His doctor had told him he would be dead within the year if he did not stop. He lasted a few more years, but it was too late to regenerate his failing lungs. I am sure he would be with us today had he not been a heavy smoker.

Some years ago my noble kinsman Lord Swinton used to smoke cigarettes. He developed that awful early morning cough which should be a danger sign to all smokers. I suggested to him that he should stop smoking for a trial period of three weeks and see what happened. His cough abated and stopped. At the end of three weeks he started smoking again. His cough returned. Being an intelligent person, he took the decision to give up cigarettes. He has not smoked one since. But he does, I am afraid, smoke cigars. They do not seem to affect him in the same way.

The report has a chapter on smoking and diseases of the lung. The real examples I have given bear out what this chapter says. Doctors used to smoke a great deal. It is noticeable how many of them have given up, and that the younger ones do not smoke. The evidence collected by the Royal College of Physicians must have had its effect, but there is still grave concern over smoking among nurses. It is stated on page 63 of the report that a factor may be stress, as nurses in the psychiatric units and certain intensive care units, where stress can be considerable, have higher smoking rates than nurses in less stressful posts, such as community care.

I also notice that many disabled people smoke, which must be even more serious, as many of them should be preserving their already damaged health to an even greater extent than those who are not already impaired. Research is needed, but I have a feeling that many people think disabled people should not be deprived of the pleasure they derive from smoking, as their pleasures in life may he so limited. When they gasp for breath and cough and wheeze, surely more effort should be taken to encourage them away from this harmful habit.

The report does not mention anything about the added hazards to disabled people. I hope that the Royal College of Physicians will include this when they undertake their next report. The pressures and continuing research on the subject will, I am sure, continue. The evidence is very convincing.

I am pleased that the report contains a chapter on children and smoking. This is a matter of great concern, as far too many children and young people seem to smoke. They are susceptible to the promotion of tobacco, especially by sports heroes, and to peer pressures. I have offered a prize to the school which my boy attends for the best essay on the dangers of smoking, to encourage the children to think. Young people so often feel that they are far away from the dangers because they are young, adventurous and feel well. I wonder if young lungs are more susceptible to the hazards than old lungs.

The Coronary Prevention Group have also published an excellent report on plans for action, and this clearly states the concern felt about children and young people smoking. That report, too, is due to be debated in your Lordships' House. This illustrates growing concern among many responsible health-orientated people. The RCP report states that children who smoke seem to do less well academically, and those who play truant from school smoke more. Perhaps this is because such children arc not fulfilling themselves and think that smoking will give them confidence, as they feel inadequate in a very competitive world.

Over the years, smoking-related diseases have cost the National Health Service millions of pounds. It is encouraging (as stated in the report) that the number of smokers is falling. This shows that health education must be paying off. I hope that health educators will be encouraged, and that health education will continue to tackle this legal form of addiction.

As a non-smoker, I welcome the Scottish Health Education group's slogan:

Smoking gets right up other people's noses". As a disabled traveller, I should like to bring to the notice of British Rail that they do not give disabled passengers a choice of sitting in a non-smoking area in a 125 train, where the seats can be removed. Often we cannot escape from the poisonous smoke. In fact, we are sitting targets! On the whole, the vital capacity of paralysed people is very poor. They should not be put at risk by being placed in the position of being passive smokers against their will. At least your Lordships' House is considerate and wise in not allowing smoking in this Chamber. I, for one, greatly appreciate that rule.

The report is encouraging when it states that the number of women who smoke is falling, but it observes that abnormalities and the consequences of low birthweight are apparent in heavy smokers when pregnant. Also, women who smoke are more likely to be infertile or to take longer to conceive; and I believe that 1 am correct in saying that sperms can also be damaged. Research has shown that, when women have cervical smears, the women who smoke are 13 times more at risk of contracting cancer than are the non-smokers.

More health education should take place in prisons and in centres of detention. Many of the people there seem to he encouraged to smoke, rather than discouraged, by the system. They should be given booklets setting out the results of smoking. If prisoners are locked up for long periods at a time, they have plenty of hours for study. Thinking about how to keep healthy is better than dreaming up further crimes for the future. They could pass such information on to their wives or girlfriends, many of whom came from social class 5 and are very poor attenders at ante-natal clinics.

There is plenty of scope for increasing health education so that the good work that is taking effect will be extended to all levels. The dangers of cancer, heart and lung diseases, along with all the other related problems, must continue to be punched home. There should be nobody who can say, "I never realised that smoking was dangerous".

4.4 p.m.

Lord Rea

My Lords, I feel privileged to be taking part in this debate in the company of such an illustrious speaker. I am also very grateful to the noble Lord, Lord Henderson, for enabling me to speak on this subject. I have spent a vast part of my professional life dealing with the consequences of smoking, either investigating the link between smoking and disease and encouraging and helping people to give up smoking, or treating those who are suffering from diseases caused by smoking; and only too often I find myself supporting and counselling those who find themselves suddenly bereaved because of the smoking habits of their spouses or parents.

Seventeen years ago I was involved in research at St. Thomas' Hospital (whose future we were just anxiously hearing about) which examined the effect of smoking on a number of diseases, particularly those relating to the heart and lungs. I was particularly concerned with measuring the levels of carbon monoxide in the expired air and in the lungs. We confirmed that this poison was present in smokers in proportion to the number of cigarettes smoked and the depth of inhalation. It was suspected then—and it is now known more definitely—that carbon monoxide is the main constituent of cigarettes which contributes to cardio-vascular disease, both coronary artery disease and peripheral arterial disease, and strokes.

At that time the first report of the Royal College of Physicians was just five years old, and all of us working in the field were convinced that Government legislation to control cigarette sales promotion was necessary. Now, after the fourth report of the college, we are still waiting. We are told that still the toll continues, with 100,000 premature deaths each year. About 45,000 (nearly half) of those deaths are due to coronary artery disease.

It is still not widely understood that heart disease is the biggest danger facing cigarette smokers. His Royal Highness the Duke of Gloucester knows this only too well, since his royal kinsman, the late King George VI, died suddenly in his sleep from coronary thrombosis. In his case this was almost merciful, because he was already suffering from two other smoking-related diseases; namely, peripheral arterial disease of the leg and carcinoma of the lung. That was in 1952, two years after Sir Richard Doll and Sir Austin Bradford Hill had published their first paper linking carcinoma of the lung and cigarette smoking in an impeccable statistical study which was nevertheless greeted initially with widespread scepticism by both the medical profession and the public.

I am surprised that our late King's illnesses did not lead to quicker condemnation of smoking, particularly when his father and grandfather (who were also smokers and helped to set the fashion) died prematurely from chest infections. In all probability, if antibiotics had been available they, too, would have survived to succumb to other smoking-related diseases. Because of this sad story, I am all the more delighted that His Royal Highness is patron of ASH. He has been courageous in taking this stand, and we should warmly congratulate him for that and for speaking so well today.

I have now been in medical practice again for the past 15 years, and have treated thousands of patients suffering from diseases which are caused by smoking or are exacerbated by smoking. Only yesterday one of my patients, who is a distinguished stage director, was admitted to hospital for his second operation in five years on a smoking-induced cancer of the tongue. We are inclined to talk about the deaths caused by smoking and to forget the conditions caused by smoking which lead to many years of suffering and impair the quality of a large part of people's lives before they die. All doctors have many examples of emphysema on their lists, a disease in which even the slightest effort causes breathlessness; and all of us have many cases of angina. The surgeons are doing very well out of this. We also all have cases of peripheral arterial disease, which may also require vascular surgery—the grafting of new arteries or veins or, if the worst comes to the worst, the amputation of limbs if the condition has progressed too far.

Magnificent surgical work is being done, but I know that most surgeons would prefer to be doing less disheartening work. In Australia recently a health education poster showing a comparatively young woman with her leg amputated caused some protests because it was so shocking, but it has helped to educate and transform public attitudes to smoking in that country. I have just such an example in my own practice. It concerns a woman of 50 who could not give up smoking until amputation was unavoidable.

It is not only people in the second half of life who suffer from the effects of cigarette smoking. Duodenal ulcers, mainly affecting men in their twenties to forties, are twice as common in smokers than in non-smokers and are more likely to lead to severe, or fatal, complications. The babies of women who smoke are smaller at birth and more likely to die at or around birth. Children have more educational difficulties, detectable up to the age of 11. Smoking increases by a factor of about four the chance of thrombosis in women who are on the oral contraceptive.

Other people's cigarette smoke, which we have heard about from the noble Lord, Lord Gisborough—and I fully agree with his views on this—can be simply unpleasant, but it can also damage health. Two studies have shown higher lung cancer rates in non-smoking wives of smokers. Children of parents who smoke have more chest infections, show impaired lung function up to five years of age, and are shorter in stature. This work was done by some of my erstwhile colleagues across the river at St. Thomas' Hospital.

I have deliberately not talked about the additional measures which the Government could take. I have recounted my own experience, padded a little with some research findings. The measures needed are clearly spelt out in the report by the Royal College. I merely mention that legislation to ban advertising and sponsorship—which we have heard is at present the main problem—would be quite simple. Section 108 of the Medicines Act could quite easily be adapted to include tobacco products; and this was very nearly enacted during the last Administration. The public are now ready for tougher measures to stop smoking in public places. Smokers are now in a one-to-two minority.

I have a final thought. Recently I was asked to look into the subject of drug misuse, because of the recent escalation of heroin dependence. It is thought that some 50,000 young people are now using heroin in this country. They are in some danger, and possibly 10 per cent. or more of them may die over a period of years. This year nearly 100,000 smokers will die prematurely—twice the total number using heroin. The Government have given £6 million of new money over three years to help combat drug misuse. For the infinitely greater problem of tobacco smoking the Health Education Council, ASH, and the Scottish Health Education Group receive £3 million a year in the face of £100 million spent by the tobacco companies as a counterblast on advertising and sponsorship. Is it not time that the Government made a determined attack on this vast problem in the way suggested by this very reasonable report from some of our most eminent physicians and scientists?

4.13 p.m.

Lord Ferrier

My Lords, I see from my notes, which I made some time ago, that I began with the words, "It is going to be very difficult to know where to begin". But it is easy, in a way, because I can thank the noble Lord, Lord Henderson, for introducing this debate and His Royal Highness for topping it up.

My main criticism of the report to which this debate refers is emphasised by what has been said in this Chamber this afternoon. But I do not think that what has been said picks out enough the importance of cigarette smoking as being the trouble. It is all very well referring to King James VI, if I may say so, and his attitude towards smoking, hut in his case, and in the case of Calverley, who wrote his "Ode to Tobacco", those were the days before cigarettes. Although King James VI may have hated smoking, he was referring to the clay pipe. which was an awfully dirty thing. When Calverley wrote: Thou who, when fears attack, Bidst them avaunt, and Black Care, at the horseman's back Perching. unseatest: Sweet, when the morn is gray; Sweet, when they've cleared away Lunch, and at close of day Possibly sweetest", he was talking of tobacco before the cigarette came along.

I first smoked when I was 18, in the days of the Wild Woodbine. I bought a pipe in the canteen—I was a private soldier—and I smoked it in my tent. I went on parade and was violently sick. That finished my smoking for some years. Since then I have smoked, smoked and smoked, including 50 years of smoking a pipe. I gave it up for perfectly sound reasons, because was beginning to get trouble with a lip.

It seems to me that nobody has mentioned the importance of snuff. I have in mind an old friend by the side of whose bed I sat while he bubbled out his last breaths because he would not give up cigarette smoking. So many people have said, "It is all very well saying, 'Give up smoking', but what do you suggest I do?". It is not like Mark Twain, who said, Give up smoking?—it is the easiest thing in the world. I have done it a hundred times. That is all very well, but I feel that I can give my personal experience to the House that the taking of snuff is an amazing method of assuaging the withdrawal symptoms of tobacco. I think that the noble Lord, Lord Rea, will agree that, medically speaking, a pinch of snuff puts more nicotine into one's blood than does smoking a cheroot, unless it is very heavily inhaled.

In talking of the cost of advertising, I entirely agree with the suggestion that the duty on tobacco, in particular on cigarettes, should be increased. But that is taking place today. I believe I am right in saying that the last increase in tobacco duty did not apply to pipe tobacco.

As regards non-smoking compartments in trains, and so on, it has almost reached the stage where there are not enough smoking compartments for the people who wish to smoke, not cigarettes but a pipe or a cheroot. Kipling referred to Burma cheroots as, A harem of dusky beauties, Fifty tied in a string. He wrote that before the cigarette, before the Wild Woodbine.

I feel very strongly about this report, our approach to the question of addiction to nicotine, and the difficulties and dangers which lie in paying court to the noble Lady Nicotine. We must be pragmatic and realise that, just as the noble Lord, Lord Rea, has said, the incidence of narcotics in young people, which is so terrifying, indicates that there is some practical trouble over the need of young people to have a little nip of something. It is important that we should be sensible about accepting the use of tobacco in a certain measure.

Even in my own lifetime I remember going to India and finding that my body servant referred to my dinner jacket as my "smoker". Those were still the days of the smoking room and the lovely caps with tassels which were worn when smoking to keep the smell from getting into one's hair.

That is the only contribution I can make; to appeal to everyone—the Government included—to be sensible and pragmatic about this matter. The big improvement which should take place is an encouragement in the use of snuff. It does not offend other people, and it need not. I hope that the results of this debate will flow fully in helping to control the awful scourge of cancer of the lung which arises from the inhaling of cigarette smoke.

4.19 p.m.

Lady Saltoun

My Lords, I, too, should like to add my congratulations to His Royal Highness the noble Duke on a most eloquent and persuasive maiden speech. I hope that less time will elapse before he speaks again than elapsed between his taking his seat and making his maiden speech. It is not their fault that both he and the noble Lord, Lord Henderson of Brompton, have not converted me to single-minded acceptance of the report, Health or Smoking?

Although I do not smoke at present, I have smoked for a large part of my life. In fact, I beat the noble Lord, Lord Ferrier, to it, because I started with a packet of five Woodbines behind a hedge at the age of 12—and delicious they were, too. They were much better than any modern cigarettes. What is more, I did not feel sick. I felt very well indeed afterwards. So I do see both sides of the question—perhaps more than some more virtuous noble Lords. As the anti-smoking lobby have had it mostly their own way this afternoon, I am going to say a few words in defence and support of poor smokers.

Smoking has several beneficial characteristics. To those who do it, it is enjoyable. I would just at this moment like to point out to the noble Lord, Lord Henderson, that drinking dirty water is not enjoyable unless there is absolutely no alternative whatsoever. Then, tobacco has the property of being able either to soothe or to stimulate, according to the need of the moment. A cigarette can calm an irritated spouse and possibly stop a nasty incident in the home. Additionally, for example, had 1 not given up smoking, I should probably not have gone to sleep and snored in your Lordships' House last week, for I should have gone out and had a cigarette and that would have woken me up. A cigarette can be invaluable in waking up a sleepy driver, and I wonder how many car crashes have been avoided simply by the smoking of a cigarette. But above all, from time immemorial, man has felt the need of some narcotic to help him on his journey through this troubled world. Of all those available, I think possibly that smoking tobacco in moderation is one of the least harmful.

I have never heard that cigarette smoking leads to crime, suicide, lethargy or the use of hard drugs, which is more than can be said for some other things. If you make the smoking of tobacco too difficult, you may drive people to other more dangerous narcotics. Perhaps the export of smoking to the third world has not been altogether pernicious, for it may have become a substitute for other and worse drugs.

Smoking may be responsible for a number of premature deaths. Those of your Lordships who have read The Times carefully for the last three days will have learnt that almost everything they eat or drink, particularly in this House, is even more likely to finish them off than smoking; so do not let us blame everything on smoking, or he too sure that other people's cigarette smoke is going to kill us, until we have real proof.

I do not know what the Government's attitude to this is going to be, but if they are concerned about saving money, which I think that they probably are—because I do not really think they mind if we live or die as long as we do it cheaply—they had much better leave us in peace to die enjoying ourselves at a reasonably young age. If we live longer and longer, getting gloomier and more despondent as our few remaining pleasures are denied to us, think what we shall cost the DHSS in pensions, sheltered housing, medical care, ancillary services, and so on; and to make matters worse, the Government will get less and less in duty on tobacco to pay for it all.

That brings me to the plight of the tobacco industry. If the Government want to stop people smoking by increasing the duty on tobacco until few, if any, can afford to smoke, it would be much more honest if they were to say so. To raise the duty on cigarettes by 3 per cent. one year, 17 per cent. the next, perhaps 5 per cent. the next and 10 per cent. the next, and so on, see-sawing about, is very unfair to the industry, which cannot plan ahead, and one of the results of that is unemployment. Another result is, of course, increased wage demands in all sectors of industry, for to many smokers their cigarettes are of more importance than many necessities.

The only argument against smoking that holds any water as far as I am concerned is the annoyance caused by smokers to non-smokers, which is paralleled by the annoyance caused to lovers of classical music, or even of silence, by those who play pop music on transistors in public places and by piped music in aeroplanes, shops, restaurants, and so on; or, to give another example, by eaters of garlic to those who hate the stuff. We can all think of similar annoyances. What it really boils down to is a question of manners. You refrain from doing what may give annoyance to others and hope they will do the same for you. When I was young, one was a little bit careful where one smoked. Indeed, no lady ever smoked in the street. A woman who smoked in the street was not a lady; she was a tart. There was no doubt about it.

Therefore. I suggest that the Government do three things: encourage the provision of non-smoking areas in public places, on transport, and so on, but not ban smoking altogether; encourage the teaching of manners in schools, which may mean starting in teacher training colleges; and, finally, try to persuade the medical profession to be a little more helpful to those who wish to, or for specific reason should, give up smoking. Quite honestly, anything less helpful than the last appendix to the report that we are debating I have never read. I could from personal experience be more helpful than that. But further than that I do not think that the Government should go, if only because I am very doubtful of the wisdom—I was going to say, the morality—of legislating to protect people from risking harm to themselves. I opposed the compulsory wearing of seat belts in motor cars for that reason. Once you start that kind of nannying, you are on a very dangerous and slippery slope indeed, and there is no end to it.

Lord Henderson of Brompton

My Lords, may I interrupt the noble Lady for just one moment? It always used to be said of nannies that they referred to Miss Manners. Is the noble Lady making the speech that I hoped would not be made—the governessy and nanny speech?

Lady Saltoun

My Lords, I am sorry?

Lord Henderson of Brompton

My Lords, is the noble Lady making the speech that I hoped would not be made? That is the nanny speech and the governess speech—the one that refers to Miss Manners.

Lady Saltoun

My Lords. I thought I was making a speech on behalf of naughty little girls who wanted to smoke. But the real thing is that the more I am preached at and told not to do what I enjoy, the more I want to do it, and I think that that applies to a great many people. You need to be awfully careful about preaching, especially to the young. If you can, for instance, persuade a girl that she may lack boyfriends if she smokes because they will not like the smell, and vice versa, you will get somewhere, but not by a holier than thou attitude.

4.28 p.m.

Lord Molloy

My Lords, I, too, should like to congratulate the noble Lord, Lord Henderson of Brompton, on introducing this debate and indeed on the manner in which he did so. I should also like to congratulate His Royal Highness the Duke of Gloucester on his remarkable speech. I knew his views. I have been a member of ASH. I joined when I was a heavy smoker. 1 am bound to say that it helped, particularly when I listened to submissions by His Royal Highness and others who felt very strongly. I hope that he will be pleased to learn that I have now gone 12 months without smoking a cigarette or a pipe, whereas I used to smoke both rather heavily. The fact of the matter is that smoking is a bad habit. Unfortunately, of course, as the noble Lady, Lady Saltoun, said, all foul and offensive habits are very pleasurable. They give somebody a kick—whether it is dropping a bomb, declaring war or butchering in a bayonet or cavalry charge and slicing someone to ribbons. All these things give some people a kick.

What I found particularly wrong in the noble Lady's speech was when she said that the ladies of the street were those women who smoked openly on the street. When I was a young man, long before she was born, all the ladies who smoked seemed to be the ones who went to Ascot or the highly paid film stars. They were the ones who did all the smoking on the open road, the street and everywhere else. Therefore, it did seem to me that the top echelon of society was giving us all a very, very bad example.

Furthermore we are given a bad example in advertising today. We all know, beyond all peradventure that smoking is bad for the constitution. It is particularly bad for breathing. Any sportsman will confirm what the Royal College of Physicians has said—that you cannot he a 100 per cent. sportsman and a smoker. There has been massive agreement on both sides of the House on that point.

Of course, the Royal College has had to say that, as yet, it cannot in any way match the lavish advertising that goes on within the tobacco industry, with the millions of pounds that the latter can spend. I always feel it unjust and unfortunate that some famous sportsmen lend their names to smoking cigarettes when they know full well that in their prime that was the last thing they would have done. Therefore the only criticism I would make of the Royal College is to ask them whether they have really concentrated on trying to find something that will prevent people smoking, particularly the young, who might be, as I was, foolishly tempted into smoking.

Before I go any further, I think I ought to mention this point, which I do not believe has yet been mentioned. It is that the agony of smoking cigarettes is that its real, insidious danger is that it does not corrupt your lungs, give you cancer of the throat, or give you cancer of the lungs in a year or two: it might take 10 to 20 years. Because of that indisputable fact about a condition which afflicts millions of my countrymen, I find little room for humour in this debate.

You see people dying from lung cancer. I watched my father dying from it. It was caused through a combination of pneumoconiosis, contracted through dust from the pits, and smoking. When miners came up from the pits they immediately smoked in order to relax. When you have seen a person dying of lung cancer and throat cancer, believe me, although all the cracks of Mark Twain, to which the noble Lord, Lord Ferrier, referred, when Mark Twain said that he found smoking easy to give up because he had done it hundreds of times, are great and humorous, you arrive at the frontier of understanding when someone close to you has just vomited up his lungs, a condition brought about by smoking cigarettes, and you cannot laugh that off. If you do, that is an appalling exhibition of vulgarity.

I have to say that smoking is probably the most important avoidable source of disease. There are lots of things that we do not know how to avoid, and we do not know what will stop them because medical science has not yet provided the answer. But surely it has indicated a way in which we can reduce the risk of throat cancer, lung cancer, severe bronchitis and premature death: by not smoking or by giving up smoking.

The Counterblasts of King James I may be smiled at, but the reasons he gave them are certainly as true today. It seems to me that there has been in the past 30 to 40 years an obsession on the part of mankind in wanting to poison everything. We poison the atmosphere on an international scale. We poison the land with so-called fertilisers. We poison agriculture and horticulture, and we now voluntarily poison ourselves through smoking.

The argument of the Budget and tax of course is very real and I can understand it. I wish I knew the answer but I do not. However, because we do not know the answer does not mean that we ought to stop seeking a solution. It may be fair to say that, whereas smokers provide the Chancellor with a vast amount of money from tax, on the other hand 50 million working days are lost through bronchial illnesses caused, in the main, by smoking.

We have to take account of all views, and there are some people who might argue that it would be much better to cut out cancer through reduced smoking and make a balance to the Exchequer by cutting out cruise. All these things have got to be taken into consideration. But I believe that one cannot and should not try to outlaw smoking. I believe that that would be extremely dangerous and I do not think it would be successful. When the United States of America tried to outlaw the drinking of alcohol, we all know what happened. I am not going to say that something of that nature would happen in this country but, in my judgment, it would be too swift and too savage. There would be undercover smoking and it would not eradicate smoking in any way.

I believe that we have to do it by example. I believe that one of the best ways of doing it is by saying—as is slowly becoming evident, and it is a good thing—that smoking is downright bad manners, that people who smoke are fools and that manners maketh man.

So, in conclusion, I turn again to advertising and to what can be done. I would not outlaw smoking at all. But I would outlaw and ban all forms of advertising. I do not think it would have very much effect on people who have been smoking for 10 to 20 years, but I sincerely believe it would have an effect and help the young not to start the habit. In conclusion, I simply say that if we fail and the weed wins, that will be a triumph for disease, suffering and anguish.

4.47 p.m.

Lord Broxbourne

My Lords, if I may, I shall start with a triple congratulation, necessarily short because of the constraints of time, but with sincerity in inverse relation to its length. First, I congratulate the noble Lord, Lord Henderson of Brompton, on introducing this important matter in so interesting and informative a way. Secondly, I congratulate His Royal Highness the noble Duke on his thoughtful, well reasoned, and persuasive maiden speech. We shall all look forward to hearing him again on other topics. I, for one, will particularly look forward to any contribution from him on another subject involving an interest in which we both share and in which he has expertise —architecture. 1 think he is admirably qualified, particularly at this present time, to make a contribution to the current controversy of "trads" and "mods".

Thirdly, I should like to congratulate the Royal College itself on this report. It is everything that a report should be: comprehensive and clear; informed and intelligible; forceful, but fair. Of course, its main conclusion is clear. It is natural that it should be so because this is the fourth report, building on the firm foundations of previous reports extending over more than two decades. But the report does not suggest that there is nothing in favour of smoking. Clearly smoking must have attractions and qualities to have attracted the great following that it has. Page 6 of the report refers to these various benefits, and on page 12 it refers to the subjective advantages of smoking: relaxation, making it easier to do boring tasks, helping stress, and so on.

Three major questions arise on this subject. First, is smoking a danger to health, and, if so, in what respects, and to what degree? Secondly, what is the position of Government and Parliament in regard to corrective action, taking account of claims of individual freedom and personal choice? Thirdly, what practical form, within these parameters, can and should Government action take?

In this debate there has been a tendency for noble Lords to identify their own personal position in this matter. I am, and have been for many years, a non-smoker, but I cannot claim, with my noble friends Lord Boyd-Carpenter and Lady Masham, to be a lifelong non-smoker. Nor can I claim to have become a non-smoker through any act of virtue or exercise of considered judgment. I became a non-smoker by accident. It is a sobering thought how many of the more sensible things one does, one does by accident. I became a non-smoker during a general election when I found that I could not combine a heavy cold, a large number of speeches and cigarette smoking. I gave up smoking for the duration of the election, and, when the election was over, I continued. This gave me the advantage that when, some years later, I went to what was then the Ministry of Health, in the early days of consideration of this subject, I had abandoned cigarette smoking and had no personal reason or temptation to resist or qualify the evidence and conclusions of the medical profession.

The years have confirmed my position. The first of my questions is an easy one. The existence and degree of danger to health is what lawyers call an open and shut case. The evidence is marshalled in a succession of authoritative reports and the numerous documents cited therein. It is good to know that this report is approved by Sir Richard Doll, to whom, with Bradford Hill, much praise is due for excellent pioneer work. It would be unnecessary and, indeed, presumptuous of me to enter into technical questions as to health risks. In summary, the three main contributory consequences of smoking are lung cancer, associated bronchial and lung diseases and cardiovascular diseases. In total, we are told, they amount to 15 to 20 per cent. of deaths in our country, with an annual death total from smoking estimated at about 100,000. Those are formidable figures.

The assessment of health risk is necessarily a matter mainly for physicians. But the second question brings us to matters properly and primarily for government and Parliament—questions as to corrective action and the propriety thereof. As with so many questions in politics and government, it is not a matter of putting a good principle against a bad principle. It is seeking to balance and reconcile two principles, each good in themselves, and seeking the highest common factor of compliance with both. The two principles are, of course, the maintenance of the health of the nation and the desirability of preserving so far as possible the freedom of the individual and his right of choice to conduct his own affairs unfettered by state regulation and interference. So we have to seek so far as possible the reconciliation of these principles.

The position as to the first of them is clear enough. The good of the people, said Cicero, is the supreme law. That must include their health. Obviously, it is supremely important for government to promote as far as possible the health of the nation. The other principle leads to more difficulty. It is a strong and favoured argument of smokers and the tobacco industry that there is no reason or justification either in constitutional law or democratic principle to interfere with lawful enjoyment. That, however, puts it in too simple a form.

The doctrine of non-interference with personal enjoyment, although a good principle, is, of course, qualified by what is called the sic utere principle—that is to say, so use what is your own as not to injure others. That principle has a dual application in this matter—the effect on the national resources and the physical effect on individuals. In regard to national resources, it is obvious that the incidence of lung cancer and associated diseases necessarily imposes a heavy burden on the health service and thereby on the taxpayer by the diversion of accommodation and of professional and nursing skill away from other and less avoidable ills. Of course, there is a set-off factor in the financial context by reason of the revenue from taxation, but that does not extend to the physical aspects of accommodation and skills.

The injury to individuals arises from the effect of "passive", or involuntary smoking, as it is called—that is the reluctant but compulsory intake by non-smokers of "side-stream smoke" in the atmosphere. Here again, the report is very fair. It shows that because there has been relatively little research into the incidence of lung cancer from this cause, you cannot prove it to be a certain fact. What is beyond question, however, is the degree of discomfort, inconvenience, annoyance and irritation inflicted by smokers on nonsmokers, aggravated by the fact, as the report says, that most smokers do not appreciate how much their habit can annoy non-smokers. There is therefore a clear case of injury to non-smokers constituting a breach of the sic utere principle and justifying or, indeed, requiring corrective action without any improper infringement of the rights of the smoker.

Time will not allow me to go in any detail into the third aspect. Fortunately, here again, the report is admirably clear and realistic. On health education, it has a good story to tell. However, on the other sort of action, the position is much less satisfactory. It is sad to read that successive governments have shown regrettable unwillingness to take the sort of action that might at first contain and ultimately overcome the tragic consequences of smoking. The action that the Government must take has been referred to— control of promotion, and the introduction of non-smoking, as far as possible, into public places.

If the Government can do that, they will do much to meet the criticisms made in the report. It is indeed a paradox that, when medicine and science have succeeded in defeating those two great scourges of earlier days, the tubercular and pneumonic diseases, graphically called "the great captains of the men of death", society should now of its own accord bring in an unnecessary and self-imposed hazard. It is for Ministers to seek to correct this unnecessary and damaging situation and for them not only to welcome the report in words but to give effect to its proposals. If they do so, they will bring great benefit to the citizens of today and generations yet to come.

4.47 p.m.

Lord Winstanley

My Lords, I must begin with a brief apology. As noble Lords may or may not have noticed, I had to leave your Lordships' Chamber for a few moments to put in a brief appearance at one of your Lordships' Select Committees. As a result, I missed two speeches and a little bit of another. I am sorry about that, and I shall read the speeches most carefully. I have, however, been present for the remainder of the debate. I am therefore able to say how much I enjoyed the admirable opening speech of the noble Lord, Lord Henderson. We are all indebted to him for introducing this subject.

I should also like to join with others in offering congratulations to His Royal Highness the noble Duke, the Duke of Gloucester, for a truly remarkable maiden speech. I say that advisedly because it is rare to hear a maiden speech in this House that turns out to be the speech that covers the whole subject succinctly yet comprehensively. It has directed our attention to the points of most crucial importance. That is perhaps understandable, because the noble Duke has deep knowledge of this subject through his long association with the organisation, ASH.

Let me say at the outset, as a doctor who has practised medicine in and out of hospital for 40 years, that I have not the slightest doubt that smoking is injurious to health. There is no longer any room for doubt about the causal relationship between smoking and lung cancer. Nor is there room for much doubt about the relationship of smoking to arterio-vascular disease, although that perhaps has been less comprehensively and decidedly demonstrated. But the most important injurious effect, from my practical experience in medical practice, is its clear causal relationship with chronic bronchitis and emphysema—diseases from which a great many people, particularly elderly people, suffer in this country.

Of course, thereby hangs one of the difficulties. Many noble Lords have referred to the ambivalent position of Government in that they reap great rewards in revenue from tobacco duty. But there is the other point. The one thing which smoking undoubtedly does every year is snuff out thousands of elderly bronchitics at round about the age of 65. On the whole they are people who have loyally and dutifully subscribed to the national insurance fund for some 50 years, and just when they are on the point of drawing something out, off they go.

In a sense that is another complicating factor which perhaps makes it difficult for the right decisions to be taken. Perhaps it also obscures the question of how much smoking costs the National Health Service. If all those elderly bronchitics remained alive for as long as they would remain alive if they stopped smoking, the health service would be in for a great deal more work. But the real reason for getting people never to take up smoking, which is the most important thing of all, or to stop smoking if they have started, is not because it would save the health service money but because it would be better for the health, happiness and contentment of society as a whole. That is the reason, and let us not obscure it by housekeeping arguments about how much smoking costs the health service, how much it causes fires, or other arguments of that kind.

This is not an easy question, and I say that again as a doctor. The noble Lord, Lord Molloy, in his powerful and brief speech, said that he had given up smoking for 12 months. All I say to him is, "Congratulations". But I say, too, that he is not cured. I say advisedly that once a noble Lord or anybody else becomes addicted to nicotine—it is an addiction in a genuine sense, not just a pyschological dependency but an addiction like any other addiction—he is always addicted. I can speak from experience because I have been a smoker and a non-smoker, then a smoker and then again a non-smoker, and so on. One is never cured, and I think it is important that one should say that.

Those who think they have succeeded in giving up have not necessarily done so. I stopped smoking on Christmas Day in 1966, when I was doing a lot of television programmes on health education. If ever I smoked, somebody would say, "Oh, I see you smoke; doesn't it matter?" I would say it did matter very much indeed but it did not happen to matter to me. I decided that that was not a tenable position, so I stopped. After 10 years I thought I was cured. But on Christmas Day in 1977 I said to my wife, "I'll have a cigar after dinner." I did so. Then I said, "I enjoyed that; I'll do that every day and that won't do me any harm—a cigar after dinner". But by the end of the week I could not get through the days in order to come to my cigar after dinner. So it became a cigar before dinner, and then a cigar before lunch, and so on. Since then I have given up several times. It becomes harder to give up again because one has proved that one can give up.

It is a clear and adequate motivation that helps people to give up an addiction of this kind. The motivation could be fear, it could be poverty, but it could also be pride and vanity because one wants to demonstrate that one can give up. When one has given up for 10 years one thinks one has proved something, and then it gets harder afterwards.

I have said all that at some length because I think it is important to understand that the addicted smoker really has a problem. From hearing a bit of the speech by the noble Lady, Lady Saltoun, I thought she had taken this point that smokers need help. I do not think they necessarily need the kind of treatment that they receive from some former smokers, who are rather apt to exude a puritanical self-satisfaction and pursue smokers with a Cromwellian zeal which sometimes turns out to be self-defeating.

Smokers need a little bit more understanding. Therefore I greatly welcome those parts of this report from the Royal College of Physicians which take a slightly different attitude towards assisting people to give up the smoking habit than was taken formerly by the Royal College of Physicians and by others. For example, when first we recommended a reduction in the tar content of smoke—that has been very helpful; there is no question about it—the reaction of some of the anti-smokers and ASH was that if one makes smoking safer people will be less inclined to give it up.

If one can make it safer, and if one remembers that some people do smoke, surely there is a social benefit from having made it safer. That is recognised clearly and explicitly in this latest report of the Royal College of Physicians, and it is a very good thing that it is. If we accept that some people are going to continue to smoke although they should not, and if we can make smoking safer, we ought to do so.

In addition, this report recognises that some people need some forms of assistance. An example is snuff. There are noble Lords who have found the use of snuff a helpful way of getting away from the addiction to nicotine. It is a fact that no medical ill-effects whatsoever have ever been demonstrated in connection with the use of snuff, save perhaps for a little unpleasant discolouration of the nostrils, which is not exactly lethal. But if some people find that by trying snuff, that can help them to get away from smoking, so be it; that is a good thing.

Similarly, when we were introduced to the new nicotine-impregnated chewing gum, people got addicted to it. I knew a young lady who had never smoked in her life but who was one of the doctors testing this nicotine-impregnated chewing gum. She became addicted. The idea of her waking up in the morning and reaching for her handbag to find the chewing gum really appals one. An addiction is unpleasant. But if, as this report shows, Nicorette, which was that form of nicotine-impregnated chewing gum, helps some people to give up smoking, then it is doing something very helpful indeed.

The ideal is for people never to start smoking. But, in conclusion, I have to say that, despite all the propaganda and all the educational work—there has been a great deal of it—many young people still smoke. I have done my own research into this. I found that, in my own area of Manchester, research into university students entering university showed that only one in 10 smoked. When I investigated new recruits into industry—into manual jobs—I found that nine out of 10 smoked. In other words, it is utterly clear that the propaganda and the educational information which has been put out has not got through to young people in certain social groups.

If people never started smoking they would not have the kind of problem with which so many noble Lords have had to wrestle in order to give up smoking. The ideal is to make our propaganda more effective in order to dissuade people from starting smoking at all. But I ask your Lordships to recognise that those who have become tobacco addicts have a problem. They need to be helped as far as possible with the problem, and not just pursued and condemned for it. I welcome this debate. I welcome this new and very enlightened report of the Royal College of Physicians, particularly, if I may say so, the appendix on giving up smoking which appears at the end of the report. I regard it as very perceptive indeed. It shows that the Royal College and others are moving in the right direction.

4.58 p.m.

Lord Ennals

My Lords, I am sure we owe a great debt of gratitude to the noble Lord, Lord Henderson of Brompton. Apart from introducing a very valuable debate, he has very nearly produced unanimity in your Lordships' House, with one notable exception. the noble Lady, Lady Saltoun. That in itself is remarkable. But perhaps it was the remarkable contribution by His Royal Highness the Duke of Gloucester which convinced all doubters. I wonder if, speaking not only from this Dispatch Box, I may thank and congratulate His Royal Highness. He is the patron of ASH and I am the patron of the National Society of Non-Smokers; so as one patron to another, but with all the humility that should go with it, I thank him for what I thought was a very courageous and very outspoken speech, and just the sort of speech that a maiden speaker should make in your Lordships' House. The facts are absolutely clear, and His Royal Highness illustrated them in terms of human suffering and human death and the cost to the National Health Service.

No one has actually pointed out that the report we are debating is not called, Smoking and Health, but, Health or Smoking? That in itself is very important. If one wishes to remain healthy, one does not smoke. The unanimity of medical opinion (certainly in this House, but it goes right across the country) about the dangers of smoking is probably unrivalled in any other category of disease or cause of disease. Secondly, the risk to health of smoking is so much greater than all other know avoidable risks to health. Even after the recent sharp decline in cigarette smoking, new smokers are still being recruited on such a scale that smoking will continue to be this country's largest cause of preventable ill-health well into the next century. That is why the noble Baronesss, Lady Masham, was so wise to concentrate, as did other speakers, on the importance of education among young people.

Thirdly, smoking is always dangerous. Unlike other major avoidable causes of ill-health which are dangerous when abused—drink can be dangerous, but only when it is abused—smoking is always dangerous. 1 thought that the noble Lady, Lady Saltoun, was almost putting forward the case for a rapid early death. I do not think that many noble Lords and noble Baronesses would subscribe to that view, and I hope that the noble Lady does not accept her own advice.

As has been pointed out by the noble Lord, Lord Winstanley, smoking is addictive to very many smokers. I do not agree with the noble Lord that once one is addicted one is always addicted. I gave up smoking about 15 years ago, and a very easy way to do so is by being appointed Minister of Health. You cannot then go on smoking—at least, you should not! The present one does, but he should not. I have not smoked since. From 1976 to 1979, when I was Secretary of State, we had a very clear strategy, and it is about Government strategy that I want to speak because it comprises a very important part of the report. At that time advertising on television had already, rightly, been abolished, but smokers were in a clear majority in the community. Our objective, and mine as Secretary of State, was so to influence the public that we could achieve an overall majority of non-smokers in society, so that not to smoke was the norm, rather than smoking being the norm.

Secondly, we wanted greatly to extend non-smoking areas in terms of travel, leisure, the work place and public amenities, because at that stage there was little argument about the effect upon other people, whether it was a medical effect or simply the inconvenience and the unpleasantness of having to work in an office where other people smoked.

Thirdly, we wanted so to influence the public that a large proportion of those who still smoked but wanted to give up smoking were helped to do so. This is a very important point, and it was touched on by the noble Lord, Lord Winstanley. A very high proportion (some have said that it is high as 70 per cent.) of those who still smoke today would like to give it up. It is interesting that when a quite short television programme was broadcast setting out the dangers of smoking, people were asked to write in requesting assistance to help them become non-smokers and in return they would be sent special packs. The organisers thought that there might be a response of 15,000; in fact, 650,000 people wrote in asking to receive the packs to assist them to become non-smokers. Therefore, it is absolutely right that one of the purposes of the national society is to help people who want to stop smoking actually to give up the filthy weed.

Thus, there has been a steady reduction in the proportion of men and women who smoke, and we must welcome the fact that over the years, with successive Governments, there has been a steady reduction and that now non-smokers are substantially in the majority. We must now ask the Government for their strategy in tackling this problem—how they are responding, and how they will respond. This is the first time that there has been a debate in either your Lordships' House or another place on this extremely important report. So far the Government have not been very clear about what action they intend to take.

In the few minutes at my disposal I simply want to suggest an eight-point programme. First, there should be a Government policy binding all departments to pull in the same direction, rather than just a DHSS policy against which other departments can, and often do, pull in the opposite direction. In saying that I draw on a good deal of experience. From being Secretary of State I know the sort of battles one has to get other departments to agree to this kind of policy.

Secondly, I believe that there now needs to be a complete ban on all promotion of tobacco. As the report of the Royal College said, and as a number of noble Lords have pointed out, this means an end to all advertising, except of course at the point of sale. There should he no effort to influence present smokers, but certainly an effort to stop new smokers. We must tackle what I can only call the scandal of promotions, which was touched upon by the noble Baroness, Lady White. It is interesting to note that in the two-week period during April of this year when the Embassy World Snooker Championship was being promoted the BBC devoted more than 100 hours of television to an event designed to promote Embassy cigarettes and cigarette smoking. The cost to the sponsors in prize money was less than £200,000; the amount of publicity which the tobacco company received was enormous. Steve Davis, himself a non-smoker, who was defending champion, was asked all about it and he said: They do it because they get tremendously cheap advertising. Snooker's the cheapest form of advertising out of all the sports". I believe that this matter must be tackled by the Government.

Thirdly, there need to be much stronger, and more prominent, health warnings, with more specific evidence, such as the kind of facts that were given by His Royal Highness during his outstanding speech.

Fourthly, there must be more intensive public education and information about smoking, especially for young people. I am sure that our efforts must be devoted to stop youngsters from starting, because there is no doubt—and this is made clear in the report—that once a youngster has the habit, he is likely to become a smoker for life. It is the younger generation to whom we must direct our attention.

Fifthly, there must be increased leadership from Government to encourage the development of nonsmoking as the nom in public places, with smoking areas set aside where practicable, rather than vice versa as at present. This is a matter on which I believe the Government need to take the initiative. There are still too many places, including restaurants, where we are subjected to the smoking of others.

Sixthly, there need to be regular increases in the real cost of smoking, regulated by taxation. I do not accept the argument put forward by, I think, the noble Lord, Lord Boyd-Carpenter—and if I am wrong, I hope he will forgive me—that this is not a deterrent. I agree with the argument that has been put forward that there should be a substantial increase, and I believe that this may have a real effect upon current smokers—

Lord Boyd-Carpenter

My Lords, will the noble Lord allow me to interrupt him?

Lord Ennals

My Lords, I shall, but I should like to finish the sentence, and I have promised that I shall sit down in one minute. I recognise the achievement of the last Budget in this respect.

Lord Boyd-Carpenter

My Lords, I am sure that the noble Lord did not want to misrepresent me. I did not say that an increase in taxation was not a deterrent. On the contrary, I advocated an increase in taxation on tobacco, but said that past experience had shown that it must be a whacking one.

Lord Ennals

My Lords, in that case I did misrepresent the noble Lord, and I am glad that he has intervened. I absolutely support what he has just said.

My last two points are a progressive compulsory lowering of maximum emission levels for each cigarette tar group—this was emphasised with considerable success during the time of the previous Administration, and we must take it further—and, finally, an end to investment grants and other financial incentives for the tobacco industry, except of course for non-tobacco diversification.

I warmly thank the noble Lord for introducing, and congratulate him on, what has been a most important debate, with almost unanimous views. I look forward to the Government's response to the report of the Royal College. I say again that this debate has been a historic occasion due to the presence of, and the quality of the speech given by, His Royal Highness, who was speaking not only as a Member of this House, but also, consciously, as the patron of ASH.

5.11 p.m.

Lord Glenarthur

My Lords, I should like to add my words of congratulation to the noble Lord, Lord Henderson, on so lucidly introducing this important debate on smoking and health. Sadly, as we have heard—and there is no doubt about it—cigarette smoking is still the greatest avoidable cause of illness and death in our society. As such there can be no more important subject in the whole field of preventive health care to bring before your Lordships. I welcome the chance that it has given us to consider an issue which is central to the nation's health and well-being, and to explain the Government's intentions and success.

The other opportunity which this debate has provided has been for us to hear the really excellent maiden speech of the noble Duke, the Duke of Gloucester. It is a particular personal pleasure, for two reasons, for me to he able, from the Government Front Bench, to congratulate him on it most sincerely. First, we were exact contemporaries at Eton, and the penalties for being caught there smoking as a boy, as I am sure he remembers, were somewhat draconian, but no doubt effective, though I do not think that either of us suffered, or indeed deserved to, in that particular way. Secondly, his family have a long and valuable association with my former regiment.

Views for or against smoking are held with a considerable degree of personal conviction. There is nothing wrong in that. I associate myself entirely with all those who have said that the noble Duke's first intervention in your Lordships' House was thoughtful and carefully constructed, and was delivered powerfully and with considerable flair. I join fully with all those who said that they hope it will not be long before we again have the benefit of his wisdom and experience in this Chamber.

I, too, should like to pay tribute to the Royal College of Physicians whose latest report we are today debating. It is now some 22 years since the college brought out their first report pointing to the serious dangers of smoking. It is perhaps no coincidence that in that year cigarette sales in this country began to fall for the first time in more than a decade, and with one or two interruptions they have continued to fall at differing rates ever since.

Three further reports have followed at intervals and no one would deny their influence in both shaping Government and medical opinion and helping to increase public awareness of the risks of cigarettes to health. For this we are greatly indebted to the college. The Government have always given the most careful consideration to their reports and recommendations. My right honourable friend the Secretary of State for Social Services recently had a very useful meeting with a delegation from the college to discuss the report. A number of useful suggestions were made, and these we shall he considering further.

The college's report underlines the gravity of the health problem caused by smoking, but, alas, the figures do not convey its full extent in terms of human suffering by the victims and the distress to their families and relatives, which cannot be quantified. As a health Minister I cannot be other than gravely concerned about the terrible toll of unnecessary death, disease and misery caused by cigarettes.

Despite the views expressed by the noble Lady, Lady Saltoun—which I understand, though I do not altogether agree with—I should like to reiterate at the outset the Government's clear commitment to discourage people from smoking. I shall say more about the forms that our policy takes, and I choose the word "discourage" carefully because in a free society the decision whether or not to smoke must in the last resort he a matter of personal choice. That too, I hope, will please the noble Lady, Lady Saltoun.

Faced with these facts, it is easy to overlook the progress which has been made in combating smoking in recent years. We have come a long way in the 20-odd years since the Royal College's original report was published, and it is perhaps worth reflecting on the progress that has been made. In 1962 the majority of adults were smokers and they knew little of the risks they were taking. Most cigarettes had a very high tar content. There were few restrictions on either advertising or where one might smoke. Smoking, as was mentioned by one noble Lord, was accepted as the social norm, and one could even say that it was encouraged.

Today much has changed. Cigarette advertising is strictly controlled by both a code of practice and voluntary agreements which require cigarette packets and all cigarette advertisements to carry a health warning. There have been tremendous advances in health education. The average tar yield of cigarettes has been drastically reduced. More significantly attitudes towards smoking have changed, and are changing, for the better.

Those who find smoking by others unpleasant—and I count myself among them—have begun increasingly to press for their right to a smoke-free environment, and there are now many more non-smoking areas in public places, on trains and buses, and in theatres, cinemas and restaurants. Only 10 days ago I was delighted to come across my first internal airline which forbade smoking entirely. I, for one, am delighted that my noble friend Lord Boyd-Carpenter, applied the kick which he described earlier.

While I deplore, as do many, the problems associated with passive smoking, I have to say that while it is unpleasant, the extent to which it can damage otherwise healthy adults is, as yet, unclear. In their most recent report the independent scientific committee reviewed the evidence and concluded that tobacco smoke can irritate the eyes, nose and throat and that it may exacerbate symptoms in adults already suffering from certain conditions. This was a point referred to by my noble friends Lord Boyd-Carpenter, Lord Gisborough and Lord Broxbourne.

So far as smoking on public transport is concerned—and the noble Lady, Lady Saltoun, referred to this, as did my noble friend Lord Gisborough—many transport authorities impose regulations and restrictions on smoking on public transport. There are, for example, regulations to enforce no smoking on buses, and most operators impose a partial ban, but the extent of any restrictions must be a matter for the appropriate transport authority to decide, taking into account all the circumstances.

So far as smoking in the workplace is concerned, which also was raised by my noble friend Lord Gisborough, this is the responsibility of individual employers. I agree with him that people who do not want to work in a smoky atmosphere should not have to do so. But I do not think that this is a matter to which hard and fast rules can be applied.

The progress being made can best be illustrated by some of the basic facts and figures, though some of them were referred to earlier by the noble Lord, Lord Henderson, in introducing this debate. In 1962 (the year of the first report) Tobacco Research Council statistics suggested that about 66 per cent. of all adult males were cigarette smokers. In 1972, according to Government statistics—the General Household Survey—that figure had fallen to 52 per cent., and by 1982 to 38 per cent. That was a remarkable fall.

Among women the prevalence of cigarette smoking rose sharply during and after the Second World War and then steadied off at a little over 40 per cent. of adult females. The 1982 General Household Survey statistics suggest that 33 per cent. of adult females are now smokers. The figures on cigarette consumption are even more striking and show a 20 per cent. fall in cigarette sales in the last five years. The statistics show that we are moving in the right direction.

So far as Norway is concerned, I have to say that, while the figures show a fall in the proportion of regular cigarette smokers, the conditions there vary somewhat from those of the United Kingdom and direct comparisons are difficult to make. In fact, the figures in 1972 and 1982 for males in Norway showed a drop from 51 to 40 per cent., but in Great Britain it was from 52 to 38 per cent. In that case it appears that Great Britain is doing rather better than Norway.

But there is, of course, still a long way to go. The number of people who smoke in Britain today is about 18 million, and surveys suggest that over two-thirds of them want to give up the habit. Some will have tried in the past without being successful, as we have heard. Given the addictive nature of nicotine, it is important that these people receive proper health advice and encouragement, and I entirely share the views expressed by the noble Lord, Lord Winstanley. I believe that in recent years there have been some encouraging developments in this area.

At the local level many health authorities have established policies against smoking as part of their preventive health strategies. General practitioners are now more geared up to giving help and support to patients wishing to stop smoking, and to stressing the importance of not smoking to their patients generally. Anti-smoking clinics in one form or another are becoming a more familiar feature of health service provisions, while self-help and other mutual support groups are also flourishing. The Health Education Council and ASH continue to provide valuable advice, and I pay tribute to them for that. They provide it in a variety of ways to smokers who are trying to quit smoking. These are heartening developments, and, of course, we want to encourage them and foster them. The Government have contributed directly by their funding of research into helping people stop, and that is through the Addiction Research Centre at the Maudsley Hospital.

The noble Baroness, Lady White, referred to lung cancer deaths. I share many of the views that she expressed. The death figures for 1982 are 26,156 for men and 8,932 for women. The Royal College of Physicians' report estimates that 90 per cent. of all deaths from lung cancer in this country are attributable to smoking. The noble Lord, Lord Rea, talked about smoking and coronary heart disease. The fact is that cigarette smoking is a powerful and independent risk factor for coronary heart disease, particularly at younger ages, and the Royal College report attributes 20 per cent. of all coronary heart disease deaths (that is, about 36,000 deaths in the United Kingdom) to smoking.

We have heard a certain amount about taxation, and few of us would dispute that price is an important determinant of cigarette consumption. The Royal College's report recognised this in calling for a steady increase in cigarette taxation. Your Lordships will he well aware that my right honourable friend the Chancellor of the Exchequer, in raising the duty on a packet of cigarettes by 10p—considerably more than inflation—stressed the health reasons for doing so. This was a point brought out by the noble Duke the Duke of Gloucester. I am sure this will help to reduce cigarette consumption further, and is evidence of our commitment to tackling the problem.

One of the most effective ways in which smoking can be discouraged is through health education. This means not just getting across the link between smoking and health which most people now recognise: it means ensuring that everyone fully understands the extent of the dangers and the damage which smoking causes. I should like to say a word here in praise of the Health Education Council's efforts in this field. The council regards the prevention of smoking as its single highest priority. The contribution it has made through both its mass campaign and its activities in support of local health and education authorities cannot be over-emphasised. The Government have played their part here, too, in their funding of the council's work, and this will answer a point raised by the noble Lord, Lord Henderson. We recently added half a million pounds to the HEC's anti-smoking campaign this year. The HEC put a lot of careful thought into planning their campaign, and I am sure it will have contributed towards the reductions I referred to earlier. I hope also that the latest HEC campaign through advertising—which many of your Lordships may have seen—will persuade many more people not to smoke.

As a result of the efforts of the health professions, health educators and Government, it is now far less likely that anyone will smoke without being aware of the dangers to their health, but the Government do have a duty to try to reduce the risk to those who are unwilling or unable to stop. The latest agreement on product modification, announced in March, will help. For those who must smoke it will mean a further lowering of the average yield of tar—one of the most dangerous components in cigarettes. This follows a recommendation by the independent scientific committee on smoking and health, which advises the Government in these matters. I should like to put on record the Government's appreciation of the invaluable work this committee does on the scientific aspects of smoking.

On other scientific matters, the noble Lord, Lord Henderson, asked about the MRC and SSRC recommendations into the psychological and social factors, and factors of attitude. These recommendations were accepted by the Government. A large-scale study was commissioned and carried out by OPCS, and the results were published in 1983 under the slightly different title of, Smoking and Health.

The agreement I referred to also includes a new tar grouping structure reflecting the large changes in the pattern of smoking over the last ten years. The new designations will be introduced next year, and will appear on cigarette packets and other relevant cigarette brand advertising. The Royal College's report recommends legislation to secure reductions in tar, carbon monoxide and nicotine. But the latest agreement is a good example of what can be achieved through co-operation with the industry and without legislation.

The problem of smoking among young people remains a major source of concern to the Government. Clearly the main hope for the future in eradicating smoking lies in dissuading the young from ever starting to smoke. Studies show that most of those who go on to be regular smokers first take up the habit in their teens. Persuading youngsters not to smoke must therefore be our main priority.

Recent research has given cause for considerable concern about this. The Government last year sponsored a survey of children's smoking habits carried out by Office of Population Censuses and Surveys. This was the first national survey of its kind, and it revealed some disturbing facts. We shall be repeating the survey later this year in order that we can observe the trend. We are taking a number of initiatives aimed at tackling the problem. We are concerned about the apparent ease with which children under 16 have been able to buy cigarettes. I recognise it may be difficult for shopkeepers to judge whether a person is below the legal age; but clearly this is an area where there is room to tighten up the law. We are having discussions with retail organisations to draw up some simple guidelines and, of course, the maximum penalty has now been doubled to a fine of £400.

Much good work is already being done in schools to combat smoking through health education lessons. A government leaflet was recently introduced at schools throughout England and Wales, and will shortly be issued in Scotland giving the up-to-date facts about smoking among teenagers. This should also help to stimulate further activity in schools. I think we need to recognise that there are limits to what the Government and other bodies can do. The work in schools and elsewhere will only succeed if parents accept their own responsibilities to discourage their children from smoking. Action must always start in the home; although, of course, some children may experiment with cigarettes regardless of what parents say.

The subject of cigarette advertising and promotion raises strong emotions, which have been voiced by many. There is a view that there should be some further control or ban on cigarette advertising. Indeed, it was one of the main recommendations of the Royal College's report. The Government, like their predecessors, have adhered to the view that voluntary agreement is the best form of controlling the industry's activities in these areas. I do not accept the argument that these agreements have been ineffective in helping us to achieve our goals. Indeed, there are good grounds for believing that successively tougher agreements have helped bring about the gradual reduction in smoking which has taken place.

Nor is there evidence to support the contention—voiced by, among others, the noble Lord, Lord Molloy—that banning advertising would substantially reduce total cigarette consumption. The evidence is not by any means conclusive. Certainly, the experience in this country illustrates what can be achieved without recourse to legislation to control or modify advertising. To set out the Government's position, we shall of course abide by the present voluntary agreement, which will last at least until March 1986. But the situation will be reviewed then in the light of all the relevant information.

Turning to the subject of sports sponsorship, many similar considerations apply. Of course, I am aware that there are some who believe it is wrong that tobacco companies should be able to sponsor sports in this way, but we must also recognise the substantial benefits many sports have received from this form of sponsorship. We think it right to balance these two points of view by regulating and controlling the amount of sports sponsorship by agreement. The present agreement runs until the end of 1985. Under its terms there will be no increase in real terms in the amount of money the tobacco industry can spend on sports sponsorship, and no new sports will be sponsored without prior consultation. The Government will also be reviewing this agreement at the appropriate time.

A number of other points have been raised. I am afraid I have not time to go through them all, but the noble Lord, Lord Henderson, and the noble Lord, Lord Rea, asked about the Medicines Act and whether that could be used. The fact is that there is a possibility but, as I have said, the Government, like their predecessors, prefer to proceed through voluntary agreements.

The noble Baroness, Lady White, asked about the third world particularly. I understand her concern that the smoking problem should not be exported to third world countries. It must be right for each Government to determine their own policies in the light of the circumstances prevailing.

The noble Baroness, Lady Masham of Ilton, asked about the disabled and the 125-type trains. I am sure this is a point that will be borne in mind by British Railways. On her other point about smoking and pregnancy, the Health Education Council has continued to publicise the dangers for the unborn children of mothers smoking during pregnancy through its education and preparation for parenthood programme. There is other information which I could give her if I had time. Neither, I am afraid, have I time to go into snuff, but I shall let my noble friend Lord Ferrier know about that.

I hope that what I have said today will underline the importance that the Government attach to discouraging smoking and to limiting its damage to health. Today's debate illustrates that while there is general agreement about the aim there is room for argument and discussion about how that aim can best be achieved. I hope that I have demonstrated that the Government's policies are making considerable impact on the smoking problem and that our strategy to dissuade people, especially the young, from smoking by persuasion and consent represents the best way forward in dealing with this most deep-rooted social evil.

Lord Henderson of Brompton

My Lords, I believe I have only 20 seconds in which to thank all noble Lords for having taken part in this debate, which has admirably covered the ground. With that, I beg leave to withdraw my Motion.

Motion for Papers, by leave, withdrawn.