SMOKING AND HEALTH

HL Deb 17 March 1971 vol 316 cc444-64

2.57 p.m.

LORD PLATT

My Lords, I rise to call attention to the recent Report of the Royal College of Physicians entitled, Smoking and Health Now; and to move for Papers. In 1962 the Royal College of Physicians published its first Report on Smoking and Health. The evidence that cigarette smoking was the main cause—almost the sole cause—of cancer of the lung, and also the cause of a large number of premature deaths from coronary heart disease and chronic bronchitis, had been building up for a number of years. The Reports of Doll and Hill in this country, and of Wynder and Graham in the United States, were published in 1950, and were I think the first to present strong evidence of the connection between smoking and lung cancer.

Since then the evidence has become stronger and stronger; it has stood up to every conceivable test and criticism, and has proved in my opinion to be one of the greatest medical discoveries of our time. For the commonest type of cancer in the male, which now causes about 32,000 deaths every year in the United Kingdom alone, has proved itself to be the only common internal cancer which is preventable.

Warnings had already been given many times by the Ministry of Health and by the Medical Research Council; but the Royal College of Physicians, of which I then had the honour to be President, felt that the evidence should be put together in a form readily available to the public, and which the public could read and understand. The idea that we should do this came to me from Dr. Charles Fletcher, and we called together a strong committee which met under my chairmanship for about two and a half years. In order that we should not be a committee of total abstainers or, worse still, of reformed addicts, we had two very heavy cigarette smokers on the committee, one of them a chest Physician and the other a medical officer of health; and both gave up smoking before we had finished our deliberations.

The Report of that committee was debated in your Lordships' House on March 22, 1962 (col. 635 of Hansard), which was before I had the privilege of being a Member of your Lordships' House. The debate was opened by the noble Earl, Lord Arran; a notable speech was made, among many others, by the noble Lord, Lord Cohen of Birkenhead, and the debate was wound up by the noble Viscount (as he then was), Lord Hailsham, in a brilliant speech in which he rapidly demolished the arguments of the cigarette manufacturers, calling upon them to drop the escapist propaganda which at the present time they are putting out, which personally I … find both distasteful and lacking in scientific courage and integrity … the first-class man is the man who recognises and accepts compelling evidence, not one that fights against it".—[OFFICIAL REPORT, Vol. 238. cols. 754–5.] Although a good deal has happened since then, the problem still remains with us, and I hope to show your Lordships in a few minutes how serious it really is. Far too little has been done, and so the Royal College, now under the presidency of the noble Lord, Lord Rosenheim, whose maiden speech we look forward to during this debate, has issued its second Report entitled, Smoking and Health Now.

Before giving your Lordships some of the latest figures, I should like briefly to say something about the nature of the cigarette addiction—although this may not be a popular subject with some of your Lordships. In the first place, there is no doubt whatever that it is by any possible standards, an addiction, and a very strong one, in that a comparatively short exposure to cigarette smoking rapidly produces a craving for the drug which many people find it very difficult or even impossible to overcome. As with heroin and other drugs of addiction, young people seem to be particularly easily hooked, and a young person in his teens who has started to smoke cigarettes regularly usually becomes a victim for life. The addiction is of course widespread. In preparing the first College Report of 1962 we found that 75 per cent. of males in this country smoked an average of 19 cigarettes per day.

As with other addictions, there are some people, especially women, who can take the drug in moderation and who seem to enjoy it. But whereas with alcohol the great majority can take it in moderation, and there are millions of people who drink only at week-ends or on a Festive occasion, with the cigarette the majority become true addicts, smoking about 20 or more cigarettes per day, which means, if you discount mealtimes and sleep, that they satisfy their craving for nicotine about once in every 40 minutes of their waking lives. This, I may say, costs them at least 31p per day, or well over £2 per week.

As in other addictions, withdrawal of the drug causes unpleasant symptoms. In the case of tobacco these usually take the form of restlessness, lack of concentration, general ill-humour and, above all, a compelling craving for the drug, which you know will almost immediately put you right again, a craving which many people find overwhelming Having been through this twice myself after having smoked for 35 years, I could offer some good advice to those of your Lordships who would like it. But I think that my noble friend Lord Rosenheim may be dealing with, inter alia, the subject of giving up smoking.

Opinions differ as to the advantages of smoking. The fact that when you give it up you crave to go back to it is no evidence at all that it has been doing you any good. The biggest craving of all, of course, is the craving of the heroin addict for his next shot in the arm. Like the cigarette addict, he feels himself again only when his craving has been satisfied. Fortunately, on the credit side it can be said that cigarette smoking, unlike some other addictions, does not noticeably alter a man's personality. But for the smell, which is very noticeable to those who do not smoke, I would not be able to tell which of your Lordships was a cigarette smoker whereas if your blood alcohol were 100 milligrams or more per 100 millilitres I think I should notice a difference in behaviour quite readily; and if you were addicted to the taking of LSD or heroin you would soon become incapable of maintaining normal social contacts and serious pursuits altogether.

The chemical composition of cigarette smoke is very complex and there is a good deal we do not know about it. But it appears that nicotine is the fraction which causes the addiction, and nicotine is very readily absorbed into the bloodstream when cigarettes are inhaled. Thus nearly all regular and addicted smokers are also inhalers of cigarettes. In addition to being responsible for the addiction, and probably for any soothing or other effect which cigarettes may have, nicotine is probably also the factor which renders the smoker more liable than nonsmokers to coronary heart disease. On the other hand, the tar which results from the burning of the tobacco leaf is probably the fraction which contains both the cancer-producing substances and the irritants which cause chronic bronchitis.

In the rest of my speech I shall be drawing heavily on the new Report of the Royal College of Physicians, but I shall try not to draw too heavily on figures. Your Lordships can read the Report for yourselves, and I hope that many of you have already done so. First of all, I want you to be in no doubt as to the seriousness and size of the problem. Let us first take lung cancer: first, because it is a horrible disease which is nearly always fatal and by the time it is diagnosed it is usually too late; secondly, because it is almost entirely due to cigarette smoking, and the lung cancer rate varies almost perfectly with the number of cigarettes smoked; thirdly, because lung cancer is the only form of cancer in which the death rate is still steadily rising, although in males it has flattened out a little in the past few years, whereas cancers from other causes have become fewer; fourthly, because cancer of the lung as I have already said, now causes about 32,000 deaths a year of people in the United Kingdom alone; fifthly, because at least 90 per cent. of those deaths are preventable; and, finally, because half of those deaths are of people under the age of 65. Indeed, the mortality in lung cancer rises sharply in heavy smokers between the ages of 40 and 50.

The death rate, at any age, is about five times as high in men as in women, and there is little doubt that this is largely, though probably not wholly, due to the different smoking habits of the two sexes. Women, on the whole, start smoking later, smoke fewer cigarettes and inhale less than men. But cigarette smoking in women has increased in the last twenty years, and their death rate from cancer is now going up, while the male death rate is flattening off. Your Lordships will have realised from these figures that the smoking addiction among males is already so high that it is not likely to rise much higher, whereas in women a similar saturations point has not been reached.

Supposing that your sole interest was to increase the sales of cigarettes, regardless of the fact that you would be increasing deaths from lung cancer still further, you would switch your advertising at this stage to women, and especially to young women, because they are more easily hooked. My Lords, you have only to look in the Sunday papers, the daily papers and some of the evening papers, and in the displayed advertisements, to see that this is precisely what is being done. Coloured pictures of glamorous young ladies lighting the after-dinner cigarette, or the slim cigarette or some other kind of cigarette surround us nearly everywhere. Do not misunderstand me: I cast no blame whatever on the cigarete manufacturers for continuing to manufacture and sell their wares. But their attempts to increase the lung cancer rate in women until it catches up with that of men—which is precisely what they are now doing—are to me so contemptible that I can find no words to describe them which I could use without incurring your Lordships' displease on the ground of asperity in speech. I am guided here by the Standing Order of June, 1626.

But, my Lords, men who act in this way will stop at nothing. I had not intended to deal with action to be taken, as I hope my noble friend Lord Rosenheim will deal with that; but I must say that although in many ways I welcome the Statement by the right honourable Gentleman the Secretary of State for Health and Social Services I am profoundly disquieted by some of its implications as I read them. It seems to me that in return for the voluntary action of tobacco manufacturers to label cigarettes, "may be dangerous to health", the tobacco manufacturers are to be allowed to continue to spend £50 million a year on advertising their wares. There is to be no curb on advertising to young people, except a notice on the advertisement, "may be dangerous" which may attract rather than deter some teenagers; no abolition of coin machines, and, worst of all, a possible attempt to drop the Bill now being promoted by Sir Gerald Nabarro.

My Lords, I was in the other place yesterday when the Secretary of State made his Statement with its tribute to the responsible and helpful action of the manufacturers. The word "responsible" can be used in more than one way, and these same men are responsible for the displayed advertisements advertising smoking to young women—the very section of the population which it is our duty to protect at the present time. I thought that the Secretary of State was somewhat embarrassed regarding some of the questions which were asked him, and I should like an assurance, possibly from the Government, that no bargain has been made with the cigarette manufacturers that Sir Gerald's Bill will be dropped. And I hope that the Government remain free, if necessary, and if they so wish, to compel the manufacturers to abandon their pernicious sales promotion. I know that a great deal of money is involved in this matter, and if this question is raised I will deal with it in my closing speech.

Let us turn now to chronic bronchitis and coronary heart disease. The total number of deaths from chronic bronchitis is similar to the number of deaths from lung cancer, but they are apt to occur at a somewhat later age, as we might predict; because chronic bronchitis causes years of invalidism, whereas lung cancer is often over in twelve months or less. The connection between chronic bronchitis and cigarette smoking is not quite so direct or so strong as the connection between smoking and lung cancer, and we must say the same of coronary heart disease. In other words, these diseases occur not infrequently in the non-smoker, though very much more frequently in the cigarette smoker. Of the three diseases, coronary heart disease claims by far the greatest number of deaths; namely, over 30,000 per annum in the United Kingdom of males under the age of 64. I will not go into other conditions which are to a less extent related to the smoking habit, but I will just call your Lordships' attention to recent evidence that cigarette smoking during pregnancy may retard the growth of the unborn child, and that spontaneous miscarriage is more common in the pregnancies of mothers who smoke.

I will now turn briefly to an examination of the nature of the evidence, dealing mainly with lung cancer because its connection with cigarette smoking is so very direct. The evidence is just about as strong as any scientific evidence can ever be. It is both experimental and statistical, but one cannot really make a distinction between the two because the results of scientific experiment are nearly always statistically judged and assessed. Analysis of cigarette smoke and the tar which results from the burning of tobacco shows that both contain cancer-producing chemicals, and applied to the skin of an animal they will produce cancerous growths. It is difficult to reproduce the human experiment more closely as animals cannot readily be made to smoke cigarettes. Nevertheless, this has been done in some rather unpleasant experiments on dogs in the United Slates, and lung cancer has been produced.

But the most important experiment of all has been done on the human subject. Doll and Hill in this country have done a large experiment extending over some twenty years on British doctors. This is what we call a prospective experiment. A large number of doctors, 31,000 or so, were persuaded to record their smoking habits in 1951. They have been followed ever since, and the death certificates of those who have died have been examined. The deaths from lung cancer almost perfectly co-relate with the number of cigarettes smoked. Similar experiments have been done on a vast scale in the United States, so that now more than a million people have been followed in this way, and the evidence stands up to every possible kind of analysis.

I hope that none of the speakers in this debate will tell me that he has an aunt who smoked all her life and is now 90 years old. The only thing that this kind of statement proves is that the speaker has a total ignorance of statistical or scientific method. As it says in the College Report, not all racing motorists are killed in car crashes, but their risk is much greater than it is for the ordinary motorist. Similarly, cigarette smokers do not all die prematurely from diseases relating to smoking, but their chances of doing so are much greater than those of non-smokers.

People who have an addiction as strong as the addiction for nicotine are, of course, loath to accept evidence which condemns what is to them a pleasant habit, and among their many excuses one is that the deaths occur mainly in old people, and "You've got to die of something anyway." I have already shown your Lordships that a very large number of the deaths occur in people at the prime of life, but people also say, "I've smoked for 20, 30 or more years, and it is too late to give up now". I am glad to tell you that this has been totally disproved by the experience of the British doctors, and this allows me to end on a more cheerful note. The doctors who have been so carefully followed by Doll and Hill, since the evidence became so clear, have radically changed their smoking habits. In the years between 1951 and 1965, half of all the doctors included in the study who used to smoke cigarettes, stopped smoking. Over this period, while lung cancer death rates among all men aged 35 to 64 in England and Wales rose by 7 per cent., they fell by 38 per cent. among male doctors of the same age. This finding not only confirms that cigarette smoking causes lung cancer but also indicates that general discontinuance of the habit would enormously lower the number of deaths from this disease.

Actually, since 1961 the percentage of men of all ages smoking cigarettes has fallen slightly in this country, and very much more so in the United States. This decrease, in this country at any rate, has occurred mainly in men of the professional and skilled occupations. There has been no change in the smoking habits of the partially skilled and unskilled occupations of social classes IV and V. That seems to me to be a good note on which to end a speech in your Lordships' House, and I will leave it to my noble friend Lord Rosenheim to deal with some of the other aspects of the problem and, above all, with what we ought to be trying to do about it. My Lords, I beg to move for Papers.

3.14 p.m.

BARONESS SEROTA

My Lords, the House and the wider public will be deeply grateful to the noble Lord, Lord Platt, for his initiative in providing us with this opportunity to consider and debate the Report and the recommendations of the Royal College of Physicians at a time when it is still relatively fresh in the public's mind and when it is of imperative importance that we should maintain and, if possible, increase the immediate drop in cigarette smoking that followed the publication of the Report. Moreover, it follows hard on the heels of the very important statement which was made in another place yesterday by the Secretary of State for Social Services and the full reply given by the noble Lord, Lord Aberdare, to Lord Platt's Written Question on the subject of warnings on cigarette packets.

The noble Lord, Lord Platt, has presented the findings of the Report so lucidly and in such detail that I feel there is certainly no need for me to speak at great length and rehearse once again all the arguments that he has put before us. We all listened to his careful analysis of those arguments with the closest interest and, perhaps most particularly of all, to his views on the nature of the evidence on which the recommendations of the Report were based. The House is also greatly looking forward to the maiden speech of the noble Lord, Lord Rosenheim, who preceded over the committee of the Royal College which produced the Report and who will bring such experience and distinction to our deliberations generally and to this debate in particular. I should, however, like to take the opportunity of thanking him and the noble Lord, Lord Platt, who chaired the first committee of the Royal College in 1962, and the Royal College itself, supported by so many British doctors, for the great public service they have rendered in producing such an authoritative Report in the highest traditions of the medical profession. I only hope that the Royal College's dispassionate and objective treatment of this emotional subject will be followed through as we proceed in our debate to-day.

Unfortunately debates on smoking all too often degenerate into a rather useless and unproductive wrangle between those who smoke and feel they have to defend the habit, and those who do not and are therefore somewhat smug and priggish about the good, clean life that they lead. The fact that some of these non-smokers may regularly enjoy the pleasures of alcohol—whether in moderation or not is a matter of opinion—is always conveniently forgotten on these occasions, although we know that dependence on alcohol, like dependence on nicotine, is just another form of behavioural disease which, in the last resort, can also be self-destructive and cause great suffering to friends and relatives who are left behind.

Once again we find ourselves, as we did so often in our recent debates on the Misuse of Drugs Bill, being concerned with the very difficult and delicate problem of achieving the right balance between individual behaviour and freedom of choice in personal consumption in a free society such as ours, and the wider responsibility of the community as a whole, which has to bear the medical, social and economic consequences of the damage caused. I had little doubt, particularly as I listened to the noble Lord, Lord Platt, that if to-day we were considering the use of tobacco for the first time, in the light of what this Report and its 1962 predecessor now proves beyond question to be its terrible effects, we should certainly be adopting much stricter controls than many may now consider it feasible to adopt, with the use of tobacco so widespread and so deeply ingrained, not only in this country but throughout the world. I do not think any noble Lord speaking in the debate to-day will question the validity of the evidence of the harmful effects of cigarette smoking and the clear, quantitative relationship between the number of cigarettes smoked and lung cancer. The facts are no longer in dispute.

The noble Lord, Lord Platt, also detailed to us the appalling toll of life which the Report describes, quite apart from the incidence of chronic bronchitis and other disabling diseases to which smokers are far more prone than nonsmokers. I join him in his concern about the still rising number of deaths among women smokers and the recent emphasis in cigarette advertising towards increasing the consumption of cigarettes by women. It would be clearly unrealistic to design a public policy based on everyone's stopping smoking immediately—that, even the most ardent advocate of abolition would agree, would not be a realistic objective. But I hope the House would agree that our overall objective should be for the community as a whole—that is, Government, all health and educational agencies, national and local, statutory and voluntary—to aim at developing a physical environment and a social climate in which positive measures are taken to promote good health and prevent disease and in which, in time, smoking is no longer regarded as a socially acceptable habit.

Logically, in view of the very clear scientific evidence set out in the Report, we should aim at achieving a situation in which attitudes are so changed that smoking is acceptable only in private and between consenting adults. Your Lordships may laugh, but, if one thinks back, this was almost the position in Victorian times when the men, dressed in special and rather beautiful velvet jackets, withdrew into special rooms (women of course did not smoke in those days, except perhaps secretly) and smoked in private by mutual consent. In addition, we need, I believe, to concentrate more of our resources on devising more effective techniques to reduce the incidence of the disease by assisting habitual smokers to smoke less and to smoke less harmfully, as the Royal College has suggested.

It is against this background that I welcome the national lead given by the Government yesterday in their statement, through a range of measures to discourage cigarette smoking, although I regard those measures as only the first, and in some cases very tentative, steps towards the general objectives I have outlined. They must be vigorously followed up if the momentum of the initial reaction to the Royal College's Report is not to be lost, as the public memory of its finding dims. The voluntary agreement which the Government successfully reached with the tobacco industry to print warning notices on all cigarette packages, and for statements referring to these warning notices to appear on advertisements, is certainly an advance on our present practice in this country. But I personally do not necessarily at this stage rule out the need for a statutory basis as a next step, particularly as I find the form of words suggested for the warning notice much too mild.

In the United States, where cigarette packets have been labelled since 1964, the original notice read: Caution. Cigarette smoking may be hazardous to your health. But this was changed only a year ago to the following: Warning. The Surgeon General has determined that cigarette smoking is dangerous to your health. I would therefore strongly urge the Government in the discussions they are to have with the tobacco manufacturers on the detailed code of practice that is to be drawn up, to delete "can" from the proposed notice, so that the notice will clearly state that "Smoking damages your health." I very much hope that I shall be supported in this view by other noble Lords who are to speak in this debate, and that the Government will listen to our views on this matter.

I should be grateful if the noble Lord, Lord Aberdare, could tell the House, either when he speaks in a few moments' time or when he replies at the end of the debate, what the Government's views are on the recommendation of the Royal College which advocates abolition of gift coupon schemes, which surely are designed solely to encourage the purchase of cigarettes. This point was not mentioned either in the noble Lord's Written Answer or in the statement made by his right honourable friend in another place. I suggest my noble friend Lady Birk might apply the great talents and ingenuity of the Health Education Council to devising a non-smoking gift coupon scheme which would positively encourage people to save the considerable sums of money they spend weekly on cigarettes for other, less harmful purposes. I know there might well be practical difficulties about such a suggestion, but I hope she will try to work out a positive scheme of this kind which would act as a financial disincentive to smoking.

With regard to the very welcome initiative which the Government are taking in tackling the problem of smoking in public places, I suggest to them that it is not sufficient at this moment in our history to invite cinemas, theatres or the public transport authorities—certainly not hospitals and clinics—to set aside more accommodation for non-smokers. Surely the boot is on the other foot, if there is to be any smoking at all in public places. Smoking is already prohibited in many of our theatres and concert halls; and many people, including regular smokers, still attend them and enjoy the performance in spite of the fact that they may not smoke. Surely the restriction should be placed on smokers rather than on non-smokers. We know that, for example, in the Underground in New York, Paris and Moscow, smoking is prohibited; yet the trains are still full.

The Report reminded us of the finding of the Social Survey that only a minority of the public would object if smoking was banned in trains and buses. I believe that since the survey was conducted, even more people, particularly smokers, would positively welcome the existence of such "smokeless zones". It would control the tobacco consumption of smokers, rather as the existence of the breathalyser enables one to refuse to drink before driving. I therefore hope that the Minister and his right honourable friend, in the discussions they are shortly to have with the interests concerned, will reverse the emphasis in their present policy statement and seek to reduce, if not totally to abolish, the amount of accommodation that is set aside for smokers in public places, cinemas and public transport in particular.

While I agree with the strictures of the noble Lord, Lord Platt, about the apparent failure to achieve any diminution in the level of cigarette advertising, I must welcome the action of the Government in their move to redress the balance between the £52 million spent on cigarette sales promotion and the £100,000 spent by the Health Education Council, under the chairmanship of my noble friend Lady Birk. I am delighted that the additional money will enable them to mount this specific television campaign, and I very much hope that it will be the first of many such projects, and not just a one-off job. I also hope, as I am sure will be so if it is in the hands of the Health Education Council, that the results of the programme will be carefully monitored, as we still know all too little about the influences which really affect attitudes and behaviour in this particular field.

Finally, in agreeing wholeheartedly with the Royal College that there are undoubtedly tremendous social and economic dividends to be gained for the nation as a whole from a drastic reduction in cigarette smoking; and, perhaps most important of all, that we need to develop better ways of educating our children and young people on the dangers of cigarette smoking, which I am sure will be a matter of prime concern to many noble Lords who are going to take part in the debate, I think it is quite unrealistic to ignore the fact that a drastic reduction in tobacco consumption will inevitably have a major impact on fiscal policy and on the employment situation in the tobacco manufacturing and distributing trades. I would conclude, my Lords, by warmly supporting the recommendations of the Report, and I very much hope that the noble Lord, Lord Aberdare, will be able to tell us that the Government are prepared to set up an official inquiry into the economic consequences of a decrease in cigarette smoking, so that we may have a full and authoritative account of the balance of benefit and loss involved, and prepare methodically for what I believe to be the necessary changes that a successful and concerted public and private effort to reduce smoking as a generally accepted habit will undoubtedly entail.

3.30 p.m.

LORD ABERDARE

My Lords, I am sure that all your Lordships are indeed most grateful to the noble Lord, Lord Platt, for giving us this opportunity to have a debate on the subject of cigarette smoking—a habit which has been rightly called the "greatest preventable cause of illness, disability and premature death". No one is better qualified than the noble Lord, a most distinguished ex-President of the Royal College of Physicians, to introduce this particular debate, and if I may say so with humility he did it in a most telling and wide-ranging speech.

It is now 21 years since the association of cigarette smoking with cancer of the lung was first demonstrated. Since then there has been a growing accumulation of evidence of its association, not only with lung cancer but also with chronic bronchitis, emphysema and coronary heart disease and, more recently, with retardation of the growth of unborn children of women who smoke during pregnancy. In the face of the mass of evidence now available there cannot be the slightest doubt of the serious health risks being run by those people who continue to smoke cigarettes. Cigarette smoking is the biggest single known cause of lung cancer from which nearly 30,000 people died in England and Wales alone in 1969, and the number of premature deaths all told that can be attributed to smoking must be reaching what has aptly been described as epidemic proportions. But premature death is only one of the consequences of cigarette smoking: another is illness. It is not easy to measure the amount of sickness for which smoking is responsible, but it must be held accountable for a substantial part of the 38,600,000 days of absence certified as due to bronchitis in 1969, quite apart from the amount of other illnesses which it causes.

The second Report of the Royal College of Physicians, Smoking and Health Now, reaffirms and gives added weight to the evidence that incriminates cigarete smoking as a major health hazard and cause of premature death, and perhaps I may quote just one forceful ilustration from the Report to bring this home. Forty per cent. of men aged 35 who are heavy smokers will die before reaching the age of 65 compared with only 18 per cent. of non-smokers, and those smokers who do reach that age can in general expect fewer years of retirement and a greater chance of disablement by chronic heart or lung disease. That is indeed strong evidence of the dangers of cigarette smoking, and we owe a debt of gratitude to the Royal College of Physicians for their excellent Report. It is very fitting that their distinguished President, the noble Lord, Lord Rosenheim, should be here to-day to make his maiden speech, and like all the rest of your Lordships, I very much look forward to hearing from him.

Last year saw the publication of another report from the World Health Organisation and this provides further corroboration of the harmful effects of smoking—if further corroboration were needed. The comparisons in the Report of studies carried out in this country, America and Canada show a remarkable similarity in their findings and demonstrate dramatically how mortality from lung cancer has risen with the consumption of cigarettes. Few people can now be unaware that they take risks with their health when they smoke cigarettes, but this state of public awareness is no new thing, as the health consequences of smoking have been known and publicised for many years. Yet the evidence about cigarette consumption shows that (with the significant exception, mentioned by the noble Lord, Lord Platt, of the medical profession) people have not on the whole reacted logically to the facts of the situation. For although in the last decade there has been a slight overall fall in the proportion of men in the United Kingdom who smoke manufactured cigarettes, from 58 per cent. in 1958 to 54 per cent. in 1969, this has been offset by an increase in the proportion of women who smoke—from 40 per cent. in 1958 to 44 per cent. in 1969.

The Government took stock of the situation last year and concluded that more needed to be done. In December, therefore, we entered into discussions with the tobacco manufacturers to see whether a satisfactory voluntary agreement could be concluded with them on the placing of warning notices on cigarette packets and advertisements. In our view, there are distinct advantages in voluntary agreement with the manufacturers rather than legislation. Speed is one advantage—another is that a voluntary agreement is more likely to be observed in the spirit as well as in the letter. It is a matter of considerable satisfaction that, as my right honourable friend announced yesterday, a voluntary agreement has in fact been reached, with the result that all packets will carry in bold print the notice

"WARNING by H.M. Government SMOKING CAN DAMAGE YOUR HEALTH."

The noble Baroness, Lady Serota—and may I say how grateful I was to her for her general welcome of the announcement made yesterday by my right honourable friend—suggested a slight alteration of the wording. I expect a great many of your Lordships will have suggestions to make of alternative words. They can be varied infinitely, from some such phrase as "Please be careful. You never know—you might harm your health by smoking a hundred cigarettes a day", to, for example, "Fags are fatal". But we came to the conclusion that the words we have agreed with the manufacturers are absolutely accurate and are a reasonable statement of the case. Had we adopted the wording suggested by the noble Baroness, "Smoking damages your health", I think we might have been held by some to have been misleading especially perhaps by some of your Lordships who have in fact survived the ordeal unscathed, and perhaps by some of those of your noble aunts who were mentioned by the noble Lord, Lord Platt. The words that we have agreed, "Smoking can damage your health", are strictly accurate.

This notice will appear on both sides of the packet, or on one side with a frame round it to make the warning more eye-catching. I have a packet here which your Lordships may like to see, but I will not pass it round because I see it contains cigarettes. Every Press advertisement and poster will carry a notice referring to the warning on the packets. Eventually, this notice will be in the form "Every packet carries a Government health warning"; but until every packet does, it may have to be slightly different. The notices on the packets and on the advertisements will go further than in any other country, and I think it is right to acknowledge the co-operative spirit with which the manufacturers approached the negotiations.

The noble Lord, Lord Platt, was highly critical of the cigarette manufacturers. I am sure they can best defend themselves against his strictures. All I would say so far as the Government are concerned is that we see distinct advantages in a voluntary agreement—and on the two specific points that he made to me, advertisements of course are already banned on television. So far as advertisements in the Press and on posters are concerned we are not banning advertising at present. It is part of the voluntary agreement with the manufacturers that there should be a warning notice on each packet of cigarettes. I would suggest to your Lordships that in some degree this means that advertisments are working for us in drawing to the attention of the general public the health hazards involved. The noble Lord also asked me about legislation with particular reference to the Bill of Sir Gerald Nabarro. Again this agreement with the manufacturers is of its essence a voluntary one, and we consider legislation unnecessary and even prejudicial to the early achievement of our object. We intend to review the situation when this Bill reaches its Report stage in another place, but naturally we cannot expect manufacturers to implement a voluntary agreement while a threat of legislation is hanging over their heads.

This is a free society, my Lords, and whether a person smokes or not is some-think which ultimately only he can decide. What we can do is to help him take an informed decision by making him fully aware of the effects, and the warning notices to which I have referred will give him a constant reminder that cigarette smoking is dangerous. But this will not be enough in itself, and the warning notices need to be complemented by publicity campaigns carried out both nationally and locally. A number of national campaigns have been conducted over the years, first by the Ministry of Health, as it then was, and then from 1968 by the Health Education Council, which was set up to take over the whole education activities of the Department. I am delighted that the Chairman of the Health Education Council, the noble Baroness, Lady Birk, is speaking in this debate and I know that I can safely leave it to her to elaborate on her publicity plans; I will only say that, because of the seriousness of the health problem caused by smoking, the Government have decided to make extra funds available to the Health Education Council for work in this field. My right honourable friend has asked the Council to carry out a television campaign to coincide with the appearance in the shops of cigarette packets bearing the new warning notices, and these two measures should reinforce each other and ensure that the maximum value is extracted from each.

An important part of educational activity must be concerned with the young. Studies have shown that, as in so many other important matters, it is the individual's response to pressures felt during adolescence that largely determine whether he or she will take up smoking. Recent research suggests that more than four-fifths of young people who smoke no more than half a dozen cigarettes by the age of 20 will become regular smokers, and that more than three-fifths of these will continue smoking for the whole of the rest of their fires. Conversely, if a person is a non-smoker at 20 he is likely to remain so for the rest of his life. "Prevention is better than cure", but in the case of smoking it is probably also true to say that prevention is much easier than cure. To this end the Department of Education and Science has helped schools to make known the hazards of smoking to schoolchildren both by the production of guidance for teachers and through visits to local education and schools by Her Majesty's Inspectorate and the Department's medical officers. A new pamphlet of advice is being prepared for distribution to local education authorities, colleges of education and schools.

Since force of example is clearly important—and not only where the young are concerned—my right honourable friend the Secretary of State for Social Services is hoping to obtain the co-operation of the television authorities in reducing the amount of smoking shown on the screen. This is a point I remember the noble Baroness, Lady Summerskill, making in a Question and Answer we had the other day. He is also proposing to send guidance to hospitals and local authorities about the discouragement of smoking on their premises and the need for health service staff to set an example to the public. The Chief Medical Officer of my Department is writing to all doctors sending them copies of the World Health Organisation report to which I referred earlier. My right honourable friend also proposes to seek the co-operation of those responsible for public tranport, cinemas and theatres, et cetera, in setting aside more accommodation for non-smokers—and I certainly take the point that was made by the noble Baroness, Lady Serota, on that subject. He will be drawing the attention of the life insurance companies to the evidence about the health consequences of smoking and asking them to consider offering lower premiums for non-smokers.

The Government hope that the measures I have referred to will have a significant effect on this serious health problem, but we of course have to recognise that, whatever steps we may take, a substantial number of people will continue to smoke. For them we must hope for safer cigarettes—not, I emphasise, cigarettes that are entirely safe, because there is no expectation, so far as I am aware, of such products ever becoming available—but cigarettes that are not so harmful as those at present available. To help in this my right honourable friend and the tobacco manufacturers have agreed that a joint scientific committee should be set up to consider what research is needed in the smoking field and the adequacy of systems for testing the relative safety of different smoking materials. One of the first responsibilities of this committee will be to consider the measurement of the tar and nicotine yields of different brands of cigarettes, and in the recent discussions the manufacturers have agreed in principle that these figures should be made available to the public.

This is a brief account of some of the steps that the Government are taking, and I hope that the House will agree that they amount to a satisfactory immediate response to the Report of the Royal College. The Government have acted or are acting in one way or another on the recommendations in the Report for increased education of the public (including the young), on the placing of warning notices on cigarette packets and advertisements, on the determination for publication of the tar and nicotine yield of cigarettes, on collaborating with the tobacco industry in the testing of safer cigarettes, on smoking in public places, on the question of lower life insurance premiums for non-smokers and on obtaining the co-operation of the mass media. There are of course other recommendations in the Report. Some of them would require legislation—such as those calling for a ban on advertisements, the banning of gift coupons, as suggested by the noble Baroness, and the removal of cigarette vending machines from public places. The Government have no plans at present for legislation. I am sure that the House will not expect me to comment on proposals that raise budgetary issues, but of course we will keep the whole situation under review.

The noble Baroness, Lady Serota, also asked me about other wider implications. The Government recognise that there are other major implications and they have arranged for these to be studied by the Departments concerned. This is a complex and difficult task. Inter-departmental discussions have begun, and the Government have asked for these to be completed with the least possible delay. But I should not like it to be thought from what I have said that the Government in any way claim a monopoly of the right to tackle the smoking problem. Far from it. The health professions have a particular responsibility and particular opportunity. I am sure that we would all agree that the Royal College of Physicians are to be most highly commended not only for producing this Report but also for establishing a new body, Action on Smoking and Health, to carry on this most important work. I hope that this debate will itself make a contribution to the efforts being made to tackle this most serious health problem.