– in the House of Commons at 12:00 am on 7th May 1959.
I wish to take the attention of the House from the agreeable subject of ice cream to that of the smoking of cigarettes by young people. The reason that I do so will be within the recollection of the House. It arises out of answers given to me by the Minister of Health at Question Time on 23rd February, when he told the House that last August he sent a circular to local health authorities asking for their reports on the measures that they had taken to publicise the risks attached to smoking, and inviting suggestions. He said:
I have now received those reports and I am studying them and am considering in consultation with my right hon. Friend the Minister of Education whether any further measures are now called for."—[OFFICIAL REPORT, 23rd February, 1959; Vol. 600, c. 801.]
I wish to ask the Parliamentary Secretary what conclusions the Minister of Health and the Minister of Education have now reached as a result of the replies to the circular and what further action they propose to take; and secondly, to urge them to launch, without delay, a really vigorous and urgent campaign to discourage smoking by young people and to prevent their being encouraged to do so by the business interests concerned.
I should like to apologise for detaining the Parliamentary Secretary after what I know has been a very exhausting week for him in this House, and I assure him that I do not propose to try to score any points off him or anybody else. My purpose is only to express my own very strong feelings on the subject and to echo those of many eminent members of the medical profession who have grave misgivings about the dangers to which the health of young people is now exposed. I assure him that my intervention tonight is not a vote-catching operation. Indeed, if it were not for the high intelligence of the people of Swindon this speech might have the opposite effect, because my constituency contains a cigarette factory.
The attention of the British public was first drawn to the dangers connected with
cigarette smoking by a report in the British Medical Journal published in September, 1950, by Professor A. Bradford Hill and Dr. Richard Doll. It contained these words:
It is concluded that smoking is an important factor in the cause of carcinoma of the lung.
I have been advised by an eminent Harley Street physician that their report alone has established a sufficiently strong case for a causal relationship between smoking and lung cancer and justifies the discouragement of young people from starting a habit which it is difficult to check, which does them no good and almost certainly does considerable harm.
Nevertheless, a period of nearly seven years went by until in June, 1957, the Government accepted a special report from the Medical Research Council to the same effect. During that period it is estimated that over 100,000 people died from lung cancer in England and Wales, and no effective action was taken by the Government during that period. The Medical Research Council reported and, on 27th June, the then Parliamentary Secretary to the Ministry of Health made a statement in this House in which he said that the Council
… has advised the Government that the most reasonable interpretation of the very great increase in deaths from lung cancer in males during the past twenty-five years is that a major part of it is caused by smoking tobacco, particularly heavy cigarette smoking.
The Parliamentary Secretary went on:
The Government feel that it is right to ensure that this latest authoritative opinion is brought effectively to public notice, so that everyone may know the risks involved in smoking. The Government consider that these facts should be made known to all those with responsibility for health education."—[OFFICIAL REPORT, 27th June, 1957; Vol. 572, c. 426.]
As I have said, my first purpose is to try to extract from the Parliamentary Secretary a statement of what has been done since that time. A number of circulars have been issued by his Department, and one of them has been repeated to local education authorities by the Ministry of Education, and in the report of his Department for last year there is an explanation and repetition of the conclusions of the Medical Research Council and the statement:
The Minister acting on this statement has requested all local health authorities to disseminate the known facts and the considered
opinions of the Council so that everyone may be made aware of the risks involved in smoking.
As 1 have said, the Department has had the report from the local health authorities since September of last year. Therefore, my first questions are: What exactly did that report tell the Department, and will the hon. Gentleman give the House some details of what the local authorities did as a result of the circulars issued by his right hon. Friend? Is he satisfied with the result of the action taken so far, and what further action do the Government propose to take through the local health authorities?
I should like to ask specifically what is being done in schools to bring the dangers of smoking to the attention of young people. I appreciate that there is a difficulty, as this is a matter where there is divided Ministerial responsibility. The Ministry of Education, the Board of Trade and even the Treasury are concerned to some extent in this matter, as well as the Ministry of Health.
My main purpose is to draw attention to the dangers facing young people, and I think that I ought to explain my personal attitude to this problem. I have no wish to interfere with the pleasure that may be derived by old people, old-age pensioners and others, who have had the smoking habit for many years and enjoy an occasional pipe or cigarette. Secondly, I do not wish to interfere with the middle-aged smoker who would like to break himself of the habit but cannot do so. Until three years ago I was an appreciably heavy smoker and I got to the stage where I derived little satisfaction from a cigarette but a great deal of irritation when I was not smoking. I was fortunate in being able to stop smoking.
I do not attach urgent importance to what happens to people in those age categories, but I think that what happens to young people and children is important. I shall do my best to see that my own children never develop the smoking habit because of the danger involved, and I am sure that the Parliamentary Secretary and every other reasonable parent will share that view.
The information which has become available lately about the extension of smoking among young people is alarming. I was looking at a report by Dr. Raven, of the Marie Curie Memorial Foundation, who did research into 141 schools recently and found that many children started smoking at the age of eight. If the Parliamentary Secretary is not shocked by that, I should be very surprised.
There was a report in The Times a couple of months ago in which reference was made to an investigation in Oxfordshire into smoking among school children, and it was found that a very large number of children between 11 and 19, boys and girls, had taken to smoking and appeared to have already developed into heavy smokers. The latest figures which are available of smoking generally in this country show a tremendously sharp increase between 1955 and the present time. It is estimated that at present 2,000 million cigarettes are smoked in this country every week. That represents a total of almost 52 cigarettes for every person a week. It includes a large number of persons, not only under 21 but under 15. The Parliamentary Secretary may have seen another report in The Times last year of an investigation by a teacher in a school who found that a large number of his pupils aged 14 smoked. One said he smoked "only forty a week "and thought that "not bad," and another asked,
Why don't they stop advertising them if they kill you?
I say straight away that my personal view is that advertising of cigarettes and tobacco ought to be prohibited at once, if necessary by legislation, as has been done in other countries. For example, it was done in 1956 in Sweden. The Parliamentary Secretary knows that enormous sums are spent in advertising in the Press and on television of tobacco products, especially cigarettes. I was looking the other day at the report of an investigation carried out into the incidence of smoking—
The hon. Member must realise that to remedy that particular part of his grievance would involve legislation, which would be out of order on the Adjournment.
I stand corrected, Mr. Speaker, but there might be other ways in which the Government could look at the problem. However, I shall not labour the point, except to draw the attention of the Parliamentary Secretary to the very much more vigorous action which is taken in a number of countries to control the ways in which manufacturers can operate than the action taken in Britain. This not only applies in Socialist Scandinavia, but in capitalist America. The best interests of tobacco manufacturers and those working for them are in direct conflict with the national interest and represents a direct menace to the nation's health. I very much hope that in due course measures can be taken to deal with that.
In this context, I remind the Minister that when an attempt was made to counter the enormously expensive advertising campaign by the tobacco interests by arranging for a poster to be put out by the Government-sponsored organisation, the Central Council for Health Education, about the dangers of smoking, that poster was banned by the British Poster Advertising Association and was never seen by the British public. There is one explanation of the reluctance of the Government to deal more energetically with this matter which is very widely believed by simple people in this country, and also by quite a number of people who are not so simple, including a number of doctors and eminent people in the medical world who think they see a sinister connection between the inactivity of the Government and the enormous revenue derived by successive Chancellors of the Exchequer from the tax on tobacco. This idea was not discouraged by the Chancellor when he said in a speech at Barnstaple on 10th January, 1957:
We at the Treasury do not want too many people to stop smoking".
I suggest it is about time that the Chancellor of the Exchequer brought that comment up to date by saying something different.
The Parliamentary Secretary knows that in 1956–57 £701·8 million reached the Exchequer as a result of the Tobacco Duty and that in the last financial year that had risen, with the very sharp rise the consumption of cigarettes and tobacco, to £736·4 million. It is not surprising that many people see a sinister connection between this revenue and the Government's reluctance to take more vigorous action.
I sum up by saying that my purpose is to elicit information from the Parliamentary Secretary about what his Departments arid Departments associated with it in this matter have been doing recently, particularly as a result of the replies of local health authorities to the inquiries which he made about their activities last year. Secondly, I urge him to consider certain specific action. I think that the steps which he should take should include a ban on slot machines, the existence of which means that cigarettes are readily available to young people at any time of the day or night; the ending of the cheap cigarette and tobacco ration to young Service men, particularly National Service men in the Forces; an effective Government campaign designed specifically to dissuade young people from smoking, using all the techniques of modern advertising and the mass media which are available to the Government; and finally, more vigorous action to counter the advertising by the tobacco interests.
I hope that the Parliamentary Secretary will be able to give some consolation to the many people who feel greatly distressed about this problem, including eminent members of the medical profession, who cannot understand why we should still be spending large sums of money on cancer research when, having found one direct connection between a habit and the disease, we take no effective action to stop that habit.
I am obliged to the hon. Member for Swindon (Mr. F. Noel-Baker) for having raised this matter tonight because it is one of great public importance. It is an appropriate moment to answer the various points which he made, to state the present position and to say what we have had in mind to do in the future about it.
The hon. Member stated very clearly the history of the way in which concern on this matter has built up. He is right in saying that it was an article by Dr. Doll and Professor Bradford Hill in late 1950, which suggested a statistical relationship between smoking and lung cancer, which started public concern about the matter in this country. There are no grounds for doubt about the statistical association. Experimental work has not yet provided irrefutable proof of tobacco smoking causing cancer, but the evidence is growing. Two known cancer-producing agents have been identified in tobacco smoke, but whether they directly cause cancer has not yet been proved.
I do not want to rest my argument too much on that, but I am bound to say that Lord Cohen, a very respectable authority, drawing attention publicly to these dangers a few days ago at Harrogate, said that there is the strongest statistical evidence to show that the more cigarettes a man smokes the more liable he is to develop cancer of the lung.
The Government's attitude, faced with this evidence, has been consistent. We took the view that the facts on the likely connection between cigarette smoking and lung cancer must be brought effectively to public notice so that all should know the possible risks involved.
The hon. Gentleman described quite correctly the action taken at the time. There was the distribution to local authorities of Circular 7/57, which enclosed the Medical Research Council's Report and urged local authorities to publicise these warnings as part of their health education functions under Section 28 of the National Health Service Act. To help them, they were told that the Central Council for Health Education already had publicity material available and that more was being prepared to give further aid in the campaigns that we urged the local authorities to start.
It is entirely appropriate—and although the hon. Gentleman did not mention this, there has been a little criticism of our action—that we should have chosen the local authorities to he the Government's agents far disseminating the information to the public. As I say, they already have health education functions under Section 28, and it also fits in very well with what they are already doing so successfully in connection with such matters as polio immunisation, clean food, home accidents and other matters in which it is necessary to bring certain risks and dangers to the knowledge of 'the public.
Following the issue of the circular, local authorities were given a year in which to take action. Just over a year later, a questionnaire was sent to them so that we could gather their reports, proceed to study them and reach conclusions. It is in this aspect that the hon. Gentleman is greatly interested. He wants to know what kind of information we received, how we assessed it, and what we propose to do about it.
The local authorities co-operated very well, and the information we received can be summarised as follows. Of the local authorities circulated, 90 per cent. accepted the need for a publicity campaign to bring to public notice these likely risks. They mostly concentrated on children and young persons, and I think that they were absolutely right in that. It is far easier to prevent a habit being formed than it is to attempt to change it after it has become chronic. It is also easier to approach children en masse because of educational factors; they are grouped together in schools and so on.
We got interesting information on the variety of media used by local authorities to get their message over. They used the local Press, posters, pamphlets, films, lectures, discussion groups, family visiting and other forms of personal contact. They did quite well there. Some of them made use of outside bodies—smaller local authorities or voluntary organisations—to help them in their work.
The general assessment of the public reaction to all this is interesting. On the whole, local authorities came to the conclusion that there was a very wide degree of apathy. Some felt that there was some increased public awareness of the risk but, on the whole, we got a general impression of considerable public apathy.
Following on that, a number of suggestions were made for further action. and those are now being studied. I should say that many are not the responsibility of the health department. I do not say that on that account they are necessarily neglected, but I cannot discuss them as fully, perhaps, as otherwise I might be able to do. Nevertheless, we have reached a point where we have to consider seriously what further steps would be appropriate in this matter.
Obviously, in a debate of this kind, it is impossible to summarise adequately the replies to the circular. Would the Department consider publishing a report on the replies received from local authorities?
I will certainly look into that. The information is readily enough available.
In assessing what the local authorities did, I am sure that they were right in concentrating their efforts on young children and adolescents. In this direction, I cannot stress too much the importance of parental action. That may sound platitudinous, but there is no doubt that if the parents can be persuaded to take a serious view of their responsibilities and to show, not only by precept but by actual example, the serious view they take, the effect on young people is undoubtedly very great. Indeed, it would probably be much greater than the combined effect of many of the other well-known measures of propaganda, including leaflets, lectures, visits, posters and all the recognised media. In this matter, it is important to enlist the active co-operation of parents.
I know that the hon. Member is anxious that we should move further and faster in the steps which he thinks we should take in this matter. While we take a serious view of the possible risks and of our own responsibilities, we are on difficult ground when we consider what big effort can be made. While I agree entirely that the effort should be confined or directed largely at the young, it is difficult to do it to the young alone. Questions of the liberty of the subject are involved.
There is the fact, although I do not place a lot of weight on it, that the state of scientific knowledge on this matter, although it is clearly tending to one conclusion, is incomplete. In addition, some of the proposals advocated by the hon. Member involve legislation, which we cannot discuss tonight. Nevertheless, it is true to say that a general desire was expressed by the local authorities for more publicity on this subject. That is a request which we have already taken up and we have discussed the matter with the Central Council for Health Education, which is ready to increase the effort it is making in this field. This will go some way to meet the position. I give the hon. Member the assurance that we shall continue to keep it under close observation as time goes on and as more scientific information becomes available to us.
The hon. Member referred to a number of specific measures which, he felt, would be helpful in checking this abuse. For reasons of order, I am unable to deal with some of them. But, in so far as they concern other Departments, I will certainly draw their attention to what the hon. Gentleman has said tonight. However, for the immediate future, I think that the right thing to do is to increase the publicity which we are putting out through the local authorities on this subject.
As I say, we have consulted the Central Council for Health Education on the matter. It is ready to help us, and we shall go ahead on these lines and see how we get on. We shall watch the situation closely, ready to take further action if and when that seems appropriate.