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Book Review
Unfiltered: Conflicts Over Tobacco Policy and Public Health
Eric Feldman and Ronald Bayer (eds)
ISBN: 0-674013-34-4 2004 363 pages Harvard University Press
Judith Peppard
Flinders University of South Australia, SA
Unfiltered: Conflicts over Tobacco Policy and Public Health provides a comparative analysis of tobacco control policies in eight liberal democracies: the United States, Japan, Canada, Australia, the United Kingdom, France, Germany and Denmark. It also describes the European Union's efforts to establish coherence in tobacco control policies in its member states. These ‘policy portraits' make up the first nine chapters of Unfiltered, giving the ‘thick description' that illuminates the way historical, social and cultural factors interact to produce a range of policy outcomes in tobacco control. Chapters Ten and eleven highlight the challenges and benefits of cross-cultural analysis in tobacco control policy and discuss why the same constellation of policies applied in different contexts, do not necessarily produce the same result.
Together the national histories reveal the difficulties of introducing policies that may be seen to limit individual freedom in countries with a liberal democratic tradition. For example Ronald Bayer and James Colgrove show how, in the United States, anti-tobacco advocates succeeded in overcoming general antagonism to government regulation and paternalism by arguing for the protection of young people from tobacco promotion and the right of ‘bystanders' to be free from sidestream-smoke. Similarly, in Canada, Christopher Manfredi and Antonia Maioni show that it was the appeal to the prevention of smoking by children that won the argument for tobacco control, both in the early 20th Century and again in the 1990s. Germany, in contrast, did not succeed in overcoming anti-paternalist sentiment. Günter Frankenburg describes how the cultural memory of the Nazi anti-smoking campaigns for ‘racial hygiene', the presence of a powerful pro-tobacco lobby and the lack of an effective grassroots anti-tobacco movement worked against the introduction of strong tobacco control measures. Similarly in France and Denmark, an ethos of individual freedom combined with a dislike of US puritanism, prevented the introduction of the kinds of policies adopted in the US, Canada and Australia.
John Ballard's analysis of the development of tobacco control policies in Australia documents the innovations developed by individual states in Australia's federal system in the late 1970s and 1980s, many of which were taken up elsewhere. As Ballard notes, ‘The small number of discrete political cultures in the Australian federation-six states and two territories-has enabled different innovative approaches to develop in close proximity of one another, thus creating frequent opportunities for cross-pollination.' However it took longer for the national government to act and it wasn't until 2000 that a comprehensive national tobacco control strategy was adopted. In his examination of tobacco control policies in Japan, Eric Feldman indicates that, unlike Australia, Japan has relied on ‘smokers' manners as the basis of the social contract underlying smoking'. Feldman shows why it is difficult to isolate one clear explanation for the Japanese government's apparent lack of concern about tobacco-related morbidity and mortality. They range proposed by commentators includes both fiscal priorities and sociocultural factors. Nonetheless, he suggests cautiously that there may be an ‘emergence of a new politics of public health in Japan', citing the introduction of a new Health Promotion Law in 2003 which has led ten private railway companies to ban smoking in the railway stations they operate.
In her chapter on tobacco control in the United Kingdom, Virginia Berridge presents a challenge to would-be recorders of recent events, arguing against simplistic ‘heroes and villians' accounts of the history of tobacco control policy. In particular she warns against ‘presentism', noting that ‘The point of historical analysis is to interpret events within the context of their own time, not ours.' She calls for the use of traditional historical methodology to attain a more nuanced understanding of policy change and uses historical methodology to build her argument that ‘there is more to British post-war smoking policy than a framework of government/industry collusion'. While one might disagree with aspects of Berridge's argument, in particular her representation of tobacco control efforts as ‘militant healthism' and her assertion that new public health ideology is underpinned by ‘individualism', she raises important questions about the way recent events are recorded and interpreted and where tobacco control policy is heading.
In Chapter 10, Allen Brandt, with assistance from those doyennes of North American etiquette, Miss Manners and Emily Post, traces the changing values and attitudes around public smoking in the United States in the twentieth century, showing how ‘debates about policy relate to deeper cultural perceptions about smoking itself'. He also examines the diffusion of policies on public smoking internationally via the example of airline smoking bans, highlighting the discrepancies between country policies and those adopted by their respective airlines. Theodore Marmor and Evan Lieberman discuss the political determinants of tobacco policy and the difficulties of conducting cross-country comparisons (Chapter 11). They propose three classes of explanatory approaches for considering variations in tobacco control regimes: policy diffusion, policy culture, and policy institutions. They then apply these explanatory approaches to the country histories (presented in earlier chapters) to good effect, providing a synthesis of contemporary tobacco control regimes. In the concluding section of the book, Feldman and Bayer identify four themes that have emerged from the studies presented, examining each theme in detail to provide a reference point for future policy work.
Unfiltered: Conflicts over Tobacco Policy and Public Health documents a period which saw major changes in tobacco policy, from the promotion of smoking as a social and economic good in the early twentieth century to the restricted tobacco control regimes that characterise many liberal democracies in the early twenty-first century. The book provides a rich source of information about the work of public health advocacy and the forces that shaped ‘the landscape of tobacco policy' in the twentieth century. The lessons learned, discussed in the conclusion, have application beyond the area of tobacco control and highlight the moral and ethical dilemmas inherent in public health policy-making and the diversity of groups and individuals that contribute to policy change. Unfiltered offers a way through the complex and convoluted terrain of public health policy development and tobacco control politics. I highly recommend it for the variety of perspectives it presents and the insights it contains. Students, researchers, policy analysts and policy makers with an interest in tobacco control policy and public health will find this book a useful addition to their libraries.
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