The campaign employed tactics including public opinion polls, briefings of MPs, proactive and reactive media work, direct contact with local authorities, employers and legal experts, and profile-raising events. In a review of the campaign, ASH staff wrote that building the evidence base for their messages was of key importance, as was making it public at the right time.8 ‘For example,’ they wrote, ‘when health minister John Reid said he feared that banning smoking in public places would lead to more smoking in the home, so harming children, a paper was put together for a Royal College of Physicians’ report collating the domestic and international evidence against this.’
ASH was also aware that in other countries the hospitality trade and the tobacco industry had successfully collaborated to resist anti-smoking legislation and support a voluntary approach instead; so another key strand to the campaign was to drive a wedge between these two powerful vested interests. Campaigners discovered that if a voluntary approach to smoke-free regulation was no longer on offer, the second-best options of each industry were different. The hospitality sector preferred nationally applicable legislation, as this would give a level playing field to geographically dispersed hotel and restaurant chains, and better protection against litigation. The tobacco lobby, by contrast, would rather have legislation that would permit local variation, which would be easier to fight location by location. The Labour government, meanwhile, had made clear that if a voluntary approach was off the cards, it would prefer locally applicable legislation. This prompted the hospitality trade to fight harder for its approach and made it easier for ASH to foment a split between it and the tobacco industry. Further pressure was put on employers by the threat of staff making claims under health and safety law. More than 50 such cases were begun, and although none made it to court before the smoking ban was passed, they had the desired effect on the debate.
There were still obstacles, not least opposition from the secretary of state for health at the time, former MP John (later Lord) Reid, who was an ex-smoker. Reid did not want legislation, and even when he accepted that a ban was inevitable he proposed exempting pubs and clubs that did not serve food. This proposal was in Labour’s general election manifesto in 2005.9 But the ASH campaign was given a shot in the arm by an extraordinary comment from Reid at a public meeting:10
“I just do not think that the worst problem on our sink estates by any means is smoking but that it is an obsession of the middle classes. What enjoyment does a 21-year-old mother of three living in a council sink estate get? The only enjoyment sometimes they have is to have a cigarette.”
The resulting media furore over Reid’s clumsy assertion, combined with declarations about the risks to health by, among others, Sir Liam Donaldson, the government’s chief medical officer at the time, helped to split the Parliamentary Labour Party and shore up support for the anti-smoking lobby.11 The charity coalition led by ASH convinced the Conservatives to allow a free vote on the issue by their MPs, and on St Valentine’s Day in February 2006, Parliament voted by a majority of 200 to pass the Health Bill.12 The smoking ban came into effect on 1 July 2007. When ASH analysed the government’s own impact assessment and concluded that more than 600,000 people would quit smoking as a result of the new law, it declared it to be ‘the single biggest public health gain since the introduction of the National Health Service’.13
Deborah Arnott, chief executive of ASH, wrote about the charity’s tactics in The Guardian newspaper after the law was changed:14
Campaigning of this kind is literally a confidence trick. The appearance of confidence both creates confidence and demoralises the opposition. The week before the free vote, we made sure the government got the message that we knew we were going to win and it would be better for them to be on the winning side.
In the event, an overwhelming 91% of Labour MPs who voted came out against the position on which the party had fought the election two years earlier.15 Barron says the contribution from ASH and other charities was crucial to getting the legislation passed:
“The story that was not told at the time was that the charities were rallying their supporters and sending them to their MPs’ constituency surgeries to ask them if they would vote in favour of a comprehensive ban. This was vital information, as we knew what was likely to happen when the actual vote came along in Parliament – we knew we would probably win the first vote. That in the end was what got us the numbers and got us the ban.”
ASH also acted as the secretariat to the all-party parliamentary group on smoking and health and organised a visit by the health select committee of MPs to Dublin to see how the ban already enacted in the Irish Republic was working in practice. Arnott said the campaign went from nowhere to victory in a very short time. ‘Some ideas reach a point at which their time has come,’ she wrote. ‘But some will also often need a vigorous campaign before politicians notice the obvious.’
But ASH wasn’t finished yet. In 2008 the charity published a report reviewing the progress of controls on tobacco and calling for a new law prohibiting retailers from displaying tobacco products, and outlawing the sale of cigarettes and tobacco from vending machines.16 The report also called for the removal of all colours, corporate logos, branding and positive images from tobacco packaging. Within a year, the Health Act 2009 brought in the ban on vending machines, effective from October 2011, and on the display of tobacco products in shops in England, Wales and Northern Ireland. ASH and its coalition partners also campaigned for standardised packaging, which was made compulsory by the Children and Families Act 2014.17 This not only forced tobacco companies to sell their products in packets showing alarming images such as diseased lungs or children wearing oxygen masks, but also outlawed the sale of tobacco in small quantities. After May 2017, smokers were permitted to buy cigarettes only in packs of 20 or larger, and tobacco in 30-gram pouches. Menthol-flavoured cigarettes were banned from May 2020.
These new laws, promoted so effectively by one small charity, have been accompanied by a substantial fall in smoking, which is generally acknowledged to be one of the biggest causes of ill-health. An analysis of hospital admissions published in the British Medical Journal in 2010 showed that in the first year after the ban, emergency admissions for heart attacks in England fell by 1,200, saving the NHS more than £8 million.18 According to Public Health England, 14.7% of adults in England were smokers in 2018, down from 19.8% in 2011.19 In 2000, 26.8% of adults aged 16 and over had been smokers.20
Another campaign that played a part in changing public opinion in the build-up to the ban on smoking in public places was an unmissable TV and poster campaign by the BHF in 2003. It showed repulsive images of fat dripping from the end of a cigarette and fatty deposits being squeezed out of a human artery. It received extensive media coverage, and traffic to the BHF website spiked by 78%.21 Another BHF advert featured two young men in a pub looking at a smiling woman smoking a cigarette. “Ugh,” remarks one. “Like kissing an old ashtray.”
Alcohol campaigns
When the first national coronavirus lockdown began in March 2020, the volume of sales in alcohol shops shot up by a third, according to the Office for National Statistics.22 By September, however, it was clear that the increase in retail sales did not outweigh the loss of sales in pubs and restaurants: a total of 1.3 billion litres were sold in the four months to 11 July, compared with 2 billion litres in the same period the previous year.23 But the charity Alcohol Change UK published a survey in April showing that 20% – an estimated 8.6 million adults – of drinkers were drinking more frequently and 15% of them were drinking more in each session.24 Three months later the charity repeated the research and found that heavier drinking by a minority was continuing even though the first lockdown was easing.25
At the same time the charity also reported a fourfold increase in visits to its website, which has advice and information about how to keep drinking under control and where to find help and support. It also referred to research showing