The advent of the cigarette
One hundred years before the foundation of ASH, hardly anyone in Britain smoked cigarettes. Tobacco consumption was limited to pipes and cigars, which remained the exclusive preserve of men, while handmade cigarettes were luxury items.
Then in 1880, James Albert Bonsack patented the cigarette rolling machine which revolutionised smoking. Machine-made cigarettes were cheap to make in very high volumes and highly addictive because they were easily inhaled, paving the way for the rapid growth in tobacco consumption that characterised the first half of the 20th century.
Lung cancer was the canary in the coal mine. A rare disease historically, it would go on to become the most common cause of death in the 20th century.
Scientists smell a rat
The alarm was first raised in Britain by Richard Doll and Austin Bradford Hill in 1950. Their research drew attention to the strong association between smoking and lung cancer, first among patients in London hospitals, then within the medical profession itself. The research convinced doctors to give up smoking but wasn’t gaining traction publicly, partly because their epidemiological methods were relatively new and unfamiliar, but also because of the ubiquity of smoking and the influence of the tobacco companies in government circles. In 1957, the Medical Research Council and the government acknowledged the causal link between smoking and cancer, but action was very limited.
1962: Publication of "Smoking and health"
Once again it fell to the medical profession to intervene, and Charles Fletcher was just the man to lead the charge. Fletcher was a respected chest doctor and a fellow of the Royal College of Physicians (RCP). He knew Doll and Hill and had been just as surprised as they were when the evidence linking smoking to cancer and bronchitis emerged. He was also developing a reputation as a public communicator and was familiar to the general public as one of the first television medics in the series ‘Your life in their hands’, a role strongly disapproved of by many in his conservative profession.
Determined to press for change, he found the perfect ally in Robert Platt, the new RCP president, who supported his suggestion that the RCP should undertake an inquiry into smoking.
Fletcher chaired the committee and edited a ground-breaking report published in 1962, Smoking and health, ensuring that the language was suitable for politicians rather than doctors.
1971: ASH is born
The popularity of Smoking and health had an impact on smoking behaviour but its recommendations for action were largely ignored. The government continued to drag its feet, not least because smoking was so important to tax revenues. By the end of the 1960s, both Fletcher and the RCP felt that the time was ripe to have another go, but this time any ensuing report should be supported by an anti-smoking organisation.
In 1971 the RCP published Smoking and health now and launched Action on Smoking and Health (ASH) with the support of around 75 organisations. Originally conceived as a channel for communication about the effects of smoking, ASH quickly became a formidable advocacy organisation, leaving information and education to the new Health Education Council.
In 1973, ASH’s first director, Dr John Dunwoody, returned to general practice and was replaced by Mike Daube, a professional activist who set about turning ASH into a fully-fledged campaigning organisation.
1976: All-Parliamentary Group on Smoking and Health founded
At the outset, the health minister Keith Joseph gave ASH a grant of £125,000 to get started and insisted that no more money would be forthcoming. But civil servants, parliamentarians, policy makers and government ministers soon recognised the value of this professional outside voice. Furthermore, Mike Daube’s success in creating a cross-party group on smoking and health in the House of Commons secured an enduring foot in the parliamentary door.
1998: First government strategy on tobacco published
Twenty years after the foundation of ASH, in 1991, smoking was still commonplace, the industry was spending £100 million a year on advertising, and ‘denormalisation’ of smoking was unheard of. Yet the expansion of the smoking epidemic in Britain had been unequivocally put into reverse. The prevalence of adult smoking had fallen from 75% to 30% among men and 50% to 28% among women. Public awareness of the risks of smoking was having an impact.
During the 1990s the decline in smoking rates slowed dramatically, government action was limited and illicit tobacco sales rose rapidly because of the complicity of the tobacco industry. In 1998 the tide turned decisively with the publication of Smoking Kills, the first comprehensive government strategy on tobacco. Legislation and policy changed shortly thereafter.
2000: Roll out of stop smoking services
In 2000, stop smoking services were rolled out across England, offering smokers treatment to tackle their addiction.
2003: Advertising ban
From 2003, advertising and sponsorship were banned. This reflected a growing acknowledgement by government that smoking was not a simple personal lifestyle choice, but a serious addiction requiring tough regulation.
2005: WHO FCTC
In 2005, after many years of lobbying, the WHO Framework Convention on Tobacco Control (FCTC) came into force, the first treaty of its kind. This brought civil society organisations together from across the world as a collective lobbying voice, countering the tobacco industry and formally excluding the industry from political lobbying.
2007: Smokefree laws
In 2007, after a long campaign focusing on the risks to non-smokers of second-hand tobacco smoke, all enclosed workplaces and public places in the UK became smokefree. As well as protecting non-smokers, this ground-breaking legislation played a key role in shifting public attitudes to smoking. Smoking had been marginalised, literally, from social discourse.
Further policy changes
All retail displays of cigarettes were gone by 2015, and plain packaging of tobacco products was mandated from 2016. On 1 October 2015 the government brought in a new law that made it an offence to smoke in a car in which children under 18 years of age were present.
ASH played a central role in campaigning for each of these changes, led from 1997 by Clive Bates and from 2003 by Deborah Arnott, whose resilience in the face of industry and political opposition became legendary. Over 5 decades, ASH’s modus operandi has been characterised firstly by building alliances and working in partnership, secondly by engaging the media and communicating the evidence, and thirdly by actively opposing the industry every step of the way.