What online harms regulation can learn from tobacco control

By Mark Rowland, Chief Executive of the Mental Health Foundation and outgoing Chair of the Mental Health and Smoking Partnership

When I agreed to Chair the Mental Health and Smoking Partnership in 2022, I understood the often ignored but devastating relationship between smoking and poor mental health. People living with mental health conditions are more likely to smoke, to become addicted, to become poorer, and to suffer the mental and physical health consequences that follow.

But what I have learnt about the tobacco industry over the past four years has wider application. The public’s tolerance for companies profiting from harms to our collective mental and physical health has increasingly frayed, but we still need politicians to wise-up to the tactics industries use to preserve access to valuable markets.

Tobacco is perhaps the clearest example of an industry whose commercial interests have come into direct conflict with public health. Every year, it causes more than eight million premature deaths worldwide. Its impact reaches far beyond mortality statistics: families lose loved ones too soon, health systems are stretched, communities carry social and economic costs, and land is used to produce a crop that kills rather than sustains life.

That lesson is increasingly relevant to one of the defining public health challenges of our time: social media and online harms.

The comparison is not exact. Social media is not tobacco. Digital platforms can connect, inform and support people, reduce isolation, help communities organise and provide access to information and support that might otherwise be out of reach.

But we have been too slow to see how unregulated social media has caused significant mental health harms by increasing the risk of anxiety, self-harm and even suicide. Engagement-driven products can also affect concentration, sleep and social connection. Given these harms, we do not consider it a coincidence that we have seen a significant rise in mental health problems since 2014.   

Despite huge progress in reducing smoking rates in the UK, the tobacco industry remains a powerful lobby and has been successful in delaying and diluting effective regulation. 

The first lesson we must take from the tobacco playbook is that businesses seeking to prevent tighter regulation frame the argument as being about individual choice. 

Progress came when smoking stopped being treated solely as a matter of personal responsibility and policymakers examined the systems that encouraged it: advertising, product design, pricing and availability. The question shifted from why people smoked to why society made smoking so easy.

Online harms regulation needs a similar shift.

The proposed ban on under-16s accessing certain social media platforms is an important first step towards a healthier online environment. A company by company ban, giving access to children only when demonstrably safe, would have been stronger. 

Still, we have to start somewhere. Tobacco control advanced through sustained action over many decades, not through one legislative fix. Tobacco companies long argued that advertising bans were imperfect and used that argument to delay change. We should not allow the same tactic to stall action on online harms.

Too much of the current debate focuses on what parents, teachers and young people should do differently. Digital literacy and family support matter, but it is neither fair nor realistic to expect individuals to manage risks created by some of the most sophisticated and well-resourced companies in the world.

Recommendation algorithms, infinite scrolling, targeted advertising, constant notifications and other engagement-driven features are not accidental. They are commercial choices. If those choices contribute to anxiety, poor sleep, body dissatisfaction, bullying, exposure to harmful content or declining wellbeing, regulation must address the systems that create those risks, not simply the people exposed to them.

A second lesson is the importance of transparency on the harms of their products.

For decades, tobacco companies knew far more about their products and their impacts than policymakers or the public. Progress accelerated when evidence became harder to conceal and independent scrutiny became possible. Even then, the industry playbook was to question the evidence and stir up doubt, protecting the status quo for as long as possible.

The same principle applies online. Regulators, researchers and civil society need meaningful access to data about how platforms operate and how harms occur. Companies should not be left to mark their own homework.

A third lesson concerns industry influence.

One of the most important provisions of the World Health Organization’s Framework Convention on Tobacco Control is Article 5.3, which requires governments to protect public health policy from tobacco industry interference. It recognises a simple truth: effective regulation is difficult when the industries being regulated exert disproportionate influence over policymaking.

Social media companies are not tobacco companies, but the principle remains relevant.

Like tobacco companies before them, some social media companies warn of unintended consequences from reform and tighter controls. Through lobbying, research funding and public argument, they seek to shape the terms of debate. Tobacco control changed when lobbying, conflicts of interest and industry-funded research were made more transparent. Public policy should be shaped by evidence, public health and children’s rights, not by the commercial interests of the companies affected by regulation.

A final feature of the tobacco industry playbook is what they call third party influencing – co-opting independent third parties to make their case for them.  Civil society must be vigilant about the same strategies being deployed by social media companies as they seek to protect the status quo and maximise shareholder value. 

It has been more than sixty years since the link between smoking and lung cancer was conclusively established. Progress finally came because we understood industry tactics, challenged harmful practices, protected policymaking from vested interests and put public health first. The sobering lesson is that confronting commercially driven harms is not the work of a single policy, a single parliament or even a single generation.

If we are serious about protecting mental health in the digital age, we should not wait decades to learn the lessons tobacco control has already taught us.