Fifty years on . . .

Fifty years ago, on 11 January 1964, the United States Government released the first Surgeon General’s Report on Smoking and Health.1 It “hit the country like a bombshell”,2 and massive global media coverage followed. While it contained nothing new, as it followed the 1962 report of the Royal College of Physicians,3 a very distinguished committee had brought together the best evidence then available. The Age (Melbourne) editorialised:

In Australia, 58% of men and 28% of women smoked, including a quarter of doctors.5,6 The Australian tobacco industry was in a “high state of prosperity”.7

The US report attracted early and substantial attention in the Australian Parliament. Prime Minister Menzies told the House of Representatives in March 1964 that “Ministers of Health of the Commonwealth and the States were unanimous that the best results would be obtained by pursuing a policy of educating young people . . .”,8 an approach confirmed by Health Minister Harrie Wade, who in April said that any warnings would “be directed particularly to those of tender years”.9 Proposals from Tasmanian Senator Turnbull that there should be tobacco advertising bans, major public education programs, and tax increases fell on deaf ears (especially those of his colleague Senator O’Byrne who asked, “what is emphysema?”).10 Treasurer Holt argued that action on tobacco might lead to similar approaches to other products, and “there is no end to it”.11 Then as now there was opposition to action because “the freedom of the individual must be safeguarded”.10

The tobacco industry responded by denying the evidence, attacking the science and the scientists, promoting smoking ever more creatively, lobbying against any measures that might be effective in reducing smoking, and turning its attention to developing markets.

It took nearly 10 years for Australian governments to legislate for even modest health warnings, 20 years until the first major mass-media campaigns on smoking, three decades to ban tobacco advertising nationally and 48 years until tobacco companies were prevented from promoting their products through glossy packaging.

Half a century after the Surgeon General’s landmark report, massively more evidence has accrued on the harms of both smoking and passive smoking, and on what is needed to reduce smoking in the community. Sixteen per cent of Australians aged 18 years and over are smokers,12 and only 4% of 12–15-year-olds have smoked in the past week.13

Successive Surgeons General have played a crucial role in informing the global community about the magnitude of the smoking problem, and the action that can be taken. A combination of well coordinated Australian health organisations and academics, government health departments and determined politicians has ensured both encouraging trends here and continuing hostility from the global tobacco industry. We can also take pride in the bipartisan approach that has seen support for tobacco control from successive Australian governments.

But much remains to be done, especially to reduce smoking further among those of lower educational attainment, and disadvantaged groups such as Aboriginal people and people with mental health problems, among whom high smoking rates are a major contributor to reduced life expectancies that shame us all.

While we must continue to resist Big Tobacco’s efforts to turn back the tide, we should also consider further measures, not only 50 years after the 1964 report, but more than six decades (and a million Australian deaths from smoking) after the first incontrovertible evidence of the harms of smoking.

Various approaches have been proposed, including limiting the number of cigarettes that may be sold, introducing smokers licences, the government taking over the tobacco industry, banning sales to anyone born after a nominated year, tough product regulation, and reducing the number of tobacco retail outlets. While some may be more practicable than others, the debate now should not be about whether we look to the end of smoking in Australia, but how we get there as quickly as possible.