to long-standing, but struggling, charity campaigns. As part of its Children’s Food Campaign, Sustain had been pressing for more than ten years for the TV ban, which its deputy chief executive, Ben Reynolds, welcomed as ‘real game-changer’.4 He pointed out that obesity was not just about personal willpower: ‘You just have to look at the environment that we live in – the torrent of unhealthy food that bombards us – dominating advertising, our high streets, through to in-store promotions – it’s everywhere.’
The difficulties of making headway against the opposition of the food industry and some politicians prompted the formation in 2015 of the Obesity Health Alliance, which has more than 40 members including health charities such as Diabetes UK, the British Heart Foundation (BHF) and CRUK, and medical royal colleges. It has agreed ten policy proposals, of which the main ones are restricting the promotion and marketing of unhealthy food and drinks, and reformulating food products to reduce calories and sugar. Caroline Cerny, Alliance lead, says that charities played a vital role in the Alliance:
“The medical royal colleges are useful for their clinical voice, and they can put up some knowledgeable experts who can give real insight into how obesity is affecting their clinical practice. When you’re trying to meet ministers, charities can open doors – they carry weight because they are seen as having credibility with the public. They also have a big reach and can get their supporters involved. The big charities can also get meetings with a broader focus – with the DCMS about advertising, for example.”
Cerny says the proposed ban on advertising before 9 pm was a breakthrough because it was “a population-wide measure”, as opposed to policies focused on individual choice and responsibility, which tend to be favoured by a government sceptical about ‘the nanny state’. But she says there is still a long way to go – the measure needs primary legislation, and the food industry is fighting back.
The charity campaign against tobacco
While progress on obesity remained piecemeal, the campaign on smoking had already scored a big hit. By 2020 it seemed inconceivable that people should ever have eaten meals in restaurants full of cigarette smoke. As recently as the year 2000, smokers could still light up pretty much anywhere, except on aeroplanes and the London Underground. But within a few years that seemed plain wrong – the thought of a pub or sports clubroom thick with tobacco haze became repellent to most people.
Even the power of the tobacco lobby, and the substantial revenues from taxes on tobacco – an estimated £9.1bn in 2019/20, according to the Office for Budget Responsibility – could not prevent the enactment of the law against smoking in public places.5 Public opinion shifted dramatically: when a ban was first mooted in 2003, people were either indifferent or firmly opposed, depending, usually, on whether they smoked or not. But public support for a ban doubled between 2003 and 2005.6 And by the time the Health Act was passed two years later, making it a criminal offence to smoke in premises that are open to the public or constitute someone’s place of work, there was overwhelming support for the change.7 So what happened in a mere four years to turn the issue on its head?
The answer, in short, is a highly effective campaign spearheaded by a tiny charity called Action on Smoking and Health (ASH). It was set up in 1971 by the Royal College of Physicians after the UK government refused to act on the College’s demands for policies to cut smoking. ASH gets nearly all its funding – about £765,000 in 2019 – from two other health charities, the BHF and CRUK, and uses it to influence public policy on tobacco. It coordinates the Smokefree Action Coalition, the umbrella group formed in 2003 to campaign for the ban on smoking in public that eventually comprised more than 60 organisations. When the Coalition started lobbying for smoke-free legislation, the debate was framed very much around what were called the ‘rights’ and ‘freedoms’ of smokers. But ASH opposed this by promoting the rights of employees not to be subjected to potentially lethal second-hand smoke at work.
This health message changed the debate. The former Labour MP Kevin Barron, an ardent anti-smoking campaigner who chaired the health select committee of MPs at the time, says that it was science that won in the end by proving that breathing in secondary smoke was damaging, and that it was ASH and other charities that brought this science to the attention of the public and policy makers. “At the time there were more than 120,000 people dying a premature death each year in the UK because of smoking,” says Barron. “If that was road traffic accidents or war, we’d try and stop it.”
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
