Health Bill [HL]

My Lords, we come now to the overarching issue presented by this clause and to what is, undoubtedly the most difficult and argued over part of the whole Bill. I am no advocate of smoking and I am conscious of the apparent anomaly that, as a health spokesman for my party, I should be proposing the removal from the Bill of a measure which appears, on the surface, to be conducive to public health. I do so, however, in the complete conviction that this measure is misconceived and that it will do considerably more harm than good, and I shall almost certainly ask the House to express its opinion about it. The Government have proposed that displays of tobacco products should be banned in all retail premises. They have done so for one main reason; they believe that tobacco displays are directly instrumental in the take-up of smoking by young people. Their case is that tobacco displays have become de facto advertisements. They pray in aid research published by Cancer Research UK and others, and they believe that a display ban will send out an important public health message. I believe that the Government’s position is wrong for two main reasons: the evidence base, and the likely damage that will be done to small shops. I have looked at the evidence base very carefully indeed, and I do not believe that a ban on the display of cigarettes in shops can be plausibly linked to the take-up of smoking by the young. Of the places around the world in which a display ban has been tried, Canada and Iceland are most normally cited. The province of Saskatchewan in Canada has had a display ban since 2002. In Saskatchewan, it is absolutely true that youth smoking has declined since the ban was brought in. The trouble is that the figures for the rest of Canada show that in provinces in which there has been no display ban, including provinces with quite similar characteristics to those of Saskatchewan, the rate of decline has been considerably steeper. Youth smoking has gone down throughout Canada in the past few years; but in places such as Quebec, British Columbia, Ontario and Nova Scotia, which until very recently had no display ban, the rate of decline in youth smoking has been much steeper than in places in which a ban has been in force. That fact makes it very difficult to conclude, even tentatively, that the display ban in Saskatchewan was responsible for the decline in smoking. Iceland introduced a display ban in 2001. Various statistics are available, some of which suggest that there has been a decline in smoking prevalence among the young since the ban was brought in, but what tends not to be mentioned is that, simultaneous to introducing the display ban, the Icelandic Government did three other things; they put up the price of cigarettes, introduced restrictions on smoking in public places, and introduced a positive licensing system for retail sales. Again, therefore, one cannot point to the display ban and say that it has brought about an improvement in smoking prevalence among the young. The statistics, in any case, do not tell a clear story. A clear story is what Cancer Research UK maintains we have in the research that has been done into the link between brand awareness among young people and smoking behaviour. Noble Lords may have attended a presentation by Professor Gerard Hastings, which suggested that the causal link between displays, brand awareness and smoking was absolutely unarguable. I hesitate to criticise Professor Hastings, but I must. In the 1990s, the Department of Health commissioned two separate studies of their own into the reasons why adolescents smoke: one was by Elaine Goddard; and the other was by Clive Smee, who was then chief economic adviser to the DoH. Goddard’s study was, and remains, the only longitudinal study in this area—that is, it followed the same students over three years in adolescence when they were likely to become smokers. It is one of the largest studies that has ever been done on adolescent smoking in the UK. Goddard found that the major predictors of whether an adolescent became a smoker are socio-economic; in other words, they are very largely to do with one’s family circumstances. Importantly, she found that brand awareness was not statistically significant as a causal factor. Smee’s study confirmed that. He found that being aware of tobacco advertisements does not reliably predict becoming a smoker and that there is no statistically significant relationship between tobacco advertising and adolescent smoking prevalence. So the Department of Health’s own research contradicts twice over the claim that advertising causes children to smoke; and if it is true of advertising then, a fortiori, it must be true of displays. Where does Professor Hastings mention those two studies in the evidence that he presents? He does not. He omits them. I have to say that I am deeply troubled by that if what we are meant to be considering is a balanced and dispassionate analysis of the research. Moreover, the studies that he cites provide no evidence that anyone at all who participated in a study started smoking because of tobacco brand awareness or retail displays. All that Hastings reports is what he calls an intention to smoke at age 18. For many participants this involves being asked to project several years into the future and to say whether they will become a smoker. Hastings then takes these projections and links them to brand awareness, but that is where it ends: the research does not offer a single instance where one of the subjects has become a smoker because of their awareness of tobacco brands or displays. He assumes that if the adolescents say that they intend to be smokers in a few years’ time then they will be. The advice I have had is that social scientists routinely warn against this type of research. It is highly unreliable, because what people do is often at variance with what they say they intend to do. But that is not all. The link that Hastings draws between tobacco display, brand awareness, prevalence and susceptibility to smoking has a confidence factor of between 1.02 and 1.17. Those figures are very low. They are well within the margin of error for being a chance finding. It is not a genuine association for statistical purposes. The association is even weaker because it fails to take into account potentially confounding factors, by which I mean the accepted and recognised causes of adolescent smoking. There are several of these: whether your family smokes, whether you live with a lone parent, how affluent you are, and so on. You cannot associate smoking with one particular causal factor, like tobacco displays, unless you have established that other factors, which may be more relevant, can be ruled out. So, for a whole raft of reasons, the research cited by the Government is shot through with weakness and leaps of logic. I turn to my second and equally serious reason for opposing this clause—namely the damage that it is likely to inflict on small shops. There are about 50,000 corner shops in the UK, and the organisations representing those outlets have told me of their acute worry that a point-of-sale ban on the display of tobacco will do serious harm to their trade. The level of concern is very high. A year ago, the Tobacco Retailers Alliance had 16,000 members. The figure now is 26,000. These shops depend on tobacco sales for a large proportion of their turnover. It is not a high-margin business; the point is that it creates footfall. People who come in to buy cigarettes typically buy other things as well, which carry a higher profit margin. If those people cease to patronise small shops, the effect on trade in those outlets could well be terminal. It is all very well for people like Professor Hastings to say, as he does, that footfall will not suffer because smokers will still know where to go to buy their cigarettes. With due respect to him, he has never run a corner shop. If you talk to the shopkeepers, as I have, they will tell you that as much as 50 per cent of their turnover can come from passing trade. These are not customers who would know in advance that a particular shop sold cigarettes or their favoured brand of cigarettes. On the other hand, they will know that they can buy their favourite brand from the local supermarket. It will be easier to go elsewhere. The fear is that the all-important tobacco sales will migrate away from small shops and quite simply make them unviable. I would say to your Lordships that these fears are not dreamt up from nowhere. In Iceland, since the tobacco display ban came into force, 30 per cent of small shops have closed. In Canada, where the display ban is now in force almost everywhere, dozens are closing every week. That means permanently closing. I have the figures beside me. In Ontario alone, where the ban was introduced only in June 2008, 765 convenience stores have closed permanently; that is 8.6 per cent of the total. So, I do not think that it is any exaggeration to say that this measure massively threatens the existence of small shops. These shops often play a very important part in the life of local communities. The shopkeepers whom I have met have said to me that they regard this clause as the biggest threat that they have ever faced. They cannot understand why the Government would allow this to happen. They regard themselves as the Government's best ally in preventing kids from getting hold of cigarettes. People who sell cheap smuggled cigarettes in the back of car parks do not care how old their customers are. It is ironic therefore that a measure designed to reduce youth smoking may actually serve to foster it, if more kids seek out tobacco from sources where no questions are asked. Again, that is what is now happening in Canada. None of us likes the idea of children smoking. I am sure that we would all approve of measures that were likely to make a real difference to it. But the policy here is not evidence-based. It is policy based on weak scientific data, and it is policy where the unintended collateral damage is likely to be unacceptable. For that reason it should be rejected. I beg to move.