Last updated: June 2020
By Maurice Swanson OAM, Lucy Scott, Noni Walker, Emeritus Professor Mike Daube AO, Dr Ruth Shean
- ACOSH: In the beginning
- The 1970s
- Advocacy for banning television advertising of tobacco products
- Voluntary Code for the Advertising of Cigarettes in Print Media
- Advocacy for smoke-free transport
- Advocacy for smoke-free hospitals and Doctors’ waiting rooms
- Following the example set by Norway
- Leadership in Australia by the Anti-Cancer Council of Victoria
- Advocacy to Local Governments
- The 1980s
- ACOSH appoints full-time Education and Research officer
- Campaign for WA legislation to prohibit tobacco advertising and promotion
- Roles played by members of the ACOSH coalition during the 1980s
- Voluntary Code for the Advertising of Cigarettes
- Continued sponsorship of major sporting events by the tobacco industry
- Health warnings on outdoor advertising and Advertorials in women’s magazines
- Sales of tobacco to minors
- A smoke-free public service
- Advocacy for Tar and Nicotine labelling on cigarette packets
- Advocacy to Local Governments
- Advocacy for smoke-free restaurants
- Estimate of premature deaths caused by smoking in Australia
- WA’s first smoke-free day
- Prohibition on the sale of smokeless tobacco products
- 5th World Conference on Tobacco and Health, Winnipeg, Canada
- National Survey of smoking among secondary school students
- ACOSH purchases shares in tobacco companies
- Advocacy to influence health policies of political parties
- People Behind the Statistics
- Smoke-free workplaces
- Smoking Death Cards
- Christmas Media Releases
- Smoking Death Clock
- Smoking body parts media conference
- The maturity of creative campaigning
- Cough up an ad
- Fire safe cigarettes
- Legal action against the tobacco industry: Ruth Scanlan v. Rothmans of Pall Mall 1986
- Alternative Tobacco Company Annual Report 1987
- Yul Brynner TV advertisement
- Reminding the community and politicians about the dangers of smoking
- ACOSH sponsors during the 1980s
- The 1990s
- Tobacco Control Act 1990
- The dangers of secondhand smoke
- Seventh World Conference on Tobacco or Health
- NHMRC Reports on the health effects of passive smoking
- Passive Smoking Task Force Report
- Advocacy for increasing the cost of tobacco
- The Dirty Ashtray Award – National Tobacco Control Scoreboard
- Tobacco industry funding of medical and scientific research
- Preventing youth from starting to smoke
- Poisons scheduling of nicotine in tobacco products
- Coordinating strategic directions for tobacco control in WA and Nationally
ACOSH: In the beginning
The Australian Council on Smoking and Health (ACOSH) was established in 1965 in New South Wales by Dr Cotter Harvey, President of the Medical Board of New South Wales, and also President of the National Tuberculosis and Chest Association.
Prominent doctors from the disciplines of respiratory medicine and tuberculosis care led the early activities of ACOSH, but they were soon joined by epidemiologists and members of the medical colleges, and complemented by representatives from government departments of health and education, and other community organisations.
Dr Harvey had first been convinced of the health risks of smoking after listening to Dr Alton Ochsner at the 1948 conference of the American Thoracic Society.
In 1950, landmark studies in Britain by Doll and Hill identified smoking as “an important factor in the cause of carcinoma of the lung” and in the United States by Wynder and Graham concluded, “the occurrence of carcinoma of the lung in a male non-smoker or minimal smoker is a rare phenomenon.”
Dr Harvey set up ACOSH in part inspired by the example of the Interagency Council on Smoking and Health, established in the United States in 1964, which brought together government agencies and health pressure groups. He was also frustrated by the lack oDf action from Federal and State Governments to carry out anti-smoking campaigns .
In 1963, the response by the Menzies Federal Cabinet to the NHMRC submission to ban tobacco advertising was that “It did not conceive it to be the function of the Commonwealth Government to take action in these matters”, a position revealed when Cabinet papers were released thirty years later.
In 1965, ACOSH members included representatives from the Australian Medical Association, Royal Australasian College of Physicians, Royal Australian College of General Practitioners, National Heart Foundation of Australia, National Tuberculosis and Chest Association and the New South Wales Health Department .
The broad objective of ACOSH was to advocate for changes in public policy and legislation that would reduce the prevalence of smoking in Australia, and the resulting epidemic of smoking caused disease and death.
ACOSH established sister organisations in Tasmania in 1966, Western Australia in 1971 and South Australia in 1973.
According to Milton Lewis , Dr Harvey was a determined lobbyist, even in the face of inaction by governments. In late 1971, he led a delegation of thirteen medical and three other national health organisations to ask the then Federal Health Minister to introduce measures called for by the World Health Organization in resolutions of May 1970.
“Unable to advance the cause of tobacco control, he [Cotter Harvey] resigned from the Liberal Party, blaming the lack of progress on its unwillingness to alienate the tobacco industry.”
Following Cotter Harvey’s retirement in the late 1970s, the NSW ACOSH dissolved in 1978, and ACOSH Western Australia assumed national responsibility for advocacy on smoking and health issues, along with the Anti-Cancer Council of Victoria led by Dr Nigel Gray.
 Walker, R. Under fire: A history of tobacco smoking in Australia. Melbourne: Melbourne University Press; 1984.
 Sydney Morning Herald 18 June, 1969.
 Milton J Lewis, The People’s Health, p65
The Australian Council on Smoking and Health Inc. (WA)
The foundation meeting of the ACOSH WA was held in the offices of the Australian Medical Association, 8 Kings Park Road on Wednesday 17 November 1971, and commenced at 4.30 pm.
Dr Max Canning, Chairman of Preventive Education and Committee of the Royal Australian College of General Practitioners, chaired the inaugural meeting of ACOSH WA. Other attendees at the first meeting were Dr M G Davey, Dr H Robert Elphick, Group Captain A G Fergusson Stewart, Dr Bruce K Armstrong, Professor R Barter and Dr Richard M Porter.
Dr Canning explained that the formation of ACOSH had been an initiative of the Preventive Education Committee of the Royal Australian College of General Practitioners, and he nominated Dr Richard Porter as the chairman for the foundation meeting.
Dr Robert (Bob) Elphick, a leading respiratory physician, was elected as inaugural President of ACOSH, Dr Richard Porter as Secretary and Group Captain Fergusson as Treasurer.
Dr Porter paid tribute to Dr Cotter Harvey whose drive and commitment to reducing smoking had led to the formation of ACOSH in New South Wales. A set of rules for ACOSH was proposed by Dr Porter and accepted subject to modification on a motion moved by Professor Barter, and seconded by Dr Canning:
- The name to be accepted for the time being, but may require to be reconsidered later.
- That all members and member bodies be required to pay a subscription.
- That the subscription be five dollars per annum.
The President, Dr Bob Elphick was keen for other member organisations be recruited to ACOSH, showing their support as leading members of the community. Dr Porter agreed to write to Dr Nigel Gray of the Anti-Cancer Council of Victoria (later the Cancer Council Victoria) for advice and suggestions on a future program of activities for ACOSH.
A discussion followed as to member organisations that could be recruited, what strategies the Council could pursue, and how money could be raised to support the organisation.
Financial resource development would focus on subscriptions from member organisations, donations from supporters, and government grants.
The Cancer Foundation of Western Australia through its Executive Director Clive Deverall, was an early and leading supporter of ACOSH, contributing to the development of effective advocacy strategies and providing office accommodation and financial support for many years.
Education of the community on the health effects of smoking was identified as a key priority, and key target groups such as school children proposed as a focus with assistance from WA Education Department and the Health Education Council of WA. Television programs as a vehicle for education messages were also discussed.
Non-smoking role models such as doctors, nurses and other public health workers were seen as vitally important. Provision of printed information on the health effects of smoking, including tar and nicotine levels of cigarette brands, would be required. These information materials could be provided by doctors to distribute to their patients and made available in surgeries, hospitals and, if possible, other workplaces.
Political action was also identified early as a key strategy to reduce smoking, to be conducted in partnership with ACOSH NSW, and the Anti-Cancer Council of Victoria. Members of the government would be asked to set an example by not smoking during cabinet meetings.
Counter educational activities to blunt the effect of tobacco advertising and marketing were discussed as a key strategy within the proposed and developing comprehensive approach.
Legislation to prohibit cigarette advertising, and requiring cigarette packets to display the tar and nicotine content of each brand, as well as a “warning message regarding the danger of smoking” were listed for future action.
Local research on the health dangers posed by smoking was identified as an effective way to generate interest and action, with researchers to be acknowledged with grants or prizes to encourage such work to be undertaken.
Chairs of the ACOSH Council 1971 – Present
Advocacy for banning television advertising of tobacco products
In early 1972, ACOSH decided that all political parties should be lobbied to ban the advertising of cigarettes. This important decision followed discussion with Dr Nigel Gray, Director of the Anti-Cancer Council of Victoria (later the Cancer Council Victoria), and the successful broadcast of a TV advertisement in Victoria featuring Sir McFarlane Burnett (1960 Nobel Prize for Medicine) that attacked cigarette advertising.
Sir McFarlane Burnett … “I am certain that cigarette smoking as practised in the past 50 years in England, the United States, Canada and Australia, is directly responsible for something between 95 and 98 per cent of primary lung cancer.
“I am also certain that it is a very important factor in deaths from coronary and other cardiovascular disease and from chronic pulmonary disease.”
Television advertisement featuring Sir McFarlane Burnett campaigning for the banning of cigarette advertisements on television
Source: Cancer Council Victoria
ACOSH continued to work with other health and medical organisations with leadership from the ACCV to campaign for the banning of cigarette advertising on television.
The Federal government finally banned cigarette advertising on television and radio in 1976. The advertising bans came as no surprise to the tobacco industry, which had planned strategies to circumvent the restrictions. The legislation contained a loophole that allowed tobacco advertising to feature in the broadcasting of sport on the condition that it was “incidental or accidental” to the media coverage of the event. The tobacco industry exploited this loophole by sponsoring major sporting organisations and events that generated television coverage.
 The West Australian 19 April 1972.
Voluntary Code for the Advertising of Cigarettes in Print Media
The advertising of cigarettes on television and radio had been prohibited since 1976, except for “accidental or incidental” coverage of cigarette brands through television broadcasting of sporting events. However, the tobacco industry was making large investments in print-based advertising.
ACOSH resolved to make regular complaints to the then Advertising Standards Council (ASC) about cigarette advertisements in print and in cinemas.
In 1978, all members of the ACOSH Council were encouraged to make complaints about offending advertisements to the Secretary of the ASC with more factual material being provided to the Media Council of Australia.
For example, specific complaints were made relating to Long Beach cigarettes and the use of Paul Hogan in cigarette advertisements.
Throughout the 1970s and 1980s, ACOSH made regular complaints to the Advertising Standards Council regarding tobacco advertisements that it believed breached the Voluntary Code.
Advocacy for smoke-free transport
- In 1972, ACOSH advocated to MacRobertson Miller Airlines and Trans Australian Airlines (TAA) to increase the number of non-smoking seats provided on each flight. All members of the Council were encouraged to write to their chosen airline emphasising the importance of decreasing the number of seats in which smoking was permitted. Throughout the 1970s and 1980s, ACOSH continued its advocacy to increase the number of seats allocated to non-smokers. An expansion of smoke-free areas in airport terminals was also requested in later years. Following further intense advocacy by ACOSH and other health organisations, and as a result of action in Canberra by Western Australian MP Ron Edwards, all commercial airlines in Australia became smoke-free in October 1987.
- In early 1973, ACOSH lobbied the Metropolitan Transport Trust to make buses smoke-free, emphasising the need to protect non-smoking passengers. Eventually, the Metropolitan Transport Trust (MTT) announced that smoking would be prohibited on buses from 4 May 1975.
- In 1974, ACOSH Councillors carried out an investigation to measure the carbon monoxide levels expired by taxi drivers. Taxi drivers who did not smoke had an extremely low level of carbon monoxide, while smokers had a level 10 to 20 times that of a non-smoker. Later, the Council lobbied the Taxi Control Board of WA to declare that smoking inside taxis “is not in the public interest”. Advocacy for smoke-free taxis continued during the 1980s.
- In 1975, ACOSH lobbied the Commonwealth Railways to make more non-smoking seats available. ACOSH also lobbied Westrail to increase the number of seats allocated for non-smokers.
Advocacy for smoke-free hospitals and Doctors’ waiting rooms
Throughout the 1970s, ACOSH advocated for increasing the number of smoke-free areas in all public hospitals in Western Australia. In 1973, letters were sent to the Boards of Royal Perth Hospital, Sir Charles Gairdner Hospital and Fremantle Hospital pressing for action to discourage smoking.
Council members reported that while smoking had not been prohibited at King Edward Memorial Hospital, cigarettes were no longer sold on trolleys and smoking and health literature was being made available.
In 1973, ACOSH surveyed each of the major hospitals in Perth and found:
- Royal Perth – no additional action was proposed but some anti-smoking notices had been introduced.
- Fremantle – staff requested not to smoke in hospital wards and some non-smoking areas operative. A complete ban was not supported by the medical staff.
- Sir Charles Gairdner – more progress was reported with chest physicians having agreed to display notices to ban smoking in the ‘chest’ wards. Cigarettes no longer sold on the ward trolleys.
In 1974, ACOSH worked with the Health Education Council of WA to test ‘Please Don’t Smoke’ signs in doctors’ surgeries in West Perth to determine whether the display of such signs decreased smoking.
“Hopefully the most important effect will be to create throughout the community a greater awareness of the rights of the non-smoker and a tendency to regard tobacco smoke as a form of air pollution. Consequently, an attempt has been made to devise messages that rather than making a bold statement or request will contain some explanation for their presence. A trial batch of wall signs in doctors’ rooms with the following messages:
- Cigarette smoke in the air is a threat to the health and comfort of others. We ask you not to smoke in this area.
- For the comfort of others, and for your own health … Please do not smoke.
- There may be people in this room with respiratory troubles who could be distressed by having to inhale cigarette smoke … Please do not smoke.
- For the comfort of others and your own health … Please do not smoke (on one side of a tent sign) and “Thank you for not smoking” on the other side.”
(Source: Minutes of ACOSH meeting, 12 August 1974)
In preliminary testing of the signs in one large waiting room (placement of two wall signs and two desk tents and removal of ashtrays) a 90% reduction in cigarette consumption was observed. Consequently, it was recommended that a similar approach be recommended to medical practitioners throughout WA.
The Health Education Council of WA published a Non-Smokers’ Bill of Rights modified from a poster published by the American Lung Association of Southeast Florida and printed and distributed 5,000 copies that proved to be extremely popular.
Following the example set by Norway
Internationally, Norway had led the way in tobacco control and by the time the second report of the Royal College of Physicians of London was released in 1971, a Bill to prohibit tobacco advertising had been drafted for the Norwegian Parliament.
1971 also saw the publication of a second report on smoking by the Royal College of Physicians, Smoking and health now, and the release of a further major report of the US Surgeon General on The health consequences of smoking.
Landmark legislation was enacted in Norway in 1973 (and implemented in 1975) to prohibit all forms of advertising of tobacco products.
Leadership in Australia by the Anti-Cancer Council of Victoria
The Anti-Cancer Council of Victoria (ACCV) (now known as the Cancer Council Victoria) published in 1972 their Smoking Supplement that reported:
- Death rates for lung cancer continued to rise while death rates for other major cancer sites had remained stationary, or in the case of the digestive system, had started to fall.
- There had been changes in attitudes to smoking in the last year, and the rates of smoking had fallen in the last year.
- Tar yields from Australian cigarettes had also fallen.
- However, smoking rates in young people remained high.
- There had been no worthwhile diminution “in the tobacco industry’s advertising activities or its freedom to construct a successful, sophisticated and mature image around the cigarette smoker.”
- There can be no substitute for the complete abolition of all forms of cigarette promotion and “indicates that as a first step it would be logical and fair for state governments to enact legislation which requires a health warning to be exhibited wherever a cigarette brand is displayed.”
- Revenue for anti-tobacco advertising could be generated by a levy on cigarettes of a half cent or one cent per packet.
ACOSH confirmed its determination to work with the ACCV to eliminate all forms of tobacco advertising and promotion in Australia.
Advocacy to Local Governments
In 1976, ACOSH wrote letters to 25 Lord Mayors, Mayors and Shire Presidents regarding the provision of cigarettes at official gatherings and income derived by Councils from advertising cigarettes. The following replies were received:
- Four councils indicated they did not provide cigars or cigarettes at their functions.
- Two said a fuller reply would be provided later.
- Two indicated that they would not withdraw the supply of cigarettes at functions.
- In regard to advertising, most felt there was no likelihood of contracts being let for their grounds, so it was not felt that this applied to them.
- One very full reply was received generally opposing any reduction of free choice and ending with a statement that the Mayor considered it was not a function of local government to become involved in such matters.
The Council resolved to continue their advocacy to discourage local governments from receiving income from the promotion of tobacco.
ACOSH appoints full-time Education and Research officer
In June 1981, ACOSH appointed its first full-time Education and Research officer, Mr Stephen Woodward, funded by the Cancer Foundation. Mr Woodward was an energetic scientist with great charm and understanding of sporting and related matters as well as the need for an aggressive approach to the tobacco industry.
In July 1983, Dr Bill Castleden, a vascular surgeon, was appointed to the position of research assistant to the Council. Dr Castleden took 6 months unpaid leave to assist in ACOSH’s work.
Campaign for WA legislation to prohibit tobacco advertising and promotion
In Western Australia, pressure for bans on tobacco advertising and promotion was led by ACOSH, working closely with organisations such as the Heart Foundation WA, the Cancer Foundation WA (later the Cancer Council WA) and the Australian Medical Association WA Branch, as well as key staff in the Health Department.
In late 1979, ACOSH initiated a campaign for WA legislation designed to prohibit remaining forms of tobacco advertising and promotion – a key advocacy priority of the Council throughout the 1980s.
ACOSH provided to all members of State Parliament a pamphlet Facts about Tobacco smoking and its promotion in Australia, to assess support for WA Legislation that would ban all forms of cigarette promotion.
ACOSH also enlisted the support of leading health, community and sporting organisations, including the Western Australian Sports Federation.
In response to advocacy from ACOSH, the then O’Connor Liberal/National government initiated the Williams Committee (Monitoring Tobacco Advertising in WA) in 1979. ACOSH provided comprehensive submissions to the Williams Committee that included critiques of the Voluntary Advertising Code for tobacco. In particular, the Council emphasised that the onus of proof regarding advertising (on not recruiting new smokers) should be on the advertisers.
The Williams Committee produced a preliminary report in late 1980 that was comprehensively critiqued by ACOSH and a copy of the critique was sent to all WA members of Parliament and the media.
In 1980, Council members Dr Bill Musk and Dr Bob Elphick approached Dr Tom Dadour MLA for Subiaco, and he agreed to assist with introducing a Bill to ban tobacco advertising into the Legislative Assembly of the WA Parliament. ACOSH Councillors also approached leading Perth lawyer David Malcolm QC about the drafting of a WA Bill to ban tobacco advertising. By May 1981, Mr Malcolm had prepared a draft Smoking and Tobacco Advertisements Bill 1981 (to prohibit the advertising of tobacco) based on similar legislation from Norway and Singapore.
In parallel, ACOSH continued to work closely with Dr Nigel Gray and Dr David Hill of the ACCV to encourage the Federal parliament to introduce legislation that would prohibit remaining forms of tobacco advertising.
Dr Dadour agreed to introduce the Bill into the WA Parliament as a Private Member’s Bill in October 1982. ACOSH produced information materials to support the bill and distributed them to all members of the WA Parliament.
The Bill was strongly opposed by the tobacco industry through the Director of the Tobacco Institute of Australia, Bryan Simpson (a lobbying organisation fully funded by the tobacco industry), which conducted a campaign of misinformation to undermine the bill, including full page newspaper advertisements claiming that there would be job losses should a ban on advertising be introduced.
The tobacco industry also exploited its links with the media, particularly with the print media for whom tobacco advertising was a major source of revenue, and seeking support for its position – “Legal to sell, legal to advertise.”
The Subiaco Post newspapers took an early but isolated stand in refusing to accept profitable tobacco advertisements.
Critics of the Bill in the WA Legislative Council presented the following arguments during debate:
- Action to update and enforce the existing legislation on sales to minors was more important than to proceed with this Bill.
- The legislation will have little effect on indirect advertising on TV.
- The legislation in its current form is unacceptable.
- Action in one state in isolation will be ineffective.
- Education is more important than legislation.
The Council targeted stories to Community Newspapers featuring local identities such as school teachers, local doctors, other local opinion leaders.
The Council also encouraged similar Bills be introduced to parliaments in other states.
In November 1982, the Bill was defeated by a margin of 2 votes in the Legislative Council.
After the election in 1983, the new Labor Government committed to reintroducing the Smoking and Tobacco Products Advertisements Bill to parliament.
ACOSH strongly supported an expansion of the former ‘Dadour’ Bill to include prohibition on the sale of cigarettes to minors, Business Franchise Tobacco Act (to increase the tax on the sale of tobacco etc).
The Minister for Health, Hon Barry Hodge MLA, introduced a more comprehensive Tobacco (Promotion and Sale) Bill in July 1983. In addition, the government committed to increasing the business franchise tobacco tax from 13.5% to 35%, based on the wholesale value of tobacco sold, and $2 million per year of this additional revenue would be allocated to a state-wide smoking and health program.
Barry Hodge was a strong and committed advocate for health promotion and tobacco control who led key initiatives both in Western Australia and nationally – including the introduction of new health warnings on tobacco packaging.
Source: WA Parliament Library
Again, the Tobacco Institute and all major tobacco companies ran a ferocious and well-funded campaign against the Bill. Opposition also came from media groups such as the Australian Publishers Bureau, sections of the advertising industry, and other groups with allegiances to the tobacco industry such as sporting organisations sponsored by the tobacco companies.
Tobacco industry campaign against the Tobacco Sale and Promotion Bill 1983 (source: UCSF Industry Documents Library)
Unfortunately, the Bill again was defeated by a margin of 2 votes in the Legislative Council.
However, it was an important stepping stone in raising awareness of the dangers of smoking and the impact and power of tobacco companies, paving the way for further efforts in Western Australia later in the 1980s.
The WA Bill acted as a catalyst for similar Bills to be considered by the South Australian and Tasmanian Parliaments. These Bills were presented by minority parties in both upper houses of their respective parliaments and for this reason, were thought unlikely to succeed. In parallel, Senator Jack Evans (an ACOSH Councillor) planned to present a draft Bill, similar to the ‘Dadour’ Bill, to the Australian parliament to be implemented in the ACT.
Roles played by members of the ACOSH coalition during the 1980s
ACOSH coordinated advocacy activities with leading health organisations in the following way:
Developing the strategies
- All worked together to determine priorities, develop strategies and identify opportunities.
Preparing the ammunition
- Epidemiologists provided statistics on smoking in a highly accessible form.
- ACOSH developed the communications strategies including preparation of media releases, background resources and photographic opportunities.
Firing the bullets
- Select, credible, high-profile experts acted as media spokespeople and signatories to communication to members of parliament and other opinion leaders.
- High-level delegations from the AMA and other organisations met with politicians to lobby on issues.
- Media consultants help build relationships with West Australian media as well as maximising coverage of tobacco issues through careful timing of attention-grabbing media releases.
- Lateral thinkers among the coalition contributed ideas and identified opportunities for keeping tobacco issues alive in the minds of the public.
Voluntary Code for the Advertising of Cigarettes
In 1982, ACOSH’s first successful complaint regarding an advertisement for Sterling cigarettes depicted in connection with the City to Surf Fun Run was upheld because the Advertising Standards Council (ASC) considered it would “likely cause needless offence” and did not stand up to the standards of the industry.
In 1984, the Council resolved to continue to complain about tobacco advertisements to the ASC because:
- The annual report of the ASC must include some mention of the number of complaints.
- Complaints provide material for publicity and publication.
- Replies from the ASC can be used by ACOSH to lobby parliamentarians.
In 1985, ACOSH provided a submission to the Trade Practices Commission that would assist in a major review of the Voluntary Advertising Code for cigarettes.
Continued sponsorship of major sporting events by the tobacco industry
The tobacco industry continued to exploit ruthlessly the loophole in the Broadcasting and Television Act that allowed the promotion of cigarette brands during the broadcasting of sporting events if those images were “incidental or accidental” to the television coverage of those events.
During the broadcast of a one day cricket match, Australia v England, on 11 February 1987, the total playing time on television was 320 minutes, and cigarette advertisements were visible for 103 minutes, being shown on 1143 separate occasions.
ACOSH recommended to the Australian Broadcasting Tribunal that the distinction between advertising matter and promotional material be removed so the 1976 ban on the advertising of cigarettes on television be properly enforced.
In 1988, ACOSH chartered a plane to tow a message around the WACA ground for the Benson and Hedges Worlds Series Cup cricket match between Australia and NZ on 3 February 1988. Two hours of exposure of the sign “Smokers are Dying to Bring you the Cricket”, cost $390.00.
ACOSH worked closely with the Cancer Council Victoria, ASH Australia, and the AMA to achieve stronger advertising restrictions at the national level, and the Federal Tobacco Advertising Prohibition Act 1992 eventually prohibited most forms of tobacco sponsorship from December 1995. The Benson and Hedges sponsorship of cricket concluded on 30 April 1996.
Health warnings on outdoor advertising and Advertorials in women’s magazines
While the ACOSH Council remained committed to achieving legislation that would prohibit all forms of tobacco advertising, it had an early focus on the criteria determining the legibility of health warnings on billboards and the status of “advertorials” in women’s magazines.
Following complaints from ACOSH, the ASC claimed that the placement of billboards was the responsibility of local governments and it was impossible therefore to set criteria for the legibility of health warnings.
The tobacco industry, through the Tobacco Institute of Australia, published and sponsored multi-page advertorials on smoking issues in the Women’s Weekly magazine. ACOSH complained to the ASC about these advertorials because they were considered to be cigarette advertisements and sought clarification of this matter from the Australian Publishers Bureau.
The ASC ruled in September 1985 that both the Tobacco Institute and the Women’s Weekly had breached the voluntary advertising code of ethics.
In October 1985, after 7 months of correspondence, the ASC upheld ACOSH’s complaint about an advertisement for Alpine cigarettes published in Cleo magazine. This was recognised as a landmark decision by advocates for smoking and health.
Sales of tobacco to minors
ACOSH continued to campaign and advocate to all WA political parties that the law regarding the sale of tobacco to persons under 18 years of age should be more strictly enforced and with larger penalties.
In 1981, ACOSH decided to press the Minister for Police to make enforcement of the sale to minors legislation a priority.
ACOSH questioned the Minister for Police on the following issues:
- Was the present legislation being policed?
- How many prosecutions were made in the last 12 months?
- Would his office support a prosecution by a private citizen?
- Would recurrent breaches result in the withdrawal of tobacco retailers licence?
In 1982, the Acting Chief Secretary (WA) had confirmed that no prosecutions had been made under the Act in the last 12 months.
A smoke-free public service
ACOSH approached the Civil Service Association (CSA) and provided facts about passive smoking and health, asking for a policy to be developed to support the provision of smoke-free zones for public servants.
In November 1981, the WA public service issued Administrative Instruction 709:
“An officer shall not, during the hours that officer is required to be on duty, smoke tobacco or any other substances-
- While attending to members of the public; or
- While carrying out official duties in the presence of any member of the public; or
- In such other circumstances and the Permanent Head determines are inappropriate.
Effective from November 25, 1981.”
In May 1982, Canberra public servant, Mr Roy Bishop, was successful in his worker’s compensation claim against the Department of Administrative Services for damages caused by tobacco smoke and was awarded $8,000 in damages. This was the first official recognition of the hazards of passive smoking in Australia. ACOSH generated massive publicity about this decision.
Advocacy for Tar and Nicotine labelling on cigarette packets
ACOSH in partnership with the Anti-Cancer Council of Victoria (ACCV) advocated to the Federal Minister for Health that each cigarette brand should be labelled with its tar and nicotine content.
On 12 November 1981, the Federal Minister for Business and Consumer Affairs announced an agreement with the tobacco industry for the voluntary tar and nicotine labelling of cigarette packs. ACOSH viewed the agreed voluntary labelling as deficient because of the absence of a limit for tar and nicotine levels. The Council resolved to lobby all health Ministers for a more appropriate labelling system.
In June 1982, the Council had received information that the machine measured levels for tar and nicotine content, that would appear on the outside of the cigarette pack, were lower than those delivered to a human smoker. The tar and nicotine levels derived from a smoking machine differed from human smoked levels because human smokers occlude the ventilation holes in the filter or crush the filter with the same effect, thereby inhaling higher levels of tar and nicotine. The Council resolved to pursue this matter further.
The voluntary agreement to label packets with the levels of tar and nicotine came into force in August 1982.
Advocacy to Local Governments
In the early 1980s, the City of Fremantle adopted a comprehensive suite of tobacco control strategies including:
- Preventing cigarette advertising in areas under their control – billboards, perimeters of sporting grounds in Council ownership, prevention of promotional distribution of free cigarettes in public places in its area.
- Restrict the siting of cigarette vending machines to licenced premises.
- Prohibit smoking in any of its health care institutions except in designated areas.
- Progressively regulate to create smoke free zones in public places under its control, beginning in premises in which food is sold.
ACOSH resolved to urge other local governments to follow the example set by Fremantle.
Policies recommended to local governments included prohibition and/or control of:
- Tobacco advertising in local government areas.
- Tobacco product vending machines.
- Smoking in public places.
- Sale of tobacco products in local government areas.
Advocacy for smoke-free restaurants
In conjunction with the Non Smokers’ Movement under the leadership of Dr Ian Wallman, ACOSH surveyed restaurant proprietors to establish their views on smoke-free areas being provided within their restaurants and to promote patronage of those businesses that had made this change.
In 1986, ACOSH published a smoke-free restaurant guide which proved to be popular with locals and tourists, particularly during the America’s Cup event held in Fremantle. The guide provided advice on smoke-free hotels, airlines, bus lines, taxis, Government and Municipal facilities.
Estimate of premature deaths caused by smoking in Australia
In 1981, ACOSH commissioned Dr Bruce Armstrong and Dr Nick De Klerk to estimate the number of premature deaths caused by smoking each year in Australia. They estimated that 10,434 deaths were caused by smoking, and the Council used this estimate to emphasise the importance of tobacco control activities conducted by state and federal governments.
For example, ACOSH wrote to the WA Minister for Health, Hon Ray Young MLA, pointing out that it was inappropriate for the WA government to continue to allow cigarette advertising on government buses when 1,000 WA citizens died prematurely each year as a result of cigarette smoking.
A few months later, the Federal Minister for Health indicated the Commonwealth Health Department believed the estimate of 10,434 deaths by Armstrong and De Klerk was conservative; the Commonwealth Department’s estimate was 16,000 death per year.
The impact of smoking in Western Australia and nationally
ACOSH consistently placed a strong emphasis on the scientific basis for its work, and was directly involved in a range of peer-reviewed academic publications.
ACOSH led the rest of Australia in estimating the health effects of smoking. In 1985, Professor D’Arcy Holman and ACOSH Executive Director Ruth Shean published in the Medical Journal of Australia the “Premature adult mortality and short‐stay hospitalization in Western Australia attributable to the smoking of tobacco, 1979‐1983“.
In men, it was estimated that 25% of all deaths were attributable to smoking. In women, the corresponding proportions were 15% of deaths. In all, tobacco‐related disease and injury accounted for around 1700 deaths and 7500 short‐stay hospitalisations each year in a population of 1.4 million persons.
Estimates of the proportions of total deaths and premature adult mortality, and short-stay hospital admissions and bed days attributable to smoking were used to draw attention to the magnitude of the problems caused by smoking and enabled the Council to press for changes in policy and legislation.
The publication of this paper in the Medical Journal of Australia caused great concern for the Tobacco Institute of Australia, because it generated coverage in most Australian newspapers on the deaths caused by smoking compared to other common causes of death.
The Institute’s lawyers Clayton Utz unsuccessfully urged the Trade Practices Commission to take action against ACOSH, claiming that statements made were “… likely to mislead or deceive within the meaning of Section 52 of the Trade Practices Act …”.
This report was one of many produced by Professor Holman that provided new and compelling ways of communicating scientific data on the harmful effects of smoking.
“So there are grounds for optimism – but the toll is great and the battle is far from over. If present trends continue, by the end of the century nearly half a million Australian’s who are now alive will have died because they smoked. Again on the basis of present trends, in Australia approximately 265 000 boys and 159 000 girls who are currently under the age of 14 years will die prematurely of smoking.”
(Holman CDJ. Smoking 2000. Projections of deaths caused by smoking in Australia in the absence of effective interventions. Perth: Health Department of Western Australia, 1987.)
ACOSH activities and reports feature prominently in once-confidential tobacco industry documents.
In another example, ACOSH and the AMA held a dramatic press conference to release a report on the number of body parts surgically removed each year as a result of smoking based on the work by Professor Holman.
The role played by the AMA WA in advocating for changes in legislation and policy to reduce smoking cannot be underestimated. Lobbying activities of the AMA WA were presented by their successive Presidents and led over many years by their determined CEO Paul Boyatzis.
WA’s first smoke-free day
ACOSH supported WA’s first Smoke-Free Day on Wednesday 10 November 1982 that was implemented by the WA National Heart Foundation.
The WA Heart Foundation’s ‘Smoke Free Day’ was the forerunner to WA’s Quit Campaign conducted from 1983 by the Health Department’s Smoking and Health Project Team (led by Debbie Fisher, who had previously worked for the National Heart Foundation, in the new Health Promotion Services Branch, led by Dr. Charles Watson).
Prohibition on the sale of smokeless tobacco products
In late 1987, there was speculation that the tobacco industry had been given an assurance by the then Prime Minister that smokeless tobacco products would be permitted to be marketed in Australia. This was despite the fact that the Minister for Health (Dr Neal Blewett) had urged a ban on smokeless tobacco in accordance with the National Health and Medical Research Council (NHMRC) recommendations.
The sale of smokeless tobacco would have required an exemption under the Poisons Act. ACOSH Councillors lobbied many federal ministers to prevent this from happening. A short time later, the Commonwealth and all states and territories introduced regulations to ban the sale of smokeless tobacco in accordance with recommendations from the NHMRC.
5th World Conference on Tobacco and Health, Winnipeg, Canada
In 1983, ACOSH Education and Research officer Mr Woodward attended the 5th world Conference on Tobacco and Health, Winnipeg, Canada, and reported to the Council that WA was a leader in the western world with its approach to legislation and smoking and health programs, particularly the role played by medical practitioners in supporting these initiatives.
A short time following his attendance at the 5th World Conference, Steve Woodward was instrumental in establishing Action on Smoking and Health (Australia) in Melbourne.
National Survey of smoking among secondary school students
In partnership with the Anti-Cancer Council of Victoria (ACCV), ACOSH sought funds from the Cancer Foundation and the Alcohol and Drug Authority for a national survey of smoking among 12-17-year old secondary school students. The survey was conducted in June and July 1984 by its then Executive Director, Ruth Shean. The survey included questions on alcohol use as this was deemed to be one method of increasing honesty from young people when reporting smoking behaviour. Staff from the Australian Bureau of Statistics’ Perth office were used for this purpose, employed under contract to ACOSH.
The prevalence of current smoking (at least one cigarette in the past week) rose with age to 34% among girls and 29% among boys at 15 years of age.
The Anti-Cancer Council of Victoria replicated the survey in 1987 and worked with ACOSH and the WA Health Departments Smoking and Health Project Team to do so.
The Australian Secondary School Alcohol and Drug Survey (ASSAD) has remained one of Australia’s most important surveys for measuring the prevalence of smoking among young people.
In 1984, the Council resolved to allocate $3000 to the purchase of tobacco company shares: 110 each for Amatil, Rothmans, Philip Morris and RJ Reynolds.
This grant allowed for the purchase of one hundred shares in each of the companies – one hundred shares being the minimum “marketable parcel” permitted at that stage through the Australian Stock Exchange. These were then re-sold off the Stock Exchange in parcels of three shares each to members of ACOSH. This helped to offset costs of the original purchase, and also allowed for ACOSH members to receive shareholder information from the three tobacco companies. Although it was the intent that ACOSH holders would be able to attend to annual general meetings, in practice this usually provide to be too difficult to arrange as all AGMs were held on the eastern seaboard. In recent years, some former members of ACOSH have been shocked to find that they are still shareholders! When these shares have finally been sold, former shareholders have donated the proceeds back to ACOSH or other related health organisations.
Following the distribution of shares, ACOSH President Dr Kingsley Faulkner and Executive Director Ruth Shean attended the Amatil Annual General Meeting in Sydney on 6 February 1986 to ask difficult questions on smoking and health to the Board and Directors of Amatil. While they were not permitted to ask questions directly, abbreviated versions of the questions were read out and prepared answers were given in response. This provoked an uncomfortable situation for shareholders and tobacco executives attending the meeting, and also provided many excellent opportunities for subsequent media follow up.
Advocacy to influence health policies of political parties
The Executive Director of ACOSH and senior members of the ACOSH Executive met regularly with leading politicians and the Chairs of health policy committees of all parties to discuss the inclusion of tobacco control policies in their policy platforms. A prohibition on all forms of tobacco advertising and promotion was advocated as a priority, as well as other strategies endorsed by the World Health Organization and the Union for International Cancer Control (UICC).
In the lead up to the 1983 State Election, ACOSH wrote to all candidates and asked them the following questions to support the need for tobacco control legislation:
- Do you accept the estimate of the Federal Minister for Health that cigarette smoking causes approximately 16,000 deaths annually in Australia (per capita this translates to 1,150 in WA annually)?
- If elected will you support legislation to increase the penalty for selling cigarettes to minors?
- If elected will you support legislation preventing the promotion of tobacco products?
- If elected will you support increasing the retail licence fees for cigarette retailers in order to provide money for programs designed to reduce the incidence of smoking-caused diseases?
Draft motions in relation to health policy positions were prepared by ACOSH for consideration of the state conference of the National Party WA in August 1985. ACOSH was successful in influencing the National Party to include education programs, health warnings, and some restrictions on advertising content, but not the advertising bans, price increases on tobacco products or agricultural tobacco subsidies.
People Behind the Statistics
In 1985, ACOSH worked with the WA Health Department’s Smoking and Health Project to produce a booklet “People behind the statistics” that described in graphic detail the impact of smoking on the lives and health of ten individuals. All ten people featured in the book had become strong anti-smoking campaigners – although a few remained heavy smokers.
On Quit Day in 1986, the Federal Minister for Health the Hon Neal Blewett AC launched “People behind the Statistics“. This event received excellent media coverage and the booklet was one of the Quit Campaign’s most requested publications.
This photograph from the launch features Dr David Watson (President AMA WA), Dr Neal Blewett (Federal Minister for Health) and Mike Daube.
In 1986, ACOSH developed a smoking in the workplace manual in conjunction with the ACT office of the National Heart Foundation to assist workplaces in the negotiation and implementation of smoke-free policies. The Manual was produced for occupational health nurses, Commonwealth, State and Local Government officers, hospitals, and other interested organisations.
ACOSH Director Ruth Shean also published in peer-reviewed journals on the theoretical and practical considerations for implementing smoke-free workplace policies.
Smoking Death Cards
In the late 1980s, the Australian Medical Association WA and ACOSH coordinated the Smoking Death Cards project to reinforce for Members of Parliament the magnitude of the problem caused by smoking. Doctors confirmed deaths that had been caused by smoking; and the cards were mailed to the State members of parliament in whose electorate the patient lived. This project generated massive local media coverage.
Doctors played a leading role in persuading politicians to take the legislative action necessary to control the smoking epidemic.
Informal communication with members of parliament confirmed that this single strategy was extremely effective in prompting their personal action. It is highly likely that this initiative alone was in part responsible for some MPs being prepared to support legislation for the cessation of cigarette advertising when it was next tabled in parliament.
Christmas Media Releases
ACOSH took advantage of the low news period over Christmas, and used this time to draw attention to newsworthy if creative stories about smoking such as the “crocodile death comparison”. This particular story which admittedly had a rather Australian flavour to it, gained widespread international coverage. As each country became aware of the statement it received news coverage in the local media. This meant that the “crocodile death comparison” story circulated the world for nearly six months, by which stage the Australian media had forgotten about it and ran it again! It was the most reprinted ACOSH media release from 1984-1989.
It preceded the Smoking Death Clock. Following the exceptional international coverage, it was also decided to feature it in this way – such was the novelty of the comparison.
Smoking Death Clock
Many ACOSH advocacy activities during the 1980s were coordinated by then ACOSH Executive Director Ruth Shean, Dr Bill Musk and Dr Kingsley Faulkner and supported from the Health Department by Mike Daube, Charles Watson, Maurice Swanson and others.
As part of the 1985 Quit Campaign, the Smoking Death Clock was launched by Mike Daube and Debbie Fisher on the Horseshoe Bridge in Central Perth.
The Smoking Death Clock recorded the number of deaths caused by smoking in Australia during the year. For its first two days the Death Clock received front page coverage in The West Australian Newspaper and was the leading item on television news programs. Within two weeks of the clock’s unveiling, more than 50% of smokers had seen or heard about it.
Prior to the launch of the Smoking Death Clock, ACOSH had calculated that ‘Smoking kills more people in Australia than the total number killed by drink, drugs, murder, suicide, road accidents, rail accidents, air accidents, poisoning, drowning, fires, falls, lightning, electrocution, snakes, spider, sharks and crocodiles.’
The Death Clock concept and the calculation on the impacts of smoking were replicated by many other health organisations around the globe.
Smoking body parts media conference
Another creative media release was the summary toll from body parts due to tobacco smoking. Professor D’Arcy Holman calculated the number of body parts removed through surgery for this reason in any one year. ACOSH released this information in a media release, and also staged a media conference featuring Professor Fiona Stanley and AMA President Dr Mike Jones. Dr Bill Musk made arrangements for the provision of one of each of the body parts in “jars” which he had sourced courtesy of the QEII Medical Centre. This graphic display once again attracted international attention. Closer to home, the ACOSH staff were returning the jars to the hospital when the car was involved in an accident. Police were surprised to see the human toll!
The maturity of creative campaigning
Initially, the work of ACOSH focussed around letters to the media, occasional media releases, submissions to government and information on damage relating to smoking. The second half of the 1980s saw the introduction of mainstream lobbying and campaigning. ACOSH members, each of them credible experts in their own fields, became involved in personal representation, especially in meeting members of state parliament. A former senior politician whose party had previously not supported a ban on tobacco advertising later said that it was one of his enduring regrets that he had taken this stance.
By the mid 1980s, media expert Joanne Fowler, who was primarily working with the AMA, joined the ACOSH team through the support of the AMA. This ensured that ACOSH media releases were well written, well targeted and received maximum coverage. ACOSH members and staff became respected media contributors. In the early days of campaigning, ACOSH staff would call radio “talk-back” shows to have their say. Over time, these actions gave way to better organised and coordinated media activity.
Cough up an ad
Such was the relationship between ACOSH and the local newspaper, The West Australian, that The West offered to run a children’s anti-smoking competition. Children were invited to design and submit art works which encouraged smokers to quit.
The result was astounding, with whole schools rising to the challenge, the newspaper made many features of the winning entries, and while not many of them may have inspired adults to quit, ACOSH was confident that the amount of glued-on cigarette butts would have discouraged most of the children from smoking for life!
Fire safe cigarettes
ACOSH advocated to the Commonwealth Department of Health for removal of the incendiary additives for cigarettes. This followed similar moves in the United States, where the Federal Government and State Governments were being actively encouraged to protect the public by prohibiting the sale of cigarettes that cause fires and many deaths. This change eventually came into law in Australia through the Trade Practices (Consumer Product Safety Standard) (Reduced Fire Risk Cigarettes) Regulations 2008.
Legal action against the tobacco industry: Ruth Scanlan v. Rothmans of Pall Mall 1986
“Ms Scanlon smoked the defendants’ cigarettes for about 20 years. She alleged that throughout that period the defendants knew or ought to have known of the carcinogenic qualities of its cigarettes. She further alleged that notwithstanding their knowledge, the defendants continued to manufacture and advertise their cigarettes and failed to warn purchasers that cigarettes were addictive and that there was a real risk that smoking would cause illness, including lung cancer and premature death. Ms Scanlon alleged that warnings that were given were inadequate and too late; further, that even after warnings were placed on packs, the defendants reassured the public that smoking would not cause grave consequences to health.”
(Source: Campaign for Tobacco Free Kids)
ACOSH promoted this legal case and Councillors wrote many letters to newspapers lamenting the tragedy to this patient and the community of the case being withdrawn due to ill health.
Alternative Tobacco Company Annual Report 1987
ACOSH Executive Director Ruth Shean developed an Alternative Tobacco Company Report to publicise the estimated number of deaths caused by each tobacco company operating in Australia.
“Each year, tobacco companies issue to shareholders an annual report which speaks proudly of cigarette sales and promotions throughout the year. The medical profession believes that these annual reports are cynical in the extreme, given that more than 23 000 Australians die each year because they have smoked. Accordingly, an alternative report has been produced. This report is the type of report which doctors believe should be issued.”
The report was launched at a media conference hosted by the Royal Australasian College of Physicians in Sydney on 22 September 1987 where Ms Shean also represented the Australian Cancer Society and the Clinical Oncology Society of Australia. Representatives from the National Heart Foundation of Australia and the Thoracic Society also participated in the media event. Extensive media coverage was generated and 1000 copies of the report were distributed to Australian parliamentarians and national and international health organisations.
Yul Brynner TV advertisement
As part of the 1985 Quit Campaign, the Health Department WA featured a TV advertisement adapted from the American Cancer Society featuring the late Hollywood actor Yul Brynner. In this powerful advertisement, Yul Brynner spoke about his own lung cancer and said, “Whatever you do, just don’t smoke.” In a comical series of event, the Australian Broadcasting Tribunal, which had previously approved the advertisement, withdrew its approval at the eleventh hour, on the basis that foreign actors in advertising might deprive Australian actors of jobs. Health Minister, Ian Taylor held a major press conference that resulted in massive national and state coverage, further reinforcing smoking as the leading cause of lung cancer.
Reminding the community and politicians about the dangers of smoking
ACOSH continued to generate media coverage of the major health effects of smoking. For example, a report was produced for each member of parliament showing the full impact of smoking in all West Australian electorates that had a real impact on local politicians. The report was produced by Dr Konrad Jamrozik and was based on a similar approach taken in Scotland.
Dr Jamrozik also launched the 1989 Quit Campaign with Dr Warwick Ruse, the then President of the AMA (WA), with a graphic presentation to demonstrate the ‘Smoker’s Odds’ for conditions such as bad breath, being puffed out, having empty pockets, and smokers cough.
ACOSH sponsors during the 1980s
It would be remiss to itemise the achievements of ACOSH during the 1980s without acknowledging the major supporters from this period, support without which would not have given ACOSH the capacity to campaign which was instrumental in the major legislative achievement of the 1980s – The Tobacco Control Act.
First and foremost, the Cancer Foundation of Western Australia [now the Cancer Council of Western Australia], under the direction of Clive Deverall, was the major sponsor throughout the 1980s. CFWA provided office space and secretarial support to ACOSH throughout, as well as advice and equipment. In offices first at 705 Murray Street, West Perth, and then, in 1987 at 42 Ord Street, West Perth, ACOSH meetings were held and a single office – initially very small [705 Murray] and then larger with its own entrance [42 Ord] was provided for the ACOSH team. Clive’s moral support and total commitment was a key factor in the success of ACOSH over the years.
Staff from the Health Department of WA were key supporters also, for equipment, administrative and design support, and intellectual support and stimulation. Dr Charles Watson, a former HDWA executive director, was responsible for the computerisation of the ACOSH office. He provided the first computer to ACOSH – the fore-runner of an Apple computer which worked as a word processor. Many government submissions were prepared on this computer, despite its user-unfriendly word processing software [Zardax] and its resistance to working in cold weather which often required a hairdryer to get it going! The Apple computer printed through a daisy wheel typewriter, and later a very basic printer. We always suspected that these items were surplus to requirements in the Department, and duly returned them when they were no longer required. Charles subsequently provided ACOSH with two IBM computers which used Word Perfect – a vast improvement on Zardax, and more modern printers were purchased over time. Charles’ team in Health promotion was initially run by Prof Michael Daube, himself later a Commissioner of Health and a strong supporter of ACOSH to this day. He and his Health Promotion colleagues – Maurice Swanson, Tahir Turk, Addy Carrol, Debbie Fisher, Betty Durston, John Belheradsky and others were extraordinarily helpful with production of resources and communication. Some of their best work is mentioned in these pages, such as the Alternative Annual Report, and People Behind the Statistics. D’Arcy Holman, Executive Director of Epidemiology during this era, was similarly helpful in assisting ACOSH calculate the costs of tobacco smoking – in its broadest interpretation. His advice on the use of aetiological fractions led to a quasi-scientific approach to much of the work of ACOSH in the media, as evidenced by the “crocodile death campaign” media statement. There were many such creative examples as well as some more serious applications on the part of ACOSH.
It would be remiss not to name some of the ACOSH Councillors who were involved on a daily basis. They included Kingsley Faulkner [Chair and constant support], Bill Musk [Secretary, honorary minute taker and campaign adviser], Bruce Armstrong [research adviser], Konrad Jamrozik [research advisor and will helper on every task including carpet laying] and many others. Being an ACOSH Councillor meant being available daily to assist with whatever task called for expert assistance.
Finally, the core ACOSH team during this period achieved great outcomes in constrained circumstances – Suzannah Carter, Glenice Porter, Joanne Fowler, Juan Crawley, Debbie Crowle, and Tricia Edwards [and various other staff who despite a strong work ethic, could never quite tame Zardax the beast – the word processing software for the Apple computer]. Although there were many volunteers, the one who stood head and shoulders above all was Ivy Cunningham – a stalwart retiree who would walk to the office several days a week to assist with filing and photocopying. Ivy was our arms and legs and sense of humour.
Tobacco Control Act 1990
During the late 1980s, legislation to end tobacco advertising and promotion remained the focus of advocacy efforts by ACOSH. Following the experiences in the early 1980s, there were four major hurdles to overcome: memories of the 1983 defeat, the need for bipartisan support in the Upper House, concerns about possible impacts on State tobacco revenues, and the perceived reliance of sports and arts organisations on tobacco sponsorship.
ACOSH’s campaign for legislation received a vital boost in 1987 with the passage of the Victorian Tobacco Act. The Victorian tobacco coalition, led by Dr Nigel Gray, developed an approach that combined a ban on tobacco advertising with a tobacco tax increase which would fund a Health Promotion Foundation to replace tobacco funding and fund health promotion programs – as well as providing the Government with additional revenue from a ‘virtuous’ tax. This approach neutralised the tobacco industry’s strongest arguments and supporters.
Opinion surveys were run, and their results published. Key politicians were visited, phoned and mailed by health organisations and constituents who were mobilised to inundate politicians and media with letters. ACOSH Executive Director Ruth Shean creatively developed new letterheads to ensure that every possible organisation was seen to be playing its part by lobbying politicians. ACOSH Chairman Kingsley Faulkner approached chairs and CEOs of these organisations and sought their engagement. Support was enthusiastic and widespread. The Headmaster of Hale School, cricket legend John Inverarity, agreed to head a community group called SWATS – Sport Without Any Tobacco Sponsorship. This was a useful foil for the tobacco industry which insisted that a ban on tobacco advertising would be the death of sport in Western Australia. It was around this time that the Victorian legislation was conceived, and the concept of a fund from tobacco tax to replace lost sports sponsorship was born.
In February 1989, Dr Hilda Turnbull has been elected to the WA Legislative Assembly, representing the electorate of Collie. Dr Turnbull, a former colleague of Dr Musk’s, agreed to support any legislative attempt to ban cigarette advertising. Following passionate lobbying by National Party MP Dr Hilda Turnbull, the leader of the National Party, Hendy Cowan, committed his party to support a similar approach to that taken in Victoria.
This support from within National Party ranks was significant, and along with the commitments from individual parliamentarians which followed the Smoking Death Cards initiative, led ACOSH to believe that there would be a majority in the WA State Parliament to support a cigarette advertising ban. In winter 1989, Mike Jones, AMA President and Paul Boyatzis, AMA CEO met with Premier Peter Dowding. They assured him that a cigarette advertising ban had significant support in the WA Parliament and that Dr Turnbull was prepared to introduce the Bill. Premier Dowding responded by saying “If anyone is going to introduce this Bill, it will be me”.
Premier Peter Dowding then announced that the Labor Government would introduce Victorian-style legislation, which was introduced in the Parliament by Health Minister Keith Wilson.
A frenetic period of lobbying followed the introduction of the Bill. ACOSH coordinated lobbying from health and medical organisations in support of the Bill.
In contrast, the tobacco industry brought in recipients of tobacco funding, tried to persuade media, sports and arts organisations that they would lose out, and threw mud and money wherever they could.
But while the tobacco industry had the big money, its spokespeople gave tobacco control advocates some easy targets. Ron Berryman, head of the Tobacco Institute’s Perth office, said in 1989, ‘Irrespective of how many children take up smoking in a year, no-one’s immortal – everyone dies sooner or later’ and ‘(Cigarettes are harmful, but …) so are potatoes. Tobacco is in the family. You inhale the fumes of potatoes when you’re cooking them.’
ACOSH brought to Western Australia experts to speak about the benefits of an advertising ban, whether in Victoria or Norway. Sympathetic leaders and organisations in sports, the arts and community organisations were harnessed to support the Bill.
Unlike the earlier attempts in 1982 and 1983, the Tobacco Control Act 1990 was passed into law and proclaimed on 1 February 1990.
The major provisions of the Act prohibited most forms of tobacco advertising under State control such as tobacco advertisements published in Western Australia, outdoor billboards and tobacco advertisements that dominated the outside surfaces of retail outlets. Importantly, the Act allowed tobacco advertising inside shops only if the advertising was sited directly adjacent to where the tobacco products were displayed for sale. However, the Act gave the Minister for Health the power to ensure these advertisements complied with certain conditions regarding their size and whether they displayed a prescribed health warning.
Schemes and competitions designed to promote the sale of tobacco products were declared illegal, as was the distribution of free samples of tobacco products. Sponsorship of activities by tobacco companies was made illegal, but the Minister for Health was provided with the power to exempt certain events.
All tobacco sold in Western Australia was required to be labelled in accordance with regulations that described health warning statements and any other information the Minister deemed relevant.
The Tobacco Control Act also established the West Australian Health Promotion Foundation ‘Healthway’ which provided dedicated funding for health promotion programs and research.
After the passage of the Tobacco Control Act in 1990 and its promulgation in early 1991, the focus of tobacco control advocacy in Western Australia shifted to ensuring effective implementation of the legislation. ACOSH identified other major priorities for advocacy including second-hand smoke, tobacco taxation and possible litigation against the tobacco industry.
The Health Promotion Foundation Healthway, and its inaugural Director Addy Carroll, made crucial contributions to advocacy organisations and activity through replacing tobacco advertising and promotion and funding health agencies directly and indirectly involved in advocacy.
The dangers of secondhand smoke
A seminal 1981 paper by Japanese epidemiologist Takeshi Hirayama clearly demonstrated the dangers of secondhand smoke and was followed by a flood of further evidence in this area. Second-hand smoke (the inhalation of environmental tobacco smoke) emerged as a strong influence on policy-making by governments, business and decision-making by individuals and became a crucial advocacy battleground.
ACOSH assisted in the development and promotion of policies on passive smoking and health in partnership with organisations such as the Thoracic Society of Australia.
In Australian Federal Courts an action coordinated by Steve Woodward of ASH Australia challenged advertisements under the Trade Practices Act (Australian Federation of Consumer Associations (AFCO) vs. the Tobacco Institute of Australia (TIA)). The case continued over many years with contributions from West Australian expert witnesses including ACOSH councillors Professor Peter Le Souef and Professor Louis Landau.
Justice Morling’s 1991 Judgement on AFCO vs TIA in 1991 found that, in publishing a particular advertisement stating that “there is little evidence and nothing which proves scientifically that cigarette smoking causes disease in non-smokers”, the TIA had engaged in misleading or deceptive conduct in breach of section 52 of the Trade Practices Act 1974.
Justice Morling concluded that second-hand smoke was a cause of lung cancer, respiratory disease in children and attached of asthma. This landmark decision was the impetus for widespread advocacy in Western Australia, and elsewhere, for the expansion of non-smoking policies to worksites, shopping centres, TAB outlets, restaurants, airport terminals, healthcare settings and other indoor public places.
Throughout the 1990s, ACOSH encouraged and supported the expansion of smoke-free places, through the following activities:
- Workplace surveys and programs.
- Surveys of smoke-free areas in restaurants
- Advocacy for amendments to the Food Hygiene Regulations (WA Health Act) to create smoke-free areas in all indoor eating areas serving food at tables.
- Publication and promotion of the guide ‘Going Smoke-free: A Guide for Restaurant Managers’.
- Advocacy for smoke-free international air travel (implemented in 1996).
- Conducted a research project funded by Healthway which tested whether simple advice from a Professor of Paediatrics and a Specialist Paediatric Respiratory Physician would prompt families of children recently admitted to hospital with an acute respiratory complaint to declare their homes smoke-free.
- Research and advocacy to support aged-care facilities to implement smoke-free policies.
- Alerting business owners to the benefits of lower insurance premiums for businesses that implemented smoke-free policies.
- Promoted Subiaco Oval and the WA Cricket Association grounds to become totally smoke-free facilities.
- Generating extensive media coverage about the dangers of secondhand smoke and the benefits of smoke-free policies.
- Advocacy for smoke-free prisons
Burswood International Casino
In 1993, ACOSH councillors also supported the WA Department of Occupational Health and Safety to pursue a breach of the Occupational Health and Safety Act by the Burswood Casino in relation to staff exposure to secondhand smoke. Tobacco company Philip Morris was closely involved in supporting the Burswood Casino in this case heard in the Perth Magistrates Court. The Casino engaged consultants who attempted to shift focus away from secondhand smoke as a hazard with the concept of ‘sick building’ and ‘indoor air quality’, asserting that other pollutants and inadequate ventilation were at fault. Court action by Occupational Health and Safety authorities saw the now-familiar appearance of experts with a history of research funded by tobacco companies providing evidence denying the effects of second-hand smoke.
Later, in 1999, ACOSH in alliance with the Australian Liquor, Hospital and Miscellaneous Workers Union, organised the testing of Burswood Resort Casino workers to determine the impact of secondhand smoke during their shifts. Workers at the casino attributed various respiratory symptoms suggestive of airway irritation to their exposure to secondhand smoke at work, even in areas designated as non-smoking. The research included sixty-five workers who completed tests before and after their shifts to measure changes in lung function and cotinine levels in their blood. Consistent with the presence of symptoms the results showed small but statistically significant changes in lung function in smoking areas, after the effects of diurnal variation in lung function were adjusted for in the analysis. ACOSH used these results to further press the Casino to implement comprehensive smoke-free policies.
Seventh World Conference on Tobacco or Health
The Health Department of Western Australia successfully hosted the Seventh Worth Conference on Tobacco or Health in Perth in 1990, which attracted over 1000 delegates, many from other countries including their Health Ministers. ACOSH made an important contribution to the planning and implementation of the conference.
NHMRC Reports on the health effects of passive smoking
ACOSH councillors, Dr Bill Musk and Dr Konrad Jamrozik made major contributions to the National Health and Medical Research Council (NHMRC)’s review of the 1986 Report on Passive smoking. The tobacco industry devoted considerable resources to undermining this review and ultimately took legal action against the NHMRC for its consultation process. Despite a concerted effort by the tobacco industry to delay and discredit the NHMRC’s review, the report was finally published in 1997 and further consolidated the evidence on the health effects of passive smoking.
Passive Smoking Task Force Report
WA Health Minister in 1995, Hon Graham Kierath, implemented a bold move to ban smoking in all enclosed workplaces. He had some doubts as to whether his Cabinet colleagues would support this measure, so took the regulations to a meeting of ExCo (the State’s Executive Council at which the Governor formally signs regulations into existence) where he had hoped – rightly as it turned out – that the other Cabinet members present would not have bothered to read the papers ahead of the meeting and as a consequence, the regulations were passed into law.
ACOSH strongly supported Minister Kierath, but unfortunately he was not supported by members of his government. In addition, some hospitality organisations, particularly the Australian Hotels Association, vehemently opposed these changes for pubs and clubs.
To manage these opposing interests, the Government of Western Australia announced on 24 August 1996 that it would establish a Task Force on Passive Smoking in Public Places to “among other things, identify and assess both regulatory and non-regulatory strategies designed to minimise the community’s exposure to passive smoking in public places.” In announcing the Task Force, the then Minister for Health said, “there is now conclusive scientific evidence and substantial public concern about the health risks for non-smokers exposed to tobacco smoke.”
At the same time that the Task Force was deliberating on this issue, in October 1996, one year before the Task Force reported, a coalition of health agencies in WA including ACOSH, the AMA WA, the (then) Cancer Foundation of Western Australia and the National Heart Foundation of Australia WA launched a campaign for a Smoke-Free State. The Campaign had fifteen objectives, four of which related directly to the following becoming smoke-free: workplaces, public places, educational institutions, cafes, restaurants, hotels and entertainment venues.
ACOSH, through its Chair Dr Konrad Jamrozik, made a significant contribution to the deliberations of the Task Force. In its report published in October of 1997, the Task Force on Passive Smoking made twenty-two recommendations. Central among these was a recommendation to “… ensure uniform protection across the entire community, all enclosed public places (except bars) where children have legal access (whether or not children are present) should become smoke-free from 1 August 1998”. This recommendation applied particularly to restaurants and food service areas. Other recommendations relating to bars, nightclubs and the Burswood Casino recommended incomplete prohibitions, with the application of ventilation as a method for reducing the effects of secondhand smoke, and varying timetables for their introduction. These recommendations, as they applied to the hospitality industry, were inconsistent with the new requirements under the Occupational Health And Safety Act 1984 for enclosed workplaces to be smoke-free. Another inconsistency was an agreement by the Chairman of the Task Force, and all Task Force members other than the Australian Hotels Association, that ventilation was not a solution to the problems created by secondhand smoke.
The Western Australian Government responded to these inconsistencies and to advocacy from health organisations by introducing amendments to the Health Act 1911 to create part IXB of this Act entitled ‘Smoking in enclosed public places’, and enabled the creation of associated regulations. These regulations required all enclosed public places to be smoke-free from 29 March 1999. There were, however, exemptions permitted allowing smoking in specified areas of the hospitality industry provided certain conditions were met. Exemptions were granted for hotels, taverns, and other licensed premises including licensed restaurants, nightclubs/cabarets, the Burswood International Casino and the Royal Western Australian Institute for the Blind (Inc.) Bingo Centre that permitted smoking in specified areas in accordance with specific conditions. Smoking was prohibited in all other enclosed workplaces by the Occupational Safety and Health Amendment regulations.
Advocacy for increasing the cost of tobacco
Growing evidence of the effectiveness of increases in the cost of tobacco in reducing demand and consumption of tobacco highlighted the need for increases in federal taxes on tobacco.
The Director of Quit Victoria, Michelle Scollo, and ACOSH Director Noni Walker worked together in preparing briefing papers making the case for regular increases in the tax on tobacco, as well as changing the tax on tobacco from a weight to a per stick-based system, that could be endorsed by a large range of leading health organisations. This initiative was supported by formal written submissions to the Federal Treasurer and senior Treasury officials outlining the economic and longer term health and social benefits of reform of the tax regime for tobacco.
Following a High Court Decision on the respective roles of the Commonwealth and States, in 1997 taxing powers over tobacco and alcohol became the sole domain of the Commonwealth. This removed an important avenue for local advocacy.
In 1999, the Federal Government changed the method of applying tax to cigarettes from one based on weight to a per stick-based system.
The Dirty Ashtray Award – National Tobacco Control Scoreboard
In 1994, ACOSH initiated the National Tobacco Control Scoreboard to recognise achievements in tobacco control by State governments and draw attention to deficits in policy-making and funding commitments. The scoreboard has become an annual event coordinated by the AMA and ACOSH to mark the World Health Organization’s World No Tobacco Day (31 May). The state scoring the highest points earns the Best Performance Award while the state with the lowest points earns the Dirty Ashtray (an engraved ashtray complete with cigarette butts superglued to the glass). The National Tobacco Control Scoreboard achieves consistently good media coverage and prompts ministers in under-performing states to introduce new tobacco control policies and legislation for their jurisdiction.
Tobacco industry funding of medical and scientific research
“The key is not so much that the companies suppressed science (which they certainly did), nor even that they spent far more to promote cigarettes than to study their health effects— which is also true. The genius of the industry was rather in using even “good” science, narrowly defined, as a distraction, something to hold up to say, in effect: See how responsible we are? Look at how much research we are funding!”
Proctor, Robert N. Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition, University of California Press, 2012.
The Australian Tobacco Research Foundation was created and funded by the three tobacco companies operating in Australia during the 1980s, as a PR strategy to cast doubt on the overwhelming evidence that smoking caused disease. ACOSH along with other leading health organisations advocated against medical researchers and colleges of medicine accepting research grants and providing a forum for presentation of research funded by the tobacco industry.
In September 1993, ACOSH resolved to work with funding organisations including the National Heart Foundation, Cancer Foundations, and the NHMRC to have a set policy in place preventing institutional acceptance of tobacco industry research funding for medical and scientific research. This initiative was led by Dr Konrad Jamrozik, then Chair of ACOSH’s medical and scientific advisory committee.
Dr Jamrozik wrote to all not for profit health charities to adopt this policy and later to government funding organisations such as the NHMRC to insist that research applicants provided a statement proving that the investigator and/or their department or institution did not accept tobacco funds.
Due to persistent negative publicity, the medical community began to reject tobacco industry research grants, leading to the eventual closure of the Australian Tobacco Research Foundation in 1994.
Preventing youth from starting to smoke
Throughout the 1990s, ACOSH continued its advocacy for smoking and health education to be included in a comprehensive school health curriculum.
From 1990-1994, ACOSH was an active participant in the WA School Health Coalition. Working together, agencies in the health and education sectors sought to highlight the poor status of health education in schools and unhealthy school environments. Findings from the ‘Health Education in WA Schools’ Survey were promoted to the media and to parent groups and school councils. Development & distribution of a resource, What is a health promoting school? was facilitated by a Healthway grant in 1994 and activities continued in 1990s through the WA Health Promoting Schools Association.
In 1995, ACOSH coordinated a coalition of health organisations to apply for funds from Healthway to support a dedicated young people and smoking project. The project was awarded significant funding and following extensive market research adopted the ‘Smarter than Smoking‘ messaging that resonated well with teenage audiences. The program was led with effective television advertising, information materials, merchandise, sports sponsorship messages and appropriate school-based resources. In May 1997, the Smart Ways to Healthy School Conference, coordinated by the ‘Smarter than Smoking’ project, was attended by over 150 school teachers and generated good media coverage.
Campaign Evaluation from its inception in 1995 to 2005 found Smarter than Smoking was effective in achieving positive shifts in awareness, attitudes, intentions, and behaviour. Effectiveness of the program appeared to have been enhanced by sustained long-term funding, youth involvement in strategy development, and a strong research and evaluation base.
Poisons scheduling of nicotine in tobacco products
A proposal by ACOSH and the AMA WA on the need to review the exemption provided for nicotine in tobacco from scheduling in the WA Poisons Act was presented to the WA Poisons Advisory Committee on 26 October 1995 and released simultaneously at a media conference. This proposal caused great consternation for the tobacco industry worldwide and generated massive media coverage. Unfortunately, this proposal was not successful. If this proposal had been approved it would have allowed the government to control the nicotine content of cigarettes and all aspects of availability, marketing and packaging of tobacco products.
Coordinating strategic directions for tobacco control in WA and Nationally
In the late 1990s, achievements in tobacco control led to a perception in the community and among some public health advocates that:
- The tobacco industry was less visible and therefore a spent force (the Tobacco Institute of Australia closed its Perth office and took a lower profile approach to media in Western Australia).
- Tobacco control measures in place were sufficient.
- Attention and resources could now be directed to other seemingly more pressing public health matters.
There may also have been some complacency following achievement of the hard-won tobacco legislation. For these reasons and because of a natural wish by some to address other issues, it became harder for a while to engage politicians, the media, the community and, even public health policy-makers and practitioners in smoking and health issues. The need for further action, however, was obvious: tobacco remained the largest preventable cause of death and disease, the evidence on the dangers of secondhand smoke was increasing, tobacco companies and their allies, as might have been expected, were adept in finding loopholes in the legislation and developing new forms of promotion, and there were worrying trends in smoking among some sub-populations, particularly school children.
Recognising shifts in community and political attitudes and with strong leadership by its then Chair, Professor Konrad Jamrozik, ACOSH took a more proactive role in planning and coordinating strategic directions on tobacco control in Western Australia, facilitating agreement on priorities and roles of the key health organisations in the State. There was a strong emphasis and agreement on the ‘best buys’, strategies for which there was robust evidence of effectiveness and that represented efficient use of the limited resources available.
In July 1998, ACOSH developed a 10-point plan to promote key advocacy priorities for tobacco control in Australia. All of these measures were stridently opposed by the tobacco industry, despite an admission by Philip Morris Limited Australia that they believed many would be implemented by the year 2020.