Public health: ethical issues

Alcohol and tobacco are enjoyed legally by many people in the UK and other countries, despite their serious health risks.

Excessive drinking is associated with major health problems and also affects third parties, for example through drink-driving and violence. The number of deaths from medical conditions caused by alcohol consumption doubled between 1991 and 2005 in the UK. The Government has calculated that the cost of alcohol-related harms in England is £20 billion per year.

For tobacco, regular smoking of even a small number of cigarettes is harmful to the health of the smoker and people around them. In the UK, smoking was associated with one in six of all deaths between 1998 and 2002. Therefore, the banning of smoking in enclosed public places in the UK was a welcome development.

More coercive public health measures?

Increasing tax on alcohol and restricting the hours of sale have been shown to be effective in reducing alcohol consumption. Yet the Government’s alcohol strategy has focused on public information campaigns and voluntary labelling schemes – measures that have been shown not to be effective.

We conclude

Measures that have been found to be effective in reducing alcohol consumption should be implemented by the UK Government. These include increasing taxes on alcoholic beverages and restricting hours of sale.

Intervening in the home to protect children

The arguments in favour of banning smoking in public spaces can also be used to support banning it in homes where children are exposed to smoke. However, this would generally be extremely difficult to enforce without compromising privacy.

We conclude

There may be exceptional cases where children would be at such a high risk of harm from passive smoking, for example if they had a serious respiratory condition, that intervention in the home may be ethically acceptable, though any such case would usually need to be decided in court.

The role of industry

Corporate social responsibility is especially problematic in the case of the tobacco industry: the best strategy would simply be not to market the product. Nevertheless, we believe that the industry does have a role to play in harm reduction, particularly in an international context.

We conclude

Policies on selling and advertising tobacco and alcohol that provide the greatest protection to consumers should be adopted worldwide. The members of the UK Tobacco Manufacturers’ Association and other companies involved with tobacco products should implement a voluntary code of practice to achieve this.