Simon Chapman honoured as Skeptic of the Year: a good time to look back on the historic tobacco plain packaging campaign
Nov 25, 2013
The Australian Skeptics awarded their Skeptic of the Year award to Professor Simon Chapman (one of Croakey’s “founding fathers”) on Saturday night.
The Skeptic of the Year goes to the individual or group that has done the most for skepticism in Australia during the last year. The accompanying release announcing the award said:
“Prof Chapman, who is Professor of Public Health, Associate Dean Communications, Public Health, School of Public Health at the University of Sydney, has undertaken extensive research into the media’s communication of public health issues and demonstrated great concern through his efforts to improve the public understanding of important public health issues, including tobacco control, alcohol, swine flu, anti-vaccination beliefs and more. In particular for 2013, he was nominated for his recent research investigating the claims of so-called ‘wind-turbine syndrome’ and his activities to educate the public about the psychogenic aspects of the syndrome which have been clearly discounted.”
Here’s how they broke the news on Twitter.
And here’s an expanded response from Simon:
“I was just bowled over to get this award. My inexorable slide into skepticism started when I read Bertrand Russell’s Why I am not a Christian when I was very young. In public health, having a skeptical orientation to the Niagara of claims that are made about particularly complementary medicine, but also a depressingly large number of dubious claims made about mainstream medicine is fundamental. My recent work has been on exploring the Old Testament-like number of claims being made about the alleged ill health effects of wind turbine exposure. Here’s a collection of 232 problems that I’ve put together, http://tobacco.health.usyd.edu.au/assets/pdfs/publications/DiseaseListIntro.pdf.”
It’s an opportune time to publish the recent speech Simon delivered as the 2013 Cunningham Lectureto the Australian Academy of Social Sciences, Australian National University, on: Plain packaging of tobacco products: a case study in radical health policy adoption and the role of advocacy.
A precursor to the book he is writing about the landmark campaign, the speech is packed with sharp insights into how to design and pursue policy change, including how plain packaging even got on the agenda (“I doubt there was anyone in the room who expected that the proposal would have any life other than as an historic but merely “noted” recommendation in a report.) Simon looks at the role of research and multi-disciplinary academic expertise in informing and supporting policy change, the central role of news media in providing ‘foundational narratives’ over many years, and, of course, the instrumental role of the Health Minister Nicola Roxon, “the real super hero in all this”.
You can watch the speech being delivered here, or read the full transcript below.
Here’s Simon Chapman’s 2013 Cunningham Lecture:
On 1 December, 2012 Australia became the first country to implement plain packaging of tobacco products. The legislation was unopposed by the Opposition and supported by the Greens and all independents except Bob Katter.
No nation has ever mandated the entire appearance of packaging for any consumer product. So this historic legislation was at once exceptional and radical. It was also a massive threat to the transnational tobacco industry which quickly unleashed an unprecedented global campaign to try to defeat the Bill and deter others from following Australia.
Across a 35 year career in tobacco control, I’ve never seen anything like it. The tobacco industry spent well over $14 million on TV and other media campaigns. It was humiliated in a failed 6-1 High Court challenge. It encouraged corrupt and several puppet governments with zero tobacco trade with Australia to launch complaints in the World Trade Organisation. It funded folksy astro-turf retail groups, who dutifully screamed in high dudgeon about the catastrophic job losses that would occur when a policy that was repeatedly predicted to “not work”, actually would do what it was meant to do and reduce tobacco sales. And it donated to the Institute of Public Affairs where the resident errand boys dutifully telegraphed their masters’ voices about how the nanny state was now running amok.
In tobacco control we call these reactions ‘the scream test’ of policy potency. We’re amused when the industry supports anodyne, useless campaigns like these. And we know we’re on the right track when they behave as they did over plain packaging.
For over a century, this industry has packaged its carcinogenic products in highly consumer-tested boxes. These are designed to maximize their appeal and to distract from the grim consequences we know occur in a majority of smokers. We know from many internal tobacco industry documents and feature articles in almost every issue of every tobacco trade magazine that packaging is the front and centre of branding. Brand “personality” is built on brand name and packaging, and all other forms of promotion hang off it.
Plain packaging makes the unavoidable statement that — of all consumer goods — tobacco is exceptionally deadly and so deserving of the exceptional status that plain packaging signifies.
While the industry repeated endlessly that plain packs “would not work” and that there was no evidence it would, privately it was saying just the opposite: that it would devastate sales. To which the only reply of course was “well, that’s the whole idea, actually”.
Perhaps most amusingly of all, it advanced the reasoning that because no nation had ever introduced plain packaging, there was therefore no evidence that it would work, and therefore it should not proceed. In this, it drew from FN Cornford’s 1908 political science masterpiece Microcosmographia Academica in which we receive the sagacious advice that: “Every public action which is not customary either is wrong, or if it is right it is a dangerous precedent. It follows that nothing should ever be done for the first time.”
Australia, along with 177 other nations, is a signatory to the World Health Organisation’s Framework Convention on Tobacco Control. This obliges signatories to ban all tobacco advertising and promotion. After Gough Whitlam introduced the Bill to ban direct tobacco advertising on radio and TV that took effect in 1976, another 16 years passed before we nearly finished the job in 1992 with the Tobacco Advertising Prohibition Act. This ended all remaining forms except the most important of all: the pack itself. It is important to understand that plain packaging legislation is simply finishing that job off.
Smoking rates have been occasionally flat, but mostly falling since the early 1960s. Public awareness campaigns have conditioned community support for policies like advertising bans and plain packaging. But an individual’s decision to quit or not start can only crudely be attributed to single ingredients of policy and campaigns. Instead, all elements of comprehensive tobacco control work synergistically — in concert.
And here, it’s important to understand that the average fall in tobacco consumption (the amount of tobacco consumed) over the past 30 years has only been about half of one percent a year. The slide in smoking prevalence moves even more slowly. So plain packaging is like adding a slow burning log to that fire. It will keep the heat under the historic de-glamourising of smoking.
Smoking used to mean things like this.
It now means this.
It’s never been thought of as a policy that would suddenly wipe out smoking overnight. Nothing has ever worked like that. It’s about shifting perceptions of smoking in emerging new generations of young people who will now grow up never having seen a box stuffed with potent carcinogens packaged like a designer box of precious secrets. Any impacts on dedicated smokers are a bonus.
Statistics ‘to die for’
Today I want to give some insights into how this unprecedented and historic development happened. Early next year, I’ve the unenviable task of having to traipse over to the Rockefeller Centre at Bellagio on Lake Como, where I’ll be force fed Italian food and wine for a month in between finishing a book on how it all happened. In selecting what to emphasise today, I’ll highlight the role of research and multi-disciplinary academic expertise in informing and supporting policy change.
And I’ll talk particularly about the central role of news media in framing policy debates over the years about tobacco that provided foundational narratives for the plain packs debate when it recommenced in 2007. I’ll also talk about some related work I’ve done into the characteristics of Australian researchers regarded by their peers and policy makers as being “influential”, because this has been a great example of the public health research community influencing something very big.
But first, for any Rip van Winkles here today who may have missed it, let me explain the basics. Tobacco produces statistics to die for. David O’Reilly, the head of science at British American Tobacco, agreed last month that there were 50 million smoking-related deaths in the 20th century and that this was expected to reach a staggering one billion this century. Most of these will occur in low income nations where often illiterate smokers have little idea of the risks involved.
The most recent estimates of deaths from smoking-caused diseases in the mature epidemic we now have in Australia shows that two in three long term smokers will die, on average 10 years earlier than normal life expectancy because they smoked. But Dr O’Reilly emphasizes that “The world would be a poorer place without nicotine. It has helped people through world wars, the stress of everyday life, and it is helpful for people suffering from Parkinson’s and dementia. It’s a wonderful drug.”
This is a little but like arguing that the Titanic was a wonderful ship because the dance band and the caviar were truly excellent.
Lung cancer was a rare disease before the 1930s. By the late 1950s it had grown to become the world’s leading form of cancer death. And in nations like Australia which have taken tobacco control seriously, male lung cancer at least, has been on the wane since 1980. Female lung cancer rates seem unlikely to ever reach even half the peak rate seen in males.
The idea of requiring tobacco packs to be “generic” or plain, with brands distinguished only by their names on the box, was first suggested by a Canadian doctor in 1986. After a 1992 recommendation that it be adopted here, some early testing of its likely impact and advocacy for the concept in New Zealand, and an aborted attempt to introduce it in Canada in the 1990s, it went dormant for a decade as the tobacco industry successfully framed the proposal as a fools’ errand for any government to consider. The industry succeeded in frightening governments into believing they would face massive compensation bills when courts determined that the companies’ intellectual property had been confiscated by laws that suppressed the use of trademarks and colours.
But in August 2012, the Australian High Court ruled 6-1 that this argument was nonsense. There is a right to register a trademark and to prevent others from using it, but there is no right to use a trademark.
In 2006, with others, I started a National Health and Medical Research Council project grant on “the future of tobacco control”. In August 2007 we published a review of the limited experimental evidence on the idea, together with insights into the importance of packaging found in internal tobacco industry documents and its retail trade press where there was no hesitation in talking about packaging as a major promotional strategy.
There we found statements like these:
In public health research, the whole idea is to produce work that is useful to informing public opinion and leveraging policy interest about control options. I’ve never seen any sense in spending four years researching and publishing work that will only be read by a few hundred colleagues closeted behind journal subscription paywalls. So I often push my research, distributing it to relevant people and writing journalistic pieces to accompany the publication of my research papers.
We circulated our paper widely among Australian colleagues and to some 5,000 members of a global internet listserv. My sense was that the main objective at the time was to first re-oxygenate the dormant concept of plain packs among the global tobacco control community to allow it to become part of the continuing narrative of “what was needed” if nations were to get serious about turbo-charging the falls in smoking.
I did not, though, write newspaper or blog articles to accompany the paper. My sense was that plain packaging was an issue that would first need considerable selling within the public health community. They would need to be comfortable enough with it to become enthusiastic supporters once it got “out there” as a policy being advocated for adoption. Being novel and never implemented before, it needed to be thoroughly “workshopped” in preparation for the inevitable major attacks it would attract.
Enter Minister Nicola Roxon
Instead, a large window of opportunity opened in the form of a committee. In 2008, I was appointed to the Tobacco Committee of the Preventative Health Task Force. This had been established as a direct response to the newly elected Rudd Government’s explicit emphasis on the importance of prevention in health policy reform. With 50 or so others, I was invited to a briefing by the new Health Minister Nicola Roxon. Her presentation started with and dwelt on prevention, not in its normal role as a policy confection to be sprinkled on the “real” meat and potatoes of health policy like hospital crises and expensive drug subsidies, but as a primary consideration. Here was a rare government sending direct and forceful signals that chronic disease prevention was to be taken seriously. Roxon at once seemed “one of us”, inhabited by the same big picture, population-focused values as the public health community.
On the first day the Task Force met, the chair, Mike Daube from Curtin University, emphasised to us that his brief had been to convene a committee who should be in no doubt that the government wanted recommendations that would really make a difference. We took turns to propose sometimes bold, but always evidence-based strategies. A substantial increased tobacco tax — 25 per cent — was unanimous. In April 2010 it was adopted and a Treasury paper from early this year shows that it reduced consumption by 11 per cent, nearly twice the predicted 6 per cent.
I predictably recommended plain packaging, which was again unanimously accepted. I recall remarks about “we can be bold here … it’s important that we get it out there on the agenda, even though it may take years to get up.” That was the spirit of our recommendation: I doubt there was anyone in the room who expected that the proposal would have any life other than as an historic but merely “noted” recommendation in a report.
The proposed legislation was first announced on 29 April 2010, at a press conference held by Prime Minister Kevin Rudd and Nicola Roxon, although late night television broke the news the night before. I and others had been called by Roxon’s office about 6pm on the 28th because a television station had got wind of the announcement. For those involved, it was one of those occasions like always remembering where you were when John Kennedy or John Lennon was shot, or when the moonwalk happened. I picked up the phone at home and Angela Pratt, Roxon’s chief of staff said deadpan: “I thought you might like to know that we’ll be announcing in the morning that we’ll be introducing plain packaging.”
From that moment, everyone working in population-focused tobacco control in Australia did little else for the next two years than concentrate our efforts to ensure the announced bill would be passed.
The confluence of a newly elected government with a prevention reformist agenda; the presence in that government of a passionate, whip smart and articulate Minister with great and accessible staff; the opening of a window of opportunity in the form of a Task Force charged with maximizing policy impact; and a small, closely networked and highly experienced circle of policy entrepreneurs advocating for change, exemplify several key ingredients of John Kingdon’s analysis of policy reform. But these features were all proximal factors that leave unexplained how a radical idea like plain packaging, when landing on the desk of a new government, found such favour.
Proximal factors like those I’ve mentioned for plain packaging are always necessary to such policies gaining traction, but they are hardly sufficient, as the long trail of detritus of excellent, evidence based proposals that went nowhere make obvious.
‘Just finishing the job’
It’s long been banal to note that policy adoption is not simply a matter of presenting the best facts and evidence to policy makers and then sitting back to watch quality evidence triumph over all other considerations. With rare exceptions, policy entrepreneurs and advocates need to engage in extended and highly strategic efforts to ensure that evidence is communicated in ways that make it publicly and politically compelling so that inaction is not an option. Policy solutions need to be framed in ways that make their rejection problematic. “Killer facts” need to mined from eye-glazing data; memorable sound bites constructed and rehearsed; analogies forged with other issues known to have widespread support; and an instinctive understanding honed of the importance of subtext and the underlining of values in potent and effective communication about proposed policies.
While plain packaging represented a novel proposal that had never before been implemented, the case for it rested on the same long running, distal narratives that had seen governments of all persuasions incrementally ban all forms of advertising and promotion, commencing with the TV and radio direct advertising in 1976. It was the “you can’t be half pregnant” sub-text which allowed Roxon and public health advocates to argue that with plain packaging that we were simply “finishing the job” of banning tobacco advertising.
We’d banned all other forms of tobacco advertising. There was no disputing that packaging was a form of advertising. So the cancer emperor’s fancy clothes had to removed.
If you Google “just like the tobacco industry” your screen will flood with examples of the ethical bottom feeder status of the industry. Big Tobacco has long been routinely referenced as the index case for a wide range of dodgy attributes. Dominant public discourses see the tobacco industry as nefarious, duplicitous, venal, as corporate Pied Pipers and purveyors of a deadly products and being indifferent to the health of Australians. A survey from 14 years ago found tobacco industry executives ranked with the standard low water mark — used car salesmen — in trustworthiness. These narratives have been current for a least 30 years and have grown ever more virulent as smoking prevalence continues in free fall.
Because of six decades of epidemiology, three decades of intense advocacy and incremental government action, and the inexorable denormalisation of smoking, smoking is now an issue with few champions. Any political party seen to be going out of its way to support the tobacco industry’s interests risks sending a message that would resonate with a very small proportion of the community. You just don’t stand next to the tobacco industry in a photo opportunity.
With only 15.7 per cent of Australians smoking each day, and 90 per cent regretting they ever started, only 1.5 per cent of Australian adults today are smokers who are happy about being smokers. And only a small fraction of these are smokers who care enough to speak out against effective tobacco control measures. Many smokers in fact support tobacco control because they believe it might help them to stop.
During the campaign to defend the bill, Roxon said repeatedly that she’d never met a smoker who hoped their own children would grow up to become a smoker. This was a masterly sound bite, as was another she used often when she said “we are killing people by not acting”.
When I interviewed Nicola Roxon for my book she emphasised several explanations of why she had taken up the recommendation on plain packs:
Australia has an extraordinarily well networked, multi-disciplinary and cooperative tobacco control community and a highly professional health bureaucracy. National and international experts in policy evaluation, consumer testing, illicit trade, international trade, copyright and constitutional law, all had a reputation of working seamlessly together to ensure high quality, rapid advice to government.
This gave her confidence that the decades of earlier advocacy and achievement in tobacco control provided “big shoulders to stand on” when it came to announcing the next steps, both in the sense of there being community expectations that tobacco control is what governments should do, and in the sense that the government would be supported by a formidable group of experts.
The metamorphosis of the tobacco industry from being just another industry in the 1950s, with its CEOs getting knighthoods, to its ethical pariah status today, did not happen either overnight or by accident. If you work in malaria control, you must study mosquitoes to know how to destroy them. If you work in lung cancer control, you must study the tobacco industry as a disease vector, to learn how to weaken it. We did that for many years, and drove the industry out of the media spotlight for over a decade when it obviously took a decision that media appearances kicked own goals.
A US colleague says that the tobacco industry are like cockroaches: they spread disease and hate sunlight. So our job became one of throwing as much light on them as possible. A four year National Cancer Institute grant I had early last decade to look through millions of formerly internal industry documents produced over 30 papers that helped shatter for ever the routine public lies the industry told about disease, addiction and its designs on young smokers.
From the moment the government’s intentions were announced, a series of major enabling goals became evident. These included ensuring that the research informing the design of the new packs would maximiSe the main goals of the policy: to make cigarette packs look as unappealing as possible, and to maximize the impact of the graphic health warnings. Legal expertise was also vital in preparing for the anticipated challenges in both Australian courts and internationally, in forums such as the World Trade Organization, and in drafting the legislation itself. The Health Department needed to steel itself for an obstructionist campaign involving massive requests from the industry under Freedom of Information, fishing for any document they fantasised might assist their efforts to derail the policy.
‘Dallying’ with the media
To understand why a proposal as radical as plain packaging was picked up politically and eventually supported by all political parties, it is also necessary to understand the central place that media advocacy has in the DNA of Australian tobacco control leadership. Every major policy battle that has been won since the 1970s (and they were all won) has been bitterly contested in the news media by those who stood to lose. We have had a lot of practice across three decades.
I tell my students each year that if you can get your story on breakfast or drive time radio, or get covered across the early evening TV news bulletins, more people will hear your message than will have heard all the concerts combined of the Rolling Stones, Bruce Springsteen and U2 on their last tours of Australia. But importantly, among that audience, are a small number of highly influential people with power to legislate and to allocate resources to your issue.
I speak with many researchers who express frustration at the rare opportunities they get to meet with politicians and senior policy makers. I meet with such people only a few times each year myself, if that. But I tell colleagues and students that I “meet” these people many times each month, and often at times when they are most relaxed and receptive.
I had never met Nicola Roxon before she became Health Minister. When we first met at a conference, I noted this and she said “I feel I have known you most of my life”. This could have only been referring to my long involvement in news media. So while never having previously had the opportunity to put perspectives and proposals to her directly, it was clear that I had done so on uncounted occasions as she awoke to early morning radio news and commentary, in her car as she drove to work, via her newspapers, through television news in hotel rooms and via any on-line social media feeds she may have followed. Her cabinet colleagues would also need to be voracious news consumers, so when health portfolio items arose, they too would be acquainted with the public narratives about these issues that have been circulating in news media.
Many researchers today remain highly ambivalent about media engagement and some are deeply distrustful. The values implicit in Sir William Osler’s 1905 advice that doctors should not “dally with the Delilah of the press” remain alive today in some academic research circles. Concerns are sometimes muttered about the impropriety of researchers actively engaging with the media to publiciSe their research and, particularly, to advocate for policy—an activity said by some to“politicise” science.
Wilkes and Kravitz’ study of first authors whose research had received press coverage found that, while most authors were satisfied with the coverage, a substantial minority thought that media attention “gives the impression that the researcher is seeking publicity” and “creates jealousy among colleagues”. Such concerns were echoed in a major study undertaken for the English Royal Society in which 20 per cent of British scientists believed colleagues who appeared in the media were “less well regarded” by their peers: they were seen as a “selling out” and seeking “self publicity”. To this substantial minority, public engagement was something “light” or “fluffy” and “done by those who were ‘not good enough’ for an academic career”.
The Royal Society report found that 60 per cent of British researchers want to engage with politicians about their research, but far fewer – 31 per cent — want to talk to journalists, despite politicians being voracious consumers of news where they daily encounter expert and public opinion directly relevant to their portfolios.
But many researchers engage often and effectively with the media, believing media coverage of their work has significant benefits. Independent health experts are the sources most trusted by journalists covering health issues: ‘experts’ are the second most frequent category of news actor in Australian television health news stories, after those experiencing health problems.
In 2009, I worked on a project looking at the characteristics of influential Australian public health researchers. We interviewed 36 researchers who had been voted as the six most influential researchers in six fields of public health (alcohol, illicit drugs, injury prevention, obesity, skin cancer prevention and tobacco control). In lengthy interviews, we asked them to try and reflect on why they believed they had been highly ranked as influential by their peers. We also interviewed senior policy makers (politicians, their staff, senior bureaucrats) and asked them to reflect on how they came to learn about public health expertise, to use and trust such experts and to regard them as influential.
Three quarters of Australian politicians we interviewed placed great importance on media profile, with media presence sometimes disturbingly considered as commensurate with expertise. For one political advisor, it was the only means of identifying experts. He said: “I have absolutely no idea how I would go about identifying someone if there wasn’t an obvious expert prominent in the media”.
The ability of the media to affect policy agenda was of paramount interest to most researchers. Media coverage of health issues had ‘brought the community along’ with new ways of thinking about public health: “without…the softening up that the media did, it [tobacco control legislation] would not have been as acceptable as it ultimately was to the community”.
Significantly, 86 per cent of the researchers we interviewed agreed that “Public health researchers have a duty to increase public awareness of their work” and the same percentage agreed that public health researchers had a “duty to influence policy and practice”.
All but one of our 36 influential informants regularly engaged with the media because of the “huge advantage” it provides in “getting your research out there”. In many cases, this had led to a media profile that, once established, became almost self-perpetuating with the media returning regularly and the researcher gaining further opportunities to promote their research and expertise: “They see that you can articulate an issue and so you tend to get called and that kind of snowballs into becoming the ‘go to’ person.
Establishing this relationship was seen to be dependent on several attributes which included:
Some interviewees had encountered colleagues who believed researchers should just “stick to the facts” in interviews. But only two of our 36 researchers agreed that “It is not appropriate for me to express my opinions about public health policy”. However, the overwhelming majority disagreed, arguing that the public expects experts to go beyond reciting and clarifying facts to provide commentary, to “translate” data and explain its meaning for policy: “They want to see what professor so and so says about it” because “people always want to know what the policy implications are”.
While nearly everyone would consider it appropriate for experts to appear in news media to explain “the facts”, journalists and the public expect that experts should also have views worth hearing about “what should be done”. This is particularly so in public health, where much news is problem-focused. As Shanto Iyangar’s work on news has shown, news coverage about problems invariably moves across a 90 second item from descriptions of the problem, to a focus on those responsible for the problem and then to its preferred solutions. Any public health expert who tries to avoid discussion on such solutions will rapidly find themselves marginalised as an authority. The public would reason “what sort of an expert is this, who knows so much about the problem but doesn’t seem to have any views about what should be done to fix it?”
Everyone also stressed the importance of being available to journalists and& appreciating news media routines and of having institutional support to deal with media.
Many researchers pointed to the lack of encouragement inherent in traditional academia which focuses on “teaching and research rather than service to the community or being a public intellectual”:
But others remarked that this neglect was fading fast, with universities rewarding their media-active staff and urging researchers to keep records of media appearances for institutional profiles.
While almost all of the peer-rated influential researchers we interviewed recognised the importance of media engagement, they were also sensitive to concerns about its inherent constraints, the dilemmas posed by differences between journalistic and academic cultures and the reputational risks from an injudicious embrace of media celebrity.
The major concerns were the news media’s insistence on brevity and simplification, and the resultant “dumbing down” of complexity, and intolerance of inconclusiveness in encapsulating commentary within sound bites. This group of researchers had developed strategies to overcome these constraints, such as interacting more with media workers that they knew and trusted. Their concerns were offset by the judgment that to absent oneself from the media was to almost guarantee the irrelevance of one’s research to public and political debates about health policy.
In summary, the opportunity that media engagement provided for researchers to contribute to research-informed public awareness and debate was regarded not only as appropriate by most of our influential interviewees, but as a critical aspect of their professional duty to advance public health.
Campaign honour board
I want to end with a roll call of colleagues who played important roles in this historic episode in public health.
Dr Mal Washer, the former Liberal backbencher, who memorably told the Melbourne Age: “The tobacco industry is jumping up and down because they’re worried about their businesses. I support these reforms unequivocally and whatever my party decides to do, I don’t give a shit”. He threatened to cross the floor if his party opposed the Bill, and was probably key to it being unopposed.
But of course the real super hero in all this is Nicola Roxon and her wonderful staff, who as both Health Minister and Attorney General, had the courage to try to make tobacco history.
In 1985 the CEO of Philip Morris in the US said “As one of our Australian colleagues puts it, ‘a sneeze in one country today causes international pneumonia tomorrow!” Already, Ireland, New Zealand, and Scotland have indicated they intend following Australia. Canada was the first nation to introduce graphic pack warnings in 2000. Today, the tumbling dominoes on that policy have seen 64 nations with those graphic warnings.
When the history of public health in the first half of this century us written, Nicola Roxon’s name will be there in neon lights as an Australian political champion of lung cancer reduction. Future generations will have much to thank her for.