In a guest blog, Dr Niamh Shortt of Edinburgh University questions whether it is time to challenge the high density of tobacco outlets in our communities.
I took a walk at lunchtime today. It wasn’t far, just a gentle stroll from the office. In 2 minutes I passed 3 outlets selling tobacco products. So what you might ask? That’s my point, the fact that we ask ‘so what’ is troubling. More tobacco outlets in a neighbourhood is not only likely to increase supply, and thus ease of access, but it may also lead to increased smoking in other ways. A high number of outlets in close proximity to one another may create a competitive local market that will reduce cost. Furthermore, having tobacco sold as an everyday commodity, alongside bread and milk, normalises the product and influences attitudes towards smoking.
Tobacco is a Group 1 carcinogenic product. Tobacco kills, yet tobacco products are sold in every corner shop, in our supermarkets and in mobile vans. Our research here in CRESH, and a large body of international research, has shown an association between availability of tobacco products and increased smoking. Where availability is highest, so too are smoking rates. We have shown that teenagers living in areas with higher availability of tobacco are more likely to be regular smokers and more likely to experiment with smoking. We have also shown that adults living in neighbourhoods with a higher number of outlets are more likely to smoke and have lower chances of giving up smoking. Perhaps more troubling is the fact that the highest number of tobacco outlets are found Scotland’s most deprived neighbourhoods. This raises concerns regarding social justice. In Scotland 32% of deaths in the most deprived neighbourhoods are attributable to smoking, compared with 15% in more affluent areas, with smoking rates ranging from 40% in the former to 10% in the latter. A greater availability of tobacco in more deprived areas may be contributing to this social gradient. Whilst all of these results are concerning, they also offer potential for change.
Change is slow, but we have come a long way in a short time in tobacco control. Who would have thought that Ireland would ban smoking in pubs? That tobacco displays would be banned in shops? That plain packaging for cigarettes was an option? This reminds me of the old saying, ‘A lot done, a lot more to do’. As a nation Scotland hopes to create a tobacco-free generation by 2034. To do so we must create an environment that will ensure that the next generation grows up free from tobacco. We need therefore to consider the potential ways that we can do this. One way is to address “a retail environment that practically spews cigarettes out of every crevice”. There are 8 times more tobacco outlets in Scotland than there are pharmacies. It is easier to buy poison than medicine in this country. This is not an environment that will create a tobacco-free generation. We need to begin to think of imaginative ways to take tobacco off the high street. We need to consider how we can support retailers to diversify their product base and move away from tobacco products. We need to highlight customer and public support for such initiatives. There will be inevitable murmurs that this can’t be done, but the same was said about creating smoke-free public places. We are beginning to see a movement towards tobacco free retailers. The Campaign for Tobacco Free Kids has launched a Tobacco Free Retailers programme. This initiative challenges American retailers to stop selling tobacco products (see pictures below). Retailers such as Target, Aldi and Whole Foods are on their ‘wall of fame’ as those who do not sell tobacco products (this is also the case for Aldi in the UK, there is an interesting story here). A similar programme, Smoke Free Shops, has begun in New Zealand and has been successful in persuading several dairies to cease selling tobacco products.
Perhaps then it can be done and we are beginning to see seeds of change within the retail environment. We must make the public health argument and consider the broader benefits that will arise from a tobacco free environment, for both retailers and the public. We cannot have an economic system that places business before public health.
Image 1: From Tobacco Free Retailers, USA
Image 2: from Smokefree Shops New Zealand