Connecting With Practice Affiliates: Tobacco Control
November 3, 2020
Les Hagen is a Centre for Healthy Communities Practice Affiliate and the Executive Director for Action on Smoking & Health (ASH), Western Canada’s leading tobacco control organization. Tobacco is the leading avoidable cause of premature death, disability, and disease in Canada and the developed world. ASH provides provincial, national and global leadership to reduce and prevent tobacco use in Alberta and beyond. Founded in the 1970s, the organization has been in operation for over 40 years.
Les is a passionate and determined advocate. In addition to his advocacy, he teaches a public health advocacy course at the School of Public Health, which has been published in an article co-written with a graduate student and other faculty. We had the opportunity to connect with Les to explore the topic of tobacco control and his critical work in public health.
Centre for Healthy Communities (CHC): How does your work in tobacco control relate to the idea of healthy communities?
Les Hagen (LH): Tobacco is one of the single biggest causes of chronic disease. If the goal is to improve quality of life, reduce disease, improve productivity, and reduce the tremendous strain on our healthcare system, then tobacco is hard to ignore. The 47,000 annual premature deaths due to tobacco use in Canada is exactly 47,000 too many.
Although we’ve made tremendous strides in reducing tobacco use, there is still a lot of work to be done. In fact, I would say tobacco reduction has been one of the greatest public health success stories of the past half-century. We don’t want to allow the tobacco industry to undermine all of that tremendous progress, which they are trying to do now by expanding their market to include nicotine vaping.
CHC: What motivated you to pursue this line of work?
LH: It’s a huge injustice that we’ve allowed an industry to exploit public health to its commercial advantage. As NGOs, health organizations, health professionals, and governments, we need to assign a top priority to protecting public health from vested interests and those who are working to compromise public health. And the tobacco industry is probably the worst example of commercial exploitation of public health.
CHC: Could you tell me a more about your role and the role of ASH in the successes of tobacco control in Alberta and Canada?
LH: Before I joined the organization in 1989, ASH was a small group of volunteers. We decided to look for some funding and develop grant proposals. Later in 1989, after securing funding, ASH became Canada’s first full-time tobacco control organization west of Toronto.
Our main objective at that time, and still is one of our objectives today, was to encourage provincial governments to take a more meaningful role in tobacco reduction. Up until that point, tobacco control had been largely led by the federal government. However, the provincial governments are largely responsible for healthcare funding and delivery and they actually have a greater vested interest in reducing tobacco use than the federal government. So, our goal was to develop a niche in provincial tobacco control, which we have, and encourage other provinces to take action beyond Alberta.
CHC: What are some of your greatest successes in your time with ASH?
LH: Number one would be setting up the first full-time tobacco control organization west of Toronto. This was a huge achievement! We’ve had some interesting successes along the way. For example, the world’s largest tobacco tax increase ever recorded, which was here in Alberta in 2002. Tobacco taxes are the single-most effective means of reducing tobacco use. More recently, Alberta was the very first jurisdiction in North America to pass legislation to ban all flavoured tobacco products.
But perhaps our biggest success was getting one of the world’s strongest tobacco laws approved in Alberta in 2007. There were only a couple of countries (Ireland and Iceland) that had approved similar legislation. In Canada there were two or three provinces that had also implemented a similar set of legislative measures. At the time, it was very cutting edge. It banned smoking in all workplaces and in bars and restaurants. It also banned the sale of tobacco in pharmacies and healthcare settings. The legislation also prohibited tobacco retail displays—or powerwalls.
CHC: What would be some key lessons that you have learned over the past several decades of doing this work?
LH: I would say the importance of taking the message directly to the people. You always have to work with the government of the day. We’ve always done our best and tried to frame our messaging and approach to suit the priorities of government. Fortunately, most governments, at least the ones I’ve worked with over the years, are committed to improving quality of life. That is always a good starting point. We’ve used publicity very successfully to keep the message on the public agenda and to frame it in a way that people will support it.
I really got interested in framing in the early 90s, when some compelling evidence was coming out about how the tobacco companies frame their messages. So that inspired ASH to develop its own frames. The first frame is that tobacco has an enormous impact on our quality of life. Our second frame is that tobacco companies must be held accountable, which builds the case for regulation. Our third frame is that kids need to be protected.
I can’t understate the importance of working and collaborating with other organizations to increase your reach. ASH is a very small organization, but we have some very big partners, such as Heart and Stroke, the Canadian Cancer Society, and the Alberta Lung Association. We also collaborate with physicians and nurses, as well as public health professionals.
It is also important to adhere to evidence-based advocacy and science. There is a solid evidence base around health advocacy. A lot of this evidence has come out of tobacco control, certainly around media advocacy. It’s important to apply these lessons so that we can be more effective to achieve the greatest impact with limited resources. We’re always battling a well-financed industry who is motivated to sustain sales and profits.
CHC: What are some common misconceptions about the work that you do?
LH: Well, one is that we are anti-smokers and that our goal is to make smokers’ lives miserable. In fact, we have nothing but compassion for people who are tobacco-dependent (especially kids). It is a very harmful and lethal substance. Nicotine is one of the most addictive substances on the planet. It is very hard for many people to quit. For some people, it takes decades and many never do. Barb Tarbox is a perfect example of that. She lamented smoking and couldn’t stop.
CHC: Do you have any new and exciting projects on the go right now?
LH: ASH received a three-year grant from Health Canada last year to expand our efforts in Alberta to all four Western provinces, with respect to municipal bylaws, school board policies, and post-secondary policies. We’re calling this the Western Canada Tobacco Control Project. We are working with the tobacco control coalitions in each province to secure more smoke-free bylaws and policies in those settings.
One of the most exciting things nationally, and has been 25 years in the making, is been plain packaging. The package is the most influential advertising medium. The latest health warnings that preceded plain packaging came into effect in 2011; ASH was very involved with that effort, as was our provincial coalition Campaign for a Smoke-Free Alberta. After lots of delays with the federal government taking action, we held a media event in Calgary in the Prime Minister’s riding with Barb Tarbox’s husband, Pat, that reached an audience of 13 million. Our efforts helped to secure 16 new graphic health warnings that occupied 75% of the package, which is the next best thing to plain packaging. Two of those 16 images include Barb Tarbox, who as you know was an Alberta tobacco reduction champion and a tobacco victim. These images now appear on millions of cigarette packages across Canada and they represent one of the most cost-effective health messaging campaigns in the country.
CHC: Is there anything else that you would like to add?
LH: The creation of the Centre for Healthy Communities is a wonderful opportunity to further advance public health in Alberta and tobacco control. It’s great to be a part of the School of Public Health and the Centre for Healthy Communities and to tackle some of the major causes of chronic disease through the Centre. I think there are lots of opportunities to be explored. The people who are engaged with the Centre, including its director Candace Nykiforuk, are strong advocates and are truly committed to promoting and advancing public health.