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The tipping point

No seductive gold wrapping.

GRAPHIC: Cigarettes in “plain” packets will go on the shelves in Australia from December 1, designed to prevent companies from using marketing tools to attract new smokers. Picture: Lukas Coch/EPA

No sharp purple and white either. However, the new packaging for all cigarette brands sold in Australia won't lack visual impact: all the companies' products will feature stark pictures.

Some will show the misery of mouth cancer or the damage caused by lung cancer. Others will carry the image of a bedridden child suffering the effects of inhaling passive tobacco smoke. The Australian scare tactics, actively under consideration by the Scottish Government, are a radical attempt to stop smokers killing themselves, and, perhaps more importantly, stop impressionable youngsters becoming addicted.

The initiative has attracted predictable fury and legal challenges from the tobacco industry, which traditionally throws its ill-gotten gains at any possible loophole its lawyers can get their hands on. Over the decades it have continued to market and promote tobacco products despite the internal knowledge of its possible fatal effects.

Even when that knowledge became public, the industry spent a further fortune denying it and setting up a campaign group of paid apologists who attempted to make it an issue of personal freedom rather than life and death.

But unsavoury as the motives of organisations such as Forest (Freedom Organisation for the Right to Enjoy Smoking Tobacco) are, they do flag up a debate across a whole range of health-based issues.

Whether it's smoking, drinking or obesity, it's important to try to define where the main burden of responsibility lies between personal choice and state or commercial initiatives in tackling the deep-seated issues of life-limiting illness, especially in a country with the stubborn record of Scotland.

It was a topic tackled head on by Michael Sandel at the Edinburgh International Book Festival last week. The Harvard University professor, known for his legendary communication skills as the "rock star moralist", told his audience about several transatlantic attempts to alter unhealthy behaviour by the use of tactics which you could call bribes or incentives depending on your perspective. It's a theme on which he elaborates in his new book, What Money Can't Buy, in which he recounts corporate involvement in public health, such as General Electric introducing a scheme three years ago which paid some of its employees £500 if they could stop smoking for at least a year.

Another tactic tried by Safeway offered cheaper personal insurance to non-smokers, and, says Prof Sandel, 80% of major US companies now offer financial incentives for staff to participate in wellness programmes, while half penalise unhealthy habits by charging more for health insurance (a particularly unsavoury variant on the insurance theme is practised by the unlovely Walmart among others who take out life insurance on employees naming themselves as beneficiaries. In the event of death the family aren't compensated but the company is).

Bringing the debate back to the UK, Prof Sandel flagged up recent efforts to stem the tide of obesity by offering monetary incentives, some through NHS clinics, to people who could lose significant amounts of weight over a longish period, typically a year.

Interestingly, this provoked the most heated exchanges between his Edinburgh listeners, some of whom were indignant at the thought of their taxes being used to subsidise the diet of people they saw as being unhealthy through their own lack of personal discipline.

And it's certainly possible to argue that paying people to shed weight is not necessarily a useful intervention unless accompanied by a real change in attitude to diet and exercise.

There is probably more of a consensus in the field of alcohol abuse where health professionals overwhelmingly back the Scottish Government's plans to use price as a disincentive to alter a situation in which some supermarkets could sell beer more cheaply than water.

Alcohol is still a major factor in crime and prison statistics in Scotland too, so we are not only talking about a health issue here, but one which can lead to fewer victims of violence, and major savings in the criminal justice system – if we can find ways to amend a culture of heavy drinking which has proved a very stubborn component of Scotland's leisure and sporting activities.

But there is one issue of alcohol-related ill health where the medics think they can usefully take a leaf out of the anti-smoking lobby's book.

Attitudes to smoking, they have noted, hardened considerably when the effects of passive smoking became more widely known.

People ruining their own health was one thing, it seemed, but ruining other people's, most especially children's, was much more contentious. Hence the movement, again pioneered in Scotland, to outlaw smoking in public places.

So we may begin to see a similar attitudinal shift on the back of new evidence about the impact of drinking on the health of unborn children.

We've known for a very long time about the serious end of this problem, the foetal alcohol syndrome found in babies with serious mental and physical disabilities directly linked to binge-drinking by the pregnant mother.

But it's becoming clearer how drinking at less industrial levels during pregnancy can also lead to milder but still significant impacts including a reduction in mental capacity, physical wellbeing and growth potential.

So, as with smoking, people researching that field think they might have a greater impact on personal habits by highlighting the secondary effect on the unborn child as well as the health of the adult in the equation.

It's bad enough that Scotland has more than its share of unhealthy grown-ups without blighting the chances of the nation's future citizens.

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