A proposal for a smoker's licensing scheme has been proposed in an article in the journal PLoS Medicine. The scheme would be designed to work with smokers to limit their access to tobacco products such as cigarettes, cigars and rolling tobacco as well as encouraging people to quit and providing a financial incentive for those who do.
"A smoker's licence allows smokers the choice to continue smoking within a regulatory framework that promises new disincentives to smoke and a major financial incentive to quit."
says Professor Simon Chapman of the School of Public Health, University of Sydney in Australia. Professor Chapman is also a director of Action on Smoking and Health, Australia and editor emeritus of Tobacco Control.
According to the paper published by Professor Chapman, the prolonged use of tobacco causes the death of about half its users, with a billion people this century predicted to die from tobacco caused disease. In particular, the cigarette is an exceptionally dangerous product: no other commodity or human activity causes a remotely comparable number of annual deaths. Yet, compared with other dangerous products, the control mechanisms applied to tobacco are comparatively trivial. In most countries, only the requirement that they be purchased and used by an adult with no restriction as to the quantity an individual is able to purchase.
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Professor Chapman has proposed a system where people nominate how many cigarettes they smoke per day, with licensing fees tied to that number. Smokers would have to undergo a knowledge test regarding the health risks tied to smoking. A smartcard would be issued to the smoker, allowing them to purchase a certain number of cigarettes per fortnight, capped at 50 per day. If a smoker chose to permanently surrender their license, all fees they had paid in the past would be refunded to them.
"A smoker's licence may seem like a radical step toward ending the epidemic of disease caused by tobacco, but it is far less radical than prohibiting the sale of tobacco, which is not a strategy that has yet been supported by any international expert report or political forum," said Professor Chapman.
The licence, Chapman argues, would be most viable in high-income nations that are actively pursuing tobacco control goals. He compares his proposal to how the sale of pharmaceuticals is regulated through the use of prescriptions which he likens to 'temporary licences' for medications that could be used incorrectly, for too long, or that require users to be monitored.
Under the system proposed by Professor Chapman, all smokers would be required to obtain a smart swipecard licence which they would use to purchase tobacco from a licensed tobacco retailer.
Most licence registrations would take place online, providing a useful database on tobacco use and a means to communicate health messages to smokers.
The smart card licence would be encoded with a maximum purchase limit, chosen from a range, at the time of application. Smokers would pre-commit to a certain number of cigarettes a week and when they made their purchase the sale would be approved or declined based on that agreement. The more cigarettes a licencee opted for, the higher the fee. There would be an upper limit of 50 cigarettes per day, averaged across 14 days, and the licence would be renewed annually.
As an incentive to quit all licence fees paid during a smoker's licenced smoking history would be fully refundable, with compound interest if they surrendered their licence.
"The requirement for a licence would send a powerful, symbolic message to all smokers and potential smokers that tobacco is not an ordinary commodity like grocery items, confectionery, or any product on unrestricted sale," Professor Chapman said.
"It would mark tobacco as a product uniquely deserving of such regulation and invite smokers to reflect on why this exceptional policy had been introduced. This step may diminish self-exempting views that smoking is just another, unexceptional risk in 'life's jungle'."
An argument against the proposal was also published in the same journal by Jeff Collin of the Global Public Health Unit, School of Social & Political Science, University of Edinburgh in Scotland. Collin states that the proposed scheme would shift focus away from the real vector of the epidemic—the tobacco industry—and that by focusing on individuals it would censure victims, increase stigmatization of smokers, and marginalize the poor.
As Collin states in commencing his argument against Chapman's proposal, "Despite its many successes, the need for tobacco control advocates to think outside the box and explore radical new options remains compelling. As always it is difficult to know whether to be more impressed by the scale of recent legislative achievements in driving change, or to despair at the widespread persistence of damaging behaviours and devastating health impacts."
Chapman S (2012) The Case for a Smoker's License. PLoS Med 9(11): e1001342. doi:10.1371/journal. PMID:1001342
Collin J (2012) The Case against a Smoker's License. PLoS Med 9(11): e1001343. doi:10.1371/journal. PMID:1001343