It is astonishing to think that, more than 64 years since the first hard evidence of a link between smoking and tobacco was published, public health bodies around the world are still struggling to convince people to stop smoking.
The 1954 Mortality in Relation to Smoking: The British Doctors Study was a landmark paper.
Produced by English physicians Sir Richard Doll and Sir Richard Peto, it revealed incontrovertible statistical evidence highlighting the correlation between smoking and serious illnesses – cancer in particular.
It is something of a cruel irony that it actually studied the mortality rates among doctors who smoked. Yet perhaps the greater tragedy is that, well over half a century later, more than seven million people per year continue to die from this entirely preventable scourge.
It is true that smoking rates are tumbling in most countries across the developed world.
And this deserves to be celebrated - changing centuries of habit and tradition is not easy, yet millions of people are becoming more aware than ever of the dangers of smoking and turning their backs on tobacco.
In France, for example, more than one million smokers stubbed out their cigarettes for good last year, while the UK has seen a seven per cent fall in smoking rates in just six years.
Yet the fact that smoking rates continue to exceed 20 percent of the population among so many European countries so long after the health link between tobacco and cancer was established is worrying.
There are a number of factors for this lag – a paucity of early follow-up research, obstruction from the tobacco industry, not to mention the difficulty in shifting long-standing public perceptions about smoking.cot
The first two factors have largely been addressed. There are so many studies now linking smoking to illness that their publication is viewed almost as routine, while the tobacco industry is now largely kept in check – in the developed world at least – by stringent advertising laws and proactive governments looking to reduce the strain placed on health care by preventable illnesses.
Yet shifting public perception remains a tough task which is still encountered today. In England, for example, less than 10 percent of people questioned in the annual State of Smoking survey understood that nicotine does not cause cancer.
There also remains a great deal of public suspicion towards electronic cigarettes, despite vaping being hailed as an indispensable tool in the battle to cut smoking numbers.
Both Public Health England (PHE) and the National Institute for Health & Clinical Excellence (NICE) recommend their use among people trying to quit smoking.
Yet public scepticism remains. According to NICE, at least half of smokers believe that electronic cigarettes are just as harmful to their health as normal cigarettes, while vaping numbers appear to have plateaued in the UK around the 3m mark.
PHE estimates that electronic cigarettes are at least 95 per cent less harmful than traditional cigarettes.
The public reaction towards heat-not-burn products will be monitored closely. Like cigarettes, these still work by heating tobacco – albeit to a far lower temperature.
Independent studies in both the UK and Germany have concluded that heat-not-burn does indeed expose the user to significantly fewer harmful compounds.
“There is likely to be a reduction in risk for cigarette smokers who switch to heat-not-burn products,” said professor Alan Boobis, chairman of the Committee on Toxicity. “But quitting entirely would be more beneficial."
Their findings were mirrored in Germany.
“We can confirm for these substances that tobacco smoke contains a significant reduction of pollutants,” said Dr Frank Henkler-Stephani, who led a study for Germany’s Federal Institute for Risk Assessment.
Heat-not-burn products are only available in certain countries as things stand, but it is hoped that they will provide more of a middle ground between smokers wishing to quit and those are yet to be convinced by electronic cigarettes.
Total abstinence remains the best solution for avoiding tobacco-related illnesses. But with many of the general public either ill-informed or unwilling to change – or both – it is clear that the fight against tobacco remains a difficult one, despite the consequences being in the public domain for so long.