In an innovative move to help reduce the damaging health effects of tobacco, the radical proposal of introducing a ''smoker's license'' is debated by two experts in this week's PLoS Medicine.
Simon Chapman from the University of Sydney in Australia and Jeff Collin from the University of Edinburgh in Scotland both agree that creative thinking is required to tackle the global smoking epidemic (especially as tobacco continues to kill millions of people around the world each year and its use is increasing in some countries) but disagree on the need for a smoker's licence.
Chapman makes the case for introducing a smart card license for smokers, which would be designed to limit access to tobacco products and also to encourage smokers to quit. He argues that as tobacco sale is subject to trivial controls compared with other dangerous products that threaten both public and personal safety, a different approach is necessary -- a smoker's (tobacco user's) licence .
Chapman explains how such a licence would work: "All smokers would be required to obtain a smart swipecard license to transact any purchase from a licensed tobacco retailer. Retailers could not sell to anyone without a card."
Key elements of the proposed smoker's license include an annual cost for the license (depending on the number of cigarettes smoked), which would be reissued every year, smokers setting daily limits for the number of cigarettes they buy, and a test of knowledge of health risks for people wanting to buy a licence.
Champan argues: "Opponents of the idea would be quick to suggest that Orwellian social engineers would soon be calling for licenses to drink alcohol and to eat junk food or engage in any ''risky'' activity. This argument rests on poor public understanding of the magnitude of the risks of smoking relative to other cumulative everyday risks to health. "
Collin is one such opponent and argues against the proposed smoker's licence: "The authoritarian connotations of the smoker's license would inevitably meet with broad opposition. In the United Kingdom, for example, successive governments have failed to introduce identity cards. If it's very difficult to envisage health advocates securing support for a comparable scheme on the basis of a public health rationale, it is still harder to see why they should wish to."
A smoking licence would also increase stigmatization of smokers argues Collins and also shift focus away from the tobacco industry, the real cause of the global smoking epidemic.
Collins concludes: "fundamental challenge confronting any endgame strategy is that the move towards a tobacco-free society should address the social determinants of health and promote equity and social justice. The proposal for a smoker's license should be rejected as failing this challenge."
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