Any history of tobacco control in Australia, and indeed in nearly all nations, would report with incredulity the lack of urgency in the pace with which governments went about trying to reduce smoking. In Australia, in 1957 the NHMRC noted the research being published from 1950 in the USA and Britain on the association between lung cancer and smoking, and recommended to the minister for health that publicity campaigns should be considered to warn the public about the risks (see Figure 5.1).

It took another 16 years before Australians saw the first health warnings peeping in small font from the bottom of cigarette packs. And it was not until 1982 – 25 years later – that any significant (multimedia) statewide anti-smoking campaigns commenced in Australia at a level going beyond simple posters and pamphlets.

Smoking was first banned in cinemas, in public halls and on buses and trains from the mid-1970s. The Australian Capital Territory began to stop indoor smoking in pubs and bars under health ministers Wayne Berry (1994) and Michael Moore (1998), but other states and territories delayed until 2005 and later.1

Advocacy for banning smoking in cars carrying children commenced in Australia in 1995. It took until December 2007 – another 12 years – before Tasmania became the first state to introduce legislation on smoking in cars in Australia. (239)

Direct forms of tobacco advertising ended on Australian radio and television in September 1976, but it was another 16 years until all remaining forms under the control of Australian governments ended with the 1992 Tobacco Advertising Prohibition Act.2

Those working in tobacco control in Australia were therefore used to long gaps, perhaps of decades, between early advocacy for a proposal and its eventual complete political adoption. All major advances in tobacco control policy have been subject to heavy attack and sustained lobbying by the tobacco industry. As outlined in Chapter 1, there had been advocacy for plain packaging since the late 1980s, with the evidence base steadily growing. It is always interesting to consider what makes proposals once considered radical, like tobacco advertising bans and smokefree public places, morph into sensible ideas whose times have now come.

Table 5.1: Major milestones in the introduction of plain packaging in Australia

 

Table 5.2: Milestones in passage of Plain Packaging Bill through Australian Parliament, 2011

 

I asked Nicola Roxon a question asked of me many times: ‘What made the government you belonged to take such an important step?’ She emphasised several factors, including the evidence base, the reputation and coherence of the tobacco control community, and expertise in the public service, legal profession and in the public health sphere.

The evidence base

Roxon repeatedly highlighted the critical role that evidence played in the government’s decision to adopt plain packaging. The public health effort to reduce smoking in Australia from as far back as the 1970s has been an evidence-based enterprise. Australian researchers have been major contributors to the international research literature in all areas of tobacco control.

The most important group researching tobacco packaging in Australia has been Professor Melanie Wakefield and her team at the Cancer Council Victoria. The Centre for Behavioural Research in Cancer at Cancer Council Victoria was established in 1986 as a scientific research centre specialising in the understanding and monitoring of behaviours that contribute to cancer, and in the evaluation of programs and policies aiming to change such behaviours. It is funded largely through competitive research grants which depend on the high levels of academic rigour and strong track records of publication in the peer-reviewed scientific literature. As noted in the government’s response to the recommendations of the National Preventative Health Taskforce, the results of studies by Wakefield et al of the effects of reducing design features on smokers’ perceptions of attractiveness and social desirability of smoking provided important evidence of the potential impact of plain packaging. Wakefield also advised the government on research it conducted to guide the design of standardised packaging and size and placement of health warnings.

An associate of the centre, Dr Michelle Scollo also deserves particular mention. Her meticulous and encyclopaedic data banks on nearly every aspect of tobacco control in Australia that form the backbone of the massive online resource, Tobacco in Australia: facts and issues (http://www.tobaccoinaustralia.org.au/), and her peerless grasp of issues concerning tax and apparent consumption, brought invaluable expertise to the development and evaluation of plain packaging.

Reputation and coherence of Australian tobacco control community

As well as the research evidence on the appeal of tobacco packaging, another crucial factor in the government’s decision to proceed was the national and international reputation of Australian tobacco control in all its achievements over the previous decades. Roxon said:

The tobacco control research and policy advocacy communities in Australia have long been a relatively small, tightly knit, personally close and extremely communicative network. Most of the leading individuals in these communities today have been working in it for well over 10 years, with several approaching or exceeding 30 years. (259) Their strategic research contributions and advocacy have often been followed by sweeping policy change successes, such as ending all forms of tobacco advertising and promotion and the roll-out of smokefree areas. Unlike some other areas of public health where policy goals are more complex and nuanced, tobacco control’s goals have long been clear and consistent.

Roxon was very aware of this coherence, talking about:

She also emphasised the attraction of plain packaging as being a strategy that would not be expensive for government to implement, with all packaging costs being borne by the companies. ‘What were the options for interventions that could have an impact and not necessarily be expensive?’ she asked. ‘Plain packaging ticked that box.’

Besides the researchers who were publishing the evidence for the policy, there were several other groups of highly skilled and experienced individuals working in different areas to whom Roxon would have been referring as ‘well respected’ people.

Legal white knights

Lawyers have played important roles in several stanzas of Australian tobacco control over the last 35 years. They have assisted in drafting laws and regulations, advising governments on potential legal risks and, especially in the case of Peter Gordon from Victoria, have run cases for individuals who were seeking redress for harms. But plain packaging acted like a clarion call to a phalanx of academic legal experts who produced a small tsunami of legal scholarship on the many domestic and international issues arising from the legislation. These included Greg Craven, Mark Davison, Tom Faunce, Jonathan Liberman, Benn McGrady, Andrew Mitchell, Mathew Rimmer, Don Rothwell and Tania Voon. Most of these lawyers contributed to a large volume of both scholarly and journalistic writing, and several were often heard in radio commentary. An edited book of legal papers was published. (36) Several of them worked closely with the government at different stages of the saga.

It is also critical to acknowledge the vital role of the Australian government’s lawyers who provided legal oversight at all stages of the legislation and its regulations, and of the successful defence of the bill in the High Court (see Chapter 6). Their work is continuing in international forums.

Commonwealth public servants

Everyone with even the slightest engagement in the passage of the bill through to law appreciated the extent and sheer quality of the expertise available in the health department and in the solicitor general’s office in Canberra. These were beyond consummate public servants who rose magnificently to meet the extraordinary range of challenges that were their responsibilities in the passage of the bill. They provided detailed input to the development of the regulations preparing the government’s defence for the High Court case, they weathered the carpet-bombing freedom of information requests from the industry (see pp107), and they collated and summarised public submissions. They also handled numerous public enquiries and much correspondence, and provided close collaboration with other government agencies on a range of issues pertinent to the legislation, and on the conduct and handling of targeted and public consultation on the legislation and the regulations.

Angela Pratt from Roxon’s office was effusive about the role played by staff in the Department of Health and Ageing:

Very fittingly, the department was awarded the American Cancer Society’s Luther L Terry Award for outstanding leadership by a government ministry at the 2012 World Conference on Tobacco or Health, held in Singapore.

Public health experts and advocates

In addition to the lawyers mentioned above, Professor Mike Daube (Curtin University and chair of the Australian Council on Smoking and Health in Western Australia), Anne Jones and Stafford Sanders from ASH (Action on Smoking and Health), Cancer Council Australia and Victoria staff Professor Ian Olver, Paul Grogan and Fiona Sharkie and ourselves were the most frequent voices being interviewed, calling radio stations and writing opinion pieces and blogs over the four-year period since the April 2010 decision to proceed was announced.

Mike Daube played a pivotal quarterback role in plain packaging from the time of his chairing the National Preventative Health Task Force’s tobacco committee. Vastly experienced in both senior levels of government (he spent time as director general of health in Western Australia) and in advocacy dating from his time as inaugural director of ASH UK in the 1970s, Mike was in on every important conference call. He and I would speak often several times a day, whether to share information, review an incident or plan a line of attack. Most important of all, Mike was the main go-to person for the minister’s office.

Angela Pratt:

Mike travelled from Perth to Australia’s east coast so much that we all joked that he must have had not a platinum frequent flyer card, but a black diamond one. We referred to him as ‘Midnight Mike’ for his indefatigable willingness to give live interviews seemingly around the clock nationally and internationally. He is a consummate media performer whose instincts on how to best respond to the latest tactic from the industry are remarkable.

Non-government agencies

Australia’s network of health and medical NGOs all sang from the same song sheet on plain packaging. The Cancer Council Australia and the Heart Foundation both employed in-house lobbyists (Paul Grogan and Rohan Greenland) who both gave high priority to supporting the bill throughout its course. Both of these organisations had for years jointly funded ASH, and tobacco control for them was core business.

ASH in turn provided a large amount of media commentary on the issue and orchestrated a coalition of smaller NGOs to contact MPs at strategically important times to show their support. Stafford Sanders, who worked at ASH for 10 years, told me: ‘What most MPs would have experienced was a flood of letters and calls from small NGOs, parent groups, local health professionals and other influential local figures supporting plain packs.’

The Australian Medical Association is widely regarded as having a more natural affinity with politically conservative parties. They were at loggerheads with Roxon and the Labor government on a range of proposed reforms (including nurse practitioner and midwife reforms, Medicare Locals, hospital funding and various Medicare rebate changes) but, to their great credit, were resolute supporters of plain packaging. They issued many press releases, were often heard providing commentary, and were known to have urged the Opposition to support the bill.

Other health organisations, in particular the Public Health Association of Australia and its CEO Michael Moore, also made substantial contributions as part of the lobbying team.

News media

With a few exceptions (particularly News Corp newspapers), Australia’s news media reported the saga of plain packaging in overwhelmingly positive ways. I had no hostile interviews across the entire period, but recall a good many openly negative, and often scathing, comments about the tobacco industry’s response from journalists, producers and camera and sound operators before, during and after interviews. Tobacco control has almost attained the status of a no-brainer issue for most in the news media. Like immunisation, it has long evolved into a story that does not need ‘two sides’ in its telling. (260)

Angela Pratt shared this view:

Columnists

A large number of opinion pieces on plain packaging were published in Australian-based newspapers and online news outlet and blogs.

Table 5.3: Opinion page and blog authors on plain packaging, 2008–14

These were overwhelmingly positive to plain packaging, and often scathing of the tobacco industry and congratulatory of the government. Table 5.3 lists authors of all those that we have been able to locate, written by both professional journalists and guest authors.

Cartoonists and satirists

Australian cartoonists, satirists and current affairs panel programs feasted on plain packaging, rarely with anything but biting support. This site features 18 such cartoons, nearly all of which rained down vicious blows on Big Tobacco’s arguments: http://atodblog.com/2012/11/20/editorial-cartoonists-did-their-duty-in-australias-tobacco-war/

‘Everyone hates them’

For many years, tobacco companies in Australia have suffered from public perceptions that they are not to be trusted, that they are corporate pied pipers with intense interests in children, rapacious corporate leviathans who put profit before all else, and are indifferent to the suffering that their products cause (260). Two surveys of Australians’ attitudes to the tobacco industry put it very plainly (318, 319). One of these found that:

Philip Morris’ own commissioned market research from 1993 had told them the same thing:

Eighteen years later, things had, if anything, sunk even lower for Big Tobacco. In 2011, the Reputation Institute published results of a global survey of 85,000 respondents (including an Australian sample of 5,611) conducted by the Reputation Institute and AMR Australia in January and February 2011. It rated all major industries in 25 categories for reputation. The top categories were consumer products (73.8), electrical and electronics (73.2) and computers (70.3). By far the worst performing category was tobacco, which scored only 50.1, well behind the next lowest category (utilities with 59).

A Google search with the string ‘just like the tobacco industry’ returns many thousands of examples of how the tobacco industry has become an index case or benchmark in everyday talk for all manner of malfeasance in corporate conduct. It has set the bottom feeder standard on trust, ethics and grubby conduct. No other industry is subject to widespread policies of academic institutions refusing to allow their staff or students to accept tobacco industry research grants or scholarships. Our own university (Sydney) has long refused to allow tobacco companies onto the campus to run job opportunity stalls at its annual student employment fair. It is the only industry thus refused.

Politicians are highly sensitive about who they are seen to be associating with. Political scandals involving associations with sex workers, criminals and corrupt land developers are common around the world, but in an increasing number of countries, being seen to be cosy with tobacco companies has become a hallmark of political poor judgement. As the CEO of the American Cancer Society, John Seffrin, has put it: ‘Politicians don’t like to stand next to a pariah in the next photo opportunity.’

Roxon was similarly emphatic that the industry’s appalling reputation as corporate pariahs (260) was important to the decision to run with plain packaging:

Angela Pratt told us:

Pratt said that Rudd shared this view:

Like millions of Australians, Rudd had lived through several decades where tobacco control was rarely absent from the news media (321, 322) for more than a week. In this time there had been years-long advocacy campaigns to get rid of all tobacco advertising and sporting and cultural sponsorship, to upgrade pack warnings, to introduce smokefree indoor air on public transport, and in workplaces, restaurants and bars. (323) There had been the train wreck of revelations about the tobacco industry’s duplicity on health and addiction and designs on children when millions of their internal documents were made public in the late 1990s. There had been large-scale public awareness campaigns on the risks of smoking. And through all this, we saw virtually continual declines in smoking, growing antipathy toward the tobacco industry and support for governments to do more to reduce smoking, particularly among young people.

Nicola Roxon

No analysis of why Australia acted on plain packs could fail to place Nicola Roxon at centre stage. Across 35 years I have encountered many federal and state ministers responsible for aspects of health, and worked with several closely. Barry Hodge (Western Australia 1983–86), John Cornwall (South Australia 1982–88), David White (Victoria 1985–89), Michael Wooldridge (Federal 1996–2001), Frank Sartor (New South Wales 2003–07 and 2009–11) and Verity Firth (New South Wales 2007–08) were all ministers who implemented major tobacco control reforms while in power. Each of these people painted their reforms on a state or national canvas, as did Roxon. But Roxon’s contribution to tobacco control history looms as one of the most important initiatives with global ramifications ever taken. If, as expected, dominoes fall around the world over the next decade, her contribution will have been monumental.

Roxon was a spectacularly good media performer. Those of us who had several decades of experience in advocating and debating for policy reform in the news media have had many hundreds, if not thousands of opportunities to rehearse particular framings, sound bites and lines of arguments. On a big news day in tobacco control, it is not uncommon to do 10 or more interviews for different media outlets, all about the same issue. You quickly get a sense of how journalists see an issue, and about which questions they see as central to a debate. You often get these questions early and develop a sense about how you have handled a question: which parts if an interview were strongest and which needed work. Subsequent interviews then allow you to push forward responses that you have used earlier to good effect. In this way, interviews throughout the day tend to get more polished. It’s a common experience to feel as thought you have nailed an interview with a turn of phrase, an analogy, a killer fact or statistic.

Nicola Roxon gave many interviews on plain packs over 2010–12. Seasoned advocates for tobacco control were in awe of her abilities to calmly and firmly explain the policy, to defend every aspect of it from attack and to go to the heart of the case for strong tobacco control. For example, on releasing the report that recommended plain packs, Roxon put the importance of firm action on tobacco by simply saying: ‘We are killing people by not acting’. (65) This stunningly direct, simple, clear-sighted and courageous statement of moral principle was one of several powerful sound bites she was to use in the months ahead. Another was her compelling observation that she had ‘never met a smoker who hoped their children would grow up to become a smoker.’ There was just no comeback on that point.

Angela Pratt told me that working with Roxon was an experience she never expected to better.

The Coalition, the Greens and the crossbenchers

After the August 2011 election, the Labor Party was returned to power in a hung parliament requiring the support of at least three of the five crossbench members of the House of Representatives to pass its legislation, such as the plain packaging bill. In the Senate, it was assured of safe passage because the Greens Party was rock solid in its support for the bill, and in voting with the government, guaranteed that it would pass. Cross-party support was important, not only for the safe passage of the legislation, but to ensure continuity of support in the event of a change of government. It was also considered important to show the world that plain packaging was unanimously supported in Australia, historically a two-party nation, particularly at a time of minority government.

Health groups such as the Cancer Council and the Heart Foundation enjoy excellent relations with all political parties, and it soon became apparent that the three needed crossbench votes were assured with the support of the sole Greens representative, Adam Bandt, and two NSW independents Tony Windsor and Rob Oakeshott. Tasmanian independent Andrew Wilkie was also emphatically supportive of the legislation. None of these three, who had often voted in a bloc on other legislative issues, needed any convincing. Maverick Queensland independent MP Bob Katter described the policy as ‘rampant wowserism’ (324) and would have never voted for it.

But the tobacco control community knew how important it was to make sure that the bill gained the support of the Opposition. This would better ensure its preservation and consolidation down the track, should they come to power.

As explained earlier (pp97), the conservative Liberal/National Coalition Opposition was by no means pro-smoking. It had introduced and sustained important platforms of tobacco control when previously in government. But in Opposition, the task of trying to find fault with most government activity is standard. The Abbott-led Opposition took this duty very seriously and developed a reputation for being extremely negative about almost everything the Labor government supported. Many expected that the Opposition would not be any different when it came to plain packaging.

The Coalition had a good number of members – including Abbott himself – who were almost genetically opposed to ‘unnecessary’ regulation of business and human behaviour. After the government had announced its intentions on plain packaging, several equivocated and publicly expressed reservations or declined to comment. Shadow health minister Peter Dutton said in June 2009: ‘In my books, in the current debate, providing a ban to packaging and to branding on packaging is a bridge too far.’ Pushed in May 2010 by prime minister Julia Gillard to say yes or no to plain packaging, Abbott eventually said: ‘If it shuts you up for a second, yes Julia.’ (see https://www.youtube.com/watch?v=pjR9JbThk1I) In May 2011, on the day BATA launched its campaign with a press conference, Abbott said: ‘My anxiety with this is that it might end up being counterproductive in practice.’

Fragments of intelligence from Opposition members and occasionally tobacco industry staff were gathered about the likelihood of support for the legislation. These painted a mixed picture. For example, a tobacco control colleague had been on holiday in Fiji resort in 2010 and got talking to some Australian businessmen. They turned out to be staff from an Australian tobacco company and some retailers who were being rewarded for achieving high tobacco sales levels. Without disclosing her interest, the colleague asked whether they were worried about the impact of plain packs. They brushed it aside and said that their management had assured them that Tony Abbott would drop the policy on gaining power.

But this may have been mere company bravado, because a leaked fax from Philip Morris’s head of corporate affairs to a PR agency in May 2010 (see pp15) noted: ‘Please note that contrary to the proposal, the Coalition’s “resolve” is not “strong”. It is at best neutral.’ This resolve referred to the industry’s hopes that the Opposition would oppose the legislation.

However, there were at least four Coalition members (Liberals Dr Mal Washer, Ken Wyatt and Alex Somlyay, and West Australian National Tony Crook) who expressed support for the policy. (324) Rumours spread that some of these may have been willing to cross the floor and vote with the government if a division had been necessary. Of these, Mal Washer was the most forthcoming about his intentions. A highly respected Perth general practitioner, Washer was a popular and trusted figure across all sides of politics, often acting as a doctor to politicians while in Canberra for parliamentary sittings. He was not someone easily ignored.

When interviewed by The Age on 22 May 2011, just nine days before his party would decide that it would not oppose the bill, Washer was asked about industry claims about increases in smuggled products. His words were blunt:

On 26 May 2011, the Cancer Council held its annual Australia’s Biggest Morning Tea fundraiser event in parliament house. Opposition leader Tony Abbott attended and told those present: ‘We all should do what we can to fight cancer.’ (326). Lung cancer is Australia’s leading cause of cancer death, with 8410 victims in 2012, more than double the cancer causing the next most deaths (colorectal with 3950), prostate (3294) and breast (2940).

The next day Michelle Grattan, perhaps the most senior member of the Canberra press gallery who had attended the event, wrote an opinion piece about the Opposition’s lack of leadership on plain packs. She wrote:

2011 World No Tobacco Day

On 31 May 2011 (World No Tobacco Day), Mike Daube and I, together with the Public Health Association of Australia, arranged a special event in Canberra to thank Nicola Roxon and the Labor government for what it was doing in tobacco control, particularly with plain packaging. This was the biggest policy advance any of us had ever experienced, and we wanted to bring together all who had played big roles in both the years leading up to it, and in all the defence of the bill described in this book.

We had earlier nominated Roxon to the World Health Organization to receive a WHO World No Tobacco Day medal. We had also arranged for her to receive the Nigel Gray Award, named in honour of the long-time head of the Cancer Council Victoria (1968–1995), widely regarded as a global ‘godfather’ of tobacco control.

She was presented with both awards that day at parliament house, where the WHO’s regional director for the Western Pacific, Dr Shin Young-soo, flew down from Manila to make the presentation. Nigel Gray was there to present the award under his name. (She was later also awarded the Public Health Association’s Sidney Sax Medal).

Mike and I had drawn up a list of those around Australia who had made outstanding contributions to tobacco control since the 1970s. About 50 were able to attend, including politicians from all sides, senior health department bureaucrats, long-time researchers, heads of leading NGOs, John Bevins (the advertising writer who had created the ‘Sponge’ ad (see https://www.youtube.com/watch?v=UbwsET7_6kQ)) and many others, and Dr Arthur Chesterfield-Evans, a leading figure in the BUGA UP anti-tobacco billboard graffiti movement from the late 1970s and early 1980s. (327)

The award ceremony took place at 11am. Unbeknown to most of those attending, the Opposition was also meeting at the same time in the parliament building, and one of its agenda items was plain packaging. At noon, Rohan Greenland and Lyn Roberts from the Heart Foundation met with Andrew Robb as part of their ongoing engagement with the Coalition on the issue. Robb came straight from the party room and told the two that the Liberals had decided not to oppose the plain packs legislation, and that they were the first to know. Greenland told me: ‘He was very happy to break the news to us.’

Angela Pratt saw the timing of announcement as no mere serendipity:

I asked Nicola Roxon and Angela Pratt to comment on the Opposition’s behaviour over the bill. Both took the stance that the Coalition were never comfortable with the issue, but were clearly able to read the very negative political realities of being seen to effectively side with Big Tobacco and having principled party members being seen to cross the floor of parliament.

Roxon said:

Pratt’s view was similar. She said:

Angela Pratt’s view was that Washer’s position was made all the easier because of the antics of the tobacco industry:

Pratt also acknowledged that:

The Adelaide Advertiser’s headline the next day was: ‘Libs yield on smokes packaging’ (our emphasis). The article stated:

On the evening of the day the awards were presented and the Coalition made its decision to not oppose the bill, the Public Health Association hosted a dinner in parliament house for Nicola Roxon, Nigel Gray and the 50 or so tobacco control stalwarts who had been there for the ceremony. Roxon’s very proud mother came along, as did Mal Washer and the Greens Senator Rachel Siewert.

I sing in a Sydney rock covers band. Our lead guitarist is Paul Grogan, the Cancer Council Australia’s lobbyist. We had put an impromptu version of a new take on the 1960s Shangri-Las’ hit Leader of the Pack on YouTube (see http://tiny.cc/8qurox), recorded after dinner one night at Paul’s house. Paul and I sang the song that night in tribute to Roxon. Everyone in the room roared the chorus lines.

On the morning that the High Court case began in Canberra (17 April 2012), Tony Abbott went out of his way to make his support even clearer. He said: ‘I think this is an important health measure. It’s important to get smoking rates down further. We didn’t oppose the legislation in the Parliament and I hope it withstands the High Court’s scrutiny.’ (329) It is noteworthy that after the 2013 election, the new Coalition government maintained strong bipartisan support for tobacco control, including plain packaging, regular excise increases and mass media campaigns.