I think having worked in other areas myself, that’s the thing that tobacco does differently from other health issues. It keeps the pot boiling on all of them. Other issues don’t seem to be able to keep it all going at the same time.

Dorothy Reading: I think the skin cancer prevention campaign has always been comprehensive and has more or less kept all these approaches going, depending on funding.

Kathy Barnsley: But no-one’s selling the sun.

Dorothy Reading: I’m talking about tobacco.

Garry Egger: That’s the point I’m trying to make. There have been papers written about the lessons from tobacco control for other epidemics. From my reading, some of them say there are lessons, others that there aren’t.

Kate Joel (McAllister): We’re dealing with human behaviour at the end of the day. That’s the common element.

Simon Chapman: One of the areas in which Australia has probably led the world in tobacco control is in strategic research, rather than just investigator, curiosity-driven research. It’s been, ‘We need some information in order to be able to move the argument in the direction towards legislative change’, that sort of thing.

Ron Borland: It’s been a much more comprehensive approach than that. I think David started it with the national survey of smoking prevalence for the Cancer Council (Victoria) with Nigel back in the early 1970s. We actually provided the database and that systematic approach to collecting the data that we need to address the issues.

It’s strategic, often in a long sense, in that it often only bears fruit 10 or 15 years after you put in place the data collection strategies and start collecting the data so you can document the problem. Then you’ve actually got the facts to be able to drive things forward. After that the little bits around the edge actually fit into place. I think that strategy has been extraordinarily important.

Mike Daube: In terms of learning lessons and so on. Of course tobacco has lessons for other areas, just as tobacco itself also has things to learn from other areas. Back in the early 1970s I learned about campaigning from the poverty lobby. I think tobacco still has something to learn from others areas, from alcohol, for example about issues around access. I don’t think there’s an argument there.

Back to the point about research, we’ve been really fortunate in tobacco that there are a lot of focussed researchers. In other areas, taking up Simon and Ron’s point, there are lots of people doing really interesting research. But some years ago when I reviewed the NHMRC’s funding on obesity, I think there were about 300 research projects for funding. I counted about five that could have any impact on public policy over the next 50 years.

There was lots of interesting theoretical stuff and, for some reason with tobacco, there’s some of that but much of it is more focussed.

Garry Egger: Simon made this point earlier. Tobacco doesn’t have the silos that you get in these other areas. When you get a silo, of the 300 articles they may not have been good, but they’re good within a very small silo and they don’t have a huge impact overall. I’m not suggesting that there aren’t things to learn from what we’ve learnt in tobacco. I’m just wondering what specifically there is to learn and what we can take into other areas. It’d just be good to have a go-to point where you can start off.

And on the point Ron made earlier about data, I was involved in the first report on obesity in Australia in 1993. We came up with a whole list of things that would work really well. None of them were enacted. Another report has just come out in the last 12 months with virtually the same items. It seems that nobody’s learned anything in those 20 or 30 years.

Paul Grogan: Here’s an anecdote (that demonstrates a particular perspective). I was trying to engage a senior MP on obesity last year. The response was, ‘I’ve just seen the new ABS[178] data . Australian men are going to live to 80 for the first time ever. We’ve got a country in debt. We’ve got an economy that’s struggling and unemployment’s rising. We like you guys but, seriously, stop trying to catastrophise stuff.’

The broader spectrum take on that is that we’ll never be able to demonise food, and alcohol to a lesser extent, to the same extent as you could with tobacco products.

To your first point, there are probably half a dozen areas I could rattle off where regulation and legislation could reduce obesity. It’s getting that level of engagement because food products are much harder to demonise and that gives people who don’t want to do things an easy way out.

Witness to the History of Australian Medicine