The current issue of the British Medical Journal carries an angst-ridden letter titled ‘Can the Dutch Government really be abandoning smokers to their fate?’ Since June 2010, the largest party in the Dutch parliament has been the People’s Party for Freedom and Democracy which, as its name implies, is anathema to the public health establishment. Last year, it relaxed the Dutch smoking ban after a grass-roots campaign led by small bar owners. This year it decided that there are better uses for public money than funding anti-tobacco advocacy groups whose beliefs are fundamentally at odds with Dutch liberalism. STIVORO, the Dutch equivalent of Action on Smoking and Health (ASH), received 2.7 million euros in 2011. By 2013, it will have to rely on donations from the public, which, in all likelihood, means it will have to close down. In addition, pharmaceutical nicotine products will no longer be handed out for free on the taxpayers’ shilling.

The BMJ letter paints a terrifying picture of a nation without a professional anti-tobacco lobby. Strangely, considering their imminent plight, none of the ‘abandoned smokers’ have put their name to it. Instead, it is written by fifteen anti-tobacco lobbyists whose livelihoods depend on the largesse of the state. They claim that the government is “closing down its tobacco control operation”. In fact, smoking prevention programmes will continue in schools and the majority of bars will remain ‘smokefree’. Physicians will continue to provide assistance to smokers who wish to quit, and nicotine patches will still be available over-the-counter to anyone who is not deterred by the 90% failure rate of such products.

The real concern of the letter-writers, who include a consultant to the pharmaceutical industry alongside employees of STIVORO, ASH and the UK Centre for Tobacco Control Studies, is that governments elsewhere might follow suit. Worse still, if smoking prevalence continues to fall in the absence a professional anti-tobacco lobby, politicians might begin to question the efficacy of tobacco control methods. Across Europe, health lobbyists of all persuasions have cause to be worried. The declining fortunes of leftist parties, combined with the dire economic situation, leaves the ranks of the ‘public health professional’ vulnerable to budget cuts. In Britain, Alcohol Concern recently lost its core funding from the Department of Health after one too many criticisms of government policy. Consensus Action on Salt and Health has also seen its grant disappear.

Under Labour, the third sector was awash with government cash and lobby groups masquerading as health charities provided noisy support for policies which had little grass-roots support. When an industry does this, we call them front groups. When the government does it, we call them stake-holders. Under the Lib-Con coalition, these groups have become more truculent and Andrew Lansley must wonder why his department is funding organisations which are unrelenting critical of his government.

The BMJ letter is careful to praise the coalition’s policy on tobacco whilst giving the implicit warning that any budget cuts will leave blood on their hands. Having painted a grim picture of what the Netherlands might look like without free Nicorette gum, they warn: “Every death that ensued would not just be the responsibility of the tobacco industry, which continues to promote its lethal product, but also of every politician in the Dutch Government who chose to look the other way and allow it to happen.” This hysterical reaction sums up everything that is misguided about the health lobby. From their perspective, smoking can be the blamed on the tobacco industry or it can be blamed on the government, but individuals themselves can never be held responsible.

This message is in stark contrast to the words of the Dutch health minister, Edith Schippers, who has said that “the state is not a nanny” . Her policy is to take a “middle path”, discouraging smoking while allowing “adults to decide for themselves over lifestyle decisions.” Such a philosophy is barely comprehensible to the anti-tobacco lobby whose current demands include the abolition of branded cigarette packaging and smoking bans in cars, private apartments, parks and beaches. If the demise of STIVORO prevents such draconian measures in the Netherlands, the government will not be “abandoning smokers to their fate”. It will be finally giving them a break.

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