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Smart card licenses and enforced quotas proposed to combat smoking

If you quit smoking, you get your license fees back—plus interest.

Smart card licenses and enforced quotas proposed to combat smoking

A public health professor has published a paper proposing that smokers be forced to apply for licences and given weekly quotas.

In his paper, published in PLOS Medicine, Simon Chapman of the University of Sydney's School of Public Health says that by issuing every smoker with a paid-for smartcard to buy cigarettes, governments will be able to gather data the health authorities can then use in anti-smoking campaigns.

Every time they buy a pack of cigarettes the smart card will need to be swiped and, depending on what annual license level the individual has purchased, the numbers will be totted up and they will be cut off when they reach their maximum weekly limit (70 per week, 140 per week or 350 per week). The higher the limit, the more the licence will cost, deterring, says Chapman, lower-income individuals: "Poor smokers, as a group, are known to be more responsive to price than those on higher incomes, in terms of both quitting and reducing use." This may perturb the world's one billion smokers, 80 percent of which, according to the World Health Organisation, reside in low- and middle-income countries.

Chapman's argument is based on a pretty simplistic premise: if we need prescriptions to get hold of potentially harmful or addictive drugs, why don't cigarettes fall into this category?

"The prescription system is in effect a system of temporary licencing to use restricted substances," he writes in the paper. "Travellers carrying restricted drugs across borders can be required to show that they have a 'licence' to be in possession of some drugs… By contrast, tobacco products can be sold by any retailer… smokers can buy unlimited quantities of tobacco. Many nations outlaw sales to minors, but prosecutions are rare and sales to children common. In contrast to the highly regulated way we allow access to life-saving and health-enhancing pharmaceuticals, this is how we regulate access to a product that kills half its long-term users."

Based on the fact that smoking kills almost six million people each year, it should fall into the same category as things like firearms and fireworks, which are heavily restricted, argues Chapman. Sheer inconvenience and cost will not be the only deterrents of this system—Chapman calls the license fee "neither trivial nor astronomical... set at a sufficient level to give smokers some pause."

Most users will sign up online, and once their contact details have been obtained, anti-smoking messages of encouragement will be e-mailed to the user. There will also be financial incentives to stop smoking—if a user decides not to renew their license, they will be given back all the fees they paid to date, with interest. There should also be a critical cut-off point for this, so people give pause for thought about the financial burden of not giving up. New smokers, those turning 18, will have to take a "knowledge of risk test" before being granted a licence.

Chapman is not so naïve as to think there would not be a minor public outcry from smokers and sceptics alike, so although he touches on issues such as black market up-take, he has also asked Jeff Collin, political scientist and director of the Global Public Health Unit, to respond.

In Collin's "The Case against a Smoker's License," he argues that in some countries it would be a totally impractical system—for instance, in the UK, where "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."

His paper also suggests Chapman's strategy would make smokers feel like registered addicts, stigmatising the habit and creating demeaning scenarios for low income individuals: "The proposal to require licences will inevitably be widely perceived as demeaning, onerous, and punitive, and in explicitly targeting smokers would dramatically exacerbate the sense that smoking 'just has that sort of feel about it, a leper.'"

Collin does, however, agree that Chapman's argument of raising the legal smoking age by one year, every year, is worth consideration. He also concedes that there should be some restrictions on sales, considering some studies into hours of sale suggest putting restrictions in place could have a great effect.

"It is indeed an historical absurdity that so dangerous a product should be so readily available," he writes, but the rigidity of Champan's system is probably not the answer. Rather, Collin wants more creative and innovative techniques that look to undo the very nature of the mass manufacturing and promotion of tobacco we have all come to accept. Aside from the aforementioned tweaks to the system, Collin doesn't appear to have an alternative, however.

Completely changing the rules of the game halfway through has not proven effective in the past. For instance, in Bhutan the government attempted to enforce an outright ban on the sale of tobacco in 2005. However, by 2009 the authorities were already debating the bill after smuggling cigarettes became big business. It's also probably not good for the country's community relations when it threatens to jail a Buddhist monk for five years for being in possession of chewing tobacco.

This post originally appeared on Wired UK.

Channel Ars Technica