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OBSERVATIONS ON THE FIFTH WORLD CONFERENCE ON SMOKING AND HEALTH BY A CONSULTANT WINNIPEG, JULY 1983 1. Focus and Sources I understood my assignment to be an overall assessment of the conference, with special emphasis on institutional dynamics and ideological themes, using my report on the Stockholm conference (1979) as a "base line". I further understood that I ought to keep the "larger picture" in mind, rather than reporting on details; I have done this in what follows, with two exceptions - the special sessions on religion and feminism, which dealt with two new ideological themes and which I therefore will comment on in some detail. It goes without saying that an overall assessment such as I was asked to make will be subjective to a degree; this too, I believe, was understood, but it should be explicitly stated, since I cannot conclusively prove everything I say here. What I have done is to apply to the conference my own "sociological sensibility" and such knowledge of the anti-smoking phenomenon as I have acquired over the last few years. I'm aware of the

- 2 - possibility that my own impressions may vary from those of others who attended the conference. The main source for the following observations, of course, is my own notes and recollections from attending the conference in its entirety. I attended some sessions in toto, but I also did a good deal of hopping around, to get a better sense of what was going on. Also, I had some informal conversations with conference participants, and I took home various documents that were handed out. 2. Institutional Dynamics One of my main points, in commenting on the Stockholm conference, was that, in my view, there were two quite distinctive institutional interests represented within the anti-smoking complex - bureaucratic interests (WHO, Western government agencies, Third World government agencies) and movement interests (the various non-governmental anti-smoking groups). I further observed that, it seemed to me, these two interests were not at all identical, with the bureaucratic interests being more reasonable, less absolutist. A further observation I made then, to the effect that the Third World emphasis of the Stockholm conference (reiterated as a major theme at Winnipeg) was a sort of bureaucratic imperialism of the West, continues to apply.

- 3 - Third World delegates were once again flown to Winnipeg at the expense of SIDA, the Swedish government foreign aid agency (as proudly stated by Lars Ramstrom, from Sweden, in his presentation at a lunch session on "Special Problems in Developing Nations"); I would guess that very few of the Third World participants came at their own governments' expense. I would continue to doubt whether the enthusiasm expressed by some of these people about the anti-smoking cause is shared by many back home. Despite the efforts in the intervening four years, especially by WHO (which, as a UN agency, must of course legitimate itself by a Third World emphasis), the anti-smoking cause continues to be a Western dominated phenomenon. It should also be noted that the sessions on Third World issues were not well attended. However, it also seems to me that the distinction between bureaucratic and movement interests, while still valid, must now be modified somewhat. There appears to have taken place a certain interpenetration. A number of bureaucrats seem strongly committed to the anti-smoking cause. More important, the movement itself has clearly become more bureaucratized and professionalized since Stockholm. It was striking with how much professional know-how many of the anti-smoking groups are operating now. There has been a displacement of missionaries by technicians - that is, by people with a lot of political and organizing competence. These may be less fanatical in their adherence to the cause, but they are much more formidable in getting things done both on the level of

- 4 - influencing political processes (including legislation) and on the level of shaping public opinion ("education"). In any case, my distinction between the two institutional interests now has to be toned down. It still exists, but there has been a certain merging of institutional identities. One might even speak of an anti-smoking conglomerate, a network of interlocking governmental and non-governmental organizations. There were some indications of tensions within the UN system. WHO continues to be the spearhead of the anti-smoking cause within the system, but the response from other UN agencies, notably FAO, may be less than satisfactory from the anti-smoking viewpoint. I take it that there are good political reasons for this. I cannot judge whether the savage criticisms of UN actions on anti-smoking matters by Frederick Claimonte (UNCTAD) represent only his own views or wider opinions within his agency. As far as Third World governments are concerned, my own knowledge of the UN system (all acquired since Stockholm) inclines me to the view that rhetoric voiced in UN-sponsored settings commonly bears little resemblance to actual government policies back home. The prominent role of some Third World participants (notably Kuwait and Swaziland) may be attributable to the personal inclinations of individual health ministers; I have no knowledge of the domestic political contexts.

- 5 - 3. Ideological Themes Officially, the Winnipeg Conference had three major themes of concentration - women, children and the Third World. The last of these, of course, was a continuation of the Stockholm emphasis; the first two were new, at least as major emphases. The three themes were, logically enough, related to the available empirical data on smoking: In the developed countries, the decline in smoking has affected women and young people less than men, and in the Third World no decline is in sight (on the whole); ergo, the anti-smoking campaign is to concentrate on the most vulnerable (from its point of view) groups. The most obvious ideological linkage in the case of women is with feminism. A special, and very interesting session was devoted to this; I report on this in detail below. The "children" theme, of course, is ideologically potent, in that it suggests exploitation of a particularly vulnerable group. In this connection, the use of language is particularly interesting: As far as I could make out, the word "children" was used for young people in general; that is, both an 18-year old and a 12-year old were discussed under the category of "children". Paradoxically, this is the opposite use of language than that current in the feminist movement - thus, an 18-year old girl smoking is referred to here as a "child", while the same individual getting an abortion will be referred to as a "young woman". In both instances, language is used ideologically, to make a propagandistic point.

6 The Third World theme, as already indicated, does not impress me as having gone very far since Stockholm. Interest by Third World Governments appears to be limited or sporadic, and these countries (with the possible exception of the Muslim world, of which more below in connection with religion) do not strike one as likely soil for the sprouting of anti-smoking movements. Perhaps the absurdity of the Third World theme was best illustrated (for me, at any rate) by the participation of individuals from those countries at the tobacco-burning ceremony in the park in front of the Manitoba capitol on the Wednesday evening. Obviously staged for television, Third World participants, in colourful indigenous dress, were very prominent in the ceremony; the uninformed observer would get a completely disproportionate notion of their importance in the anti-smoking campaign. The pyre was lit by a Nigerian, appropriately garbed. My attention was caught by an Ethiopian, who gleefully threw some tobacco products into the pyre; one had to wonder about the priority of the smoking issue in a country beset by not one but several insurgencies, ruled by one of the most oppressive regimes in Africa, and facing massive starvation. To be sure, Third World participants kept repeating the customary formulas about neo-colonialism, with the tobacco industry representing the multinationals that are the general villains in this Third World rhetoric.

7 My guess is that this is not to be taken very seriously. If it is serious, it is rather in the susceptibility to this rhetoric by intellectuals and people influenced by them in Western countries; there, of course, such rhetoric is part and parcel of Leftist propaganda. I was struck, though, by the fact that, in sessions I personally attended, the address by Clairmonte was the only one that was characterized by an unabashedly Marxist analysis of the situation. Perhaps the decline of the Left in Western countries has an influence here. In my report on Stockholm I commented on the cognitive assumptions in play, scientific as well as political ones. There has been no change in these. The most important assumption, of course, is that smoking (as was repeated ad nauseam in Winnipeg) is the most important casue of preventable death in the world today, is an "epidemic". I did not attend the (quite few) sessions devoted to scientific papers (with one exception, in which "safer cigarettes" were discussed). But the overall assumption in the conference was very clear: Supposedly, there are no more scientific questions of any importance left; the causal link between smoking and a list of diseases has been established beyond reasonable doubt; thus the agenda now is simply how to act on this allegedly scientific certainty.

8 I should add, though, that in the session on "safer cigarettes" that I attended, the atmosphere was very objective and information that might be deemed damaging to the anti- smoking cause was allowed full discussion. The major political assumption continues to be that government has an obligation to control the "epidemic"; given the scientific assumption, this is hardly surprising. Once again, the Scandinavian countries (notably Norway, Sweden and Finland) were held up repeatedly as models, as having gone a long way toward making smoking an activity engaged in "by consenting adults in private" (a phrase already used in Stockholm and repeatedly used in Winnipeg). Yet, while the underlying ideology has not changed, there have been significant changes in the manner in which this ideology is represented in anti-smoking propaganda. These changes were repeatedly underlined by speakers in the strategy session. Overall, there has been a shift from negative to positive imagery. Four years ago there still was a very strong emphasis on the dangers of smoking - images of disease, playing on the fears of people. It appears that this strategy has been deemed by many in the anti-smoking movement to be counter-productive. Increasingly now, the emphasis is on projecting a positive image of healthy living, of which non-smoking is only a part. This new emphasis came out very clearly in the session on the use of media (in the reports on a TV campaign in Austria, on the sponsorship of the Scottish

- 9 - World Cup squad by a British anti-smoking group, and in the Great American Smokeout enacted by the American Cancer Society). The new emphasis was put very eloquently by S. Chapman (Australia), in a session on how to counteract tobacco advertising, who urged that the anti-smoking movement must get over its earlier puritanical, spoil-sport image. Essentially, what is happening now is the selling of an integrated lifestyle - healthy, yes - but also modern, with-it, and above all youthful. The Scandinavian campaign for "A Non-Smoking Generation" has, since 1979, been effectively internationalized. To put it graphically, there has been a shift from portraying people coughing their lungs out to images of sexy blondes jumping around in evidently enjoyable pursuits. In terms of this imagery, it is smoking that is the spoil-sport. Or, to put it differently, the hedonistic theme, which culturally used to be associated with smoking is now expropriated and em loyed in the anti-smoking cause. This, in my opinion, is a significant shift. By way of illustration, one may cite here the physical exercises staged during conference intermissions. A surpri- sing number of individuals (most of them middle-aged and not in obviously good physical condition) participated in these, following the instructions of the teenage cheerleader in charge of these proceedings. The scene reminded one of some

revivalistic healing cult in Southern California - all these people jumping up and down, hands raised to the sky, silly ecstatic smiles all over their faces; I noted that the least attractive ones wore T-shirts that said "Non-Smokers Make Better Lovers" (an expression of desperate hope, one may surmise). I take all this as a rough validation of my origianl intuition about the anti-smoking movement - that it is, au fond, a quasi-religious quest for immortality (or perhaps, slightly more rationally, for the fountain of youth). As far as the evidence from developed countries goes, the campaign has been successful to a remarkable degree. In an age in which health has attained quasi-religious status, and in which, because of secularization, competing ideals have lost plausibility, none of this should be surprising; nor should the continuing fierce hostility against the tobacco industry (no hatred is as deep as religious hatred). However, one sociological reflection may modify this picture slightly: As data from the developed countries continue to indicate, class has become the major factor discriminating smokers from non-smokers. More specifically, smoking has become increasingly an element of working-class culture. I cannot say to what extent working-class individuals (including working-class youth) are impressed by the essentially middle- class imagery of the anti-smoking propaganda. Generally, in Western societies, there is a good deal of working-class resis- tance to the schemes of reform and redemption, and the concomi-

- 11 - tant lifestyles, promoted by middle-class professions, bureaucrats and assorted do-gooders. Politically, working- class voting patterns in several Western democracies (notably the United States, Britain and West Germany) demonstrate this resistance. It is at least possible that working-class culture will also continue to resist the imposition of a non-smoking lifestyle by upper-middle-class professionals and government bureaucrats. The religion theme : The session devoted to this ("Smoking and Religion") was chaired by a Dr. Omar Sherif (sic) , an Egyptian cancer surgeon. There was only a handful of people attending. This evident lack of interest may lead one to dismiss the theme as a non-starter; this may be premature, if the theme is taken up again and pushed by those in charge of anti- smoking activities; more on this below. Be this as it may, the session in itself was fairly grotesque. Sherif, correctly enough, opened the session by saying that this was the first time that religion was discussed in an international conference on smoking. He expressed the belief that this could initiate "a new avenue to reach the masses" in the

anti-smoking cause. He then discussed Islam in relation to smok- ing. He argued, with reference to some (to my knowledge, marginal) authorities on Islamic law, that smoking was contrary to Islam because it is an intoxicant harmful to health (thus, by analogy, falling under the Quranic prohibition of alcohol). He made refer- ence to a meeting on the topic recently held in Medina (no less); he was a member of this group, which, according to him, concluded that smoking was indeed to be proscribed. Sherif was followed by one R. P. Bulka, a Canadian rabbi, whose argument was very similar. While traditional Jewish law did not mention smoking, one could reason by analogy: Harming innocent others and committing suicide were both contrary to Jewish law, and smoking could be subsumed under both these behav- ioral categories. This argument was buttressed by various tradi- tional citations. Bulka admitted that his position was not at all common among rabbis, but expressed the hope that it would gain credence as the harmful effects of smoking became more gener- ally known or acknowledged within the rabbinical community. Christianity was represented in this anti-smoking ecumen- ical troika by three speakers - F. A. Soper, director of the Seventh-Day Adventist "5-day plan to stop smoking"; R. Vincent, a Mormon physician; and A. Haggart, an Anglican bishop from Scotland. Both Soper and Vincent reiterated the theological/ethical position on smoking long held in their respective denominations, as a violation of the body created in the image of God. Soper Z501021696

emphasized that, quite apart from practical health reasons, abstin- ence from smoking was a spiritual goal. Vincent spent the bulk of his time presenting data on the superior health of Mormons (to my knowledge, these data are correct), which he attributed not only to non-smoking but to various other health-producing aspects of the Mormon way of life. Haggart's presentation was rambling, very poorly organ- ized (he was actually supposed to be a discussant of the preceding four papers, but, as an Anglican, had little to say about them). He regretfully reported that smoking was hardly an issue in the mainline Protestant and Catholic churches. He ended with a "con- fession of guilt and promise of amendment", and with the not very confident intent to push the anti-smoking agenda in church circles (such as the forthcoming assembly of the World Council of Churches). Taken by itself, this session would lead one to the conclusion that nothing much is to be expected by way of anti- smoking activities by religious groups. Both Sherif and Bulka represent minority viewpoints within their own communions (in the case of Bulka, this minority is very small indeed). The anti- smoking positions of Adventists and Mormons are long-standing and well-known, and are very unlikely to influence anyone outside these denominations. And Haggart hardly appeared as a herald of a new wave of concern among mainline Christians. For the moment, this may well be a correct conclusion. However, I would suggest some caution, for two reasons. One (and

by far the more important one): Sherif may still represent a minority viewpoint within the Muslim world. However, as was pointed out both by himself and by a member of the audience (an- other Egyptian physician), there are data showing that non-smoking is strongly correlated with strong adherence to Islam, especially among young people (the data mentioned are from Egypt). I know from other sources that abstinence from smoking is part of the lifestyle urged on their members by fundamentalist Muslim groups in several countries (for example, Pakistan and Malaysia). It follows, therefore, that Sherif may be quite correct in surmising that the anti-smoking cause could have considerable appeal to the Muslim "masses" - or, more precisely, to fundamentalist Muslim groups. Since such groups are a very powerful presence in most Muslim countries, the little gathering at Winnipeg could con- ceivably be the beginning of a much more serious development. In that context, it could be significant that the session was chaired by a Muslim. Two (and this is the less important reason): Mainline Christianity, both Protestant and Catholic, has become very sus- ceptible to rhetoric attacking multinationals and endorsing the interests of the Third World. It is at least possible, if efforts are mounted to this end, that anti-smoking could become incorpor- ated within the general anti-capitalist/Third-Worldist agenda of various Christian organizations. At the moment, this does not seem terribly likely; these organizations are preoccupied with

other concerns ("peace", "social justice", "equality", and so on). But the possibility of anti-smoking creeping into their agendas cannot be summarily dismissed. The feminism theme: The session devoted to this theme ("Smoking and Feminism") was very well attended (a majority of women, but considerable male attendance as well). It was chaired by Bobbie Jacobson (a British physician, active in both feminist and anti-smoking activities, and author of The Lady-Killers, a little book that was for sale at the conference). Jacobson (an evidently self-satisfied individual, bursting with energy) ran a brisk meeting, introducing speakers (all women) by their first names (standard feminist etiquette) and injecting forceful com- ments of her own. In ringing tones, she began by declaring that the anti-smoking movement must no longer be run by "middle-class, middle-aged, white men"; instead, the session was run by middle- class, middle-aged and (with one exception) white women. The most interesting problem of this session was one of (so to speak) ideological dissonance: The data about smoking women would seem to indicate that smoking is correlated with emancipation; if so, here is something that feminists generally applaud; it is, therefore, necessary to dispute the notion (appar- ently expressed by some) that feminism is to be blamed for women smoking so much. The basic ideological thrust of the session was to argue that, on the contrary, women's smoking is an additional

oppression (presumably foisted upon them by men) , and not to be confused with genuine liberation. Jacobson initiated this thrust by referring to the three groups singled out by the conference - women, children and Third World people - as "the three most underprivileged groups in the world". She insisted that there was no evidence that women smoke in order to relate to the world in a masculine way; on the contrary, "women smoke like women and die like.women"; this sen- timent was much applauded by the audience (most of which was very much in tune with Jacobson's fervor). Then came several presentations. Ingrid Eide (a Norwe- gian sociologist and former government official) presented data on women and smoking, from a Norwegian study. Based on criteria of age, education, location and occupation, Eide had constructed an "index of emancipation", on the basis of which she concluded that the most "emancipated" women were not over-represented among heavy smokers. She also reported on another study, which supposedly shows that feminists are under-represented among daily smokers but ("unfortunately") over-represented among overall smokers. Eide concluded that her data show that feminism cannot be blamed for increased smoking among women. It is difficult to evaluate these data without more knowledge about them. But in my opinion the "index of emancipa- tion" is not very convincing; as to the data, I suspect that they simply reflect the class bifurcation in the smoking population - 2501021700

since feminists tend to be upper-income individuals, they will naturally smoke less than lower-income individuals. This would mean that Jacobson and Eide are quite right that feminism per se cannot be "blamed" for women's smoking; this, though, is rather besides the point; the point is that women, and especially working- class women, smoke more as they enter the labor force - and that has been one of the goals of the feminist movement. There was a purely factual report on smoking and women in India, by M. B. Aghi (of the Tata Institute, Bombay). Virginia Ernster (a professor of public health from UCLA) gave a witty presentation, with slides, of changing images of women in tobacco advertising - the main point being, of course, that women were "exploited" in a sexist mode in this advertising. Pattie White (an ASH activist from Britain) argued that smoking represented women's place in society - again, of course, a place of under- privilege/exploitation. She related (convincingly) data on smok- ing to the desire of women to remain thin. She attacked "male bias" in research on smoking and women, though it was not very clear in what that bias consisted. She also confirmed that smok- ing was higher among women in the labor force. The discussion was spirited, with an obviously engaged and concerned audience. The data on women and work were obviously disturbing, from a feminist point of view, and there was the evident need to "explain" these data in feminist terms - a not very easy undertaking. Eide took a leading role in these efforts.

There were complaints that the feminist movement has generally been indifferent to the smoking issue. For example, it was reported that attempts to get Ms. Magazine to drop its (allegedly) pro-smoking slant have been unsuccessful. There was applause, though, when one member of the audience reported that the forthcoming new edition of the feminist health-bible, Our Bodies, our Selves, will include a chapter on smoking. After the discussion, the session broke up into workshops that mainly dealt with "how to" questions of organisation and propaganda. I'm not sure what to make of all this. As several speakers themselves stated, anti-smoking is not a prominent issue within the feminist movement either in North America or in Europe. I could well imagine though, that it could become more important. The class location and the general ideological posture of the movement makes it natural "soil" for anti-smoking sentiments. There are themes with an affinity to anti-smoking already strong in the movement - a generalized sentiment of being put upon by male-dominated institutions, and thus a readiness to identify with other categories of alleged "victims" (I would suggest the concept of victimological amalgamation for this); ergo, a tendency to come out on the Left on miscellaneous political issues (for example, the "gender gap" on economic and defense issues in the U.S.); this would lead to a perception of the tobacco industry as one more case of predatory capitalism, which is supposedly a key cause for the oppression of women.

My guess would be, though, that it would be on the positive rather than the negative side that feminists would come out on in terms of anti-smoking. That is, feminism would be perceived as linked to a non-smoking lifestyle - with the implications discussed above. In this connection, I will allow myself a general sociological hypothesis here: The anti-smoking cause is part of a much larger ideological configuration, which is marked by a tendency toward hypochondriacal and paranoid perceptions of the world. Therefore, the readiness of groups to adopt the anti-smoking cause may be predicted by the degree of proclivity toward such perceptions (no matter with what specific contents) that a group already has. So much for religion and feminism. There was one other new ideological theme, that of smoking among minorities. The session devoted to this theme was not only very sparsely attended, but the papers supplied straightforward information (such as on smoking rates among American blacks) with very little ideological payoff. I can only guess why this theme was included in the program - either for token reasons, or as yet another attempt to expand the anti-smoking constituency by the strategy of what I have ~ just baptized as "victimological amalgamation". If the ~ Q latter was the intention, it flopped. ~ ~ C Lh?

- 20 - In my observations of Stockholm, I had spent some time discussing ideological linkages of the anti-smoking cause - such as Third Worldism, anti-capitalism, environmentalism and consumer protection. All these linkages continue to be visible, thus placing the anti-smoking cause broadly Left-of-center in terms of conventional Western politics. However, the emphasis on health is so overriding and the explicit Marxist or even quasi-Marxist themes so muted that most Right-of-center people would have little difficulty affiliating with the cause, as long as they were persuaded of its cognitive assumptions concerning the health efforts of smoking. To put it crudely, being against lung cancer is not necessarily a Leftist position. The healthful/youthful/ with-it lifestyle that is now intended to incorporate non-smoking as one of its features could also go quite comfortably with Right-of-center politics (Republicans do jog, eat health foods, and - sad to say - have been known to be both hypochondriacal and paranoid); an older American movement, the campaign against fluoridation, may serve as an example of such linkage between health cultism and Right- leaning politics. I do suppose that Right-of-center adherents of the cause would be less enthusiastic about the role of government in controlling smoking and more inclined toward voluntarism in this area; take that as a hypothesis. Institutionally, the linkage with consumer protection appears to have been strengthened (thus a number of papers mentioned anti-smoking actions by consumer groups - for example, in Malaysia).

I can also see no significant change since Stockholm in the relation between ideology and recommended strategy. The overall strategy, as based on the above-discussed ideological perspective, is to move from the stigmatization of smoking to the segregation of smokers to the elimination of the habit as acceptable conduct. What was very obvious, though, at the Winnipeg conference was a clear bifurcation between a hard-line, aggressive and hostile approach to the issue and a much softer, "user-friendly" approach. Both approaches were well-represented. The non-smokers' rights movement sharply represents the hard-line approach - it is not just the industry that is the enemy; smokers are. There continue to be such endearing suggestions as the one made by a Dr. Lewis (Australia) that public smoking areas should be small, unattractive and poorly ventilated. There continue to be suggestions that smokers be aggressively confronted and embarrassed. However, there were also repeated calls for an approach that tries to appeal to smokers in a friendly, concerned way - they are victims, not enemies. For example, this is the explicitly stated aim of the Great American Smokeout. I cannot judge which approach has more adherents; I was not in a position to make a full count of all the "how to" sessions. However, in view of the clear shift from negative to positive propaganda (selling a lifestyle rather than playing on fear), it seems likely to me that the softer

- 22 - approach is on the ascendancy. This would mean that the stored-up feelings of hatred, which fuel the "war" against tobacco, will be completely concentrated on the industry and not on smokers. The very effective address of Mike Daube (British anti-smoking activist) would seem to represent this combination of a very hard line against the industry and a friendly attitude toward smokers. If this approach is indeed gaining, I should think that it will be much more effective than the old vindictiveness against smokers. 4. Overall Comparison of the Two Conferences Much more so than in Stockholm, one obtained the impression in Winnipeg that the anti-smoking movement had come of age. It has consolidated itself in many Western countries in durable, well organised pressure groups. It has established beachheads in various government agencies and international organisations. In several Western countries, it can point to legislative and political successes. Smoking is declining. The movement has a much clearer sense of purpose and a carefully mapped-out strategy (which was repeated over and over throughout the conference, so that even the least bright activist could understand it). While there are still battles ahead, the mood at Winnipeg was up-beat and ~ t~'1 are a ho feel that the iiti Th l t y c. e w op m s ese are peop 0 Q winning; I'm inclined to think that, as far as Western f~J ~ countries are concerned, they are probably right (though one p Cn must add that no victories are ever total, at least not in

- 23 - democracies, and the goal of reducing smoking to the level of furtive pornographic enjoyment in some sort of social underground may not ever be attained). The situation is clearly different in the Third World, probably so in the socialist countries in Europe (which, as in Stockholm, were very poorly represented at the conference). One somewhat amusing sign of the maturity of the movement is that it now has its grand old men and its martyrs. The grand old man par excellence, of course, is Sir George Godber (monocle and all), whose plenary presentation dwelled on some nostalgic reminiscences. The two major martyrs (eulogized by Kjell Bjartveit and others) appear to be Joseph Califano and Sir George Young, who were supposedly removed from their positions by the U.S. and British governments, respectively, because their strong anti-smoking stands antagonized the industry. There appears to be much less emphasis on scientific findings. As was repeatedly stated by speakers at the conference, the position is that all the relevant data are in now, there are no more important open questions; the agenda now is one of action, not of research. It follows that anyone who still has doubts about the scientific evidence concerning the pathogenic effects of smoking is wilfully ignorant. In other words, the case has been proved; the agenda now is one of pushing the practical implications.

- 24 - Consequently, the conference was primarily devoted to strategy, tactics and techniques - on "how to" questions.. I made a rough count, based on the program (obviously, not having attended all sessions, I had to go by titles, and there is a subjective element in the categorization). I divided the sessions into three categories - those devoted to medical and epidemiological information; those devoted to information on smoking incidence and behavior; and "how to" sessions on organizational, political and educational methods. (There are more entries than sessions, because I entered a session into more than one category if the content so indicated.) By this procedure, I arrived at the following count for the three categories - respectively 12, 30 and 56. Even allowing for errors due to subjectivity, I feel confident in saying that the "how to" sessions far outweighted those devoted to scientific information. I no longer have the Stockholm program and thus cannot make a comparison; it is my impression that the "how to" component was considerably larger in Winnipeg. I have already commented on the impressive professionalism in evidence at the conference. In this, incidentally, the anti-smoking movement is typical of comparable movements that manage to perdure over a number of years (compare the pro and anti-abortion movements, the consumer movement, various peace movements). In Western democracies, movements spring up all the time, gathered around a dazzling variety of causes. Some are fleeting fashions and soon disappear. But those which survive are increasingly managed by

- 25 - professional movement-managers - experts of all sorts, from public interest lawyers, political consultants and media methodologists to therapists and kindergarten agitators. This has clearly happened to the anti-smoking movement. In consequence, it has become a formidable social and political reality.