Sean Semple, Kate Hunt, Martine Stead.

Two products that history is unlikely to reflect upon kindly are tobacco and petrol/diesel. The first kills two-thirds of those who consume it regularly and has led to more than 100 million deaths in the past century with many more deaths to occur in future, particularly in lower and middle income countries. The second, arguably more pervasive in society, has played a significant role in our addiction to carbon, and helped to drive atmospheric CO₂ above 410ppm with the consequent climate emergency estimated to impact on the health of billions as our planet experiences an increase in average temperatures of 1.5^oC and beyond. From a public health perspective these two products are similar in many respects; both are:

• damaging to the health of the consumer and those exposed to second-hand effects;
• could be classed as ‘addictive’ and have been marketed as providing a desirable lifestyle;
• are produced by a small number of global multinationals who have expended considerable effort to argue that their products are not harmful to society;
• and are generally accepted by society as products that we need to phase out either through the tobacco end-game or the global drive towards ‘net zero’ carbon emissions.

So let us reflect a little about how public health has successfully tackled tobacco and societal addiction to such a harmful product over the past half century, with a view to considering if we can apply any of that learning to help tackle our collective and destructive use of fossil fuels.

Introduce a global treaty with targets for governments and guidelines for consumers

The first step towards the need for public health action on tobacco came through epidemiological evidence that smoking, and then second-hand tobacco smoke exposure, is harmful to human health. We have high quality data about the burden of tobacco on global health which has helped develop concerted international action on tackling smoking through the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) now adopted by 180 countries. The FCTC sets out a roadmap of how to tackle the impacts of tobacco with measures outlined in the MPOWER principles. These include Monitoring use, Protecting non-smokers from second-hand smoke effects, Offering help to smokers who want to quit, Warning about tobacco’s dangers, Enforcing bans on advertising, promotion and sponsorship, and Raising the price through taxation.

It is not difficult to identify parallels between , and how the public health community could apply a similar methodology to societal ‘addiction’ to carbon-based fuels for private transport. We can measure carbon footprints with the aim of helping individuals identify where they can make changes and monitor emissions to hold organisations and governments to account. We can provide help and alternatives for those who want to ‘quit’ their addiction to car use: better active travel options and increased investment in public transport infrastructure. We can further educate the public to warn about the global and local effects of continued reliance on fossil fuels. We can increase taxation on petrol and diesel to reduce consumption, fund environmental mitigation strategies, encourage alternatives and increase demand for electric vehicles. And perhaps, just as we have done with tobacco, we can boldly tackle the advertising, promotion and sponsorship associated with petrol and diesel consumption.

Introduce health warnings and ban advertising and sponsorship

One of the first tobacco control measures in the UK was the introduction of health warnings on adverts and then tobacco packaging, and this could be a first step in terms of tackling carbon-based fuel use. Article 11 and 12 of the FCTC provide the mechanism for text and pictorial health warnings on cigarettes, while Article 13 ensures that we are no longer subjected to TV and billboard tobacco advertising. Perhaps there are significant lessons from these measures for how public health can help tackle the demand-side of our consumption of petrol and diesel. Images and warnings at the point of sale explaining the impact of CO₂ emissions from fuel use and/or poor air quality on individual and global health could be used to help consumers consider meaningful behaviour change each time they visit the garage forecourt. Holding that fuel nozzle at the car filling cap is a near perfect ‘teachable moment’ that can be used to target increasing knowledge and initiate the process of behaviour change. It is a two-minute period during which the consumer is less distracted by other things. Indeed, using a petrol pump is now about the only time in most people’s day when they are actually legally forbidden from interacting with their mobile phone in the UK. Advertisers strive to target such focused time.

With tobacco we have had to fight hard to limit advertising at the point of sale and to introduce health messaging on cigarette packs. Could this fight have usefully paved the way to introduce similar methods on the forecourt to remove branding, to have prominent marketing about the global harm of the product and the urgency of reducing carbon consumption, and to introduce positive images, messages and videos suggesting changing habits from driving to public transport or providing information on how to ‘quit petrol your way’? There is huge potential to transfer decades of public health and social marketing experience from tobacco to carbon.

Public health professionals often talk about the ‘scream test’ in relation to tobacco – the louder the industry objects to a policy, the more effective it is likely to be in getting people to quit or reduce consumption. If proposals to introduce the fossil fuel equivalent of tobacco health warnings cause pushback from the representatives of big oil, then perhaps that should similarly provide us with a pointer to their potential effectiveness. The industry may argue that such an approach is impossible, unfair and the public does  not need to be ‘lectured by the nanny state’ about individual choice. Their approach may be to suggest scientific naivety, that such measures are ineffective, and that they are working hard and investing billions of dollars as an industry to make their products less harmful to the planet. ExxonMobil (Esso in the UK) currently markets ‘Synergy’ fuel as ‘Helping to reduce emissions’, which has ghostly echoes of the sophistry of the tobacco industry’s ‘filtered’, ‘mild’ and ‘low tar’ cigarettes from the past.

It is, however, possible that some of these counter-points may be valid and health and environmental messaging at the point of sale will not work –many made the same arguments about starting to tackle smoking and tobacco’s corrosive impacts on our society in the 1970s and 1980s. But instead public health took bold steps:

• internationally, many countries have banned smoking in indoor public spaces;
• advertising for cigarettes has vanished, including at the point of sale;
• in many countries, people now see stark warnings each time they pick up their drab green, plain-packaged cigarette pack;
• and price rises have helped to drive down consumption.

The proportion of the population who smoke and the percentage of non-smokers exposed to second-hand smoke are at historically low levels in many high-income countries where tobacco control has been strongest to date. These are achievements that would have seemed almost inconceivable when the first tobacco control and public health experts started wondering how best to tackle the smoking epidemic.

Denormalising fossil fuel consumption

Just as with tobacco, warnings on the petrol and diesel pump are unlikely to be sufficient in themselves, but they have the potential to be an important first step. Warnings and information must be one part of a wider package of measures to reduce consumption and use. Innovative thinking is required to consider how best to ‘de-market’ car use, encourage users to value the benefits of greener, non-carbon forms of transportation, and control the marketing activities of health-damaging corporations.

The public health community has well-established expertise to fight the societal harms of many unhealthy commodities in relation to non-communicable disease. We have built a strong evidence base on how to motivate behaviour change and use social marketing methods to counter various addictive products. We have a proud history of providing direction and solutions to seemingly intractable problems, and are often at the forefront of understanding where health and the environment interact. Now is the time to think widely and boldly about the methodologies we can wield to tackle CO₂ emissions and help strive towards a future where our society can break free of our collective addiction to fossil fuel consumption. The tobacco control community includes public health experts with diverse expertise and has much to contribute in the fight to tackle the urgent climate emergency.

Dr Sean Semple, Prof Kate Hunt and Martine Stead are part of the team involved in tobacco control and wider public health research at the Institute for Social Marketing and Health at the University of Stirling in Scotland.