Thomas J. Kehoe and colleagues*
*Other contributors listed at end of the article.
August 2024 marks 40 years since Professor Mike Daube AO started work in the Western Australia Department of Health, in Australia. It is an opportune time to acknowledge his continuing and tireless contribution to international tobacco control over more than 50 years.
His role in the adoption of the world’s first plain packaging legislation in Australia is just one but a telling indicator of the scope of that contribution.
Passing plain packaging in Australia
By the late 2000s, Australia was already a world leader in tobacco control. Tobacco advertising, sponsorship and promotions were all but completely banned, and tobacco taxes were increasing. Smokefree policies were ubiquitous, and graphic pack health warnings mandated. Eager to continue this progress, Labor Health Minister Nicola Roxon appointed Daube chair of a special Tobacco Working Group, under the National Preventative Health Taskforce. Daube’s committee proposed “plain packaging” of tobacco products, which was adopted by the taskforce and recommended to government.
Originally conceived in 1986 by a Canadian general practitioner, attempts in the 1990s to legislate plain packaging in Ontario and New Zealand were defeated by the tobacco industry. As a result, many tobacco control advocates saw it as politically impossible.
But it had never been defeated in Australia, which was partly due to Daube’s understanding the importance of policy-relevant evidence. In 1991, when plain packaging was initially pursued by advocates, he was Chair of the Commonwealth Ministerial Council on Drug Strategy Tobacco Task Force and he commissioned research into making cigarette packs less appealing. This work informed investigations by the Labor government into regulating pack design, and when they took the incremental step of legislating stronger warnings, they also left the door open for tougher regulations to follow some two decades later.
When plain packaging was proposed in 2009, Daube and the other members of the National Preventative Health Taskforce took a similar view and hoped the government would at least adopt other strong tobacco control measures. But courageously, the Gillard government legislated plain packaging in 2011, implemented from 1 December 2012. To date, twenty-three countries have since enacted the policy.
Developing a successful modus operandi
Many advocates and policymakers deserve credit for plain packaging. But as Daube’s long-time compatriot, former CEO of Cancer Council Victoria and President of the Union for International Cancer Control (UICC) David Hill reflects, convincing the government to adopt the policy exemplified Daube’s “modus operandi”. Through a decades-long career, Daube acquired an astonishing ability to advance health agendas by rallying key people. Current CEO of Cancer Council Victoria Todd Harper attributes this skill to Daube considering issues “in a broader paradigm. He sees, for example, how alcohol, tobacco, and gambling are connected, as are the people and policy levers to address them”.
Daube’s approach draws on his experience in advocacy, academia, and government, the roots of which colleague Simon Chapman finds in his early career: “Mike has an enormous intellect and a sophisticated understanding and instinct about politics and the policy process.” Daube grew up in Cambridge and Oxford. He attended the University of Reading and in 1970 joined the Coal Board. But he quickly moved to Shelter, the UK’s national housing and homelessness advocacy organisation, which set him on his five-decade career path in advocacy and policy change.
In 1973, Daube became the first director of Action on Smoking and Health (ASH), then a new venture by the Royal College of Physicians. Its founders imagined a “mega charity”, comprising doctors and scientists using the evidence of tobacco harms to reduce smoking. But in one estimation, its actions were “pretty low key”. Daube took the leadership position because “it seemed more interesting” than other jobs, and he provided the organisation with new energy and direction. He began by attempting to build consensus around a policy agenda, but found that first curtailing the tobacco industry’s influence over government was crucial. As one of the world’s first anti-smoking organisations, ASH was virtually alone in this effort.
These circumstances compelled Daube to become a savvy stakeholder influencer and user of the media. Drawing on lessons from his time at Shelter, Daube turned ASH towards aggressive, “intensely media conscious” advocacy. He courted controversy to stoke media interest. At the time, for instance, senior tobacco industry figures were sometimes honoured and knighted, which he publicly ridiculed. He once quipped that “awarding a knighthood to a tobacco industry executive was like awarding a rabid dog Grand Champion at Cruft’s Dog Show”.
He maintained close relationships within government, which allowed ASH to visibly pressure the then Labour government. In the press he explained his rationale: “Here was a pressure campaign that was ripe.” There was a clear “villain”. And therefore, “You had your St. George and the dragon scenario”.
Daube led ASH until 1978, and in Chapman’s view, he “in many ways set the pace for global tobacco control” during that time. Global coalitions provided another means to leverage pressure at home; through the Union for International Cancer Control (UICC), Daube connected with Australian Nigel Gray, Director of the Anti-Cancer Council of Victoria (now Cancer Council Victoria), who was leading the UICC’s tobacco control effort. He also made strong links with the American Cancer Society (ACS). For Daube, these “allies” were critical to effecting change, and together they developed a comprehensive tobacco control “toolbox” comprising evidence-based advocacy, consensus-building, and campaigning. This approach underpinned a number of influential reports such as the 1976 UICC report, Guidelines on Smoking Control and the 1979 WHO strategy document, Controlling the Smoking Epidemic.
A move to Australia
Following ASH, Daube joined the University of Edinburgh, beginning an academic career to which he would periodically return over the next 40 years. In 1983, he was recruited for his “dream job” heading the British Government’s Health Education Council, which would have allowed him to “run campaigns nationally”. But the tobacco and alcohol industries successfully lobbied Margaret Thatcher’s Conservative government to block his appointment, sparking a controversy aired in the UK media, and he recalls the episode as “an absolute low point”.
An offer in 1984 to head prevention programs for the Western Australian Health Department seemed like a fresh start. Tobacco remained a priority, and Daube remembers a zeitgeist that offered “huge opportunity to make things happen in tobacco [control]”. During his decade at the WA Health Department—including a period as director general—he devised powerful new Quit campaigns and launched the Death Clock, which tallied the number of West Australians who died from smoking. He acquired the influential Yul Brynner television advertisement from the ACS, in which the famous actor—dying from lung cancer—urged “Whatever you do, don’t smoke”. And he worked to secure passage of the WA Tobacco Control Act (1990), which further restricted tobacco promotions, and established the WA Health Promotion Foundation.
WA’s hosting of the seventh World Conference on Smoking and Health in 1990—the first and only to be held in Australia—was a testament to Daube’s abilities to bridge science, advocacy, and politics. Conference attendees included doyens of tobacco-disease epidemiology, Richard Doll and Ernst Wynder; Australian and global tobacco control scholars and strategists; and prominent politicians. The event brought international attention to Australian tobacco control.
Since plain packaging
Daube continues to work tirelessly to curtail the promotion of unhealthy products, advocating the regulation of marketing of alcohol and unhealthy food, and bans on gambling advertising. And his legacy still influences the fight for tobacco control. “The tactics Mike [Daube] pioneered guide Quit’s advocacy today”, says Director of Quit Victoria Rachael Anderson, “especially as we move to tackle e-cigarettes”.
Daube also helps guide a new generation of advocates and academics. In the view of former head of Behavioural Science at Cancer Council Victoria, Melanie Wakefield: “Mike’s sound judgement and infectious optimism makes him a treasured, supportive colleague and mentor for researchers and other public health professionals who must engage with duplicitous industries.” This contribution to the future was affirmed by his appointment as Chair of Advisory and Editorial Boards of Health Promotion International.
For these achievements and many others, Daube was made an Officer of the Order of Australia in 2014 and named Western Australian of the Year in 2018. We look forward to many more contributions from Daube to public health in the years to come.
Thomas J. Kehoe is a historian at the Cancer Council of Victoria in Melbourne, Australia. Other contributors to this article include: Ann Westmore, University of Melbourne; Carolyn Holbrook, Deakin University; Elizabeth Greenhalgh, Cancer Council Victoria; David Hill, Cancer Council Victoria; Simon Chapman, University of Sydney; Todd Harper, Cancer Council Victoria; Melanie Wakefield, Cancer Council Victoria; Sarah Durkin, Cancer Council Victoria; Rob Moodie, University of Melbourne; Rachael Anderson, Quit Victoria; Michelle Scollo, Cancer Council Victoria.