a key current concern is how scientific knowledge may inform policy in relation to major 
         environmental and health concerns . the demand for  evidence based 
         medicine ,  evidence based practice , and  evidence 
         based policy has its own history .
one recent lineage came from the us , canada , 
         and the netherlands in the 1960s through the rise of clinical epidemiology . in britain
the post - war redefinition of the 
         ideas of social medicine had a twin legacy in the  new public health on 
         the one hand , and , on the other , in the rise of health services research and the dominance 
         of the randomized controlled trial ( rct ) as the gold standard of medical and scientific 
           evidence .
the rise of evidence can also be related to the  customer 
         contractor changes in government research funding in the 1970s , initiated by the 
         1972 rothschild report .
there are distinct schools of thought about how the relationship between science / evidence 
         and policy or practice operates or should operate .
these can be categorized under three main 
         tendencies : evidence based or rational arguments ; the journalist school ; and science 
         policy / sociology of scientific knowledge ( ssk ) approaches .
its proponents argue 
         that all that is needed are technical adjustments to make the relationships work , that 
         improvements in process are what is needed , rather than a more fundamental critique . 
        
underlying this model are positivist models of science , the assumption that knowledge can 
         have an impact in a value - free way .
analogous but more narrowly channelled approaches to the science / policy relationship 
         appear in the journalist school . the term 
journalist 
         means practised by journalists , and embodying a way of looking at the world which often 
         characterizes media agendas on science and policy . here
again , a relationship between 
         science / research and policy is seen as desirable , but perhaps in a more partisan way .
when 
         some hiatus occurs in the relationship , the interpretation is in terms of conspiracy .
the 
         interruption is seen in terms of  delay and blame is attached to key 
         participants .
this  heroes and villains school of analysis is a 
         conventionally accepted mode , even in academic circles , of looking at the nature of response 
         to public health issues .
some analysis of aids provides a recent example , also responses to 
         bse and developments in alcohol policy .
the third main school can be broadly categorized as network analysis , but the field is 
         complex and there are different tendencies within it .
one such is the ssk which has 
         undergone rapid development over the past twenty or so years . here
network theories have also been developed with a great degree of sophistication 
         within science policy analyses .
in fact analysing policy networks has become a dominant 
         approach for the study of policy making processes in britain , europe , and north america . 
        
such approaches emphasize the interaction and patterns of association between actors in 
         different policy areas .
networks have been one of the most discussed and contested terms in 
         political science .
richardson and jordan developed the idea of the  policy 
         community , focusing on what they called  the government , civil 
         service  pressure group network. the relationship between government departments and external bodies is what matters , 
         in this interpretation ; policy formulation takes place in stable subsystems comprising 
         government agencies and outside groups .
the whole system is compartmentalized such that 
         relationships between government and external groups vary for each policy area .
marsh and 
         rhodes , using studies of uk policy making , have differentiated between 
policy 
         communities and  issue networks. the overall view is that policy communities are small , formal , highly focused , and 
         centralized policy groupings , while issue networks are more diffuse , informal , with less 
         power and more diverse interests .
so far as health policy is concerned , wistow has stressed 
         the role of 
professionalized networks , a network dominated by a single 
         profession , in this case medicine .
the dominant role of the medical profession is a theme in 
         many health policy analyses , although there is little specifically on public health .
journalist case , and the history has 
         been entwined with advocacy for current policy positions .
british smoking policy provides 
         examples in peter taylor s book , smoke ring , and david 
         pollock s denial and delay : the political history of smoking and health , 
           19511964 : scientists , government and industry as seen in the papers at the 
           public records [ sic]office .
the chapter headings for the book present the interpretation of denial and delay . 
         
pressure for a government statement , 19511954 ; chapter 2 . 
         neutralizing the mrc findings 19541957 .
the start of 
         modern tobacco control , 19631964. the framework here is one of delay and conspiracy , of heroes and villains , and 
         represents the 
whig history of medicine , the assumption of value - free 
         scientific truth , and the notion of progress towards a correct course of action .
this is a 
         dominant interpretation of smoking policy overall . in recent years activism in smoking
has 
         focused on archival work to a degree which has so far been little appreciated in the british 
         historical profession .
such work , using industry archives , has mainly researched policy making in the 1980s 
         and 1990s in the us , europe , and asia and has tended to present a universal , american 
         dominated history , with little appreciation of national policy differences or the changing 
         objectives and strategies of policy over time .
political scientists have also used the smoking story to illustrate the role of networks in 
         policy making .
one of the most extensive discussions of this point of view is in melvyn 
         read s ph.d .
thesis and subsequent articles and book on the politics of 
           tobacco . read segments the smoking story into a case study of a  producer 
         network of industry interests with links into allied government departments ; and 
         an 
issue network of anti tobacco organizations and interests also with 
         links into relevant government departments , chiefly health . read uses an historical approach 
         but proceeds primarily through published documentation and interviews to make the argument . 
         in this analysis the science is taken as a given orthodoxy and the main focus is on the 
         operation of what are seen as rival networks over time , concentrating on the years after 
         1971 rather than earlier .
historians can have an effect on the debates on evidence and policy through challenging the 
         assumptions made by the political lobbies and refining the models through which social 
         scientists present their case .
the former operate from the perspective of the present : the 
         models used by the latter fail to take account of complexity and of change over time .
the 
         case of smoking policy and its history in the 1950s and 1960s in the uk offers an 
         opportunity to present a case study of such an historical contribution .
indeed it is 
         imperative to do so , given the dominance of archivally based 
         
the early history of the smoking and lung - cancer connection is well known and has been 
         recounted in a number of different histories .
concern was roused by the gradual increase in the incidence of cancer ; a change in 
         the balance of the sexes , towards men ; and the increasingly important role of lung cancer . 
         the greatest increase in lung cancer came in males over forty - five , where the incidence 
         increased sixfold between 1930 and 1945 . at
first it was thought that these changes might be 
         due to improved diagnosis and better recording and registration . but work carried out by sir 
         ernest kennaway in the 1930s and published in 1947 , a detailed examination of post mortem 
         certificates , helped eliminate occupational and environmental factors .
kennaway pointed to a 
         connection with cigarette smoking , but his work , based on statistical correlations , carried 
         little weight .
research had also 
         been undertaken before the war in nazi germany and by the american biometrician raymond 
         pearl , for the insurance industry .
there had been concern about the high incidence of cancer 
         of the lung among workers in tobacco manufacturing .
the issue became more urgent post - war and discussions between the ministry of health 
         ( mh ) and the medical research council ( mrc ) led to the council convening an informal 
         conference on cancer of the lung in february 1947 .
the mrc agreed to initiate a large scale 
         statistical study of the past smoking habits of those with cancer of the lung and of two 
         control groups . who would take the work forward was a matter of discussion : both the social 
         medicine unit under professor jerry morris and patrick lawther , who subsequently ran the air 
         pollution unit at st bartholomew s hospital , were under consideration .
but it was the statistical research unit at the london school of hygiene and 
         tropical medicine ( lshtm ) led by professor bradford hill which was chosen to carry out the 
         work and dr richard doll was employed to work on the study .
the results , published in the 
           british medical journal ( bmj ) in 1950 , concluded that 
         there was a 
real association between carcinoma of the lung and smoking 
         and that smoking was a factor , and an important one , in the production of carcinoma of the 
         lung .
later studies 
         carried out by doll and bradford hill and by cuyler hammond and horn in the us implicated 
         cigarette smoking even further .
charles webster has shown in detail how the issue fared over the next seven years.a written parliamentary answer from ian macleod as minister of health in february 
         1954 accepted that there was a connection but that it was not a simple one .
when the mrc issued its own report on smoking and lung cancer in june 1957 the mh 
         adopted the argument more fully .
the parliamentary secretary to the mh for the first time on 
         27 june 1957 expressed unambiguous support for the conclusions reached by doll and hill in 
         1950 .
webster locates this sequence of events in the machinations of the powerful and 
         complex advisory machinery which stood between the mrc and the mh .
the main advisory body 
         was the cancer and radiotherapy standing advisory committee ( sac ) , reporting to the central 
         health services council , which in turn advised the mh .
horace joules of the central 
         middlesex hospital , a member of both bodies , was the only person within the advisory 
         committee machinery consistently to press the issue .
the initial government response focused on an mh circular encouraging local 
         authorities to develop health education campaigns on smoking .
further action under the 
         labour government of the 1960s saw the banning of cigarette advertisements on television in 
         1965 , and attempts by the labour minister of health , the gp kenneth robinson , to introduce 
         legislation to ban cigarette coupon schemes and to limit other forms of advertising .
health 
         warnings on cigarette packets appeared in 1971.what issues lay behind the nature of the 
         initial response in the 1950s and early 1960s ?
the response in the 1950s will be discussed 
         separately from that in the 1960s when new factors came into play .
the initial response to the putative link between smoking and lung cancer came at a time of 
         reorientation in post - war public health and in modes of investigation .
the medical officer 
         of health in local government , once perceived as the potential linchpin of the coming 
         state - funded health service , had been downgraded by the establishment of the hospital and gp 
         dominated national health service ( nhs ) . at a broader level
it was chronic rather than epidemic or infectious disease which was to 
         dominate , and chronic disease epidemiology would emerge as the primary technical tool for 
         the study of such conditions within populations . the social medicine movement ,
avenue 
         for medical practice , was changing its emphasis in the 1950s to a reliance on chronic 
         disease epidemiology .
this epidemiological technique was to become the foundation of a 
          new public health in the 1960s and 1970s when public health 
         practitioners were relocated in health services , moved out of the local authorities where 
         they had established their pre - war empires .
jerry morris s key text , uses of epidemiology , published 
         in 1957 , set the tone for the emergence of the new scientific approach and the new role for 
         public health ( to be known as community medicine ) ; the text used smoking extensively as its 
           exemplar .
the fluidity of the smoking science was thus embedded in a more general period of 
         reorientation both within public health and in the ideology and the technical tools of the 
         field .
the 1950s and 1960s were also a period when science emerged as an international 
         enterprise .
the post - war establishment of the world health organization ( who ) was important 
         as a mechanism for the cross national transfer of ideas and concepts in health , and for the 
         development of internationalism in science , building , to some degree , on earlier attempts 
         through the pre - war league of nations .
british and american researchers and scientists began 
         to become more aware of each other s work in these years .
the 1950s thus saw a fluid policy situation and the government response was conditioned by 
         a number of factors , not all of them directly smoking related .
the nature of the evidence 
         which the epidemiological studies presented in the 1950s has been much discussed by 
         historians in recent years in ways which have drawn on both the science studies and the 
          delay and blame frameworks . debates over the american response to 
         smoking / lung cancer research illustrate these arguments . in the american context , allan 
         brandt and john burnham have seen the smoking / lung cancer 
discovery 
         and subsequent events as a watershed in the acceptability of chronic disease epidemiology to 
         provide legitimate forms of scientific explanation ; this was a major paradigm shift towards 
         epidemiology and statistical modes of explanation and causation at the expense of laboratory 
           science .
mark parascandola has argued that it was not simply a case of blanket opposition 
         between two styles of science .
he has related the discussions , in the us context , to the 
         politics of the national institutes of health in the 1950s and to controversy between 
         biostatisticians and epidemiologists .
talley et al . have argued that there was a legitimate scientific controversy over 
         smoking and lung cancer in the 1950s and early 1960s which reached its denouement and 
         codification in the surgeon general s report of 1964 .
however , these historical positions have been complicated by the involvement of 
         historians in the litigation through which us smoking policy primarily proceeds .
brandt , for 
         example , has modified his position recently to place great stress on the role of the tobacco 
         industry , in legal testimony given on behalf of anti - tobacco interests .
the american story was part of the internationalization of science in the 1950s . in the 
         1940s hill and doll were not aware of the parallel research being carried out by wynder and 
         graham , but in the 1950s contacts between british and american epidemiologists developed 
         rapidly .
there were national differences in the process of consolidation of the science , for 
         example in terms of opposition to the smoking and lung cancer hypothesis .
one key opponent 
         was the statistician ronald fisher , who had played a central role in the development of the 
           rct .
ronald fisher has been criticized because of his role as adviser to the tobacco 
         manufacturers standing committee , set up in 1956 to assist research .
in addition , his 
         eugenic worldview subsequently became unfashionable as a mode of statistical explanation , 
         although it was a dominant position at the time .
fisher s opposition arose in part from statistical 
         issues : correlation should not be taken as proof of causation .
but it also emanated from his 
         libertarian views , which meant that he was strongly against anti - smoking publicity .
he 
         thought people should be given the data and draw their own conclusions ; he criticized doll 
         and hill only after an article in the bmj had stated that people should be 
         discouraged from smoking .
the issue of inhalation also divided the researchers , since , paradoxically , it seemed that 
         fewer smokers who inhaled developed lung cancer .
bradford hill had offered data to fisher from the 1952 
         study he and doll had carried out , but not from the 1950 study .
this controversy was played out in a number of publications and also taken up by 
         other authors .
the closure of scientific controversy on the issue of causation came finally 
         through bradford hill s postulates , published in 1965 when hill was president of 
         the section of occupational health of the royal society of medicine .
hill had first begun to 
         develop the criteria for cause and effect and association in the late 1930s and had expanded 
         them in a lecture at harvard in the 1950s.their publication in the 1960s formalized 
         guidelines for causal inference and marked the closure of the main period of controversy . in 
         a recent paper ,
luc berlivet has taken the british story and looked at the controversy 
         surrounding smoking and lung cancer and its key role in the formation of the modern science 
         of epidemiology .
 causal 
             hypothesis than just a reaction of rear guard scientists and vested interests 
             plotting to undermine a promising , if young , scientific 
             practice    the controversy stirred up by the publications on 
             the relationship between tobacco and lung cancer was eventually transformed into a 
             highly positive retrospective story .
this is a process which reminds us of other famous 
             episodes of  discovery in the history of science.this scientific debate had an effect on the policy response of civil servants 
         and others in government .
after the publication of the second doll and hill report in 
         december 1952 , the imperial tobacco company , the main british tobacco company , entered the 
         fray and papers from both sides were circulated to the sac in february 1953 . as a result , 
         the conflicting evidence , from doll and hill and from geoffrey todd , assistant manager in 
         the statistical department of the imperial tobacco company , was submitted to a committee 
         chaired by the government actuary , sir george maddox , later that year .
sir john charles , the chief medical officer ( cmo ) , told percy stocks , 
         chief medical statistician to the registrar general s office ,  as 
         regards the evidence , i am in general agreement with what you say , but what i was looking 
         for was evidence apart from the analogous or purely statistical .
so far as i am aware , there 
         is no purely pathological evidence of this long incubation period in lung 
           cancer. neville goodman , an mh civil servant , cited in an internal minute the tobacco 
         industry s opposing research report , the failure of attempts to show a carcinogen 
         in tobacco , and other causes of the rise in lung cancer such as smoke pollution .
doubts about the scientific objectivity of wynder , who visited the ministry in 1953 , 
         also compounded the issue.he is a young man  far gone in enthusiasm for the causal 
             relationship between tobacco smoking and lung cancer .
( i had been told when i was in new 
             york this spring that he was the son of a revivalist preacher and had inherited his 
             father s antipathy to tobacco and alcohol ) .
the american cancer society was 
             very suspicious of his early work for this reason .
causal 
             hypothesis than just a reaction of rear guard scientists and vested interests 
             plotting to undermine a promising , if young , scientific 
             practice    the controversy stirred up by the publications on 
             the relationship between tobacco and lung cancer was eventually transformed into a 
             highly positive retrospective story .
this is a process which reminds us of other famous 
             episodes of  discovery in the history of science .
he is a young man  far gone in enthusiasm for the causal 
             relationship between tobacco smoking and lung cancer .
( i had been told when i was in new 
             york this spring that he was the son of a revivalist preacher and had inherited his 
             father s antipathy to tobacco and alcohol ) .
the american cancer society was 
             very suspicious of his early work for this reason .
the statistical panel reported in november 1953 , and found that a  real 
         association had been established , with a  strong presumption 
         that the real association was causal .
it might also be dependent on co - factors such as the 
         urban  rural difference , occupational matters , and so on , and the report therefore 
         treated with great reserve the death rates which had been calculated by doll and hill 
         through a section on estimated risks in the 1952 paper .
the sac accepted this conclusion , 
         recommending that young people should be warned about the risks of smoking .
the government 
         assessment of the state of scientific opinion was beginning to become clearer , and it was 
         this development in opinion which led to the first mh statement in the house of commons in 
         february 1954 , followed by a press conference .
macleod as minister of health made a 
         statement but promised no further action ; there was a need for further research .
he 
         chain - smoked his way through the subsequent press conference , but subsequently gave up his 
         sixty a day habit in favour of two or three small cigars a day .
the parliamentary discussions of the time show similar fluidity in the political 
         appreciation of the health risk . in an adjournment debate held in march 1953 , mps from 
         across the political spectrum expressed uncertainty or opposition .
harmar nicholls , 
         conservative mp for peterborough , expressed the then common view of the dangers of arousing 
         
the report  is more a report of statisticians than a medical report. 
         bessy braddock , labour mp for liverpool exchange , drew attention to the 
         urban  rural divide in the figures and favoured an environmental explanation . 
        
 in view of the fact that cigarette and pipe smoking goes on all over the country , 
         it is folly to say that it is the main cause of lung cancer. expert opinion was related to another issue : the role of the tobacco industry .
tobacco was a key import during the 
         second world war and its duty a major source of government revenue . during the war
the 
         industry had been under strict government control and the board of trade appointed sir 
         alexander maxwell , who before the war had been a leading leaf merchant , as tobacco 
         controller .
the industry , in its relationships with government , was different to the us 
         tobacco industry , which had no such continuing corporate tradition .
both maxwell and sir john partridge of the imperial tobacco company had close and 
         continuing access to government .
imperial dominated the industry / government relationship in 
         the uk until the late 1970s .
the imperial board had been astonished by the doll / hill studies 
         and saw its role as working with government , as it had done during the war , this time to 
         produce a cleaner product .
the us industry , by comparison , was distant from government , and 
         concentrated from the start on public relations exercises to counteract the perceived 
         dangers of smoking . in the late 1970s , with changes in the ownership of the industry , 
         imperial s dominance faltered and the role of the us companies in the uk became 
         more significant .
but in the 1950s the close relationship with government was marked by efforts to 
         deal with the health issue .
the industry provided another source of scientific expertise , in particular through its own 
         statistician , geoffrey todd , whose report had been submitted to the sac .
the industry also 
         planned to fund research , and had approached both the mrc and the mh in 1953 .
sir alexander 
         maxwell , chairman of the tobacco advisory committee , in a secret memo to harold himsworth , 
         secretary of the mrc , stated his lack of belief in any true association between smoking and 
         lung cancer . in order to investigate the true causes of lung cancer the committee wished to 
         covenant
discussions between the treasury 
         and the mh resulted in a compromise whereby the tobacco company s gift was to the 
         government , which would then allocate it to the mrc .
this avoided charges of the impropriety 
         of the council accepting money from an interested body .
the gift was for research into 
         smoking and lung cancer , but also into the means of removing the harmful elements from the 
         tobacco , when they were identified .
this was the origin of a long programme of 
          product modification research which was of particular significance in 
         the 1970s and also fuelled the work on nicotine carried out in the 1980s and 1990s .
the gift 
         was to be made , so john boyd carpenter at the treasury wrote to the lord president , the 
         marquess of salisbury , for research into smoking and lung cancer , and  presumably 
         of the means of removing the elements in the tobacco which may have this 
           effect. a visit paid to europe by dr c.  c. little in 1956 to survey the state of play on 
         tobacco research and funded by the tobacco industry research committee , an american industry 
         organization , provided an outsider s view of the relationships between the british 
         industry and government .
the industry took a public relations stance from the outset with a view to defence of future 
         legal actions .
but the british industry , little reported , had no knowledge at all of what had been 
         funded from its mrc benefaction ; industry was not seeking to influence the course of 
         research . during his visit ,
dr little moved easily between the scientific cancer research 
         community , the mh , where he met the cmo , sir john charles , and the imperial tobacco company 
         offices and laboratories in bristol .
he advised the british industry that it should follow 
         the us model and set up a co - ordinating committee to fund research .
his idea was that it 
         could be an mh advisory committee . in the event the manufacturers set up in 1956/7
the 
         tobacco manufacturers standing committee , subsequently renamed the tobacco research 
         committee , which opened its own laboratories in harrogate in 1962 after the mrc benefaction 
         had come to an end .
the industry did not make a secret of its connections and referred to 
         the us industry research committee in its first published report .
there was criticism of the us industry from the british side , which was uneasy with 
         the american industry s public relations approach .
the tobacco industry connection was also a concern for government because of the revenue 
         implications . in february 1954
macleod as minister of health made a statement to the commons 
         which relayed the advice given by the sac .
this statement was made , as herbert brittain of 
         the treasury put it ,  in language which was in no way dangerous or embarrassing to 
         us from the revenue point of view. macleod himself had commented with cheery 
         cynicism in a letter to boyd carpenter at the treasury in january 1954 ,  we all 
         know that the welfare state and much else is based on tobacco smoking. tobacco tax was an important part of government revenue ( 16 per cent of central 
         revenue in 1950 ) and signs of further movement on the causal hypothesis later in the 1950s 
         evoked treasury anxiety . a supplementary answer given by robin turton from the mh on 5 march 
         1956 , where he said there was a causal connection , brought forth enquiries from the 
         treasury ; had there been more developments since 1954 ?
sir john hawton , the mh permanent 
         secretary , replied soothingly , needless to say , we are very conscious of the close treasury interest in this subject 
             and that is one of the things which governs the guarded sort of statements which we have 
             so far made   
if there is any question of our being driven 
             to say more than we already have on this subject , we shall of course only do it in 
             consultation with you or your people   
i have a strong 
             feeling that we are going to be put under more and more pressure to give more positive 
             warnings to the public    and particularly from our own 
             central health services council and its medical 
             committee   
until then i do nt think there is 
             anything we need do and i think that the best policy is to keep the subject as quiet as 
             we are allowed to.but the matter was not allowed to remain quiet .
it was referred to the full 
         cabinet , where it was decided that turton should make a restrained statement in the commons . 
        
his 
         diary entry for 19 april 1956 read ,  cabinet 11.45 , singapore , british guiana ; 
         medical views on the dangers of smoking .
if we lose singapore , it s a terrible 
         blow to all our far eastern interests . if people really think they will get cancer of the 
         lung from smoking it s the end of the budget! politicians at this period were generally cynical about the whole smoking issue , 
         apart from its economic implications .
macleod told a house of commons questioner who wanted 
         an american report on smoking and lung cancer published as a white paper , that dozens of 
         reports , all claiming to be authoritative , were being published .  if my hon . 
        
friend is a heavy smoker and is concerned about the connection between cancer of the lung 
         and smoking , i would recommend him to give up reading. macmillan commented about the statement to be made in 1956 by the minister of 
         health ,  cabinet approved a statement to be made by the minister of health about 
         tobacco and cancer of the lung .
i only 
         hope it wo nt stop people smoking! needless to say , we are very conscious of the close treasury interest in this subject 
             and that is one of the things which governs the guarded sort of statements which we have 
             so far made   
if there is any question of our being driven 
             to say more than we already have on this subject , we shall of course only do it in 
             consultation with you or your people   
i have a strong 
             feeling that we are going to be put under more and more pressure to give more positive 
             warnings to the public    and particularly from our own 
             central health services council and its medical 
             committee   
until then i do nt think there is 
             anything we need do and i think that the best policy is to keep the subject as quiet as 
             we are allowed to .
smoking was politically 
         difficult for government , but so too was air pollution , with which the 
         smoking  lung cancer issue intersected .
the text of a tv broadcast on the subject in 1953 after publication of the 
         doll / hill research on smoking and lung cancer in 1950 gives a sense of the focus on both 
         individual and environment .
introduced by charles fletcher , later famous for his pioneering 
           your life in their hands , the programme was called matters of 
           medicine .
dr guy scadding , taking part , expressed the views clearly : smoking can not be called the cause of lung cancer , since non - smokers also get the 
             disease , and moreover the increase in cigarette smoking is not likely to be the only 
             cause of the increase in the lung cancer death rate .
the effect of smoking can not 
             explain the difference in mortality between town and country dwellers .
if the effects of smoking and general 
             pollution of the air    reinforce each other , i think that 
             most of the known facts about the incidence of lung cancer can be explained.this scientific uncertainty also caused difficulties at the political level , in 
         the negotiations which took place in 1957 between the cabinet committee on cancer of the 
         lung , which was appointed in that year , and the mrc , which planned to issue a statement on 
         the causes of lung cancer .
the minutes of the cabinet committee show that both the potential 
         of the smoking issue and the issue of air pollution included in the mrc draft statement were 
         matters of alarm    but that air pollution was more central .
smoking can not be called the cause of lung cancer , since non - smokers also get the 
             disease , and moreover the increase in cigarette smoking is not likely to be the only 
             cause of the increase in the lung cancer death rate .
the effect of smoking can not 
             explain the difference in mortality between town and country dwellers .
if the effects of smoking and general 
             pollution of the air    reinforce each other , i think that 
             most of the known facts about the incidence of lung cancer can be explained .
the mrc , so it was reported to the cabinet committee , had for the first time come to the 
         conclusion that the smoking of tobacco had a direct causal relationship to lung cancer and 
         therefore there was no alternative but to publicize their conclusions .
it was the proposed 
         inclusion in the mrc statement that up to 30 per cent of lung cancer might be caused by air 
         pollution which caused the greatest political alarm .
unwarranted prominence. the committee thought that 
         professor bradford hill and dr doll had failed to show any substantial difference in risk 
         among non - smokers in greater london and in rural areas .
both statements , so it was commented , had obvious political 
           implications . on 31
may 1957 , lord home , the lord president of the council ( responsible for the 
         mrc ) , reported back on the changes made in the statement .
the mrc had re - examined their 
         draft and proposed to modify the references to atmospheric pollution which implied that it 
         might be responsible for up to 30 per cent of such deaths .
the section would read instead , 
          on balance it seems likely that atmospheric pollution plays some part in causing 
         the disease , but a relatively minor one in comparison with cigarette smoking. a 
         further section was modified to read ,  a proportion of cases , the exact content of 
         which can not yet be defined , may be due to atmospheric pollution. the pollution issue was effectively headed off .
the 1956 clean air act , passed after 
         the great london smog of 1952 , was just on the statute book , but had been widely criticized 
         for failing to deal with industrial pollution and for only dealing with smoke .
this episode showed that , although government was wary about the smoking and lung 
         cancer case as a policy issue , it was infinitely preferable to air pollution .
health education 
         had traditionally been conducted by the central council for health education ( cche ) 
         established in 1927 , the successor to the british social hygiene council , the interwar 
         voluntary body which had conducted health education campaigns . during the war publicity
had 
         been a central responsibility of the ministry of information but after the war 
         responsibility was again passed back to the local authorities who were to rate - fund the 
         cche s work .
central government had no wish to resume funding of these activities 
         as discussions of smoking publicity made clear .
an 
         mh statement in may 1956 explained why central publicity would not be the right thing.the considerations on publicity concerning smoking and lung cancer differ slightly from 
             those on cancer publicity generally in that the special 
             point    that people might give up 
             smoking   
it does 
             however concern an individual decision which involves others to a very much smaller 
             extent than the subjects of past central public health campaigns.smoking , it argued , was not a  disease in the way cancer 
         or indeed infectious disease was .
risk , as we have seen , was not yet central to 
         public health in the 1950s .
publicity would be asking people to curtail a habit which was 
         deeply embedded in everyday culture .
it might also raise public fear about cancer , which the 
         ministry had been concerned to damp down .
unfounded cancer phobia might generate a demand 
         for services at a time when nhs costs were becoming a political issue .
the considerations on publicity concerning smoking and lung cancer differ slightly from 
             those on cancer publicity generally in that the special 
             point    that people might give up 
             smoking   
it does 
             however concern an individual decision which involves others to a very much smaller 
             extent than the subjects of past central public health campaigns .
r.  a. 
         butler , lord privy seal , commented in may 1956 ,  from the point of view of social 
         hygiene , cancer of the lung is not a disease like tuberculosis ; nor should the government 
         assume too lightly the odium of advising the general public on their personal tastes and 
         habits where the evidence of the harm which may result is not conclusive. this is a theme which emerged consistently throughout the political discussions . 
        
nanny state. as 
         the minutes of the cabinet committee on smoking record ,  the government should not 
         seek to intrude into the sphere of an individual s personal responsibility .
it was 
         however , important to stress this element of personal choice since direct government action 
         was excluded. the focus was also quite different from traditional public health campaigns .
one 
         civil servant pointed out that any campaign would have to be directed to men ( who were the 
         majority of smokers ) rather than women and children who were the more usual objects of 
         public health attention .
it was much easier on many political grounds to leave this to the local authorities . lying behind
this discussion was the cultural normality of smoking and its embedding in a 
         range of social customs and practices .
this was far from the simple continuation of the 
         liberal individualism of the gentlemanly culture of smoking which hilton has ascribed to 
         this period . tobacco tokens for old age pensioners were issued by government in the 1950s . 
        
the public health researcher 
         walter holland recalled that for many years after the smoking / lung cancer research had been 
         published , bradford hill would keep a box of cigarettes in his room at lshtm . when holland 
         asked him why this was so , hill was incredulous ; it would be impolite not to offer visitors 
         a cigarette .
norman brook as cabinet secretary was equally amazed at a suggestion that government 
         should set trends .
 does this mean that prime ministers should not 
         smoke    or at least should not be seen smoking in 
         public? he wrote in amazement in 1962 . in the 1970s ,
when the researcher nicholas wald wished to trace the changes in tar 
         levels in cigarettes since the 1940s , he was deluged with cigarette stubs and cigarette 
         cases containing tobacco which grieving widows had kept as mementoes of their dead husbands . 
         
his last cigarette had a cultural significance which has become 
          hidden from history with the subsequent marginalization of 
           smoking .
the cultural aspects of post - war smoking have been surprisingly little 
           researched . for the labour government of the 1960s these had political implications which will 
         be discussed below .
thus policy in the 1950s was being formed in a very different political 
         and social climate to that which operated later on . as doll
himself stated in evidence to 
         the commons health committee in 19992000,in retrospect , it may be surprising that resistance to the idea that smoking caused so 
             much disease was initially so strong .
one 
             was the ubiquity of the habit , which was as entrenched among male doctors and scientists 
             as among other men and had dulled the sense that tobacco might be a major threat to 
             health .
another was the novelty of the epidemiological techniques , which had not 
             previously been applied to any important extent to the study of non - infectious disease . 
            
the 
             evidence that lung cancer also occurred in non - smokers was consequently taken to show 
             that smoking could not be the cause and the possibility that it might be a cause was 
             inappropriately doubted .
the manner in which lung cancer was linked to smoking was not , 
             however , unique .
all the other major diseases related to smoking were found to be so by 
             epidemiological enquiry and laboratory evidence of physiological effects that provided 
             plausible mechanisms by which smoking might cause them was obtained only later and , in 
             some instances , is still awaited .
in retrospect , it may be surprising that resistance to the idea that smoking caused so 
             much disease was initially so strong .
one 
             was the ubiquity of the habit , which was as entrenched among male doctors and scientists 
             as among other men and had dulled the sense that tobacco might be a major threat to 
             health .
another was the novelty of the epidemiological techniques , which had not 
             previously been applied to any important extent to the study of non - infectious disease . 
            
the 
             evidence that lung cancer also occurred in non - smokers was consequently taken to show 
             that smoking could not be the cause and the possibility that it might be a cause was 
             inappropriately doubted .
the manner in which lung cancer was linked to smoking was not , 
             however , unique .
all the other major diseases related to smoking were found to be so by 
             epidemiological enquiry and laboratory evidence of physiological effects that provided 
             plausible mechanisms by which smoking might cause them was obtained only later and , in 
             some instances , is still awaited .
there was  pressure from 
         without , and there was an incipient policy lobby or policy community on the issue 
         which linked medical or public health interests within government with medical interests 
         outside .
within government there was political rethinking of the issue , although the 
         electoral arguments still remained strong , even for the labour government of the 1960s . 
        
above all , a  new public health for which smoking was the central 
         issue , was beginning to consolidate .
even before the royal college of physicians ( rcp ) 
         published its first report on smoking in 1962 , there were some signs of change .
scotland , in this as in other 
         health issues , was often a catalyst for developments in british health policy more 
           generally .
edinburgh carried out an active health campaign about smoking in 1959 , organized by 
         the city corporation in response to the mh circular .
the impact of the campaign was assessed 
         by the social survey researchers , ann cartwright and fred martin , newly arrived with john 
         brotherston from lshtm .
pressure came from the scottish office for a more effective health 
         education campaign and more extensive government action . in june 1961
a memorandum was sent 
         from the scottish office which stressed the high and rising incidence of lung cancer in 
         scotland and criticized government policy .
two main policy options were identified : a 
         campaign directed at children and young people ; and one directed at the whole population 
         followed by an increase in the tax on cigarettes .
the scottish office favoured the latter 
         option although recognizing that this would be a new departure in health policy , one area of 
         several where the public had to be induced to exercise personal self - restraint .
the 
         relatively newly established who published a report on the epidemiology of cancer of the 
         lung , the report of a study group in geneva in november of that year , chaired by doll .
this 
         confirmed smoking as a major cause of lung cancer and downgraded air pollution .
the model of 
          policy transfer is perhaps appropriate here , the transfer of models 
         developed in other countries ( scotland ) or at the transnational level into national 
           policy . at the same time
policy lobby was emergent on smoking , developing 
         as a  policy community in the way in which jordan and richardson have 
         delineated the concept with links into government . in the 1950s , there had been no real interest group or 
apart from key individuals like joules , no significant 
         lobby was pushing the anti - smoking case , nor indeed was there any consistent policy 
         position .
although bradford 
         hill had worked within government during the war , he had advised doll that it was best to 
         steer clear of the political dimensions of the research .
it was his view that a young 
         researcher s career could be tainted by an apparent lack of scientific 
           objectivity .
doll s socialist convictions were known and he remained a member of the 
         communist party until 1957 .
hill remarked towards the end of his life that he had made doll passionate about 
         statistics as a replacement for left - wing politics . in the 1960s smoking became emblematic of a new role for medicine as the defining voice in 
         the delineation of health risk in post - war british society .
he was quietly encouraging charles 
         fletcher to take the issue through the royal college as a way of exerting external pressure 
         on government .
this was a way of convincing the cmo , sir john charles , who was 
         reluctant to act , but also for wider reasons , as a way of giving the issue a significance 
         which it might not otherwise have .
godber wrote to goodman in july 1961 ,  i am 
         convinced that a considerable increase in price would do more than anything else to cut down 
         consumption but that the pressure to do this should come from unattached scientific bodies 
         from the weight of the medical profession    and not from any 
         official sources. enid russell smith in the ministry also recognized the need for an external source 
         of pressure so that government could use that to justify action .
that policy lobby was indeed emergent in the late 1950s and early 1960s , comprising 
         chest medicine , cancer , and epidemiology ; it had moved from the low status central middlesex 
         hospital , where many of the specialists had been based , into the medical elite represented 
         by the rcp .
robert platt as president and his modernizing agenda for medicine was a key 
         influence as well as the networks of charles fletcher .
the role of godber as cmo provided the link with government and to the international 
         level : it was also symbolic that , on retirement , godber became the chairman of the health 
         education council , one of the key institutions which promoted the new public health agenda .
the rcp report for the first time provided an agenda for action for this community .
it 
         dropped air pollution as a priority ( the committee had originally been intended to consider 
         both ) and provided an alternative package for government to consider .
more education of the public ; more restrictions on the sale of tobacco to children ; 
         restrictions on advertising ; restriction of smoking in public places ; increased taxation ; 
         information on tar and nicotine content ; anti - smoking clinics .
the college employed a public relations consultant for the first time and held its 
         first press conference ; the book sold to the public , and there was a 
          panorama programme shortly after its publication in march 1962 .
this was a new era in the role of scientific argument and of the medical lobby . for 
         the first time
, science was reaching out to the public and using the full panoply of 
         marketing and consumer oriented techniques which were then emergent in a post - rationing 
         society .
the cohen report on health education of 1964 and the formation of the health 
         education council in 1968 set the seal on the new style of persuasive public health .
the politics of the issue also began to change , although this change was less apparent by 
         the end of the 1960s .
some differences can be identified between the conservative and labour 
         governments of this decade , but it was rather a question of the attitudes of individual 
         politicians rather than one of party political division .
after the publication of the first 
         rcp report , the government had set up a cabinet committee on smoking which held its first 
         meeting in the home secretary s room in the house of commons on 28 february 1962 . 
        
the publication of the report 
         broke a stalemate in government where policy was in limbo ; the ministry was 
          waiting for the rcp. enoch powell , as minister of health , had seen a 
         draft of the rcp report and wrote with characteristic vigour in november 1961:the government has it in its power , without prohibition or interference directly with 
             anyone s freedom of choice , to cut cigarette smoking whenever and to whatever 
             extent it pleases .
indeed , given the probable flatness of the demand curve , they could 
             combine a big cut in consumption with no reduction , and possibly an increase in revenue . 
            
if duty were increased for explicitly public health reasons , the opprobrium would be 
             much less than with ordinary increases of taxation , and it would be possible to use a 
             cost of living index which excluded tobacco ( or 
             cigarettes )    in my opinion if the government is unwilling 
             to use this power   
then health education and all the rest 
             is merely humbug and will be felt and seen to be such . in any case , 
health 
             education has already gone a long way    without 
             producing the slightest effect , and i do nt believe advertising makes any 
             difference one way or the other.the publication of the report will excite temporary interest and for weeks afterwards 
             we shall have to answer a shower of tiresome questions about what the government is not 
             doing ; but unless my colleague is prepared to use the fiscal weapon , i personally 
             propose to indulge in as little humbug as i can get away with .
the government has it in its power , without prohibition or interference directly with 
             anyone s freedom of choice , to cut cigarette smoking whenever and to whatever 
             extent it pleases .
indeed , given the probable flatness of the demand curve , they could 
             combine a big cut in consumption with no reduction , and possibly an increase in revenue . 
            
if duty were increased for explicitly public health reasons , the opprobrium would be 
             much less than with ordinary increases of taxation , and it would be possible to use a 
             cost of living index which excluded tobacco ( or 
             cigarettes )    in my opinion if the government is unwilling 
             to use this power    then
health education and all the rest 
             is merely humbug and will be felt and seen to be such . in any case , 
health 
             education has already gone a long way    without 
             producing the slightest effect , and i do nt believe advertising makes any 
             difference one way or the other . the publication of the report will excite temporary interest and for weeks afterwards 
             we shall have to answer a shower of tiresome questions about what the government is not 
             doing ; but unless my colleague is prepared to use the fiscal weapon , i personally 
             propose to indulge in as little humbug as i can get away with .
but there was in - fighting between the cche and the mh about the responsibility for a 
         health education campaign .
bruce fraser , the new mh permanent secretary , was of the opinion 
         that the cche could not conduct a campaign for central government which was distinct from 
         its role in helping the local authorities with their health education work .
the lack of 
         central government control , when potentially central government money would be spent , was a 
         basic sticking point .
various institutional alternatives were extensively discussed , battles 
         which were certainly re - run thirty years later over hiv / aids .
but the two ministries , health and education , did bring a joint memorandum to the 
         cabinet committee at its first meeting .
this called for a national campaign with further 
         restrictions on the sale of cigarettes to children and on smoking in public places , 
         restrictions on tobacco advertising , and a differential tax on cigarettes .
cabinet committees had been briefly formed in the 1950s at the time of the various 
         parliamentary statements and had been chaired by the home secretary of the day .
macmillan as prime 
         minister did not want him in this role and hailsham as lord president of the council took 
         over .
the ministerial committee was paralleled by one of officials which did the detailed 
         work .
cary , deputy secretary in the cabinet office , was chair of the committee.a draft report was ready to go to the lord president by the middle of april .
the report , preceded by a flurry of activity in the relevant departments , was 
         relatively anodyne , placing its reliance on health education and on voluntary agreements for 
         advertising .
this would penalize the poor , raise the cost of living , and have a serious 
         effect on producer economies such as rhodesia .
it was underpinned by a belief that more 
         restrictive action could not be sustained without major change in public attitudes to 
         smoking .
the edinburgh research and the government s own pilot survey of public 
         attitudes to smoking through the central office of information had confirmed that most 
         people knew about the smoking and lung cancer link , but their views on why smoking was 
         harmful to health were different , laying stress on the environmental nuisance aspects rather 
         than the risk - based epidemiology . in the event education and voluntarism were the keynotes of the response and the committee 
         decided not to make a statement . as hailsham told macmillan , a small publicity campaign 
        
he proposed to set up 
         the machinery and start the campaign , perhaps issuing a statement later on .
a meeting with 
         the manufacturers might also result in an agreement to apply the tv restrictions voluntarily 
         to other advertising so the government could also claim credit for that . at a subsequent meeting in the house of lords with representatives of the tobacco 
         advisory committee ,
the lord president said the government accepted the scientific case as 
         in the rcp report but was against compulsion and action which would lead to pressure for 
         similar measures in respect of alcohol and even foods like chocolate .
it was  not 
         the government s purpose to induce any catastrophic change in smoking 
         habits. the meeting resulted in a move towards overall agreement on advertising 
         restrictions based on the code applicable to television .
he felt the informal way this matter had been dealt with was suited to other issues 
         as they arose .
someone at 
         carreras had sent him a box of filter - tipped piccadilly . 
this was indeed bearding 
         the lion in his den , but it was as ineffectual as the devil s attempt on st . 
          
anthony. the government response was thus muted and focused on a strategy , health education , which 
         the health minister recognized as ineffective .
the treasury view ultimately prevailed over the taxation issue but not 
         before the implications had been fully aired at the political level .
the role of the 
         industry was important , although its representatives were called in after the political 
         decisions had been taken . also behind these decisions was a desire to achieve a balance in 
         policy and the realization that , without a huge change in the social positioning of smoking , 
         there was little point in initiating a major programme of change .
the publication of the american surgeon general s report in 1964 led to a further 
         officials report and political interest .
the american report extended 
         associations between smoking and health risk to diseases other than lung cancer , but the 
         officials did not feel this warranted further action .
the social survey had focused on smoking and had 
         shown that attitudes were changing . on 6 april 1964 he wrote , 
i consider that the 
         american report , the american action and the social survey have 
         strengthened the case for action , and that it is not too early to say that 
         our limited campaign is failing and that unless we can bare our teeth nothing that we do 
           will be taken seriously. he suggested an extension of the 
         health education campaign and consideration of banning smoking in cinemas and advertising , 
         together with a health warning on packets .
now the words  it would bear more 
         hardly on the poor than on the rich were replaced by 
it could be 
         harder for a poor man than for a rich man to continue his existing level of smoking and 
         while this element of discrimination might be said to be more to the poor man s 
        
benefit , it would be unlikely to go uncriticised. on 30 june the cabinet committee approved the officials suggestion of a 
         modest extension of the government health education campaign .
there was no support for a ban 
         on tv advertising or on smoking in cinemas .
the minister of health in the succeeding labour government , kenneth robinson , was a doctor 
         who took a more active line on smoking .
his meetings of individual ministers on the matter 
         caused alarm on the part of burke trend , the cabinet secretary , who channelled these through 
         the home affairs committee in order to stop the proliferation of ad hoc ministerial 
         committees on the boundaries of home and economic affairs .
trend also promoted the 
          anti nanny state argument which had carried weight with conservative politicians.but on what grounds are the government justified in intervening in those cases where a 
             man s personal habits may damage only himself ? and , if we accept that the 
             government are entitled to intervene in such cases , does this argument apply only to a 
             man s physical habits , or does it extend also to his mental 
             habits   
i.e. to what he reads or watches on television ? in 
             short , where does the argument , if logically pursued , stop?but the nature of policy was changing .
robinson promoted voluntary agreements 
         which led to the disappearance of cigarette advertising from tv .
the acceptance of money 
         from the manufacturers for research was no longer a straightforward matter .
when the issue 
         of resumed industry funding was reopened in the mid-1960s , various possibilities came under 
         consideration , including an mrc takeover of the industry s new laboratory complex 
         opened at harrogate in 1962 , but nothing came of the contacts .
such requests were seen as calling into question government policy , including the 
         banning of tv advertising of cigarettes .
but on what grounds are the government justified in intervening in those cases where a 
             man s personal habits may damage only himself ? and , if we accept that the 
             government are entitled to intervene in such cases , does this argument apply only to a 
             man s physical habits , or does it extend also to his mental 
             habits   
i.e. to what he reads or watches on television ? in 
             short , where does the argument , if logically pursued , stop ?
wider proposals were killed off by richard crossman when he moved to the department of 
         health and social security in 1968 .
both he and the prime minister , harold wilson , were 
         worried about the electoral implications of smoking restrictions .
when robinson presented a 
         draft bill to outlaw cigarette coupons , crossman s reaction was brusque .
hesimply blurted out that this was another of those bills which we simply 
             could nt afford to pass when we were running up to an election because bans of 
             this sort made us intensely unpopular , particularly with children and families .
if 
             you re going to deal with the cigarette smoking problem , you should not try 
             this kind of frivolous but intensely unpopular method .
there was a tremendously violent 
             reaction with everyone saying that here we must stand on moral principle .
i heard it 
             from eirene white , dick taverne , and edmund dell , representing the board of trade which 
             has switched its junior ministers around , and , indeed , i only had two or three people on 
             my side .
however , i m still just powerful enough to hold the thing up and 
             finally i suggested that instead of forbidding coupons we should ration the amount of 
             money to be spent on advertising and leave it to the cigarette manufacturers to decide 
             how they should spend their money .
harmony 
               achieved.it was significant that dell , as minister for the department with close links 
         to the tobacco industry , supported restriction , not a 
smoking s significance as an electoral issue was changing , although 
         electoral concerns were still a strong disincentive to action as this incident 
       indicates
. simply blurted out that this was another of those bills which we simply 
             could nt afford to pass when we were running up to an election because bans of 
             this sort made us intensely unpopular , particularly with children and families .
if 
             you re going to deal with the cigarette smoking problem , you should not try 
             this kind of frivolous but intensely unpopular method .
there was a tremendously violent 
             reaction with everyone saying that here we must stand on moral principle .
i heard it 
             from eirene white , dick taverne , and edmund dell , representing the board of trade which 
             has switched its junior ministers around , and , indeed , i only had two or three people on 
             my side .
however , i m still just powerful enough to hold the thing up and 
             finally i suggested that instead of forbidding coupons we should ration the amount of 
             money to be spent on advertising and leave it to the cigarette manufacturers to decide 
             how they should spend their money .
by 1971 , when the rcp published its second report , much water remained to flow under the 
         bridge .
the end of the 1960s can be see as the  end of the beginning 
         and a suitable resting point for assessment of the initial policy response .
denial and delay 
         is an inadequate framework of assessment and policy science theories are helpful but need 
         historicizing .
the changes of the 1950s and 1960s were symbolic of a wider paradigm shift in 
         the way in which health issues were presented by and to politicians and the public . a new 
         role for medicine , the presentation of scientific facts to the public through the media , was 
         an important component of the changed situation .
the medical reports of 1962 and 1964 made 
         risky behaviour by the public a matter for governments ; and they made smoking an issue for 
         the public .
politicians were engaged : witness hailsham , powell , and robinson , who 
         represented an opposite view to those who stressed public opinion .
the policies which 
         emerged reflected fiscal concerns but also interests like health education , air pollution , 
         or the state of public opinion .
the 
         central / local tension over control and financing of health education often occupied 
         ministers minds as much as its content .
it would have been unthinkable for governments to impose the public smoking bans of the 
         early twenty - first century in the 1950s .
networks changed over 
         time ; and they were not so clearly segmented for and against smoking .
the anti - smoking 
         policy lobby , absent in the 1950s , consolidated in the 1960s .
the negotiations about the 
         establishment of the rcp committee and its subsequent report saw the formation of a policy 
         community with links into government and also with the outside medical constituency .
in the 1960s 
         and after , parts of that lobby also linked with industry round an agenda of  harm 
         reduction. historical analysis of post-1945 public health has focused on the 
         organizational and professional changes which brought the demise of the medical officer of 
         health and his rebirth as the community physician within health services . alongside that service - focused world , a  new public health was 
         forming with an ideology which stressed individual responsibility in the context of 
         population - based interventions aimed at persuading the public .
this public health was not 
         centred on the community physician and drew on different networks and strategies to achieve 
         policy change .
smoking was the key issue which acted as the template for much that followed : 
         it symbolized a new era of health risk and individual responsibility .
the historical modifications presented here are also suggestive of the policy uses of 
         history .
smoking policies and cultural change have passed through stages in the uk in 
         which different relationships have operated at different points in time .
policy formation is 
         messier and more complex than public health advocates or political science would have us 
         believe .
we need to take account of such historical analysis as a detached basis for 
         discussion of the interaction between evidence , culture , and regulation and its potential 
         future implications .
 a key current concern is how scientific knowledge may inform policy in relation to major 
           environmental and health concerns . 
 there are distinct schools of analysis about this 
           relationship between science and policy . 
 they stress rational relationships ; denial and 
           delay ; or the role of networks . 
 history is important in modifying such perspectives : 
           smoking policy in the 1950s and 1960s is the case study here . 
 the initial response in the 
           1950s to the link between smoking and lung cancer was in part conditioned by the role of 
           the tobacco industry and the financial importance of tobacco : the british tobacco industry 
           had closer relationships with government than the american one , and did not rely on public 
           relations . 
 public health interests worked with the industry . 
 but politicians were 
           concerned also about the fluidity of the epidemiological evidence ; the dangers of stirring 
           up further pressure over air pollution ; the financial and ideological implications of 
           health education and its location ; and the electoral dangers of intervening in a popular 
           mass habit . 
 in the 1960s the british and american medical reports stimulated the growth of 
           a public health  
 policy community. the initial political 
           considerations began to weaken and these years marked the beginning of a new style of 
           public health . 
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