London School of Hygiene & Tropical Medicine

Smog Conference: Leading historian documents how shift in public health agenda and political necessity combined to keep air pollution off the agenda.

Delegates attending an international conference in London today to commemorate the 50th anniversary of the Great London Smog of 1952, which caused an estimated 12,000 deaths, will hear how governments from the late 50s onwards deliberately downplayed the huge threat to public health caused by air pollution, and sought to shift the blame firmly onto cigarette smoking instead.

Professor Virginia Berridge of the London School of Hygiene & Tropical Medicine's History Unit has researched papers relating to cabinet committee meetings in the late '50s looking into smoking, air pollution and lung cancer. She asserts that although there were clear political reasons for obscuring the link between air pollution and lung cancer, other factors, including a shifting public health agenda, which focused on an individual¹s responsibility for their health rather then environmental influences, were also key in ensuring that the issue of air pollution was 'damped down'.

'If you look at the manner in which the public health agenda has shifted since the aftermath of the Great Smog right up until the rise of the environmental movement in the 1980s, you can see that 'smoke' - be it atmospheric pollutants or cigarette smoke - has been a continuous symbol throughout the period', she observes.

In 1953, Dr Guy Scadding, speaking on the television programme Matters of Medicine, had expressed a belief that air pollution was as much a factor in whether someone developed lung cancer as smoking, citing the significantly higher number of deaths from the disease among those living in polluted cities, as opposed to the countryside, and assuming that rates of smoking were likely to be similar in both populations.

A few years later, in 1957, the Medical Research Council was planning to issue a statement saying although smoking was a significant cause of lung cancer, up to 30% of cases might be caused by air pollution. But the Cabinet committee on cancer of the lung, fearful of another political embarrassment which could be caused by stressing the air pollution connection, asked the MRC to reconsider its statement. On 31 May 1957 a modified version was published, which asserted that although it was likely that atmospheric pollution did play a role in lung cancer, it was 'a relatively minor one in comparison with cigarette smoking'.

A committee was appointed by the Royal College of Physicians in 1959 to consider both the connection between smoking and air pollution, and to produce a report. But when it met on 17 March 1960, it decided to publish a separate report, giving smoking priority.

'It was agreed that the evidence would be of an entirely different quality and nature', explains Professor Berridge. 'It was pointed out that individuals could avoid the dangers of smoking but not those of pollution. It was also thought that a section on atmospheric pollution within the main report might detract from the main arguments on smoking and lung cancer'.

'What was happening in this committee was a shift away from a concept of health and wellbeing related to an individual¹s environment, occupation, class or work, towards one focused strongly on that individual's responsibility for his or her health, which smoking came to symbolise. After the 1962 report, it was smoking and the type of public health which it epitomised which was to become the central public health issue. Smoking was
something which the individual could do something about; air pollution was not,' explains Professor Berridge.

'The first Royal College of Physicians' report in 1962 was a harbinger of a new style of public health, the first building block in a change which was fully in place by the end of the 1970s. But it was not until the 1980s that environmental public health finally began to make a comeback and, once again, it was the issue of smoking - and passive smoking in particular - which was to prove the turning point. However, this environmentalist agenda differed significantly from the earlier one. Passive smoking and the policies it helped to emphasise, combined with the individualism of 1970s public health and the new environmentalism of the '80s, led to "environmental individualism", bringing the two disciplines together at last', concludes Professor Berridge.

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