Health workers and anti-smoking campaigners have given a mixed reaction to the government's White Paper on smoking.

The Health Education Authority called the paper "the biggest step forward in tobacco control since the 1960s".

Anti-smoking group ASH and the British Heart Foundation, which describes smoking as a major cause of heart disease, said they were "delighted".

ASH called the paper "the first serious and broad-based assault on the appalling burden of illness, addiction and death caused by tobacco since scientists first warned of the dangers 40 years ago".

But the Institute of Health Services Management (IHSM), the Imperial Cancer Research Fund (ICRF) and the British Medical Association (BMA) said the proposals did not go far enough.

Dr Martin Jarvis of the ICRF said the paper was "a landmark", but added: "We should aim to do better than reduce children's and adults' smoking by 2% by 2005."

Suzanne Tyler, deputy director of the IHSM, said: "Tobacco is responsible for the largest number of preventable deaths in the UK. Nine men and five women die every hour from smoking-related diseases.

"And treating tobacco-related illness costs the NHS �1.5bn every year. The overall costs are just too high to excuse a cautious approach."

The IHSM says " a steep price hike" in the cost of cigarettes, particularly the cheaper brands, would be a good deterrent.

And, although it welcomes plans to give free nicotine patches to low income families, and set up anti-smoking clinics, it says one week's supply of nicotine patches is not enough.

Historic first step

The BMA called the White Paper "an historic first step" in the fight against tobacco.

It welcomed plans to keep increasing tax on cigarettes and for free nicotine replacement therapy.

But it accused the government of being too cautious and is unhappy that the government has steered clear of imposing an outright ban on smoking in the workplace.

And both the BMA and the IHSM call the decision to impose only a voluntary ban on smoking in public places "disappointing".

But the proposal was welcomed by the Restaurant Association of Great Britain.

The BMA also wanted the government to take faster action against tobacco advertising.

"I really do think we should be able to start the new millenium free from billboards and glossy inducements to smoke," said Dr Ian Bogle, chairman of the BMA.

Insulting

However, John Carlisle, public affairs director of the Tobacco Manufacturers' Association, said the government's plan to implement the European Union directive on tobacco advertising by the year 2000 was illegal.

He said it was being challenged by the German government and four tobacco companies and implementation should be put on hold until the outcome of the case was known.

John Carlisle: 'the paper is an affront to personal freedom'

Mr Carlisle called the White Paper "an affront to legitimate commercial and personal freedoms" which reflected "the unacceptable face of the Nanny State".

He agreed that children should not be encouraged to smoke, but denied the charge that tobacco companies have deliberately targeted teenagers with their advertising.

The TMA wants the rights of smokers to be protected as well as those of non-smokers and the "legitimate interests" of the tobacco industry.

But ASH says the White Paper is devoid of "nannying tendencies" and offers people, particularly the poor, the choice of coming off smoking if they want to.

Global attack

The World Development Movement says the government should ensure that the attack on smoking is only UK-based.

It wants a ban on British embassies promoting tobacco companies' interests.

It also wants the government to sign up to an international framework convenction on tobacco control which it says would represent a global attack on tobacco.

It believes tobacco companies are targetting developing countries as they lose markets in the West due to increasing tobacco controls.

"On the face of it, this is a piece of UK legislation, but in reality its consequences could be felt from Chile to China," said campaigns officer Emma Must.

"British tobacco companies will evade tough marketing restrictions in Britain by simply shipping their cargo overseas like toxic waste.

"To tackle this, we need global standards on tobacco marketing."

ASH also supports an international convention on tobacco.