In July 2019, the Government stated its ambition of going “smoke-free” by 2030 in England. In Scotland, the target is 2034, while Northern Ireland and Wales have not yet set a date. In practice, “smoke-free” involves reaching 5% average adult smoking prevalence. The Government has acknowledged that this goal will be “extremely challenging” to achieve. Over the last 35 years, smoking rates in Britain have halved. According to Cancer Research UK, currently around 15% of UK adults smoke cigarettes. This is among the lowest rate in Europe.
A February 2020 report from Cancer Research UK states that to reach the 5% target by 2030, the pace of change needs to be “40% faster” than is currently predicted.
Smoking: A Habit in Decline
Smoking was banned in enclosed public places in Scotland in 2006, and the rest of the UK in 2007. Also in 2007, the minimum age for purchasing tobacco rose from 16 to 18 in Scotland, England and Wales. Plain packaging for cigarettes was introduced in 2016, following an independent review. The review concluded that:
There is sufficient evidence that the introduction of standardised packaging as part of a comprehensive policy of tobacco control measures would be very likely over time to contribute to a reduction in smoking prevalence, especially in children and young adults.
A particular focus on preventing the uptake of smoking in children and young people has seen the proportion of children who smoke fall from 1 in 5 two decades ago, to 1 in 20 in 2018.
Despite this progress, in 2019 there were still nearly 7 million smokers in the UK. In 2017, 16% of all deaths in England were attributable to smoking.
Prevalence of smoking is strongly correlated with socio-economic status. Research suggests that as personal income increases, the likelihood of smoking decreases. In England, around 23% of those in routine or manual employment smoke, compared to around 9% of those in managerial and professional occupations. This gap has widened since 2012.
Hospital admissions attributable to smoking are significantly higher in economically deprived areas. In 2018, Blackpool, which ranks number one in local authority deprivation rankings, recorded the joint highest incidence of smoking related hospital admissions (2,900 per 100,000 population). In Wokingham, which ranks 316 out of 317 authorities in the deprivation rankings, this was 721 per 100,000.
Smoking prevalence is also higher among:
- unemployed people;
- those living with mental health conditions;
- people with no qualifications; and
- renters compared to property owners.
Action on Smoking and Health (ASH) have highlighted some causes of these disparities. A smoker whose “socio-economic or psychosocial needs are unmet on a daily basis” may not prioritise quitting and may view smoking as a necessary everyday coping strategy for stress relief. In addition, children and young people exposed to adults smoking in their households are more likely to start smoking themselves, creating an inter-generational cycle of tobacco addiction.
The Government addressed these health inequalities in its 2017 ‘Tobacco Control Plan for England’. It states that Public Health England (PHE) will “target support at those areas with high levels of smokers”. It also calls for local councils to:
Identify the groups and areas with the highest smoking prevalence within their local communities and taking focused action aimed at making reductions in health inequalities caused by smoking in their population.
How realistic is the 2030 target?
A group of charities, including ASH, the British Heart Foundation and Cancer Research UK, have published the ‘Roadmap to a Smoke-Free 2030’. It states that if the Government is to meet the 2030 target, it must to commit to certain further measures. These include:
- legislating to force tobacco manufacturers to finance a smoke-free 2030 fund (sometimes known as the ‘polluter pays’ principle);
- ensuring universal access to support for smokers to quit, in both healthcare and community settings; and
- further policy consultations, including requiring retailers to have a licence to sell tobacco.
Cancer Research UK state that the combination of pharmacotherapy and behavioural support offered by local smoking cessation services is “the most successful way to support smokers to stop”. Concern has been raised about the impact of public sector cuts on these services.
One of the major achievements of tobacco control over the last two decades has been a shift in social norms and public attitudes toward smoking. ASH state that it is vital this continues in communities and groups where smoking still carries levels of status and acceptability. It is possible that, if a targeted approach is not taken, then more affluent areas will reach smoke-free status over a decade before poorer communities.
Some groups have presented alternative viewpoints. The Institute of Economic Affairs argue that smoking “results is a net saving for the Government of £19.8 billion”. The Adam Smith Institute have called for greater focus on the promotion of tobacco harm reduction products, such as e-cigarettes.
Dr Katrina Brown from Cancer Research UK states if the 2030 target is met, 3.4 million fewer people will be smoking in England compared with current rates. However, she also states that:
Unless Government acts to make smoking rates fall faster, we’re unlikely to reach the target.
Recent data suggests that more than one million people have given up smoking since the beginning of the Covid-19 pandemic. Researchers at University College London have found that more people have quit in 2020 than in any year since 2007.
On 13 July 2020, Baroness Northover tabled an amendment to the Business and Planning Bill, stating that:
Pavement licences may only be granted by a local authority subject to the condition that smoking is prohibited.
On 20 July 2020, Lord Faulkner of Worcester is to ask the Government about the “objective of making England smoke-free by 2030”.
- APPG on Smoking and Health, Delivering the Vision of a ‘Smoke-free Generation’, February 2019.
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