Will England really be smoke-free by 2030?

The Government's plan to curb smoking once and for all by 2030 in England has been widely applauded by various health charities. But is it realistic?

By now we all know how bad lighting up is for us. Thankfully, smoking rates have drastically decreased in the UK over the last few decades. In 1975, about 46% of the adult UK population (51% of men and 41% of women) smoked, compared to 14.7% in 2018.

Tobacco advertising in the UK ceased in 2003. Since 2007, the indoor smoking ban has helped reduce the number of deaths related to second-hand smoke across the UK by almost 50%. Since 2016, it's been illegal to sell 10-pack cigarettes (or fewer than 30 grams of loose tobacco).

Nearly 1.5 billion fewer cigarettes have been smoked each year in England since 2011, according to new figures. But smoking remains the biggest preventable cause of death in the country. And the number of smokers in marginalised communities such as LGBTQ+, people who experience poor mental health and those in deprived areas remains high.

So where do we go from here?

The next step

This summer, the UK Government released a Green Paper, which outlined its plans to tackle preventable ill health in the near future - including making tobacco obsolete in England by 2030.

"Thanks to our concerted efforts on smoking, we now have one of the lowest smoking rates in Europe with fewer than one in six adults smoking," the document reads. "Yet, for the 14.7% of adults who still smoke, it's the main risk to their health."

The paper proposed that the NHS will provide aid for all smokers admitted to hospital, regardless of whether the reason for their admittance was smoking-related.

Based on health models that have been successfully implemented in Canada and Manchester, a spokesperson for the Department Of Health said this will involve: "Identifying the smoking status of all admitted patients; providing brief advice to all smokers; the offer of personalised bedside counselling to help smokers quit or temporarily abstain; timely nicotine replacement therapy and/or pharmacotherapy; and follow-up after discharge."

The document also suggested several other factors which could help reach the 2030 goal including:

  • Monitoring the health impact of e-cigarettes.
  • Looking into a 'polluter pays' approach - where the tobacco industry will be called upon to fund stop-smoking services.
  • Ensuring that NHS Trusts convince their workers to quit, to create a smoke-free NHS by 2020.
  • Support for local councils to help people to quit by identifying local solutions, particularly in areas where prevalence remains high.
  • Maintaining high duty rates for tobacco products to make smoking less affordable.

Further proposals regarding the Government's efforts to make England smoke-free over the next 11 years will be outlined "at a later date".

Should the tobacco industry pay for harming

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The 'polluter pays' principle is the idea that those who produce pollution should bear the costs of managing damage to human health.

Currently, the tobacco industry makes £1 billion a year. In comparison, It costs £2.5 billion for the NHS to treat smoking-related illnesses every year.

Director of Policy for Action on Smoking and Health (ASH), Ciaran Osborne, admits that the target for 2030 is plausible, but suggests the Government could be more ambitious in its methods.

He says: "The 'polluter pays' charge will fund a lot of mass media campaigns which should encourage people to quit smoking. We would also like to see raising the sale of tobacco back to 21 and several other things around retail licensing for tobacco, and reducing its affordability."

What could really make a difference though, opines Osborne, is more funding for stop-smoking services. In 2018, it was reported that 44% of local authorities no longer have a specialist stop- smoking service open to all smokers in their area, due to funding cuts.

According to ASH, cheap tobacco that has been illegality imported into the UK promotes teen use, as well as exposure to criminal activities in low-income areas. Without access to local quit-smoking services in these areas, the smoking rate for poor communities across the UK will most likely remain steady.

Kruti Shrotri, policy manager for Cancer Research UK, agrees: "What local authorities need is more funding so that they can fund those really important services and fund wider tobacco control measures to reduce smoking rates in that area. We have been pushing for more money in public health funding through the public health grant; it's because of those cuts that we're seeing cuts to stop-smoking services."

Pushing against an open door

Persuading one in seven of the adult population to give up smoking in the next 11 years might seem a tall order. But the good news is that most of them are eager to quit in principle.

According to Public Health England (PHE), around 60% of the 6.1 million smokers in England say they want to quit, along with one in five who claim they want to stub out their habit within three months.

An independent review by PHE found vaping to be at least 95% safer than smoking, with negligible risk to people around. But because the World Health Organization (WHO) is concerned that vaping is still harmful to ex-smokers and people who have never smoked before, e-cigarettes are unlikely to be a part of future NHS smoking cessation programmes.

However, PHE wants to permit patients who are committed to quitting smoking to vape on hospital grounds, coupled with behavioural support.

Professor Peter Hajek, director of Health and Lifestyle Research Unit at the Wolfson Institute of Preventive Medicine, Queen Mary University of London, is optimistic about the 2030 goal.

"E-cigarettes and other low-risk nicotine delivery products are continuing to develop. They already provide an acceptable replacement for cigarettes to some 15% of smokers who switched to them, and the proportion will grow. If the current trends continue, smoking will virtually disappear sooner than in 10 years."

Success stories from other countries

In Sweden, the adult smoking rate is now only 5% for the entire adult population, which is expected to drop drastically given the new law which makes it illegal for anyone to smoke in virtually all public areas.

Its success has been largely attributed to many former smokers now consuming 'snus' - a small pouch of tobacco placed under the lower lip, which gives a nicotine rush with far less harmful health implications. Importantly, unlike other chewing tobacco products linked with mouth, tongue and oesophageal (gullet) cancer, a review by the WHO did not link snus use with cancer. The product is currently unavailable in the UK.

As a result of WHO regulations enforced in 2014 which prohibit smoking indoors in public and private residences, Brazil is the largest population in the world protected by a comprehensive smoke-free law. About a fifth (20.3%) of men and 12.1% of women are smokers.

Over the past 20 years, Brazil has successfully reduced its adult smoking rates by nearly 50%, from 34.8% in 1989 to 18.5% in 2008. This dramatic decrease can also be attributed to the introduction of cautionary images displayed on the packaging in 2001.

The good news is that smoking rates across England are going down every single year. With the introduction of more tobacco control policies and the willingness to learn from other countries, a smoke-free Britain could well be on the horizon.

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