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Are we in sight of a smoke-free Britain?

Dr Mike Knapton, associate medical director at the British Heart Foundation, a member of NHE’s editorial board and a part-time GP in Cambridge, discusses smoking cessation.

In a few weeks I expect nearly a million smokers will try to quit for good on No Smoking Day on 11 March. 

It’s taken a long time, but with initiatives like this and significant progress on new measures to tackle smoking, we could finally be in sight of a smoke-free Britain. Although there are still more than 100,000 deaths caused by smoking each year, smoking prevalence is at its lowest level since records began in the 1940s.

In 1954, around 80% of adults smoked, but current levels are now at just 19%. 

While this has been great progress, recent years have seen smoking rates stagnate and we must now crack the ‘final fifth’ of adults who are still smokers, many of whom are desperate to quit. 

National policy on smoking 

We’ve known for years what a devastating effect smoking has on health, and smoking rates could have been even lower with proper measures in place. 

As far back as 1950, when Richard Doll and Austin Bradford Hill, both of whom were later knighted, authored a groundbreaking paper establishing that smoking was an important factor in developing lung cancer, we’ve known that smoking kills. But it wasn’t until 1998 that the UK government first published a national policy to tackle smoking. 

Thankfully rates have fallen significantly in that time and continue to do so, helped by health campaigns to raise awareness, restrictions on tobacco advertising and health warnings on cigarette packs. 

And now we are starting to see the necessary measures to cut smoking rates even further, prevent people from starting, and reduce its cost on society. 

In October, a ban on smoking in cars carrying children will come into law, subject to agreement from both Houses of Parliament. This ban is a welcome measure, which has been long overdue. Most exposure to second-hand smoke happens in the home, and it is very harmful in enclosed places, such as cars – particularly to children. 

Every week, thousands of children are exposed to second-hand smoke in cars, putting them at greater risk of respiratory infections, asthma, and sudden infant death. I would urge families to consider this risk when smoking in cars or the home, with children present. 

Standardised packaging 

Before the general election in May, Parliament will have the opportunity to vote to introduce standardised packaging for tobacco products in the UK. This would see all advertising removed from packets of cigarettes, and packs would just have the brand name printed in a standardised way. 

Health charities have been following progress in Australia closely, where standardised packaging was introduced in 2012. Early findings are very encouraging. A British Heart Foundation-funded report earlier this year demonstrated that smokers were almost twice as likely to notice the health warnings on packs stripped of advertising, and packs were less appealing. 

Smoking rates in Australia have plummeted since 2010, and now just 13% of people aged over 14 are daily smokers. This is why I would like to see standardised packaging urgently introduced here in the UK. 

Tobacco levy 

Looking even further forward, we could see the tobacco industry making a bigger contribution to the costs smoking has on society. In the Autumn Statement, chancellor George Osborne announced a consultation on a levy on the tobacco industry. 

Tobacco companies continue to make large profits and it is estimated by health charity Action on Smoking and Health that a levy of 1p per cigarette could raise more than £350m, which could go towards treatment and cessation services. 

Differences in smoking rates 

In 2012-13 the government spent £88.2m on services to help people stop smoking and a further £60.1m on stop-smoking medication. But as well as legislative measures, we must also address the reasons for differences in smoking rates across communities, genders and socioeconomic status. People from poorer communities are more likely to smoke and are less aware of the risks to their health. For example, unemployed people are twice as likely to smoke as those in employment. And those with manual occupations, such as delivery drivers and bar staff, are far more likely to smoke than those in managerial or professional occupations, such as accounting and teaching. 

There are also differences within ethnic minorities, particularly amongst men. Rates are particularly high in Black Caribbean, Bangladeshi and Chinese populations. Part of the problem is that more people within these communities do not understand the risk that smoking has on their health. For example, more than a quarter of African-Caribbean men say smoking has ‘no effect’ on their health, more than double the UK average. 

There have clearly been great strides recently to reduce the number of smokers and prevent further generations from taking it up. We now need governments across the UK to urgently commit to standardised packaging and there needs to be greater efforts to support communities where smoking continues to be a problem. Smoking is an addictive, toxic and deadly habit and it is not our aim to take away freedom of choice, but to help protect people and save lives.

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