Smoking

Government attempts to reduce the harm of smoking have been far more robust than their attempts to reduce obesity and alcohol consumption. Since 2000 there have been consistent and rigorous efforts to reduce smoking in the UK but there is much more that can be done.

There have been a number of anti-smoking strategies in recent years, with the government White Paper “Smoking Kills” published in 1998 being perhaps a milestone in public health in the UK. Since 2000 there have been several reports, laws and directives aimed at reducing tobacco consumption.

The 2001 EU Tobacco Products Directive brought in upper limits on the amount of tar in cigarettes, banned additives in tobacco and description such as ‘lite’ and ‘mild’ and increased health warnings on packaging. In 2002 the Tobacco Advertising and Promotion Act banned tobacco sponsorship from sports events including Formula One motor racing.

In 2004 the Wanless Report on the future of public health policy ‘Securing Public Health for the Whole Population’ included a number of recommendations to tackle smoking including a ban on smoking in the workplace.

The 2006 Health Act (Smoking in Public Places and Workplace) was seminal public health legislation and banned smoking in virtually all enclosed public places and workplaces from 2007. In addition, Scotland launched a Register of Tobacco Retailers under the Tobacco and Medical Services Scotland Act 2010.

The coalition government in 2012 brought in a new Tobacco Plan for England which set out national targets to reduce smoking rates among adults. It also committed to removing the display of tobacco products from shops and held a public consultation on plain packaging.

In 2014 under the Children and Families Act, by way of amendments the government was able to bring in regulations requiring standardised tobacco packaging. It also allowed for regulations to prohibit smoking in vehicles with children and made it an offence for adults to buy tobacco for children.

In 2016 the EU Tobacco and Regulated Products Regulation was transposed into British law, aimed at reducing smoking. 65% of wrapping had to be covered with picture public health warnings, and there was a minimum packet size of 20 sticks, so that packets of 10 would disappear.

Local Authority Attempts to Reduce Smoking

Local authorities have been tasked with the duty to improve the public’s health, including reducing smoking, and has a central government grant to that effect. They are tasked with a ‘place based’ approach that can bring together funding streams and expertise from local government, central government and the NHS. Unfortunately, as far as smoking is concerned, this mass of bureaucracy leads to little more than the continued offering of NHS delivered smoking cessation programmes, all of which were available before the distribution of public health to local authorities.

Other Attempts to Prevent Smoking

Other proposals have been made to prevent smoking, for example the prevention of people who were born from the year 2000 from smoking. This was brought up in June 2014 at the British Medical Association’s annual public health medicine conference. The BMA which represents more than 153,000 doctors from all branches of medicine voted overwhelmingly in favour, but the matter was unable to progress any further.

E-Cigarettes

The most controversial aspect of the battle against tobacco harm is the substitution of cigarettes with e-cigarettes.

E-cigaretts deliver a faster, stronger nicotine hit than patches or gums, and mimic the act of smoking better, and so meet many of the criteria for a tobacco herm-reduction product.

In 2016 the Royal College of Physicians published an authoritative report arguing that fears about e-cigarettes had been overblown, that they can help smokers to quit, and that they are relatively harmless and do not tempt children and non smokers. John Britton, chairman of the College’s tobacco advisory group said ‘We are moving into a situation where people are able to use nicotine without killing themselves’. (The Time April 16 2017). Prof. Britton said that the review was designed to bring an end to ‘mixed messages’ from health experts sceptical of e-cigarettes. The report was backed by numerous medical organisations such as Cancer Research UK and the British Lung Foundation.

However, many national legislatures and organisations have taken a tougher line on e-cigarettes, seeing them as potentially harmful.

The EU’s revised Tobacco Products Directive 2016 introduced new rules restricting the supply, manufacture and promotion of e-cigarettes. This included restrictions on the advertising of electronic cigarettes.

It seemed that the Directive was designed to make vaping as difficult as possible without actually banning it. However, the British authorities tended to be liberal in their implementation of the directive, bearing in mind that e-cigarettes have been backed by the NHS. Many other countries have taken a tougher stance (partly because they may have more toxic e-cigarettes); the UK compares, for example, to the UK Federal Drug Administration who have applied a much tighter regime.

The retail value of e-cigarettes is now above £500,000 a year. The number of users in 2012 was 700,00 and by 2016 it was 2.8m.

The big cigarette companies are trying to change their product portfolio to radically less harmful products and that needs to be encouraged. Philip Morris has taken the lead on this, publicly stating that they intend to replace their cigarettes with e-cigarettes in a limited period of time.

Do e-cigarettes reduce harm?

The harm reducing effects of e-cigarettes remain controversial. Certainly, e-cigarettes are not harm free. E-cigarettes contain no tobacco and it is considered that nicotine and propylene glycol, the other main ingredients are no more harmful than coffee. (Royal College of Physicians). However, their report concludes that the flavourings that are sometimes added might have higher risk, adding ‘Longterm or rare adverse effects will remain uncertain until e-cigarettes have been in use for several decades’. Nevertheless, Public Health England was criticised for claiming that vaping was 95% safer than smoking tobacco after it was revealed that the figure was based on research by industry funded scientists. Two out of twelve authors of that study had earned money in the past advertising e-cigarettes. The controversy will no doubt continue.