The problem
Smoking is the lifestyle factor whose link to cancer is most widely known and accepted. Lung cancer is the most prevalent type of preventable cancer, and tobacco also has a role in causing many others.
Nature of the problem
Unlike alcohol or unhealthy food, where we want to see consumption moderated, tobacco should be removed entirely from its place in society. Under current policy, a “smoke free” society is defined as one where fewer than 5% of people smoke: we should aim to achieve this, and then go further.
This is not straightforward. Tobacco use is bound up with health inequalities and wider social and economic inequalities: people are more likely to smoke if they live in a deprived neighbourhood, if they rent rather than own their home, or work in a manual occupation, among many other correlations.[1]
It is also the case that smoking uptake flows through generations: young people who are exposed to smoking behaviour are more likely to see smoking as normal. And in communities where smoking is still very visible, quit rates are lower (although attempts at quitting are no less common).
Governments across the UK have set strong ambitions: for England and Wales to be smoke-free by 2030, and Scotland by 2034. However, the independent Khan Review, which published its findings in 2022, reported that the English target will be missed by seven years without further policy action, and by 14 years in the least well-off parts of the country.
Recommendations
Tackling smoking will therefore require a range of approaches, including addressing wider economic inequalities: reducing economic insecurity will help more people become capable of quitting, and reduce their need for smoking’s stress-relieving effects.
Public health services to help people to quit should be properly funded: cuts made during the 2010s were deeply misguided, and must be reversed. Vaping can be a useful tool to aid smoking cessation when used with professional support: it is not entirely free of health risks, but is much less dangerous than smoking and does not carry the same risks of passive smoking.[2]
Policy over the last 15 years or more has made smoking more expensive, and more marginal within our society, including with bans on smoking in indoor public places, and plain packaging for cigarettes. There is some scope for further action of this sort, including greater restrictions on where smoking is permitted.
The Government should take the strong approach recommended by the Khan Review, including increasing tobacco duty markedly more steeply than recent rises, licensing tobacco sales to reduce the number of outlets where it is available, and funding new measures using a levy on a “polluter pays” basis. Its decision not to adopt most of these measures is highly regrettable, and will have to be revisited.
About CancerWatch
CancerWatch is an organisation made up of people whose lives have been affected by cancer, who are passionate about eliminating preventable cancers in the future.
June 2023
[1] https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/articles/likelihoodofsmokingfourtimeshigherinenglandsmostdeprivedareasthanleastdeprived/2018-03-14
[2] https://ash.org.uk/media-centre/news/press-releases/cuts-to-local-funding-for-smokers-requires-national-government-action