Action on Smoking and Health

Tag Archives: Smokefree legislation


My role in the smoking ban

Caroline Flint MP was public health minister from 2005 to 2007 and oversaw the introduction of the smoking ban, which she describes below.

Caroline Flint MP. Image: Foreign and Commonwealth Office

 

On 1 July England celebrated a decade since the ban on smoking in enclosed public spaces came into force. It’s been a huge success for public health and today, as smoking is becoming increasingly marginalised, it’s easy to forget just how controversial the ban was at the time.

The numbers are significant. There are around 10% fewer deaths caused by smoking in the over-35s today, compared to 2007. Deaths from strokes are down 14.5%, and heart disease by 20.8%, just because of the decline in smoking, and exposure to secondhand smoke. These are not fractional gains — thousands of lives have been saved, many more improved.

When I became the public health minister, the policy situation was difficult. On the one hand, there was plenty of evidence of the negative health impact of secondhand smoke. On the other, there was nervousness in some quarters that a smoking ban would be seen as a “nanny state” measure, and many were concerned about the effect it may have on the hospitality industry. As a result, some MPs called for pubs that didn’t serve food and private members’ clubs to be exempted.

Quite rightly, the exemptions were labelled by the Health Select Committee, chaired by MP Kevin Barron, as “unfair, inefficient and unworkable”. How do you define food? Where do you draw the line, do crisps count, what about pickled eggs? My department looked at the potential for problems that might result from such legislation and there were plenty. It was also clearly unfair to protect the health of people working in some pubs and not others.

The Opposition agreed to allow a free vote and Kevin Barron and I, with the backing of the chief whip, pushed for the Government to allow a free vote on the issue too. We won, and the exemptions were removed by an overwhelming majority of 200 votes.

We spent eighteen months ensuring that the legislation would be properly implemented. Scotland had already implemented a smoking ban, and we learned a lot from their success. From day one it was supported by the majority of the public and compliance rates were over 98 per cent, and now most smokers too say they support the legislation. Fewer smokers are now smoking in the home in front of their children, something that was of concern to some MPs at the time the legislation was passed. The number of under-16s who smoke is half what it was in 2007.

Clearly, we have come a long way and, a decade on, smoking rates are down to their lowest recorded level at 15.5%. But this is not the end. Smoking is still the leading cause of preventable death killing 78,000 people in England last year, and hundreds of children still start smoking every day. But looking back, I’m reminded that politics can make a difference, and not a smoke-filled room in sight.

Caroline Flint is a Labour MP and was Public Health Minister from 2005–2007. You can follow her on Twitter @CarolineFlintMP

Ten Years On: the growth in public support for tackling tobacco

 

 

This post was written by Deborah Arnott, Chief Executive of ASH.

Like a lot of students I worked in a bar to help pay my rent. Not a bad job, it fitted in with my studies and was flexible. But what I didn’t like was getting home gone midnight, exhausted, with my hair and clothes stinking of tobacco smoke. I’d wake up the next morning and my sheets would smell of it too. I hated it despite, at the time, being a smoker. I was once asked to wash down the walls in one of the pubs I worked for, before they were repainted. I’ve never forgotten the dark and sticky substance that with some effort I was able to remove, revealing underneath it the cream coloured original. People think pubs used to be painted all the same dingy brown colour, but no, that was the colour of cigarette tar, the same substance that sticks to the lungs of smokers and those exposed to tobacco smoke. So years later, when I was recruited by ASH with the primary aim of getting legislation to prohibit smoking in enclosed public places, I wanted to make sure pubs, bars and clubs were included.

The first step was to shift the debate from the rights of smokers to the rights of workers. Rights to clean air and protection from the harm caused by secondhand smoke. We put together an alliance of leading charities like Cancer Research UK and the British Heart Foundation, medical organisations like the Royal College of Physicians and the BMA, public health bodies such as the Chartered Institute of Environmental Health and regional organisations like Smokefree Liverpool and Fresh Northeast. Together we worked to engage the public, parliament and the media, and work it did. In England between Spring 2004 and the end of 2005 support for smokefree pubs and bars rose from 51% to 66%. [1]

It seems obvious now, but it wasn’t then, that smokefree laws would be widely supported, and that support grew once people understood the evidence. The story of how parliament forced the Government to listen to public opinion and pass comprehensive legislation has been told in a previous blog. [2] The story I want to tell here is about how public support for measures to tackle smoking has continued to grow since the legislation was passed, particularly among smokers. ASH carries out an annual survey of public opinion which enables us to track this growth, published today in a report, Smokefree: The First Ten Years [3]. Back in 2007 when smokefree laws in England came into effect, 78% of all respondents to the survey were in favour of the legislation. In the ten years since, support has grown to 83%, primarily due to an increase in support from smokers from 40% to 55%. The overall change is entirely due to changing attitudes among smokers support among non-smokers has been stable.

And the public is right to support Government action to limit smoking. I was still a social smoker when I started working for ASH. I didn’t smoke regularly, but every few weeks, after a few drinks down the pub, I’d buy a packet of very expensive cigarettes from the pub vending machine, and wake up the next morning with a hoarse throat regretting it bitterly. Working for ASH did the trick for me and I finally quit forever, but not everyone can work for ASH! Most smokers want to quit, but it’s a serious addiction and they need help and encouragement. There are still 7.6 million adult smokers in Britain and nearly 100,000 people die from smoking every year [4], losing many years of productive life. Despite smoking rates having dropped to a record low in England, smoking remains a public health epidemic, the leading cause of preventable premature death, with hundreds of children under 16 starting smoking every day. [5]

We have to stop this epidemic. The evidence of the last decade is that measures to limit smoking are popular and effective, when they are part of a comprehensive strategy and are properly funded. Today is the 10th anniversary of the implementation of smokefree legislation in England — and by now we had hoped to see publication of the next Tobacco Control Plan, with a commitment to delivering a smokefree future for our children. Before the election the Government committed to publishing a new Tobacco Control Plan ‘shortly’[6], a commitment has reconfirmed to parliament earlier this week [7], but it is now 18 months since the last Plan expired. The best way for the Government to prove its continuing commitment to public health and tackling tobacco is not just to talk about it but to publish the new Plan without further delay.

References

[1] ASH media release. Major new poll shows public support across UK for comprehensive smokefree law. 30 December 2005.
[2] 10 years of smokefree: a victory for Parliament and public health 
[3]ASH report. Smokefree: The First Ten Years. 2017.
[4] NHS Digital. Statistics on Smoking, England — 2017. 15 June 2017.
[5] Hopkinson, NS., Lester-George, A., Ormiston-Smith, N., Cox, A. & Arnott, D. Child uptake of smoking by area across the UK. Thorax 2013. doi:10.1136/thoraxjnl-2013–204379
[6] Tobacco: Written question — 69400. Hansard. 18 April 2017
[7] Tobacco: Written question — 269. Hansard. 26 June 2017.

Making tobacco vending machines a thing of the past

This piece was written by Chloe Watson, Policy Manager for Research and Prevention at the British Heart Foundation.

This weekend marks 10 years since smoke free legislation was introduced in England. Its introduction has transformed our pubs and restaurants, making smoke-filled meals and drinks out with friends a thing of the past. But smoke isn’t the only thing that has disappeared from our local pubs over the last 10 years. Tobacco vending machines used to be a regular feature, providing young people with an easy way to buy cigarettes without the risk of being asked for ID.

So what?

We know that smoking is a major risk factor for cardiovascular disease — compared with non-smokers, smokers have a 2 to 4 times increased risk of heart disease and stroke. [1]

Two-thirds of smokers start before the age of 18, and until 2011 [2], vending machines made it easy for them to do so.

Although legislation already stated that it was an offence to allow tobacco to be purchased by children and teenagers from vending machines, a number of studies found that it was surprisingly easy for a teenager to purchase cigarettes unchallenged, as so many of the vending machines were unsupervised. In fact, it is estimated that in 2006, a staggering 45 million cigarettes were sold to 11–15 year olds through cigarette vending machines. So, in the same year that smoke free legislation was introduced in England, the British Heart Foundation and others began working to secure a complete ban of tobacco vending machines.

What did we do?

The task ahead was not straightforward. We knew that there was public support for a ban — a survey commissioned by ASH found that 65% of respondents in England were in favour of a ban, with only 16% against the measure [3]— but that the Government would take some convincing. At BHF, we set to work gathering our evidence — commissioning a survey of pub landlords, looking to examples from elsewhere in Europe, and even creating our own undercover video designed to show how easy it is for children to buy cigarettes.

Then, in mid-2008, the Department of Health launched a consultation on the future of tobacco control, giving us a real opportunity to influence. We began to build support, from our network of supporters right through to MPs and government officials. In total, 6000 members of the public signed our petition calling for the ban, 100 letters were published in local newspapers and 100 MPs signed an Early Day Motion tabled by supportive MPs. We had meetings with the Department for Business, spoke to Ministers at party conferences and much more besides. We weren’t the only ones working to build support — in total the Government’s consultation received more than 100,000 (mostly positive) responses! By 2009, it seems the Government had been convinced and the ban was introduced as part of the 2009 Health Act, which came into effect on 01 October 2011.

Have we seen an impact?

The last decade of tobacco control — from the introduction of smoke free legislation to the ban on vending machines — has been instrumental in protecting people from smoking-related heart attacks and stroke.

The number of 11 to 15 years olds who have tried smoking is now at its lowest level since 1982 (when the Government’s survey began)[4] , and deaths from smoking-related cardiovascular events have fallen by over 20% since 2007 [5].

This is a fantastic achievement but we cannot afford to be complacent — there are still up to 20,000 deaths a year in the UK from smoking-related heart attacks and stroke. [6] When we look back over the next 10 years, let’s make sure we have just as much to celebrate.

References

[1] October 2016, ASH Fact Sheet, Smoking, the heart and circulation
[2] March 2017, ASH Fact Sheet, Smoking Statistics
[3] November 2011, ASH Fact Sheet, Smoking and vending machines
[4] July 2015, Smoking, Drinking and Drug Use by Young People in England Survey, NHS Digital
[5] NHS Digital, Statistics on Smoking
[6] BHF UK estimate based on NHS Digital, Statistics on Smoking, 2017

Media advisory: Tenth anniversary of smokefree legislation

12 June 2017

1. The first of July 2017 is the tenth anniversary of the most important public health reform in generations – the ending of smoking in enclosed public places in England.

2.This media advisory is designed to provide background to journalists in advance of the anniversary about out the reasons why and how the law was introduced, the health benefits it has brought, the strong public support it enjoys, and subsequent developments. It is fully referenced. Contact the ASH office on 020 7404 0242 if you have any questions.

Secondhand smoke is a killer

3. Decades of evidence have established beyond doubt that breathing in other people’s cigarette smoke is bad for health. [1] It significantly increases the risks of a range of diseases, including:

  • lung cancer;
  • heart disease and stroke; and
  • chronic obstructive pulmonary disease (sometimes called emphysema)

4.Secondhand smoke make respiratory problems worse; cause asthma attacks; reduce coronary blood flow; and cause headaches, coughs, sore throats, dizziness, and nausea.

5. In 2003, around 11,000 adults in the UK are estimated to have died due to exposure in the home, and about 600 people in the UK died as a result of exposure to secondhand smoke at work. [2]

6.Children are particularly vulnerable to secondhand smoke. Exposure to secondhand smoke increases a child’s risk of cancer, asthma, bronchitis, middle ear infection, and sudden infant death syndrome (SIDs). [3]

Health Act 2006 [4]

7. Following a strong campaign by parliamentarians and the public health community and with growing public support, [5] the Government announced its intention to introduce smokefree legislation in November 2004. The original plan was to include exemptions for licensed premises such as bars, private clubs and pubs where no food was served. This was after the Republic of Ireland had instituted an outright ban on smoking in the workplace without such exemptions in March 2004, and the Scottish Executive had already voted to introduce a complete ban on smoking in enclosed public spaces in Scotland.

8. Public support in England for comprehensive legislation including pubs and bars grew from 50% to 66% between May 2004 and December 2005. [5] Furthermore the proposed exemption for non-food pubs was widely criticised as unworkable, and as failing to protect workers (bar staff) who were exposed to particularly high levels of secondhand smoke.

9. In its December 2005 Report (‘Smoking in Public Places’: HC 485-1), the House of Commons Health Select Committee, then chaired by Kevin Barron MP, described the exemptions for non-food pubs and clubs as “unfair, unjust, inefficient and unworkable.” [6] Members of the Select Committee, from all Parties, proposed an amendment to the Health Bill, which the Government in effect adopted, tabling its own version and allowing a free vote on the issue in both Houses of Parliament. In the House of Commons the amendment was passed by a majority of 200 votes on 14th February 2006. The vote set a precedent for treating future tobacco control legislation, such as the introduction of standardised packaging, as in effect a cross-Party issue.

10. Smokefree legislation was implemented in England on the 1st July, 2007. [7] Similar laws were implemented in Scotland (March 2006), Wales (April 2007), and Northern Ireland (April 2007). [8]

What has smokefree legislation achieved?

11. In the year following smokefree legislation, there was a 2.4% reduction in hospital admissions for heart attack. That meant 1,200 fewer emergency admissions in a single year. [9] In the three years following the law’s introduction, there were almost 7,000 fewer hospital admissions for childhood asthma. [3]

12. Levels of exposure among barworkers (the group with the highest occupational exposure to secondhand smoke) reduced significantly and respiratory health improved after the legislation was implemented. Prior to implementation 67% of workers reported one or more respiratory symptoms compared with 40% one year later. [9]

13. The smokefree law, and the campaign that supported it, also helped to change attitudes and behaviour on smoking. An extra 300,000 smokers were inspired to make a quit attempt as the law came into force. [9]

What did the tobacco industry say?

14. The tobacco industry and its funded front groups claimed that the legislation would be widely flouted, that pubs and restaurants would be forced out of business, and that smoking in the home would become more common. All these claims were proved to be false.

15. Implementation was smooth and the legislation widely complied with from the start. Local councils were given responsibility for enforcement, and had powers to levy fixed penalty notices of £50 for those found smoking in prohibited places, with a maximum fine of £200 if the case went to court. [10] During the first 18 months of the legislation, authorities in England inspected almost 600,000 premises and vehicles and found that 98.2% of premises and vehicles were smokefree. [11] There were on average 2 fixed penalty notices a day issued to smokers for smoking in a smokefree area during this period.

16. The “smokers’ rights” group FOREST (almost entirely funded by the tobacco industry) claimed that: “after the [smokefree legislation] more people are going to smoke at home.” [12] In fact, the proportion of adults living in a smokefree home was 61% before the legislation, but by 2008/9, this had increased to 69%. [9] And in the period leading up to and immediately following the introduction of smokefree legislation in England, children’s exposure reduced rather than increased. [9]

17. The Institute of Economic Affairs (a right-wing think tank that refuses to disclose its sources of funds, but is known to have received tobacco industry funding over many years) [13] has claimed that (smokefree) “legislation is ‘particularly culpable’ for ‘the decimation of the UK pub industry.” [14] In fact, between March 2007 and March 2008, the number of premises with licenses to sell alcohol increased by 4,200. [15] And following the introduction of the smokefree laws, more people reported that they went to the pub more often than reported they went less often. [16] BBC journalist Mark Easton carried out a detailed analysis of the claims that large numbers of pubs had closed as a result of the legislation and concluded that British pubs weren’t dying they were just adapting and evolving as they always have done. [17]

What do the public think?

18. Support for the smokefree legislation has become even stronger in the ten years since its introduction. The current level of public support in England has been measured by YouGov surveys at 83%. Even the majority of those who smoke every day support the legislation (52% support; 25% oppose). [18]

19. The same survey found popular support for smoking to be banned in outdoor areas not covered by the legislation:

  • 82% agreed with banning smoking in outdoor children’s play areas (7% disagreed).
  • 72% agreed with banning smoking in hospital grounds (15% disagreed).
  • 59% agreed with banning smoking in communal recreational spaces such as parks and beaches (23% disagreed).

Beyond smokefree legislation

20. Smokefree legislation was extended to cover smoking in private cars with children from October 2015 (smoking in public and work vehicles was prohibited under the original legislation from July 2007). [19] Opinion polls carried out in 2016 after the law was implemented found that 87% of adults supported the legislation [20] and 86% of children reported no exposure to smoking in cars.[21] The Department of Health has no plans to extend the legislation further, although Scotland, Wales and Northern Ireland have done so (see below).

21. Smokefree places have, however, been extended beyond those required by legislation. The Association of Train Operator Companies (ATOC) and Network Rail introduced their own no smoking policies in addition to what is required by legislation. This means as well as in indoor areas, such as trains and cafes, smoking is prohibited on all station concourses, ticket halls, platforms (covered and uncovered), footbridges and subways at station premises. [22] The football league prohibited smoking in football stadia following a survey of supporters. Football League stadia are smokefree and smoking is not permitted inside the grounds. [23]

22. NICE guidance published in 2013 on smoking in acute, maternity and mental health services [24] recommended that smoking should be banned on the grounds of hospitals and such policies have been widely, though not yet universally, implemented. Public Health England is working to encourage hospitals to become smokefree by ensuring all smokers get help to quit as well as requiring premises to be smokefree. [25] Smoking in hospital grounds is already banned by law in Northern Ireland [26] and Scotland, [27] and legislation was passed in May to cover hospital grounds in Wales. [28]

23. Prisons were given a partial exemption from the 2007 legislation to allow prisoners to smoke in their cells. In October 2015 the National Offender Management Service (NOMS) announced that smoking would be phased out of prisons in England and Wales. Smoking in enclosed areas in open prisons was prohibited from the end of October 2015. All prisons in Wales went smokefree at the beginning of 2016 and starting in the southwest a complete ban on smoking in prisons is being rolled out through the rest of the estate, which is due to be completed over the next 12 months. As of May 2017 there are 21 smokefree prisons with remainder going smokefree in a phased process, with the exact timing dependent on operational readiness. [29]

24. A number of local authorities in England have put in place voluntary measures to discourage smoking in children’s play areas and outside schools, including Nottingham, [30] and Leicester. [31] Legislation was passed by the Welsh Assembly in May which will restrict smoking in children’s playgrounds, school grounds and hospital sites. [28]

25. Brighton and Hove City Council is encouraging local restaurants and pubs to introduce smokefree zones in their outdoor areas. This followed a consultation which found that around 65% of non-smoking residents agreed restaurants with outdoor seating should be smokefree, and 55% said the same about pubs. From initial discussions with 12 business they have found three already enforce a no smoking policy in their outdoor areas. [32]

26. Around the country businesses are making their own decisions in the light of needs to extend smokefree areas. For example, at the beginning of June, a pub in Leeds decided to turn its beer garden smokefree after spending more than £100,000 to build a purpose built play area for children and launching outdoor music events at the pub. [33]

27. On a voluntary basis many businesses have decided to extend the prohibition on smoking to e-cigarettes. [34,35] However, the Department of Health has confirmed that it has ruled out extending the smokefree laws to e-cigarettes [36], a position ASH supports as there is no evidence that e-cigarette vapour causes the same harm as tobacco smoke. [37]

28. A range of other legislative measures have been introduced in England since the smokefree laws including: increasing the age of sale from 16 to 18 (October 2007); prohibiting the sale of tobacco from vending machines (October 2011); prohibiting display of tobacco products in shops (April 2012 for large shops and 2015 for small shops); and a range of measures including larger health warnings and standardised packaging of tobacco packs (from May 2016). [38]

29. However, smoking remains the leading cause of preventable premature death in Britain killing nearly 100,000 people a year and there are still around 9 million smokers. [37] The last Government failed to introduce a new Tobacco Control Plan for England, although the previous one expired at the end of 2015. Cuts in local authority funding mean that public health activity, including the provision of stop smoking services, is seriously threatened in many areas, or has closed altogether. The evidence from other jurisdictions is that action to cut smoking rates has to be progressive and continuous – or smoking rates could stop falling and may even start to rise again. [39] Smoking remains the single most important public health problem facing the UK today. The public health community is calling on the Government to publish a new Tobacco Control Plan without further delay [40], backed up by cross party support in both the House of Lords [41] and the House of Commons.[42]

ENDS

Notes and Links:

Action on Smoking and Health is a health charity working to eliminate the harm caused by tobacco use. For more information see: www.ash.org.uk/about-ash

ASH receives funding for its programme of work from Cancer Research UK and the British Heart Foundation.

ASH staff are available for interview and for more information. Please contact Deborah Arnott on 020 7404 0242 or 07976 935 987.

References

[1] The evidence was summarised for the Government in a November 2004 by the Scientific Committee on Tobacco and Health. The Committee concluded that: “It is evident that no infant, child or adult should be exposed to SHS [secondhand smoke]. This update confirms that SHS represents a substantial public health hazard.”

[2] The Tobacco Advisory Group. Going smoke-free. The Royal College of Physicians 2005.

[3] ASH. Secondhand Smoke: the impact on children. March 2014.

[4] UK Government. Health Act 2006: Chapter 28. 2006.

[5] More detail on the campaign can be found in Comprehensive smoke-free legislation in England: how advocacy won the day.

[6] House of Commons Health Committee. Smoking in Public Places: First report of session 2005-06: Volume 1. 15 December 2005.

[7] Public Health England. The smokefree (premises and enforcement) regulations 2006. Statutory Instruments 2006 No. 3368.

[8] For more information about the legislation in each jurisdiction see table 1.1 in: Tobacco Advisory Group. Passive smoking and children. Royal College of Physicians 2010.

[9] Bauld L. The impact of smokefree legislation in England: Evidence review. Department of Health March 2011.

[10] NHS and Smokefree England. Smokefree regulations – February 2007 update. February 2007.

[11] Local Government Analysis and Research. Smokefree Legislation Compliance Data.

[12] Smeaton Z. Will the ban boost public health? BBC 1 July 2007.

[13] Institute of Economic Affairs. Tobacco Tactics. [Accessed 7 June 2016]

[14] Snowden, C. Closing time: Who’s killing the British pub? Institute of Economic Affairs 10 December 2014.

[15] Department for Culture, Media & Sport. Alcohol, entertainment and late night refreshment licensing, England and Wales, April 2007 to March 2008. 14 January 2010.

[16] Office for National Statistics. Smoking related behaviour and attitudes 2008/09, July 2009.

[17] Easton M. British pubs aren’t dying – they are evolving. BBC online news 31 July 2009

[18] ASH and YouGov, Smokefree Survey 2017. The survey was carried out online by YouGov for ASH; the total sample size was 10488 adults in England. Fieldwork was undertaken between 16th February 2017 and 19th March 2017.  The figures have been weighted and are representative of all adults (aged 18+).

[19] Department of Health. Smoking in vehicles. 11 August 2015.

[20] YouGov survey.  All figures, unless otherwise stated, are from YouGov Plc.  Total sample size was 10058 adults. Fieldwork was undertaken between 2nd to 23rd March 2016.  The survey was carried out online. The figures have been weighted and are representative of all England adults (aged 18+).

[21] YouGov survey. ASH Smokefree Youth Great Britain Survey 2016.  All figures, unless otherwise stated, are from YouGov Plc.  Total sample size was 2,331 11 to 18 year olds. Fieldwork was undertaken between 11th March and 10th April 2016.  The survey was carried out online. The figures have been weighted and are representative of all GB 11-18 year olds.

[22] ATOC press release. End of the line for smoking on the railways. 4 June 2007.

[23] Sport Industry Group. Football league to reward non-smokers. 29 April 2008.

[24] NICE. Public health guideline [PH48]. November 2013.

[25] Selbie D. It’s time for a truly tobacco free NHS. Public Health England 6 December 2016.

[26] NI Direct. Smoking regulations in Northern Ireland. [Accessed 7 June 2017]

[27] Scottish Government. Smoke-free hospital grounds. 1 April 2015.

[28] Wales. Public Health (Wales) Bill. [Accessed 7 June 2017]

[29] ASH. Smokefree Prisons. October 2015.

[30] Nottingham playgounds to go smoke-free. BBC News Leicester 8 November 2011.

[31] Martin D. ‘No smoking’ request at 173 Leicester children’s play areas. Leicester Mercury 12 July 2016.

[32] Bastable B. Plans to cut smoking outside pubs and restaurants in Brighton. Brighton and Hove Independent 7 June 2017.

[33] Landlord of Leeds pub stubs out smoking in beer garden. Yorkshire Evening Post 31 May 2017.

[34] Glanfield E. BBC bans use of electronic cigarettes from all of its offices and studios across the country. Mail Online 16 July 2014.

[35] So where can you still vape? BBC Newsbeat 10 June 2015.

[36] Campbell D. E-cigarettes: no indoor smoking ban planned in England despite WHO call. The Guardian 26 August 2014.

[37] Royal College of Physicians. Nicotine without smoke: Tobacco Harm Reduction. London: RCP, 2016.

[38] ASH media release. All tobacco packs on sale will be in standardised “plain” packs from 20th May 2017. 15 May 2017.

[39] ASH. Smoking Still Kills. London 2015.

[40] Letter from 1100 healthcare professionals and public health experts including Presidents of medical royal colleges. The need for a new Tobacco Control Plan: an issue of justice. BMJ 2017;356:j342

[41] House of Lords. Tobacco Control Plan. 23 February 2017. Volume 779

[42] House of Commons. Tobacco Control Plan. 13 October 2016. Volume 615.

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