Ruth Tennant, Board Member, Association of Directors of Public Health
Hazel Cheeseman, Deputy Chief Executive, Action on Smoking and Health
In July it will be three years since the Government announced the goal of making England Smokefree by 2030. Despite the upheaval of the pandemic, we have continued to make progress to tackle the huge health impact of smoking.
But with half the difference in life expectancy between rich and poor caused by smoking, securing a smoke-free 2030 across society is vital to levelling up and reducing health disparities. Equally, the economic case to progress smoke-free is powerful with huge implications for NHS and social care spending from managing smoking related illness.
There is no single bullet to achieving smoke-free. It will need concerted effort at national level as well as a properly coordinated approach locally that takes every opportunity to help people to quit and recognizes and tackles the drivers of smoking.
As we reach the 1st July go-live date for Integrated Care Systems in England, it’s worth reflecting on the current landscape of smoking and tobacco control.
It’s complicated. Around £70 million is currently being spent by local authorities on stop smoking services as part of their public health responsibilities and despite significant falls in resourcing, many councils continue to support wider schemes to tackle smoking and tobacco control, including interrupting counterfeit supplies. Others have used their responsibilities around housing to work directly with social housing to provide bespoke support to residents in the most deprived areas – who often have the highest rates of smoking and lowest quit rates. All of this activity has good evidence and good rationale. Tobacco control works.
Locally elected members have also, in many areas, been powerful champions for change. As experience from the COVID vaccination programme has shown, local councils have the connections and local links to reach deep into their communities with targeted messaging.
The NHS is of course another key part of the jigsaw with £42 million of investment already coming on stream to support new treatment services in acute, mental health and maternity services and to help NHS staff to quit. Community pharmacies are also helping support smokers being discharged from hospital. If tackled with the same laser-sharp focus that is applied to other NHS priorities such as urgent and emergency care, this has enormous potential.
But with more than 5 million smokers in this country, many with additional challenges that make it tough to quit, where do we go next to make this a true revolution?
With so many players on the field, it’s important that local areas develop properly integrated local plans for smoking and tobacco control with the right mix of support available at the right time and right place. Both tobacco control and smoking cessation are needed.
Although the medicalization of smoking cessation in the NHS closes an important and, arguably, anomalous gap, it will miss out a large cohort of smokers who don’t need NHS care as well as those inpatient smokers who are discharged before treatment ends. Community solutions therefore remain critical. We need to maximise all available opportunities to encourage people to quit, make it as easy as possible for them to do so and ensure these services are adequately funded.
Smoking support is highly cost effective. However, it’s only a part of the solution. We need to shift from individual behaviour change – which miss the complex factors that make it easy to start and hard to quit – and move upstream. There is good evidence for this. We know that the biggest shifts in prevalence have come as a result of implementing comprehensive strategies which have shaped the social, environmental and legal context of smoking. Smoking rates in this country would not have fallen so far or so fast without smokefree legislation, comprehensive ad bans, raising the age of sale or requiring standardized packaging for tobacco products. Again, there is good evidence for this.
It’s encouraging that an independent review on smoking to ‘inform the government’s approach to tackling health disparities’ has been so high on the post-COVID ‘must do’ list and we welcome its imminent publication. Turning this into a cohesive national plan, supported by investment, which provides a strong blueprint for action at national and local level and charts a route to a smokefree 2030 will be essential. Measures such as raising the age of sale from 18 to 21, and a proper licensing scheme for tobacco retailers alongside the resources needed so local government can enforce regulations also have a part to play.
Equally, industry tactics which shed doubt on public understanding of risk are increasingly recognized as a powerful tool influencing public attitudes. These need to be called out if we are to counter the strong commercial factors at play as they continue to undermine the aspirations of Smokefree 2030.
The clock is ticking. This year more than 60,000 people will die from preventable smoking related diseases. More than a million people will have care needs caused by smoking. Over 400,000 households will be pushed into poverty because they include a smoker. With just eight years to go to achieve a Smokefree 2030, there’s no time to waste.