Why we need a new ambitious smokefree goal

At ASH we recently published our new five-year strategy, setting out our vision for a world free from tobacco and our work towards that vision. As part of our strategy, we set a new goal for smoking rates to be to be below 6.7% by 2030. ASH Chief Executive Hazel Cheeseman and Jamie Brown, Professor of Behavioural Science and Health and Director of the UCL Tobacco and Alcohol Research Group explain the rationale behind this goal.

In 2023, smoking prevalence in England stood at 11.6%, according to the Annual Population Survey (APS). This is the lowest on record, but with more than one in ten adults still smoking, it is still far from where we need to be if we are to make smoking obsolete for the next generation.

It is now very unlikely that the government can achieve the goal set by the Conservative Government in 2019 for England to be ‘smokefree’ – defined as less than 5% smoking rates – by 2030. The failure to meet this ambition could, in part, be explained by the covid pandemic. Not only was this distracting in terms of diverting resources and government capacity – it also created circumstances which may have undermined efforts to reduce smoking, for example, the growth in poor mental health and the increase in other harmful behaviours such as drinking.

Post Covid, it took until April 2023 for the Government to announce new measures to help more people quit smoking, including the swap to stop scheme and financial incentives for pregnant smokers. Finally, in October that year a comprehensive legislative and funding package was announced as part of Rishi Sunak’s party conference speech. However, the 2030 target was not revised.

Without stronger action, current trends suggest that smoking rates will only decline slowly reaching around 8% by 2035 based on APS projections. To accelerate progress, we need to almost double the pace of decline achieved over recent years.

With so much time lost to make progress to a smokefree 2030 a new goal is now urgently needed that combines a realistic assessment of current trends, with ambition for what can be achieved with an evidence-based strategy. Based on this assessment, ASH has proposed a goal of 6.7% smoking prevalence by 2030 with 5% smoking rates achieved 2 years later.

To reach this goal, smoking prevalence must fall by nearly one percentage point per year. If this is achieved, there will be at least two million fewer smokers by the end of this Parliament, a huge step towards saving lives, cutting health inequalities, and reducing the strain on our NHS.

Researchers at UCL have assessed various policy options for improving the support offered to people who smoke. As a result, we have estimated that an additional £97m invested in evidence-based measures in local government and the NHS (in addition to the current funding committed nationally) could deliver an additional 1.16 percentage point decline above the background trend getting us close to the ambitious goal in the ASH strategy.

Experience from the UK and around the world shows that when governments ease their efforts to tackle smoking, progress quicky stalls. Achieving a smokefree future requires more than the measures in the Tobacco and Vapes Bill, more than the odd programme or initiative, more than the delivery of any single government body. It requires a comprehensive and well-funded national strategy. This should include:

• Long term funding provided by a ‘polluter pays’ levy on tobacco companies: Tobacco companies continue to manipulate the price of tobacco to make vast UK profits. A well-structured levy could limit industry’s profits and ensure they are used to end smoking.
• Targeted action for disadvantaged groups: Smoking rates remain much higher among people in routine and manual jobs, those on lower incomes, and people experiencing disadvantage. Rapid progress here is possible and will have many wider benefits to society.
• Support for high-prevalence populations: People with mental health conditions and other vulnerable groups are being left behind in progress.
• Investment in prevention and treatment: Public health campaigns, accessible stop smoking services, and affordable alternatives must be properly resourced to make quitting achievable for everyone.

These ambitious targets are critical to saving tens of thousands of lives, reducing health inequalities and reducing NHS costs. We have based these targets on the APS figures, which are the government's primary means of monitoring smoking prevalence. However, it is critical we also closely monitor other data sources and do not focus only on meeting this target. For example, there are indications that the APS underestimates non-daily smoking in England. The Smoking Toolkit Study (STS) also estimated daily smoking prevalence was 11.0% in 2023 but estimates that there were another 3.6% of adults who smoked non-daily.

The STS also monitors non-cigarette smoking (such as cigars, cigarillos and waterpipe) and estimates that all tobacco smoking was 16.5% in 2023. If we are to truly achieve a Smoke Free country, there is an increasing need to address non-daily smoking and non-cigarette smoking in England.

Beyond both the APS and the STS, there is a substantial ‘hidden population’ who are ‘missed’ by official population surveys, including people living in care and residential homes, populations experiencing homelessness, as well as those who have an "absent or "temporary" household status (e.g. bed and breakfasts, unsupported temporary accommodation, and those in prison). Including these groups likely increases APS smoking prevalence estimates by around 1.5 percentage points, and should be central to accurate planning, policy formulation and resource allocation in the future.

If the Government acts decisively we can reach smoking rates below 6.7% within five years. That would mean 2 million fewer smokers by the end of this Parliament, thousands of lives saved, and significant reductions in health inequalities.

We recognise that achieving smokefree 2030 may no longer be achievable. This makes it even more important for the current government to accelerate progress and set a vision for change that goes beyond the current legislation. At the same time, those of us outside central government must recognise the crucial role our organisations can play in ending smoking for good.