Yvette Cooper is Health Secretary: A look back at her work on tobacco control

Yvette Cooper has been appointed Secretary of State for Health and Social Care by the new Prime Minister Andy Burnham. While her appointment marks a new chapter following her time as Foreign Secretary, it is also something of a homecoming. 

Cooper first worked in the Department of Health as a Public Health Minister between 1999 and 2002, where she played a key role in turning ambitious commitments on tobacco control into action. As she returns to the Department during the implementation of the UK’s first smokefree generation, we’re looking back at her work on tobacco control during her time as Public Health Minister.

When Cooper became Public Health Minister in 1999, the Government had just published their landmark White Paper on tobacco, ‘Smoking Kills’. The White Paper recognised the scale of the harm caused by smoking, and set out three clear priorities:

• To reduce smoking amongst children and young people
• To help adults – especially the most disadvantaged – to give up smoking
• To offer particular help to pregnant women who smoke

Whilst Cooper was not involved in writing the White Paper itself, she was responsible for taking much of the strategy forward. This was one of the first Government strategies to really mirror the scale of the harms of smoking, so it was vital that the measures were delivered.

Following the White Paper, between 1999 and 2000, £10 million was invested across 26 of the most deprived communities to establish NHS smoking cessation services. By 2000-2001 all health authorities in England were funded to provide smoking cessation services. Smoking cessation aids also became available on the NHS via prescription, including nicotine replacement therapy, giving people access to effective support to quit smoking.

Speaking at the time, Cooper identified that the “responsibility of the Government is to give people the support they need when they want to give up.” 

Over 25 years later, this statement is as relevant as ever. From January 2027, the UK will lead the world in creating a smokefree generation, ensuring all future generations are protected from the harms of tobacco. However, there are still at least 4.9 million people who smoke in the UK, many of them living in disadvantaged communities. There is now an opportunity to build on the model established in the early 2000s and ensure that it is fit for the decade ahead. Since services were established there have been significant innovations in cessation treatments and a shifting population of smokers who are more likely to be living in disadvantage and experiencing co-occurring mental and physical health conditions.

One of Cooper’s key contributions to delivering on the measures in the White Paper was overseeing the launch of a national tobacco education campaign. In December 1999, the Department of Health launched a national campaign to encourage people who smoked to quit and to persuade non-smokers not to start. The campaign urged smokers to “leave your cigarettes in the 20^th century” and combined billboard posters with a television campaign, aiming to drive down smoking prevalence. 

Today, mass communication remains a vital tobacco control tool. We know far more than we did in 2000 about the messages that resonate with the public and drive change. Communications must be a central plank of Cooper’s efforts to bring us closer to creating a smokefree country and maximising the impact of the smokefree generation.

Cooper also became a leading advocate for the tobacco advertising ban, which eventually became the Tobacco and Advertising Promotion Act 2002. 

Although the European Parliament and the Council of EU health ministers agreed an EU wide tobacco advertising ban in 1998, this was overturned by the European Court of Justice. Cooper responded by making it clear that the Labour government would put forward legislation in Parliament and fulfil its manifesto commitment to end tobacco advertising in the UK.

Cooper took the Tobacco and Advertising Promotion Act through Parliament, consistently defending the importance of the legislation and rejecting calls for a voluntary agreement with the tobacco industry instead. 

The result was the Tobacco Advertising and Promotion Act 2002, ahead of the EU directive in 2003, a landmark piece of legislation that remains a cornerstone of tobacco control policy today. The Tobacco and Vapes Act updates and broadens many of the provisions in the 2002 Act ensuring that all tobacco products, and many tobacco accessories, will now be comprehensively captured.

Alongside this work, Cooper also led a major review on health inequalities. Although the review was presented in 2002 by Cooper’s successor, she is credited with leading the work.

The review highlighted the stark differences in health outcomes between the richest and poorest in Britain, recognising that the opportunity for a healthy life is closely linked to social and economic circumstances.

Reducing smoking in high-prevalence groups was recommended as one of the most effective ways to narrow these inequalities. In particular, reducing smoking amongst manual occupational groups and reducing smoking during pregnancy were identified as key areas for action. The review showed that at the time, smoking in pregnancy was four times more prevalent among women in households in social class V compared to those in social class I. 

The progress since then has been remarkable. Today, smoking at time of delivery rates have reached a record low of just 4.2%, far lower than 18% when this report was published. Progress has also been made in reducing rates of smoking in routine and manual populations and in narrowing the differences between English regions. These successes reflect the importance of good investment and targeted interventions that set a clear goal to drive down smoking rates. 

There is a real opportunity to capitalise on this progress through the new legislation and the investment made into local services, but to truly accelerate progress Cooper should bring forward a new plan to end smoking, modelled on the success of Smoking Kills.

Whilst a huge amount of progress has been made since Cooper was last in DHSC, there is still so much more to be done. The Tobacco and Vapes Act does not mean ‘job done’ and there is a busy legislative agenda to oversee to regulate nicotine products and tobacco in a way that reduces youth appeal but also supports smokers to quit. 

Health inequalities also continue to be persistent across the UK. Smoking prevalence is still 2.5 times higher in the most deprived areas in the UK than the least deprived. The Government should take a strategic, laser-like approach to identifying and supporting current smokers to quit; for example by ensuring that all smokers who come for a Lung Check are offered co-located cessation support there and then. 

The publication of a Roadmap to a Smokefree Country, with a bold new target to end smoking, would cement this Government’s legacy as one that truly started the ‘beginning of the end’ for tobacco in this country.