Yesterday the Government announced a 10-year strategy to halve the number of smokers from 21 per cent to 10 per cent of the population by 2020. That means persuading four of the eight million current smokers to give up, or avoid starting, the habit. The number has fallen by a quarter in the last decade and 337,000 stopped in the last year. Emboldened by this success, ministers are determined to follow it with a series of new measures that will make smoking less attractive.
Are we turning smokers into pariahs?
No, although it may sometimes feel like that if you are one. In a speech yesterday, the Secretary of State for Health, Andy Burnham, set out four principles where state intervention to improve public health could be justified. The four principles are – to protect the health of children, where one person’s choice interferes with the choices of others, where there are barriers to healthy behaviour, and where the environment can be improved to encourage people to behave healthily. He ruled out intervention in people’s own private spaces – homes and cars – even to protect children.
How will the target be achieved?
To general astonishment the 2007 law banning smoking in public places was introduced with hardly a murmur of protest. Ministers had feared outbreaks of civil disobedience, especially in pubs, as smokers found themselves unable to enjoy a ciggie with their pint unless they were prepared to brave the weather outside. Having overcome that hurdle, ministers now want to take the ban a stage further – by removing smokers from the entrances to buildings.
What other measures are planned?
Video: Pledge to halve smoking by 2020
Those scary pictures of lungs riddled with cancer that have recently been emblazoned on cigarette packets may disappear. In their place will be – plain brown paper. Ministers are considering stripping all cigarettes of their distinctive packaging to reduce their appeal. The use of tobacco vending machines may also be banned. A crackdown on cheap illicit cigarettes will see extra customs officers deployed overseas to tackle the smuggling of tobacco. Lastly there will be extra NHS support for those who want to quit.
Why should any of this discourage smokers?
Because most smokers would like to stop. Seven out of 10 say they want to give up. The Government has pledged that every smoker, no matter what level their addiction is or however many times they’ve tried to stop before, will be able to get help from the NHS if they want to give up. It acknowledges that some smokers need longer-term support and treatment, but it says that is better than continuing to smoke.
How much damage does tobacco do?
Smoking kills half of all lifelong smokers. The toll from tobacco was 227 people a day in England in 2007 – equivalent to an airliner crashing every 24 hours – and caused 1,200 daily hospital admissions. That is despite the huge fall in smoking in recent decades. A quarter of the patients had cancer, with the remainder divided between heart and respiratory conditions. The cost to the NHS was £2.7bn.
Is there any good news?
Yes. Smoking has been declining for 50 years. Latest figures show 21 per cent of adults smoked, down from 39 per cent in 1980 and from 80 per cent (among men) in the 1950s. Over the past decade, smoking has fallen by a fifth among adults whilst smoking among 11-15 year olds has halved. There are now 2.1 million fewer smokers than 10 years ago and this has reduced the cost to the NHS by nearly £380 million pounds a year. Deaths are declining, as more people give up, or never start. Deaths are down 14 per cent since 2001, equivalent to saving more than 37 lives a day.
Do medical organisations support the strategy?
Up to a point. Deborah Arnott of Action on Smoking and Health said it provided a “solid foundation” but there were still “gaps” which left people, especially children, at risk from second hand smoke. The Faculty of Public Health called for a ban on smoking in cars carrying children. That was echoed by Professor Steve Field, chairman of the Royal College of General Practitioners, who dubbed smoking in the presence of children a “form of child abuse”. Professor Field called for a ban on smoking in British made television programmes.
What about the tobacco lobby?
They were unimpressed. Simon Clark, director of the smokers’ lobby group Forest, said halving the number of smokers by 2020 would require even more laws and “further erode our ability to choose how we wish to live our lives”. The Government had introduced “some of the most draconian anti-smoking laws in the world”. He added: “In an allegedly free society, this is nothing to be proud of.”
Christopher Ogden, chief executive of the Tobacco Manufacturer’s Association said: “The plans will do nothing to meet public health policy objectives but will instead impose further unwarranted restrictions on legitimate businesses and private citizens alike.”
Are there any other measures that could cut smoking?
Yes. Bribery. This approach is increasingly being used to persuade people to change unhealthy habits. In Essex, pregnant women who smoked were offered up to £60 in food vouchers on the NHS if they gave up. Payments were made after one week, one month and one year.
One of the highest rewards offered was by General Electric in the US to staff who stopped smoking. They were paid up to $750 (£500) with the major part ($400) payable only after 12 months of abstinence. Paying people to change their habits works because it offers immediate rewards for behaviour that will only provide a health benefit in years ahead. However, it has proved difficult to sustain. A review of 17 trials of the use of payments to help people give up smoking found the effects only lasted as long as the incentives were paid.
Can action against smoking go too far?
Yes. From smoke-free workplaces it is only a small step to smoker-free workplaces – a ban on employing smokers. The National Cancer Institute in Washington encourages the preferential hiring of non-smokers, while the World Health Organisation has barred smokers from its workforce since 2005. But it is not only health organisations that have enacted this policy.
Weyco, a US employee benefits company, stopped hiring smokers in 2003. It later went further by making smoking a sackable offence, on or off duty, and extended the rule to employees spouses. Weyco is thought to be the only company that has threatened to fire existing employees if they smoke (even in the privacy of their own homes). As the anti-smoking charity Ash (which bans smoking but not smokers among its own employees) says, the object of the policy should be the habit, not the person who has it.
Could smoking become a thing of the past?
* Despite the harm that smoking causes, eight million people continue to smoke
* The nicotine in tobacco is one of the most addictive drugs known and very hard to shake
* The public, especially smokers, resent being told what to do, even if it is for the benefit of their health
* Smoking has declined by a quarter in the last 10 years and by threequarters in the last 50 years
* Seven out of 10 smokers say they want to give up if only they had the support to do so
* Ministers are determined to build on the success of the smoking ban in public places
By Jeremy Laurance, Health Editor
Tuesday, 2 February 2010