The health and social care crisis makes tobacco control an imperative

The healthcare community has for a long time been pressing the UK government to produce a tobacco control plan that sets out how it will deliver on its Smokefree 2030 objective, which was first articulated in 2017.12 However, reports from “insiders” now suggest that the secretary of state for health and social care, Thérèse Coffey, does not intend to honour the government’s repeated promises to do this.3 It was reassuring to see that the Department for Health and Social Care (DHSC) denied that the story was true.3 Given that smoking is the leading preventable cause of death in the UK and that smoking causes more than 500 000 hospital admissions per year in England alone, only someone who was a committed enemy of human health and wellbeing would adopt such a bizarre position.4

The health secretary set out her “ABCD” priorities clearly on her first day in office—ambulances, backlogs and social care, as well as doctors and dentists. These are all complex problems, but all four will be significantly ameliorated by taking prompt action to reduce smoking rates. This is exemplified by Royal College of Physicians modelling which shows that investment in smoking cessation produces substantial in year financial savings for the NHS.5

Smoking cessation rapidly reduces the risk of acute vascular and respiratory events. Every person whose stroke, heart attack, pneumonia, or acute exacerbation is prevented is someone who is not having to call an ambulance and someone who will not have to join the hundreds of thousands of people now being forced to wait longer than 12 hours in A&E.6 Smoking increases the need for elective care in many conditions and quitting is associated with fewer surgical complications and shorter hospital stays, reducing capacity and worsening the backlog.5 People who smoke require social care on average 10 years earlier than non-smokers, and the cost of social care attributable to smoking is at least £14 billion/year.7 Social care needs are driven by poverty—achieving the 2030 smokefree goal throughout the country would improve the health and wealth of disadvantaged communities more than any other measure, lifting 2.6 million adults and 1 million children out of poverty.8 As well as increasing the demand on the health and social care system and by extension on its workforce, smoking increases sickness absence and worsens mental health.59 Supporting the people who work in health and social care to become smoke free is an important step towards increasing capacity.

Fortunately Coffey has available a ready-made set of polices for tobacco control, set out in The Khan review: making smoking obsolete, commissioned by her predecessor.8 These include immediate and substantial investment in cessation services and mass media campaigns, increasing the legal age of tobacco sale annually through a smokefree generation policy, and NHS systems change to embed smoking cessation support across all areas of care. Other measures include reducing the affordability of tobacco, introducing health warnings on individual cigarettes, requiring a license to sell tobacco products, and ensuring that trading standards enforcement is properly resourced. The economy is in a state of shock. However, a polluter pays levy on the tobacco industry, which capped tobacco company profits from UK sales at 10% and uses a mechanism that already exists to regulate pharmaceutical pricing, would bring in around £700 million/year into the DHSC.10 This would be more than enough to fund the necessary measures twice over.

Despite denials that it has been abandoned, the ongoing delay in delivering a tobacco control plan is bemusing—the government is supposed to be committed to “levelling up,” reducing health inequalities, and increasing life expectancy. Moreover, lowering smoking rates puts money back into disadvantaged communities and translates into productivity increases.810 The influence of tobacco-industry funded hard-right lobby groups such as the Institute for Economic Affairs may be relevant. 11 Perhaps also a curiously limited libertarian conception of freedom and personal responsibility, which makes little sense in the context of a habit driven by an addiction which, for most people, begins in childhood.

A more useful “capabilities” concept of freedom is that it encompasses what people across society are actually capable of being and doing.12 The tobacco industry robs individuals of the ability to live a life of adequate length, free from disability and able to pursue the goals and objectives that they value. It robs them of parents and grandparents, denying the capability to enjoy family life.

Failure to deliver on the Smokefree 2030 ambition, would be a choice to diminish human freedom and a moral affront.