11 December 2023

Smoking must become a habit of the past | blog from Professor Sanjay Agrawal

For too long smoking has cast a cloud over our society, inflicting pain, suffering, and premature death. As a consultant in respiratory medicine, I have seen countless lives ruined and just as many needlessly lost through this devastating and avoidable addiction. Tobacco smoking, with its vast array of cancer-causing toxins, remains the single largest preventable cause of disease and death in the UK.

The government’s recent commitment to create a smoke-free generation was roundly applauded by health leaders, including the Royal College of Physicians (RCP), who have long called for a dramatic sea change in our approach to tobacco use.

More than 60 years ago, the RCP published Smoking and Health – a report which first highlighted the link between smoking and lung cancer, heart diseases, and other serious illness. These severe health implications, once new learnings, are now common knowledge.

That 1962 report garnered a hostile response from some sections of the media, Westminster, and wider society. Despite the backlash, the science was eventually respected, measures were put in place by successive governments, and smoking reduced precipitously over the following decades. We must now take the next step forward.

Last year, the Office for Budget Responsibility reported that tobacco duties amount to approximately ten billion pounds, with forecasts that duties will raise to £10.4bn for 2023-24. However, Action on Smoking and Health (ASH) revealed that smoking cost society £17bn in England alone every year – £5bn more than previously estimated. The numbers do not lie. This eye-watering difference would be the continued price of inaction – a public health and financial tab society can afford to foot no longer.

Until recently, New Zealand was spearheading the smoking ban movement after introducing a world-first in smokefree legislation last year. But last month, its newly formed government announced it would scrap the pioneering move to fund tax cuts. The UK Government must press ahead with its proposals. They are strongly supported not just by the health sector, but by the public. Polling from ASH shows 67% of people in England support the government’s plans to create a smokefree generation by banning the sale of tobacco to those born after the start of 2009. This move was supported by 74% of those who plan to vote Conservative, 72% of those planning to vote Labour and 65% intending to vote Lib Dem at the next election.

The RCP also welcomes the measures the government is seeking to introduce to tackle the increase in uptake of vaping among children and people who have never smoked. The latest figures from ASH show that 20% of children have tried vaping – a significant rise from around 14% before the first COVID lockdown. We know vaping is safer than smoking and that e-cigarettes are a vital smoking cessation tool for adults wanting to quit smoking. E-cigarettes should be available for adults to support a successful quit attempt. But the RCP strongly supports measures to reduce their appeal and availability to young people and never smokers, which is why we have called for standardised packaging, regulating point of sale displays and restricting the use of flavour descriptors that often target children. We’ve also supported the recommendation put forward by ASH to raise the price of disposable vaping products – most commonly used by young people – by implementing an excise tax, rather than prohibiting them entirely.

The pursuit of a smoke-free generation should not be a mere aspiration; it is a moral and practical imperative. It is a commitment to the well-being, prosperity, and longevity of our nation. The government's efforts will ensure that future generations are spared the often life-altering choice of picking up that first cigarette, reducing the long-term health risks for millions and future demands on our health service. The era of smoking must now fade into memory, relegated to history books as a bygone societal ill. The legislation has the support of voters, and it must be carried through.