Words: Jessica McKendrick (She/Her)
Smoking is one of the greatest lifestyle choices causing death and sickness in the UK, killing around 78,000 people annually, and leaving many more debilitated as a result of related illnesses. Tobacco usage also acts as a gateway drug for other substance addictions, catalysing substance abuse and poverty. By encouraging addiction and related illnesses, the burden of tobacco usage continues to cripple the already struggling NHS, accelerating instances of over 50 fatal health conditions, and hospitalising millions of individuals across the country. Years on from the introduction of anti-smoking legislation, such rates are yet to fall significantly, and it is therefore worth questioning the efficacy of these strategies… is it all just smoke and mirrors?
In 2002, the government introduced the Tobacco Advertising and Promotion Act, firstly banning the inclusion of direct marketing in print media, before going further in 2003 to ban the use of misleading terms describing tobacco strengths. By 2008, it was a legal requirement for all tobacco packaging to include picture warnings, and a total ban on the open sale of tobacco products formed a significant part of the regulations accompanying the to the Health and Social Care Act.
In more recent years, concern lies in the marketing of tobacco, recruiting younger smokers by pitching smoking as aspirational, rather than deadly. This opens up the global tobacco market, maintaining an epidemic. To curb this rising trend in consumption, priority has been given to taxing of tobacco products. Despite these efforts, tobacco companies consistently undermine the effectiveness of said policies, cushioning smokers from the full impact of tax rises, and simultaneously profiting from sales. Currently, the tobacco industry successfully evades the effectiveness of tax policy through brand proliferation, price segmentation and the strategic timing of price increases. This differential shifting in tax price increases allows companies to offset costs and maximise profits on premium brands, while simultaneously keeping price-conscious smokers in the market by earning lower profits on value-brands.
A recent study conducted by the University of Bath’s Department for Health proposes tactile taxation strategies, with the aim of reducing the profitability of the industry, and therefore the overall incidence of smoking. The paper advocates for wholesale price capping with retail licensing, which could form part of England’s ambitious objective to be smoke free by 2030. A price cap would effectively mean there was a standardised cost on tobacco, ensuring that tax increases consistently trigger price increases, addressing the issue of price-based market segmentation.
However, this policy suggestion, like many, is flawed. A price cap and excise duties will disproportionately impact poorer tobacco users, entrenching poverty for those who do not quit, while encouraging tax evasion and an increase in illegitimate tobacco sales. Not only that, with a Tory government still at the helm, it is doubtful that the additional tax revenue raised will be invested into the NHS, which bears the greatest burden of the consequences of the smoking industry.
So, what would a simultaneously socially progressive and health-oriented policy approach to smoking look like? Though hugely underfunded, the NHS offers a variety of support for individuals keen to quit. GPs and Pharmacists offer a plethora of strategies, including specialist support from advisers, in conjunction with the prescription of stop smoking aids, including patches and Zyban tablets. Though effective, these NHS services only suit individuals with the incentive to quit, and aren’t effective in discouraging new users in the same way that taxation policies would be. However, statistics from the NHS Stop Smoking services in England from April 2021 to March 2022 reported a 54.8% quit rate for those on the program. This is perhaps explained by the programmes being driven by human connection, rather than financial punishment to users, which underpins the current approach to smoking policy.
Interestingly, the same statistics showed that quit rates increased with age. Therefore, it may be useful to categorise strategies targeting older age demographics as proactive, and those catered towards younger demographics as preventative. This approach is already set in motion in New Zealand, passing a law that steadily increases the minimum smoking age per annum, outlawing smoking for the next generation, and forming part of the goal to make New Zealand smoke free by 2025. But there is still a long way to go. For progress to be made, the clinical/non-clinical binary in treatments must be broken down. It is also fundamental that policymakers are forced to stop “blowing smoke”, and address the ineffectiveness of current legislation with more demographically targeted support programmes.
A fire is burning, and the call is coming from inside the house: if there’s any chance of being smoke free by 2030, the time for change is now.