BMJ 2024; 387 doi: https://doi.org/10.1136/bmj.q2231 (Published 16 October 2024)Cite this as: BMJ 2024;387:q2231
The UK government has set out a bold mission to improve the nation’s health. This is an urgent and essential task, not just to improve individual wellbeing, but because poor health is a huge drain on the economy. The mission will require action across all arms of government. Unless smoking is tackled, there is no prospect of delivering on Labour’s manifesto commitment to halve the gap in healthy life expectancy between the richest and poorest regions. We therefore urge the chancellor to use the budget on 30 October to invest in creating a smoke-free UK as quickly as possible and make the tobacco industry pay.
The rationale for investing to end the tobacco epidemic could not be stronger. The annual cost of smoking to individuals, public services, and the wider UK economy is £93bn. The direct cost of smoking to the UK public finances in 2023 was £21.9bn, with a net cost of £13.5bn.
We understand that there are acute constraints on spending. But investing to tackle tobacco use is not fiscally neutral—it will improve public finances. Smoking cessation treatment is one of the only interventions that can reduce in year NHS costs, saving £2.37 for every £1 invested, and improving health improves economic productivity. New support to inpatients to quit smoking, for example, is currently helping the NHS to avoid around £65m in costs. But if services were being funded at the levels intended in the NHS Long Term Plan, it would be avoiding an additional £33m. The gap in investment is estimated to be around £15m based on cost savings found in Ottawa when they implemented a similar model.
Introducing a “polluter pays” levy on tobacco manufacturers, as recommended in the Khan review and by the All Party Parliamentary Group on Smoking and Health, would raise around five times the sum needed to fund comprehensive tobacco control. Capping tobacco industry prices and hence profits could raise £700m a year for vital tobacco control activity in a way that would prevent companies from simply passing the cost on to consumers.
The previous government committed five year funding for stop smoking services and mass media campaigns in England, along with UK-wide enforcement activity. This was in addition to England only funding for a national vaping “swap to stop” scheme and financial incentives to help pregnant smokers quit. The new government needs to go further but has not yet committed to maintaining this funding and seems to have scaled back funding for tackling illicit tobacco from £30m a year to “more than £20m.”
The smoke-free generation proposal in the Tobacco and Vapes Bill will be crucial for protecting future generations from tobacco addiction. But we also need to support the 6.4 million adult smokers in the UK to quit. Dedicated long term funding is vital to deliver stop smoking support in hospitals and the community, national marketing campaigns, a robust illicit tobacco strategy, and targeted measures to reduce smoking rates in priority groups.
The UK must now re-establish its global leadership in tobacco control. The last Labour government was instrumental in the development and adoption of the first World Health Organization health treaty, the Framework Convention on Tobacco Control (FCTC). The UK has supported implementation of the treaty in low and middle income countries by co-funding the FCTC 2030 project. This has been a small investment with a big effect, but UK funding for it is set to expire at the end of 2024-25. Committing the UK to contribute at least £2m a year for a further five years will cement our place as a world leader in tobacco control.
Source: BMJ
