Increasingly constrained public health budgets are calling into question the UK’s ambitious goal of reducing smoking levels to one in 20 people by 2030 – a full 10 years ahead of comparable EU targets. The public health funds parcelled out to local authorities have been cut across the board, but smoking cessation and tobacco control measures have seen the sharpest cuts of any health services, losing 33 percent of their funding since 2016. These curbs have raised fears that the UK will falter in its efforts to curtail a habit that contributes to about 78,000 deaths a year across the nation and costs the UK economy in excess of £19 billion, including social care costs and lost productivity for businesses.
The funding curbs are particularly frustrating given the fact that until now, the UK government has crafted a progressive tobacco policy which has driven smoking rates down considerably, falling from 27% in 2000 to as little as 12.3% today.
UK ahead of the curve on tobacco policy
Part of the UK’s success in achieving one of Europe’s lowest smoking rates is its embrace of a harm reduction approach to tobacco policy. When e-cigarettes were first introduced to the UK market in 2010, the government’s decision to use its regulatory powers to improve the product’s quality and reliability – rather than to ban them outright – pushed vaping into the mainstream and underpinned a significant decline in UK smoking rates over the next decade.
Public Health England (PHE) has consistently promoted vaping as a safer alternative to tobacco usage, in light of PHE’s findings that vaping is roughly 95 percent less harmful than tobacco. The NHS has since highlighted e-cigarettes’ potential to help smokers reduce the risks to their health in a variety of successful anti-smoking campaigns like ‘Stoptober’, the UK’s annual smoking-cessation drive.
Meanwhile, in the EU, caution rules
By contrast, other countries, including many EU member states, have dragged their feet on recognising e-cigarettes’ potential to lower smokers’ health risks—and some have even introduced counterproductive measures which could drive European vapers back to smoking. Given the available scientific evidence that vaping and smoking do not have remotely the same risk profile, some MEPs such as Peter Liese, on the European Parliament’s Special Committee on Beating Cancer (BECA), have warned that policymakers should be more open towards e-cigarettes and ensure, at a minimum, “that they are not more difficult to access than traditional cigarettes”.
Yet many European politicians are advocating for policies which would do just that, conflating the reduced-risk products with tobacco. The flavoured e-cigarettes which are appealing to many smokers have already been outlawed in some member states such as Hungary, with similar measures planned in the Netherlands. At the same time, tobacco use across the EU remains stubbornly high, with smoking a startling twelve times more prevalent than vaping among EU citizens—a paradox which will likely continue unless Brussels takes a page out of London’s book and adopts a harm reduction approach.
Concrete evidence of harm reduction success
Despite some policymakers’ claims that large numbers of non-smokers might acquire a vaping habit, there’s little evidence to support this fear. A 2021 report by ASH (Action on Smoking and Health) estimated that out of 3.6m British vapers, two-thirds were ex-smokers, with a further 30 percent so-called ‘dual’ smokers and vapers.
Moreover, a study by University College London (UCL) highlighted how effective vaping is at getting smokers to kick the habit. The university’s researchers estimated that 50,000 to 70,000 people a year managed to use e-cigarettes to stop smoking who wouldn’t have succeeded by other means. It’s hoped that deploying e-cigarettes as an aid to reducing smoking prevalence could prevent at least 165,000 avoidable deaths in England over the next three decades.
Maintaining momentum and expanding outreach
This progress shouldn’t be squandered – which is precisely what will happen if funding for the UK’s vital stop-smoking efforts continues to be curtailed. Smoking not only directly costs the NHS in the region of £2.5 billion a year, but also causes billions of pounds more in losses to the broader economy. Cutting back on effective tobacco control policies, therefore, makes no sense – from either a public health or an economic perspective.
Indeed, much more needs to be done – whether highlighting the benefits of reduced-risk nicotine products, targeting policies at young people to ensure that they don’t take up smoking or crafting bespoke policies for economically disadvantaged areas.
Delaying or diminishing anti-smoking programmes merely reinforces existing societal inequities. Recent research by Cancer Research UK shows that smokers from the lowest income groups have double the cancer rates of those from the most affluent groups. That overall smoking rates are in decline shouldn’t blind us to the fact that the benefits of quitting are far from evenly distributed; poorer people, people with mental health problems and people who use drugs are the most likely to start smoking in the first place – and the least likely to get the support they need to kick the habit.
With the UK government having committed to a ‘Smokefree 2030’ that sets the bar at lower than 5 percent smoking prevalence, public health providers need even greater access to practical resources. By providing local authorities with the funds necessary to pursue the strategies that are already working so well, including applying a well-crafted regulatory approach and increasing public awareness of reduced-risk nicotine products like patches and e-cigarettes, the UK could finally turn the dream of a smokefree society into a tangible reality.