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Forty Fatal Years

Please note: As pages 32 and 33 are very difficult to read in pdf format, we have reproduced the text below on this page under The Way Forward.

The Way Forward

The following letter was sent by Professor Sir George Alberti, President of the Royal College of Physicians of London to Derek Wanless of the Health Trends Team, HM Treasury.

Re: Public health and tobacco policy as part of NHS modernisation

In addition to the RCP's priorities and concerns about the modernisation of the NHS I have already discussed with you and your team, I would like to submit some brief written evidence on tobacco issues.

This year marks the 40th anniversary of the publication of the College's major report on smoking and health. Tobacco is still by far our greatest threat to public health, and the policy recommendations in that report aimed at reducing tobacco use are just as valid today, yet many have still not been implemented.

There has of course been great progress since the 1960s in reducing smoking prevalence, and the NHS is today reaping the rewards of those efforts in terms of reduced cancer, CHD and respiratory illness. If we can build more primary prevention into the reform of the NHS, then we can build on those gains.

The case for a radical and sustained approach to tobacco is clear. It is obviously better for both the patient and the NHS to spend a given sum on avoiding disease than treating it. We know that smoking cessation is extraordinarily cost-effective compared to almost everything else the NHS does. That begs the question - why we do not do more of it? We noted the very high projected spend on statins described in the interim report - smoking cessation is a far cheaper way to reduce CHD risk (and many other risks) and would be effective for 80% of patients currently taking statins. Achieving an appropriate balancing of resources between smoking cessation and statins expenditure would be a good case study in the use of cost-effectiveness data in modernising the NHS.

The College would like to see a far-reaching and committed approach to tobacco policy emphasised in your final report. Specifically, this could include:

Interventions that help motivated smokers to quit - for example:

Long-term commitment to stabilise and expand the established smoking cessation services to meet far more challenging targets (up to four times the current target);
Inclusion of obligations to make regular and brief smoking cessation interventions in GP contracts;
The development of a smoking cessation service in every hospital.
The inclusion of smoking cessation in other settings - for example, ante-natal services, social services, prisons, educational institutions.
Integration of smoking into medical training at all levels - the College is already active in rising to this challenge.

Interventions that motivate smokers to quit - for example:

Substantial spending on a powerful mass media-based education campaign
Increased provision of smoke-free environments at work and in public places - Government inaction in this area has been a conspicuous failure of the commitment made in its tobacco White Paper.
Proper risk communication on packs
Continuing use of tax policy (combined with measures to control of smuggling) to apply price incentives to quit.

Interventions that reduce the motivation to smoke - for example;

Banning all forms of tobacco advertising, sponsorship and promotion - nationally and internationally. We were, as you already know, deeply and openly disappointed by the omission of the tobacco advertising legislation from the Queen's speech, an omission which also disappointed our Fellows and Members coping with tobacco-related illnesses at ward level. We hope that the Government will continue its quiet support for Lord Clement Jones' private members bill to ban tobacco advertising and do what it can to push the legislation through
The use of bold, bleak warnings to communicate risk - and to reduce the attractiveness of cigarette packs.
Elimination of misleading reassurance to smokers - such as 'light' branding and disproportionate claims of reduced harm in novel tobacco products.
Control of additives and other manufacturing techniques that may make tobacco products more addictive or easier to learn to use.

Overall, this effort could be far better funded. The tax revenue from tobacco amounts to over £9 billion, yet the tobacco White Paper voted £37 million per year to tobacco policy - about 4 pence in every £10. I think it would be fair to return rather more than that directly to smokers as an investment in their health and long-term well being.

I do hope these views are of interest and that efforts to tackle tobacco receiving some prominence in your final report.

Yours sincerely

PROFESSOR SIR GEORGE ALBERTI

*(A free Adobe Acrobat PDF reader can be downloaded from http://www.acrobat.com)

This page last updated on March 6, 2002