Beyond the Tobacco and Vapes Act: realising the smoke-free dividend

The Tobacco and Vapes Act has been hailed as a landmark step towards a smoke-free future. By preventing future generations from being legally sold tobacco and introducing new powers to regulate the availability, promotion and appearance of tobacco and nicotine products, including vapes, it represents a major step forward in protecting people from the harms of smoking and nicotine addiction.

However, legislation alone is not enough. Millions of people in the UK are already living with tobacco addiction, and smoking-related harm is increasingly concentrated among people experiencing poverty, poor health, insecure housing and social exclusion. Achieving a smoke-free future will require action not only to prevent smoking uptake, but also to support those already most affected by tobacco dependence and its consequences.

National smoking prevalence figures can mask stark inequalities. In the recent RCP report, Smoking, health and social justice, we examine the structural factors that continue to drive smoking among the most disadvantaged communities. Smoking prevalence in Blackpool, one of the UK’s most deprived towns, is close to 20%, compared with around 4% in affluent Woking. These disparities are shaped by wider determinants of health, including poverty, housing, education and commercial influences from the tobacco industry. They are not simply the result of individual choices, but of wider social and economic conditions that make smoking more likely and quitting more difficult.

Furthermore, the true scale of tobacco-related inequality may be even greater than national figures suggest. More than a million people form part of a ‘hidden population’ of smokers who are often excluded from national surveys, including those living in temporary accommodation, prisons, care homes and other settings where smoking prevalence is significantly higher than the national average. Better data collection is essential if support is to be targeted where it is most needed.

Tobacco control policies must do more to reach groups with the highest smoking prevalence, including people experiencing homelessness, those living in temporary accommodation, people with mental health conditions, low-paid workers and other underserved communities. Many people in these groups are motivated to quit and make repeated quit attempts, but face greater barriers to success, including financial pressures, unstable living conditions, poorer health and reduced access to support.

We also need a coordinated, cross-government approach to tackling the commercial and social drivers of smoking. This should include stronger regulation of tobacco pricing, availability and marketing, recognising that the tobacco industry continues to retain and recruit customers in less advantaged communities. Addressing smoking inequality is not only a public health imperative but a matter of social justice.

There is also a significant economic opportunity with the potential for a ‘smoke-free dividend’. Billions of pounds could be returned to local economies through improved health, increased productivity and reduced spending on tobacco. Reducing smoking prevalence among the communities most affected by tobacco harm could help tackle poverty, improve wellbeing and narrow health inequalities, while generating benefits that extend far beyond healthcare.

Healthcare services also have a crucial role to play. Evidence shows that making smoking cessation support a routine part of healthcare increases quit rates and improves access to treatment among populations that are often least likely to seek support themselves. Rather than relying on people to ask for help, opt-out approaches make identifying tobacco dependence and offering treatment a standard part of care, helping to reach those who might otherwise miss out on support. This is why opt-out tobacco dependency treatment should be extended across all NHS settings.

The Tobacco and Vapes Act is an important milestone, but legislation alone will not eliminate tobacco-related inequality. A smoke-free generation will only become a reality if it is matched by sustained investment, targeted interventions, better data collection and a renewed national tobacco control plan that supports people already living with tobacco addiction. National governments across the UK must now build on the Act and ensure that no group is left behind. Reducing smoking prevalence is vital, but so too is reducing the unjust burden that smoking places on less advantaged individuals, families and communities.