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Health inequalities and tobacco

Dr Sanjay Agrawal is chair of the RCP’s Tobacco Special Advisory Group. In this blog he explores the link between health inequalities and smoking.

Smoking tobacco used to be the domain of the wealthy and the well-to-do. Over the past century this addictive habit was adopted by less affluent people to mimic the status tobacco use provided. It was also encouraged by the tobacco industry and driven by market growth and profit.

The aggressive growth strategy adopted by the tobacco industry has resulted in more than 80% of global tobacco sales now being in low- and middle-income countries, creating tobacco-related non-communicable diseases alongside the infectious diseases that affect the developing world. In the Global Burden of Disease Study published in October 2020, tobacco use still accounted for more deaths than any other modifiable risk factor across 204 countries and territories.

In the UK, tobacco use is firmly established as the single largest cause of health inequality accounting for 50% of the difference between the least deprived and the most deprived communities. Despite a tobacco control policy that has led to a significant reduction in smoking prevalence over the past 50 years, most of the benefit has accrued to the most affluent who have shown much higher rates of quitting. Poorer smokers are just as likely to want to quit smoking and succeed when provided with treatment, but more effort and initiative needs to be directed at engaging this group, along with policies such as tobacco pricing and taxation which have a disproportionate impact on quitting in less affluent smokers.

While the health benefits of reducing smoking prevalence are clear, there is in addition a strong financial case. Currently a quarter of a million children live in households tipped below the poverty line due to expenditure on tobacco. With a drop in smoking prevalence in the most deprived communities, hundreds of millions of pounds would be returned to local communities rather than going directly into the profit lines of tobacco companies.

In the post-COVID world in which health inequalities have been exacerbated and are likely to become wider, effective policies that address smoking prevalence and treatment have never been more important. They have the potential to lift households out of poverty, reinvigorate local economies and reduce the burden on the NHS.

This is one of a series of blogs to mark the launch of the Inequalities in Health Alliance, a coalition of organisations who have come together to campaign for a cross-government strategy to reduce health inequalities