A new report from the Royal College of Physicians (RCP) recommends that all smokers be provided, routinely and on an opt-out basis, with smoking cessation treatment by the NHS. At present many smokers are offered help with quitting by the NHS, but introducing an opt-out system can double the uptake of the service, so should be provided as a default.
A new report from the Royal College of Physicians (RCP) recommends that all smokers be provided, routinely and on an opt-out basis, with smoking cessation treatment by the NHS. At present many smokers are offered help with quitting by the NHS, but introducing an opt-out system can double the uptake of the service, so should be provided as a default.
The recommendation is one of a raft of measures designed to put an end to tobacco smoking in the UK. Smoking and Health 2021: a coming of age for tobacco control comes almost 60 years after the RCP’s ground-breaking first tobacco report Smoking and Health in 1962, reviews the UK’s progress in reducing smoking, and sets out comprehensive recommendations for the UK’s forthcoming National Tobacco Control Plan.
The report says that while the reduction in smoking by 75% since 1962 has been considered a national success, if the policies advocated by the RCP in 1962 had been adopted and followed through, smoking would have been eradicated from the UK years ago. Instead, modelling of current tobacco control policies shows a failure to achieve a smoking prevalence of <5% until after 2050.
Smoking remains a major cause of death and disease in the UK, killing 94,000 people in 2020. It is a major cause of health inequality, as the UK’s 7 million smokers are predominantly the disadvantaged and marginalised in our society. The action we take now has to be thoroughly comprehensive, not piecemeal as in the past. Health measures are not enough on their own, and the report contains recommendations on reforming tax policy, eradicating media promotion of smoking, prioritising the treatment of tobacco dependency, realising the potential of comprehensive public health campaigns to promote quitting, raising the legal age of sale for tobacco products, and silencing the voice of the tobacco industry:
- Taxation - increasing tobacco tax is one of the most effective means of reducing smoking uptake and promoting quitting. Large, above-inflation annual tax increases and other measures are needed to make smoked tobacco substantially less affordable and reduced harm nicotine alternatives much more affordable. As tax increases have more of an effect on people with lower incomes, it is essential that they are used in combination with better cessation services – eradicating tobacco use can take families out of poverty and could inject up to £7 billion of current tobacco spending back into the pockets of smokers and their communities.
- Health promotion - restoring investment in media campaigns at the very least to the equivalent of the 2008 level of £23 million (the year that immediately preceded the highest uptake of NHS smoking cessation services by smokers) would provide a low-cost, highly effective method to incentivise smokers to quit. Media campaigns should also encourage switching from smoked tobacco to e-cigarettes and provide balanced information on other harm reduction options such as heated tobacco.
- Preventing smoking uptake – smoking uptake occurs because children see others smoke – among family, friends, and in the media – including films, TV and social media. The report calls for better regulation of film and television to ensure that children are not exposed to tobacco imagery. A 9pm watershed and 18 certificates should be applied to TV programmes and films including tobacco imagery, and health warnings displayed whenever tobacco imagery is present.
- Countering tobacco industry tactics – the tobacco industry has been a lucrative business for more than a century, and has consistently slowed, blocked, circumvented or overturned comprehensive tobacco control policies, often in contravention of measures to counteract it. The industry should be excluded from all policymaking, meeting government officials and elected representatives, and prevented from making gifts or payments. A lobbying register should be set up to disclose the funding sources of individuals or organisations lobbying government on tobacco control, and a tax on tobacco companies introduced to fund independent tobacco control research.
Professor John Britton, RCP Tobacco Advisory Group member said:
"Smoking is entirely preventable, but ending smoking requires us to go even further with the more familiar prevention measures, such as tax and providing help for smokers to quit, but also tackling some of the causes that have not yet been addressed – and particularly the exposure of children to tobacco imagery in film, television and other media. Doing this will prevent countless deaths, dramatically reduce the burden placed by tobacco use on health services and wider society, substantially reduce inequalities in health and, by alleviating poverty and improving health, contribute significantly to the levelling up of our society."
Dr Nick Hopkinson, RCP Tobacco Advisory Group member said:
"Support to quit smoking is one of the most effective and highest value treatments that the healthcare system can deliver, but many smokers are missing out on this. Developing a universal offer through the NHS so that every smoker receives this support, unless they actively opt out, has to be a priority.
"Smoking is a health issue right across the life course - raising the age of sale from 18 to 21 has the potential to reduce smoking uptake dramatically among children and young people and help to make smoking obsolete."
