The next steps in the long journey to tobacco harm reduction

Professor John Britton, the RCP's special adviser on tobacco, reflects on recent developments in tobacco control and the introduction of standardised packaging.

Reflections from Professor John Britton

The RCP has a long history of campaigning for tobacco control. Our landmark report ‘Smoking and Health’, published in 1962, highlighted the link between smoking and lung cancer. It called on government to implement a range of public health measures to reduce smoking. It also called on doctors to advise patients on illnesses caused and exacerbated by smoking.

Since then, the RCP has spearheaded five decades of action on tobacco control in areas such as: advertising and promotion, packaging and labelling, and smoking in public places. The most recent success in this area comes into force today. New legislation is introduced making the UK the second country in the world and the first in Europe to require tobacco products to be sold in plain, standardised packaging. This is a huge victory for public health and will help to reduce the number of deaths and burden of disease caused by smoking. 

As a doctor, I see first-hand every day the devastating effects of tobacco addiction. Every year, around 100,000 smokers in the UK die from smoking related causes and around half of all regular cigarette smokers will eventually be killed by their addiction.[1] That's one in every two smokers. The RCP has campaigned since 2010 for the government to introduce standardised packaging as a way of helping smokers quit and to help non-smokers, especially young people who are heavily influenced by tobacco marketing, to never start.[2]

There is a wealth of evidence to show that standardised packaging works. A systematic review of peer reviewed studies carried out for the Department of Health found that plain standardised packaging is less attractive - especially to young people, improves the effectiveness of health warnings, and reduces mistaken beliefs that some brands are ‘safer’ than others.[3] Since introducing standardised packaging in 2012, the Australian government released research showing that smoking prevalence in Australia has continued to decline, from 15.1% in 2010 to 12.8% in 2013.[4]

Nicotine without smoke

However, there is still more to do. In addition to standardised packaging, the RCP is also calling on the government to promote e-cigarettes widely as a substitute for smoking to help smokers to quit. The RCP’s ‘Nicotine without smoke: tobacco harm reduction’ report examines the science, public policy, regulation and ethics surrounding e-cigarettes and other non-tobacco sources of nicotine. It found that:

  • e-cigarettes are not a gateway to smoking 
  • e-cigarettes do not result in normalisation of smoking 
  • e-cigarettes can act as a gateway from smoking.
  • the possibility of some harm from long-term e-cigarette use cannot be dismissed due to inhalation of the ingredients other than nicotine, but is likely to be very small, and substantially smaller than that arising from tobacco smoking.

The report also recommends that regulation of e-cigarettes should be proportionate and should not be allowed significantly to inhibit the development and use of harm-reduction products. 

The planned increases in tobacco duty of 2% above the rate of inflation for manufactured cigarettes and 5% for hand-rolled tobacco set out in the Chancellor’s 2016 budget will also provide a significant boost in the campaign to reduce smoking. However, cuts to local authorities’ public health budgets are having a damaging impact on services that help people to stop smoking[5]. We hope that the government’s tobacco control strategy, due to be published this summer will set out ways to support these vital services.

In the 54 years since the RCP published ‘Smoking and health’, the place of tobacco in UK society has changed beyond recognition. Nevertheless, smoking is still the largest avoidable cause of premature death and disability in the UK, where there are still around 10 million smokers, of whom half will die prematurely as a result of their smoking, unless they quit. The RCP will continue to work with partners in the public health community to ensure more people can give up smoking and lead longer, healthier lives.

References
ASH smoking statistics
2 Tobacco Advisory Group of the Royal College of Physicians. Passive smoking and children, 2010
3 Moodie C, Stead M, Bauld L et al. Plain tobacco packaging: a systematic review, Public Health Research Consortium, University of Stirling, Institute of Education and UK Centre for Tobacco Control Studies, 2012.
4 Kmietowicz, Z. (2014). Australia sees large fall in smoking after introduction of standardised packs. BMJ (Clinical Research Ed.), 349 (July), g4689. doi:10.1136/bmj.g4689
5 Results of a survey of tobacco control leads in local authorities in England. Action on Smoking and Health. 

Notes to editors

Professor John Britton is special adviser to the RCP on tobacco and professor of epidemiology at the University of Nottingham’s School of Medicine. His research focuses on smoking prevention and other avoidable causes of chronic respiratory disease.