In October 2023, the UK Government published a policy paper detailing its plans to ‘stop future generations from starting to smoke’ and to ‘tackle the rise in youth vaping’ – all in a bid to create a smokefree generation.
What does ‘smokefree’ mean?
Smoking is less prevalent than it used to be; 11% of adults in Great Britain said they smoked cigarettes in 2022, compared with around 40% of adults in the 1970s. However, smoking remains a serious public health concern. Tobacco is reportedly “the single largest cause of preventable illness and mortality killing two out of three lifelong smokers”. And while the Treasury receives roughly £10 billion annually from taxes on tobacco products, the cost of smoking to the economy and the NHS is estimated to be £17 billion per year.
The government’s ambition is for the UK to become ‘smokefree’ by 2030, which it defines as reducing the prevalence of smoking to 5% of the adult population. “Stopping the start: our new plan to create a smokefree generation” outlines the government’s strategy for reaching this smokefree target. The headline proposal is introducing legislation that will stop children who turn 14 in 2023 from ever legally being sold cigarettes – making them the first smokefree generation. This would be rolled out by increasing the age of sale by one year, every year, until no one can buy a tobacco product. New Zealand did this in January 2023 through the Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Act, which banned the sale of smoked tobacco products to anyone born in or after 2009.
‘If you smoke, swap to vaping; if you don’t smoke, don’t vape’
Professor Sir Chris Whitty, Chief Medical Officer for England, wrote the foreword to the government’s policy paper, in which he spoke about the need to support adults to quit smoking using alternatives such as vaping products, while also reducing the appeal, availability, and affordability of vapes to children. The key message was that ‘vapes are safer than smoking, but not risk-free’.
“One of the tools to help people addicted to nicotine to stop smoking is vaping – and because the harms of smoking are so great, it is safer to vape than smoke, but vapes are not risk free. So, if you smoke, swap to vaping, if you don’t smoke, don’t vape. Marketing vapes to children is utterly unacceptable. Some are now clearly trying to addict children including with colours, flavours, cartoons and other marketing methods aiming to tempt children towards addiction.”
The government suggests that action around vaping could include restricting the flavours and descriptions of vapes, regulating point-of-sale displays in retail outlets so that vapes are kept out of sight from children and away from products that appeal to them (e.g. sweets), and regulating vape packaging and product presentation.
‘The government is already off-target’
In June 2022, Dr Javed Khan OBE published an independent review (known as the ‘Khan review’), which assessed the government’s ability to reach the smokefree target. Dr Khan reported that “without further action, England will miss the smokefree 2030 target by at least 7 years, and the poorest areas in society will not meet it until 2044”. He made 15 recommendations to the government, including four ‘critical must-dos’:
- Raise the age of sale by one year, every year, until no one can buy a tobacco product in England.
- Invest an additional £125 million per year in smokefree 2030 policies, including £70 million ringfenced for stop-smoking services.
- Promote vaping as an effective tool to help people quit smoking tobacco.
- Improve prevention via the NHS by offering smokers advice and support to quit at every interaction they have with health services (e.g. GPs, hospitals, psychiatrists, midwives, pharmacists, dentists, or optometrists).
The government has not explicitly responded to each of Dr Khan’s recommendations – either inside or outside the 2023 policy paper. Without the opportunity to conduct a careful comparison and analysis, it would seem that the government has accepted some (but not all) of the recommendations. As described above, the government is willing to “prohibit the sale of tobacco products for future generations”. In addition, it has made commitments to invest more in smokefree policies, including providing financial incentives for pregnant women to stop smoking and doubling the budget for stop-smoking services; and it has pledged support for people to switch from smoking to vaping through local authority-led stop-smoking services and free vaping starter kits.
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