Will we ever stamp out smoking entirely?

A government paper recently laid out plans to eradicate smoking by 2030. Is that feasible?

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Every child of a smoker has a complicated relationship with addiction.

The rate of smoking has dramatically fallen in the last few decades. Increasing the legal age to purchase tobacco from 16 to 18, banning smoking indoors, to mandatory health-warnings on tobacco packaging have all contributed to the demise of smoking. 

None of these measures, including the ever-increasing tax duty on cigarettes, has stemmed my father’s addiction. 

Last week, the government quietly published its Prevention Green Paper, which sets out aims to eradicate smoking by 2030. How this would be achieved was left vague, with details of the plan to be sketched out at a later date. It was also reportedly almost canned by Health Secretary Matt Hancock to avoid riling incoming Prime Minister Boris Johnson, who has made clear his opposition to so-called “sin taxes”. 

But is it even possible to eradicate smoking entirely?

Britain has the second-lowest rate of smoking in Europe (behind only Sweden), but despite all the measures taken to discourage the habit, just under 15 per cent of the population still smoke. This percentage rises among certain groups, such as blue collar workers, those who live in social housing and those with mental illnesses. Those in the LGBTQ community are also more likely to smoke. 

Eradicating smoking completely would almost certainly require a more targeted approach. While tax increases are a virtually guaranteed means of reducing smoking rates, it can also lead to rising sales of illicit tobacco. Tobacco companies also attempt to absorb tax rises by overcharging for their most expensive products and undercharging for their cheapest. 

Tax rises have also led to the rise of roll-your-own cigarettes, which have been shown to make users less likely to want to quit because they are so much cheaper.

Those who do want to quit need all the help they can get.

Dr Nicola Lindson, a researcher in smoking at the University of Oxford, tells me “people can try to quit more than 30 times before being successful.”

Lindson adds that therefore “providing support to keep trying is very important.” Despite studies showing that nicotine replacement therapies are 30 per cent more likely to work if prescribed by a doctor than if a person buys them for themselves, funding cuts to local authorities are resulting in many smoking cessation services being scrapped entirely, reports The BMJ. 

The eradication of smoking, Lindson says, requires “research and health services focus on identifying and implementing more effective tailored approaches to help the people who are finding it most difficult to quit.”

The increasing popularity of e-cigarettes is proposed as another route to eradicating smoking. Studies suggest that these products are significantly safer than conventional cigarettes, and UCL researchers this year found that those who started using e-cigarettes were more likely to quit smoking completely.

However, we still know little about the long-term effects.

Studies have shown that e-cigarettes are more likely to be taken up by all demographics, in contrast to nicotine replacement therapies which studies have shown are more likely to be effective for older people. Anna Saunders, a 24-year-old chef who switched to vaping from cigarettes, says she did it because she thought it would be better health-wise, but says “it’s not as fun and not as satisfying.” 

E-cigarettes, of course, are also owned by the tobacco companies that produce cigarettes. Philip Morris International, the multinational company behind brands such as Marlboro and Benson & Hedges, has started a campaign to promote the use of e-cigarettes as a means to achieving a “smoke-free world”. Dr Derek Yach, the CEO of the Smoke Free World organisation funded by Philip Morris, tells me that public health has always been about harm-reduction and that if millions of lives could be saved by smokers switching to e-cigarettes today, shouldn’t we be promoting that?

While it feels queasy to side with the tobacco industry, the studies are becoming more and more conclusive: e-cigarettes help smokers quit. Nevertheless George Butterworth, senior policy manager at Cancer Research UK, says vaping is just one small part of the “overall solution to smoking” and that “medications, nicotine patches, gums… combined with behavioural support” is essential. 

Ultimately, one of the biggest barriers to eradicating smoking by 2030 is the wide array of people smoking for all types of reasons, meaning there is no one solution fits all.

On top of this, government cuts have only made it harder to help the most vulnerable, and we need to remain wary of powerful tobacco lobbies which have learned to rebrand themselves. 

Lindson reiterates that “quitting is extremely hard” saying “even the quitting methods and medications we know are most effective only help a minority of people to stay quit in the long term.” The eradication of smoking will not happen by 2030, but if it is to happen at all, it will require a government to take the task seriously and make a concerted action. 

And if we need a reason to keep trying, just remember that two-thirds of all smokers die from smoking-related diseases.

Jason Murugesu is a postgraduate student in science communication at Imperial College London, and a former Wellcome Scholar at the New Statesman.