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Will banning cigarettes create a smoke-free generation?

Health experts discuss whether gradually raising the age of sale is the only way to stop young people smoking.

By Spotlight

Last year, Rishi Sunak announced a radical health policy reform – a gradual smoking ban that means anyone born on or after 1 January 2009 will never legally be able to buy cigarettes. The legal age of sale will increase by one year, every year from 2027 onwards. Last month, the new Tobacco and Vapes Bill began its journey through parliament, and MPs voted to pass the plan by 383 votes to 67. The new legislation will mean the UK’s smoking laws are amongst the strictest in the world. It follows a similar law being passed in New Zealand, which has since been repealed after a change in government.

The upcoming legislation has been controversial amongst certain political factions, with some right-wing free-market libertarians such as Liz Truss claiming the ban indicates a shift towards a “nanny state”. However, health professionals are largely in agreement that it will eventually help to eradicate one of the UK’s biggest, preventable killers. Spotlight asks health experts what their thoughts are on the ban, and whether they think it is the only way to create a smoke-free generation.

“The immoral tobacco industry must be curbed”

Nicholas Hopkinson, professor of respiratory medicine at Imperial College London, and chair of Action on Smoking and Health (ASH)

Smoking is uniquely lethal and incredibly addictive. It is the leading preventable cause of premature disability and death; two out of three people who continue to smoke will die from a smoking-related disease. Bringing this avoidable harm to an end involves two tasks: supporting smokers (of whom there are more than six million in the UK) to quit, and ensuring that people don’t start smoking in the first place.

Most smokers started in their teens or early twenties. Steadily raising the age of sale so that tobacco products can never legally be sold to people born on or after 1 January 2009 is a key step towards creating a smoke-free generation. We are confident that it will be effective in reducing uptake, given the clear reductions in youth smoking seen after the legal age of sale was increased from 16 to 18 in 2007. Increasing it incrementally will also prevent the tobacco industry from addicting people later in life, an inherent risk associated with limiting the increase to a particular age, such as 21.

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The smoke-free generation policy has popular support across party lines, including among smokers – most would like to quit, wish they had never started and certainly don’t want their own children to become addicted. It will be simple to implement, as only a single date needs to be remembered, and surveys of retailers show that they also support it. Smoking is a key driver of miscarriage and infant mortality, and the gradual ban will mean less smoking during pregnancy. Publicity is also likely to prompt many current smokers to attempt to quit.

To ensure the health, social and economic benefits of a smoke-free future are achieved as soon as possible, the government should also swiftly implement the recommendations of the 2022 Javed Khan report Making Smoking Obsolete in full. These include putting health warnings on cigarettes themselves, and introducing both a tobacco licence for retailers, and a “polluter pays” levy to claw back the £900m profit that the lethal and immoral tobacco industry makes on UK sales every year.

“Prohibition is riskier than it first appears”

David Nutt, professor of neuropsychopharmacology at Imperial College London and chair of the charity DrugScience

A gradual smoking ban is not the only way. It is an interesting approach first conceived in New Zealand, though too recently for there to be any useful data. It looks like a victimless plan – people who currently cannot buy cigarettes will never be allowed to: where’s the harm in that?

But it’s perhaps riskier than it appears. Most people who are dependent on cigarettes start at an age well before they are legally allowed to purchase them, so it’s hard to see how the new law will make any difference to this early onset group. History also tells us that drug prohibition usually leads to greater harms through smuggling, organised crime and the emergence of less safe counterfeit products.

Moreover, making retailers legal gatekeepers doesn’t work because they want income, and underage restrictions can’t be enforced. The significant underage use of cigarettes and vapes shows this, as does the total failure in stopping the illegal sale of nitrous oxide cannisters. To stop such sales would incur huge policing costs that would be disproportionate to the goals.

All this just confirms that the ban is another example of gesture politics preceding an election. At least we should be thankful there is no plan to prosecute underage smokers for possession (or have I given the government another idea?)

There are better alternatives, such as allowing people to access recreational nicotine (a relatively harmless substance) without smoking cigarettes. The UK could emulate Sweden, which has largely eliminated smoking by encouraging the use of snus, a small nicotine pouch held in the cheek.

Cigarette taxes should also rise to deter young users and encourage switching to the less harmful vaping. Vape flavours should not be restricted (as the proposed legislation also stipulates), and current smokers with cigarette-related illnesses could be given snus or vapes on the NHS. And the best way to stop young people vaping would be to make it unfashionable: stop all advertising and put vapes behind the counter, alongside cigarettes.

“We need a society where not smoking is the norm”

Alice Wiseman, vice-president at the Association of Directors of Public Health (ADPH)

Achieving a smoke-free future is far more complex than implementing one single measure. However, given that 83 per cent of smokers start before they turn 20, raising the age of sale will significantly reduce the number of people becoming addicted.

Simultaneously, we need to tackle industry influence by strengthening our approach to advertising and sponsorship. This will ensure that people, especially children, are not subjected to clever targeted media campaigns that encourage take-up of tobacco and products containing nicotine, and that policymakers cannot be swayed by big financial incentives. Fact-based media campaigns should show the positive impact of smoke-free environments and keep the negative impacts of smoking on health and the economy at the forefront of people’s minds.

Cost is also a big motivator in helping people quit and we should reduce affordability further by increasing the tobacco tax escalator to 2 per cent above the UK’s average weekly earnings. We also need a retailer licensing scheme so people are better protected from illegal products, and enforcement and regulation should be much better resourced.

There is also scope to extend smoke-free environments, reducing harm caused by passive smoking and promoting healthy spaces so that the next generation sees this as the norm.

We also need to support existing smokers to quit. Recent investment in stop smoking services is very welcome but must be sustained over the next decade to help create a society in which smoking becomes increasingly uncommon. This work should be accessible to all, and targeted; for example, pregnant women who come into contact with health services should be supported to quit.

All this takes time and resources. But with a combination of measures, and collaboration across political parties and sectors, a smoke-free future is well within our grasp, and will give everyone the freedom to live healthier lives for longer.

This article first appeared in a Spotlight print report on Healthcare, published on 17 May 2024. Read it in full here.

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