The UK government have pledged to stamp out smoking by the year 2030. Smoking causes premature deaths of millions world wide every year. And in the UK the death toll is equivalent to a jumbo jet crash every day. This week, an independent report was published by former Barnados Chief Executive Javed Khan looking at what needs to happen to realise this goal of a smoke free country within 20 years. Speaking with Chris Smith, Edinburgh University’s Linda Bauld, whose own work looks at this same topic…
Linda – Chris, I think the way to describe this is, it’s the last big push. So if you think back to the 1950s, we had over 80% of men who smoked, we be got up up to about just under half of women in the 1960s. And now we’ve got the second lowest rates in Europe. So smoking is concentrated in particular groups and what they’re effectively recommending, he’s got 15 recommendations, there’s quite a comprehensive approach. And it has elements that are around prevention, raising the age of sale every year. So that means that at the moment it’s 18 and it would gradually become even older in terms of when people would be allowed to smoke. And then they’re also looking at investments in services, in vaping as an alternative for smokers, looking at pregnant women looking at a mental health and smoking really importantly. So a whole variety of really quite ambitious measures to try and get us over the line to 2030.
Chris – We’ll, come on to some of the specifics in just a second, but is there any evidence that packages like this actually work?
Linda – There is actually. So, in 1962, the Royal college of Physicians produced “Smoking and Health”, which set out a package of measures that should be implemented. It actually took 50 years, but as they were implemented in stages, and that meant raising the price, banning marketing, offering people support, when you change the environment and you change behaviour together over time, it really does have an impact. And in fact, smoking is probably the best example in public health of a comprehensive approach and things acting together. So, you know, I, I don’t know whether much or any of this will get implemented, but if they actually did implement it, I would be really quite confident this would be adding to what we already have and make a real difference.
Chris – Playing devil’s advocate though for second, Linda, heroin is universally illegal and there’s no age at which that’s considered acceptable. Yet we have unfortunately, a steady stream of victims every year. And young people join that list of victims every year, despite many of the measures being in place that you’ve already mentioned. So what’s the evidence that we’ll crack down on smoking and get that last about 15% of people who do smoke with these measures, if we can’t do it for something as severe as heroin addiction?
Linda – Well, they’re very different drugs in different ways. And also the drug death issue has actually been getting worse. Whereas what you’ve seen in tobacco control are consistent improvements. And I think there are a couple of things there. The first thing is that it’s uniquely harmful and people know the risks and also it’s been de-normalised. So gradually it’s just become less acceptable to smoke. And then importantly, there are also alternatives that people have in terms of nicotine replacement therapy, which some people – actually a committee I chaired for NICE said you could use it for life if you wanted to. So I know people who are still using NRT lozenges, and they stopped smoking 10 years ago. So nicotine is not the problem. We don’t need to abandon the actual drug that’s addictive, cuz it’s not causing harm. It’s the burning and the tobacco – also oral tobacco – that causes the harm. So I think it’s quite a different scenario.
Chris – And just in the last half minute or so, one of the recommendations is let’s offer people vaping as an alternative. Is that not possibly substituting one poison for another though?
Linda – Well, vaping is not risk free and it’s really important to emphasise that. But the thing I come back to the burning Chris, smoking kills one in two of its regular users. In fact, two and three of its regular users when used as intended while vaping has a very small proportion of that risk. We don’t have the long term data, but for smokers, it’s definitely the better option. The challenge of course, Chris, is to keep it outta the hands of non-smokers and young people because we don’t know long term how it might affect them.