Following much uncertainty amid unprecedented political turmoil in the United Kingdom, the country has recommitted to making smoking in England obsolete by 2030, a promise it had made earlier this year.
In February, the government announced that Dr. Javed Khan, the former chief executive of Barnardo’s, the UK’s largest children’s charity, would spearhead an independent review to study smoking-related health disparities. That report, published in June, recommended 15 actions that England could take in order to go “smoke-free” by the end of the decade.
These included offering nicotine vapes to people looking to stop smoking, providing free “swap to stop” starter packs for deprived communities, helping to “accelerate the path to prescribed vapes through medical licensing,” investing 125 million pounds for a comprehensive program to achieve the recommendations in the report, and “increasing the age of sale by one year, every year” to eventually make no one eligible to purchase tobacco products. (On this latter point, New Zealand has adopted a similar approach—not without some controversy over its prohibitionist aspects.)
An Action on Smoking and Health (ASH) report said earlier this year that the UK is going through a “vaping revolution,” with 4.3 million people vaping regularly in Great Britain. This has been aided by one of the world’s most pro-vaping regulatory landscapes. But political upheaval had, until recently, left Khan’s review sitting on the table.
Last month, then-Health Secretary Thérèse Coffee, who smokes cigarettes herself, was apparently set to do a huge reversal on the government’s promise. The Guardian reported that she would abandon plans to put out a tobacco control plan at the end of the year.
Coffey’s stint in that position, however, was short-lived, as Conservative Prime Minister Liz Truss—who took office after a never-ending series of scandals forced Boris Johnson to begrudgingly resign—served as head of state for a mere six weeks before she, too, resigned on October 21, amid self-inflicted economic meltdown.
Under new Prime Minister Rishi Sunak, a Conservative like the rest, Coffey is now the secretary of state for environment, food and rural affairs. And Sunak has seemingly recommitted the government to its goal of 5 percent smoking prevalence or less in England by 2030. (In other parts of the UK, this area falls to the devolved governments of Scotland, Wales and Northern Ireland.)
Under-secretary O’Brien said he understood the “compelling arguments made by the Khan review.”
In a parliamentary debate on England’s so-called “smoke-free” strategy held on November 3, the government indicated that it was considering the recommendations of Khan’s review.
The debate saw Neil O’Brien, the new under-secretary of state for health and social care, loosely confirm the government’s position. He stated that the government was “determined to address the challenges raised by the independent review” and meet the 2030 target. O’Brien said he understood the “compelling arguments made by the Khan review” and “the very strong evidence in the recent ‘Nicotine Vaping in England’ report.”
That report, commissioned by the Office for Health and Improvement and Disparities in the Department of Health and Social Care, found that biomarkers showed “significantly lower exposure to harmful substances from vaping compared with smoking.”
O’Brien also touted the government’s investment in anti-smoking campaigns such as “Stoptober,” a well-known initiative that encourages people to abstain for 28 days each October. “This year alone, we have provided £35 million to the long-term NHS [National Health Service] commitment on smoking,” he continued.
Khan’s review highlighted that people from deprived areas spent a higher percentage of their income on tobacco, causing a disproportionate burden on families and communities. That’s why he ultimately suggested an “increased investment of an additional £125 million per year in smoke-free policies and £70 million per year ring-fenced for stop smoking services.” The review also called for an investment of £15 million to support smoking cessation during pregnancy; existing pilot programs that support vaping as an alternative might suggest what that could look like. Another £15 million, he suggested, should be spent on a “national mass media campaign” to “dismantle myths about smoking and vaping.”
His other proposed interventions include making retailers get a tobacco license as a way of making tobacco less available, rethinking the way cigarettes are packaged in order to make them less desirable, and raising tobacco duties (essentially sales taxes) by 30 percent across all tobacco products. The review also suggested “increasing duty rates for cheaper tobacco products, such as hand rolled tobacco, so they are the same as standard cigarette packages.” (Unlike US health agencies, Khan defines “tobacco products” as anything that literally includes tobacco, so vapes are excluded.)
Khan’s recommendations, however, have their detractors. One of them is Clive Bates, a former director of ASH, who has called the review “punitive” with measures that involve “far too much punishment and coercion.”
“Khan has endorsed tobacco control policies that are a mixture of unworkable, gimmicky, politically naïve, pointless or excessively coercive,” Bates told Filter. Of the proposed 30 percent increase in taxes on tobacco products, he said: “So in the cost-of-living crisis and with the government’s commitment to ‘leveling up’ (i.e. helping the poorest communities), Khan decides that what’s needed is a substantial transfer from one of the poorest subpopulations in society (smokers) to the Treasury via a highly regressive tax.”
“Why not nicotine pouches? The problem is that Khan has not really gone ‘all in’ on tobacco harm reduction.”
On his blog, Bates has also argued that “shaping the regulation of the market to favor consumer and producer migration to non-combustible smoke-free products” would be a less costly and more effective way for the government to meet its target. On Khan’s suggestion of increasing smoke-free places to “denormalize” smoking, Bates said he found the recommendation surprising as smoking is already banned where it counts. He suggested that “denormalize” could actually mean “stigmatize.”
What Bates did agree with was the recommendation for promoting vapes, as what Khan called a “swap to stop” tool. Khan said that people should be given “accurate information on the benefits of switching.”
Bates commented that although this suggestion was a good idea, he wondered why it was the only option. “Why not nicotine pouches, probably the safest of all forms of smoke-free recreational nicotine?” He added, “The problem is that Khan has not really gone ‘all in’ on tobacco harm reduction.”
Still, the government is expected to issue its new tobacco control plan, strongly influenced by the Khan review, by the end of the year.
“The prize of reaching a smoke-free 2030 will be huge for this country, particularly for our most disadvantaged citizens,” O’Brien said.
Photograph by Elliott Brown via Flickr/Creative Commons 2.0
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