UK Launches Independent Review to Look at Tobacco Health Disparities

    On February 4, the United Kingdom launched an independent review to study smoking-related health disparities.

    It’s the government’s latest move in positioning tobacco harm reduction (THR) explicitly in its public health agenda. The UK has embraced vaping products as safer nicotine alternatives, and has become something of a model for THR advocates around the world. Its health agencies (formerly led by Public Health England, which was last year amalgamated into bodies like the new UK Health Security Agency and the Office for Health Improvement and Disparities) have maintained for years that vaping is 95 percent less harmful than smoking. Activists often point to the different approaches in the United States as opposed to the UK, where there are even some vape shops attached to hospitals.

    According to the government, 21.4 percent of routine and manual workers smoke, as do 25 percent of people with long-term mental health conditions.

    Though the UK’s adult smoking rate has dropped in the past decade, there are still an estimated 6 million smokers in the country, who disproportionately come from the most disadvantaged communities. According to the UK government, for instance, 21.4 percent of routine and manual workers smoke, as do 25 percent of people with long-term mental health conditions. Smoking rates also vary drastically throughout the country—at about 20 percent in cities in the North of England like Manchester and Blackpool, but only about 5 to 6 percent in more affluent southern towns like Wokingham and Richmond.

    The new independent review—led by Javed Khan, the former CEO of Barnardo’s, the UK’s largest children’s charity—will provide the government with evidence-based advice for how to tackle health disparities associated with tobacco use, targeting the most successful smoking cessation interventions and contributing to an overall tobacco control plan set to be released later this year.

    More work needs to be done, but the UK has been successful even without this kind of renewed attention: A recent survey from Action on Smoking and Health (ASH) and Cancer Research UK found that English councils managed to improve their local smoking cessation services in 2021, including specifically for marginalized populations, despite notable funding issues. These services can include recommendations to try vaping, even if they do not directly provide vapes. Meanwhile vapes are soon to be prescribed to smokers through the National Health Service (NHS), while remaining fully available in a range of shops.

    “The more the government stresses health disparities, the more it will be drawn to policy that favors safer nicotine products.” 

    “All the plans promising a smoke-free world gradually have to address the needs of people who are more committed to or dependent on cigarettes,” Clive Bates, a tobacco control expert and the former director of ASH (UK), told Filter. “A pathway that lets the user quit smoking without quitting nicotine is easier to follow and bound to be more successful with harder-to-reach groups. The more the government stresses health disparities, the more it will be drawn to policy that favors safer nicotine products.” 

    Along with Martin Cullip, an advocate who formerly chaired the New Nicotine Alliance (NNA), Bates has urged politicians to use Brexit to the UK’s advantage. They’ve called to reverse the ban on snus—a smokeless form of tobacco significantly less harmful than combustible cigarettes that’s currently banned by the European Union—and remove nicotine caps on e-liquids, among other measures.

    The review announcement also arrives on the heels of the “Leveling Up” plan, the Conservative government’s much-touted aim of “spreading opportunity and prosperity to all parts” of the UK—including areas of northern England where the Conservatives in 2019 won parliamentary seats long held by the opposition Labour Party.

    The smoking cessation plan will include setting up at least 100 community diagnostic centers in England by 2025. England intends to go smoke-free by 2030, which means achieving a smoking prevalence of 5 percent or less.



    Photograph by Doug88888 via Flickr/Creative Commons 2.0

    • Alex is Filter’s news editor. He previously worked as a reporter and copy editor at VICE, and has been published in The New York Times MagazineThe Columbia Journalism Review, The Los Angeles Times and The New Republic, among other outlets. He was also previously a freelance editorial consultant for the Foundation for a Smoke-Free World; The Influence Foundation, which operates Filter, has received grants from the Foundation for a Smoke-Free World. He is currently based in Los Angeles.

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