A momentous day

Today, the Tobacco and Vapes Bill has been granted Royal Assent. This is a momentous day and, if I am really honest, one I never thought I would see. It is without doubt the greatest piece of public health legislation in a generation and a huge landmark which will be talked about for years to come.

To recap, in case anyone has missed it – smoking kills. The stats are astonishing – in the UK alone, 80,000 people die from smoking every year. It is the leading preventable cause of cancer in the UK, responsible for 16 types of cancer and six in 20 cancer deaths and is also a major factor in heart disease and stroke.

It also costs. £43.7 billion a year. That’s due to health and social care costs as well as lost productivity according to recent modelling from Action on Smoking and Health which, going by my (very rough) calculations, would be enough money to triple the number of nurses working in the NHS.

What’s more, 65% of people in England want to live in a country where no one smokes, with support spanning all age, income, and regional groups.

For me though, the stat that really brings home the reason today’s legislation is such a game changer is that over 80% of smokers start before they turn 20, many as children, with 127,500 young adults aged 18 to 25 taking up smoking each year in the UK. These young people at the start of their lives then quickly become addicted and, once addicted, it is incredibly hard to stop.

Today’s legislation will stop that cycle of addiction before it ever starts, protecting our children, and their children after them, from ill-health, disability, and premature death.

The other area that this legislation will really change the dial on is the unacceptable gap between health outcomes for people living in different areas and from different backgrounds. Despite a steady fall in smoking rates thanks to the various interventions and restrictions introduced over the past 50 years, smoking is one of the biggest drivers of poor health, with higher smoking rates being linked to almost every indicator of disadvantage.

In 2023, 14% of people aged 18 and over living in the most deprived areas were current smokers compared with only 9% of people living in the least deprived areas. That means that people already at a disadvantage financially, are far more likely to have to reduce or stop working due to ill-health, compounding their financial challenges.

That is simply not fair.

Smoking is not a result of individual people’s choices – the stats bear that out. If it were, then population level interventions like restricting tobacco advertising, would not have had the impact they have. This Bill therefore represents the next big moment in our fight against the tobacco industry’s drive to make a profit from selling lethal products because, by protecting our children and young people from ever becoming addicted, we are giving them the freedom to live a future where everyone – regardless of background, education or income – has more of an opportunity to live a healthy life for longer.

This shift in focus away from individual choice and treatment towards preventing harm in the first place is absolutely key to improving the nation’s health. I am beyond delighted that it is happening with tobacco, but I really hope that it also signals a change in direction for how we tackle the negative impacts on our health that result from the consumption of other unhealthy products, including gambling and alcohol.

Just as rates of smoking have, over the years, been influenced by a range of industry tactics, from advertising and marketing to research funding and policy influence, consumption of a range of other harmful products is also driven by similar tactics.

One such tactic is the ongoing re-invention of industry products, with new iterations often framed as helping to combat any negative consequences of the original product. This is a tricky area. On the one hand these products – like vapes, or no and low alcoholic drinks, or gambling industry funded spending limiters – are healthier.

Vapes, for example, are a really important tool in helping adults quit and it is imperative that people don’t equate the harms of smoking with vaping. However, they should be seen as just that, a tool – not an alternative that should be marketed at children and young people as an exciting product to get hooked on. Again, this Bill is paving the way in how to handle these ‘healthier’ commodities by bringing in regulation to stop targeting children and young people in this way, potentially setting them up for a life-time of addiction.

There is still lots to be worked on and ADPH will be representing the views of Directors of Public Health in all of these things. For example, we are currently putting the finishing touches to our response to the Government consultation on the proposals to extend smoke-free laws, and will continue to engage with both national and local governments about the best way to implement and enforce the new regulations.

Today though is a day for celebration. It is a culmination of the decades of hard work the public health, and voluntary and community, sectors have done to bring about an end to smoking harm. It will significantly help our efforts to achieve a smoke-free England by 2030, and I am truly honoured to be in just a small way associated with a day that will be referred to in the history books of tomorrow.