The history of tobacco legislation
Tobacco is the single biggest cause of preventable illness and death in the UK with smoking highlighted as a top five priority of risk factors which cause premature deaths in England, in The Global Burden of Disease study. Globally, WHO cites the ‘tobacco epidemic’ as ‘one the biggest public health threats the world has ever faced, killing more than eight million people a year, including 1.2 million deaths from exposure to second-hand smoke’.1
The foundations of tobacco control are built upon research carried out by Sir Richard Doll into the epidemiological link between tobacco and cancer.2 In 1950, Doll and statistician Sir Austin Bradford Hill conducted a large case-control study to demonstrate that smoking was a cause of cancer, following a ‘phenomenal increase in the number of deaths attributed to cancer of the lung’.3 Following the results, Doll and Hill began the 50-year long British Doctors Study which ultimately proved beyond reasonable doubt the relationship between smoking and a prospective risk of death from lung cancer.4
In 1962, the Royal College of Physicians published their first report: Smoking and Health5, which included early data from Doll’s studies, highlighting the link between smoking and lung cancer. The report made recommendations to the Government on the advertising of tobacco, smoking in public places, taxation on cigarettes and restricting the sale of cigarettes to children. The report was widely publicised, selling thousands more copies than expected and, for the first time in ten years, sales of cigarettes fell.
Although it received criticism and resistance from many sectors, the report was one of the first progressive steps in the tobacco control movement.
Throughout the late 20th Century, some controls on tobacco were introduced, but many remained voluntary. In 1965, cigarettes were banned by the Government from being advertised on television and taxation on cigarettes slowly began to increase. Public opinion also began to shift and in 1984 National No Smoking Day was launched to encourage smokers to quit smoking. By 1989, a survey of smokers showed that 79% thought the day was a good idea and 5 million intended to try and give up.6
However, it wasn’t until the early 2000s that legislation on tobacco really began to change. Scotland was the first country in the UK to enforce rules which banned smoking in public, passing the Smoking, Health and Social Care (Scotland) Act 2005. In 2006, The Health Act was passed in England which implemented various legislation on smoking and tobacco products – creating a ban on smoking in enclosed public places and raising the legal age of purchase from 16 to 18. In 2007, the Smoke-free premises regulations (Wales) came into effect using the powers in the Health Act 2006 and Northern Ireland’s equivalent, the Smoking (Northern Ireland) Order came into effect in 2006.
In October 2015, the Health Act was updated, requiring private vehicles to be smoke-free when carrying more than one person or a passenger under 18 and then two years later, the Government produced the ‘Tobacco-control plan 2017-2022’ which laid out various targets to achieve and recognised achievements from the previous plan.
The milestones reached are, in no small part, attributable to the work of Directors of Public Health, who identified local solutions and the need to support local councils to eliminate regional and socio-economic variations in smoking rates. Current targets include reducing the prevalence of 15-year-olds who smoke regularly from 8% to 3% or less, reducing the prevalence of smoking in pregnancy from 10.7% to 6% or less and reducing smoking among adults in England from 15.5% to 12% or less.
In 2019, the ‘2030 Smokefree’ ambition was announced by the UK Government, aiming for fewer than 5% of people to smoke by 2030. However, despite pressure from ADPH and other partner organisations campaigning to end the harm caused by tobacco, few policy measures have been introduced to reach the target and following current trends, the poorest in society will not meet it until 2044.7
Dr Javed Khan was commissioned to produce an independent review, ‘Making Smoking Obsolete’, which was published a year ago, in June 2022. The review, which considered what was needed to achieve the 2030 target, made 15 recommendations, including the promotion of vapes as an effective ‘swap to stop’ tool to help people quit smoking. Khan also recommended that an extra £125 million should be spent per year on Smokefree 2030 policies.8 The Smokefree Action Coalition and Action on Smoking and Health (ASH), of which ADPH is a member and partner organisation respectively, have vocalised their support for the Smokefree target whilst emphasising the need for continued funding and support to ensure the Government delivers on these targets.9
In April this year, Minister Neil O’Brien gave a speech in response to the findings of the Khan Review. He laid out the Government’s plans to introduce a ‘swap to stop’ scheme, and to support pregnant women to quit. Whilst these proposals came as a welcome commitment to the Government’s tobacco control plan, ADPH feel they fall short of the measures needed to achieve a Smokefree 2030 and are concerned that others, such as raising the age of sale, have been overlooked6. There are also growing fears regarding the use of vapes in children and young people, with a recent study from ASH showing a 50% increase in children experimenting with vapes from 7.7% in 2022 to 11.6% in 2023.10
In recent years, e-cigarettes have been proffered as a substitution for smoking as they are less harmful than cigarettes. According to a study by ASH, nearly two thirds of current vapers are ex-smokers, and nearly 3.6 million people in the UK now vape.11 However, concerns remain regarding their effect on health due to the nicotine content of vapes, and given the relative newness of the technology, knowledge of the long-term consequences on health are still unknown.
Just last month, in May 2023, the Prime Minister Rishi Sunak and Chief Medical Officer (CMO) for England, Professor Sir Chris Whitty, responded to an investigation into the sale of vapes to underage children which exposed dangerous levels of lead and other poisons in vapes. The PM laid out plans to close the legal loophole that allows free samples of vapes to be given to children, and to tackle advertising aimed at underage consumers.12 The CMO summarised vaping in three key points, echoed by ADPH:
- If you smoke, vaping is much safer.
- If you don’t smoke, don’t vape.
- Marketing vapes to children is utterly unacceptable.13
Although the medicalisation of smoking cessation in the NHS supports many thousands of smokers, community solutions remain critical in maximising all opportunities to encourage people to quit.
‘What good local tobacco control looks like’, an ADPH publication released as part of ‘The What Good Looks Like’ programme, represents a practical translation of the goals set out in the Control Plan using existing evidence and examples of good practice.14 One such example is a letter from the North East DsPH titled ‘Smoke Free Laws 10 years on’ which highlights the progress made in the North East, with DsPH witnessing the largest regional fall in smoking in England with around 218,000 fewer adults smoking.15
Tobacco controls have definitely become more stringent through decades of campaigning and the prioritisation of public health and, as a result, there has been a significant improvement to people’s health. Meanwhile, vapes and e-cigarettes pose both a new threat and an opportunity to tobacco control plans, serving as a useful tool in eliminating the widespread use of cigarettes whilst raising questions around their long-term health impacts.
ADPH have recently published a new policy position statement outlining the public health threat that tobacco poses. As well as publicising our local and national recommendations for mitigating these threats, ADPH will continue to advocate for the views of DsPH, who are doing everything possible to stop the entirely preventable impact that tobacco has on our health.
1 https://www.who.int/news-room/fact-sheets/detail/tobacco
2 https://tobaccocontrol.bmj.com/content/14/5/289
3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2038856/
4 https://www.ctsu.ox.ac.uk/research/british-doctors-study
5 https://www.rcplondon.ac.uk/projects/outputs/smoking-and-health-1962
6 https://ash.org.uk/resources/view/key-dates-in-tobacco-regulation
7 https://www.adph.org.uk/2023/04/fallfarshort/
9 https://smokefreeaction.org.uk/wp-content/uploads/2020/01/Roadmap-to-a-Smokefree-2030-FINAL.pdf
10 https://ash.org.uk/resources/view/use-of-e-cigarettes-among-young-people-in-great-britain
11 https://ash.org.uk/uploads/Use-of-e-cigarettes-vapes-among-adults-in-Great-Britain-2021.pdf
12 https://www.gov.uk/government/news/no-more-free-vapes-for-kids
13 https://www.gov.uk/government/speeches/chief-medical-officer-for-england-on-vaping
14 https://www.adph.org.uk/wp-content/uploads/2019/06/What-good-local-tobacco-control-looks-like.pdf
15 http://www.freshne.com/in-the-news/pr/item/2179-smokefree-law-directors-public-health.html