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Burning Injustice: Reducing tobacco-driven harm and inequality

Recommendations to the government, local authorities and the NHS

The APPG on Smoking and Health launched this Inquiry to review current action on tobacco control by central Government, local authorities and the National Health Service in a period of tight public spending restraints. There are grounds for serious concern in all three cases that funding is being reduced for work on tobacco control and that the funds that are available are not always being used effectively. The report makes evidence-based recommendations to central Government, local authorities and the NHS about this critically important public health issue in a time of limited resources and increasing pressures on the NHS and social care systems.

In her first major speech as Prime Minister, the Rt Hon Theresa May said that she committed to fighting against “the burning injustice that if you’re born poor you will die on average nine years earlier than others”. This objective cannot be achieved without further progress in reducing smoking prevalence. Reducing smoking prevalence is also essential to the sustainability of public services, and delivers value for money to national and local Government by reducing costs to the NHS and the social care system, and increasing productivity.

Since implementation of a sustained and comprehensive tobacco control programme in 1998 smoking prevalence has reduced considerably, by a third amongst adults and two thirds amongst children. However, smoking remains the leading preventable cause of premature death and disease, responsible for half the difference in life expectancy between richest and poorest social classes.

All the key tobacco control measures set out in the WHO Framework Convention on Tobacco Control have now been implemented in England. Many of these measures, such as the advertising ban, smokefree laws, taxation and standardised packaging, are self-sustaining. However other measures, including mass media campaigns, smoking cessation services and enforcement measures such as tackling tobacco smuggling, require ongoing funding. The inequalities created by smoking will only be eliminated if these measures are sustained.

Given that public spending will be tightly constrained for some years to come, it may be necessary to find new ways of raising funds to pay for tobacco control measures. The tobacco manufacturers, whose products cause so much health, social and economic damage, should make a greater contribution to mitigating that harm. The four major tobacco manufacturers remain among the most profitable companies on Earth, so they could certainly afford to do this.