Tobacco ruins lives. It causes conditions ranging from stillbirth and asthma to dementia and cancer, leads to over 400,000 hospital admissions a year, and ultimately kills two in three lifetime smokers.
Over the coming weeks, MPs will debate new laws to create a ‘smoke-free generation’, meaning no-one born on or after 1 January, 2009, can be legally sold a cigarette. This is a truly transformative piece of public health policy that could see an end to tobacco use in England.
Banning sales of a product eliminates individual choice and is not a policy approach to be taken lightly. Yet, as a freely available product to people over 18, tobacco is a uniquely harmful and addictive substance that warrants a uniquely restrictive policy approach. There are no safe levels of tobacco, no safe age to smoke, and no health benefits.
Addiction generally starts young; children who grow up in a household with smokers are three times more likely to start smoking themselves. And once hooked, three out of four smokers wish they had never started, yet it takes an average of 30 attempts to quit.
The costs are eye-watering. Tobacco use in England is estimated to cost £49 billion annually in lost productivity, health care and social care – with smokers generally earning less, experiencing more ill health, and needing social care up to a decade earlier than non-smokers. By contrast, tobacco duties in 2022-23 were less than a quarter of costs at just £10bn.
The policy will see the legal age for being sold tobacco rise by one year each year from 2027. While the proposed age escalation approach is novel, we know that raising the age of purchasing works. Smoking rates dropped by 30 per cent among young people within a year when the legal age increased from 16 to 18 in 2007. The drop was closer to 40 per cent among the target age group when it was raised from 18 to 21 in the US.
There are concerns among some that the new policy could drive an illicit market, but the evidence doesn’t back this up.
Since 2000 the illicit market for tobacco has halved from 22 per cent to 11 per cent despite raising the age of purchasing to 18, banning smoking in public places, introducing plain packaging, and continued price rises.
Furthermore, the policy focuses on preventing people from taking up smoking – no one who can currently buy tobacco will be unable to do so – making it unlikely there will be an increased demand for illegal tobacco. And finally, there is £30m a year extra over the next five years for Border Force, HMRC and council trading standards teams to deliver a new illicit tobacco strategy and strengthen enforcement both in stores and online.
There is limited precedent for this type of age-escalating legislation, so councils, enforcement officers, and the UK government will need to quickly learn about how best to work with retailers and the public over the coming years.
New powers for trading standards teams to issue £100 spot fines to retailers breaching age-of-sale regulations may help, but more fundamentally, trading standards teams across England face huge challenges with recruitment and resourcing which will have to be addressed.
Local government budgets have also faced a decade of severe cuts, with the current funding gap in England estimated to be as much as £4bn. Trading standards teams need long-term financial security, and it is unclear how much of the £30m for enforcement will make its way to support local officers.
Online sales may also present their own challenge as the age of sale increases, with digital retailers being obliged to verify the age of customers remotely. The government is promising “enhancing online age verification” but it would be far simpler to ban online tobacco sales altogether, as recommended in a recent independent government review.
Alongside preventing people from taking up smoking, it is also crucial that people who currently smoke get the help they need to quit.
Cuts to the local government public health grant since 2015/16 has seen spending on local ‘stop smoking’ services down by 45 per cent. In response, the government is doubling funding for these services to £138m, with the aim of helping 360,000 people set a quit date each year.
Polling from Ipsos and the Health Foundation shows that 69 per cent of the public support the smoke-free generation policy – including 74 per cent of Conservative voters and 73 per cent of Labour voters.
Yet the recent experience of the incoming government reversing similar plans in New Zealand underlines how politically fragile the smoke-free generation policy can be. Ongoing evaluation of the policy will therefore be vital to maximise benefits, address any unforeseen consequences, and to build the evidence base for longstanding political support into the future.
The UK government has a unique opportunity to lead the world in tackling tobacco and preventing death and disease for generations to come, an opportunity that MPs should grasp with both hands.
- Kate Dun-Campbell is Specialist Registrar in Public Health and Adam Briggs is Senior Policy Fellow at The Health Foundation
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