The Khan review is an illiberal non-smoking utopia

Stephanie Holmes

June 10, 2022

A century on from prohibition America, Britain is failing to listen to the history of its friend across the Atlantic. A recent government-commissioned review has called for the smoking age to be lifted by a year, every twelve months. Dr Javed Khan, who led the review, contests that “a smoke-free society should be a social norm.” This healthy utopia is not inherently illiberal, but the measures the review suggests will get us there are.

I am sure Beveridge did not pitch universal healthcare with restricting people on the basis of a common lifestyle choice in mind. Fortunately, his legacy need not be undermined by the financial threat of smokers. Why? Because their hefty cost to the welfare state is nothing more than a common myth. The British Medical Journal published a study using data over 27 years in Finland, showing that a non-smoker costs more to the state than a smoker, by about €4700.

Similarly, an American study found that “thin and healthy” non-smokers cost $417,000 and smokers only $326,000. The Khan review claims that the cost of smoking to the NHS is £2.4 billion, but simply put, non-smokers live longer and therefore require more from the welfare state. The taxes lost by prohibition will not be cancelled out by the financial promise of a non-smoking utopia, because that promise is farcical.

So, if costs were the real problem, the government would encourage smoking, which means that health is the main concern. But contrary to what the review hopes, prohibition doesn’t stop consumption, it creates black markets. Bhutan banned the sale of tobacco products in 2004. In 2008 alone, 1.4 million Ngultrums worth of tobacco products were seized. While Bhutan differs socio-economically from the UK, the latter is still home to a significant illicit tobacco trade, and prohibition policy will undoubtedly worsen it.

Regardless of this, prohibition should not be enforced on principle. If the negative health and economic effects are limited to the individual, what justifies state regulation? After the sugar tax, the government must learn that technocratic public policy just doesn’t work. Value problems must be navigated, as civil liberties must be upheld. All in all, smokers know the side effects and should be free to make the trade-off between health and pleasure.

On this premise, designated smoking areas allow smokers and non-smokers to co-exist, and yet the review calls to get rid of hospitality smoking areas altogether. Ironically, this is to give “customers greater choice of where they sit outside.”

The main caveat of the choice-based approach is that opting out of this cycle is easier said than done, and the decision to quit is often taken from the individual by their addiction. To combat this, instead of taking away more choices, governments can implement non-restrictive mechanisms, which are surprisingly effective and recognised in recommendation 10 of the review.

Media campaigns, for example, can contribute 28 per cent of the cause to the reduction in smoking according to research. And much to Dr Javed Khan’s disappointment, prohibition, as we have seen in Bhutan, cannot lead to a “smoke-free society.” So the review aims to reduce choice, but also to introduce an incremental restriction that will not achieve its proposed health benefits.

The transition to a “smoke-free” utopia that Dr Javed Khan proposes is an unwarranted threat to individual choice. The sooner we stop taking a technocratic approach to public policy, the sooner civil liberties are secured. Challenging misconceptions about the cost of smoking to the state should give power back to the consumer — and set a much-needed precedent in the policy space. Governments do not have to adopt technocratic policies and wait for them to fail. They can nip them in the bud and save us the bother.


  • Stephanie Holmes

    Stephanie Holmes reads Bsc Politics at the London School of Economics and is interested in the role of science in public policy-making.

Written by Stephanie Holmes

Stephanie Holmes reads Bsc Politics at the London School of Economics and is interested in the role of science in public policy-making.

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