There have been howls of protest from public health activists over press reports that Secretary of State for Health, Thérèse Coffey, may have backed out of a commitment to publish a tobacco control plan for England later in the year. The same knee-jerk activists have expressed dismay at rumours that the government will not act on recommendations contained in a government-commissioned independent review by Dr Javed Khan published in June.
Khan’s review demanded costly and punitive state interventions along with eye-watering tax increases as the country was entering a cost-of-living crisis. It also contained off-the-wall proposals such as banning the sale of cigarettes in supermarkets, raising the smoking age by a year every year, and painting cigarette sticks green. All of these recommendations would be unpalatable to the previous government let alone the current one with its commitment to ditch the nanny state.
However, this should not mean that the government can do nothing to drive down smoking rates. Indeed, there are options which would fit in perfectly with the liberal path the Truss government wishes to pursue.
The steepest declines in smoking were not achieved by thoughtless traditional approaches such as plastering cigarette packs with ghoulish images or hiding them behind shutters, but instead through allowing smokers to make their own choice to switch to far safer products. Between 2012 (when vaping went mainstream) and 2020, smoking prevalence plummeted by an unprecedented 25 percent, proving that harm reduction – the acceptance that people will consume unhealthy products so it is best to guide them to those which present the least risk – can be a highly effective public health tool.
These trends have been seen globally. The use of heated tobacco products in Japan has led to a halving of cigarette sales in just six years. Whilst they are available in the UK, poor public health messaging means that only 14 percent of the public are aware these much safer products exist. The sale of Snus, oral tobacco which has been pasteurised to remove all carcinogens, is banned in the UK for no convincing reason. This is despite it being responsible for Sweden boasting by far the lowest smoking prevalence and rate of smoking-related diseases of any European country.
Khan’s review spoke of making smoking obsolete, but to do so requires there to be a better alternative. Vaping has been that alternative for 4.3 million British people, so the government should double down on tobacco harm reduction and promote other options for smokers who are unsure about switching or for whom vaping does not work.
There are still around 7 million people smoking, mostly concentrated in the poorest and most disadvantaged socio-economic areas. The current tobacco control approach is interventionist, costly, and ineffective. Endorsing lower-risk products instead and promoting their use would encourage many more to try them and could achieve better results than a top-down tobacco control plan.
Governments try to stop people from smoking because of the well-known deadly health effects, but non-combustible nicotine products all but eradicate these while giving smokers the nicotine that they enjoy in cigarettes. If Ms. Coffey is looking for a low intervention Conservative way of proceeding, unleashing the potential of reduced risk products is low-cost, liberal, and is a welcome departure from nanny state intervention.
