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Doctors urge Theresa May to publish anti-smoking strategy

In a letter to the PM, medical professionals say plan is essential to cut smoking rates, which are highest among poorest in society

More than 1,000 doctors, healthcare professionals and public health experts, including heads of royal colleges and public health institutions, are calling on the prime minister to publish the latest tobacco control plan without delay.

In a letter to Theresa May, the senior doctors say the plan is essential to drive down smoking rates, which are highest and most damaging to health among the least well-off. The plan was due to be published last summer.

Reminding May of her commitment to “fighting against the burning injustice that if you’re born poor, you will die on average nine years earlier than others”, they point out that half of that difference in life expectancy is caused by smoking.

The letter, which is being published in the British Medical Journal, is being sent to May by Dr Andrew Furber, president of the Association of Directors of Public Health, and Prof John Middleton, president of the Faculty of Public Health.

Furber warned that progress against smoking, which has been good in recent years, could slip. “Directors of public health in local authorities are charged with the responsibility of reducing smoking prevalence. But to succeed needs leadership at national as well as local level,” he said.

“The government must renew the tobacco strategy without further delay. Otherwise we risk losing the momentum gained from recent welcome changes such as standardised packing.”

Middleton said: “Smoking rates have declined over the years, in large part because of concerted government action. However rates are still highest amongst the poorest and if the prime minister truly wants to increase the life expectancy of the poorest in society her government needs to renew its tobacco control strategy, which expired over a year ago.”

The first tobacco strategy in the UK was the Blair government’s white paper, Smoking Kills, published in 1998. Other plans followed, including Andrew Lansley’s in 2011, then health secretary in the coalition government, which included a commitment to consult on standardised cigarette packaging.

Some anti-smoking measures have been a response to EU legislation, such as advertising and promotion bans. However, says Deborah Arnott, chief executive of Action on Smoking and Health, tobacco control strategies have reduced smoking rates in England faster than in some other European countries, particularly among children.

In 1998, 24% of 15-year-olds were smoking, but by 2014 that proportion had dropped to 8%. “France and Germany had European legislation but their rates have not gone down as fast,” she said.

There is also evidence that smoking rates can rise again if the pressure is eased. New York City’s successful Tobacco-Free Living initiative, which lowered smoking rates from 21% in 2002 to 14% by 2010, suffered funding cuts to mass media campaigns from 2009. By 2011, smoking rates rose, reaching 16.1% in 2013, but fell again after more investment in 2014.

Experts hope the new UK tobacco control plan, which has been delayed in part because of the Brexit vote and its fallout, will plot the course for driving smoking rates down to 5% by 2035, which a report from Cancer Research UK said was feasible.

“What we want is a smoke-free future,” said Dr Nicholas Hopkinson, a consultant chest physician at the Royal Brompton hospital and reader in respiratory medicine at Imperial College, who coordinated the letter.

Support for mass media campaigns is needed, he says, as well as the continuation of policies on the cigarette pricing and tobacco smuggling. Spending on media campaigns in England has dropped in the past five years from just under £25m in 2009-10 to £5.3m in 2015, although evidence shows they help people quit.

“It is absolutely clear these interventions work. It is just keeping up the momentum and making sure there is a high priority to this,” he said. “There are 9 million smokers in the UK, and smoking is increasingly associated with inequality – it is quite a bit higher in the poorer parts of society.”

Among the signatories are the heads of several medical colleges. One of them, Prof Neena Modi, president of the Royal College of Paediatrics and Child Health, said: “Most smokers become addicted as children and once addicted find it extremely difficult to quit. Since the government introduced a strategy to tackle smoking in 1998, smoking rates among 15-year-olds have fallen by two-thirds.

“We must not put that achievement at risk. The last tobacco strategy expired over a year ago, so we want to see the new plan published and enacted as a matter of urgency.”

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