Smoking prevalence in England

Smoking is a leading cause of preventable illness and death. Figures for England show there were just over half a million (506,100) hospital admissions due to smoking in 2019/20 and in 2019 there were 74,600 deaths attributed to smoking.

Smoking prevalence has shown a declining trend since the mid 1970s. In 2009, 22% of men and 20% of women in England smoked, compared with 17% of men and 14% of women in 2019. Overall smoking prevalence fell from 21% in 2009 to 16% in 2019.

The ‘smokefree’ target will be said to have been reached when adult smoking prevalence falls to 5% or less.

The Smokefree 2030 target for England

In 2019, the Government published its green paper on preventative health; Advancing our health: prevention in the 2020s. Here, it announced its ambition for England to become ‘smoke-free’ by 2030. This included an “ultimatum” for industry to make smoked tobacco obsolete by 2030, and an intent for smokers to quit or move to “reduced risk products like e-cigarettes”.

Some health campaign groups, such as Action on Smoking, have welcomed the target whilst warning that the scale of work needed to accomplish it is . Speaking of this “extremely challenging target”, the Government itself has acknowledged that to “achieve this vision of a smoke-free future, we need bold action to both discourage people from starting in the first place, and to support smokers to quit”.

Public health policy is devolved and each of the devolved nations sets its own policy on smoking cessation.

In October 2021, the Government launched the Office for Health Improvement and Disparities (OHID). This formed part of a wider reform of the public health system in England which saw the dissolution of Public Health England (PHE) and the formation of the UK Health Security Agency (UKHSA) which will focus on health protection. OHID’s responsibilities include preventable risk factors for poor health, such as obesity, alcohol consumption and smoking.

The Welsh Government has also set a smokefree target for 2030, whilst the smokefree target has been set for 2034 in Scotland. Northern Ireland has not set a smokefree target.

The Tobacco Control Plan

The 2017-2022 Tobacco Control Plan for England, published by the Department of Health and Social Care (DHSC) in July 2017, highlighted the progress made in reducing smoking prevalence since the previous Plan but acknowledged that there was still more work to do.

Particular concern was raised about smoking prevalence in young people, pregnant women and people with pre-existing health conditions and low socioeconomic status.

The Plan set out the Government’s vision for a ‘smokefree generation’, and four overarching ambitions:

1. The first smokefree generation

People should be supported not to start smoking, so we aim, by the end of 2022 to: 

  • Reduce the prevalence of 15 year olds who regularly smoke from 8% to 3% or less.
  • Reduce smoking prevalence amongst adults in England from 15.5% to 12% or less.
  • Reduce the inequality gap in smoking prevalence between those in routine and manual occupations and the general population. To do this we need all public services to work together, leading the way in helping people to stop smoking. After 2022, we will continue to reduce smoking prevalence further, on our way to a smokefree generation.

 2. A smokefree pregnancy for all 

Every child deserves the best start in life, so we aim, by the end of 2022 to: 

  • Reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less. 

3. Parity of esteem for those with mental health conditions

 People with mental ill health should be given equal priority to those with physical ill health, so we aim to: 

  • Improve data collected on smoking and mental health to help us to support people with mental health conditions to quit smoking.
  • Make all mental health inpatient services sites smokefree by 2018. 

4. Backing evidence based innovations to support quitting

 We are committed to evidence-based policy making, so we aim to:

  • Help people to quit smoking by permitting innovative technologies that minimise the risk of harm. · Maximise the availability of safer alternatives to smoking.

The Government’s new Tobacco Control Plan is due to be published later in 2022.

For further discussion of the Tobacco Control Plan, see our briefing Delivery of a new Tobacco Control Plan (November 2021).

Independent review on the Smokefree 2030 target

In February 2022, Health Secretary Sajid Javid made a statement in the House of Commons where he updated Members on work the Government was taking in response to health inequalities. 

He explained that Government . The first review, into “potential ethnic bias in the design and use of medical devices”, would be led by Professor Dame Margaret Whitehead.

The second review would consider the Government’s ambition to be Smokefree by 2030, and is being led by Javed Khan, formed CEO of children’s charity Barnardo’s. The the premise for the review:

Whilst the Government has made good long-term progress in reducing smoking rates, there are still nearly 6 million smokers in England, and an estimated 64,000 people died from smoking in 2019 alone. Smoking is one of the largest drivers of health disparities and causes a disproportionate burden to our most disadvantaged families and communities.

The Health Secretary further explained that the review would support the Government to identify “the most impactful interventions to reduce the uptake of smoking, and support people to stop smoking, for good”. Government has also said that the review will inform the new Tobacco Control Plan, expected later this year.

A DHSC press release explains that the reviews on medical devices and the 2030 smokefree target form part of OHID’s agenda to address inequalities in health and care.

What will the review consider?

The Terms of Reference explain that the review will make recommendations about which policies should be put in place to achieve the government’s Smokefree 2030 ambition, particularly to address the health disparities associated with smoking. Its objectives are to consider: 

  • The most impactful interventions to reduce the uptake of smoking particularly among young people.
  • The top interventions to support smoking cessation, particularly in deprived areas of England where there are significant health disparities. 

The review is expected to take place over 12 weeks. Whilst it is focused on England, it will also consider whether policies would be suitable for UK-wide implementation. 

The Government has said it hopes to publish the review in May, and that it does not intend to publish a response.

Further reading: News and comment

Local Government Association briefing

Progress towards the Government’s smokefree ambition, House of Commons, 26 April 2022

Asthma and Lung UK

March 2022

Levelling up health by stamping out tobacco

British Medical Association

9 March 2022

Tobacco

Action on Smoking and Health

Roadmap to a smokefree 2030

FT

2 January 2022

Spending cuts and deprivation hit England’s plans to stub out smoking by 2030

Delivering a Smokefree 2030: The All Party Parliamentary Group on Smoking and Health recommendations for the Tobacco Control Plan 2021

British Heart Foundation

9 June 2021

Smokefree England an ‘achievable’ ambition, says BHF following new report

Guardian

11 June 2021

Once unthinkable, a ‘smoke-free’ Britain may soon be a reality

Cancer Research UK

23 July 2019

Government says England will be smokefree by 2030. But how will it get there?

Commons Library briefing for previous debates

Delivery of a new Tobacco Control Plan

November 2021

Recommendations for the new Tobacco Control Plan

June 2021

Effect of the covid-19 outbreak and the abolition of Public Health England on achieving a smokefree England by 2030

November 2020


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