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Opinion: ‘Widening health inequalities in England should be a wake-up call for the Government’

Alizée Froguel
by Alizee Froguel | Analysis

25 February 2020

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A crowd of people

In 2010, research revealed that people living in England’s most deprived neighbourhoods were not only dying sooner but were also living in poor health for longer.

And 10 years on, things have only got worse.

The newly published Marmot review paints a fairly bleak picture, with health inequalities widening and life expectancy stalling in England. For the first time in more than 100 years, life expectancy has failed to increase for a decade across the country.

People are also spending more of their lives in poor health than they were a decade ago and there’s a steep social gradient associated with this – the poorer the area, the longer people are living with bad health.

It’s a depressing, but perhaps unsurprising picture given the large and widespread cuts to local authorities’ budgets over the last decade. These cuts have varied across the country, falling the hardest on areas where needs are higher.

Smoking and health inequalities

Tobacco control has faced some of the harshest cuts, despite the fact that smoking remains the biggest preventable cause of cancer in the UK, causing 120 new cases of cancer every day. It’s also responsible for half of the difference in life expectancy between the richest and poorest in society.

Smoking rates among adults in routine and manual work in the UK are more than double (25.5% vs 10.2%) those among adults in managerial and professional roles. And smoking rates vary dramatically between the richest and poorest communities.

Slashed budgets have had a hugely detrimental impact on tobacco control, with cuts threatening the success of essential activities that help people avoid smoking as well as giving them the motivation and support they need to quit. While all areas used to have a universal Stop Smoking Service, which gives people the best chances of quitting, this has now dropped to only 59% of areas in England offering this service.

And while smoking rates have fallen in the UK as a result of government action, we can’t afford to be complacent.

The latest figures should be a wake-up call for the Government. New projections show around a 20-year gap in smoking rates between the least and most deprived people in England, with the richest expected to achieve smoke-free in 2025, and the poorest not reaching it until the mid-2040s.

The message is clear: we cannot truly close the gap in health inequalities unless we take action to significantly reduce the number of smokers across England.

The ambition is there. The UK Government has committed to making England smoke-free by 2030 – getting the overall proportion of adults who smoke down to 5%. They admitted at the time that reaching this goal would be “extremely challenging” and would require “bold action”.

And our most recent projections suggest they were right, we’re not on track to meet this target, particularly amongst the most deprived people in England who are not expected to reach smokefree until well into the 2040s.

If we’re to meet this lofty target by 2030, smoking rates need to drop 40% faster than projected. The Government must urgently reinvest in stop smoking services and national education campaigns that encourage smokers to quit. And it will mean finding a sustainable way of funding these essential activities.

The tobacco industry should pay

There is a clear solution – forcing the tobacco industry to pay, through a Smokefree 2030 fund.

Tobacco is the only commercial product that’s lethal when used as intended, killing at least half of its users. As the makers of such a harmful product, it’s only right that the tobacco industry pay for the harm it causes. And they have the funds for it – tobacco manufacturers make more money every year than Coca Cola, Disney, Google, McDonalds and FedEx combined.

Whatever solution the Government reaches, it’s vital they reach it without influence from the tobacco industry. Which could prove difficult.

Documents obtained by The Guardian and Channel 4’s Dispatches show that Phillip Morris International tried to put forward a bill that would put in place a tobacco transition fund in the UK to be spent by local authorities and Public Health England.

But there’s a catch – they want to be able to influence where the money goes, using it to persuade smokers to switch to one of Phillip Morris International’s other products, such as the “heat not burn” tobacco device, IQOS. And they wanted to lift advertising restrictions that help ensure these products are not promoted to non-smokers and children.

Granting the tobacco industry this type of influence would not only contravene our legal obligations, it would also be hugely detrimental to public health interests.

To help make smoking history, tackle health inequalities and ensure that everyone is getting an equal chance to be healthy for longer, Government must implement a Smokefree 2030 Fund. One that uses industry funds but without industry interference.

Alizee Froguel is a policy advisor at Cancer Research UK