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The UK Government’s response to Javed Khan’s tobacco review: A small step in the right direction, but much more action is needed

Alizée Froguel
by Alizee Froguel | Opinion

11 April 2023

3 comments 3 comments

Earlier today, the Public Health and Primary Care Minister Neil O’Brien MP made a speech that finally responded to the independent review into tobacco control led by Dr Javed Khan OBE.

Whilst a small positive first step, the UK Government has missed a key opportunity to get us back on track to achieving a Smokefree 2030 and cementing the UK’s historic position as a world leader in tobacco control.

Smoking is still responsible for around 150 cancers a day – cancers that can be prevented. This means that since Khan’s review (which was published in June last year), at least 40,000 people’s lives have been changed forever with a cancer diagnosis caused by smoking in the UK.

This sobering statistic demonstrates how important the UK Government’s response to the review was to Cancer Research UK’s aim of preventing more people from getting cancer.

As well as preventing cancers, we also know that reducing smoking rates will help to reduce pressure on the NHS and grow the economy.

The UK Government had commissioned Khan to guide them in deciding which measures they would implement to achieve their own target of making England smokefree (5% overall adult smoking prevalence) by 2030 – which Cancer Research UK modelling suggests we’re currently 9 years off track for. This review was informed by the latest evidence from experts in tobacco control across the world.

Today, the Minister unveiled which of Khan’s 15 recommendations 4 of which he deemed critical – would actually be taken forward by this Government

“If the Government is to reach its own target of a smokefree England by 2030 and reduce pressures on the NHS it needs to go much further and faster. While today’s announcement is a small step in the right direction, Government has missed a key opportunity by only substantially implementing 1 of the 4 critical recommendations made by the Independent Review of Smoking.

“Since the Khan review was published in June 2022, at least 40,000 people’s lives have been changed forever with a cancer diagnosis caused by smoking in the UK. To help reduce these numbers the Government should follow the evidence by raising the age of sale on tobacco and committing more funds to help people quit.

“Bold action is required if future generations are to be protected from the suffering caused by smoking addiction – and we urge the Government to act further.”

– Michelle Mitchell, chief executive of Cancer Research UK

 

Welcomed commitments

 Around 5.4 million adults currently smoke in England – so we were pleased that today’s speech took forward some of the recommendations made by Javed Khan to help people quit smoking.

E-cigarettes are the most popular smoking cessation tool in England. Whilst we do not know their long-term effects, evidence so far shows that e-cigarettes are far less harmful than smoking and they are effective at helping people to stop.

Today’s announcement committed to a world-first national ‘Swap to Stop’ scheme that is set to offer 1 million people who smoke, over two years, a vape starter kit, alongside behavioural support to help them quit smoking. This scheme – in line with one of Khan’s four ‘critical recommendations’ – will be overseen by local authorities who will be able to tailor it to the needs of their specific populations.

Smoking is the biggest driver of health inequalities, and there are nearly twice as many cancer cases caused by smoking in the most deprived areas compared to the least deprived in England. Providing a free e-cigarette to people who want to stop smoking could help to remove a key financial barrier to swapping.

We also know that staying smokefree during pregnancy reduces the risk of miscarriage, stillbirth, and babies born underweight or with health problems.

That’s why it was extremely positive that the Minister announced that all pregnant women who smoke will be offered financial incentives to quit, alongside behavioural support, by the end of the year. This announcement follows the success of local schemes, was recommended by NICE clinical guidelines, and was informed in part by research funded by Cancer Research UK.

The speech also confirmed the UK Government would be consulting on introducing mandatory pack inserts in cigarette packs, which would include positive messages and information to help people quit smoking. This is a measure we have been calling on the UK Government to explore, so it’s great to see it being taken forward.

Measures to combat the illicit sale of tobacco and vapes were also announced. For tobacco, this included a new strategy from HMRC and Border Force which will be launched later this year. This will lay out how they continue to target, catch and punish those involved in the illicit tobacco market.

To reduce youth vaping, the UK Government also announced £3m of new funding to create a specialised ‘illicit vapes enforcement squad’ that will combat illicit vapes and sales of vapes to under-18s. A call for evidence was also launched that will look at ways to limit young people vaping – while ensuring vapes remain available as a quit tool for adults who smoke.

Whilst far less harmful than tobacco, e-cigarettes are not risk-free and we don’t know their long-term impact. It’s therefore important we prevent people who have never smoked, especially young people, from taking up e-cigarettes.

We welcome the UK Government taking a balanced approach to e-cigarettes that both maximises their potential to help people quit, but also minimises the risk of uptake by young people.

More action is needed

However, on their own, these announcements will not be enough to achieve Smokefree 2030 – which would require smoking rates to drop 70% faster than currently projected – according to our modelling. The burden of smoking is not felt equally – we know that certain groups are more likely to smoke than others and more needs to be done to help those most at need.

Whilst the measures above do include some new funding for tobacco control, it is substantially less than the minimum £125m increased investment called for by Javed Khan as his first ‘critical’ recommendation. In particular, the £70m recommended investment to fund local stop smoking services and the £15m for mass media campaigns were notably absent from today’s announcement.

As our #SmokefreeUK campaign has been highlighting – we need more funding to help people quit tobacco for good. Stop smoking services give people who smoke the best chance of quitting – but unfortunately these aren’t available universally across the country, largely due to funding cuts.

The UK Government could have made this investment without costing the taxpayer – by making the tobacco industry foot the bill for the damage it causes, through a Smokefree Fund. This would use industry funds, but without industry interference, to help pay for the cost of tobacco control.

Our campaign has also been calling on the UK Government to Stop the Start of smoking – by consulting on raising the age of sale of tobacco. Whilst it’s positive to see the UK Government act to reduce the uptake of vaping by young people, this does not address the uptake of cigarettes – despite the harms of tobacco being indisputable. When used exactly as recommended by the manufacturer, cigarettes are the one legal consumer product that will kill most users – 2 out of 3 people who smoke will die from smoking.

Almost 9 in 10 people who smoke report taking up smoking before the age of 21. Raising the age of sale of tobacco – either to 21 or by a year each year (such as in New Zealand) could therefore help prevent people from starting smoking in the first place.

The above measures would not only help to reduce pressure on the NHS, grow the economy and save lives – but we also know that they’re supported by the public. YouGov polling for Cancer Research UK showed that 75% of people agreed with raising the age at which you can buy tobacco products from 18 to 21, and 61% supported raising it by a year each year (the so called New Zealand model)*. We have a duty to protect young people and the next generation from a lifetime of ill health, so it’s extremely disappointing to not see an announcement on raising the age of sale.

Overall, today was a small step in the right direction, but the UK Government has a lot more work to do and we need to act fast if we’re actually going to stub out smoking for good and reach the Smokefree target. We know what needs to be done – and with your help, through our #SmokefreeUK campaign we can turn these small steps into giant leaps forward to tackle smoking – the biggest cause of cancer in this country.


* Question asked: To what extent, if at all, do you agree or disagree with the following suggestions as measures to decrease tobacco use? All figures are from YouGov Plc.  Total sample size was 1774 adults. Fieldwork was undertaken between 11th – 12th July 2022.  The survey was carried out online. The figures have been weighted and are representative of all adults in England (aged 18+).


    Comments

  • Lizzy Bowen
    30 April 2023

    Interesting report. Could be more succinct.

  • J Chapman
    27 April 2023

    Keep up the pressure

  • Samirah
    26 April 2023

    I agree with this suggestion as a measure to decrease tobacco use

    Comments

  • Lizzy Bowen
    30 April 2023

    Interesting report. Could be more succinct.

  • J Chapman
    27 April 2023

    Keep up the pressure

  • Samirah
    26 April 2023

    I agree with this suggestion as a measure to decrease tobacco use