Will banning future generations from smoking prevent future hospitalisations? By Altay Shaw
At the Conservative Party Conference this year, Rishi Sunak announced his intent to increase the legal smoking age in England. His new plans state that the minimum age would increase by one year every year, preventing anyone who is 14 from ever buying a tobacco based product legally.
So, are there similar policies in other countries? And do they set a precedent for plans in the United Kingdom to work?
The Oceanic Approach
In December 2022, New Zealand became the first country in the world to introduce legislation that would ban smoking for those aged 14 and below. The bill, which had near universal support in its first reading, made it a criminal offence to purchase tobacco based products if the individual was underage. This is part of a larger goal by the New Zealand Ministry of Health to reduce smoking prevalence in the country to less than 5% by 2025.
The Australian government followed suit with their own plans to decrease the number of smokers. They committed $511.1 million AU towards a range of measures aimed at reducing smoking, including a national lung cancer screening program and a $141.2 million AU expansion to an existing program to tackle smoking within the Indigenous population. The higher prevalence of smoking in the Aboriginal and Torres Strait Islander communities is responsible for 1 in 5 deaths. Though these laws extend to increasing the warnings on cigarette packs and sticks they fall short of banning the sale of cigarettes for future generations.
The individual choice of the 6 million smokers in the UK have a high collective cost. Smoking is estimated to cost the taxpayer around £17 billion per year, with around 5% of hospital beds currently occupied by a patient with a smoking-related illness.
Why is it so difficult to quit smoking?
The World Health Organization report on the Global Tobacco Epidemic suggested that there were 24 million adolescents between the ages of 13-15 who smoke worldwide. Whilst quitting is possible, an estimated 92% relapsed within a year. Thus, the factors that contribute to these failures must be thoroughly reviewed.
A systematic review suggested a mixture of environmental and individual factors helped to quit long term. Separate studies indicate that warnings on tobacco products do not encourage smokers to stop. The Department of Public Health Dentistry in India found that these warnings were more effective at deterring non-smokers than smokers.
The normalisation of ‘social smoking’ was also found to have a negative effect on those attempting to stop smoking. Environments where smoking was more prevalent would ultimately increase positive views of smoking. Additionally, a study from the year 2000 suggests that the “cost” of smoking did not solely lie with the physical cost of cigarettes, rather the social cost of losing opportunities to interact with peers would be detrimental in the long run.
A recent study suggests that a mixed approach would be beneficial to reduce smoking within the targeted age group. Reframing public perception of smoking as being ‘shameful’ yielded better outcomes than providing standard health warnings on cartons. Furthermore, studies within the Aboriginal Australian population suggested that increasing the tax on tobacco products was a successful deterrent. motivations around life goals e.g., sporting performance, and a focus on the financial issues with smoking were more successful in impacting decisions relating to smoking behaviours.
What happens next?
The Prime Minister’s plans to curb smoking was welcomed by Michelle Mitchell, the chief executive of Cancer Research UK. She credited the Prime Minister for placing the “health of UK citizens ahead of the interests in the tobacco lobby”. The current plans will take place from 2027 when the recommendations of the Khan Review are brought, a review ordered by then Secretary of Health and Social Care, Sajid Javid, to introduce a "smokefree 2030", into law.
The move should reduce the number of preventable cancers in the United Kingdom, which is estimated to cost £78 billion a year. However, critics have raised concerns about enforcing these measures. They suggest that it will only lead to older individuals giving or buying cigarettes on behalf of younger adults who cannot purchase them legally.
The scheme will need to provide lasting results to ensure generations can benefit from the legislative changes brought in. As cardiovascular disease increases amongst smokers and non-smokers, as a result of passive smoking, preventing a ban will have longer reaching consequences for the health of the country.
Article written by Altay Shaw
References:
- Increase by one year every year - Rishi Sunak. BBC News [Internet]. 2023 Oct 4; Available from: https://www.bbc.co.uk/news/health-67008051
- Would ban smoking for those aged 14 and below - McClure T. New Zealand moves ahead with world-first tobacco laws in bid to create smoke-free generation [Internet]. The Guardian. 2022. Available from: https://www.theguardian.com/world/2022/jul/27/nz-moves-ahead-with-world-first-tobacco-laws-in-bid-to-create-smoke-free-generation
- Less than 5% every year - Smokefree Aotearoa 2025 Action Plan [Internet]. Ministry of Health NZ. Available from: https://www.health.govt.nz/our-work/preventative-health-wellness/smokefree-2025/smokefree-aotearoa-2025-action-plan
- $511.1 million AU towards a range - Parliament House C. Tobacco and vaping control measures [Internet]. www.aph.gov.au. Available from: https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/Budget/reviews/2023-24/VapingSmokingMeasures
- Responsible for 1 in 5 deaths - Australian Government Department of Health and Aged Care. Smoking and tobacco and Aboriginal and Torres Strait Islander peoples [Internet]. Australian Government Department of Health and Aged Care. 2019. Available from: https://www.health.gov.au/topics/smoking-and-tobacco/smoking-and-tobacco-throughout-life/smoking-and-tobacco-and-aboriginal-and-torres-strait-islander-peoples
- Banning the sale of cigarettes for future generations - The Guardian [Internet]. 2023 Oct 5; Available from: https://www.theguardian.com/australia-news/2023/oct/05/ban-smoking-for-next-generation-to-keep-pace-with-uk-and-nz-advocates-tell-australian-government
- 6 million smokers in the UK - Rishi Sunak defends his plan to ban smoking for younger generation. BBC News [Internet]. 2023 Oct 5; Available from: https://www.bbc.co.uk/news/uk-67010681
- Around £17 billion per year - Campbell D, editor DCH policy. Health charities welcome Sunak’s plan to curb smoking in England. The Guardian [Internet]. 2023 Oct 4; Available from: https://www.theguardian.com/society/2023/oct/04/health-charities-welcome-sunaks-plan-to-curb-smoking-in-england
- 5% of hospital beds - Multi-Specialty Recruitment Assessment (MSRA) | Health Education England [Internet]. Health Education England | Medical Education Hub. Available from: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/multi-specialty-recruitment-assessment-msra
- 24 million adolescents - WHO report on the global tobacco epidemic 2019: offer help to quit tobacco use [Internet]. www.who.int. Available from: https://www.who.int/publications-detail-redirect/9789241516204
- 92% relapsed within a year - High School Students Who Tried to Quit Smoking Cigarettes --- United States, 2007 [Internet]. www.cdc.gov. [cited 2023 Oct 29]. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5816a4.htm
- A systematic review - Bitar S, Collonnaz M, O’Loughlin J, Kestens Y, Ricci L, Martini H, et al. A systematic review of qualitative studies on factors associated with smoking cessation among adolescents and young adults. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco [Internet]. 2023 Aug 30 [cited 2023 Sep 30];ntad167. Available from: https://pubmed.ncbi.nlm.nih.gov/37648287/
- Increase positive views of smoking - Molyneux A, Lewis S, Coleman T, McNeill A, Godfrey C, Madeley R, et al. Designing smoking cessation services for school-age smokers: A survey and qualitative study. Nicotine & Tobacco Research. 2006 Aug 1;8(4):539–46.
- A study from the year 2000, Studies within the Aboriginal Australian population - Seguire M. Addressing the costs of quitting’ smoking: a health promotion issue for adolescent girls in Canada. Health Promotion International. 2000 Sep 1;15(3):227–35.
- Khan Review, “smokefree 2030” - Khan J. The Khan review Making smoking obsolete Independent review into smokefree 2030 policies [Internet]. 2022. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1081366/khan-review-making-smoking-obsolete.pdf
- £78 billion a year - Campbell D, editor DCH policy. 184,000 in UK to get preventable cancer diagnosis this year, study finds. The Guardian [Internet]. 2023 Sep 10 [cited 2023 Oct 29]; Available from: https://www.theguardian.com/society/2023/sep/10/184000-in-uk-to-get-preventable-cancer-diagnosis-this-year-study-finds