Delivering the vision of a ‘Smokefree Generation’

1. Delivering the vision of a ‘Smokefree Generation’ A report by the All Party Parliamentary Group on Smoking and Health

2. Background Delivering the Vision of a ‘Smokefree Generation’ report • Researched and written by ASH and the UK Centre for Tobacco and Alcohol Studies • A response to the Secretary of State’s policy paper ‘Prevention is better than cure’ and ahead of the Prevention Green Paper (Spring 2019) • Based around the Government’s vision of a ‘Smokefree Generation’ where less than 5% of the population smoke Full report: https://bit.ly/2T4axK9 Press release: https://bit.ly/2TaKMrq ASH’s submission to the Prevention Green Paper consultation: https://bit.ly/2VBIBis The All Party Parliamentary Group (APPG) on Smoking and Health • Cross-party group of Peers and MPs founded in 1976 • Currently chaired by Bob Blackman MP • The secretariat of the group is provided by ASH

3. Vision and challenges • Smoking remains the leading cause of premature death, with smokers losing on average 10 years of life • For every death caused by smoking it is estimated that another twenty people are suffering from serious illnesses attributable to smoking • If the current rate of decline in smoking prevalence is maintained, we may reach the ‘Smokefree Generation’ target • However smoking-related inequalities are widening: • 1 in 4 people in routine and manual occupations smoke compared to 1 in 10 in managerial and professional posts • The odds of smoking in the routine and manual group are more than twice those of other employed groups • People who are unemployed are almost twice as likely to smoke as those in work • Further, we’re unlikely to reach the Government’s aim to reduce smoking in pregnancy to 6% by 2022 • Currently rates have stalled at just below 11% for 3 years

4. To achieve the Government’s ambition of 6% or less smoking prevalence in pregnancy by 2022, rates of decline in England will need to double. Instead, data for 2017/18 shows that rates of smoking in pregnancy have stalled and are no longer falling

5. Despite youth smoking rates falling to the lowest recorded levels since surveys began in 1982, youth uptake of smoking remains significant

6. Recommendations The report focuses on what more central government can do to deliver the national vision of a smokefree generation as an integral element in an effective national prevention strategy: • A levy on tobacco manufacturers • Introducing retail licensing for tobacco products • Increased funding for mass media campaigns • Increasing the age of sale to 21 • Reducing the affordability of tobacco (through tax and illicit trade) • Greater surveillance of tobacco industry behavior • Reducing children's exposure to smoking on screen • Ensuring proposals made in the NHS Long Term Plan are implemented • Ensure the Medicines and Healthcare products Regulatory Agency (MHRA) ensures the working group on e-cigarettes delivers its recommendations by July 2019 • Require manufacturers to include educational tobacco pack inserts promoting quitting, with exact content determined by Government

7. Making the polluter pay Introduce a mandatory levy, or charge on the tobacco industry, used to raise a fixed total amount of money to support costs of tobacco control measures designed to prevent uptake and encourage quitting Needed:With public health budgets under immense pressure, making the leading tobacco transnationals responsible for the vast majority of tobacco sales in the UK pay toward the cost of reducing their harm is a wholly justified extension of the ‘polluter pays’ principle Wanted: 71% of the public support a levy on the industry with the money raised used to fund measures to help smokers quit and prevent young people from starting smoking Workable: In 1992, the tobacco industry spent around £100 million on advertising, which it is now prohibited from doing • In 2018 prices, this amounts to around £144 million – a useful benchmark for the amount a levy could raise

8. The tobacco industry is more than capable of paying for the harm it causes. Recent research by the University of Bath found tobacco companies headquartered in the UK pay almost no corporation tax, despite their huge profits

9. Introducing retail licensing Local authorities could be supported to prevent underage and illicit sales of tobacco with the introduction of a retail licensing scheme Needed: No license is required to sell tobacco, the most lethal product available, allowing them to be sold by anyone, anywhere • Retailers of tobacco products have been implicated in or prosecuted for a number of offences but without a license to remove they can simply carry on selling • More than a third of underage smokers buy their cigarettes from shops Wanted: The introduction of a retail license to sell tobacco is supported by 76% of the public and 69% of retailers (who also support losing their license if they break the law) Workable: Introducing a licensing system for tobacco retailers is supported by Trading Standards Officers nationally

10. Funding for media campaigns Public Health England should increase its funding for national mass media campaigns, backed up by social marketing and public relations activity to motivate quitting and discourage uptake Needed: Mass media campaigns are highly effective in discouraging people from starting to smoke and encouraging existing smokers to quit, and can be effectively targeted at disadvantaged smokers • National spending in England on campaigns has fallen sharply, from a peak of £23.38 million in 2008/9 64 to just £2.4 million for 2018/19 Wanted: 52% of the public support increased Government investment in television adverts and other marketing to encourage smokers to quit (only 14% oppose) Workable: Campaigns are effective and cost-effective, costing just £344 per quality year of life gained (some lung cancer drugs cost £86,913 for a similar gain)

11. In some areas regional tobacco control programmes, involving proactive mass media activity, have made up for the absence of funding, but this is not universal and all areas are threatened by budget cuts

12. Increasing the age of sale to 21 The age of sale for tobacco products should be increased from 18 to 21 Needed: The more we can do to stop under 21s smoking the better • Two-thirds of those who experiment with smoking go on to be smokers. Experimentation rare after 21 • In England, 77% of smokers aged 16 to 24 in 2014 began smoking before the age of 18 Wanted: 57% of the British public support increasing the age of sale to 21 (only 19% oppose) Workable: Increasing the age of sale for tobacco in 2007 from 16 to 18 reduced regular youth smoking in England - there is good evidence that a rise to 21 would improve health and save lives • As of 27th March 2019, 7 US states and 440 US localities have already increased the age of sale to 21

13. How local government can support the recommendations • Write an email to the Secretary of State for Health and Social Care to show your support using this suggested template • Share the recommendations locally to build support for national action • Provide feedback to ASH on the recommendations and how they could impact locally (admin@smokefreeaction.org)

14. For any questions and for further information, please contact enquiries@ash.org.uk