By Matthew Thaxter, Analyst, Centre for Health Solutions
Each year, the World Health Organization (WHO) holds its ‘World No Tobacco Day’ on May 31. Its goal is to raise awareness on the harmful and deadly effects of tobacco use and second hand smoke exposure, and to discourage the use of tobacco in any form.1 This blog explores some of the latest data on smoking prevalence in the UK, the achievements in reducing the prevalence of smoking and impact that smoking is having on the health of the UK population, the NHS and the wider economy.
Smoking is the leading cause of cancer in the UK, contributing to almost 115,000 deaths annually.2, 3 However, the smoking rate among adults in the UK continues to fall. As recently as 1974, 45 per cent of the British population smoked, this was down to 30 per cent by the early-1990s and hit at a record low with only 15.1 per cent of people aged 18 and above being smokers in 2017 (see Figure 1).4 This is equivalent to 7.4 million smokers - over one million fewer than in 2014. Smoking prevalence is highest among 25 to 34 year olds at a rate of almost one in five, with the over 65 age group demonstrating the lowest prevalence at a rate of under one in 10 (see Figure 2). Smoking prevalence is also disproportionately spread among the population by social position, income and educational attainment:
- a quarter of people employed in routine and manual positions are smokers, compared to one in ten in managerial and professional positions5
- smoking prevalence is more than twice as high in the lowest income quintile (20 per cent of population), compared to the highest income quintile6
- almost 30 per cent of the UK population with no qualifications are smokers, compared with just 7.6 per cent with a degree or equivalent qualification.7
Figure 1. Smoking prevalence in the UK (age 18+), 2011-2017 8
Figure 2. Smoking prevalence in the UK by age, 2011-2017 9
What’s the impact?
Smoking is harmful to almost every organ in the body and significantly reduces life expectancy as well as quality of life. Up to two-thirds of long-term smokers are expected to die from a smoking-related disease, and, on average, cigarette smokers die 10 years younger than non-smokers.10 Smoking is the single largest avoidable risk factor for cancer, and tobacco smoke is estimated to be the cause of almost one fifth of all new cancer cases annually, causing over a quarter of all UK cancer deaths.11 In 2016 alone, there were a total of 78,000 deaths attributable to smoking, which represented 16 per cent of all deaths across the UK.12
It is clear that smoking places a significant burden on an individual’s health, but also on the NHS, society and wider economy. There are varying estimates on the cost of smoking to the NHS, but the Action on Smoking and Health group estimates that the cost in England alone is £2.5 billion annually.13 This includes expenditure on hospital admissions, GP and practice nurse consultations and prescriptions. As well as public healthcare costs, a total of £8.4 billion of potential wealth is lost from the economy in England annually as a result of lost productivity due to smoking. This includes lost productivity due to early deaths, absenteeism and smoking breaks. Many current and former smokers also require care in later life due to smoking-related illnesses, costing a further £1.4 billion annually in social care spending. If the £300 million cost of house fires are included, this equates to a total cost of £12.6 billion in England each year. On the other hand, tobacco is heavily taxed meaning that the government does receive money through the sale of smoking products. An estimated £7 billion is collected annually in tobacco duty, leaving a net annual cost of £5.6 billion.14
What more can be done?
Currently, 60 per cent of smokers in England want to quit, but around half of those who do attempt to quit use willpower alone, or ’cold turkey’, despite this being the least effective method. Getting support can significantly improve the chance of successfully stopping smoking:15
- using nicotine replacement therapies (NRT) such as patches or gums, or e-cigarettes increase the probability of success by one and a half times
- using prescribed medicines such as Champix (varenicline) or Zyban (bupropion) doubles the chances of success
- using a combination of pharmacological and behavioural support improves the likelihood of success by four times.
Over the past few years, e-cigarettes have become the most popular aid for quitting smoking in England. Today there are an estimated 2.5 million e-cigarette users, with over half having stopped smoking completely. E-cigarettes are not licensed medical products, however, there is growing evidence supporting their effectiveness as a stop smoking aid.16 The widespread use of e-cigarettes as a stop smoking aid is now backed by many leading UK health organisations, and Public Health England published a review of the evidence in 2019, which concluded that while not completely risk free, vaping is substantially less harmful than smoking.17 Growing evidence also suggests that using an e-cigarette can be one of the most effective ways to quit.18
While there are one million less smokers than there were in 2014, there are still 7.4 million active smokers across the UK, and 6.1 million in England. Reducing the number of smokers even further remains one of the key priorities for the NHS. The Tobacco Control Plan for England 2017-2022 was published by the Government in 2017 and identifies specific areas of focus that include reducing the inequality gap in smoking prevalence between those in routine and manual occupations by the end of 2022.19 Additionally, the NHS Long Term Plan published in 2019 sets out to offer all smokers admitted to hospital with NHS-funded tobacco treatment services by 2023-24.20
The harmful impact of smoking on long-term health is well known, and the facts show that the cost to the NHS and wider economy remain significant. While the UK has been successful in recent years in reducing the overall number of active smokers, this downward trend needs to continue along the same trajectory if the government’s vision for a smoke-free generation (smoking prevalence of 5% or below) is to be realised by 2030.21There are positive steps being made by the government and public health services to achieve this goal and these actions combined with the likely higher uptake of e-cigarettes should help the UK to drive down the prevalence further still in the coming years.