Chapter 42 Smoking, tobacco control and doctors

The global picture

Smoking is the largest preventable cause of premature death and disability in the UK and the world, and the largest cause of social inequality in health in most industrialized countries. Cigarettes kill half of lifetime users. Half of these deaths are under 70 years. Those dying before 70 lose on average 21 years of life. In 2000, tobacco killed over 4.8 million people. Half of these deaths were in developing countries. By 2020 deaths will double to 10 million, 7 million of these in developing countries (Mackay et al., 2006; Davies et al., 2007). Death rates are higher in men than women as men have a longer history of smoking. In countries such as the UK, where women have smoked for several decades, the gap is closing rapidly.

The costs of smoking in the UK

Smoking affects health throughout the life course. Each year 112 000 people in the UK are killed by smoking – one-fifth of all deaths (ASH, 2006a). Most die from lung cancer, chronic obstructive lung disease (bronchitis and emphysema) or coronary heart disease. Smoking is also a risk factor for other cancers (e.g. mouth, larynx, liver, bladder, cervix), strokes, miscarriage, cot death, infertility, impotence, osteoporosis and many other diseases. Breathing in other people’s smoke, second-hand smoke (SHS), causes around 12 000 deaths in the UK each year (ASH, 2006b). Children are particularly vulnerable. SHS increases their risk for diseases such as pneumonia, bronchitis, glue ear and worsens asthma (Muller, 2007).

The NHS spends £1.5 billion a year treating diseases caused by smoking (ASH, 2006c). This includes 364 000 hospital admissions, 8 million GP consultations and over 7 million prescriptions. Other costs to the state include sickness/invalidity benefits, widows’ pensions and social security benefits for dependants. Industry loses 34 million working days each year from smoking-related sick leave.

Smoking and inequalities

In the UK smoking has declined since the 1970s. In 2005, 25% of men and 23% of women smoked cigarettes. This decline has been faster in affluent than poorer groups. Smoking is a major cause of inequalities in health, accounting for over half of the excess deaths due to

Case study

The Massachusetts tobacco control programme

In 1992 voters in Massachusetts agreed that 25 cents be added to the cost of a pack of cigarettes, with the extra revenue to be used to reduce smoking. Subsequently Massachusetts spent about $39 million a year on its tobacco control programme – $6.50 for each person in the state. This was the highest per capita expenditure on tobacco control in the world. The programme was designed to increase quitting, reduce uptake and reduce exposure to SHS. It included:

Mass-media campaigns: to inform the public about the dangers of smoking and SHS.

Services: local cessation services, youth leadership programmes, telephone counselling and educational materials.

Promotion of local policies: funding local tobacco control policies, e.g. smoke-free public places, illegal sales to children.

The data in Figure 2 show a significant reduction in smoking in Massachusetts compared to little change in the rest of the USA (with the exception of California, which had a similar programme). The Massachusetts experience shows that a strongly implemented, well-funded, comprehensive programme can reduce smoking.

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