WHO Framework Convention on Tobacco Control

Alex Cunningham Excerpts

Thursday 5th March 2020 Commons Chamber

[Alex Cunningham (Stockton North) (Lab)]

I am pleased to have this unexpected opportunity to speak in this important debate, and I congratulate the hon. Member for Harrow East (Bob Blackman) on securing it. My politics and his are far apart, but we are brothers in the cause of eradicating smoking. I pay tribute to his work as chair of the APPG and am pleased to serve as his vice-chair.

There are around 23,000 smokers in my Stockton North constituency, and 60% of them want to quit. Sadly, due to cuts to Stockton Council’s budget and to budgets across the north-east, councils in the area have cut stop smoking services by 10% in just two years. I will come back to that later.

Requiring tobacco manufacturers to pay into the smoke-free 2030 fund mentioned by the hon. Gentleman would provide sustainable funding to motivate the smokers in my constituency who want to quit, or who want to give quitting a go, and would fund the specialist support for those who need it. That would be the correct way forward, and it would provide the necessary transparency without the likes of PMI being given free rein to dictate or influence public policy.

I pay tribute to successive Governments for making tremendous progress. We had the smoke-free pubs and restaurants under Labour, and of course we have had the point-of-sale stuff under recent Conservative Governments. That all plays a part, but the extent to which smoking is reducing has continually slowed down and we need to accelerate it again.

Although this is a national issue, I will be parochial this afternoon and outline the challenge we face in my part of the world. In Stockton-on-Tees, 16.4% of the population smoke, compared with 16% across the north-east and an English average of 14.4%. Some 17.7% of women are smokers when their babies are delivered, compared with a national average of 10.6%, and that has significant implications for stillbirths, neonatal deaths and birth weight.

Those statistics hide the reality of what is happening in my constituency. In my inner-city wards, the prevalence of smoking, including during pregnancy, is much higher. Our leafy suburbs and nicer areas—perhaps I should say more affluent areas—bring down the average to that lower level of 16.4%. I do not know of many households in the town centre ward of my constituency in which people do not smoke, which is a terrible situation. We need targeted support for them.

The prevalence of smoking among adults in my area with serious mental health illnesses is 40%, which is actually slightly below the English average of 40.5%, but it still needs to be tackled. In 2018-19, there were 2,780 smoking-attributable hospital admissions in Stockton-on-Tees, which is a rate of 2,474 per 100,000 of population, notably above the English average of 1,612.

From 2016 to 2018, 1,013 deaths in Stockton-on-Tees were attributable to smoking, which is also significantly above the English average. There were 398 deaths from lung cancer and 325 deaths from chronic obstructive pulmonary disease, and over 80% of those disease cases are caused by smoking. Again, from 2016 to 2018 there were 23 smoking-attributable stillbirths in Stockton-on-Tees, which is above the per population average.

I have talked about the more affluent areas of Stockton-on-Tees, and the smoking rate among people in managerial and professional occupations is 9.3%. The rate rises to 11.7% among people in intermediate-level occupations and to 23.1% among people in routine and manual occupations. Men are more likely to smoke than women, with a smoking rate of 17% compared with 13%.

We have much to do if we are to do this, and we have to do it right, without allowing tobacco companies to play the sort of role proposed by PMI, because this is an issue of health inequality. A smoking rate of 16.4% in my constituency compares with 8.3% in mid-Suffolk, where the Minister’s constituency is located.

Like the hon. Member for Harrow East, I was concerned to hear least week that England is not on track to reach the 5% ambition by 2030. The 20-year difference between when the richest and poorest communities are expected to be smoke free shows that we are failing to support the most vulnerable in our constituencies. So does the Minister agree that the smoke-free 2030 ambition must be more than a headline target and that the Government must ensure that they will also deliver a smoke-free generation for communities such as mine in Stockton?

The hon. Gentleman mentioned illegal tobacco, so I wish to say just a few words about that. During the general election, I was on the Hardwick estate in my constituency, where a woman was standing at a door. I was walking up the path and then I realised that money was changing hands. The money changed hands and the door closed. When it reopened, someone had a package in their hand. I know what it was, but the woman saw me and said, “Just wait a few minutes.” She then said, “How can I help you?” I nearly said, “You could help by not operating an illegal tobacco operation”, but I was looking for their vote, so perhaps I prejudiced my principles on that occasion.

These things are happening day in, day out. My wife was a school nurse and she went to schools to talk about smoking. She used to deploy the economic argument, saying to the kids, “If you have so many cigarettes a week, it will cost you £10. Over a year that works out at £520 and that would take the family on a short holiday.” One day, a child put up his hand and said, “Miss, you’ve got the price wrong. They are only £3 a packet from—”. He named a person around the corner from where he lived. So it is clear that we still have a problem to solve and we have an education problem to deal with as well.

Finally, I know that PMI’s proposals for a “tobacco transition fund" in partnership with the industry have already been put to Parliament in a ten-minute rule Bill tabled by my former colleague Kevin Barron in the last Parliament. Kevin is a long-standing supporter of tobacco control, but he admitted to The Guardian that he had had discussions with PMI before tabling the Bill, that he now supported partnering with the industry and that he had spoken to Ministers about the proposals. Kevin was probably the greatest parliamentary campaigner, perhaps even better than the hon. Member for Harrow East, against the tobacco industry for nearly all his 36 years as an MP, so I was really concerned that he was prepared to work with a tobacco company, albeit with the best of intentions, to change the law. Although some people may have been convinced that PMI has been reborn as a public health champion, that is certainly not the case for the all-party group on smoking and health, and I hope the Minister will confirm that the Government agree on that. PMI’s attempts to whitewash its reputation are nauseating, in a company that continues to promote its deadly cigarettes to children and young people whenever and wherever it can get away with it.

So there is still much yet to be done, and I will be interested to near what the Minister has to say. I want her not just to rule out any sort of relationship with PMI, except perhaps taxing it a bit more, with no recognition of its bid to influence public policy; I also want to hear what the Government are now going to do, perhaps in replying to the Green Paper, to get us the resources we need into public health and elsewhere to start again and accelerate the number of people who quit.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

I thank my hon. Friend the Member for Harrow East (Bob Blackman) for securing this important debate on the World Health Organisation framework convention on tobacco control. His passionate work on tobacco harms, including through his chairmanship of the all-party group, and the work of his worthy sidekick as co-chair, continues to keep us focused on what we have to do and on our goal of being smoke-free by 2030. I thank them for that. I agree with both of them that smoking is one of the most significant public health challenges that we face today and that, sadly, it is one that disproportionately affects disadvantaged groups, with the resultant impact on their health and their finances.

This year, the WHO framework convention is celebrating its 15th anniversary. Over those 15 years, the parties to the convention have worked towards a tobacco-free world. We have seen encouraging improvements in tobacco control worldwide, but there is still much more work to be done to protect the world’s population from the harms of a tobacco epidemic.

As a recognised world leader in tobacco control, the UK is firmly committed to the World Health Organisation’s framework convention on tobacco control—which I will now abbreviate to FCTC for all our sakes—and we will remain an active member. I thank my hon. Friend for continuing to remind us how important the obligations under the convention are. In answer to his direct question, we will remain fully committed to the convention and, importantly, to article 5.3 during the transition period and beyond. I can assure him, as my predecessor did, that we write to NHS trusts and local authorities to remind them of their obligations under article 5.3 to protect public health interests from tobacco industry interference. I am proud that, in the first global tobacco industry interference index, published last year, we were rated No. 1 for the work we do to protect health policy from tobacco companies, but I take on board the fact that we need to make sure we continue on that path.

It is estimated that at least 8 million deaths around the world every year are linked to tobacco—more than for AIDS, tuberculosis and malaria combined. Some 80% of the 1 billion smokers live in low and middle-income countries. That puts a huge strain on the development of those countries and their achievement of the sustainable development goals. There is high demand from such countries for help to implement tobacco control measures. That is why, as a global leader, the UK is providing support, via official development assistance, to the FCTC 2030 project, working with low and middle-income countries to support its implementation, with the ultimate aim of reducing the burden of tobacco-related deaths and diseases.

The project has received praise from countries participating, as well as from the global public health and development communities. It has also helped to raise the UK’s profile as a global leader in tobacco control, and is strengthening its global reach. Building on that success, we are increasing capacity within the existing budget to include several more countries to support over years four and five.

In the UK, smoking prevalence is at the lowest ever rate on record and is falling, but we are not complacent—as has been pointed out, the rate of decline is slowing. Around 78,000 people die every year in this country from smoking-related illnesses. As I said yesterday during the debate on health inequalities, and as my hon. Friend pointed out so eloquently, we know that the smoking habit particularly affects disadvantaged communities. We must end that, and our prevention Green Paper sets out the ambition to be smoke-free by 2030. That is undoubtedly a challenging ambition. The public consultation that closed in October had 1,600 responses—more than double the number we usually get—and it is taking some time to go through the analysis. We are analysing the proposals and developing our own response, which will be with Members shortly.

[Alex Cunningham]

I appreciate everything the Minister is saying. It is the 2030 target I am really interested in. The estimate a couple of weeks ago was that, with current programming, we are 20 years behind where we need to be. Will she tell us how we are going to achieve that target instead?

[Jo Churchill]

I thank the hon. Gentleman, and, yes, I will. There is a need to be smarter with what we do. As was stated, we will achieve the target in some communities, but not in others, so refocusing on where we have the problem must be part of the strategy. However, as I am sure my hon. Friend and the hon. Gentleman appreciate, I do not want to pre-empt what we publish in the Green Paper.

I acknowledge and thank my hon. Friend and the hon. Gentleman for the report by the all-party parliamentary group on smoking and health, which I have read and which sets out the group’s recommendations, including on the smoke-free 2030 fund. I assure them that the Department will speak to Her Majesty’s Treasury to discuss possible financial levers to support our smoke-free ambitions. However, I also expect that both of them—and particularly my hon. Friend, who is indefatigable in his lobbying on this matter—will lobby the Chancellor themselves.

Across the country, people are tackling the harms of tobacco every single day. During a recent visit to Tameside Hospital, I witnessed at first hand the commitment and dedication of healthcare professionals involved in the delivery of an innovative approach to reducing smoking in pregnancy. While the hon. Member for Stockton North (Alex Cunningham) was speaking, I was reflecting on the fact that many of the things that he was saying about his own constituency were very similar to those in this particular project. The prevalence within their local community to start with was much higher than average, and the people who were starting to smoke as a habit were of a much younger age. Therefore, by the time these young women were pregnant, they had been smoking for a longer period of time, making cessation more difficult. The project was thoughtful and holistic in terms of the agencies that it used, and the way that it wrapped around the young pregnant women. It actually reached out into their families, encouraging partners, mothers and other family members to support them. That gave the young women a great deal of motivation. I spoke to one young father who had not yet managed to quit his habit, but he had taken many of the messages on board, was not smoking in their home, and was actually attempting to change his behaviour for the long-term benefit of his future’s baby’s health.

This is a particular passion of mine. I believe that we give both people a much better, healthy start if we can tackle pregnant mums as a particular cohort, because, obviously, we not only help the mother, but, as my hon. Friend has said, help the future health of the baby and ensure that a health compromised by smoking in pregnancy is not something that then follows them through their lifetime. I spoke to those mums and partners about how using a joined-up approach could work and I would be delighted if my hon. Friend and the hon. Gentleman would talk to me further about the matter.