London Health Commission: Smoking

Lord Darzi of Denham Excerpts

Thursday 15th January 2015 Grand Committee

Asked by

[Lord Darzi of Denham]

To ask Her Majesty’s Government what plans they have to support the recommendations of the London Health Commission with regard to combatting the impact of smoking on health.

[Lord Darzi of Denham (Lab)]

My Lords, in opening the debate, I declare my interests as in the register. Over the past year, I had the privilege to chair the London Health Commission at the request of the mayor, Boris Johnson. I express my thanks to the mayor for giving me the opportunity to do so. As a politician, the mayor took a brave step by establishing an independent commission, tasking it with examining the evidence and giving my fellow commissioners and I the freedom to make the right recommendations for London.

I also express my thanks to the thousands of health and care professionals and Londoners who contributed to the commission. They were generous with their time and their ideas. The work of the commission and the report, Better Health for London, are the expression of the passion and the ambition that Londoners have for better health. London can be the healthiest major global city. As our nation’s capital, London should be a leader and set an example for other cities in Britain. London should not be an exception, and the proposals set out by the commission could, and indeed should, apply to other cities in our country.

We all want to lead healthy lives. Our health is determined by all different parts of our lives—what we eat and drink, whether we choose to smoke or drink and how much, how we travel to school or work, and how we choose to spend our leisure time. Yet we can lead healthy lives only by working together to improve health—schools, employers, charities and voluntary groups, local and regional government, transport, the NHS and, above all, individuals and families. We each can choose to invest in our own health and we can help each other to choose better health.

At the heart of the commission’s vision of a healthy city lies a very simple idea: making healthy choices should be easier. Making those choices easier requires action from us all. The healthiest choice is not always easy or obvious. Every day, we make hundreds of choices that affect our health: how we get to and from school or work, what we choose to eat and how we spend our free time. The goal is to make each of those millions of individual choices that little bit easier, because in that difference is everything: making small changes individually will make a huge difference collectively.

Smoking is one of the worst choices for health. Every year, in London alone, about 8,000 people die prematurely due to smoking and more than 80,000 people die prematurely across the country as a whole. The consequences of smoking cost society as a whole at least £2.7 billion a year. Smoking does not simply cause an earlier death; it causes poorer quality of life. Tobacco does enormous harm to health and limits life’s possibilities. Tragically, about 45% of cigarettes that are smoked are consumed by people with mental illness, contributing to life expectancy that is 10 to 15 years shorter than in the population as a whole.

Hundreds of children take up smoking every week—two classrooms’ full a day. With advertising outlawed, they do so inspired by the adults they see. Once they start, they continue, as cigarettes are more powerfully addictive than narcotics. It is little surprise that in places where more adults smoke, more children begin to smoke as well.

Just as smokers’ lungs are polluted, the lungs of our city—our parks and green spaces—are polluted by smoking. London should lead the way for Britain, and the mayor should lead the way for London by acting to make our public spaces smoke-free. Our parks and green spaces account for nearly 40% of the capital, the equivalent of 20,000 football pitches—imagine that space completely smoke-free. I also believe that Trafalgar Square and Parliament Square should be rid of smoking. It would be a powerful message for the iconic centre of our city and the political heart of our country to become smoke-free. Indeed, such a measure would make our capital and our country an exemplar for the world.

Many noble Lords will have seen the launch of the commission’s report last October, when the mayor and I played a game of football with a classroom of schoolchildren. Of course, noble Lords may have seen it for all the wrong reasons, as it featured the rather entertaining sight of the mayor fouling a nine year-old boy. What was so striking was what the children had to say, not about the foul, but about making parks smoke-free. They were universally stridently in favour of the idea. They were far better advocates than I. One said, “It’s horrible when people come and smoke where we are playing football. I hate it”. Another said, “They leave all their cigarette ends on the floor”, and another young child said, “It’s really disgusting. I wish they wouldn’t do it”.

That is what London schoolchildren think. Making parks smoke-free will not only help smokers to make better choices by reducing the opportunities to smoke, it will help children to make the right choice to never start smoking. Yet this is more serious than childish debate. The question of making parks smoke-free exists precisely at the boundaries of the proper role of the state. I understand and I acknowledge that different people will hold different beliefs. Our parks are public. They are shared spaces that we should enjoy together. We already accept some limitations on our actions within them. There are restrictions on letting dogs foul, dropping litter or consuming alcohol. I believe that our parks should be spaces that promote healthy behaviour, such as exercise.

As a cancer surgeon, I see the pain and suffering of people afflicted by smoking-related diseases, as well as that of their friends and families. True compassion for their experience lacks authenticity if it is not joined with resolute action. I have not come across a single patient who did not wish that they had never smoked. I contest the notion that it is a question of liberty. Cigarettes are more powerfully addictive than narcotics, as I said. There is no freedom in addiction. Indeed, addiction is the antithesis of freedom. I have always been struck by that great revolutionary rallying call, “Give me liberty or give me death”. The advocates of smokers’ rights are generous enough to give them both.

I have no doubt that parks will become smoke-free by the end of this decade. Thirty years ago, it would have been unthinkable that pubs and restaurants would be smoke-free. Today, it is unthinkable that we would ever return to smoking indoors. The 2007 smoking ban was a major achievement of the previous Government and the present Government have continued the good work with new measures to control advertising at the point of sale and to stop smoking in cars with children. These measures are very welcome and I applaud the Government for having taken them. None the less, it is vital that the work continues.

As part of the work of the commission, we examined cities around the world that have made progress in the fight against smoking. New York City has famously led the way. Noble Lords who have visited New York recently will know that Central Park and all the city’s parks are smoke-free. Today, significantly fewer New Yorkers smoke than Londoners. The lesson of two decades of pioneering tobacco control in New York is that the fight must be sustained with new measures and initiatives. When it is not, smoking rates creep back up again. For that reason, I urge the Government to progress their plans for plain packaging of cigarettes in a timely manner so that the regulations are made within this Parliament. If they do, they will surely be saving lives. With the election so uncertain a few months from now, Ministers, Members of the other place and noble Lords can proudly know that they will have saved lives. Other than the protection of corporate interests, I can see no earthly reason to protect the brand value of tobacco.

As I close, I encourage noble Lords to take a moment to read the findings of the commission. I am an advocate for smoke-free parks, yet the report presents a broader range of measures to make our capital the healthiest major global city. Progress for better health can be made only through bold aspirations. I thank noble Lords for their contributions today and for demonstrating their commitment to better health for all the people of this land.