Smoking-Related Diseases

Lord Faulkner of Worcester Excerpts

Wednesday 14th September 2016 Lords Chamber

Asked by

[Lord Faulkner of Worcester]

To ask Her Majesty’s Government what further action they are taking to reduce the incidence of smoking-related diseases.

[Lord Faulkner of Worcester (Lab)]

My Lords, by way of prologue, I should explain that this debate was originally initiated not by me but by the noble Lord, Lord Young of Cookham. His new ministerial responsibilities—I warmly congratulate him on his appointment—preclude him from speaking this evening, but I am delighted to see him in his place on the Government Front Bench, and I know that his lifetime commitment to the cause of tobacco control is undimmed. When he asked me to take on the debate in his place, I was, of course, very happy to agree.

Underlying what we are discussing this evening is the inequality which continues to blight our society. In her initial speech as Prime Minister, Mrs May committed her Government to,

“fighting against the burning injustice that, if you’re born poor, you will die on average 9 years earlier than others”.

Half of this difference in life expectancy is due solely to higher rates of smoking among the least affluent. This is an injustice that we cannot allow to continue.

Throughout my time in this House, I have spoken on tobacco control many times, as, indeed, have many of the other noble Lords contributing to this debate. We started with the Private Member’s Bill to abolish tobacco advertising and sponsorship, and the adoption of a smoke-free environment on the parliamentary estate. The UK has emerged as a world leader in tobacco control, with successive tobacco control plans, starting with Smoking Kills in 1999. Since then, the rate of smoking in England has declined by more than a quarter, to only 16.9% of the adult population in 2015.

Is there anybody, except possibly Mr Farage, who wants to go back to smoke-filled pubs and restaurants, and to coming home stinking of tobacco smoke after a night out? I think not. This fall in prevalence, which has already and will continue to save many thousands of lives year on year, could not have been achieved without commitment from successive Governments to comprehensive tobacco control strategies, which have ensured that we live up to our obligations as a party to the WHO Framework Convention on Tobacco Control. This includes comprehensive smoke-free laws, putting tobacco out of sight in shops, banning smoking in cars carrying children and the passage of standardised packaging legislation, which in Britain came into effect in May and which this House supported overwhelmingly.

I do not intend to say much about the tobacco industry this evening, but I remind your Lordships that the tobacco companies and their apologists opposed every piece of legislation that affected them over the last two decades, using spurious arguments about commercial and individual freedom, and claiming that the measures proposed would not work. Well, as the smoking prevalence figures demonstrate, they could not have been more wrong.

Having said that, there are still 7 million smokers in England, and nearly 80,000 die from diseases caused by smoking each year. That is why we need a new tobacco control plan for England. The last one expired at the end of 2015, and in December the Government committed themselves in the other place to publishing a new tobacco control plan this summer. We have now been without a tobacco control plan for nine months. It is essential that the Government do not delay any further in bringing forward the next tobacco strategy. I hope that the Minister may be able to say something about this when he replies to the debate.

We cannot afford to be complacent. The decline in smoking rates in England has been similar to the decline in Australia or Canada—countries that have comprehensive tobacco control strategies. By contrast, smoking prevalence in France or Germany—countries without such strategies—has barely shifted over the last 20 years. Without sustained action, the decline in smoking rates could plateau or, as has happened in France, start to rise again. Further progress requires further action, and, as the Prime Minister has identified, action to tackle health inequalities.

The new plan needs to set out clear ambitions, recommendations for action and provisions to ensure sustained funding for tobacco control. The ambitions contained in the previous plan, concerning smoking in pregnancy, smoking and young people and adult smoking prevalence, have all been met. Stretching new ambitions are essential to build on this success and highlight areas, especially health inequalities, where more needs to be done. International evidence tells us that cutting funding limits the effectiveness of tobacco control measures; sustained funding will be vital to achieve continued reductions in smoking rates.

The new plan also needs to set clear targets for reducing health inequalities. Smoking rates among people in the routine and manual socioeconomic group are more than double the rates among those in the professional and managerial group. Smoking prevalence is even higher among those who are unemployed, in prison, have a mental illness or are experiencing homelessness. This means that the most disadvantaged members of our society suffer disproportionately from smoking-related diseases. Not only do individuals in disadvantaged communities suffer from a greater burden of smoking-related disease, but children growing up in those communities share that burden through greater exposure to second-hand smoke. Those children are also more likely to try smoking. Those who grow up in a household where their parents or siblings smoke are far more likely to become smokers themselves. Children may experience considerable peer pressure to start smoking, and tobacco is often more accessible in both the community and at home. This creates a cycle of inequality where smoking and smoking-related disease is passed down through generations, resulting in an appalling gap in life expectancy between rich and poor in our country.

This cycle of inequality is reinforced by lower rates of quitting among disadvantaged smokers. Poorer smokers are usually more heavily addicted and, while on average all smokers make a similar number of attempts to quit each year, well-off smokers are more likely to succeed. To reduce inequalities and the impact of smoking-related disease, support for quitting must be tailored to the needs of smokers in the lower socioeconomic groups. This requires mass media campaigns targeted at poorer communities, designed to motivate quitting and discourage uptake. Such campaigns are effective and cost-effective and an essential underpinning of a strategy to reduce smoking prevalence.

In addition, funding for stop smoking services needs to be secured. They are one of the most cost-effective healthcare interventions and smokers are four times more likely to quit successfully with the combination of behavioural support and medication provided by these services compared with unsupported quit attempts. This is particularly relevant for poorer smokers, who are more likely to be successful with this specialist support.

A new tobacco control plan is needed to set out the future of these services and to ensure that local authorities have the resources necessary to pursue targeted smoking cessation work with pregnant women and disadvantaged populations. This is vital to helping vulnerable people to give up tobacco and protect themselves from smoking-related diseases, and we need a clear strategy to help local services deliver on those aims.

Reducing smoking rates among poorer smokers will further support other government health aims, including reducing stillbirths and neonatal deaths. Women in routine and manual jobs are almost three times as likely to smoke during pregnancy as those in professional and managerial roles. The Government have committed themselves to reducing the rate of stillbirths, neonatal and maternal deaths in England by 50% by 2030. Cutting rates of maternal smoking will significantly advance this agenda, and this means cutting smoking rates among mothers from disadvantaged communities.

My Question asks the Government what action they are taking to reduce the incidence of smoking-related disease. As I have explained, the action needed is the publication of a new tobacco control plan for England without delay, with renewed and enhanced ambitions. Under the last plan we achieved a great deal and made large steps towards improving public health and we must not allow these achievements to go to waste. A new plan must build on the progress that has been made, continue to drive down smoking rates and protect our most disadvantaged from the burden of entirely preventable death and disease caused by tobacco.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, I thank the noble Lord, Lord Faulkner, and my noble friend Lord Young of Cookham for enabling us to have this debate today. The fact that there are so many speakers, with only three minutes each, shows how important this subject is to many noble Lords in this House.

I was particularly taken by how many noble Lords addressed the issue of smoking within the context of health inequalities. I had not appreciated that it accounts for maybe 50% of the difference in life expectancy between people from poorer backgrounds who smoke and those who do not. It is one indication of just how serious smoking is. Linking it to Theresa May’s first speech when she became Prime Minister was a clever move. I hope she will read this debate with interest during the Recess.

The noble Lord, Lord Faulkner, said that he has spoken on this issue many times over many years in this House and elsewhere. It was actually back in 1604 that King James wrote a treatise called A Counterblaste to Tobacco, describing smoking as:

“A custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black, stinking fume thereof, nearest resembling the horrible Stygian smoke of the pit that is bottomless”.

He did not mince his words. Slightly depressingly, however, that was in 1604 and here we are over 400 years later, still struggling. Although we have made great progress, 7 million people are still smoking in this country and, as we will discuss later on, I saw a frightening statistic recently showing that by 2030 it is estimated that nearly 500 million people in Africa might be smoking. This is a global problem and it is not going away.

Of course, we have taken action. Many noble Lords pointed out the success that we have had in this country. Over the last 25 years the number of people smoking in England has fallen from just over 28% in 1992 to just under 17% at the end of 2015. Despite this progress, in England smoking still kills around 200 people a day. The noble Baroness, Lady Masham, gave us a moving story of a friend of hers who recently died from lung cancer. I remember when I was chairman of a hospital watching an operation and seeing the inside of a patient’s lung. I am sure that my noble friend Lord Ribeiro has seen similar things. The colour of a heavy smoker’s lungs is absolutely vile. They are blackened.

I want to reassure noble Lords that this Government have always and will continue to take very seriously tackling the great harm caused by tobacco. In the last year, we have introduced a number of important measures to achieve this. First, we introduced a tranche of legislation that has greatly strengthened tobacco control and reduced even further children’s exposure to tobacco branding and second-hand smoke. This included the introduction of standardised packaging, which I am pleased to say is already in shops across England. I am sure that noble Lords have seen the standardised packaging. It represents a big step forward. This measure aims to motivate more people to quit while also deterring greater numbers of young people from ever taking up smoking in the first place. This is a fantastic achievement.

Secondly, we have delivered a range of impactful mass media campaigns which promote quitting. In just two weeks from now, we will launch a fifth ‘Stoptober’ campaign. This campaign has proven extremely successful. In 2015, more than 130,000 people successfully quit for 28 days for Stoptober. That is an impressive figure. Looking ahead, a number of noble Lords raised the issue of a new tobacco control plan. I am unable to commit to a publication date, but I can confirm that a new plan will set out renewed national ambitions to reduce prevalence even further and build on the success of the previous tobacco control plan. I was very struck by noble Lords’ comparison of countries with a tobacco control plan such as Australia and Sweden—

[Lord Faulkner of Worcester]

Canada.

[Lord Prior of Brampton]

I apologise, it was Canada. We can contrast that with the experience in countries such as France and Germany, where there is no control plan. The Government fully support renewing the tobacco control plan. During the last five-year plan, the proportion of smokers in England reduced by more than 10%.

Addressing the inequalities caused by smoking will be a central component of this plan. As has been highlighted in this debate, there remains significant geographical and demographic variation. The noble Baroness, Lady Janke, mentioned the situation in Bristol, for example. Staggeringly, smoking prevalence today in Sevenoaks is 6% and in Corby it is 29.8%, which demonstrates the variation around the country. Reducing smoking rates in populations with comparatively high prevalence will be a priority in reducing this variation and the health inequalities caused by tobacco.

In particular, we are considering what more can and will be done to support those with mental health conditions in quitting smoking. In developing this aspect of the plan, the recommendations set out in The Five Year Forward View for Mental Health, authored by Paul Farmer, are being taken into consideration. The noble Baroness, Lady Gale, mentioned the importance of improving maternity outcomes, and giving children the best start in life is an important priority for this Government. We have already set out an ambition of achieving a 50% reduction in stillbirths and neonatal deaths by 2030.

Supporting pregnant women in quitting smoking will be an important factor in working towards that. This was a priority in the previous tobacco control plan, during which prevalence for this group fell by 3 percentage points. I can confirm that it will remain a priority. Exposure to smoke during and after pregnancy can have devastating health consequences for babies. As well as these immediate health risks, evidence also shows that children who have a parent who smokes are two to three times more likely to be smokers themselves. Supporting adults to quit is therefore vital to ending the cycle of children who take up smoking, in order to cut off the pipeline of new smokers at risk of smoking-related disease. This is a battle we are winning. The proportion of young people smoking continues to fall, as my noble friend Lord Ribeiro pointed out, with prevalence amongst 15 year-olds more than halving in the last decade.

I will touch on a couple of other important elements of tobacco control. First, my noble friend Lord Borwick and the noble Baroness, Lady Walmsley, commented on e-cigarettes. I am well aware of the report by the Royal College of Physicians, which said that vaping was 95% better than smoking. I saw the recent reports in the paper, and I have read the BMJ article that supported them, saying that 18,000 people gave up smoking last year because of vaping.

Clearly, e-cigarettes have an important role to play, but they are not risk free. We do not want to encourage young people to take up vaping. In the UK we are adopting the right approach, which reduces the risks of harm to children and provides assurance on safety for users. In the UK, our e-cigarette policy has been successful, with minimal long-term take-up by children and non-smokers. This is not the case everywhere. In the US, for example, there is an upward trend of children who have never smoked cigarettes using e-cigarettes. This is why the Government have taken a precautionary approach to any possible risk of renormalising smoking behaviours that we have fought long and hard to denormalise. If any noble Lord has seen some of the advertising around vaping, they can see the potential dangers of attracting children who would never have smoked to the habit of smoking.

The UK’s approach to the regulation of e-cigarettes has and will remain pragmatic and evidence-based. The Government will continue to monitor and develop this evidence base, adapting policy accordingly, to ensure that policy on e-cigarettes best supports the protection and improvement of public health.

Secondly, through PHE we will maintain a programme of evidence-based mass-marketing campaigns to encourage more people to quit smoking, and raise awareness about products and services that can help. The noble Lord, Lord Rennard, in particular raised this issue. I can tell him that £4 million has been allocated for tobacco-specific marketing activities, £1 million of which is for the Stoptober campaign launching next month. On top of this there is further funding for multiple-issue campaigns, such as the One You and Be Clear on Cancer campaigns, which also contain messages about smoking. We also need to consider Heat Not Burn and other novel tobacco-containing products that are starting to emerge.

Difficult decisions have had to be made across government to reduce the deficit and ensure the sustainability of public services, as the noble Lord, Lord Hunt, has drawn to my attention on a number of occasions. However, councils will still receive £16 billion over the next five years for public health, on top of what the NHS will spend on vaccines, screening and other public health measures. The noble Lord asked whether I can draw to PHE’s attention its powers in this area to make sure action is taken locally. I certainly will draw that to the attention of my colleague in the other House, Nicola Blackwood, the Minister for Public Health, to ensure that happens.

Tobacco use is, as the noble Lord, Lord Crisp, and the noble Baroness, Lady Northover, pointed out, very much a global issue and an international priority. Tobacco companies are becoming increasingly active in the developing world. By 2030, more than 80% of the world’s tobacco-related mortality will be in low and middle-income countries. The uptake of cigarette smoking in Africa is pretty alarming. The UK will continue to work collaboratively with other countries to reduce the burden that smoking places on individuals, families and economies across the globe.

The Government intend to invest part of the development assistance funds to strengthen the implementation of the WHO’s Framework Convention on Tobacco Control—known as the FCTC. This project will be delivered by the WHO. For a number of years the UK has been rated the best country in Europe for tobacco control policy. Through this project we will share the UK’s experience to support low and middle-income countries in saving lives by putting effective measures in place to stop people using tobacco. This project will involve assistance to implement the “time-bound” measures of the FCTC: to ban tobacco advertising and to require health warnings on tobacco packs. We will also support countries to strengthen tobacco taxation to improve public health and raise new revenues for governments.

In conclusion, I am very pleased that we have had the opportunity to have this debate. It is probably disappointing to some noble Lords that I cannot give a specific date for the new tobacco control plan, but I can assure them that it is coming, that there will be one and that it will build on the success of the previous tobacco plan. The noble Lord, Lord Crisp, and the noble Baroness, Lady Northover, asked a particular question about a new initiative for which we were being given funds by the WHO to deliver. I will have to write to them on that matter if that is acceptable. Obviously, we will reflect on all the points that have been raised this evening. I am sure they will add to the new tobacco control plan.