Tobacco Control Plan

Mary Kelly Foy Excerpts

Thursday 10th June 2021 Westminster Hall

[Mary Kelly Foy (City of Durham) (Lab)]

I beg to move,

That this House has considered recommendations for the forthcoming Tobacco Control Plan.

It is a pleasure to serve under your chairmanship, Mrs Miller. In December, the Minister confirmed to Parliament that the Government will publish a new tobacco control plan this year, setting out measures to deliver the smoke-free 2030 ambition in the 2019 prevention Green Paper. I welcome this announcement: as a former chair of the Gateshead tobacco control alliance, this issue is close to my heart. In my own area of County Durham, adult smoking prevalence is 17%, compared with 13.9% nationally, and rising to 27% among people in routine and manual occupations. Some 16.8% of mothers smoke during pregnancy, compared with 10.4% in England, and smoking in County Durham has an annual cost to society of approximately £122 million.

The Secretary of State himself stated that the “extremely challenging ambition” of a smoke-free 2030 will not be delivered by business as usual. The new report from the all-party parliamentary group on smoking and health sets out the evidence-based recommendations needed to achieve that ambition. Smoking is responsible for half the difference in life expectancy between rich and poor, and the impact is passed down through generations, with those who grow up in smoking households far more likely to become smokers. With 1,500 people dying from smoking-related diseases every week, and less than a decade to go to achieve a smoke-free 2030, there is no time to waste.

However, this will not happen without investment. That is why the key recommendation of the APPG’s report is for a smoke-free 2030 fund, requiring the tobacco industry to pay for tobacco control. This is the “polluters pay” approach that the Government committed to considering in the 2019 prevention Green Paper. As such, can the Minister assure me that the proposals put forward by the APPG on smoking and health will be considered as part of the forthcoming control plan? In particular, will the Government deliver on their commitment to consider a US-style “polluter pays” approach to fund the tobacco control measures needed to deliver a smoke-free 2030?

More investment is needed, because the huge gap in smoking prevalence between those in routine and manual occupations and those in other occupations is stubbornly persistent. Ending smoking would lift around 450,000 households out of poverty, including more than 250,000 million children and 140,000 pensioners, concentrated in the most disadvantaged parts of the country. That would not only benefit the health and wellbeing of individuals but inject money into local economies, which would show just how serious the Government are about the levelling-up agenda.

Smoking is linked to almost every indicator of disadvantage, and those indicators overlap different communities. Smokers in routine and manual occupations or who are unemployed are also more likely to live in social housing and to be diagnosed with mental health conditions. The Government have been unsuccessful so far in reducing the inequality gap in smoking and need to redouble their efforts to achieve a smoke-free 2030 for all. There is a clear need for a national strategy that targets investment and enhanced support at disadvantaged smokers.

Unfortunately, smokers from deprived communities with higher smoking rates tend to be more heavily addicted than those from more affluent areas. Analysis of Government data shows that in 2019 nearly half of England’s smokers were in routine and manual occupations or were long-term unemployed. They are just as motivated to quit as other smokers, but it is harder to succeed when smoking is more commonplace and cheap, illicit tobacco is widely available.

Regional tobacco control programmes have been effective in tackling these disparities, as shown by the example of Fresh in the north-east, which is the longest-running—indeed, the only surviving—regional office of tobacco control. When Fresh was founded in 2005, smoking prevalence in the north-east was over 20% higher than the national average for England, and the disparity was growing. Since then, the north-east has seen the greatest decline in smoking prevalence of any region: smoking prevalence in the north-east is now only 10% higher than the England average. However, the regional work done in the north-east and elsewhere has been limited by cuts to the public health grant for local authorities since 2015-16. This led to the closure of the regional offices in the north-west and the south-west, and funding in the north-east has been significantly reduced. New funding streams are needed.

Smokers can successfully quit only if they are motivated to make an attempt to quit. Sustained mass multimedia behaviour change campaigns are the most impactful and cost-effective way to provide that motivation. The US Government’s “Tips From Former Smokers” campaign was funded by tobacco manufacturers through the USA’s user-free scheme, which raises $711 million annually from the tobacco industry. The Food and Drug Administration campaign led to over half a million sustained quits in three years, and it was associated with healthcare cost savings of $11,400 per lifetime quit.

Such campaigns have an immediate impact and can be targeted with precision at disadvantaged smokers, yet investment in behaviour change campaigns has fallen year on year in England. This has coincided with a significant decline in the number of adult smokers who have tried to quit. In 2008, 40% of adult smokers in England had tried to quit within the previous year; by 2018, that had fallen to just 30%. Over the same period, funding for mass media campaigns fell by over £20 million.

Behaviour change campaigns need to be targeted at key groups and communities to reduce socioeconomic inequalities. The effectiveness of national campaigns can be significantly enhanced when they are supplemented by targeted regional campaigns. Regional funding for stop-smoking behaviour change campaigns in the north and midlands would support the levelling up of some of the more deprived regions of England. These are the regions with the highest rates of smoking, combined with the lowest gross disposable household income. Supporting smokers in these regions to quit will prevent people’s hard-earned incomes from going up in smoke, lifting thousands of households out of poverty and providing a boost to local economies.

Modelling by University College London for the all-party parliamentary group on smoking and health estimates that a sustained national behaviour change campaign aimed at deprived smokers, combined with regional campaigns in the north and midlands, would result in an additional 1 million quit attempts, 179,000 successful quit attempts and 45,000 more ex-smokers in C2/DE occupations in England by 2030. The investment required is estimated to be about £28 million a year, which the tobacco manufacturers could easily afford to pay from their £900 million profits in the UK—and more than three quarters of the public want the tobacco manufacturers to pay for those measures. Does the Minister agree that targeted investment to tackle high rates of smoking among our most deprived communities is vital to delivering the Government’s levelling-up agenda?

Sadly, illicit tobacco is more accessible to children, and as it is cheaper than legally sold tobacco it reduces the incentive for adult smokers to quit. In 2018-19, the total tax revenue lost because of illicit tobacco was estimated by Her Majesty’s Revenue and Customs to be £1.9 billion. The illicit trade is heavily concentrated in the more deprived communities, contributing to higher smoking rates. Addressing that disparity requires tackling both the supply and demand for illicit tobacco in communities where it is endemic.

In the north-east, there have been dedicated multi-stranded programmes of work in place since 2007 to reduce the supply and demand as part of a broader activity to reduce smoking prevalence and improve the population’s health. Such programmes drive a strategic approach to tackling illicit tobacco at local, regional and national level. One programme was described as follows:

“an exemplar of partnership working…and…deserves to be widely disseminated”—

a recommendation supported by the National Audit Office. Unfortunately, that has not yet been possible owing to lack of funding, and the funding in the regions where it does exist is under threat because of cuts to public health budgets. Fresh and the Greater Manchester health and social care partnership have estimated that it would cost approximately £5 million annually to roll it out across England.

As the Minister said at the launch of our report, we need to get HMRC to do more to tackle illicit tobacco. Just £5 million for a highly effective regional programme is peanuts and would return far more in lost revenue than it costs. Will the Minister commit to discussing with HMRC how funding can be found for the illicit tobacco partnership to extend cover to all the regions of England to reduce the use of illicit tobacco, which is endemic in poorer communities in every part of England?

We are delighted that the Minister was able to attend the launch of the report by the APPG. I know how passionate she is about the issue. I look forward to hearing her response to our report and recommendations. I am confident that if the Government can embrace our recommendations in the forthcoming tobacco control plan, we will be well on the way to a smoke-free England by 2030.

[Mrs Maria Miller (in the Chair)]

Before I call the next speaker, I should say that I shall be moving to Front-Bench contributions at 2.35 pm. I suggest an informal five-minute time limit to enable all colleagues to make their contributions. I call Bob Blackman.

--- Later in debate ---

[Mary Kelly Foy]

I thank you, Mrs Miller, the Minister and right hon. and hon. Members for their contributions to the debate. I am so pleased that there is cross-party support. I just want to reiterate that in order to go some way towards reducing inequalities, levelling up and increasing healthy life expectancy—especially in poorer communities—we must implement this plan.

Motion lapsed (Standing Order No. 10(6)).