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By Jill Duffy, Reducing Inequalities Senior Manager at Bradford District and Craven Health and Care Partnership.

On the 4 October last year, the government announced their intention to create a ‘smoke-free generation’ by ending the sale of cigarettes to those born on or after 1 January 2009 and introduce a historic new law to protect future generations of young people from the harms of smoking.

The following day I attended the West Yorkshire (WY) tobacco control summit in Leeds and there was much excitement at the announcement. If passed the new legislation will effectively raise the legal smoking age by a year each year until it applies to the whole population and has the potential to phase out smoking in young people almost completely by 2040.

Smoking is the UK’s biggest preventable killer – causing around 1 in 4 cancer deaths and 64,000 in England alone, costing the economy £17 billion each year. It puts huge pressures on the NHS in terms of hospital admissions and GP appointments and is one of the biggest drivers of health inequalities, whether one smokes or not is a bigger determinant on life expectancy than social position.

The announcement was hailed as ‘historic’ and ‘one of the most significant public health interventions by the government in a generation’ and it certainly feels that it might be the case. It is predicted that there will be 1.7 million fewer people smoking by 2075, a saving to the health care system of billions of pounds and boosting the economy by £85billion by 2075, not to mention the avoidance of an estimated 115,000 cases of stroke, heart disease, lung cancer and other lung diseases.

Starting young

Most smokers start when young (before the age of 18) and stopping people from becoming addicted to nicotine early must be a main priority in reducing smoking rates.

Although I gave up smoking in the late 1990’s I started young, sometime around 1984/85 when I was studying for my O Levels. The legal age for selling cigarettes at that time was 16 but I could go to my local off license and be sold a single cigarette (I think it was for 10p at the time) and when you walked in there was an array of brightly coloured and branded packs behind the counter. A packet of 10 was about 70p.

My dad smoked and all his brothers smoked, I was brought up used to passive smoking, and once at upper school most of my friends smoked too. Cigarette advertising and tobacco sponsorship of sporting events was everywhere, people smoked on buses, in public places, in cinemas and workplaces. When I started work (as an apprentice in engineering) you could smoke on the shop floor and later when I moved into the office everyone smoked at their desks.

Looking back, it was so easy to start smoking and access cigarettes. It was also so… normal and I think that is what really stands out. But from where I stand now, I can see the distance travelled and how things are different, smoking is no longer as visible or accessible and much less of a social norm.

A decline in smoking rates

Action on Smoking and Health (ASH) states that in the last 10 years smoking rates in children aged 11-15 have halved due to a combination of legislation. For example, raising the legal smoking age to 18, greater powers to police the illegal sale of tobacco to children and measures to reduce visibility, and non-branded packets and cigarettes not on display.

ASH also has a really interesting paper that charts the timeline of interventions mapped to reductions in smoking prevalence.

It is interesting to note that progressive reforms regarding advertising and health warnings in the early years were largely under voluntary agreements with the tobacco industry (for many years). It isn’t until we see major legislative changes that reforms start to bite.

Whilst adult smoking prevalence drops steadily due to progressive reforms on advertising, health warnings, evidence, legislation, policy reforms and other public health interventions and campaigns, the prevalence of children smoking drops relatively slowly between 1982 (when statistics first reported) until 2007 when the legal age for purchasing tobacco was raised to 18.

It remains a surprise to me that it wasn’t until 1986 that the sale of all forms of tobacco to children under the age of 16 was legislated against and 1992 before it became illegal to sell single cigarettes. But, it was in 2007 that we see the biggest impact on childhood smoking when the country went smoke-free and the legal age for purchasing all forms of tobacco was raised to 18. According to ASH the prevalence rate for children smoking in that year was 6% where it had previously been 9%.

Keeping our eyes on the ball

So, it is easy to see why the announcement in October last year created, quite rightly, such excitement, but we cannot afford to take our eyes off the ball, and we need to be alert to new challenges when it comes to the health of our children.

Significant inequalities exist in relation to tobacco in Bradford that can be mapped against deprivation and some key population groups. WY is moving towards the 2030 ambition to have a smoking rate of 5% but Bradford has the highest rate in WY and within Bradford there are areas that have significantly higher rates of smoking that are masked by the overall prevalence. We must continue to address these inequalities.

Addressing smoking inequalities in Bradford District and Craven

The Tobacco Control Alliance aims to reduce smoking prevalence within the district setting the vision and strategic direction and advocating for the tobacco control agenda through the Tobacco control Strategy and Action Plan which aims to reduce the harms and inequalities associated with tobacco.

Addressing inequalities and working with young people to prevent take up are central to the strategy. There is a need to understand youth vaping and address emerging patterns of tobacco/nicotine use among young people. You can read more about the strategy on our Tobacco deep dive page.

People who live in areas of greatest deprivation are less likely to try to stop smoking and less likely to succeed if they do. Smoking cessation services need to be targeted on the priority groups and areas that need them and we need to utilise our community networks and levers such as Core20Plus5 funding to support this, ensuring there is networking and continuity with NHS programmes. People who work in routine and manual occupations are more likely to smoke and employers need to be supported to help their employees quit.

The availability of illicit tobacco has the greatest impact on our poorest communities and significantly undermines all other strategies, it funds organised crime and modern day slavery and can provide an entry route into crime for young people. We need to find ways to support actions to reduce the availability of illicit tobacco particularly for young people.

Legislation to raise the legal age for purchasing tobacco has shown that it is effective and the new legislation will make a huge impact on moving us, as a nation, towards a smoke-free society. However, we must not forget that the impact of poverty and deprivation is significant and without focused strategic local action to target inequalities significant numbers in our population will miss out and continue to experience health inequalities associated with tobacco use.

Jill, circa 1989/1990

View more inequalities blogs below or on our Reducing Inequalities Alliance webpage. To write a blog about inequalities work you’re involved in, please email ria@bradford.nhs.uk

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