BEYOND Smoking Kills : PROTECTING CHILDREN, REDUCING INEQUALITIES BEYOND Smoking Kills : PROTECTING CHILDREN, REDUCING INEQUALITIES CONTENTS Foreword ................................................................................................... 1 Executive Summary .................................................................................. 2 Chapter 1 The goal and aims of tobacco control ...................................................... 9 Chapter 2 Ten years of progress ............................................................................. 12 Chapter 3 Children and young people ..................................................................... 23 Chapter 4 Health inequalities ................................................................................... 29 Chapter 5 Public opinion .......................................................................................... 35 Chapter 6 The regulation and use of tobacco ......................................................... 40 Chapter 7 Help to quit ................................................................................................ 51 Chapter 8 Alternatives to smoking ............................................................................ 57 Chapter 9 New commitment, new targets ................................................................ 63 References .............................................................................................. 70 www.ash.org.uk/beyondsmokingkills www.ash.org.uk/beyondsmokingkillssummary i BEYOND Smoking Kills is published by Action on Smoking and Health and funded by Cancer Research UK and the British Heart Foundation. This report marks the tenth anniversary of the white paper Smoking Kills and sets out an agenda for action for the decade to come. The development of the report was overseen by an editorial board of tobacco control experts and is supported by more than 100 organisations. We would like to acknowledge the contributions made by all our partners. Editorial Board Peter Kellner, President YouGov, Chair of the editorial board Will Anderson, Managing Editor Deborah Arnott, Director ASH Professor John Britton, Royal College of Physicians Tobacco Advisory Group Professor Martin Jarvis, University College London Dr Mike Knapton, British Heart Foundation Elspeth Lee, Cancer Research UK Dr Lesley Owen, National Institute for Health and Clinical Excellence Ailsa Rutter, Fresh Smoke Free North East Professor Joy Townsend, London School of Hygiene and Tropical Medicine Professor Robert West, University College London New research compiled for this report Christine Callum, Martin Dockrell, Professor David Hammond, University of Waterloo, Canada Jane MacGregor, Professor Ann McNeill, University of Nottingham Data provided by BMRB Dr Foster Intelligence YouGov ISBN 978-1-872428-79-6 © Copyright All rights are reserved. No part of this publication may be reproduced in any form without the written permission of the authors. Applications for the copyright owner's permission should be addressed to Action on Smoking and Health, 144-145 Shoreditch High Street, London E1 6JE Printed on Naturalis. Made from 100% ECF pulps. Text recycled paper contains a minimum of 70% Forest Stewardship Council material. It is made up of 50% recycled fibre which is FSC accredited and a minimum of 20% FSC virgin pulp. Graphic design: [email protected] ii ORGANISATIONS ENDORSING THIS REPORT NATIONAL LOCAL AND REGIONAL Arrhythmia Alliance Mental Health Foundation Bolton PCT ASH Wales Mental Health Network Brent Teaching PCT Association of Directors of Public Mouth Cancer Foundation Bristol PCT Health National Association of Child Bury PCT Association of Public Health Contact Centres Dorset PCT Observatories National Children's Bureau Dudley PCT Asthma UK National Heart Forum East and North Herts PCT Beating Bowel Cancer NHS Alliance East Midlands Public Health Observatory British Association for Cardiac No Smoking Day Eastern Region Public Health Observatory Rehabilitation Orchid Fresh Smokefree North East British Association for Nursing in Primary Care Cardiovascular Gateshead PCT Cardiovascular Care Society Heart of Birmingham PCT British Cardiovascular Society QUIT Heart of Mersey British Dental Association Royal College of General Kent County Council - Children, Families and British Dental Health Foundation Practitioners Education Directorate British Lung Foundation Royal College of Midwives Kingston PCT British Society for Heart Failure Royal College of Nursing Leeds PCT British Thoracic Society Royal College of Obstetricians Liverpool PCT Cancer Campaigning Group and Gynaecologists London Health Observatory Chartered Institute of Royal College of Pathologists London Teaching Public Health Network Environmental Health Royal College of Psychiatrists NHS North West SHA Children's Heart Federation Royal College of Physicians NHS South Central SHA Diabetes UK Royal College of Physicians of NHS West Midlands SHA English Community Care Edinburgh North East Essex PCT Association Royal College of Radiologists North East Public Health Observatory Faculty of Public Health Royal National Institute of Blind North Lancashire Teaching PCT Families Need Fathers People North Lincolnshire Council/ North Fatherhood Institute Sainsbury Centre for Mental Lincolnshire PCT Foundation for the Study of Infant Health North West Public Health Observatory Deaths The Stroke Association North Yorkshire and York PCT GMFA - The gay men's health Scottish Public Health Portsmouth City Teaching PCT charity Observatory Redbridge PCT H.E.A.R.T UK - The Cholesterol South Asian Health Foundation Richmond and Twickenham PCT Charity The Roy Castle Lung Foundation Sandwell PCT Heart Care Partnership UK Tobacco Control Collaboration Sheffield PCT and City Council Ireland and Northern Ireland's Centre Smokefree North West Population Health Observatory Tommy's (pregnancy related Solihull NHS Care Trust Kidney Research UK recommendations) South Staffordshire PCT Local Government Association UK Centre for Tobacco Control South East Public Health Observatory Long Term Conditions Alliance Studies South West Public Health Observatory Macmillan Cancer Support UK Public Health Association South West Thames Institute for Renal Men’s Health Forum Wales Centre for Health Research South West Thames Kidney Fund West Herts PCT West Midlands Public Health Observatory Wolverhampton Coronary Aftercare Support Yorkshire and Humber Public Health Observatory iii iv BEYOND Smoking Kills : PROTECTING CHILDREN, REDUCING INEQUALITIES FOREWORD Children and young people are the primary victims of tobacco in the 21st century. They suffer today when they get addicted to smoking before they know the meaning of addiction, when they are forced to breathe tobacco smoke in their homes and, in the earliest moments of their lives, when they are exposed to tobacco toxins in the womb. They will suffer tomorrow when they face the reality of the harm of smoking, when they struggle to quit, and when the consequences of not quitting finally hit home. One in every two life-long smokers is killed by tobacco and most smokers lose many years of active life. Smoking remains the largest preventable cause of death in England. There have been huge advances in tobacco control in England since the publication of the white paper Smoking Kills in 1998. Cigarette advertisements have disappeared from billboards and the pages of magazines and sporting events are no longer emblazoned with the colours and logos of tobacco brands. Above all, no-one is forced to breathe tobacco smoke in the workplace or in enclosed public places. These are huge achievements - achievements which are the envy of the world - but no-one beyond the tobacco industry takes pride in the fact that a new generation of young smokers is growing up in England today. Some smokers may feel that enough has been done to restrict their behaviour and that they should be left alone to enjoy the choices they freely make. Yet this misses the point. The focus of tobacco control today is not restriction but protection, above all the protection of children and young people from the harm of smoking. This can be achieved in many different ways: Children are more likely to become smokers if their parents smoke. Helping adult smokers to quit is vital in reducing smoking initiation and so achieving a long- term decline in smoking prevalence. Adults in England today can now enjoy their everyday lives without ever coming into contact with secondhand tobacco smoke. Millions of babies and children do not have this freedom. New initiatives are needed to protect them from exposure to secondhand smoke. Smoking is the main reason why people from poor and deprived backgrounds have lower life expectancy than the affluent. An effective strategy to reduce adult smoking will also help to reduce health inequalities and add to the disposable income of millions of poor families in England. New investment and new ideas are needed to achieve these goals. This report explores these ideas, defining a new agenda for tobacco control which aims to reduce the harm to children and to reduce the inequalities which define the smoking epidemic in England. The government has signalled its intention to develop a new national tobacco control strategy. This document welcomes this renewed government commitment and advocates for a comprehensive, long-term strategy, underpinned by vision and ambition. There is much to be proud of. There is much to be done. 1 BEYOND Smoking Kills :