Yesterday evening saw a joint statement from the Cabinet Office and DHSC arrive unannounced into inboxes. It contained news of the publication of a crucial and long-awaited green paper, Advancing our Health: prevention in the 2020s, and asked for views on proposals to help people live healthier, happier lives for longer.

Matt Hancock outlined plans that put prevention at the heart of the NHS long-term plan during a keynote speech in November. Yet, the actual publication of the green paper was one of Theresa May's last moves as prime minister. Labour’s shadow health secretary Jonathan Ashworth said in the Financial Times today that the green paper and the manner of its coming out looked like Mr Hancock was trying to bury the bad news.

There is speculation this is because it contains an announcement that the government will end the sale of energy drinks to children under the age of 16 and there are proposals to extend the Soft Drinks Industry Levy (SDIL) to sugary milk drinks.

No matter the reasons behind its timing, the prevention green paper has been met with mixed reactions from charities with many saying it is missed opportunity. 

BMA board of science chair, Professor Dame Parveen Kumar, said that the green paper has been introduced at the same time as public health funding is being repeatedly cut. In order to truly prioritise prevention, the Government must reverse these cuts and invest in services, while ensuring the public health workforce are motivated, properly resourced and mobilised across the system. 

She added: “Ultimately the success of this strategy, lies in the hands of the next Government who have the responsibility of delivering it. It is concerning that this paper lands at a time of such political uncertainty so it is vital that the new prime minister not only commits to delivering on the positive steps outlined in this paper, but that they also go beyond this and commit to the much bolder action that is needed.”

A smoke-free generation will be 'extremely challenging' to achieve

Despite the political back drop, one of the biggest headline grabbing news from the paper is that the Government is committed to delivering a smoke-free generation by 2030. This is defined as a prevalence below 5% across society. This includes an ultimatum for industry to make smoked tobacco obsolete by the same time, with smokers quitting or moving to reduced risk products like e-cigarettes. 

Deborah Arnott, Chief Executive of health charity Action on Smoking and Health (ASH), said that the goal was achievable, popular and will make the single most significant contribution to delivering the Vision for Prevention goal of five extra healthy years of life. It will also narrow the health inequality gap between the richest and the poorest.

However, she added that it will be “extremely challenging” to achieve and will require innovative new policies and funding.

There has been good progress in moving towards a smoke-free society. Over the last 35 years, smoking rates in Great Britain have halved and we now have one of the lowest rates in Europe, with fewer than 1 in 6 adults smoking.

Yet, for the 14% of adults who are not yet smoke-free, smoking is the leading cause of ill-health and early death, and a major cause of inequalities. The government said that although smoking rates are falling overall, they remain stubbornly high in certain groups, including:

  • In areas of deprivation. In Blackpool, one in four pregnant women smoke. In Westminster, it’s one in 50. Rates are also higher among manual workers and social renters

  • Among people who identify as LGBT

  • Among people living with mental health conditions. A joint report from the Royal College of Physicians and the Royal College of Psychiatrists suggests that one in three cigarettes in England are smoked by somebody with poor mental health.

It added that if it is to achieve this vision of a smoke-free future, it needs bold action to both discourage people from starting in the first place, and to support smokers to quit. 

Tobacco manufacturers could pay a levy to help smokers quit

The Green Paper is the start of a more detailed consultation process and it is looking at a ‘polluter pays’ approach requiring tobacco companies to pay towards the cost of tobacco control as well as other ideas such as raising funds under the Health Act 2006. It is also examining the possibility of inserts in tobacco products giving quitting advice as part of the review of tobacco legislation.

According to a large survey of over 10,000 adults in England in 2019, such measures would be welcomed by the general public as 72% of adults in England supported a tobacco manufacturer levy to help smokers quit and prevent young people from taking up smoking.

Other countries, such as France and the USA, have taken a ‘polluter pays’ approach and the government states it would aim to use any funds to focus stop-smoking support on those groups most in need, such as pregnant women, social renters, people living in mental health institutions, and those in deprived communities; and to crack down on the illicit tobacco market by improving trading standards enforcement.

Smoking is still the leading cause of premature death

According to the All Party Parliamentary Group on Smoking and Health (APPG), smoking remains the leading cause of premature death, killing nearly 80,000 people in England and 100,000 in the UK as a whole per year. Half the difference in life expectancy between the richest and poorest in society is solely due to smoking.

Children growing up in homes with smokers are not only more likely to be exposed to smoking, they are also significantly more likely to become smokers themselves. In 2016 99% of children aged 11-15 who were regular smokers had friends who smoked, and 83% had family members who smoked. Reducing adult smoking is also key to reducing youth smoking initiation, and the translation of inequalities in smoking across the generations.

While youth smoking rates have fallen to the lowest recorded levels since surveys began in 1982, between 2014 and 2016 more than 127,000 children a year aged 11-15 started to smoke in the UK, according to analysis by Cancer Research UK.

The APPG states that smoking prevalence will only continues to decline if tobacco control policies continue to be updated, invigorated and improved. Furthermore, the more extensive and comprehensive the tobacco control policies are, the more effective they will be in reducing youth initiation and increasing the number of adult smokers who quit. 

The consultation on the green paper runs until 14 October, with the government's response expected by next spring.


Join our sister journal GM in London this October at The Ageing Patient: Midlife and Beyond for updates on:
• primary and secondary prevention strategies for patients aged over 50 years
• promoting and maintaining independence in frail older populations.

View the full CPD programme and book your place here.