This past year promised to be an important one when it came to putting in place properly researched tobacco harm reduction policies. Unfortunately, as another No Smoking Day comes and goes, there is clearly still much progress to be made. For all the talk of a ‘vaping revolution’ paving the way to the first truly smoke-free generation, this shift has yet to materialise. But perhaps the issue is that policymakers are looking for change in the wrong place.
The truth is that traditional tobacco control policies have been predominantly focused on heavy-handed taxation or, if Wes Streeting gets his way, a near total ban on cigarette sales. These approaches have done virtually nothing to shift the dial and are entirely counterproductive. It should be remembered that smoking is, at its core, a cultural phenomenon: just over 25% of the adult population in Blackpool smoke, compared with only 4.2% in Richmond-upon-Thames. If change is to be achieved, there needs to be a shift in the culture.
It will soon be a year since The Khan Review: Making Smoking Obsolete was published. While most of it focussed on the usual red herrings in the form of punitive state interventions, Javed Khan was right when he declared the promotion of vaping as one of his core critical recommendations. Between 2012 and 2020, smoking prevalence plummeted by an unprecedented 25%. It is no coincidence that this was the decade in which e-cigarettes went mainstream.
It is no longer affordable to ignore the clear link between e-cigarette use and declining smoking rates. Public Health England found vaping to be the most successful therapy for stopping smoking, helping more than 50,000 smokers quit. In Japan, the use of heated tobacco products has led to a halving of cigarette sales in just six years. Cultural shifts are hugely powerful phenomena and there is no reason why heated tobacco couldn’t have a similar positive effect in the UK.
Cultural change is not easy to generate, but small differences are what ultimately add up to a significant shift. This No Smoking Day, focus should be on the incremental changes that can lead the way to a smoke-free Britain.
For example, challenging the widespread misperception that vaping is dangerous would go a long way in altering the status quo. More than a third of smokers wrongly believe that vaping is as harmful as smoking. This contrasts with the extensive evidence featured in reviews by Public Health England and the Office of Health Improvement and Disparities. They repeatedly estimate that vaping is at least 95% less harmful than cigarettes. Including inserts into cigarette packets, informing people who smoke of the facts surrounding safer choices and encouraging them to make the switch, is exactly the type of small but significant change which should be pursued.
The recommendation, floated by then Health Secretary Sajid Javid, that vapes be prescribed on the NHS should be revisited. It would not only go a long way in tackling health inequalities, but it would also make England the first country in the world to prescribe e-cigarettes. Such a move would both embolden experimentation with vaping amongst smokers, but also serve as a reassurance for medical practitioners who still harbour some doubts. These are the kind of trailblazing measures that could pave the way for a significant shift in the understanding of alternative products and a change in the culture of nicotine use.
This will be the 39th No Smoking Day. This year the UK is in a strong position to spearhead change. Decades of learning and science have taught us that it is cultural change that ultimately shifts the dial in human behaviour, not top-down heavy-handed state intervention.
Crucially, there is now a vast array of safer alternatives to smoking available for consumers to choose. That could be vapes, heated tobacco, or nicotine pouches. Evidence shows them to be highly effective in moving consumers away from the most dangerous nicotine delivery system – combustible tobacco. This diverse range of lower-risk, non-combustible products should be utilised to the full if the goal of No Smoking Day is truly to consign smoking to the past.
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