Public Health England chief vows to get "ruthless" on smoking
Thursday, September 6, 2018 at 17:07
Simon Clark

What do Philip Morris and Public Health England have in common?

They're both targeting 2030 as the year England will be 'smoke free' (sic).

Their definition of 'smoke free' is a strange one because it actually corresponds to a smoking prevalence of five per cent.

As the IEA's Mark Littlewood said at an event hosted by Philip Morris earlier this year (and I paraphrase), no-one would say Britain is 'heroin free' yet the number of people who use that drug is far less than five per cent of the population.

Moreover, five per cent of an adult population of 40 million is two million, so PHE (and Philip Morris) intend to declare England 'smoke free' when there are still two million people smoking. Really?

Anyway, PHE's chief executive Duncan Selbie has once again been making noises.

According to one report published today, Selbie says the NHS long term plan, which is due to be published in November, must have a “really big” prevention ambition'.

The same report notes that:

In a statement released today, PHE said prioritising smoking cessation, cardiovascular disease and obesity in the long term plan will have a huge impact.

It said this could lead to reducing smoking prevalence to less than five per cent by 2030, and halving childhood obesity and the number of avoidable deaths from cardiovascular disease.

If you want to know what that means, Selbie has posted an article – 'Prevention and the NHS long term plan: 3 ways we can save more lives' – on PHE's Public Health Matters blog:

Smoking [he writes] remains England’s biggest killer and ends the life of 200 people every day. Our prevalence rates are at an all-time low at just under 15% but this belies huge variation, such as in affluent Epsom and Ewell, where rates are at 4.9%, but just 60 miles away on the south coast in Hastings the rate is more than five times greater at 25.7%. We also see big variation particularly in people in manual work and those who suffer with mental health problems. Our prisons are now largely smokefree but it can be harder to smoke outside a railway station or pub than it can outside a hospital, and this is not okay.

Smoking is the single biggest modifiable risk factor that impacts on infant mortality and morbidity, causing up to 2,200 premature births, 5,000 miscarriages & 300 perinatal deaths per year. Almost 11% of women in England are still recorded as smoking at the time of delivery, which translates into over 65,000 infants born to smoking mothers each year. We need to take action and support women to increase the number having a smoke free pregnancy, including implementing the actions set out in the Government Tobacco Control Plan in respect of pregnant women and of the Maternity Transformation Programme.

Our ambition to remove smoking from England will only be achieved by the concerted efforts of everyone, but it can be done, and the NHS could be a more powerful driving force by actively nudging patients and its own staff onto cessation programmes, treating smoking addiction as a medical condition and taking an absolutely zero tolerant approach to smoking on the NHS estate.

All of this and more will play out through the long term plan and this time we must be more literal about the priority that we are giving to prevention. We need less rhetoric and more action. We need to be ruthless in our priority setting and ruthless in our implementation.

Interestingly, and despite PHE's declared support for e-cigarettes as a smoking cessation tool, vaping doesn't get a single mention.

Selbie's contempt for smokers is all too obvious however.

Of course, if he achieves his ambition to make England 'smoke free' by 2030 (he won't), expect to see a new NHS plan featuring a "zero tolerant approach to vaping on the NHS estate" allied to the "need to be ruthless in our priority setting and ruthless in our implementation" of anti-vaping policies.

We probably won't have to wait that long because I predict that public health campaigners – even those that are currently advocating e-cigarettes as a smoking cessation tool – will turn on vaping the moment there are more vapers than smokers.

I'd bet my house on it, if my wife would let me. (She won't.)

Update: Here is Forest's response to PHE's statement:

Prioritising smoking cessation is an "attack on choice and personal responsibility"

Article originally appeared on Simon Clark (
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