Smoking

Smoking and health

Inequalities

There is a higher prevalence of smoking in lower socio-economic groups. In 1996, 29% of men and 28% of women smoked, but this ranged from 2% of men and 11% of women in professional occupations to 41% of men and 36% of women in unskilled manual work. Not only is the percentage of smokers higher, but on average, individual smokers in unskilled work smoke more cigarettes than professionals. Men and women in unskilled work also show a far lower success rate in giving up smoking. Since 1973, the number of people stopping smoking among professionals and the most socially advantaged groups has more than doubled. In less advantaged groups, however, the number of people who successfully give up has only risen from between 8 and 9% in 1973 to between 10 and 13% in 2000.

Evidence

Smoking is an important component in the different life expectancy of people from different classes. In the UK, more deaths from cancer can be attributed to smoking than any other factor. In 1995, smoking was estimated to be the cause of more than 30,000 deaths from lung cancer and a further 16,000 from other cancers - especially of the oesophagus, bladder, stomach, mouth and throat. Altogether, smoking-related cancers were responsible for approximately one-third of all deaths from cancer. Smoking is also an important cause of chronic obstructive lung disease, coronary heart disease, stroke and aortic aneurysm. Furthermore, smoking damages the health of non-smokers. Recent studies show passive smoking as the cause of lung cancer and coronary heart disease in adult non-smokers and of respiratory disease, sudden infant death syndrome, middle ear disease and asthma attacks in children.

The price of tobacco has an impact on the level of consumption. When the cost goes up, sales go down. Studies in the USA and Canada show that young people who are not nicotine-dependent habitual smokers, but may be thinking of starting smoking, are particularly sensitive to price. Very few people take up smoking after the age of 20. A high price could therefore be an effective way of stopping teenagers from becoming regular smokers, and have a long-term impact on smoking-related disease and the number of smokers in different socio-economic groups.

Smoking also has a disproportionate effect on the living standards of the UK's poorest households. Households in the lowest 10% of income spend six times as much of their income on tobacco as those in the top 10. More than 70% of two-parent households on Income Support buy cigarettes - costing them about 15% of their disposable income. Studies indicate that Income Support - which specifically excludes spending on non-essentials such as tobacco - is not in itself enough to provide a household (especially one with children) with an adequate standard of living. Therefore, it is no surprise that, if a parent smokes, households on Income Support or other low income are much more likely not to provide basic amenities such as food, shoes or coats. (It is fair to assume that, under the circumstances, they are also more likely not to have smoke alarms or modern, flame-retardant furniture.)

Disadvantaged people are the least likely to give up smoking. A recent survey of lone mothers shows that living in severe hardship is the main reason they give for not stopping smoking. Price has little effect on this. The cultural and environmental barriers that disadvantaged people face in giving up smoking will take time to change.

Advice from a GP is a highly effective way of promoting giving up smoking - the number of people giving up as a result of their doctor's advice seems to be as high as of those who respond to mass media campaigns. Community-based intervention and specialised anti-smoking clinics are also effective routes for smoking health and safety information.

Benefit

Reduction in smoking would decrease the risk of smoking-related diseases over time and reduce the risks of passive smoking. Given that smokers have a higher mortality rate and that more people in lower socio-economic groups smoke, reduction in smoking will also change the difference in mortality rates between socio-economic groups.