PJ McCarthy, a retired railway worker, whirrs down a shuttered Great Yarmouth shopping street on a mobility scooter, leaving a faint whiff of menthol-scented vapour in his wake.
The life-long smoker had a stroke five years ago. Quitting after 35 years was “extremely difficult” but his doctor in the town on England’s East Anglia coast recommended vaping. “I used to smoke 40 cigarettes a day,” he said. “I haven’t looked back since.”
The government needs many more quitters like McCarthy if it is to achieve its goal of reducing smoking levels to one in 20 people by 2030. Unveiled in 2019, this “smokefree 2030” target for England is 10 years ahead of the EU’s goal.
The smoking rate among over 18s was 14 per cent in 2019. But on its current trajectory, the country will overshoot 2030 by seven years, the charity Cancer Research UK predicted.
In places such as Great Yarmouth, where almost one in four adults smoked in 2019-2020, strained public health budgets, the impact of the pandemic and socio-economic barriers suggest the target is very ambitious indeed.
The borough is the most deprived in Norfolk. Men in one ward have a reduced life expectancy of 10 years below the UK’s average. Mike Smith-Clare, a Labour councillor who runs community organisation Bread Kitchen CIC, said: “We’ve got huge problems with poverty.”
Local authorities fund public health through a grant from central government. This has been cut by 24 per cent on a real-terms per capita basis since 2015-2016, according to research from the Health Foundation, a charity. Smoking cessation and tobacco control have had the largest cut of any services, at 33 per cent.
“The signs are that the government is not learning the lessons about the need for adequately funding public health,” said Grace Everest, a policy fellow at the Health Foundation.
Smith-Clare said stretched health services had historically been backed up by community organisations but “over the past 18 months, they’ve been unable to run their services properly”.
As a result of the pandemic most smoking cessation clinics in Norfolk are now delivered remotely. Louise Smith, Norfolk County Council’s director of public health, said fewer smokers across England had set quit dates or stopped successfully during the pandemic, including in Great Yarmouth.
Nationally, smoking contributes to about 78,000 deaths and costs the NHS £2.5bn a year, with a wider cost to society of around £10bn, including lost productivity for businesses and social care costs, according to official statistics. Delays to the government’s tobacco control plan for England have hindered progress. The strategy, which will set out how to reach “smokefree 2030”, was due in July 2021 but has yet to be released.
“Basically the government has done nothing in the two years since it committed [in 2019] . . . to make England smokefree by 2030,” said Deborah Arnott, head of the charity Action on Smoking and Health. “We’re doing all we can to make government engage the gears and get a move on.”
The Department of Health and Social Care said: “We will set out how we will deliver our bold ambition to be smoke free by 2030 in our new tobacco control plan”, although it did not confirm the publication date.
The all-party parliamentary group on smoking and health, advised by ASH, published a raft of suggestions in June. These included a “polluter pays” model, which would levy profits on big tobacco companies that benefit from high smoking rates.
Capping profits at 10 per cent could raise £700m a year, enough money to support smoking cessation services and leave £385m for the government to spend on other public health measures, ASH said.
One sign of progress is the UK’s emphasis on tobacco harm reduction, where it is “quite rightly” regarded as a world leader, Everest said.
In Great Yarmouth, smokers have been given vouchers to buy vapes, a successful pilot that is now a county-wide scheme, Smith said. Plans to medicinally license e-cigarettes, given recent impetus by new guidance from the Medicines and Healthcare products Regulatory Agency, could allow general practitioners to prescribe them nationwide.
This approach is a product of the Cabinet Office’s former “nudge unit”, which encouraged vapes in 2011. Led by David Halpern, the behavioural insights team now operates outside of government and advocates for harm reduction.
As well as giving smokers e-cigarettes, “scaffolding” must be applied around them, including therapy, Halpern said. “Why have we retreated from smoking cessation?” he asked. “Let’s do it all. It’s not that expensive or difficult and it’s such a big part of health inequalities.”
Everest pointed to New Zealand’s “multipronged” approach. The country aims to be “smoke free” by 2025 and recently announced plans to bring in progressively rising age restrictions for smokers. Anyone aged 14 or below when the law comes into effect will never legally buy cigarettes. There will also be interventions for disadvantaged communities and limits on nicotine levels in cigarettes.
Though vapes can be given to smokers, nicotine addiction among young Britons in deprived areas must also be avoided. “I’d say a good 70 per cent of my friends smoke,” said Luke Bullard, 21, in Great Yarmouth. “I started on a vape [at 16]. Then my vape broke and I moved to cigarettes.”
Creating opportunities for young people in places like Great Yarmouth could help tackle health problems. Smith said: “We know deprivation is directly linked to tobacco use, and the sad fact is Great Yarmouth is in the top 20 per cent most deprived areas of the country.”
Bullard, who volunteers with Smith-Clare’s Bread Kitchen, has spent the last five years in and out of jobs. “People on the limit aren’t going to have the motivation to not smoke,” he said. “You can say ‘I’m going to quit smoking’ but if there isn’t the support it’s not going to happen.”