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Public Health Leaders’ Khan Letter

Public health leaders have sent a letter to the British Medical Journal following the publication of the Khan review

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Public health leaders have sent a letter to the British Medical Journal following the publication of the Khan review. The authors welcome the review’s recommendations and say the government now needs to act swiftly and detail its plans in the Health Disparities White Paper.

We welcome the publication of Javed Khan’s Independent Review into smoking and urge the Government to heed his call for immediate investment of £125 million in tobacco control to deliver its Smokefree 2030 ambition,” they say.

Up to two thirds of smokers die prematurely, losing on average 10 years of life. Achieving the Smokefree 2030 ambition of adult smoking rates of 5% or less, would at a stroke deliver the Levelling Up mission to extend healthy life expectancy by 5 years.

“Targeted investment to tackle inequalities in smoking rates across society is desperately needed. Smoking is a far greater source of difference in life expectancy than socio-economic status, and these differences can only be eliminated if we achieve the Government’s goal of making smoking obsolete. We agree with the Secretary of State for Health, that it is a ‘moral outrage’ that England’s richest people live on average up to a decade longer than the poorest. It is time for the Government to match words with deeds, outrage with action. “That’s what the public wants too, with a substantial majority supporting a range of Government interventions, and only 6% thinking the Government is doing too much.”

Authors of the letter:

  • Nicholas S. Hopkinson, chair, Action on Smoking and Health
  • Helen Stokes-Lampard, chair, Academy of Medical Royal Colleges
  • Jim McManus, president, Association of Directors of Public Health UK
  • Sarah Woolnough, chief executive, Asthma+Lung UK
  • Charmaine Griffiths, chief executive, British Heart Foundation
  • David Strain, chair, BMA Board of Science
  • Ian Walker, executive director, Cancer Research UK
  • Maggie Rae, president, Faculty of Public Health
  • Jennifer Dixon, chief executive, The Health Foundation
  • Gill Walton, chief executive, Royal College of Midwives
  • Eddie Morris, president, Royal College of Obstetricians and Gynaecologists.
  • Andrew Goddard, president, Royal College of Physicians
  • Adrian James, president, Royal College of Psychiatrists
  • Linda Bauld, director, SPECTRUM
  • Pat Cullen, general secretary & chief executive, Royal College of Nursing
  • Martin Marshall, president, Royal College of General Practitioners
  • Carol Black, chair, Centre for Ageing Better

They continue: “No time is to be lost, if current trends continue we will miss the target by 7 years, and around double that for the poorest communities. Ministers have recognised the need to ‘floor it’ on public health, but that requires fuel in the tank. The Tobacco Control budget has been cut by a third in real terms since 2015, and additional investment is desperately needed, alongside tougher regulation. If the Government cannot find the necessary funding, then, as Khan says, it should ‘make the polluter pay’.

“This was also the recommendation of the APPG on Smoking and Health, which urged the Government to strictly control the profitability of the tobacco transnationals. Reducing net profit margins from around 50% to no more than 10%, in line with the average for other businesses, could release £700 million excess profits a year which should be used to fund tobacco control and other Levelling Up measures.
“Smoking is not a lifestyle choice, it is an addiction usually starting in childhood. Stopping smoking benefits hard-pressed families, reducing poverty by increasing disposable household income; creating jobs; increasing productivity; reducing NHS waiting lists; and improving health and wellbeing.

“The £12 billion a year spent on tobacco has greatest impact on poorer communities where smoking rates are highest, exacerbating the cost of living crisis. In addition to the £2.4 billion smoking costs the NHS; and £1.2 billion for social care; a further £13 billion accrues from lost productivity due to premature death, disease and disability. The Government rightly wants to make smoking obsolete [3]. If this were achieved, it is estimated that UK jobs would increase by 500,000 as smokers spent their money on other goods and services. The net benefit to public finances would be around £600 million for England alone.

“Nationally around 14% of adults smoke but rates in social housing, where a third of smokers live, are double that. Around 25% of people with depression and anxiety and over 40% of those with severe mental illness smoke. Smoking is the single biggest modifiable risk factor for cancer and COPD, as well as for miscarriages, stillbirth, premature birth and birth anomalies. Women in the most deprived group are five times more likely to smoke in pregnancy than the least deprived.

“Every day the Government fails to act more than 200 people in England die from smoking and 280 children under 16 have their first cigarette. Two thirds of those smoking one cigarette will go on to become addicted, daily smokers, taking on average thirty attempts before they successfully quit.

“The Health Disparities White Paper is due shortly, a fully-funded comprehensive Tobacco Control Plan to make smoking obsolete must follow swiftly on its heels.”


Dave Cross avatar

Dave Cross

Journalist at POTV
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Dave is a freelance writer; with articles on music, motorbikes, football, pop-science, vaping and tobacco harm reduction in Sounds, Melody Maker, UBG, AWoL, Bike, When Saturday Comes, Vape News Magazine, and syndicated across the Johnston Press group. He was published in an anthology of “Greatest Football Writing”, but still believes this was a mistake. Dave contributes sketches to comedy shows and used to co-host a radio sketch show. He’s worked with numerous vape companies to develop content for their websites.

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