Key Messages
1 Active Smoking
Smoking is a major cause of illness and death from cardiovascular disease, chronic respiratory disease and cancer of the lung and other sites. It is the most important cause of premature death in developed countries and accounts for one fifth of all deaths in the UK: some 120,000 deaths a year.2
The avoidance of smoking would prevent one third of the deaths due to cancer in Britain and one sixth of the deaths from other causes. A person who smokes cigarettes regularly, more than doubles his or her risk of dying before the age of 65, and half of all who continue to smoke cigarettes are eventually killed by the habit,3 but stopping smoking is effective: even in middle age those who stop before they have overt disease avoid most of their risk of death from tobacco, and for those who stop before middle age the benefits are even greater.
The enormous damage to health and the large number of deaths caused by smoking should no longer be accepted. The Government should take effective action to limit this preventable epidemic. The importance and urgency of the smoking problem needs to be recognised by both the Government and the public.
The Government should require of the tobacco industry a normal standard of disclosure and the recognition of the evidence that smoking is a major cause of premature death. Tobacco manufacturers should be required to inform their customers clearly and accurately of the nature and magnitude of the risks of smoking.
2 Passive Smoking
Passive smoking is a cause of lung cancer and childhood respiratory disease. There is also evidence that passive smoking is a cause of ischaemic heart disease and cot death, middle ear disease and asthmatic attacks in children. Restrictions on smoking in public places and work places are necessary to protect non smokers. Parents need to be informed about the effects of passive smoking on their children.
3 Nicotine Addiction
Addiction to nicotine is now known to sustain the smoking epidemic. Thirty five years after the first report by the Royal College of Physicians on Smoking and Health, nearly 30% of adults in the UK still smoke. Smoking in young adults is on the increase, leading to an overall rise in adult smoking prevalence in 1996 after 24 years of steady decline. Most smokers begin in their teenage years, at a time when the prospect of illness and death in adult life seems remote. Some eventually give up the habit, but for many the intractability of smoking behaviour reflects the fact that nicotine is a powerful drug of addiction.
4 Price and Advertising
Price and marketing are important factors in influencing cigarette consumption. Regular price increases above inflation will reduce consumption. Young people in particular should not be exposed to tobacco advertising or to the images associated with sports promotion and other forms of indirect advertising. These counteract public health messages, undermine a proper understanding of the real size of the hazard and promote the social acceptability of cigarette smoking. In view of the burden of disease and death caused by tobacco, there can no longer be any justification for the deliberate promotion of this habit, which is the most important cause of cancer in the world.
5 Smoking Cessation
Because of the time lag before onset of morbidity, the prospects for reducing smoking related disease in the next 20 years depend mainly on increasing the rate at which established smokers give up the habit. Policies to increase the price of cigarettes and to restrict smoking in public places are effective in encouraging many to quit, but smokers often find it difficult to overcome their dependence without help. Effective treatments to promote smoking cessation are available and need to be implemented in primary care, hospitals, pharmacies and other health settings.
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