Letters

Tobacco policy

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6938.1241b (Published 07 May 1994) Cite this as: BMJ 1994;308:1241

Punitive taxes won't cut consumption

  1. Ben Walsh
  1. Tobacco Manufacturers Association, London SW1E 5AG
  2. Institute of General Practice, Postgraduate Medical School, Exeter EX2 5DW.

    EDITOR, - The non-response of ASH's spokesman, Stephen Woodward,1 to Poor Smokers, the recent report from the Institute of Policy Studies,2 neatly encapsulates the antismoking lobby's dilemma on tobacco taxation.

    Is it right that around 20% of Britain's poorest smoking households pay more income tax than tobacco tax, making tobacco one of the most regressive of all central government taxes? For many poorer smokers, a cigarette at the end of a long hard day represents a small but welcome luxury, but the price they pay for that luxury is excessively high, thanks to the government's punitive treatment for tobacco tax in recent years.

    Tobacco taxes in the United Kingdom are almost the highest in the European Union; 76.5% of the price of a pack of 20 goes to the Treasury. Smokers pay a massive pounds sterling 24 million every day in tobacco taxes, enough to pay for any one of the armed services or nearly all the annual police force budget. Indeed, tobacco is the highest taxed consumer product in the United Kingdom by some distance.

    It may have worked in the past, but these days, stinging British smokers for more tax will not necessarily cut their tobacco consumption. More likely, they will travel to France or Spain, where cigarette duty is much lower (cigarettes in Spain are up to pounds sterling 2 cheaper per pack). Single market “rules” mean they can buy as many duty paid cigarettes as they wish, provided they are for personal use.

    Ironically, the main beneficiaries of cross border shopping will be more affluent smokers, who can afford the trip to Europe. Poorer smokers will either have to continue buying overtaxed cigarettes at the local shop or, more worryingly, become targets for criminals who sell smuggled cigarettes in pubs, clubs, and car boot sales all over the United Kingdom.

    If Stephen Woodward's demands for ever higher tobacco taxes “succeed,” the United Kingdom could find itself in a similar position to Canada, where huge tax increases in the past few years have given rise to wholesale smuggling, to the extent that tobacco consumption will rise this year for the first time in a decade. The Canadian government has since been forced to cut tobacco taxes to stem the flood of smuggled cigarettes. The policy caused predictable outrage from antismoking campaigners, who seemed to have lost sight of the fact that their call for ever-higher tobacco taxes actually created the problem in the first place. Plus ca change in the antismoking world!

    Doctors should counsel children on smoking

    1. P D G Eichstorff
    1. Tobacco Manufacturers Association, London SW1E 5AG
    2. Institute of General Practice, Postgraduate Medical School, Exeter EX2 5DW.

      EDITOR, - Targets have been set in Health of the Nation to reduce smoking in the 11-15 year age group by 33%.1 Bruce Guthrie discusses the tobacco industry's weak commitment to avoiding advertising near schools, but doctors could also do more by giving children and teenagers antismoking advice.2

      I audited computer records over a three week period from one partnership with 6368 patients, including 360 between 11 and 15 years of age, and also the social histories of 115 paediatric inpatients. In the 360 children, records showed that smoking had been asked about in only four (1%). The 115 hospital admissions included 13 cases where a smoking history had been recorded (11%). One year later a repeat audit in the practice showed almost no change, with three records of smoking history (1%), despite 237 children (67%) being seen in that year. In the three year period 338 (94%) had been seen. For comparison, a second practice had records on 24 271 children (9%).

      These results show that both in general practice and in hospital the smoking histories of children are inadequate, and behaviour in practice needs active encouragement to change. The fact that the general practitioners did not modify their behaviour highlights the difficulty of discussing smoking with children when a parent is present. There may also be problems in computer software or the ease with which some doctors can use it. Software settings may preclude entries for children. It is inequitable that in general practice children are excluded from health promotion band one. An opportunity for health promotion is also being missed in hospital.

      When 110 000 smokers die this year replacements will have to be recruited from our children. The removal of tobacco advertising will help to prevent this, but it is only part of the answer as children will continue to smoke. Doctors simply asking about smoking may deter some from starting. In addition, the discussion may prompt parents to give up and decrease the availability of cigarettes at home.

      All doctors should consider taking a smoking history from those aged 11- 15 years, and general practitioners might check that their computers are set to receive this data. General practitioners should receive incentives via health promotion banding to ask children about smoking. We can do nothing more beneficial for the health of the nation.

      References

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