Intended for healthcare professionals


Tobacco policy must not increase poverty, says report

BMJ 1994; 308 doi: (Published 19 March 1994) Cite this as: BMJ 1994;308:737
  1. C Court

    The British government's policy of increasing the real price of cigarettes each year does nothing to cut smoking among the least well off, according to research carried out by the Policy Studies Institute, an independent charity. Indeed, say the researchers, it merely increases hardship, since those least able to afford cigarettes are those who are most likely to smoke.

    The study, which was funded by the Health Education Authority, finds that, while smoking has halved among the better off families in Britain since the 1970s, there has been no change among those on low incomes. In addition, lone parents - who are likely to face higher levels of hardship anyway - are the most likely to smoke, often seeing smoking as their only luxury.

    Even a marginal improvement in quality of life could alter the picture radically, says the study. If poor smokers become owner occupiers or find work after being unemployed they are no more likely to smoke than most other people.

    The study finds that smoking is much more likely to be seen as the cultural norm among the least well off. It observes, “It is important to remember that these people did not start families, place themselves on a low income, and then irresponsibly decide to take up smoking. They took up smoking as children, as many people did. Their circumstances have since prevented them from giving up, as many people did.”

    The report, Poor Smokers, by Alan Marsh and Stephen McKay, calls for new policy initiatives that would link tobacco control policy to family welfare policy - for example, by placing antismoking aids on prescription.

    It says: “A significant fraction of the many millions a year paid by Britain's poorest smokers in tobacco tax could be used to fund major new community based health education initiatives.”

    The deputy director of the campaigning group Action on Smoking and Health, Stephen Woodward, welcomed the report and said, “We, like everybody else, are very disturbed about the central findings from this report. Certainly, current tax policy is right and that ought not to be changed because of the benefit it has to the whole community. I don't think anybody can say what the solutions will be to the dilemmas highlighted in the report, but they will need to be imaginative and innovative.”

    Stephen Woodward does not believe that putting antismoking aids on prescription would have much effect. He says that the report shows that lack of optimism seems to be a key feature among poor people: “When looking at lone parents, for example, it may be that something like the weekly provision of child care will enable them to learn some new skills or participate in a community activity, which will increase their optimism about the future.”

    * Health minister Dr Brian Mawhinney marked National No Smoking Day on 9 March by reiterating his commitment to see four million fewer smokers by 2000. He called on parents to help their children to stop smoking.