Intended for healthcare professionals


Over 1000 doctors sign letter calling for new tobacco plan for England

BMJ 2017; 356 doi: (Published 05 January 2017) Cite this as: BMJ 2017;356:j18

Re: Over 1000 doctors sign letter calling for new tobacco plan for England

The doctors including former presidents of royal colleges are right to draw attention to the urgent need for a new Tobacco Control Plan (1,2). A move that the Institute of Health Promotion and Education endorses. Smoking is still the largest single preventable cause of ill health and death and there are now many authoritative reports detailing the extensive harm that smoking causes to individuals and society (3-6).

In the UK the reduction in smoking should be seen as one of the great public health success stories. Far fewer people now smoke. For example, the highest recorded level of smoking among men was 82% in 1948 – this has now been reduced by over 60%. It is of note that much illness has been prevented and many people are able to live longer thanks to the work of dedicated health promoters including many doctors and nurses.

However, it is important to look behind the figures – the success has not been evenly shared amongst the population. Smoking is strongly associated with socio-economic disadvantage: smoking rates are markedly higher among poorer people than among those who are better off. Unemployed people, those with low incomes and those with longstanding mental health condition are more likely to be smokers who tend to be more heavily dependent on smoking (3). We believe that major improvements in health can be achieved by supporting the most disadvantaged in society to make healthier choices.

In developing a new Tobacco Control Plan it is essential to have a sound knowledge of who is promoting tobacco including the tactics they have used in the past (7). Tobacco companies have tremendous financial and political powers and, despite the overwhelming medical evidence against traditional cigarettes, companies are still able to sell their products. Moreover, some markets are expanding and there is considerable potential for profit (8,9). British American Tobacco, for example, is one of the top 10 companies on the London Stock Exchange and is a global company with over 200 brands sold in more than 200 markets (9). Their global market of e-vapour products also continues to expand.

A future plan needs to contain support for children and young people. They need to be provided with key information and skills so that they can make sound decisions in relation to health issues. National surveys into smoking drinking and drug use in schools have shown that smoking amongst young people has fallen consistently over the years and that lessons on smoking have had some impact (10). However, such lessons do need to be contextualised by inclusion in a mandatory properly planned PSHE programme for all pupils taught by well trained, confident and competent teachers and one that avoids ‘shock horror’ approaches.

In the UK “shock horror” tactics are being used in some anti-smoking campaigns. We would be strongly against this type of approach being included in any new plan. If a smoker is scared into changing their behaviour - will they really be healthier? In addition, many smokers simply “switch off” when this type of advert appears. Moreover, there are other effective strategies that can be used.

Many health professionals are currently working hard at a local level in supporting smokers who want to change their behaviour. However, leadership at a national level is needed to support them. The government must renew the Tobacco Control Plan as a matter of urgency both to help the most disadvantaged in society and to ensure that smoking rates do not begin to rise again.


1) Kmietowicz Z. Over 1000 doctors sign letter calling for new tobacco plan for England. BMJ 2017;356:j18 doi: 10.1136/bmj.j18 (Published 5 January 2017)

2) The need for a new Tobacco Control Plan: an issue of justice. 2017.

3) Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction. London: RCP, 2016.

4) BMA. Promoting a tobacco-free society. London: BMA, 2015.

5) World Health Organization. Raising taxes on tobacco. WHO Report on the Global Tobacco Epidemic, 2015. Geneva: WHO, 2015.
[Accessed 8 January 2017].

6) US Department of Health and Human Services. The health consequences of smoking – 50 years of progress. A Report of the Surgeon General, 2014. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

7) Taylor P. Smoke Ring: The Politics of Tobacco. London: Bodley Head Ltd, 1984.

8) Imperial Brands PLC. Delivering Against Our Strategy. Annual Report and Accounts. Bristol: Imperial Brands PLC, 2016.

9) British American Tobacco. Delivering today Investing in tomorrow. Annual Report 2015. London: BAT, 2015.

10) Health and Social Care Information Centre. Smoking, Drinking and Drug Use among Young People in England. [Accessed 8 January 2017].

Competing interests: No competing interests

09 January 2017
Michael Craig Watson
Associate Professor in Public Health.
Dr John Lloyd (Vice President Institute of Health Promotion and Education, Institute of Health Promotion and Education,
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA