Intended for healthcare professionals

Letters Government ambition to make England smoke-free by 2030

Open letter to the prime minister and secretary of state on the second anniversary of England’s announcement that it would be smoke-free by 2030

BMJ 2021; 374 doi: (Published 21 July 2021) Cite this as: BMJ 2021;374:n1839
  1. Nicholas S Hopkinson, chair1,
  2. Helen Stokes-Lampard, chair2,
  3. Jennifer Dixon, chief executive3,
  4. Maggie Rae, president4,
  5. Linda Bauld, Bruce and John Usher chair of public health5,
  6. Sarah Woolnough, chief executive6,
  7. Andrew Goddard, president7,
  8. Jeanelle de Gruchy, president8,
  9. Charmaine Griffiths, chief executive9,
  10. Ian Walker, executive director of policy information and communications10,
  11. Jon Bennett, chair11
  1. 1Action on Smoking and Health
  2. 2Academy of Medical Royal Colleges
  3. 3The Health Foundation
  4. 4Faculty of Public Health
  5. 5University of Edinburgh
  6. 6Asthma UK and British Lung Foundation
  7. 7Royal College of Physicians
  8. 8Association of Directors of Public Health
  9. 9British Heart Foundation
  10. 10Cancer Research UK
  11. 11British Thoracic Society
  1. n.hopkinson{at}

Two years ago today the government announced its ambition to make England smoke-free by 2030.12 This includes making smoked tobacco obsolete, with smokers quitting or moving to reduced risk products like e-cigarettes. Despite acknowledging that it would be “extremely challenging,” there is still no sign to date of the “bold action” the government promised to deliver this crucial public health objective.

Although we are a world leader in tobacco control, the current rate of decline in smoking is insufficient to deliver the ambition.3 Indeed, since it was announced over 200 000 children under 16 in England have started smoking,4 two thirds of whom will go on to become daily smokers.5

Half the difference in life expectancy between rich and poor people is the result of smoking,6 and the economic, as well as health, gains from a smoke-free country will benefit most those in disadvantaged groups and disadvantaged regions.7 Smoking is estimated to have killed more people last year than covid-19 and will do so for many years to come unless the government takes action.8 Tobacco is the public health epidemic hiding in plain sight.9

Delivering the smoke-free ambition would play a major role in achieving government manifesto commitments to increase healthy life expectancy by five years by 2035, while reducing inequalities and levelling up the nation. The blueprint to achieve this is laid out in the All Party Parliamentary Group on Smoking and Health’s recommendations for the forthcoming Tobacco Control Plan, which we all endorse.7

The comprehensive and sustained strategy recommended in the report can deliver, if properly funded. But given the many competing priorities for the forthcoming comprehensive spending review, public health is unlikely to be prioritised. The alternative, which the government promised to consider when it announced its smoke-free ambition, is a US-style “polluter pays” levy on the tobacco manufacturers.1

The All Party Parliamentary Group’s report sets out how a levy on manufacturers could raise £700m (€813m; $960m) in year one alone, without the costs being passed on to smokers, now that we have left the European Union. This could pay for delivery of the Tobacco Control Plan and provide additional funding that public health desperately needs.7 In 2019 Imperial Tobacco made £71 for every £100 in sales10—these are extreme profits, many times higher than those made by other consumer product manufacturers.11 The time has come to make tobacco manufacturers pay to end the epidemic that they and they alone have caused.


  • Competing interests: HS-L is an employed professor at the University of Birmingham (0.5 whole time equivalent) and GP principal the Westgate Practice, an NHS General Medical Services GP surgery (part time). She is chair of the Academy of Medical Royal Colleges, chair of the National Academy for Social Prescribing, trustee of Macmillan Cancer, patron of Kendall and Wall charity (patient transport local to my surgery), member/fellow of several medical royal colleges and faculties, member of the BMA, and member of the Society for Academy Primary Care. JB is expert adviser for BMJ Best Practice and deputy medical director of RCP Invited Service Reviews. All other authors: none declared.


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