Intended for healthcare professionals

Rapid response to:


What did the spending review do for population health?

BMJ 2021; 375 doi: (Published 08 November 2021) Cite this as: BMJ 2021;375:n2686

Rapid Response:

The Health and Care Bill – an opportunity not to be wasted to deliver the promise of a Smokefree nation

It is now more than two years since the Government committed to the ‘bold action’ needed to make England Smokefree by 2030 [1]. Achieving this would be the single most important step it could take towards delivering manifesto commitments to reduce health inequality and extend healthy life expectancy by five years by 2035 [2].

Unfortunately, the Government has still not published its new Tobacco Control Plan to deliver the Smokefree ambition, which it pledged to publish this year [3], nor the post-implementation review of tobacco regulations, which it was required in law to do by May 2021 [4 5].

Given current trends in smoking we are on course to miss the 2030 target by seven years, twice that for the most disadvantaged smokers [6]. Worse still, new evidence shows that during the pandemic there has actually been an increase in smoking among young adults [7].

The All Party Parliamentary Group on Smoking and Health is to be congratulated therefore for publishing a well-evidenced set of recommendations [8] for how government can get back on track. We write now to support the amendments to the Health and Care Bill tabled by officers of the APPG, which will provide the Government with powers to implement the APPG’s recommendations.

These amendments could fix loopholes in existing legislation and make it illegal to brand e-cigarettes with the intent of increasing their appeal to children and younger people [9]. They would also require the Government to consult on raising the age of sale to 21, within three months of royal assent, a key measure which has been effective in the US in reducing smoking in 18-20 year olds by 30% [10].

The APPG’s amendments also enable the government to introduce a ‘polluter pays’ levy, something it promised to consider when it announced its Smokefree ambition. The Spending Review failed to reinstate public health funding, so the levy is essential if the necessary resources are to be found for important tobacco control measures such as comprehensive media campaigns to change behaviour.

We strongly urge the Government to accept the amendments championed by the APPG on Smoking and Health, without which it cannot deliver on its commitment to ‘finish the job’ [1].

Prof Nicholas S Hopkinson
Chair, Action on Smoking and Health ASH

Ms Sarah Woolnough
CEO, Asthma UK and British Lung Foundation Partnership

Prof Helen Stokes-Lampard
Chair, Academy of Medical Royal Colleges

Prof Maggie Rae
President, Faculty of Public Health

Dr Charmaine Griffiths
CEO, British Heart Foundation

Dr Simon Langton Hewer
President, British Paediatric Respiratory Society

Dr Andrew Goddard
President, Royal College of Physicians

Gill Walton
CEO, Royal College of Midwives (RCM)

Dr Jyotsna Vohra
Director of Policy and Public Affairs, Royal Society for Public Health

Professor John Greenwood
President, British Cardiovascular Society

Dr Bernadette Cullen
Chair, ASH Northern Ireland

Richard Spratt
CEO, Cancer Focus NI

On behalf of 656 other authors working in health-related fields.


1 Department of Health and Social Care. Advancing our health: prevention in the 2020s—consultation document. 22 July 2019.

2 The Conservative and Unionist Party Manifesto 2019. Get Brexit Done Unleash Britain’s Potential. 2019

3 UK Parliament. Smoking. Question for Department of Health and Social Care. UIN 122663, tabled on 30 November 2020. Answered 9 December 2020.

4 Tobacco and Related Products Regulations 2016. 20 May 2016.

5 The Standardised Packaging of Tobacco Products Regulations 2015.

6 Cancer Research UK. Smoking prevalence projections for England, Scotland, Wales, and Northern Ireland, based on data to 2018-19. Feb 2020.

7 Jackson, SE, Beard, E, Angus, C, Field, M, Brown, J. Moderators of changes in smoking, drinking and quitting behaviour associated with the first COVID-19 lockdown in England. Addiction 2021.

8 All Party Parliamentary Group on Smoking and Health. Delivering a Smokefree 2030: The All Party Parliamentary Group on Smoking and Health recommendations for the Tobacco Control Plan 2021. June 2021.

9 ASH and SPECTRUM consultation response on tobacco and related products legislation introduced between 2015 to 2016: reviewing effectiveness. March 2021.

10 Beard, E, Shahab, L, Brown, J. UCL modelling of recommendations for the Tobacco Control Plan. Open Science Framework. 2021.

Competing interests: No competing interests

18 November 2021
Nicholas S Hopkinson
Professor of Respiratory Medicine
National Heart and Lung Institute, Imperial College London
London, UK