Intended for healthcare professionals


Key tobacco control report focuses on children

BMJ 2022; 377 doi: (Published 15 June 2022) Cite this as: BMJ 2022;377:o1457
  1. Sanjay Agrawal, consultant in respiratory and intensive care medicine
  1. University Hospitals of Leicester NHS Trust, Leicester, UK
  1. sanjay.agrawal{at}

Lack of political will threatens progress on this lethal addiction

Javed Khan’s report on tobacco control policy, published on 9 June 2022, will inform the forthcoming tobacco control plan for England.1 The government’s ambition is to reduce smoking prevalence to below 5% by 2030,2 but like others,3 Khan estimates this target will not be met with the current trajectory. The report’s conclusions were based on research evidence and consultation with academics, people who smoke, public health bodies, clinicians, UK based smoking cessation services, and regulatory agencies from across the world.

Khan makes 15 main recommendations, including four “critical” recommendations: an extra £125m (€145m; $152m) investment in tobacco control, raising the legal age of sale for all tobacco products, active promotion of vaping as a quit smoking tool, and a bigger role for the NHS in treating tobacco dependency.

The report focuses on measures to prevent the uptake of smoking in children and young people, possibly reflecting the author’s previous role as chief executive of Barnardo’s children’s charity and the observation that young people, especially those from poorer communities, have high smoking rates and the most to lose from becoming addicted to tobacco.

One of the most eye catching recommendations is to raise the legal age of sale of tobacco products by one year every year. This would mean that children born after a specified year will never be able to legally purchase tobacco, a policy recently adopted in New Zealand.4 Raising the legal age of sale from 16 to 18 years of age in the UK in 2007 led to a more than 30% reduction in smoking prevalence in that age group,5, with a similar effect in the US when the age limit was raised from 18 to 21.6

Other recommendations to reduce access to tobacco for children and young people include a licensing scheme for vendors of tobacco products to restrict the number and location of tobacco vendors, similar to established licensing schemes in other countries.7 Measures are proposed that would reduce the attractiveness of tobacco products, such as using dissuasive colours and warnings on cigarette sticks; a consultation on a comparable proposal has begun in Canada.8


The report acknowledges the negative effect of adult role models who smoke on the uptake of smoking in children and young people and makes several recommendations to reduce adult smokers, specifically promoting vaping as an aid to quitting, scaling up NHS screening and treatment of tobacco addiction, and the use of mass media campaigns to trigger quit attempts.

The likelihood that all four critical recommendations will be adopted or funded by the government seems low. One obstacle is the £125m price tag, although Khan suggests a levy on the tobacco industry profits, similar to the windfall tax on energy companies, as a solution. The much bigger obstacle is the immediate political climate that has seen the government delay or dilute public health policy proposals such as the recommendations to restrict foods high in salt and sugar,9 junk food advertising, and limiting two-for-one supermarket offers.10

Tobacco addiction remains stubbornly high in the UK, concentrated in deprived communities, perpetuating poverty and inequality.11 Whether the government adopts Khan’s recommendations or those set out by the Royal College of Physicians3 or the All Party Parliamentary Group on Smoking and Health,12 much more clearly needs to be done to make smoking obsolete. We need to prioritise measures that will help current smokers to quit and to reduce the number of young people ever starting this lethal habit. There is no silver bullet to achieve these ambitions, but instead a suite of measures is required, outlined in these reports. The biggest barrier to achieving this goal is not the knowledge of what works, it is the political will to make it happen.


  • Competing interests: I have read and understood BMJ policy on declaration of interests and have no interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.


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