Intended for healthcare professionals

Opinion Open letter

Meagre spending on tobacco control is costing the economy billions

BMJ 2023; 381 doi: (Published 18 April 2023) Cite this as: BMJ 2023;381:p867

Linked News

Government plans are insufficient to make England smoke free by 2030, warn experts

  1. An open letter signed by a group of doctors and public health experts

On the publication of Javed Khan’s Independent Review into smoking last year we wrote an open letter urging the UK government to heed Khan’s call for immediate investment of £125 million per year in tobacco control to deliver its Smokefree 2030 ambition.12 While £125 million a year may sound a large amount, it is only 0.6% of the direct cost of smoking to public finances in 2022.3

Instead, nine months on from Khan’s review, cuts to the tobacco control budget have bitten even deeper. Last year it was estimated that real terms spending on tobacco control was a third lower than in 2015, this year it will be 45% down.45 On current trends we will be nearly a decade late in reaching a smokefree 2030.6

An announcement by Neil O’Brien MP last week on achieving a smokefree 2030 are a step forward, but the announcement provided only around a quarter of the investment needed and represents a re-allocation of existing Department for Health and Social Care funds to public health, rather than new money.7 This is unacceptable at a time when health budgets are under increasing strain due to inflation.

The immediate benefits of quitting smoking are such that if the government invested £125 million from the public purse to put us on track to a smokefree 2030, a net benefit would be delivered to public finances from year one onwards.3 In 2022, the costs of smoking to health, social care and the benefits system were £22bn—nearly double tobacco tax revenues.3 The cost to the economy as a whole, including lost productivity and premature death, totalled £173 billion.3 For every one percentage point fall in smoking prevalence there would an additional 24 000 people available for work, and 40 000 new jobs as spending switched away from tobacco.8

However, if the government is unwilling or unable to find the funds from the public purse, there is cross party support for a “polluter pays” levy on the tobacco industry, which the government said it would consider when it announced its smokefree 2030 ambition, and which is supported by Khan and the signatories to this letter.19 Capping net profit margins on UK tobacco sales from what they are currently, around 50%, to no more than 10%, in line with the average for UK manufacturing, could bring around £700 million a year directly into the DHSC.1011 This would be enough to fund the comprehensive tobacco control measures in the Khan report five times over, and is popular with the public. Three quarters of the population support the Government’s smokefree 2030 ambition and the same proportion support a levy on the tobacco industry to pay for it.12

Achieving a Smokefree 2030 would do much to reduce pressure on our NHS and social care systems, significantly increase disposable incomes for many of the poorest in society and deliver the economic growth our country so desperately needs.

Smoking is the leading cause of health inequalities, responsible for half the difference in life expectancy between rich and poor.13 Delivery of government commitments to increase healthy life expectancy by five years by 2035 while narrowing inequalities can only be achieved by making smoking history.14


  • Signed by: Nicholas S. Hopkinson, chair, Action on Smoking and Health; Helen Stokes-Lampard, chair, Academy of Medical Royal Colleges; Sarah Clarke, president, Royal College of Physicians; Adrian James, president, Royal College of Psychiatrists; Kamila Hawthorne, chair, Royal College of General Practitioners; Ranee Thakar, president, Royal College of Obstetricians and Gynaecologists; Kevin Fenton, President of the Faculty of Public Health; David Strain, chair, BMA Board of Science; Gill Walton, chief executive, Royal College of Midwives; Pat Cullen Chief Executive Royal College of Nursing; Carol Black, chair, Centre for Ageing Better; Alice Wiseman, Association of Directors of Public Health UK; Jennifer Dixon, chief executive, The Health Foundation; Charmaine Griffiths, chief executive, British Heart Foundation; Ian Walker, executive director, Cancer Research UK; Linda Bauld, Director, SPECTRUM public health research consortium; Sarah Woolnough, chief executive, Asthma+Lung UK.

  • Competing interests: none declared.

  • Provenance and peer review: not commissioned, not peer reviewed.