What is smoking
In the UK, people commonly smoke cigarettes, cigars and pipes. "Smoking" in public health debates is usually used as a by-word for tobacco consumption, with cannabis treated separately as part of the drugs debate. Similarly, public health campaigns warning of the dangers of tobacco smoke occasionally outline the health risks associated with chewing tobacco.
Smoking became popular because of its short-term effects, as well as a highly effective marketing campaign and little awareness of its health risks. Users claim positive effects include increased alertness, concentration and mild euphoria. However, long-term use leads to nicotine addiction, with withdrawal exposing users to confusion, restlessness, anxiety and insomnia. Smoking tobacco has been linked to a number of health problems including lung cancer, emphysema and cardiovascular disease.
Public and medical awareness of the dangers of tobacco smoking was low when cigarettes were first marketed for mass consumption. By early 1950, however, an article in the British Medical Journal found a link between smoking and lung cancer. This appeared to be confirmed by further research in 1954, prompting the government to issue its first warning of the link between lung cancer and smoking.
The Department of Health (DoH) has since made it a stated aim to reduce levels of smoking - despite few efforts from the Home Office to criminalise tobacco. The legal age to purchase cigarettes has risen progressively to 18, but for the adult population smoking remains a legal pursuit, albeit surrounded by aggressive health warnings.
According to the DoH, smoking is the biggest preventable cause of death in England, accounting for more than 80,000 premature deaths each year and tobacco use is one of the most significant public health challenges. About 21% of adults in England smoke, although rates are much higher in some areas.
In an effort to reduce the number of smoking-related deaths, the DoH has introduced a number of measures. These include media and education campaigns about the dangers of tobacco smoke; stop-smoking and nicotine replacement therapies, available through the NHS; a comprehensive ban on tobacco advertising and promotion; regulating the contents and labelling of tobacco products.
In March 2011 the Government launched 'Healthy Lives, Healthy People: A Tobacco Control Plan for England', setting out the action the Government intends to take nationally over a five year period "to drive down the prevalence of smoking and to support comprehensive tobacco control in local areas".
The plan includes commitments to:
Implement legislation to end tobacco displays in shops.
Look at whether the plain packaging of tobacco products could be an effective way to reduce the number of young people who take up smoking and to support adult smokers who want to quit, and consult on options by the end of the year.
Continue to defend tobacco legislation against legal challenges by the tobacco industry, including legislation to stop tobacco sales from vending machines from October 2011.
Continue to follow a policy of using tax to maintain the high price of tobacco products at levels that impact on smoking prevalence.
Promote effective local enforcement of tobacco legislation, particularly on the age of sale of tobacco.
Encourage more smokers to quit by using the most effective forms of support, through local stop smoking services.
Publish a three-year marketing strategy for tobacco control.
The plan sets out national ambitions to:
Reduce adult (aged 18 or over) smoking prevalence in England to 18.5 per cent or less by the end of 2015 (from 21.2 per cent), meaning around 210,000 fewer smokers a year.
Reduce rates of regular smoking among 15 year olds in England to 12 per cent or less (from 15 per cent) by the end of 2015.
Reduce rates of smoking throughout pregnancy to 11 per cent or less (from 14 per cent) by the end of 2015 (measured at time of giving birth).
As with many public health issues, the state risks taking a paternalistic approach in pushing an unashamed anti-smoking policy. Unlike with alcohol or 'junk food' the government does not set limits for a "safe" level of smoking and instead encourages smokers to give up entirely. Perhaps this is a realistic position given the addictive nature of nicotine.
The government justifies its anti-smoking policy on two grounds; firstly the cost of smoking-related health problems to the NHS and secondly the harm caused by passive smoking, for which there is now convincing evidence.
However, the government has made no effort to ban smoking outright, despite evidence nicotine is more harmful than a number of recreational drugs included on the ABC list of controlled substances.
Smokers will no doubt dispute claims the government has not tried to outlaw smoking, pointing to the ban on smoking in public places. Sales have also been restricted to minors and as of October 1st 2007 the decision whether to smoke became as important as who to vote for, as the smoking age was raised to 18.
While the government tells smokers they are a drain on the NHS, pro-smoking groups argue the taxes charged on tobacco more than compensate for the additional health needs of smokers.
The government certainly has an interest in maintaining tax revenue from tobacco products. Up to 89 per cent of the cost of a packet of cigarettes is the excise duty levied by the Treasury, prompting pro-smoking group Forest to argue cigarettes are almost a fully nationalised product. The DoH justifies high taxation, arguing rising prices have been identified as a very effective way of getting smokers to quit.
The government is actively concerned by black market cigarettes, not just because of any additional health risks but because of the loss in revenue. A recent Smoking and Health fact sheet estimated up to 25 per cent of cigarettes smoked in the UK avoid taxation, representing a multi-billion pound loss in funds.
The government spends a significant amount promoting the anti-smoking message and as with all public health campaigns, the success of these messages is open to debate. The DoH maintains its ongoing media and education campaigns about the dangers of tobacco smoking are one of the primary reasons smokers in the UK decide to try and quit.
In a bid to further promote the anti-smoking message, the government has enforced a comprehensive ban on tobacco advertising and promotion. The DoH predicts this will reduce smoking rates by 2.5 per cent over the long-term.
The DoH also regulates tobacco contents and labelling, giving the government remarkable influence over the design of private products. Since 2003 all cigarette products must carry large warning labels and companies are banned from describing cigarettes as low tar.
Government efforts have not been without effect. Between 1998 and 2004 smoking rates among adults fell from 28 per cent to 25 per cent, which the government claimed amounted to 1.2 million ex-smokers.
The greatest source of controversy has no doubt been the smoking ban. After a staggered start, a ban on smoking in public places was in force across the whole of the UK by July 1st 2007. Ministers argued this would protect members of the public from passive smoking, with specific benefits to bar and pub staff working in smoky environments.
The risks associated with passive smoking have been less readily accepted than the health-risks of cigarettes and other tobacco products, but research shows ambient smoke still contains carcinogens and toxic components. The DoH now holds the view passive smoking does present a public health risk and shows no signs of modifying this position.
In 2007 the DoH announced it wanted to introduce pictures onto cigarette packets as a graphic illustration of the health-risks of smoking. It quoted Canadian research which found shocking images could be an effective tool for motivating smokers to quit. The first pictures of diseased and cancerous organs appeared on cigarette packets from late 2008.
Reports that a consultation on introducing plain cigarette packaging was to be launched by the Department of Health in spring 2012 attracted strong criticism from the tobacco industry.
Both British American Tobacco (BAT) and the Tobacco Manufacturers' Association (TMA) said they were strongly opposed to the idea.
BAT claimed there was "no proof to suggest that the plain packaging of tobacco products will be effective in discouraging young people to smoke, encouraging existing smokers to quit, or increasing the effectiveness of health warnings." TMA suggested that plain packs would "likely lead to yet further increases in the illicit trade in tobacco products by making them much easier for a counterfeiter to copy than existing branded packs."
However, health groups are firmly in favour of the move. The British Heart Foundation stated that it believed plain packaging would "help to save lives by preventing the packaging being used to advertise the product; making the packaging less attractive particularly to young people; increasing the effectiveness of health warnings; and ensuring that smokers are not misled about some brands being less harmful than other."
Australia is set to become the first country in the world to introduce plain packaging for cigarettes. The law was passed by the Australian Senate in November 2011 and is due to take effect from December 2012.
The quitting timeline:
After 20 minutes your blood pressure and pulse return to normal.
After 24 hours your lungs start to clear.
After two days your body is nicotine-free and your sense of taste and smell improve.
After three days you can breathe more easily, and your energy increases.
After two to 12 weeks, your circulation improves.
After three to nine months coughs, wheezing and breathing improves.
After one year your heart attack risk is half that of a smoker.
After 10 years your lung cancer risk is half that of a smoker.
Source: NHS Choices - 2011
There are 10 ways your health will improve when you stop smoking.
Younger looking skin
Improved smell and taste
Healthier loved ones
NHS Choices - 2011