In this blog, Dr Helen McAvoy, IPH Director of Policy, explores the UK government’s groundbreaking announcement to progressively raise the age of sale of tobacco.
What exactly is this new measure?
Earlier this month, the UK Prime Minister Rishi Sunak announced new legislation which will make it an offence for anyone to sell tobacco products to someone born after 01 January 2009. In effect this means that the minimum legal age for sale of tobacco will increase by a year, each year, until it applies to the whole population. The measure has been rightly termed ‘one of the most significant public health interventions by the government in a generation’ and is the core tenet of England’s new plan to create a smoke-free generation.
What is the evidence behind this measure?
Previous studies show that raising the minimum legal age of sale of tobacco has significant, and relatively rapid, impacts on reducing smoking among young people. When the age of sale was first raised from 16 to 18 years, this reduced the prevalence of smoking among 16/17-year-olds by 30%.
There is also supportive evidence from evaluations of the Tobacco 21 policy in the United States. As well as looking at ‘before and after’ effects from previous efforts to raise the minimum legal age of sale of tobacco, there are other important forms of evidence to take into account.
There is the evidence that:
- smoking kills up to half its users, and drives disability, poverty and health inequity to an extent far greater than any other addictive substance –around 4,500 people die every year in Ireland as a result of tobacco use
- incremental style tobacco control policy approaches deliver incremental results and are not powerful enough to get anywhere near endgame targets of less than 5% prevalence,
- getting even soft regulatory measures on tobacco enacted takes an inordinately long time, whether due to tobacco industry interference or a lack of political priority
- investing in stop smoking services, while valuable and cost-effective, will never be enough to turn the tide on smoking prevalence; upstream supply side approaches are needed.
What are the expected results of this policy measure?
This measure has the potential to phase out smoking in young people almost completely in the next 15 years. Similar to New Zealand, the UK government produced a detailed modelling study, which sets out proposed effect sizes and timelines based on four possible scenarios.
These estimates suggest that by 2075:
- between 11,466 and 28,688 smoking-related deaths would be avoided, and
- there would be between 2,331 and 6,328 fewer cases of lung cancer and over 50,000 fewer cases of Chronic Obstructive Pulmonary Disease (COPD).
Who is most likely to benefit?
Announcing the measure, both the Prime Minister Rishi Sunak and Chief Medical Officer (CMO), Chris Whitty, were keen to emphasise the reduction of chronic disease and premature death, with the Minister for Health and Social Care Steve Barclay also highlighting the reduction in health service demand and costs.
It was also encouraging to see the emphasis placed by the CMO Chris Witty on reductions in perinatal mortality and improvements in child health, which are often missed in the media narrative around tobacco-related harms.
What about Northern Ireland?
In Northern Ireland, the Department of Health recently published an end-of-term review of the regions ten-year Tobacco Control Strategy. The absence of a sitting government or Executive, creates a challenge to policy development but does not preclude certain activities to help inform any future policy decision.
Importantly, Northern Ireland has been included in the UK government consultation on creating a smoke-free generation and tackling youth vaping which opened this month. It will be critical for all parties working to reduce tobacco-related harm in Northern Ireland to make their views heard in this process, as the Department of Health in Northern Ireland will consider appropriate measures relating to a smoke-free generation following the consultation.
What about Ireland?
The Tobacco Free Ireland policy, launched a decade ago, set a target to reduce smoking prevalence to less than 5% by 2025. With current smoking prevalence estimated at around 18% and no new tobacco legislation enacted in several years, it is widely accepted that this target will not be met.
The Public Health Tobacco and Nicotine Inhaling Products Bill 2019 was most recently discussed by the Oireachtas Health Committee on 12 October 2023. This Bill will introduce a minimum legal age of sale for e-cigarettes, a new licensing system and prohibit sale of tobacco from vending machines, but it does not include any definitive endgame measures like progressively raising the legal age of sale of tobacco.
There is now sound evidence that there is widespread public support for tobacco endgame measures in Ireland. 76% of the general population said the government should do more to protect the public from tobacco-related harm and 83% supported a phasing out of the sale of tobacco products.
It remains to be seen whether the governments of Ireland and Northern Ireland will now revisit their approach to secure a smoke-free generation in light of the substantial step forward in endgame legislation in the UK.
Could we see a smoke-free generation on the island of Ireland? In my view, it’s possible, it’s popular, and with the announcement ‘across the water’, it’s starting to feel increasingly within our reach.
If you would like to submit views on measures to reduce smoking and tackle youth vaping in Northern Ireland, respond to the UK consultation before 06 December 2023.
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