Why isn’t everyone enjoying the benefits of quitting smoking?

We all have the ability to change but unfortunately we don’t all have the means, writes Ian Hamilton

People are more likely to be successful at quitting smoking when there are as few obstacles as possible (Getty/iStock)

One of the greatest public health achievements has been the significant reduction in UK rates of smoking. Some 6.6 million people, or 13.3 per cent of the population, were smokers in 2021 – the lowest proportion on record. This has been achieved by using a combination of carrot and stick policies – restricting where smoking is permitted, and providing support for those who want to abstain.

Nicotine has proved to be one of the most addictive drugs that humans are exposed to. Two-thirds of people who try a cigarette once go on to develop a habit. Reducing the number of people who smoke is the single biggest intervention we can make if we wish to improve the nation’s health. There won’t be many people in 2022 who aren’t aware of the risks and harms caused by smoking.

Of course, there is a time lag between falling rates of smoking and any benefits to the health of the population as a whole. In England, 200 people a day die as a result of smoking, and it will take some time before we see a fall in smoking-related mortality, the scale of which is a legacy of the large numbers who smoked in past decades.

Despite the overall success in reducing the number of smokers, not everyone has benefited from this achievement. Several groups have been left behind when it comes to abstaining. People with a mental health problem continue to smoke at much higher rates than those without such issues. Likewise, those who are dependent on drugs are also more likely to smoke than those who are not.

Both of these groups are part of a larger subgroup that has higher rates of smoking: namely, people who live in poverty or are on very low incomes. Those living in the most deprived areas are four times more likely to smoke than those in the least deprived. This group already experiences significant disadvantages, and smoking does little to alleviate inequality.

An estimated two-thirds of smokers say they would like to quit the habit. Fortunately, we know what is effective in supporting people to give up. A combination of nicotine replacement and expert advice increases the success rate of abstaining threefold.

As with so many aspects of health, not everyone is able to access this type of treatment. It is those with the least who struggle to get the help they need when trying to stop smoking. Despite having access to clear evidence of what helps people to quit, and the benefits of doing so, the government has cut the budget of smoking cessation services in recent years. The public health grant is £1bn lower now than in 2016, and “stop smoking” services bear the brunt of this reduction, with a real-terms decrease in funding of 41 per cent.

This leaves many people with no choice but to pay for smoking substitutes such as nicotine patches or gum to help them quit the habit. With the cost of living crisis already affecting the poorest the most, those who are already having to countenance tough choices on paying for basics such as heating and food are unlikely to be able to spare the money for these treatments.

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People are more likely to be successful at quitting smoking when there are as few obstacles as possible. Motivation to change is a fragile state and needs to be nurtured, as summoning the energy and will to quit such an addictive drug, and the ingrained routine of smoking, is tough at the best of times. With so much financial pressure – let alone hunger and cold – it is difficult to see how anyone would contemplate taking on an additional challenge like quitting smoking.

We all have the ability to change, but unfortunately we don’t all have the means. Unless the government gives local authorities the resources to provide “stop smoking” services, we will witness a growing divide in the population, between those who are able to reap the benefits of quitting such a high-risk habit and those who are not.

The relatively small amounts needed to fund these services will be dwarfed by the economic, as well as human, costs in years to come, as smokers develop cancer and other serious health problems. Even without empathy for those at the bottom of society, the economic case should be sufficiently compelling. Supporting these services would be the single most effective way of levelling up.

But I wouldn’t hold your breath, given the track record of this government, as it seems to be committed to growing – rather than reducing – inequality. This is something it has achieved with remarkable consistency, year on year.

Ian Hamilton is a senior lecturer in addiction and mental health at the University of York