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Prime Minister Rishi Sunak has proposed incremental raising of the smoking age in England.
Prof Caitlin Notley, Professor of Addiction Sciences, Norwich Medical School, University of East Anglia, said:
“Incrementally raising the age of sale of tobacco products is a progressive policy that would undoubtedly impact on population level smoking prevalence, and ultimately improve rates of smoking related disease. There is a precedent, as New Zealand have adopted this policy in a similar attempt to prevent new generations of young people ever taking up tobacco smoking. Prevention is extremely important, but we must not forget that this is just one aspect of striving towards a smokefree 2030. We must also continue efforts to promote smoking cessation to adults who smoke at every opportunity, and this means using innovative ways to intervene, meeting people ‘where they are’, and sustained investment in harm reduction approaches such as the ‘swap to stop’ scheme. It is the poorest and most deprived people in our society who continue to smoke tobacco at the highest rates. Tobacco smoking is an inequalities issue, therefore we need focused and sustained efforts to help these underserved populations, as well as wider prevention approaches.”
Prof Linda Bauld, Bruce and John Usher Professor of Public Health, University of Edinburgh, said:
“These proposals in England are good news for public health and the future health of the nation. New Zealand has already implemented a tobacco age of sale law similar to what is being proposed by the Prime Minister, and the New Zealand experience to date suggests this has broad public support and can be implemented. It’s important to point out that today’s announcements and the policies to follow don’t criminalise the smoker but instead puts the onus on the retailer not to sell to those underage and this is supported by new funding for enforcement.
“Some of the devil will be in the detail, however. New Zealand has a retailer licensing scheme and tobacco sale licenses can be removed with non-compliance. New Zealand is also working with retailers to completely phase out tobacco sales in most shops in the next few years, which will strengthen their policy and should be watched with interest. Perhaps the most welcome element of today’s announcements, however, is the additional funding for evidence-based local stop smoking services which provide life-saving support to smokers who want to quit, supported by mass media campaigns. Along with measures to address the recent rises in youth vaping, these announcements provide hope that we can make further progress on reducing the leading preventable cause of death and health inequalities.”
Prof Rachael Murray, Professor of Population Health at the University of Nottingham, said:
“The announcement by the Prime Minister is a bold and welcome step towards achieving a smokefree future and follows the recent adoption of a similar Act in New Zealand. Raising the smoking age each year until it applies to the whole population has the potential to steadily reduce smoking prevalence in England until smoking is effectively eliminated by 2040. As the biggest preventable killer, and often disproportionately impacting the worst off in society, eliminating smoking will improve the overall health in the nation whilst at the same time reducing health inequalities and burden on the NHS.”
Prof Nick Hopkinson, Professor of Respiratory Medicine, Imperial College London, said:
“Smoking is the leading cause of preventable ill health and premature death. For most people who smoke, the habit is driven by an addiction starting in childhood. So raising the legal age of sale for tobacco products is an important step to protect children and young people from getting hooked on smoking. Two out of three continuing smokers will die from a smoking-related disease.
“It’s one of the key measures called for in Javed Khan’s independent review Making Smoking Obsolete* which set out the steps needed to reach SmokeFree 2030.
“It’s evidence based – we saw a fall in youth uptake of smoking in the UK when age of sale was raised from 16 to 18 in 2005, and when it was increased to 21 in the US more recently.
“Government needs to move swiftly and get this measure in place as soon as possible.
“But we need to do more. There are more than 6 million people who smoke in the UK. They need support to quit, including smoking cessation services and mass media campaigns. Laws that regulate sales need to be enforced, but trading standards budgets have been halved, cut by £200 million, since 2010.
“A polluter pays levy on tobacco industry profits would claw back hundreds of millions of pounds, and provide a mechanism to pay for what is needed.”
* https://www.gov.uk/government/publications/the-khan-review-making-smoking-obsolete
Dr Debbie Robson, Senior Lecturer in Tobacco Harm Reduction at King’s College London said:
“It is always worth reminding ourselves how uniquely deadly smoking is for adults. For people who smoke long term – two out of three will die prematurely, often after years of disability from smoking related conditions such as lung and heart disease.
“Measures to drive down smoking rates across all ages are welcome. While we don’t yet know the impact of incremental age increases on age of sale, like those introduced in New Zealand, we do know from countries that have raised the age of sale to 21 that is already having a positive effect on driving down young people’s smoking rates.
“What’s less clear is the role that new restrictions on vaping will play. Like many in the sector, we have been calling for action for some time to curb the availability, access and affordability of vaping products, and measures designed to curb young people vaping are very welcome, particularly where point of display and packaging are concerned. However, it is vital that any new restrictions do not disadvantage people who have switched from smoking to vaping. If the PM truly wants to address the leading preventable cause of death, people who currently smoke need an alternative to cigarettes.”
Prof Sir Nilesh Samani, Medical Director at the British Heart Foundation, said:
“Smoking is a major risk factor for cardiovascular diseases, such as heart attacks and strokes, needlessly taking many lives prematurely.
“We welcome this important initiative from the Prime Minister to limit its damage to the health and wellbeing of our nation.”
Prof Lion Shahab, Professor of Health Psychology and Co-Director of the UCL Tobacco and Alcohol Research Group, University College London (UCL), said:
“This government’s plan to introduce “smokefree generation” legislation could become its defining legacy, righting a century-old wrong, with tobacco products being the only legally available commodity that, if used as intended, will kill over half of its lifelong users. The UK government is following similar plans, already enshrined in law, in New Zealand, where – as part of its Smokefree Aotearoa 2025 Action Plan- starting in 2027, those 14 years of age and younger will no longer be able to purchase cigarettes for the rest of their lives, with age restriction on purchasing will increase by 1 year every year.
“Given the UK’s government own ambition to reduce smoking prevalence to below 5% by 2030, this most certainly is a step in the right direction. Evidence, looking at the implementation of smokefree legislation from around the world, shows that limiting access to, and use of, cigarettes (e.g., with indoor smoking bans) reduces both ill health and smoking rates. While comprehensive support needs to be provided, and properly funded, to those currently still smoking to give them the best chance to avoid unnecessary morbidity and mortality in the near future, legislation to ensure a smokefree generation will save millions of lives, reduce health inequalities and improve well-being for the whole UK population.”
Dr Sharon Cox, Principal Research Fellow in Behavioural Science, Tobacco and Alcohol Research Group, University College London (UCL), said:
“Smoking is an addiction of childhood. People start when they are young, when the harms feel distal, and many continue into adulthood when they find it hard to stop. Making it more difficult for children to start is therefore a welcome step. But we cannot be complacent, we now need more investment in stop-smoking services and wider prevention measures, so we can help the millions of people who are still smoking.”
Dr Maeva May, Associate Director for Policy and Research at the Stroke Association said:
“We welcome the Prime Minister’s bold proposal to raise the smoking age year on year to prevent stroke. Stroke is preventable, treatable and recoverable, but smoking doubles your risk of dying from a stroke. Implementing this plan will save lives, support people to live healthier and help avoid the devastating effects of stroke.”
Prof Jamie Brown, Director of the Tobacco and Alcohol Research Group, and Professor of Behavioural Science, University College London (UCL), said:
“This is wonderful news and has the potential to be one of the most significant public health interventions for a generation. There is excellent evidence that increases to the age-of-sale from 16 to 18 in the UK, and 18 to 21 in the US, substantially reduced smoking prevalence. This provides good reason to expect this measure to have a similar impact, and we join New Zealand in taking this bold new regulatory approach to a lethal product.
“Critically, the government have also now announced substantial additional funding for our world-leading stop smoking services, and to restore funding for mass media campaigns to motivate quit attempts. Together, these measures can get the country back on track for a smokefree future, and avoid the 76,000 deaths a year that smoking causes.”
Dr Sarah Jackson, Principal Research Fellow, UCL Tobacco and Alcohol Research Group, University College London, said:
“I welcome this bold policy action. Typically, people take up smoking in their teens or early twenties. And while they may not plan to be a life-long smoker, experimentation can quickly develop into a long-lasting addiction – with devastating health impacts – that most smokers try to break with repeated attempts to quit. Cigarettes are uniquely lethal: no other legal product used as intended kills one in two people who use it. There’s good evidence that raising the age of sale is effective in reducing uptake of smoking among young people. When the age of sale of cigarettes was increased from 16 to 18 in England in 2007, smoking rates fell by more over the next decade among young people who could no longer legally buy cigarettes (16 and 17 year olds) than those who could (18-24 year olds).
“Banning the sale of combustible tobacco outright would not immediately stop the ~6.4 million smokers in the UK from smoking. Because cigarettes are so highly addictive, many people would be unable or unwilling to do so, and a ban would likely drive demand towards the illicit market. However, a complete ban is not what’s being proposed. Gradually increasing the age of sale over time – a policy that has already been implemented in New Zealand – will be helpful in discouraging young people from taking up smoking in the first place.”
Michelle Mitchell, Cancer Research UK’s chief executive, said:
“Raising the age of sale on tobacco products is a critical step on the road to creating the first ever smokefree generation. If implemented, the Prime Minister will deserve great credit for putting the health of UK citizens ahead of the interests of the tobacco lobby.
“Smoking is the biggest cause of cancer and places huge pressure on the NHS and the economy – with over 500,000 hospital admissions every year in England attributable to smoking.
“We urge all MPs to support the legislation so the UK Government can swiftly raise the age of sale. The Government should also invest more money in stop smoking services and public health campaigns, by introducing a ‘polluter pays’ approach, so that the tobacco industry is made to pick up the bill for the damage it causes.”
Declared interests
Sarah Jackson – I have no conflicts to declare.
Lion Shahab: No COIs
Nick Hopkinson is Chair of Action on Smoking and Health (ASH)
Linda Bauld: No conflicts
Caitlin Notley: No COIs
For all other experts, no reply to our request for DOIs was received.