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The Treasury can't bail everyone out – let’s impose a levy on the tobacco industry instead

4 min read

The past two years have laid bare underlying health disparities across the UK.

Our health needs are changing, and lifestyle choices are increasing our risk of preventable disease. As we continue to live longer with conditions like cancer, this inequality gap will only widen. 

As a nation, we’ve made great progress in helping people live longer lives but many spend too many years in poor health - a great deal of which can be prevented. “Prevention is better than a cure” might well seem like a folksy medical adage, but it will need to be the mantra of a sustainable, well-run healthcare system fit for the 21st century.  

Between the Spring Statement this week and the Health Disparities White Paper, Autumn Budget and Tobacco Control Plan for England later this year, there’s much opportunity for the government to act - to improve public health, secure the future of our care services, and boost the health of our economy. 

To achieve smoke-free targets, we’ll need bolder action on tobacco control

A key lever for government to prevent ill health, then, is to reduce tobacco use. The public health campaigns and national policy measures of the past 50 years successfully reduced smoking prevalence in the UK to a record low of 14.1 per cent in 2019. But smoking is still deadly – it’s the leading cause of preventable disease and death in the UK, killing more than 125,000 Brits in 2015: around a fifth of all deaths from all causes.  

The government already has an ambitious target for England to be smoke-free by 2030. This is welcome, but according to Cancer Research UK modelling this won't be reached until 2037 and the most deprived won’t reach this until the mid-2040s. Let us be clear on what this means: those who are poorer and smoke will continue to be sicker and die younger than their wealthier counterparts. 

I’m glad government has recognised that levelling up must begin with an acknowledgement of the impact that inequality has on the number of years we get to live, and it’s encouraging that the Levelling Up White Paper addressed the need to improve life expectancy. But to achieve smoke-free targets, we’ll need bolder action on tobacco control, and this requires additional and sustainable funding. 

In an extremely challenging economic environment, it’s time for the Chancellor and the Secretary of State for Health to introduce reasonable and fair fiscal measures to finance investment in cancer prevention, such as establishing a smoke-free fund. This would require tobacco manufacturers to pay a “polluter pays” levy, without any influence on how the funds are spent.  

The “polluter pays” principle has been accepted by Conservative governments for over 30 years; starting with the Landfill Levy, running through the Soft Drinks Industry Levy. To quote the minister, Lord Greenhalgh: “The reality is that we cannot keep looking to the Treasury to keep bailing everybody out—we have to get the polluter to pay.” 

He is, of course, correct. It’s the tobacco manufacturers’ product that kills. They – and not the public – should pay for the damage caused. Funds raised would pay for tobacco control, including behaviour change campaigns, smoking cessation services, retailer compliance and policy work. 

Now is the time for government to set a course of action to reduce health disparities. We know that tobacco’s a stubborn problem (despite progress, in the first lockdown, smoking among young adults increased by 25 per cent) – and poorer communities continue to be disproportionately impacted – half the difference in life expectancy between the lowest and highest income groups in England is attributed to smoking.  

There are clear opportunities for the government to reduce the prevalence of tobacco across the UK and achieve its smoke-free 2030 aspirations – an aspiration I share since my time as health minister and will continue to champion in Parliament. 


Steve Brine is the Conservative MP for Winchester and former health minister. 

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