By Leah K. Lawrence
Posted: August 21, 2020
In July 2019, England’s government announced its goal to make the country “smoke free” by 2030.1 That may be easier said than done, however, according to a new joint report put out by Action on Smoking Health (ASH) and Cancer Research UK (CRUK).2
The annual report showed that among the 69% of English local authorities— counties or districts—that still had a budget to support smoking-cessation services, more than one-third of the budget had been cut between 2018-2019 and 2019-2020.2
Between 2014-2015 and 2018-2019, total local authority spending on smoking-cessation and tobacco-control services in England decreased from £135.9 million to £87.3 million—a 36% decrease.2
“In order to help people quit smoking, there are comprehensive tobacco-control policies in place,” said Kruti Shrotri, the tobacco-control manager at Cancer Research UK. “Those include everything from public education campaigns about the benefits of quitting smoking to encourage people to make a quit attempt, to stop-smoking services to give them the best chances of making that quit successfully, to local and national actions to tackle the illicit trade of tobacco, to raising taxes on tobacco.”
These efforts are in danger though; the ASH/CRUK joint report found that 74% of respondents to their survey of tobacco leads in 127 local authorities said that pressure on budgets was a threat to local tobacco control.
“The biggest driver of these cuts are cuts made to the public health grant,” Ms. Shrotri said.
England’s public health grant is currently approximately £3.1 billion a year, which is approximately £850 million lower than initial allocations in 2015- 2016.3
“CRUK has been calling on the government to restore funding to public health so that funding can be [returned] to stop-smoking services as well,” Ms. Shrotri said.
One of the ways to inject new funds into local tobacco control is a “polluter pays” charge on the tobacco industry, the ASH/CRUK report noted. These charges would raise an estimated £300 to £500 million per year and would fund many stop-smoking services.2
“We are at a point now where if the government wants to meet this ambitious goal, it has to do something and do it soon,” Ms. Shrotri said.
The commitment to tobacco cessation must be strengthened in many countries, according to the World Health Organization (WHO) Report on the Global Tobacco Epidemic, 2019.4
“Many countries still have no national tobacco-cessation strategy. Only a few countries have dedicated personnel or clearly identified budgets for cessation [programs],” the WHO report stated.
For example, efforts in the United States are falling short, with most states failing to properly fund—or cutting the budgets of—effective smoking-prevention and -cessation programs.5 An annual report from The Campaign for Tobacco-Free Kids found that no state in the country currently funds tobacco-prevention programs at Centers for Disease Control and Prevention–recommended levels.
“The states this year (Fiscal Year 2019) will collect $27.3 billion from the tobacco settlement and tobacco taxes, but are spending only 2.4 percent of it—$655 million—on tobacco-prevention and -cessation programs,” the report stated. “This means the states are spending less than three cents of every dollar in tobacco revenue to fight tobacco use.”
Information on the efficacy of tobacco-control programs in many low- and middle- income countries is scarce. A study of India’s National Tobacco Control Programme (NTCP), implemented from 2007-2009, showed that districts included in this program saw no significant reduction in bidi or cigarette use compared with control districts.6
“Comparison of the programme funding shows that the 2018/2019 budget allocated to the NTCP equates to US$0.009 per capita (US$8.8 million/911.6 million adults aged ≥ 15), which is two times above the WHO estimated tobacco-control expenditure among low-income countries (US$0.0004), but this is only one-third of the amount spent by middle-income countries (US$0.03 per capita) and below 1% of those spent by high-income countries (US$1.26 per capita),” the study researchers wrote.
Adequate funding is vital to successful tobacco-cessation programs, according to the WHO report, making it “essential to identify a sustainable funding source.”
Ms. Shrotri said that CRUK’s international efforts are focused in low- and middle-incomes countries, where tobacco control tends to be low and tobacco use tends to be high.
“The general approach in those countries is to push for taxation as a tobacco-control measure because it is one of the most effective methods and doesn’t cost the government anything,” Ms. Shrotri said. “In fact, it brings the governments money.”
Although not a low- or middle-income country, Australia has increased tobacco tax by 12.5% every year from 2013 to 2020. This aggressive tobacco taxation campaign is expected to bring the government $4.7 billion between 2016 and the final increase.7 In September 2019, the average price for a pack of cigarettes in Australia was $35.
In the report, WHO stated that countries “should consider placing the cost of tobacco-cessation support on the tobacco industry and other retailers through measures such as designated tobacco taxes, tobacco manufacturing and/or import license fees, a tobacco-selling license for distributors and retailers, and noncompliance fees levied on the tobacco industry and retailers.”
Free or reduced-price cessation treatment could increase the number of people who attempt to quit and increase the likelihood of their success, the report said. ✦
1. Triggle N. Pledge to end smoking in England by 2030. BBC. https://www.bbc.com/news/health-49079515. July 23, 2019. Accessed February 20, 2020.
2. Action on Smoking and Health. Cancer Research UK. Many ways forward. Stop smoking services and tobacco control work in English local authorities, 2019. https://ash.org.uk/wp-content/uploads/2020/01/Many-Ways-Forward.pdf. Accessed February 20, 2020.
3. The Health Foundation. Urgent call for £1bn a year to reverse cuts to public health funding. https://www.health.org.uk/news-and-comment/news/urgent-call-for-1-billion-a-year-to-reverse-cuts-to-public-health-grant. June 12, 2019. Accessed February 20, 2020.
4. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2019. Offer help to quit tobacco use. https://apps.who.int/iris/bitstream/handle/10665/326043/9789241516204-eng.pdf?ua=1. Accessed February 20, 2020.
5. Campagin for Tobacco-Free Kinds. U.S. State and Local Issues. Prevention and Cessation Programs. https://www.tobaccofreekids.org/what-we-do/us/prevention-cessation. Accessed February 20, 2020.
6. Nazar GP, Chang KCM, Srivastava, et al. Impact of India’s National Tobacco Control Programme on bidi and cigarette consumption: a difference-in-differences analysis. BMJ. 2020;29(1):103-110.
7. Dean, Lucy. $35 a pack: Has Australia Tobacco Tax Worked? Yahoo Finance AU. https://au.finance.yahoo.com/news/has-australias-cigarette-tax-230653562.html. November 21, 2019. Accessed February 20, 2020.