Policy changes needed for tobacco control

Dr Raouf Alebshehy is a public health consultant with a background in medicine and healthcare reform. He works as monitoring coordinator in Tobacco Tactics, part of the Tobacco Control Research Group at the University of Bath, which is research partner in the global tobacco industry watchdog STOP.

The number of smokers in the UK has been falling since 2011, helped by regulatory changes like smoking bans and the introduction of plain packaging. But there are still almost 7 million smokers in the UK population, and in 2019-2020 there were over 500,000 hospital admissions and almost 75,000 deaths attributable to smoking. Each year, smoking is estimated to cost the NHS £2.5 billion, while local authorities in England spend £1.2 billion on home and residential social care support caused by smoking.

The government has ambitions for England to be smoke free by 2030, with smoking prevalence reduced to less than 5%. The tobacco control plan for England, however, which should set out how this goal will be realised, has been delayed.

The UK government is a signatory to the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), the world’s first global health treaty, which provides an internationally co-ordinated response to combating the tobacco epidemic. It sets out specific steps for governments to address tobacco use, covering tax measures, advertising and promotion, creating smoke-free spaces, packaging, cessation services and tackling illicit trade.

The biggest challenge governments face in putting FCTC into practice is the tobacco industry itself. The industry’s long history of interference in and obstruction of public health policy is well documented. In recognition of this challenge, Article 5.3 of FCTC provides specific guidance to governments on how to protect themselves from the interests of the tobacco industry. Specifically, it states that:

‘In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law.’

If the UK government is to have any chance of realising its 2030 ambitions for England, blocking industry interference is crucial. So how is it doing? For the past four years, the UK Tobacco Industry Interference Index (UKTI), produced by the Tobacco Control Research Group (TCRG) at the University of Bath, has been measuring government performance. It forms part of the Global Tobacco Industry Interference Index (GTI), a global survey of how public health policies are protected from the industry’s subversive efforts, and how governments have pushed back against this industry influence.

The most recent index included 80 countries and, compared to most, the UK is doing well. But having ranked first in 2019, its performance worsened in 2020 and it now sits at third, with no signs of improvement over the past two years.

The latest report from the UKTI showed how the tobacco industry has taken advantage of major public concerns around COVID-19 and the environment to get close to government. Tobacco companies conducted so-called corporate social responsibility (CSR) activities via informal parliamentary groups and by lobbying, and in the case of COVID-19, this was in response to government requests.

Despite Foreign and Commonwealth Office guidelines to the contrary, UK diplomats engaged with the tobacco industry in low- and middle-income countries; and there was a lack of transparency across government departments about their interactions with the tobacco industry, with inconsistent and insufficient requirements for reporting between different departments.

Alongside the UKTI report, researchers produced a policy brief with recommendations for government. Over the past four years, these briefs have highlighted that tightening policy in key areas (outlined below), would help the government tackle the problem of industry interference and influence; strengthen its chances of introducing even more robust tobacco control and public health policies, and realise its 2030 ambitions.

Policy recommendations

1. Require, collect, and publish tobacco industry data (including on profits, taxes, prices, spending on marketing and research, and local sales data of all products).
2. Ensure comprehensive procedures for publishing details of all meetings with the tobacco industry, and groups and individuals funded by the industry, are fully implemented across all government departments.
3. Implement and embed central and devolved government programmes to regularly raise and maintain awareness of Article 5.3 and how to comply with it across the whole of government.
4. Require the Department of Health and Social Care to develop and disseminate, in partnership with devolved administrations, a comprehensive set of rules for public officials, prescribing standards for dealing with the tobacco industry and vested interests.
5. Ban CSR activities by the tobacco industry and vested interests.
6. In government summaries, identify and separate out the tobacco industry’s responses to regulatory consultations that relate to public health and tobacco control.
7. Create and maintain a legally binding and publicly accessible register that covers all lobbying and policy influence activity across UK administrations. Furthermore, make it a legal requirement for organisations involved in policy discussions to register and disclose their funding before lobbying. Ensure that organisations failing to register or fully declare funding are excluded from policy discussions.
8. Avoid conflicts of interest by prohibiting the tobacco industry and vested interests from making contributions (monetary or otherwise) to political parties and public officials at all levels. Prohibit public officials from holding positions in, or being seconded to, the industry, or taking up posts with the industry for at least five years after leaving public positions (and vice versa).
9. Audit HMRC to ascertain whether the government provides preferential tax exemption to the tobacco industry and remove duty-free concessions for tobacco products.
10. Ensure that bilateral trade agreements developed as a result of Brexit are compliant with the UK’s obligations as a Party to the WHO FCTC and the Protocol to Eliminate Illicit Trade in Tobacco Products.

TCRG would like to dedicate this blog to our dear friend and colleague Dr Mateusz Zatoński, who died in January 2022 at the age of 34. Mateusz authored the first two UKTI reports, provided expert support and guidance to Dr Alebshehy for the third report, and developed the UK policy recommendations. He was committed, through his research, to helping countries worldwide strengthen their tobacco control measures, and improving public health for all.

All articles posted on this blog give the views of the author(s), and not the position of the IPR, nor of the University of Bath. Learn more about the Tobacco Control Research Group.