Smoking

Smoking continues to present a major public health challenge in England. It is the leading cause of preventable illness and premature death, responsible for around 74,600 deaths in 2019. Despite a continued decline in smoking prevalence, 11.6% of adults in England still smoke, equating to over 6 million people. Smoking is also one of the key drivers of health inequalities, and the leading cause of cancer in the UK.  

The economic toll of smoking is experienced by the NHS, local authorities, and wider society. Tobacco control is recognised as a priority internationally, nationally, and locally. There have been significant developments in national tobacco control policy and legislation over recent decades. Internationally, the WHO Framework Convention on Tobacco Control (WHO FCTC) was adopted in 2003 and was the first international public health treaty.  

In 2019, the government set an objective for England to become smokefree by 2030, meaning only 5% of the population would smoke. The Khan review found that without further action, England will miss the smokefree 2030 target by at least 7 years, and the poorest areas in society will not meet it until 2044. To hit the smokefree 2030 target, we need to accelerate the rate of decline of smoking by 40%.  

It is important to focus on smoking as a topic area as it is the largest cause of preventable ill health and premature mortality in the UK. Smoking is a major risk factor for many diseases, such as: 

• lung cancer
• chronic obstructive pulmonary disease (COPD)
• heart disease

There is a significant association between smoking and multiple mental health conditions, including:

• dementia
• depression
• psychosis
• eating disorders

This relationship is reciprocal, meaning those with worse mental health are more likely to smoke, and those who smoke are likely to develop worse mental health. Research also suggests that those who smoke are more likely to be lonely and have less frequent engagement with their communities.

There was a 30% increase in the number of children living in a smoke free home in England from 1998 to 2018. Nevertheless, of the estimated 1.8 million households in England where a child lives with a smoking adult, the second highest proportion of these are in the north east of England at 8.7% of households. 

Children exposed to second-hand smoke are more likely to experience a range of poor health outcomes. Their risk of developing asthma is increased by up to 85%.  

Children who live with a parent who smokes have increased odds of going on to smoke themselves. Increasing the number of smoke free homes will therefore have both immediate and long-terms benefits for the health of our younger generations.

Smoking-related impacts on society 

Smoking comes at a cost to society of over £17 billion per year in England, when considering healthcare spending, social care spending, and productivity costs. In the north east region, this cost is around £1.99 billion. 

A significant burden is placed on our health system because of smoking. Smoking-related illness costs the NHS around £2.6 billion each year, representing 2% of their whole budget.

In the north east specifically, the NHS costs of smoking are estimated to be around £93.4 million per year. In 2019 to 2020, the rates of hospital admissions regarded as being caused by smoking for the population of Stockton-on-Tees reached 2,015 per 100,000. This is 44% higher than the figure for England in the same time period. This highlights the disproportionate impact of smoking-related illness on NHS services in our area.

The cost of social care to north east local authorities due to smoking is approximately £65 million. This figure does not include the cost of informal care provided by family and friends, or the additional costs that would be incurred if the remaining unmet need was addressed. This would equate to an additional £732 million. In Stockton-on-Tees specifically, social care costs from smoking amount to £4.8 million pounds annually. 

Beyond health and social care, there is a high cost to the wider economy from smoking, owing to a loss of productivity. This refers to the costs of unemployment, lost earnings, and early deaths due to smoking, which are estimated to total around £14 billion per year in England, with nearly £1 billion of this attributable to the north east specifically. On average, smokers take more time off work than non-smokers do.

Environmental impact

Cigarette smoking is harmful to our environment because it contributes to climate change through the generation of carbon dioxide. To offset one person smoking 20 cigarettes per day for 50 years, it would require planting 132 tree seedlings and growing each of them for 10 years.  

Cigarettes are also the primary cause of accidental fires in the home. In the north east, this comes at a cost of more than £15 million per year, as well as posing a significant risk to life.

The health impacts of smoking do not affect everyone in society to the same extent. Smoking is the greatest driving force for health inequalities in England, accounting for approximately half of the difference in life expectancy between the highest and lowest socioeconomic groups. Those who live in the most deprived areas are more than twice as likely to smoke, reflected in the fact that approximately one-third of all smoking adults in England were living in the two most deprived deciles in 2021. In Stockton-on-Tees, 7 out of 27 wards are among the top 10% most deprived in the country, and an average male life expectancy gap of 14.2 years exists between the most and least deprived areas. 

Those who smoke earn on average 6.8% less than non smokers. They are also more likely to be unemployed, further perpetuating smoking-related inequalities. This highlights the function of stopping smoking as an effective intervention for reducing health inequalities in Stockton-on-Tees.

When looking at specific priority groups, large disparities exist. These priority groups include:

• pregnant women
• people with mental health problems
• people who are socioeconomically deprived

The people of Stockton-on-Tees need to:

• recognise the higher rates of smoking in Stockton-on-Tees in general and particular in at risk groups such as pregnant women, people with long term mental illness, and people in routine or manual jobs or living in more deprived areas
• understand the detrimental impact of smoking on health outcomes such as respiratory disease, cancer and cardiovascular disease and is a driving force for health inequalities (the Stockton Stop Smoking Service has new link worker roles which are doing some targeted work with housing, adult social care and mental health to work towards the health inequalities)
• work with the general population and particular at-risk groups to raise awareness through strategic communication campaigns such as via Fresh which includes both stop smoking and vaping information and resources
• look at the training on offer within Stockton-on-Tees at present, including 'very brief intervention' training and Making Every Contact Count, and how training around smoking and vaping can be delivered to ensure professionals receive the correct level of training required for their role
• explore enhancing the offer of the current Stop Smoking Service offer to suit the needs of the local population such as a tiered level of support offer and a 'quit vaping' offer
• explore improving the targeted interventions offered through the Stop Smoking Service by utilising the 'what works' public health research such as considering including face to face group interventions and exercise incentive schemes (this is in addition to supporting the continuation of the 'swap to stop' and financial incentive schemes)
• encourage and establish strong partnership working, particularly through the Smoke Free Alliance, to ensure work on smoking within Stockton-on-Tees is co-ordinated and services can understand their role in supporting the smoke free generation vision
• continue to advocate for a smokefree generation from various sources and at a range of various levels (including but not limited to Stockton-on-Tees Borough Council, Fresh and Ash)
• recognise the importance of data to advise on the needs and issues of service users to help direct targeted interventions (such as those who wish to get support to quit vaping) and improve data collection across several different organisations to provide a holistic view of the issues regarding smoking and vaping within Stockton-on-Tees
• monitor new government legalisation and the impact locally, this can be done through the Stockton Smoke Free Alliance to ensure multi agency approach

Smoking remains a significant public health problem and the leading cause of preventable illness and premature death. Smoking is a key driver of health inequalities and causes significant cost to health, social care, and wider society. National and international policy support further reduction in smoking, for example, the United Kingdom's ambition to achieve a smoke free generation.

The most recent estimate of overall smoking attributable mortality (the proportion of deaths in the population that are directly caused by smoking) in Stockton-on-Tees was 249 deaths per 100,000 people. This is greater than the England average of 202, but lower than the north east of England average of 271. Smoking is estimated to be responsible for around 1 in 8 CVD (cardiovascular disease) deaths, and at least 15 different types of cancer.

Stockton has a Specialist Stop Smoking Service which is delivered by North Tees and Hartlepool NHS Foundation Trust. They offer free, friendly, non-judgemental support and advice. A stop smoking advisor can offer support for 12 weeks including free stop smoking medication (if you get free prescriptions) and a vape offer. The support is available for anyone 12 years and older.

The 5 to 19 service can offer brief health education. The service is currently going through a review.

Service users who are attending Change, Grow, Live are offered the opportunity to attend one of the regular stop smoking clinics, where they will be assessed by one of the nurses or coordinators who have been specifically trained by our local stop smoking service. They also offer the swap to stop (vape) offer.

1. Smoking Profile on the Fingertips website. Public health profiles.
2. Action on Smoking and Health (ASH) website.
3. World Health Organization. WHO Framework Convention on Tobacco Control. 2003
4. Khan J. The Khan review: making smoking obsolete.
5. Office for National Statistics. Sickness absence in the UK labour market: 2023 and 2024.
6. Stockton-on-Tees Borough Council. A Fairer Stockton-on-Tees 2024 [cited 2024 12th February]. Visit the Stockton-on-Tees Borough Council a Fairer Stockton-on-Tees webpage.
7. He Z, Wu H, Zhang S, Lin Y, Li R, Xie L, et al. The association between secondhand smoke and childhood asthma: A systematic review and meta-analysis. Pediatr Pulmonol. 2020;55(10):2518-31.