Smoking is a key proximal determinant of health and an important contributor to England’s ‘big killers’ of coronary heart disease and cancer. Cigarette smoking is a primary cause of preventable morbidity and premature death in England: between 1998 and 2002, it is estimated to have lead to an average of 86,500 deaths per year. Cigarette smoking also generates high health care costs for the NHS, and for the wider economy.
Additionally, social inequalities in smoking make a major contribution to social inequalities in health. Although smoking prevalence is considerably lower than it was in the 1970s, the rate of decline slowed in the mid-1990s and this pattern of gradual decline has continued. Estimates suggest that prevalence rates are dropping by 0.4% a year. Socioeconomic inequalities in cigarette smoking remain pronounced for both men and women. Patterns by equivalised household income capture these socioeconomic differentials in smoking. Prevalence rates in the lowest income quintile for men (36%) and women (30%) are more than twice those found in the highest income quintile (16% and 13% respectively). There are also inequalities in exposure to second-hand smoke, with mean hours of exposure estimated to be highest among those in the lowest-income households.
Reducing the public health burden of cigarette smoking is central to improving health in England. Tobacco control policy is therefore a key lever of government policy. As well as investment in NHS smoking cessation services, policy has recently been strengthened by the introduction of additional restrictions on the promotion and sale of cigarettes and, following legislation, virtually all enclosed public places became smokefree from July 2007.
It is against this background that the Consortium's projects relating to smoking have been set.