Smoking Kills
Government White Paper [1998]


Preface - Tony Blair:

If people chose to stop smoking, they would live longer. Smoking kills. Yet we recognise that people have a choice. We would like them to stop smoking, and to choose life. The detailed proposals set out in this White Paper, the first-ever in this country on smoking, will help them to make that choice. I reject completely that this is the so-called nanny state in action. It is instead the Government meeting what are clearly its responsibilities. Smokers have rights. So do non-smokers. Both have responsibilities - to themselves, to each other, to their families, and to the wider community.

Conclusions & recommendations:

10.1   This White Paper will save lives. It contains arguably the most comprehensive strategy to tackle smoking embarked upon anywhere in the world. It represents a huge leap forward in our efforts to reduce smoking in the UK, and is a critical contribution towards achieving the overall aims of our public health strategy and reducing deaths from cancer and heart disease. Informed by evidence and international experience, it covers the whole range of measures needed to tackle this issue.

10.2   We have put together a balanced package of measures. Legislation is used only where required, to implement the EC Directive on the advertising and sponsorship of tobacco products. Where possible, we have looked for partnerships: with local government on under-age sales, with industry on a proof-of-age system, and with the licensed trade on smoking in public places. Individuals have a great part to play in looking after their own health and that of their families.

10.3   We believe that the balance is right and that it will deliver the results we are determined to achieve. But we will be monitoring the outcomes closely. If it looks as though some of the measures may not be as effective as we hoped, we will be ready to re-examine particular problems and to consider tougher action. While our aim is to make existing legislation work better, we will not rule out the option of new legislation in particular areas if it becomes the only realistic way to make progress, all other avenues having failed to deliver enough.

10.5 This is a list of the measures we are taking.

  • End tobacco advertising, promotion and sponsorship.
  • Minimal tobacco advertising in shops. ... to protect children from exposure to tobacco advertising whilst taking account of the need of retailers to display products and prices for existing smokers.
  • Tobacco tax increases.
  • Action against tobacco smuggling.
  • Pressure for European-wide fiscal action. ... so that we can maximise the effectiveness of our taxation policy.
  • New NHS services to help smokers give up.
  • A week's free NRT on the NHS.
  • Tackling smoking will be a priority for the NHS as part of a new emphasis on disease prevention.
  • Co-operation with the pharmaceutical industry.
  • Mass media health promotion campaign.
  • An Approved Code of Practice on smoking in the workplace.
  • Choice for non-smokers and smokers in pubs and restaurants.
  • Smoking policy reviews in all Government buildings.
  • Tough enforcement of law against sales of tobacco to children.
  • A single, cross-industry proof of age card. We will ... encourage the manufacturers of all age-restricted products to develop a national scheme.
  • Support for Europe-wide initiatives to protect health.
  • Tough industry code to prevent sales to children from vending machines.
  • Non-promotion of tobacco products, or events overseas.
  • Full support for international tobacco control work.
  • Reform of CAP regime to cut tobacco growing in the EU.


1.1   Smoking kills. Smoking is the single greatest cause of preventable illness and premature death in the UK. Smoking kills over 120,000 people in the UK a year - more than 13 people an hour.

1.7   More and more children and young people are starting to smoke. The proportion of those aged 11 to 15 who smoke regularly was 8 per cent in England in 1988. In 1996 it was 13 per cent.

Smoking - the risks

1.14   Most people know that smoking is bad for health. Smoking, more than any other factor, cuts people's life expectancy. As well as being the prime cause of cancer and heart disease, it also causes many other fatal conditions and chronic illnesses among adults. The dangers of smoking are clear:

  • over 120,000 people are killed a year because they smoke
  • half of all who continue to smoke for most of their lives die of the habit; a quarter before the age of 69, and a quarter in old age, at time when average life expectancy is 75 for men and nearly 80 for women
  • those who smoke regularly and die of a smoking-related disease lose on average 16 years from their life expectancy compared to non-smokers
  • for every 1000 20-year-old smokers it is estimated that while one will be murdered and six will die in motor accidents, 250 will die in middle age from smoking, and 250 will die in older age from smoking. For every 1000 20- year-old smokers it is estimated that one will be murdered, six will die in road accidents and 250 will die in middle age from smoking.
  • smoking is dangerous at any age, but the younger people start, the more likely they are to smoke for longer and to die early from smoking. Someone who starts smoking aged 15 is 3 times more likely to die of cancer due to smoking than someone who starts in their mid-20s
  • smoking causes 84% of deaths from lung cancer, and 83% of deaths from chronic obstructive lung disease, including bronchitis
  • smoking causes 46,500 deaths from cancer a year in the UK - 3 out of 10 cancer deaths. As well as lung cancer, smoking can cause death by cancer of the mouth, larynx, oesophagus, bladder, kidney, stomach and pancreas
  • smoking causes 1 out of every 7 deaths from heart disease - 40,300 deaths a year in the UK from all circulatory diseases
  • smoking is also linked to many other serious conditions including asthma and brittle bone disease (osteoporosis)
  • levels of smoking are particularly high among people with severe mental illness. This is likely to be one of the reasons why the severely mentally ill tend to die younger
  • some ethnic groups in the UK favour chewed or other oral tobacco, notably betel quid. All forms of tobacco cause cancer. Treating illness and disease caused by smoking is estimated to cost the NHS up to 1.7 billion every year.
  • treating illness and disease caused by smoking is estimated to cost the NHS up to 1.7 billion every year in terms of GP visits, prescriptions, treatment and operations.

1.17   Several hundred people a year in the UK are estimated to die from lung cancer brought about by passive smoking.

1.18   Passive smoking, even in low levels, can cause illness. Asthma sufferers are more prone to attacks in smoky atmospheres. Children, more vulnerable than adults and often with little choice over their exposure to tobacco smoke, are at particular risk. 17,000 hospital admissions in a single year of children under 5 are due to their parents smoking.

Smoking - the cost

1.24   The cost of smoking is high in terms of people's health. But the cost of smoking is high in other ways too. Smoking is estimated to cost the NHS up to 1.7 billion every year. And it costs families, especially the poorest, a great deal too. It is estimated that, in 1996, there were approximately 1 million lone parents on Income Support, of whom 55 per cent smoked an average of five packs of cigarettes a week at a cost of 2.50 per pack. That means lone parent families spent a staggering 357 million on cigarettes during that year.

Smoking - Government action

1.25   We recognise that Government action in areas of personal choice like smoking is a difficult and a sensitive issue. Tobacco is a uniquely dangerous product. If introduced today, it would not stand the remotest chance of being legal. But smoking is not against the law. We do not intend to make smoking unlawful. We are not banning smoking.

1.26   Currently, well over a quarter of the people of Britain smoke. The Government fully recognises their right to choose to do so. We will not in any of our proposals infringe upon that right. But with rights come responsibilities. Smokers have a responsibility to themselves - to their own health, and to ensure that in making the choice to smoke, their choice is based on a real understanding of the risks involved. With their right to smoke, too, comes the responsibility to others who choose not to smoke. Just as the Government is determined not to infringe upon people's rights to make free and informed choices, it is also determined to ensure that the responsibilities of smokers to people who choose not to smoke are carried out. That means a balance of rights and responsibilities -for those who smoke and for those who do not. Striking that balance is a clear and tough challenge - for the Government, for business, for local authorities, for voluntary groups and especially for individuals. With their right to smoke, too, comes the responsibility to others who choose not to smoke.

1.27   The Government has a clear role in tackling smoking. While it is for individuals to make their own choices about smoking, the impact of smoking on the people of Britain - on their health, in causing premature deaths, on non-smokers and in terms of its overall cost - is so great that if it were any other cause, the Government would face accusations of negligence for failing to take action. The Government also has a clear responsibility to protect children from tobacco.

1.28   Reducing smoking will save lives. The Government intends to implement a tough and comprehensive programme to ensure that those who smoke are aware of the potential consequences of their choice, that those who do not smoke are protected against those who do, and that the number of people smoking in Britain falls.

2.1 Widespread public support... is essential for real, lasting change.


2.12   Research shows that the demand for tobacco products is related to their price. As prices rise, demand falls. So high tax levels are one important means of reducing tobacco consumption. High tobacco prices are also a deterrent to children tempted to take up smoking. The real price of tobacco - that is, after allowing for inflation - has increased significantly in recent decades. But people's real incomes have also risen. When people's incomes increase faster than the price of cigarettes, the 'affordability' of cigarettes goes up.

Why do children start to smoke?

3.1   Children smoke for all sorts of reasons. Some smoke to show their independence, others because their friends do. Some smoke because adults tell them not to, others to follow the example of role models. There is no single cause. Parents, brothers and sisters who smoke are a powerful influence. So is advertising. So too is sport which is often sponsored by tobacco companies.

3.2   Many children experiment with smoking, believing they will be able to stop when they want to. But smoking is highly addictive and a great many will find themselves unable to give up.

3.5   Among children aged 11, 1 per cent smoke at least once a week. But by the time they are 15 it is 30 per cent. The proportion of girls aged 15 who smoke at least one cigarette a week has increased from 22 per cent in 1988 to 33 per cent in 1996.

[Tobacco suppliers]

Tough enforcement on under age sales

3.16   Although it is illegal to sell cigarettes to anyone under 16, it is clear that the existing law is not being applied effectively.

3.17   Most children who smoke say they buy their cigarettes from shops. Of those children who get their cigarettes from shops, only 22 per cent of boys and 15 per cent of girls in England say they found it difficult. That suggests that many shopkeepers are selling tobacco to children.

3.21   We are developing a new Enforcement Protocol, with representatives of local authorities, trading standards officers and environmental health officers, for use by local authorities in carrying out their duty under the 1991 Act. Every local authority should be properly exercising its statutory role in preventing under-age sales in accordance with best practice.

3.23   There is currently no statutory obligation on local authorities to carry out an enforcement campaign.

3.28   For such offenders, there is scope for making more use of the full range of penalties within the current limit on fines. The maximum fine for this offence was raised in 1991 to 2,500. The average fine is around a tenth of that figure.

3.29   Prosecutions for selling tobacco to under-16s are relatively rare, and magistrates and trading standards officers may need to consider in greater detail the issues surrounding such offences and the ways in which such cases can best be presented to courts. The Magistrates' Association and LACOTS will be discussing how these cases should be approached following this White Paper. As Parliament has provided a maximum fine of 2,500, there needs to be a clear understanding of the circumstances which could justify the higher levels of fine, such as previous convictions, or sales to particularly young children clearly well below the legal age.

3.30   Occasionally there will be individuals who flout the law and do so repeatedly. We do not believe that people who are prepared to behave so irresponsibly should be allowed to continue to sell tobacco. The Government will explore the scope for new measures to stop repeat offenders or their staff from selling tobacco. In principle, we favour the introduction of a new criminal sanction to deal with this problem, and will be looking carefully at the practicality of introducing and enforcing such a measure.

Anti-smuggling drive

 6.51   Smuggling is a crime. It can be punished with a fine, or a 7 year prison term. The total revenue lost on unpaid tobacco duty was 1 billion in 1997/98 about 9.5 per cent of the total amount of duty and VAT collected on tobacco in the 1997/98 financial year.

6.52   The growth in tobacco smuggling is a major cause for concern, but cutting duty rates is not the answer since it would increase the number of smokers.

6.53   By evading UK tobacco taxes, smugglers are in a position to charge lower prices than reputable shopkeepers and still make large profits. Because smugglers operate outside the law, they may well be prepared to sell tobacco to children, and that is a particular cause for concern.

Changing attitudes

6.34   Public education programmes are the most direct way of changing attitudes and behaviour, and an essential component in any strategy designed to combat smoking.

Passive smoking

7.3   Hundreds of people die every year in the UK as a result of high levels of exposure to passive smoke.

7.4   We do not think a universal ban on smoking in all public places is justified while we can make fast and substantial progress in partnership with industry.

7.5   We have looked very carefully at the case for an outright ban, or legal restrictions, like the ones tried in some other countries. A number of countries have tried an outright ban on smoking in bars and restaurants. But such restrictions have proved difficult to implement. We want to work with business and others to achieve real change, highlighting and building on best practice. In public places we want to see real choice for the public as a whole - non-smokers and smokers.

7.9   Consumers deserve to know they have a choice to make and to be able to exercise it. Staff have a right to choose not to work in smoky conditions. New legislation is not necessary if owners and employers recognise these points and act accordingly.

7.10   Ultimately, it is the responsibility of all of us as individuals, employees, consumers and employers to drive change in public places generally. Our health and comfort are at stake.