The costs of smoking fall largely on reluctant smokers in disadvantaged communities

The relationship between smoking and poverty is complex, but the harm that smoking causes lands most heavily on disadvantaged groups and this demands a response.

We know that smoking rates are higher in disadvantaged groups, with the latest figures indicating that the smoking rate in SIMD 1 (the most disadvantaged fifth, determined by postcode) is three times as high as in SIMD 5 (the least disadvantaged). Before the recent ban on smoking in prisons the smoking rate amongst inmates was nearly three quarters. Nearly half of those who are out of work and seeking employment, or living with a long term disability, smoke. At least a third of tobacco is used by people with a diagnosed mental health issue.

Crucially, across all these groups people are just as likely to say that they want to stop smoking. With the likelihood of smoking so determined by social and economic circumstance, rather than any notion of lifestyle choice, any response that assumes smoking is a freely entered personal decision will not be fit for purpose. Instead we need to understand and address the factors that lead some people to smoke and make it harder for them to stop.

This is important because between a half and two thirds of smokers who do not manage to stop will die from some smoking-related cause. Nobody interested in the well-being of individuals and communities should ignore the devastation caused by thousands of deaths every year in Scotland alone.

The latest Scottish Health Survey figures suggest that 27% of adults in SIMD1 and 23% of adults in SIMD 2 smoke. Given the latest population figures, that means that over 450,000* people in Scotland’s disadvantaged communities are living with greatly increased risk of cancer, heart disease, stroke, diabetes and dementia because of smoking.

Consistently two thirds of smokers say that they want to quit. Given that the average cost of smoking is £1600 a year, then the total financial cost to people in disadvantaged communities who don’t even want to be smokers is nearly half a billion pounds a year**. That’s ten times the financial impact of the bedroom tax.

Most people who smoke have weighed up the costs and benefits of smoking and decided that on balance they would like to stop. The moral case to help them to do so is clear — and supporting clients who want to stop smoking needs to be an integral part of all frontline health and social services.

* Out of a total population of 5,424,800, there are 4,507,358 adults of 16 or over, which means 901,472 in each SIMD group. An average of 25% across the SIMD 1 and SIMD 2 groups gives us 457,960 people who smoke.

** If 457,960 people smoke, and two thirds of them wish to stop, then 306,833 people in these groups wish to stop smoking. At an average of £1600 a year each we then have £490 million a year.