This Challenge Poverty Week, we need to talk about smoking and poverty.

ASH Scotland
Oct 4, 2019 · 4 min read

This week is Challenge Poverty Week. As part of this, the Poverty Alliance and other organisations across Scotland are highlighting how people are trapped by poverty and how it puts people in impossible situations. Solving poverty is about ensuring we can all participate in a just and compassionate society.

Recognising and addressing health inequalities is a crucial part of the solution. ASH Scotland has previously drawn attention to how the story of smoking in Scotland is one of inequality. Smoking rates are highest in SIMD* 1 and 2, and latest Scottish Health Survey figures indicate that the smoking rate in SIMD 1 has risen from 27% to 32% in 2018. This means that too many people in the grip of poverty in Scotland are also at greatly increased risk of cancer, heart disease, stroke, diabetes, dementia and premature death.

This is an equalities issue. This Challenge Poverty Week, ASH Scotland is therefore calling on people to reflect on some of the commonly held assumptions about smoking and poverty.

This was the focus of a recent project undertaken by ASH Scotland and the Poverty Alliance. Together, we explored how anti-poverty organisations perceive smoking as an issue and where overlap between public health and anti-poverty work exists. Some interesting points of convergence emerged, which led to five main recommendations for the future:

· Improve understanding of the situation: Further exploring the role and impact of smoking in the lives of people living in poverty, including the participation of people with lived experience.

· Positively frame messages: In order to engage anti-poverty interests, messaging around smoking must be framed positively, with the emphasis on supporting people rather than on taking something away.

· Help to find alternative coping strategies: With smoking so often used as a coping mechanism, we must do more than just call on people to stop smoking and need to support them in finding alternative coping strategies.

· Offer organisations advice: Offer organisations the advice, resources and training they need in order to engage clients who smoke in an empathetic and supportive manner.

· Encourage better collaboration: Provide the necessary leadership, and encourage better collaboration between health and anti-poverty interests, by integrating smoking and poverty in local and national strategies.

Crucially, ASH Scotland’s work with the Poverty Alliance highlighted how the narrative that “smoking is a free choice” is not fit for purpose. Smoking is an addiction and most people who smoke say they want to quit**. However, additional challenges mean that you are less likely to be successful in this if you live in a low-income community and are faced with the daily stress and stigma of poverty. In this context, smoking can be used as a coping mechanism, (though an ultimately ineffective one), especially in the absence of fewer available alternatives.

For many people, smoking is therefore experienced as an unwilling addiction exacerbated by the pressures and anxiety of poverty. It also creates financial burdens on families and communities. ASH Scotland has estimated that the average yearly cost to someone who smokes is £1626***. At the same time, global international tobacco companies’ profits continue to boom****.

Given this evidence, supporting people to quit smoking is not about telling them what to do, it is about working with them to achieve their own life goals and helping to eliminate health inequalities that exist for people living in poorer communities in Scotland.

To do this effectively, we must take a person-centred approach that acknowledges the complicated relationship between smoking and poverty, and the costs and benefits that people themselves weigh up when continuing or quitting smoking. This, for instance, is what ASH Scotland does through our Smoking and Money Advice project, which helps money advice workers support their clients when they want to quit smoking and boost their incomes.

It is crucial that we examine our assumptions about why people continue to smoke in stressful circumstances. Challenge Poverty Week presents an opportunity to reflect and start to shift our thinking about the relationship between health inequality and poverty. Doing so will help move us towards Scotland’s goal of building a more just and compassionate society for all.

Elizabeth Hurst-High

Policy, Information and Communications Officer

ASH Scotland

*SIMD = Scottish Index of Multiple Deprivation.

**These figures are from the 2017 Scottish Health Survey. Data from the question ‘Do you want to quit smoking?’ were not included in the 2018 main report. This blog will be updated with the most recent figures once they are available.

***This figure is based on calculations from 2016. Though the price of cigarettes and rolling tobacco have gone up since 2016, the average number of cigarettes smoked by adults in Scotland has gone down (from 12.7 in 2016 to 11.8 in 2018). We therefore estimate that the average yearly cost of smoking for a Scottish adult might have gone up slightly, but not significantly since 2016.

****According to The Tobacco Atlas (Fifth Edition, 2015), the 2013 profits of the top six tobacco companies were $44.1 billion. This is the equivalent to the combined profits of The Coca-Cola Company, Walt Disney, General Mills, FedEx, AT&T, Google, McDonald’s and Starbucks in 2013.

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Our vision is that everyone has the right to good health and to live free from the harm and inequality caused by smoking.

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