The Royal College of Physicians (RCP) has issued a briefing to MPs and peers on its new report on smoking, health and social justice. The report calls for urgent action to address the deep inequalities in tobacco use, including the introduction of universal, opt-out smoking cessation services across the NHS and a stronger focus on the social determinants of smoking.
The RCP’s latest analysis highlights that smoking remains the leading cause of preventable death in the UK, responsible for around 76,000 deaths each year. It also shows that smoking accounts for around half of the gap in life expectancy between the most and least advantaged communities, underlining its central role in driving health inequalities.
The briefing to MPs highlights:
- How smoking remains a major, preventable public health threat: Smoking continues to have a profound impact on population health, despite declining national prevalence. It is a leading cause of preventable illness and premature death, placing significant strain on the NHS and wider society.
- How smoking drives health inequalities: Smoking rates are more than twice as high in the most deprived communities compared with the least deprived, and can reach as high as 40–80% among some marginalised groups. These disparities are driven by structural factors such as poverty, housing insecurity, and social exclusion rather than differences in motivation to quit.
- How smoking is shaped by wider social and economic factors: The report emphasises that tobacco use is not simply an individual behaviour, but one strongly influenced by social conditions including education, employment and living circumstances. Without addressing these underlying drivers, progress in reducing smoking will remain uneven.
- How access to effective cessation support is unequal: While smoking cessation is highly effective and cost effective, access to evidence-based treatment is inconsistent. Those with the greatest need are often least likely to receive support. The introduction of universal, opt-out NHS smoking cessation pathways would significantly help close this gap.
- How commercial practices reinforce inequalities: The tobacco industry continues to adapt pricing and marketing strategies to sustain consumption, particularly in more deprived communities. This includes the availability of cheaper products and targeted promotion, which undermine efforts to quit and perpetuate health inequalities.
- The economic burden and opportunity of action: Smoking imposes substantial economic costs, including lost productivity and healthcare demand. However, reducing smoking prevalence could deliver a significant ‘smokefree dividend’, estimated at £10.9 billion annually in England through increased economic participation and reduced household spending on tobacco.
- The importance of better data and targeted policy: Current data often underestimates smoking prevalence by excluding marginalised populations, such as people experiencing homelessness. Improved data collection is essential to ensure resources are directed where they are most needed.
- The actions government must take to reduce inequalities: The RCP calls for a comprehensive, equity-focused tobacco control strategy, including stronger regulation of the tobacco industry, expansion of cessation services, improved data collection, and coordinated cross-government action to address the wider determinants of smoking.