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Smoking-Related Diseases

Volume 774: debated on Wednesday 14 September 2016

Question for Short Debate

Asked by

To ask Her Majesty’s Government what further action they are taking to reduce the incidence of smoking-related diseases.

My Lords, by way of prologue, I should explain that this debate was originally initiated not by me but by the noble Lord, Lord Young of Cookham. His new ministerial responsibilities—I warmly congratulate him on his appointment—preclude him from speaking this evening, but I am delighted to see him in his place on the Government Front Bench, and I know that his lifetime commitment to the cause of tobacco control is undimmed. When he asked me to take on the debate in his place, I was, of course, very happy to agree.

Underlying what we are discussing this evening is the inequality which continues to blight our society. In her initial speech as Prime Minister, Mrs May committed her Government to,

“fighting against the burning injustice that, if you’re born poor, you will die on average 9 years earlier than others”.

Half of this difference in life expectancy is due solely to higher rates of smoking among the least affluent. This is an injustice that we cannot allow to continue.

Throughout my time in this House, I have spoken on tobacco control many times, as, indeed, have many of the other noble Lords contributing to this debate. We started with the Private Member’s Bill to abolish tobacco advertising and sponsorship, and the adoption of a smoke-free environment on the parliamentary estate. The UK has emerged as a world leader in tobacco control, with successive tobacco control plans, starting with Smoking Kills in 1999. Since then, the rate of smoking in England has declined by more than a quarter, to only 16.9% of the adult population in 2015.

Is there anybody, except possibly Mr Farage, who wants to go back to smoke-filled pubs and restaurants, and to coming home stinking of tobacco smoke after a night out? I think not. This fall in prevalence, which has already and will continue to save many thousands of lives year on year, could not have been achieved without commitment from successive Governments to comprehensive tobacco control strategies, which have ensured that we live up to our obligations as a party to the WHO Framework Convention on Tobacco Control. This includes comprehensive smoke-free laws, putting tobacco out of sight in shops, banning smoking in cars carrying children and the passage of standardised packaging legislation, which in Britain came into effect in May and which this House supported overwhelmingly.

I do not intend to say much about the tobacco industry this evening, but I remind your Lordships that the tobacco companies and their apologists opposed every piece of legislation that affected them over the last two decades, using spurious arguments about commercial and individual freedom, and claiming that the measures proposed would not work. Well, as the smoking prevalence figures demonstrate, they could not have been more wrong.

Having said that, there are still 7 million smokers in England, and nearly 80,000 die from diseases caused by smoking each year. That is why we need a new tobacco control plan for England. The last one expired at the end of 2015, and in December the Government committed themselves in the other place to publishing a new tobacco control plan this summer. We have now been without a tobacco control plan for nine months. It is essential that the Government do not delay any further in bringing forward the next tobacco strategy. I hope that the Minister may be able to say something about this when he replies to the debate.

We cannot afford to be complacent. The decline in smoking rates in England has been similar to the decline in Australia or Canada—countries that have comprehensive tobacco control strategies. By contrast, smoking prevalence in France or Germany—countries without such strategies—has barely shifted over the last 20 years. Without sustained action, the decline in smoking rates could plateau or, as has happened in France, start to rise again. Further progress requires further action, and, as the Prime Minister has identified, action to tackle health inequalities.

The new plan needs to set out clear ambitions, recommendations for action and provisions to ensure sustained funding for tobacco control. The ambitions contained in the previous plan, concerning smoking in pregnancy, smoking and young people and adult smoking prevalence, have all been met. Stretching new ambitions are essential to build on this success and highlight areas, especially health inequalities, where more needs to be done. International evidence tells us that cutting funding limits the effectiveness of tobacco control measures; sustained funding will be vital to achieve continued reductions in smoking rates.

The new plan also needs to set clear targets for reducing health inequalities. Smoking rates among people in the routine and manual socioeconomic group are more than double the rates among those in the professional and managerial group. Smoking prevalence is even higher among those who are unemployed, in prison, have a mental illness or are experiencing homelessness. This means that the most disadvantaged members of our society suffer disproportionately from smoking-related diseases. Not only do individuals in disadvantaged communities suffer from a greater burden of smoking-related disease, but children growing up in those communities share that burden through greater exposure to second-hand smoke. Those children are also more likely to try smoking. Those who grow up in a household where their parents or siblings smoke are far more likely to become smokers themselves. Children may experience considerable peer pressure to start smoking, and tobacco is often more accessible in both the community and at home. This creates a cycle of inequality where smoking and smoking-related disease is passed down through generations, resulting in an appalling gap in life expectancy between rich and poor in our country.

This cycle of inequality is reinforced by lower rates of quitting among disadvantaged smokers. Poorer smokers are usually more heavily addicted and, while on average all smokers make a similar number of attempts to quit each year, well-off smokers are more likely to succeed. To reduce inequalities and the impact of smoking-related disease, support for quitting must be tailored to the needs of smokers in the lower socioeconomic groups. This requires mass media campaigns targeted at poorer communities, designed to motivate quitting and discourage uptake. Such campaigns are effective and cost-effective and an essential underpinning of a strategy to reduce smoking prevalence.

In addition, funding for stop smoking services needs to be secured. They are one of the most cost-effective healthcare interventions and smokers are four times more likely to quit successfully with the combination of behavioural support and medication provided by these services compared with unsupported quit attempts. This is particularly relevant for poorer smokers, who are more likely to be successful with this specialist support.

A new tobacco control plan is needed to set out the future of these services and to ensure that local authorities have the resources necessary to pursue targeted smoking cessation work with pregnant women and disadvantaged populations. This is vital to helping vulnerable people to give up tobacco and protect themselves from smoking-related diseases, and we need a clear strategy to help local services deliver on those aims.

Reducing smoking rates among poorer smokers will further support other government health aims, including reducing stillbirths and neonatal deaths. Women in routine and manual jobs are almost three times as likely to smoke during pregnancy as those in professional and managerial roles. The Government have committed themselves to reducing the rate of stillbirths, neonatal and maternal deaths in England by 50% by 2030. Cutting rates of maternal smoking will significantly advance this agenda, and this means cutting smoking rates among mothers from disadvantaged communities.

My Question asks the Government what action they are taking to reduce the incidence of smoking-related disease. As I have explained, the action needed is the publication of a new tobacco control plan for England without delay, with renewed and enhanced ambitions. Under the last plan we achieved a great deal and made large steps towards improving public health and we must not allow these achievements to go to waste. A new plan must build on the progress that has been made, continue to drive down smoking rates and protect our most disadvantaged from the burden of entirely preventable death and disease caused by tobacco.

My Lords, I remind the House that this is a popular time-limited debate in which speeches should conclude as three minutes appears on the clock.

My Lords, I thank the noble Lord, Lord Faulkner, for taking on this debate from my noble friend Lord Young of Cookham.

The Wanless report in 2011 warned of a sharp rise in avoidable deaths if we did not take prevention seriously. The NHS Five Year Forward View identified the future health of millions of children, the sustainability of the NHS and the economic prosperity of Britain as dependent on a radical upgrade in prevention and public health. The Government are to be congratulated on achieving their targets under the old plan. Targets for adult smoking rates down to 18.5%, smoking rates among 15 year-olds down to 12% and smoking rates in pregnancy down to 11% have all been met. It is an excellent record but more is needed to achieve the Prime Minister’s stated aim to reduce inequalities in health and the gap between rich and poor.

Smoking prevention can also be achieved in acute settings. Anesthesiology noted in 2011 that smokers were 38% more likely to die after surgery than non-smokers. In my own specialty of colon and rectal surgery, smoking was a predictive factor in causing anastomotic breakdown and poor wound healing. I was accused of being draconian for advising my patients to stop smoking before surgery. However, we have evidence to show that stopping smoking two months before surgery provides the most benefit for patients and reduces complications. It strikes me that this would be a good time to offer a smoker an e-cigarette—preferably on prescription. This approach was endorsed by the Royal College of Physicians and the Royal College of Surgeons and others in a joint briefing in April 2016, which encouraged healthcare providers to be proactive in supporting those who want to use e-cigarettes. We must of course be careful not to encourage young people to try them. We must use every means, including mass media, as the noble Lord, Lord Faulkner, mentioned, and social media to change public attitudes to tobacco smoking. A campaign to stop smoking in cars with children present was a case in point. Can the Minister say what plans he has to consult the public on a new tobacco control strategy?

My Lords, smoking-related diseases create a huge burden on British society, both in human and financial terms. Smokers know how dangerous it is, but quitting is not easy. My noble friend Lord Ashdown of Norton-sub-Hamdon reminded me earlier today that he used to quit smoking three times a day.

To reduce the burden of smoking-related disease, we must continue to apply downward pressure on smoking rates. The Government must publish a new, comprehensive, properly funded tobacco control plan without further delay. We know that smokers are four times more likely to quit smoking with the combination of behavioural support and the medication offered by local stop-smoking services. These services are among the most effective healthcare interventions, quadrupling the success rate of quitting, and are therefore very good value. However, in 2014-15 around 40% of local authorities in England cut budgets for these services.

Media campaigns are also highly cost-effective, because they are highly effective in encouraging smokers to quit and preventing young people starting to smoke in the first place. Mass media should also be utilised to deliver better information on e-cigarettes, which many smokers do not realise are much less harmful than smoking tobacco. In the debate before the Summer Recess the Minister said that Public Health England would be getting this message across in its quit smoking campaigns. But we are not spending enough on such campaigns. In 2015, we spent less than a quarter of the amount that we spent on them in 2009, and we know that if they are not properly funded they cannot be effective. I would therefore be grateful if the Minister would confirm what funding will be committed to mass media for this year.

There is also a threat to the successful work undertaken with our European partners in fighting the illicit tobacco trade—a threat caused by Brexit. We know that the tobacco trade has promoted smuggling and tax evasion by dumping large quantities of cigarettes in countries where there are low rates of tobacco taxation in order for them to be smuggled illegally into countries with higher rates of tobacco taxation such as the UK. EU-wide co-operation has meant that, while tobacco taxation has risen sharply in the UK since the start of the century, the number of illicit cigarettes in our markets has halved. So I was not surprised to see support for Brexit from some of those who lobby to promote the cause of the tobacco industry. We must not let them succeed.

My Lords, I, too, congratulate the noble Lord, Lord Faulkner, on his comprehensive and clear introduction to this important debate. I also acknowledge and congratulate everyone, including the Government, on the progress that has been made over recent years. But we must keep the pressure on. It is easy to think that smoking is beaten as it is relatively rare in public, but it is still very common in some parts of the country.

Most key points have been made. I will bring in only one additional point, but I will first reiterate three fundamental aspects that have already been mentioned. The first is the importance of having a tobacco control plan. The evidence is there that those countries that have one, such as Australia and Canada, do much better in controlling smoking than those such as France and Germany that do not have a strategy. Of course, a strategy is only as good as its contents, and a good strategy and a good plan are needed. The important point here is that there is evidence: local smoking cessation works, properly constructed mass media campaigns work, and the use of vaping or e-cigarettes is also important. So when will we see this strategy and plan, and will it be built properly on the evidence?

The second point, simply put, is that smoking hits poorest people hardest. As the Prime Minister said, if you are born poor you are likely to die earlier. There is evidence that 50% of that impact is due to smoking-related diseases.

The third point I will reiterate is that this is of course not an isolated subject and that stopping smoking has an impact on other diseases and on the health of people in so many different ways, including reducing stillbirths, as has already been said. The key point here is that smoking should not be treated in isolation—although smoking cessation clinics are important—but should be part of a properly integrated health promotion policy.

My single additional point is on overseas development. I was interested to see that the Public Health Minister said in December 2015 that the Department of Health had received a grant to help other countries with their tobacco control strategies and was setting up a dedicated team. This is a global problem that is still growing in many low and middle-income countries. I would be interested if the Minister were able to give us an update on this work by the Department of Health and perhaps by other parts of the UK Government.

My Lords, I thank the noble Lord for raising this important Question for debate at the behest of my noble friend, and I declare my interests as a long-standing trustee of the British Lung Foundation. I know from its extensive work that the health of lungs is strongly correlated with wealth. Smoking prevalence is higher among those on lower incomes. That of course means that those people are more likely to get lung problems, and to be crippled by chronic obstructive pulmonary disease and lung cancer—on top of all the other pressures faced by those on the lowest incomes. There are social stigmas, too. Guilt associated with smoking-related diseases means that diagnoses are made much later, reducing the effectiveness of treatment. To top it all off, poorer people also tend to live nearer to roads and traffic, which further increases the likelihood of developing some kind of lung disease.

All that makes the objectives of public health initiatives laudable. Having seen the shocking human impact of smoking-related diseases, I think that it is good that people want to do something about it. Research published today in the BMJ found that e-cigarettes helped about 18,000 extra people in England give up smoking in 2015. Public Health England also found last year that e-cigarettes are 95% less harmful than regular cigarettes. Surely that is a welcome shift in the fight to reduce and prevent smoking-related diseases. After all, it is not nicotine that kills people or causes lung diseases—it is the tar and other chemicals found in cigarettes. While I would absolutely like more research to be done on the long-term impact and potential harms of e-cigarettes, it is important that they are not overregulated or treated in the same way as other tobacco products.

Evidence suggests that marijuana is more harmful than an ordinary cigarette. That may be because smokers inhale it more deeply and hold it in their lungs. It may be more to do with the illegality of marijuana than its inherent carcinogenic nature—although I have no doubt that that exists, too.

We also have a continuing problem with emissions from vehicles. PM 2.5s are particles that come from diesel engines that cause damage similar to that caused by cigarette smoke. Which is worse for our lungs? How do they interact and does one make the other worse? The truth is that we do not really know—but we should, and we would if we were able to spend larger sums on research.

We will need to ensure that the forthcoming tobacco control plan is robust and ambitious enough to lead to reductions in smoking-related illnesses. It should target those most in need of smoking cessation—those who already have a lung disease. This plan should be helped with a cross-departmental government strategy on improving air quality. Together, such actions will help better progress in ensuring that people breathe clean air, and in tackling smoking-related diseases.

My Lords, I thank my noble friend Lord Faulkner for bringing this important debate before us tonight. Action by successive Governments to reduce the harm caused by tobacco has been highly effective, but much remains to be done. The timely publication of a new comprehensive plan is of vital importance.

I will focus my comments on the need for the plan to contain specific recommendations to further reduce the harm that tobacco causes to children and young people. For many, particularly in deprived communities, the harm of tobacco begins before birth. The ambitions set out in the previous tobacco control plan, including driving down smoking rates among young people and pregnant women, were achieved. However, one in 10 pregnant women still smokes at the time their baby is born, and smoking remains the single biggest modifiable risk factor for poor birth outcomes. Children born to mothers who smoke, and children who live with smokers, are also far more likely to become smokers themselves than those from non-smoking households. Smoking and smoking-related disease is passed down through generations.

The Public Health Minister has recently written to the Smoking in Pregnancy Challenge Group—a partnership of charities, royal colleges and academics—confirming that ambitions on smoking in pregnancy will be renewed in the new tobacco plan. I am delighted by that news and hope that the Minister can confirm today that all the ambitions will be reviewed and renewed in the new plan when it is published.

We have a duty to our children to protect them from an addiction that takes hold of most smokers when they are young. Each day, hundreds of children take up smoking, starting out on a path that will lead to smoking-related disease and premature death. I echo the call from other noble Lords for the Government to publish a new tobacco control plan without delay.

My Lords, I too thank the noble Lord, Lord Young, for securing—and whipping —this debate, and the noble Lord, Lord Faulkner, with his outstanding record on this subject, for taking it over. I wish to focus on the international dimension.

We know how challenging it was and still is in the UK, and in the West, to counter the tobacco industry. It was only through the remarkable work of Sir Richard Doll, based on the metadata that he had available to him through the NHS and cancer registries—something not as comprehensively available in the US—that the correlation of smoking with cancer and other diseases was decisively demonstrated. We know what measures the tobacco industry took to undermine that research and its conclusions.

How vulnerable are those in developing countries, where the tobacco industry is now looking to replace its western markets, and where corruption, poverty and lack of transparency undermine good governance? The WHO has sought to address this with the Framework Convention on Tobacco Control, the world’s first treaty on public health. One hundred and seventy-nine countries and the EU are parties to this treaty, but signing up is one thing and implementing is another. I know of so many instances where the industry has run rings around those provisions in developing countries.

Last year, the world signed up to the sustainable development goals. Ending poverty, ending hunger, ensuring healthy lives and so many of the other goals are undermined by smoking and the tobacco industry. The SDGs call specifically to strengthen the implementation of the WHO framework. The United Kingdom is rightly committed to spending 0.7% of GNI on aid. The noble Lord, Lord Crisp, said that, as part of that commitment, in December 2015 Jane Ellison—then Public Health Minister—announced that the DH had been awarded an ODA fund to assist countries to develop their tobacco control policies. She said that she would update Parliament in due course. I seek that update. Given our expertise in the field, it is vital that we play our full part internationally to stem so far as we can the terrible suffering which otherwise the tobacco industry will inflict on those least able to bear it round the world.

My Lords, since I was a young child I have been passionate about the dangers of smoking and the unpleasantness that it causes to non-smokers. Someone left a medical book in our nursery and, as I was looking through it, I saw pictures of lungs that had been blackened and damaged by smoking. So much more should be done to show children and young people the dangers of smoking. The pictures that I saw did impress.

Two weeks ago, on 28 August, my daily’s husband—a smoker—died of lung cancer. He had undergone chemotherapy and radiotherapy, which he found very difficult. After treatment, he went downhill very quickly. His funeral was this afternoon.

Our National Health Service is struggling to survive. There are so many added worries and insecurities, and pressures and demands on the service. Will the Minister do all he can to stop it going downhill? If the Government are to achieve their targets, they will have to address smoking as part of an overall picture of public health. Smoking is one of the dangers of addiction. The cuts to the NHS and public health are savage when there are so many people needing treatment. We need more research. One question is: why do some people respond well to treatment and others fail?

At the age of 18, I watched my father die of coronary heart disease. He had been a smoker. The doctor who came out thought he had a chest infection. My father died an hour later. Smoking increases the risk of developing more than 50 serious health conditions; for example, many cancers, stroke, heart and vascular diseases, many respiratory conditions including asthma, and damage to unborn and born babies.

There are also the effects of passive smoking on so many people. I used to spend my time at meetings and social gatherings dodging the smokers, but it was so often impossible. It is a great relief that so much has been done to stop smoking in public places. The UK should be congratulated on the improvements so far, but it must not stop now. Much more needs to be done. We need a new tobacco strategy now. I hope the Minister will give your Lordships a positive response tonight.

My Lords, I rise to draw attention to Public Health and its contribution to the success of cutting smoking. I speak as someone who comes from Bristol, where the legacy of the tobacco industry has left generations suffering following the free cigarettes that were provided to workers as a matter of course. As has already been said, the estates in south Bristol, which were built to provide workers for the tobacco industry, are still among the most deprived in the country. Life expectancy there and in other parts of the city differs by 10 years and sometimes more. It is not just about death. It is about the quality of life for very many people in those communities.

When I was leader of the city council, I took a very active part in the Smoke Free Bristol campaign. The campaign was very successful because it captured the imagination of local people. The owners of clubs, bars and pubs were not all as enthusiastic, but very many of them could see the arguments, and we supported them and worked with them to bring the campaign in.

Equally, in the Public Health self-help groups, the fact that local people were trained to support each other —the health trainers and assistants were all local people —led to a much greater awareness of health within these communities. There was a wide range of projects, tackling not just smoking but such things as obesity, alcohol, depression and diabetes. I was very impressed with the progress that was made. However, the Public Health budget is being cut by 9.6% from 2015-16 to 2020. That is on top of the dramatic local authority cuts.

I would like the Minister to consider making this a priority. The emphasis on health that we have through Public Health, rather than on illness, has had a huge impact in these poorer communities. Public Health has enabled people-led schemes rather than professional-led schemes. I agree with others who have said that sustained investment and funding is absolutely vital if we are to do the things that are needed in these communities and to help people take responsibility for their own health.

My Lords, last year, the Minister Jane Ellison confirmed that the Government were working on a new anti-smoking plan to be published this summer. I too hope that we are going to hear news about that from the Minister today. Jane Ellison stated that the Government would seek to,

“further empower local areas and support action within them, particularly where tobacco control strategies can be tailored to the unique needs of local populations”.—[Official Report, Commons, 17/12/15; col. 636WH.]

The Government, she said, would also seek to tackle the “stark differences” in health outcomes among smokers from different parts of the country. I strongly support those ambitions but fear that those words have not yet been translated into enough action. Indeed, the Government’s action in making cuts to public health funding for local authorities has flown in the face of those objectives.

The BMJ says that prescription medication and personal support are the best routes to quitting smoking. The Government agree, and yet up and down the country local authorities have reluctantly had to cut these services. The Government, therefore, are relying on the commercial supply of expensive aids to quit smoking, such as patches and electronic cigarettes, in order to achieve further reductions in smoking. I would like to know whether the Government support prescribing more of those aids to the people who really need them but cannot afford to buy them.

The Government have also said that although they believe that e-cigarettes can help smokers quit smoking, they are,

“not harmless and there is a lack of evidence on their effects in long term use”.

I would certainly agree with that. There is massive evidence that e-cigarettes are much safer than smoking, but there is also some evidence that they may have undesirable short and long-term effects, particularly on the heart. It was irresponsible for a national newspaper to claim that vaping is just as dangerous as smoking. There is no evidence for that claim. However, there is still a lot that we do not know. Therefore, I now repeat the call I made during the recent debate on the EU tobacco directive: we need more research. After all, we now have many thousands of users, and I am sure many would be happy to co-operate with research.

It is estimated that over 200,000 children take up smoking every year. I call on the Government to ensure that every child has good-quality PSHE lessons in which the dangers of smoking are emphasised. I welcome the proposed removal of packets of less than 20 cigarettes, which used to be so popular with children, and also the plain packaging and larger pictorial health warnings. I hope that Brexit does not get in the way of all that.

The BMA calls for more measures to protect others from second-hand smoke. This is particularly important for children. Since we cannot ban smoking in people’s own homes, it is really important to help all smokers voluntarily give up smoking or never to smoke when children are present. Those on these Benches fought for the legislation that banned smoking in cars with children present, but the ban is not being properly enforced. Will the Government carry out a public information campaign about this and encourage the police to enforce the law?

My Lords, I first declare an interest as a president of the Royal Society of Public Health. Principally, I would like to reinforce the argument made by my noble friend Lord Faulkner about the need to tackle health inequalities, in which smoking clearly plays a key part. He said smoking was responsible for half the variation in life expectancy. My noble friend Lady Gale also spoke eloquently about the impact of smoking on mothers during pregnancy and after the birth of their children.

The principal question I would like to put to the Minister focuses on the tobacco control plan. It is generally agreed that the last tobacco control plan produced a huge number of positive outcomes. Clearly, it is vehicle by which further improvements can be made. However, despite the UK’s leadership and the advances that we see, there is no room for complacency. Will the Minister tell the House exactly when we can expect to see the plan published?

Secondly, may I raise with the Minister the problem of local authorities reducing funding for stop-smoking services? He will know that, with the transfer of budgetary responsibility to local government, there were great hopes that local government would use its position to enhance public health programmes. I am afraid that so far the opposite has been the case. How much is his department monitoring what is happening with local authorities and smoking cessation services? Can he make it clear to Public Health England that it is empowered to make interventions when it feels that local authorities are not doing the right thing? I have a great deal of time for Public Health England but it feels inhibited in challenging local authorities where they are not investing sufficiently in these kinds of services. It would be good if the Minister was prepared to say that it can do that.

Will the Minister also help us on mass media campaigns? They have proved very effective. Will he assure us that in the plan there will be sufficient investment in those campaigns in the future? On the question of electronic cigarettes, I agree with the noble Lord and the noble Baroness that they ought to be part of the smoking cessation programmes. Equally, some research would also be welcome to pick up some of the issues that have come to the fore recently. On the general principle, I have no doubt that for adult smokers who find it difficult to give up smoking, e-cigarettes definitely have their part to play. It is important that the Government continue to signal their support for that.

My Lords, I thank the noble Lord, Lord Faulkner, and my noble friend Lord Young of Cookham for enabling us to have this debate today. The fact that there are so many speakers, with only three minutes each, shows how important this subject is to many noble Lords in this House.

I was particularly taken by how many noble Lords addressed the issue of smoking within the context of health inequalities. I had not appreciated that it accounts for maybe 50% of the difference in life expectancy between people from poorer backgrounds who smoke and those who do not. It is one indication of just how serious smoking is. Linking it to Theresa May’s first speech when she became Prime Minister was a clever move. I hope she will read this debate with interest during the Recess.

The noble Lord, Lord Faulkner, said that he has spoken on this issue many times over many years in this House and elsewhere. It was actually back in 1604 that King James wrote a treatise called A Counterblaste to Tobacco, describing smoking as:

“A custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black, stinking fume thereof, nearest resembling the horrible Stygian smoke of the pit that is bottomless”.

He did not mince his words. Slightly depressingly, however, that was in 1604 and here we are over 400 years later, still struggling. Although we have made great progress, 7 million people are still smoking in this country and, as we will discuss later on, I saw a frightening statistic recently showing that by 2030 it is estimated that nearly 500 million people in Africa might be smoking. This is a global problem and it is not going away.

Of course, we have taken action. Many noble Lords pointed out the success that we have had in this country. Over the last 25 years the number of people smoking in England has fallen from just over 28% in 1992 to just under 17% at the end of 2015. Despite this progress, in England smoking still kills around 200 people a day. The noble Baroness, Lady Masham, gave us a moving story of a friend of hers who recently died from lung cancer. I remember when I was chairman of a hospital watching an operation and seeing the inside of a patient’s lung. I am sure that my noble friend Lord Ribeiro has seen similar things. The colour of a heavy smoker’s lungs is absolutely vile. They are blackened.

I want to reassure noble Lords that this Government have always and will continue to take very seriously tackling the great harm caused by tobacco. In the last year, we have introduced a number of important measures to achieve this. First, we introduced a tranche of legislation that has greatly strengthened tobacco control and reduced even further children’s exposure to tobacco branding and second-hand smoke. This included the introduction of standardised packaging, which I am pleased to say is already in shops across England. I am sure that noble Lords have seen the standardised packaging. It represents a big step forward. This measure aims to motivate more people to quit while also deterring greater numbers of young people from ever taking up smoking in the first place. This is a fantastic achievement.

Secondly, we have delivered a range of impactful mass media campaigns which promote quitting. In just two weeks from now, we will launch a fifth ‘Stoptober’ campaign. This campaign has proven extremely successful. In 2015, more than 130,000 people successfully quit for 28 days for Stoptober. That is an impressive figure. Looking ahead, a number of noble Lords raised the issue of a new tobacco control plan. I am unable to commit to a publication date, but I can confirm that a new plan will set out renewed national ambitions to reduce prevalence even further and build on the success of the previous tobacco control plan. I was very struck by noble Lords’ comparison of countries with a tobacco control plan such as Australia and Sweden—

I apologise, it was Canada. We can contrast that with the experience in countries such as France and Germany, where there is no control plan. The Government fully support renewing the tobacco control plan. During the last five-year plan, the proportion of smokers in England reduced by more than 10%.

Addressing the inequalities caused by smoking will be a central component of this plan. As has been highlighted in this debate, there remains significant geographical and demographic variation. The noble Baroness, Lady Janke, mentioned the situation in Bristol, for example. Staggeringly, smoking prevalence today in Sevenoaks is 6% and in Corby it is 29.8%, which demonstrates the variation around the country. Reducing smoking rates in populations with comparatively high prevalence will be a priority in reducing this variation and the health inequalities caused by tobacco.

In particular, we are considering what more can and will be done to support those with mental health conditions in quitting smoking. In developing this aspect of the plan, the recommendations set out in The Five Year Forward View for Mental Health, authored by Paul Farmer, are being taken into consideration. The noble Baroness, Lady Gale, mentioned the importance of improving maternity outcomes, and giving children the best start in life is an important priority for this Government. We have already set out an ambition of achieving a 50% reduction in stillbirths and neonatal deaths by 2030.

Supporting pregnant women in quitting smoking will be an important factor in working towards that. This was a priority in the previous tobacco control plan, during which prevalence for this group fell by 3 percentage points. I can confirm that it will remain a priority. Exposure to smoke during and after pregnancy can have devastating health consequences for babies. As well as these immediate health risks, evidence also shows that children who have a parent who smokes are two to three times more likely to be smokers themselves. Supporting adults to quit is therefore vital to ending the cycle of children who take up smoking, in order to cut off the pipeline of new smokers at risk of smoking-related disease. This is a battle we are winning. The proportion of young people smoking continues to fall, as my noble friend Lord Ribeiro pointed out, with prevalence amongst 15 year-olds more than halving in the last decade.

I will touch on a couple of other important elements of tobacco control. First, my noble friend Lord Borwick and the noble Baroness, Lady Walmsley, commented on e-cigarettes. I am well aware of the report by the Royal College of Physicians, which said that vaping was 95% better than smoking. I saw the recent reports in the paper, and I have read the BMJ article that supported them, saying that 18,000 people gave up smoking last year because of vaping.

Clearly, e-cigarettes have an important role to play, but they are not risk free. We do not want to encourage young people to take up vaping. In the UK we are adopting the right approach, which reduces the risks of harm to children and provides assurance on safety for users. In the UK, our e-cigarette policy has been successful, with minimal long-term take-up by children and non-smokers. This is not the case everywhere. In the US, for example, there is an upward trend of children who have never smoked cigarettes using e-cigarettes. This is why the Government have taken a precautionary approach to any possible risk of renormalising smoking behaviours that we have fought long and hard to denormalise. If any noble Lord has seen some of the advertising around vaping, they can see the potential dangers of attracting children who would never have smoked to the habit of smoking.

The UK’s approach to the regulation of e-cigarettes has and will remain pragmatic and evidence-based. The Government will continue to monitor and develop this evidence base, adapting policy accordingly, to ensure that policy on e-cigarettes best supports the protection and improvement of public health.

Secondly, through PHE we will maintain a programme of evidence-based mass-marketing campaigns to encourage more people to quit smoking, and raise awareness about products and services that can help. The noble Lord, Lord Rennard, in particular raised this issue. I can tell him that £4 million has been allocated for tobacco-specific marketing activities, £1 million of which is for the Stoptober campaign launching next month. On top of this there is further funding for multiple-issue campaigns, such as the One You and Be Clear on Cancer campaigns, which also contain messages about smoking. We also need to consider Heat Not Burn and other novel tobacco-containing products that are starting to emerge.

Difficult decisions have had to be made across government to reduce the deficit and ensure the sustainability of public services, as the noble Lord, Lord Hunt, has drawn to my attention on a number of occasions. However, councils will still receive £16 billion over the next five years for public health, on top of what the NHS will spend on vaccines, screening and other public health measures. The noble Lord asked whether I can draw to PHE’s attention its powers in this area to make sure action is taken locally. I certainly will draw that to the attention of my colleague in the other House, Nicola Blackwood, the Minister for Public Health, to ensure that happens.

Tobacco use is, as the noble Lord, Lord Crisp, and the noble Baroness, Lady Northover, pointed out, very much a global issue and an international priority. Tobacco companies are becoming increasingly active in the developing world. By 2030, more than 80% of the world’s tobacco-related mortality will be in low and middle-income countries. The uptake of cigarette smoking in Africa is pretty alarming. The UK will continue to work collaboratively with other countries to reduce the burden that smoking places on individuals, families and economies across the globe.

The Government intend to invest part of the development assistance funds to strengthen the implementation of the WHO’s Framework Convention on Tobacco Control—known as the FCTC. This project will be delivered by the WHO. For a number of years the UK has been rated the best country in Europe for tobacco control policy. Through this project we will share the UK’s experience to support low and middle-income countries in saving lives by putting effective measures in place to stop people using tobacco. This project will involve assistance to implement the “time-bound” measures of the FCTC: to ban tobacco advertising and to require health warnings on tobacco packs. We will also support countries to strengthen tobacco taxation to improve public health and raise new revenues for governments.

In conclusion, I am very pleased that we have had the opportunity to have this debate. It is probably disappointing to some noble Lords that I cannot give a specific date for the new tobacco control plan, but I can assure them that it is coming, that there will be one and that it will build on the success of the previous tobacco plan. The noble Lord, Lord Crisp, and the noble Baroness, Lady Northover, asked a particular question about a new initiative for which we were being given funds by the WHO to deliver. I will have to write to them on that matter if that is acceptable. Obviously, we will reflect on all the points that have been raised this evening. I am sure they will add to the new tobacco control plan.

Sitting suspended.