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Tobacco Harm Reduction

Volume 797: debated on Tuesday 2 April 2019


Asked by

To ask Her Majesty’s Government what assessment they have made of the levels of smoking and incidence of lung cancer in Sweden as a result of steps taken by that government; and what plans Ministers have to visit that country as part of their forthcoming review of tobacco harm reduction.

My Lords, the current smoking rate in Sweden is 13%, compared to England where the rate is 14.9% and, across the UK, 15.1%. There are no current plans to visit Sweden. Smoking is at the lowest level recorded in England but we are not complacent and remain committed to reducing the rate to 12% or less by 2022, as outlined in the tobacco control plan for England.

My Lords, I thank my noble friend for that reply. She will be aware that the policy of harm reduction, whereby a less harmful new technology is used to displace a more harmful technology, was pioneered in this country by the noble Lord the Lord Speaker when he was Health Secretary in the 1980s with respect to needle exchanges and HIV. Such a policy has since proved effective in the introduction of e-cigarettes. However, in Sweden, the adult smoking rate is now down to 5% because of another harm-reduction technology, snus—the little teabag of snuff tobacco that one presses against one’s gum and is widely used in Sweden. As a result, there are low lung cancer rates in that country but, because snus is banned in the EU, we are currently unable to follow. Could we not save tens of thousands of lives if we were to legalise this technology when we left the EU at the end of next week?

I thank my noble friend for his question and join him in paying tribute to the noble Lord the Lord Speaker’s role in harm reduction. No tobacco product is safe to consume, due to its links to cancers. As my noble friend says, snus is banned under the EU tobacco products directive as an oral product, except in Sweden. We have made a commitment under the tobacco control plan that, following EU exit, the Government will consider reviewing the position on snus and whether the introduction of the product to the UK market would promote the kind of proportionate harm-reduction approach that he proposes. However, there is no evidence that snus in Sweden has reduced smoking rates, so the matter is very much under review.

My Lords, it is important to say that snus is snuff—let us be quite clear that we are talking about a tobacco product. It seems slightly odd that the noble Viscount should suggest that we swap one very carcinogenic product for one that might be slightly less carcinogenic and will give you only mouth and throat cancer. Will the Minister commit that the review of tobacco regulation will include an assessment of the continuing attempts by major tobacco companies to market their brand identities through advertising campaigns and sponsorship—for example, through Formula 1? Indeed, one of her colleagues recently had to write to Philip Morris, which makes Marlboro cigarettes, telling it to remove poster adverts for “healthier” tobacco products from shops around the UK.

Smoking remains the biggest cause of death in this country. Strict rules are in place to prevent tobacco companies promoting their products, including through sponsorship. We take the unlawful promotion of tobacco products extremely seriously and expect any organisation found to be flouting the rules to be investigated.

My Lords, although snus contains both nicotine and tobacco—that is why the Swedes use it—the lung cancer rate in Sweden has reduced, whether that is to do with the use of snus or other reasons. That is the main thing that we should be talking about. What strategies do we have to reduce our lung cancer deaths, which run at about 35,000 a year? Tobacco is a key cause—80% of them are related to tobacco. Does the Minister agree that we should think about a strategy for harm reduction, whether it is snus, e-cigarettes or any other product?

I thank the noble Lord, who has expertise in this area, for his intervention. He is absolutely right that we need to target a reduction in lung cancer rates. Cancer Research UK states that smoking tobacco is the biggest cause of lung cancer in the UK, with seven out of 10 lung cancers caused by smoking. The NHS Long Term Plan has a very heavy emphasis on prevention, including smoking cessation services. One of the first interventions from that plan to be rolled out is the innovative targeted lung health check, which will provide an easy-access gateway to lung health and smoking cessation services. I hope that he is reassured by that answer.

My Lords, Sweden has banned the advertising of tobacco products, introduced clean indoor air laws and increased the price of cigarettes. Together with the properly regulated promotion of e-cigarettes, have not these measures been shown across the world to be the best methods of tobacco control? Is there not a real danger with products such as snus that tobacco companies want to promote their dual use, pushing potentially dangerous tobacco products in clean air environments and continuing to push traditional tobacco smoking products elsewhere?

The noble Lord is right. E-cigarettes have proved to be a beneficial aid in quitting smoking, but the best thing that a smoker can do for their health is to quit smoking entirely. That is the priority of the tobacco control plan and the measures that are pushed through the NHS and by other means. In the UK, about 5.5% of adults—about 2.2 million—currently use e-cigarettes. It has proved to be an effective means of quitting smoking, which is why we encouraged this route through the tobacco control plan and will continue to do so.

My Lords, five years ago I smoked 50 cigarettes a day. Then I took up vaping and have not had a puff of tobacco since. Should the Government not do more to encourage smokers to switch to vaping?

I emphasise that smoking is now at the lowest levels recorded, and we should be proud of the fact that the UK is seen as a world leader in tobacco control. However, we are by no measure complacent, because there are variations between different groups and across the country. That is why the NHS Long Term Plan contains a commitment to do more to target smokers in NHS care, why NHS health checks offer an opportunity to smokers to quit, why PHE backs the very successful Stoptober campaign, why we are introducing smoke-free prisons, why we are introducing interventions for those within the mental healthcare system, and why we are introducing a new smoke-free pregnancy pathway. All those things will ensure that we continue to reduce the incidence of smoking in the UK.

My Lords, will the Minister look at the experience of Scotland 20 years ago? A factory was opened that produced these small tobacco pouches, but it was closed down within a year—I was one of the people responsible—because of the incidence of mouth cancer. We saw that, in the United States and elsewhere, mouth cancer was caused by sucking those pouches. It really is a crazy suggestion from the noble Viscount.

I thank the noble Lord for his point. I shall certainly look at the experience of Scotland. There will be an evidence-based review, which will look at the risks as well as at the proposals.