uk tobacco control policy & expenditure_ash

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UK Tobacco Control Policy and Expenditure An Overview

Updated March 2010

Health policy is largely formulated and implemented by the devolved administrationsof each of the member countries of the United Kingdom. However, as tobacco fallswithin the remit of a number of different government departments: e.g. Health,Treasury, Trade, etc. tobacco control policy is partly determined at UK-wide level andpartly by the devolved administrations. The four nations of England, Scotland, Walesand Northern Ireland have responsibility for their own smoking cessation and healtheducation campaigns while UK-wide policy and law applies to taxation, smuggling,advertising, and consumer protection issues such as the provision of health warningson tobacco packaging. Some of these measures are determined by European Unionlegislation. [Note: for a quick overview of the laws relating to tobacco see the ASHlaw guide ] Procedures for enforcement may vary between the administrations to

reflect the differing legal systems.An independent review of tobacco control policies in 30 European countries revealedthat the UK scored the highest of the major European nations in a range of tobaccocontrol measures. 1 These included the price of tobacco products, resourcesdevoted to tobacco control, and smoking cessation treatment.

Targets to reduce smokingFrom 1998 to 2009 tobacco control policy in England was largely guided by the 1998White Paper Smoking Kills and the Public Health White Paper, Choosing Healthpublished in November 2004. (Devolved administrations have had their own healthpolicy since around 2000.) In 2004, the Department of Health set targets to reduce

smoking prevalence in the population. The targets for England were as follows: toreduce smoking rates to 21% or less by 2010, with a reduction in prevalence amongroutine and manual groups to 26% or less. 2 (The target for all adults in England wasreached by 2007.) For Scotland, the Scottish Executive set a target to reducesmoking among all adults from an average of 26.5% in 2004 to 22% by 2010.

In 2004, a Treasury-commissioned review of the future of the National Health Serviceconcluded that in order to achieve optimum health outcomes, smoking rates wouldneed to be reduced to 17% of adults by 2011. 3

In February 2010, as part of a new tobacco control strategy for the next decade, theGovernment announced new targets for England to reduce smoking to 10% or lessamong adults and to 1% or less among 11-15 year olds . 4

Current smoking prevalence in the UK 5

Smoking prevalence United Kingdom 2008

Persons aged 16 and overMen Women All Adults

England 21 20 21Wales 20 21 21Scotland 23 24 24

N. Ireland(2007) 26 23 24

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Key measures contained in the tobacco control strategy for England include:

Reducing exposure to children from secondhand smoke throughtargeted campaigns highlighting the benefits of smokefree homes andcars;

Further strengthening the NHS Stop Smoking Services and providingnew routes to quitting for smokers unable to stop abruptly;

Increased investment to further drive down tobacco smuggling; Sustaining high levels of spending on marketing campaigns to

encourage smokers to quit; Implementation of the retail display ban and ban on sale of tobacco

from vending machines in the Health Act 2009; A commitment to review the smokefree legislation

Policies applicable to the whole of the United Kingdom

ADVERTISING

Tobacco advertising is banned by law throughout the United Kingdom. The TobaccoAdvertising and Promotion Act 2002 prohibits tobacco advertising on billboards, inprint media, by direct mail and through sponsorship. Currently limited advertising atthe point of sale - equivalent in size to one A5 sized ad - is still permitted but this willend when a new law banning the display of tobacco products comes into effect from2011. (See section below). A health warning equivalent to one third of the surfacearea of the advertisement must be included.

Law: http://www.hmso.gov.uk/acts/acts2002/20020036.htm

PROTECTION OF CHILDREN

Tobacco products can be sold from any retail outlet but retailers have a duty toensure tobacco products are not sold to anyone under the age of 18. The minimumage for the purchase of tobacco was raised from 16 to 18 in England, Wales andScotland on 1 October 2007 and was raised to 18 in Northern Ireland from 1September 2008.

In all places where tobacco is sold a warning notice must be prominently displayed

stating: It is illegal to sell tobacco products to anyone under the age of 18. Thisnotice must also be displayed on cigarette vending machines which must be sited inplaces not easily accessible by children, e.g. in licensed premises.

Cigarettes cannot be sold in packs of fewer than 10 or singly.

There is no centrally held data of expenditure on enforcement costs relating to underage sales of tobacco products. Enforcement is undertaken at Local Authority level.

The Health Act 2009 (covering England, Wales & N. Ireland) includes clauses tofurther protect children by banning the display of tobacco products at the point of saleand ending the sale of cigarettes from vending machines. These measures will enterinto force from October 2011 although small shops will have until 2013 to comply withthe point of sale display ban . 6 Similar proposals were passed in Scotland as part of

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the Tobacco and Primary Medical Services (Scotland) Act 2010l.

Law: Children and Young Persons (Protection from Tobacco Act) 1991http://www.hmso.gov.uk/acts/acts1991/Ukpga_19910023_en_1.htm

Order amending the law on the age of sale:The Children and Young Persons (Sale of Tobacco etc.) Order 2007

PRODUCT REGULATION AND LABELLINGWritten health warnings are required on all tobacco packaging as determined by theEuropean Union Council Directive 2001/37/EC, implemented in the UK by theTobacco Products (Manufacture, Presentation and Sale) (Safety) Regulations 2002.The EU Directive permits Member States to add pictorial warnings on tobaccoproducts but only EU approved images are allowed. To date, five EU Member States

Belgium, Latvia, Malta, Romania and the UK have opted to include pictorialwarnings on tobacco products. In addition, 3 non EU countries Norway, Switzerlandand Turkey have adopted EU style pictorial warnings on cigarette packs. In the UK,picture warnings on cigarette packs were introduced from October 2008. Pictorialwarnings on other tobacco products will be required by October 2010.

The Tobacco Products Directive also places maximum levels on the amount of tar,nicotine and carbon monoxide permitted in cigarettes and requires tobaccocompanies to disclose tobacco ingredients to national governments.

Law: EC Directive 2001/37/EC UK Regulations: http://www.hmso.gov.uk/si/si2002/20023041.htm

The picture warnings can be viewed at: http:/ / tinyurl.com/ 3pg95f

TAX AND SMUGGLING

In the 1998 White Paper Smoking Kills the government announced that it plannedto increase tobacco tax by at least 5% a year in real terms. This policy was droppedin 2001 and since then annual increases have generally been at, or marginallyabove, inflation rates.

In 2000, the Government launched a 200 million initiative to tackle tobaccosmuggling. As a result, the illicit market share fell from a peak of 21% in 2000-1, to15% by 2003-4. In the 2006 Budget, the Treasury announced plans to extend thecampaign which included a target to reduce the size of the UK illicit tobacco marketby 1,200 tonnes by 2007/08. (See Treasury website for further details: www.hm-treasury.gov.uk ) In the 2008 Budget, the Chancellor announced that the recentlycreated Borders Agency would take responsibility for developing a newcomprehensive strategy to tackle tobacco smuggling.

In answer to a series of Parliamentary Questions 7 on how the money allocated tothe anti-smuggling strategy had been spent, HM Treasury provided the followinginformation:

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http://www.hmso.gov.uk/acts/acts1991/Ukpga_19910023_en_1.htmhttp://www.opsi.gov.uk/SI/si2007/20070767.htmhttp://www.opsi.gov.uk/SI/si2007/20070767.htmhttp://europa.eu.int/scadplus/leg/en/cha/c11567.htmhttp://europa.eu.int/scadplus/leg/en/cha/c11567.htmhttp://www.hmso.gov.uk/si/si2002/20023041.htmhttp://tinyurl.com/3pg95fhttp://www.hm-treasury.gov.uk/http://www.hm-treasury.gov.uk/http://www.hm-treasury.gov.uk/http://www.hm-treasury.gov.uk/http://tinyurl.com/3pg95fhttp://www.hmso.gov.uk/si/si2002/20023041.htmhttp://europa.eu.int/scadplus/leg/en/cha/c11567.htmhttp://www.opsi.gov.uk/SI/si2007/20070767.htmhttp://www.hmso.gov.uk/acts/acts1991/Ukpga_19910023_en_1.htm


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Full-time equivalents of staff employed on tackling tobacco, 2005-2009

Year Detection Investigation Intelligence Total2005/06 1407 319 279 20052006/07 1557 278 295 2130

2007/08 1574 287 264 21252008/09 1500 395 255 2150

The figures given are HMRCs best estimate of the way resources were used in theyears specified, bearing in mind that the work of staff employed on anti-fraud andsmuggling activity often covers a number of different taxes and commodities.

Expenditure incurred on salaries for full time equivalent staff allocated to tobaccosmuggling is shown in the table below. Figures for 2000 to 2006 are not available.

Year Detection Investigation Intelligence Total2006/07 61,351,790.69 13,246,434.95 12,246,665.35 86,844,8902007/08 65,037,870.02 14,243,597.55 11,271,899.07 90,553,3662008/09 64,257,196.50 19,998,544.53 12,244,642.47 96,500,383.50

HMRC is unable to disaggregate time spent on the provision of legal advice ontobacco from related matters on time spent on other advisory work.

HMRCs fleet of mobile x-ray scanners has made a vitally important contribution tothe success of the tobacco smuggling strategy. HMRC has had 14 scanners inoperation since 2003. These scanners were purchased between 2000 and 2001 at atotal cost of 29,663,005.

There are substantial maintenance costs for all the fourteen scanners currently inoperation. The annual maintenance costs per unit are as follows:

Number Monthly maintenance Total annual cost4 24,519 1,176,9126 14,788 1,064,7364 6,768 324,864

Five new scanners have recently been purchased at a cost of 842,000 per scanner

with ongoing maintenance costs of 180,000 per scanner over a ten year contract.

HM Revenue and Customs have spent almost 1.5m (excluding VAT) on targetedmedia campaigns to support their anti-tobacco smuggling strategy in the last 5years. The costs per year are shown below.

2003/04 672,4492004/05 83,3682005/06 556,3822006/07 91,9932007/08 55,000

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OTHER POLICIES

Non-promotion of tobacco products, or events overseas . UK embassies and

high commissions are required to take care to avoid involvement in events whichadvertise or promote tobacco products overseas. See:http://www.ash.org.uk/files/documents/ASH_560.pdf

Support for international tobacco control work . The UK government has ratifiedthe Framework Convention on Tobacco Control (FCTC) and is committed toimplementing the policies contained within the treaty.

Policies implemented by differing laws or regulations within the UK

SMOKING CESSATION

Note: The summary below applies to England only although similar measures are inplace in Scotland, Wales and Northern Ireland. For information on Scottish stopsmoking services see: http://www.tobaccoinscotland.com , for Waleshttp://wales.gov.uk/news/topic/health/2007/1880755/?lang=en and Northern Irelandsee: www.healthpromotionagency.org.uk

Smoking cessation has been a key component of the governments tobacco controlpolicy as set out in the Smoking Kills White Paper. Specialist stop smokingservices are available across the country. Nicotine Replacement Therapy (NRT),

bupropion (Zyban) and varenicline (Champix) are available on prescription. Mostforms of NRT are also on general sale.

The importance of helping smokers to quit is stressed in priorities guidance to theNHS and health professionals. Details are included on the NICE website(www.nice.org.uk ) Targets have been set for smoking cessation treatment and alsofor prevalence reductions in each Primary Care Trust (the main unit of funding andprimary care treatment in the NHS).

NHS STOP SMOKING SERVICES

The NHS Stop Smoking Services (formerly smoking cessation services) werelaunched in the Health Action Zones (HAZ) - areas of high deprivation - in 1999/00.The services were rolled out to the rest of England and Wales in 2000/01.

Expenditure on smoking cessation services has steadily increased since theircreation in 2000, rising from 21.5 million to 74 million in 2008-09. The cost perquitter in 2008/09 was 219. The net ingredient cost of all pharmacotherapies tohelp people stop smoking was 61 million in 2007/08. This compares to 45m in2006/07. The increase is due to the introduction of varenicline (Champix) in late2006.

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http://www.ash.org.uk/files/documents/ASH_560.pdfhttp://www.who.int/tobacco/framework/en/http://www.tobaccoinscotland.com/http://wales.gov.uk/news/topic/health/2007/1880755/?lang=enhttp://www.healthpromotionagency.org.uk/http://www.nice.org.uk/http://www.nice.org.uk/http://www.healthpromotionagency.org.uk/http://wales.gov.uk/news/topic/health/2007/1880755/?lang=enhttp://www.tobaccoinscotland.com/http://www.who.int/tobacco/framework/en/http://www.ash.org.uk/files/documents/ASH_560.pdf


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Year Allocation Actual ExpenditureNHS services 1999-00 (HAZ) 10m 5M2000-01 20m 21.5m2001-02 20m 24.7m2002-03 20m 24.7m2003-04 41m 36.2m2004-05 46m 46.8m2005-06 51m 51.9m2006-07 56m 51.2m2007-08 56m 61.0*2008-09 73.5m

*56m supplied by Department of Health. Additional money from other funding streamsnegotiated locally.

Smoking and Pregnancy initiative2001-02 additional money 3m Sum included in final

total above2002-03 additional money 3m Sum included in final

total above

Net ingredient cost of NRT onprescription1999-00 (HAZ) 142,0002000-01 931,0002001-02 21.7m2002-03 25.6m2003-04 32.5m2004-05 40.9m2005-06 43.5m2006-07 39.7m2007-08 35.8m2008-09 30.0m

Net ingredient cost of Bupropion(Zyban) on prescription 1999-00 (HAZ) Not available until

June 2000 no data2000-01 14.7m2001-02 7.3m2002-03 4.7m2003-04 4.5m2004-05 5.2m2005-06 4.6m2006-07 4.3m2007-08 3.8m

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2008-09 2.2m

Net ingredient cost of Varenicline(Champix)

2006/07 0.76m2007/08 21.7m2008/09 24.2m

Source: Department of Health Statistical Bulletins 1999-2005;Statistics on Smoking in England, 2007 , Statistics on stop smoking services England: Apr2008- Mar-2009 Prescription Cost Analysis report 2008

SMOKING IN PUBLIC PLACES AND THE WORKPLACE

Scotland was the first country within the United Kingdom to ban smoking in all indoorworkplaces and public places. The law entered into force on 26 March 2006. TheSmoking, Health and Social Care (Scotland) Act 2005 requires virtually allworkplaces to become smokefree. Limited exemptions include places where theworkplace is also a place of residence such as hospices and psychiatric hospitals.

A ban on smoking in workplaces and other indoor public places was implementedthroughout the rest of the United Kingdom in April 2007 (Wales & No. Ireland) andJuly 2007 in England. The legislation is contained in the Health Act, which waspassed in July 2006. Implementation details are contained in Regulations, availableat: www.smokefreeengland.co.uk/thefacts/situation.html

The Government allocated funding to support implementation of the smokefreelegislation for the financial years 2006-07 and 2007-08.

The Department of Health distributed 29.5 million to support first-tier localauthorities in England to undertake new work associated with the introduction ofsmokefree legislation on 1 July 2007. Local Authority Circular (2006) 17 sets out thebackground to the funding and breakdown by local authority.http://www.dh.gov.uk/assetRoot/04/14/17/46/04141746.pdf

MASS MEDIA HEALTH PROMOTION CAMPAIGNS

Expenditure on mass media education campaigns in England and Wales hasincreased in recent years, reaching a peak in the 2004/05 financial year.Expenditure in 2004-05 included the provision of 15M over three years to CancerResearch UK and the British Heart Foundation. 8

1999/2000 - 6.18m2000/2001 - 8.97m2001/2002 - 7.79m2002/2003 - 7.87m2003/2004 - 17.34m

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http://www.dh.gov.uk/PublicationsAndStatistics/Statistics/StatisticalWorkAreas/StatisticalPublicHealth/StatisticalPublicHealthArticle/fs/en?CONTENT_ID=4032542&chk=GhPZ+yhttp://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/smoking/statistics-on-smoking-england-2007-%5Bns%5Dhttp://www.ic.nhs.uk/webfiles/publications/sss0809/SSS_2008_09_finalised.pdfhttp://www.ic.nhs.uk/webfiles/publications/sss0809/SSS_2008_09_finalised.pdfhttp://www.ic.nhs.uk/statistics-and-data-collections/primary-care/prescriptions/prescription-cost-analysis-2008http://www.opsi.gov.uk/legislation/scotland/acts2005/20050013.htmhttp://www.opsi.gov.uk/legislation/scotland/acts2005/20050013.htmhttp://www.smokefreeengland.co.uk/thefacts/situation.htmlhttp://www.dh.gov.uk/assetRoot/04/14/17/46/04141746.pdfhttp://www.dh.gov.uk/assetRoot/04/14/17/46/04141746.pdfhttp://www.smokefreeengland.co.uk/thefacts/situation.htmlhttp://www.opsi.gov.uk/legislation/scotland/acts2005/20050013.htmhttp://www.opsi.gov.uk/legislation/scotland/acts2005/20050013.htmhttp://www.ic.nhs.uk/statistics-and-data-collections/primary-care/prescriptions/prescription-cost-analysis-2008http://www.ic.nhs.uk/webfiles/publications/sss0809/SSS_2008_09_finalised.pdfhttp://www.ic.nhs.uk/webfiles/publications/sss0809/SSS_2008_09_finalised.pdfhttp://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/smoking/statistics-on-smoking-england-2007-%5Bns%5Dhttp://www.dh.gov.uk/PublicationsAndStatistics/Statistics/StatisticalWorkAreas/StatisticalPublicHealth/StatisticalPublicHealthArticle/fs/en?CONTENT_ID=4032542&chk=GhPZ+y


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2004/2005 - 24.0m2005/2006 - 22.7.0m2006/2007 - 13.5m2007/2008 - 11.39m2008/2009 - 23.38m

OTHER TOBACCO CONTROL EXPENDITURE (England and Wales)

NHS Cancer Plan Commitments (September 2000)

NHS Cancer Plan Pilot Projects announced with funding of up to 1M

Tobacco Alliances - funding of up to 1M

Programme of research on smoking cessation 2.5 million

Regional Tobacco Control

Since 2003-2004 2007-2008 2M a year has been allocated to the RegionalDirectors of Public Health to fund local tobacco control strategies, including tobaccoalliances.

1 Raw, M and Joossens, L. Progress in tobacco control policies in 30 European countries,2005 to 2007. ENSP, 2007 View report

2 Department of Health 2004 Spending Review Public Service Agreements. View DH targets 3 Wanless, D. Securing Good Health for the Whole Population. Final Report. HM Treasury,

2004 View report 4 A Smokefree Future. A comprehensive tobacco control strategy for England. HM

Government, 2010http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_111749

5 Smoking prevalence data for England, Wales and Scotland is from the General HouseholdSurvey 2007 www.statistics.gov/ghs and for N. Ireland from Northern Ireland Statistics andResearch Agency. Continuous Household Survey. Belfast: NISRA, 2009.

http://www.csu.nisra.gov.uk/survey.asp140.htm 6 Health Act 2009 receives Royal Assent.http://www.dh.gov.uk/en/News/Recentstories/DH_108443

7 PQs tabled by David Taylor MP. Response provided by HM Treasury on 10 June 2009 8 House of Commons Hansard. Reply to a Parliamentary Question Column 362W 15/7/2008http://www.parliament.the-stationery-

office.co.uk/pa/cm200708/cmhansrd/cm080715/text/80715w0031.htm
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