Is Britain Winning the Battle Against Smoking?

Adult smoking prevalence in the UK has fallen from 45% in 1974 to 12.7% in 2023 — a halving in under 50 years that represents one of the most successful public health interventions ever documented.^[1] The tools have been consistent: advertising bans, workplace and public place bans (the landmark 2007 smoking ban), plain packaging (2016), tobacco tax rises, and stop-smoking services. By 2023, more adults in England vape (estimated 5.4 million) than smoke cigarettes (4.9 million) — a remarkable inversion.^[1] The Tobacco and Vapes Bill, introduced in 2023, will create a rolling generational prohibition: no one born after 2009 will ever be able to legally buy tobacco.^[4]

But the headline figure conceals a profound inequality. In the most deprived quintile of the population, around 32% of adults smoke. In the least deprived quintile, it is around 8.6%.^[2] This 3.7x gap has barely changed in 15 years. Working-class and low-income communities bear a disproportionate share of smoking-related disease — lung cancer, COPD, cardiovascular disease — and their stop-smoking services have faced deep cuts since 2013. Total local authority spending on tobacco control fell by around 40% in real terms between 2013 and 2023.

The NHS spends an estimated £2.5 billion a year on treating smoking-related illness. The productivity cost — from premature death and chronic disease — is estimated at a further £12 billion.^[3] Against these figures, investment in tobacco control is remarkably cheap: a comprehensive national stop-smoking service costs tens of millions, not billions. The evidence for nicotine replacement therapy and varenicline (Champix/Chantix) is strong; brief advice from GPs doubles quit rates; intensive support programmes produce quit rates of 25–30% at one year.