Tobacco Control Plan for the UK

Introduction

Cigarette smoking is a debilitating issue in the UK. Majority of the people smoke for recreational use and some because of its immediate effects such as increased alertness which helps them concentrate as they work or study (Griesar, Zajdel, and Oken, 2002). The increased alertness occurs dues to nicotine, which is a stimulant that is found in tobacco (Martin, 2019). Smoking can take two forms: active and passive smoking. Active smoking occurs when the individual lights the cigarette and deliberately smokes it (Martin, 2019). Passive smoking occurs when a non-smoker is exposed to smoke when active smokers are smoking. That shows that the effects of smoking are not only felt by those who actively smoke but also by the ones who may be inadvertently exposed to the smoke. As such, tobacco control for a smoke-free generation in the UK is something that must be addressed. For the sake of this report, tobacco, smoking, and cigarettes shall be used interchangeably since smoking cigarettes is the chief manner through which individuals consume tobacco.

Smoking is a very potent issue among many people in the UK. People usually smoke cigarettes, cigars, and pipes. Smoking became very popular because of its short-term effects coupled with a very effective marketing campaign and very little awareness of the negative side effects of long-term smoking. Due to that, many people got in smoking, assuming that it is a great thing with little side effects. According to the NHS (2019), smoking is one of the biggest causes of death and illness in the UK, and it accounts for 78,000 deaths annually with many more people living in debilitating sickness. Continued smoking will increase the risk of one getting more than 50 other serious health conditions. Some of those health conditions such as liver cancer may be fatal and lead to the death of an individual and others such as throat cancer will have a very negative effect on the quality of life of an individual (Martin, 2019). The other debilitating effects that may occur are cancer of the mouth, bladder, kidney, liver, esophagus, larynx, increased probability of heart attack, stroke, and coronary heart disease, and it has been known to cause impotence in men (NHS, 2019). Therefore, the short-term benefits of tobacco, such as increased alertness pale in comparison to the aforementioned negative side effects.

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Having policies in place that will reduce tobacco consumption is very important. The policies will ensure that access to tobacco products, in this context, mostly cigarettes, becomes very challenging. If it becomes challenging to procure such products, the addiction rates will decrease, and the effects caused by both active and passive smoking will also decrease.

According to Rawlinson (2018), the number of individuals, 18 years and above, who smoke cigarettes was 16.8% in 2017 when compared to 24.6% in 1974. In 2010, 26% of individuals identified as smokers, and there has been a decrease in the number of individuals who identify as smokers. The Press Association (2017) notes that the smoking rate in the UK has fallen to second-lowest in Europe, which is a very precipitous decline. As such, the UK is winning the war on tobacco. It is estimated that if 15% of smokers in the UK were to quit, then the health care expenses of around 2 billion per annum would be saved. Part of the reason the UK is winning the war on tobacco has to do with the policies that have been put in place to combat the tobacco industry.

The aim of the report is to explore the various policies that have been put in place to combat the tobacco industry. The efficacy of the various policies will also be explored and how they have contributed to the overall decline of tobacco use in the UK and whether they will continue being effective. The rationale of the report is that it will show that with proper policies, various industries that may be considered to be harmful can be regulated in a manner that will be beneficial for the society as a whole. The audience of the report is policy makers since they are the ones that formulate or will formulate policies to regulate various industries beyond the tobacco industry. The other audience is individuals that would like to learn more about the policies that have been applied to combat the tobacco industry.

Overview of the Country

The UK has had issues with cigarette smoking, which is the preferred mode of tobacco ingestion. If the issue revolved only around a few people, then it would not have garnered public and political attention. The fact that it led to the formulation of strict policies to regulate the tobacco industry shows how much it was an issue. It is important to understand the social and political context. As stated by the NHS (2019), 78,000 people die annually from cigarette smoking. The issue is not the people died but the fact that they died from a cause that could have been easily controlled. If one does not die, then their quality of life reduces drastically, mostly because of various illnesses such as cancer of the throat, poor sleeping patterns, and affected appetite (Martin, 2019). Say that the person who smokes is the primary provider of a family, if they die, they have left their family without any means through which they can provide for themselves, more so the children. According to Belvin et al. (2015), smoking exacerbates poverty for a very large proportion of children in the UK. 1.1 million children were estimated to live in poverty, and if tobacco expenditure was subtracted from household income, then an additional 400,000 children would join the list. This shows that while the key issue is the primary effects that primary smokers experience, there are ancillary effects such as increased poverty that make tobacco consumption an issue that must be addressed. As of 2017, 16.8% of individuals over the age of 18-years-old, identify as smokers (Rawlinson, 2018). The numbers clearly show that tobacco consumption is a social issue.

Since smoking became extremely prevalent in the social domain, it found itself into the political domain, which influenced the formulation of the policies that currently regulate the tobacco industry. Before 1990, the political method of dealing with smoking and the tobacco industry revolved around taxation and tobacco companies setting up their own voluntary measure to deal with the tobacco industry. Such controls worked to some extent since they laid the foundation for future aggressive policies that currently control the tobacco industry. The key drivers for change were medical experts who taught people about the dangers that smoking presents to one’s health. Berridge and Loughlin (2005) note that that between 1950-1970 smoking was identified as being very hazardous to one’s health by public health officials, and after much lobbying, it became a political issue. Making it into a political issue led to the formulation of the policies that shall be discussed in the subsequent chapter. The resistance to change is expected from tobacco companies. According to Critchlow and Mitchell (2018), note that companies within the tobacco industry will do their best to resist the change for as long as they can through lobbying and through third-party interference. The key stakeholders are the people who smoke, medical health experts, tobacco companies, and policymakers.

Policy

Over the years, there have been various policies that have been enacted to combat the tobacco industry. The policy instruments that have been enacted are in the form of laws, education, taxes, use of scientific research, and voluntary agreements. Some of those policies have proven to be successful, and some may not have been as effective as envisioned during the formulation process. The efficacy revolves around the policy content, policy process, and actors.

Before, the 1990s the UK addressed the issue of smoking through levying greater taxes, and voluntary restrictions that the tobacco industry placed on themselves. The relatively complacent means of dealing with the issue of smoking transformed after the 1990s through the introduction of more aggressive means of dealing with the issue of smoking (Belvin et al. (2015). The first policy that the UK enacted revolved around showing that tobacco was a health hazard. To meet this policy, aggressive campaigns were pursued all over the UK by channeling more finances to public health education.

The second policy that was developed, revolved around reducing the prevalence rates of smoking in the workplace and in public places. Under the Health Act of 2006, smoking was prohibited in hospitals, cinema halls, and prisons. This policy was supported by the removal of tobacco vending machines from public places. As a policy supporting the reduction of prevalence rates of smoking in public places, the government aimed to combat teenage smoking. A legal age for buying tobacco products was set to 18-years old. Moreover, smoking in vehicles with people under the age of 18-years-old was also made illegal.

The third policy revolved around restricting the influence that tobacco companies had in policy making. To meet that goal, every policy discussion revolving around the tobacco industry was revealed to the public. At the same time, high taxation was levied against Tobacco companies, with stricter controls being levied. Tobacco advertising was banned. There was “The Tobacco Advertising and Promotion Act (TAPA) that was introduced between 2003 and 2005 in the UK. Moodie and Hastings (2009), the law prohibits all tobacco advertising, promotion, and sponsorship. The act was developed because the packaging was and continues to be a very important promotional tool for the tobacco industry. The packaging was also standardized to a dull brown that also had a health warning (University of Bath, 2019).

The other policy that was enacted revolved around education through the use of mediums such as advertisements and short films showing why smoking is dangerous for one’s health. The other policy that has been employed is educating people about the negative and detrimental effects of smoking. The education part was supported by scientific literature. Science found a correlation between smoking and various forms of cancer and an overall reduction in quality of life. The government worked on making such information open to the public through various social teaching methods, and insisting that tobacco companies must show that smoking is hazardous. The National Institute for Health and Clinical Excellence (NICE) helped by setting a framework to guide smoking cessation services. The combination of the above policies has helped fight smoking in the UK.

As of July 2017, the UK adopted a policy dubbed smoke-free generation. The purpose of the policy is to reduce the prevalence rates to below 5%. The government has shifted its focus to a more communal level more so in communities where smoking rates are very high. The smoke-free generation serves as a guide for the UK government when formulating further policies to address the issue.

Before addressing the policy process, it is important to understand what a policy is. According to Blakemore & Warwick-Booth (2013), a policy is a set of rules that guide people in achieving desired results. The policy can be informal or formal. Informal policy refers to behaviors that are widely considered to be the societal norm and it is usually supported by informal culture. Formal policies are guidelines that have been decisively premeditated and made into law. Furthermore, the policies can be regulatory, distributive, and constituent. Knill and Tosun (2012) note that regulatory policy aims to make society better by prohibiting or promoting certain acts; distributive policies aim to offer direct benefits; constituent policies imbue an individual or organization with the power to act as an agent of the government.

Policy making refers to the formal process of the government setting laws that will help them achieve the desired result. The process can be expressed through the use of programmes, white papers, manifestos and laws and regulations (Cairney, 2012). As it pertains to smoking the government aim to adopting and evidence-based approach. The evidence-based approach revolves around facts and data. If the facts and data are moving in the direction the government wants, then they know that the policies are working; the converse is true. The great appeal of an evidence-based approach is that it gives room for the quantitative measurement of the efficacy of the policies. The policy process has several steps such as problem identification, problem definition, policy-analysis, selecting policy instruments, policy consultation, and policy adoption (Howlett & Mukherjee, 2017). The steps help in streamlining the policy formulation process.

Different policies have different objectives and they require different instruments, and implementation frameworks. Currently, the objectives are guided by the “Towards a smoke free generation” and the key performance indicators are reducing the smoking rate to lower than 12%, reduction in prevalence rates amongst pregnant women to lower than 6%, promoting modes of smoking cessation such as e-cigarettes.

The instruments driving policy are different. The instruments come in the form of laws, public education, evidence-based approaches supported by scientific research, and heavy taxation against tobacco companies (Cairney, 2012). The most utilized instrument is laws and regulations that place restriction on the use of tobacco products in public as well as limiting advertising. Social media and other media have been utilized to offer health education and increase awareness of the harmful effects of smoking. Taxation has reduced the affordability of tobacco products. Furthermore, the government has launched many programmes that aim to motivate people to quit smoking (Haustein, 2013). The government has increased its provision of nicotine replacement therapies, online support for those aiming to quit smoking, creating smoke free environments, and offering hospitalization for those that may need it. Moreover, the campaigns run at a local level are the ones that have been most effective.

Smoking policy has been supported by an ever changing economic, political, and social arena. Smoking has shifted from being a status symbol to being considered a great health hazard. At the beginning, smoking was considered to be an individual’s choice. There were close ties between the government and tobacco companies which more or less limited the government’s intervention in the industry. When the government became serious in enforcing the policies, tobacco companies moved swiftly to salvage the situation. The tobacco industry fought back against the policy through lobbying and third-party interference (Critchlow, and Mitchell, 2018). The government tried a self-regulation approach but it was an exercise in futility since tobacco companies only did things like promoting filters and offering flavored alternatives. The government sought stricter measures that continue to shape modern policies.

The smoking policies need to be translated into reality through far and wide circulation. The UK government should follow a three-tiered approach. First, it should ensure that the policy is effectively documented and shared with the concerned parties. Second, groups such as the Department of Health should be employed to monitor and measure the efficacy of the implemented policies. Third, funds should be deployed for the good of the policies. The three-tiered approach focus on the governmental and societal level. The governmental level gives the time and resources needed to make the policy effective and that leads to a positive societal effect. Strong leadership will be very important in implementing the smoke-free policies. Moreover, the policies to be effective, the whole society must be included. Including the society, will help in transforming the social perspectives and help people understand that individual health is dependent on the overall social health.

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Theoretical Connection

There are various policies that explain the various smoking policies based on the basis of the policies.

Institutional Theory

One of the key theories is known as institutional theory. As the name implies the framing and subsequent execution of policies around key institutions that have the power to come up with the theories. According to Saebo (2017), institutions such as the executive, the legislative, and the judicial arms of government are the ones that are responsible for coming up with policies and enacting the policies. In the context of this report, it is clearly seen that institutions play a very important role more so when the policy has been enacted into law. TAPA was as a result of the institutions coming together to formulate policies. Furthermore, when there is an arm of the institution such as the Judiciary whose purpose is to carry out judgment on those that do not follow the policies, it is easier for the policies to be followed. It is very important to have the support of institutions when it comes to formulating policies because institutions lend weight and credence to the cause since they come with power in the form of political and financial power. In the context of smoking and tobacco-related products, the institutions work in tandem to come up with the policies and to enact them.

Rational Choice Theory

The other theoretical connection that should be considered is the rational choice theory. According to Zey (2001), rational choice theory is based on the premise that an individual will make the choices that will maximize their utility in the long-run. The argument further argues that individual choice is self-interested, and it might be generated from the inside rather based on extrinsic factors and motivators. The person will consider the options that are before them, and they will choose the one that will bring them the greatest utility. In the context of cigarette smoking, the rational choice theory maintains that an individual will be less inclined to purchase a product that is relatively expensive when they have many other things to take care of.

Moreover, the application of rational choice theory would imply that since individuals are aware of the harmful effects that cigarette smoking will have on their health and any individual that passively breathes in the smoke, then they will be less inclined to purchase the cigarettes. The broader application of rational choice theory is that it argues that every alternative should be measured against the value that it adds in social, political, and economic domains. In this context, limiting the ability of tobacco companies to trade will lead to a great social, political, and economic benefit in the long-run. In terms of social, devoid of smoking there will be fewer instances of cigarette-caused deaths and illnesses; politically, more time will be directed into formulating other policies rather than ones that revolve around regulating the tobacco industry; in terms of economy people who are less under the influence of an addictive substance are bound to be more productive which will have ripple effects into the overall economy.

Recommendations for the Policy

There is a shift in the smoking culture. According to Buse, Mays, & Walt (2012), people are becoming more aware of the effects of both active and passive smoking and have developed less tolerance for unhealthy habits. This shift occurs due to stricter laws revolving around pricing, packaging, and taxation. The number of smokers has reduced significantly and it continues to drop every year. Due to the apparent effect of the policies, various recommendations can be made.

First, the UK should continue with the policies that they have elected to employ. The data shows that the policies that they have chosen to employ are working since there has been a gradual and precipitous decline in the number of individuals that smoke cigarettes. Second, there should be more active education on the dangers of cigarette smoking and its short-term and long-term detrimental effects. People should be made to understand that when they choose to smoke, they are not only going to affect themselves but all the people that are around them. A poignant example is that of a mother who smokes. If she continues to smoke her children will become passive smokers, and they may transform to become active smokers too. If the smoking results in health issues and death, her children will be left with no one to fend for them, and that will affect their lot in life. The example is one of many that can be given alongside factual information about the effects of cigarette smoking on the individual and those that are around them. People should be made to understand that in the long-run health is one of their greatest assets, and smoking cigarettes robs one of their health.

Third, the taxation against tobacco companies as well as the restrictions on advertising should continue. The taxation increases the price of cigarettes and tobacco companies will have no choice but to pass the burden to the consumer, which will result in an increase in the price of cigarettes. The increase in price will result in fewer people buying the products in the long-run. Advertising, which has been a great tool for tobacco-companies should continue to be limited. Without great advertising tobacco products will be less appealing and will be hidden from the collective societal psyche, which will, in turn, reduce smoking.

Conclusion

Smoking has been an issue in the UK from the mid-20th Century. In the 1950s, around 50% of the individuals in the UK were smokers. As of 2017, 16.8% of individuals identify as smokers. The decline in the number of smokers is as a result of policies that have been set in place by both institutions and individuals too. The policies have increased the taxation of tobacco products, which has resulted in a subsequent increase in the price of cigarettes, restrictions have been placed on advertisements, and packaging has been reduced to generic packaging. People have also played a role in that they are more aware of the detrimental effects of cigarette smoking on one’s self and on others too, and they have elected not to smoke. If the institutional driven policies and the rational individual choices persist, the number of cigarette-caused deaths and illnesses should decrease as the future continues.

References

Belvin, C., Britton, J., Holmes, J. & Langley, T., 2015. Parental smoking and child poverty in the UK; an analysis of national survey data. BMC Public Health, vol. 15,

Blakemore, K. & Warwick-Booth, L., 2013. Social Policy: An Introduction. London: McGraw-Hill Education.

Buse, K., Mays, N., & Walt, G., 2012. Making Health Policy. London (UK): McGraw-Hill Education.

Cairney, P., 2012. Understanding Public Policy: Theories and Issues. Basingstoke: Palgrave Macmillan.

Griesar W, S., Zajdel D, P. & Oken B, S., 2002. Nicotine effects on alertness and spatial attention in non-smokers. Nicotine Tobacco Research, vol. 4(2), pp. 185-194.

Haustein, K, O., 2013. Tobacco or Health?: Physiological and Social Damages Caused by Tobacco Smoking. New York: Springer Science & Business Media.

Howlett, M. & Mukherjee, I., 2017. Handbook of Policy Formulation. Cheltenham: Edward Elgar Publishing.

Moodie, C. & Hastings B, G., 2009. Making the pack the hero, tobacco industry response to marketing restrictions in the UK: Findings from a long-term audit. International Journal of Mental Health and Addiction, vol. 9(1), pp. 24-38.

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