ASH Scotland signed the recent joint letter calling on Scotland’s political parties to give robust support to the new Poverty and Inequalities Commission, and to guarantee its independence by giving it secure legal status and having it report only to the Scottish Parliament.
The focus of our work is tobacco and smoking, so what is noteworthy is that we as health campaigners felt able to sign a letter that centres on economic inequality. That may be challenging for some, but to me it feels like a natural development.
Smoking is not usually about free choice, and policy responses that treat smoking as a recreational pursuit are not fit for purpose. Some people do willingly choose to smoke, but that now counts for just 7 per cent of adults in Scotland, a figure that is falling year on year.
Yet smoking remains Scotland’s biggest cause of preventable illness and death and to respond to it we need to listen to what smokers are telling us, and really take on board the fact that far more of those who smoke say that they want to quit.
Central to any discussion about smoking is that nicotine is as addictive as heroin, and that cigarettes are engineered to be addictive.
Recently we have been exploring the number of other factors that push people to smoke and make it harder for them to quit. These include stress, anxiety and boredom, but also what is normal in people’s communities, such as a lack of alternative coping mechanisms or a lack of hopeful or optimistic plans for the future. This is where smoking becomes a social concern – and when some groups experience these factors more than others it should come as no surprise that they are statistically far more likely to smoke.
So, we are able to understand why smoking rates in the most disadvantaged communities are several times higher than those in the most advantaged, why we see that half of all people out of work long-term smoke, and how it comes to be that a third of all tobacco smoked in the UK is used by people with mental health issues.
This is the dominant narrative for smoking in Scotland today, with the casual fag with a drink at the weekend increasingly a distraction from the main concerns.
We want to reduce the harm caused by smoking. But when most tobacco consumers say they don’t want to be smokers, there’s no point just telling them people they should quit.
Looking at the factors that push them to smoke and prevent them from stopping, highlighting how the benefits from smoking are fleeting while the harm is ongoing, stressing that they have it in them to take back control of their health and well-being – there we might be on to something.
This narrative is all about inequalities. Scotland still has the highest health inequality in Western Europe. Which takes us back to the Poverty and Inequalities Commission. The Scottish Government has set a target for Scotland to be tobacco-free (meaning that the smoking rate is very low) by 2034. Meeting this target would deliver huge health, economic and social benefits to Scotland, but it will not be met unless many more smokers in disadvantaged communities who say they want to quit manage to do so.
The skewed social distribution of smoking, and the factors associated with it, demand a targeted response. That is why the pledge to create smoke-free prisons, where smoking rates are currently over 70 per cent, is so welcome. That is why it is important that the new national mental health strategy has an ambition to have smoking rates in this group decline as fast as in the general population. That is why we need to look to bodies such as the Poverty and Inequalities Commission to see reducing inequalities as part of action on smoking, and action on smoking as part of reducing inequalities.
Sheila Duffy, chief executive, ASH Scotland.