Tobacco dependency: Treat it like any other illness

Sarah MacFadyen, Vice Chair of the Taskforce for Lung Health and Head of Policy and External Affairs at Asthma UK and the British Lung Foundation, says it’s time that tobacco dependency was treated just like any other illness

Tobacco dependency is the largest preventable cause of death in the UK. Although most people are aware that smoking is bad for your health, few people who don’t smoke realise how difficult it can be to quit. Unfortunately, tobacco dependency is still seen as a personal vice or habit, and the majority of the 6.9 million people who smoke in the UK do not get the support they need to stop.

The reality is that delays to quitting smoking are serious – on average, smokers live ten years less than non-smokers, and every additional day as a smoker can have an impact on someone’s quality of life. While not all lung conditions are caused by smoking, the majority of cases of conditions such as lung cancer and COPD are linked to it. Tobacco causes a huge range of debilitating smoking-related illnesses and as a result, kills half of its users; if a patient went to their doctor for any other condition as life-limiting, they would rightly expect to receive a range of treatment options and tailored support.

This is the crux of why tobacco dependency needs to be taken as seriously as any other life-threatening condition.

Smokers are more likely to quit with support

Smokers are three times more likely to quit with the support of a stop smoking service. According to the Lung Health Data Tracker, launched by the Taskforce for Lung Health, a quarter of specialist stop smoking services became integrated with other services, or closed altogether between 2017 and 2018. This follows years of funding cuts for specialist stop smoking services. As a result of the decrease in specialist support available, the Taskforce estimates that as many as 1 million people may have been left behind in access to support to quit smoking.

Furthermore, an audit of hospitals across the country by the British Thoracic Society showed that more than one in five patients still do not even have their smoking status recorded in their medical notes, and only 15% of hospitals offered their outpatients reliable access to a stop smoking service. People who might even be in hospital for a smoking-related condition are not currently getting the treatment they desperately need – evidence-based help and support to quit smoking.

It’s clear that while much progress has been made towards improving smoking rates across the country, we’re letting down those who still smoke by narrowing the availability of support.

The poorest people are most likely to smoke

Those left behind in being supported to quit smoking are also often the poorest in our society, widening the existing health inequalities across the UK. It’s a sad fact that people in the most deprived areas are four times more likely to smoke than those living in wealthier areas, and are twice as likely to develop chronic obstructive pulmonary disease (COPD) or lung cancer if they’re poorer.

The fact that your socioeconomic status can leave you so much more at risk of starting to smoke as a child, and less likely to quit as an adult, is a key reason as to why tobacco dependency needs to be treated as an illness. People should not be at risk of an early death because of where they are born, where they grow up and what their social connections are like. We need to make sure that everyone across the country has equal access to the care and support they need to create a future where more people than ever before live with healthy lungs, but this is not currently the case.

The solutions are out there

It is crucial that supporting people to quit smoking becomes a priority so that we can meet the government’s target of becoming smoke-free by 2030.

To ensure that millions of people living with tobacco dependency do not continue to be left behind, the government needs to provide sustainable funding for the delivery of stop smoking services and ensure that there are good quality services available to everyone who wants to quit in primary care and the community, as well as in hospitals across the country. It’s no longer enough to talk about a future where we are smoke-free by 2030 – it’s time to actively create one.

A key tool for supporting people to quit is Very Brief Advice (VBA), also known as VBA. The Taskforce for Lung Health recommends that this 30-second intervention is delivered by all healthcare professionals in consultations with a patient who smokes. VBA is also recommended by the National Institute of Health and Care Excellence (NICE) as an evidence-based and cost-effective intervention in which all frontline practitioners should receive training. According to Asthma UK and the British Lung Foundation, over half of UK GP’s have not had access to this training even though GPs who have had training in the delivery of VBA are three times more likely to deliver VBA at least once a week.

The pandemic has highlighted how vital our NHS is for supporting people across the country, so it’s now a better time than ever to ensure that healthcare professionals receive the training they need to support people who smoke across the country. For the problem of tobacco dependency, simple solutions – such as training all frontline health professionals in delivering VBA – are highly effective and offer professionals an easy tool to support people to quit. If we don’t take advantage of the solutions to tobacco dependency which we know work to support people, and fail to prioritise this addiction as an illness, we will continue to see thousands of people every year die as a result of smoking.