IndyWales, Smoking & Vaping

Following neatly on from last week's look at alcohol policy and independence , it's time to look at one old vice (smoking) alongside a much newer one (vaping). Smoking, Vaping & Public Health [caption id="attachment_14797" align="aligncenter" width="700"] Most powers over smoking and vaping are devolved to Wales, with the Senedd leading the way on public smoking bans in many circumstances. 9Pic: BBC Wales).[/caption] Health impacts of smoking You'll all know this – even the smokers amongst you – but it's an understatement to say that "smoking is bad for you". Nicotine addiction – Nicotine is a stimulant that causes adrenaline, dopamine and serotonin to be released, increasing mental sharpness and a feeling of calmness. Only cocaine and heroin are more addictive than nicotine ( Radical Wales: Legalise Drugs ) and a tolerance to nicotine can be built up quickly, resulting in harsh withdrawal symptoms. Cancer – Up to 70 chemicals present in cigarette smoke are cancer-causing. According to Cancer Research UK, smoking causes up to 60% of all cases of lung cancer and is linked to 16 other types. Chewing tobacco (such as snus) is also linked to mouth and throat cancers. Chronic Obstructive Pulmonary Disease (COPD) – A group of lung diseases whereby the airways within the lungs become blocked by inflamation. These include asthma, bronchitis and – if left unchecked – emphysema, where the parts of the lung that exchange oxygen and carbon dioxide (alveoli) disintegrate. COPD can be managed but can never be cured. Once it reaches the emphysema stage the only treatment option to delay death is a lung transplant. Heart & blood disorders – Smoking causes fatty deposits to build up inside arteries which restrict blood flow, increasing the risk of strokes and heart attacks. Nicotine caused blood vessels to constrict, increasing blood pressure. Over time this may lead to blood vessels losing their flexibility and "hardening" (atheriosclerosis). Oral health – Alongside bad breath, smoking stains teeth and can lead to tooth loss and gum disease. To make matters worse, toothpastes aimed at smokers are more abrasive and can damage the tooth enamel leading to an increased risk of decay. Fertility & pregnancy problems – A good blood supply is essential to male fertility (for obvious reasons). As well as impotence, smoking is linked to lower sperm counts and lower quality sperm – all reversible if a man quits smoking. For women, smokers have lower chances of fertilised eggs attaching to the wall of the uterus – again this is reversible. Smoking during pregnancy has been linked to Sudden Infant Death Syndrome (aka. cot death), lower birth weights and increased risk of premature births and miscarriages. Passive smoking – What makes smoking uniquely dangerous amongst drugs is that it can negatively affect the health of everyone near a smoker. Smokers only take in 15% of the smoke from a cigarette, the rest spreads around them. Passive smoking can trigger asthma in children and adults and if exposed to second-hand smoke over a longer period, increases the risk of non-smokers developing heart and lung diseases – up to an including lung cancer. Health impacts of vaping Vaping is significantly safer for a person's health compared to smoking, but it's not harmless . Vapes don't use or generate the same toxic cancer-causing chemicals present in burning tobacco. The main by-product is steam. That means there's no evidence yet of a "passive vaping" risk either. Vaping is also recommended by many health organisations as an effective means to help people quit smoking. However, vapes still contain nicotine – which, as noted, is highly addictive – and some of the chemicals used in vape flavourings will cause side effects. The truth is we don't know enough about the long-term impact of vaping to say anything other than, "It's healthier than smoking, but you shouldn't start vaping unless you're moving from tobacco". Smoking & the NHS According to the latest report from Public Health Wales 1 , up to 11% of ALL deaths of people aged 35 years and over in Wales during 2022 were related to smoking in some way. That's 3,845 people. To put that in perspective, around 1,000 people were killed or seriously injured in road accidents in Wales over the same period. Additionally, smoking-related illnesses resulted in over 17,000 hospital admissions – up to 5,000 more than alcohol and dwarfs the number of admissions relating to illegal drugs ( around 4,500 ). The mortality rate is also significantly higher in more deprived areas than in less-deprived areas because smoking rates are higher. A Welsh Government estimate from 2022 2 suggests that smoking-related illnesses cost the Welsh NHS over £300million per year. Smoking, Vaping & Devolution The Senedd has more control over smoking and vaping than they do over alcohol. There is no specific exception regarding smoking and vaping in the Government of Wales Act 2006, meaning powers – other than those over taxes and duties – haven't been reserved to the UK Government. Resultingly, the Senedd has been responsible for changing rules around smoking: Ban on smoking in indoor public places and public service work vehicles (2007). Ban on smoking in private vehicles carrying under-18s (2015). Ban on smoking in "enclosed" or "substantially enclosed" workplaces (2021). Ban on smoking in certain outdoor public places including hospitals, playgrounds and school grounds (2021). Ban on smoking indoors in hotels, self-contained holiday accommodation and mental health units (2022). Vaping has been a different matter. An attempt to restrict public vaping as part of a Public Health Bill failed when the Bill was voted down following a row between Labour and Plaid Cymru (Leighton Andrews' infamous "cheap date" quip ). New rules and laws restricting vaping are being co-ordinated across England, Scotland and Wales. The first of these will ban single-use vapes (mainly for environmental reasons) from June 2025. The other major change in the pipeline is the UK Government's Tobacco and Vapes Bill . This Bill – which will require the Senedd's consent – proposes: Banning tobacco sales to anyone born after 1st January 2009. Restrictions on how vapes are promoted to children, including flavours, display and packaging. Granting the Senedd additional powers to restrict public vaping. Introducing a new licensing regime for the sale of tobacco, herbal smoking products, cigarette papers and vapes. The introduction of a new duty/tax on vapes. 1. Public Health Wales (24th September 2024). "Smoking attributable mortality and hospital admissions for Wales, 2020-22". Available here: https://phw.nhs.wales/news/over-10-percent-of-deaths-in-wales-due-to-smoking/ 2. Welsh Government (26th July 2022). "A smoke-free Wales: Our long-term tobacco control strategy". Available here: https://www.gov.wales/tobacco-control-strategy-wales-html Is smoking dying out in Wales? [caption id="attachment_14798" align="aligncenter" width="1068"] Click to enlarge[/caption] The evidence to date suggests that while smoking is in decline (not only in Wales but across the rest of the UK) smokers still make up around 14% of the adult population. According to the Office of National Statistics 3 , men are more likely to smoke than women. Also, there are suggestions that smoking rates actually increased amongst people aged 25-34, against the trend with other age groups. [caption id="attachment_14799" align="aligncenter" width="1709"] (ONS, click to enlarge)[/caption] As you can see, there are regional differences within Wales. While smoking rates have dramatically fallen since 2015, they remain noticeably higher in the Valleys and across the north. ONS figures also show that smoking rates are much higher amongst people with no qualifications (27.5% across the UK), but are very low amongst degree-holders (6.5%). According to the National Survey of Wales 4 , only 7% of people aged 16+ use e-cigarettes/vapes, though the rate was higher amongst the under-45s (9%). The rate has remained largely unchanged since the question was asked. A Market in Death The domestic tobacco market is dominated by three companies. Imperial Brands (Bristol, formerly Imperial Tobacco), Phillip Morris (New York City) and Japan Tobacco International (Tokyo). According to ASH, in 2016 cigarette sales in the UK were worth £12.1billion 5 . In addition, British American Tobacco – based in London – is one of the largest tobacco companies globally. All UK-based cigarette production ended in 2017. In light of declining tobacco sales, these companies have started to switch attention towards vaping. Tobacco is a significant source of tax income too. UK Government figures state that tobacco duty raised £8.8billion in 2023-24 6 . According to the Wales Fiscal Future report 7 , tobacco duties raised £512million in Wales in 2018-19 – though it's hard to tell if the figures now would be lower in light of declining smoking rates. 3. Office of National Statistics (5th September 2023). "Adult smoking habits in the UK: 2022" Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2022 4. StatsWales. "Adult lifestyles by age and gender". Available at: https://statswales.gov.wales/Catalogue/National-Survey-for-Wales/Population-Health/Adult-Lifestyles/adultlifestyles-by-age-gender 5. ASH (January 2017). "The UK tobacco industry". Available at: https://ash.org.uk/uploads/UK-Tobacco-Industry.pdf 6. HM Revenue & Customs (30th August 2024). "Tobacco statistics commentary July 2024". Available at: https://www.gov.uk/government/statistics/tobacco-bulletin/tobacco-statistics-commentary-april-2024 7. Cardiff University, Wales Governance Centre (March 2020). "Wales' Fiscal Future" (p65). Available at: https://www.cardiff.ac.uk/__data/assets/pdf_file/0004/1767424/Wales_Fiscal_Future_FINAL.pdf Smoking & Vaping: The Policy Challenges Some of the more obvious and pressing issues – regulation of the vaping industry, introducing a tax/duty on vapes and tighter licensing of tobacco and vapes – are set to be addressed in the UK Parliament's Tobacco & Vapes Bill (mentioned earlier). Due to the common law system, laws passed before independence by the UK Parliament would continue to apply in an independent Wales unless we decide to repeal them. The other issues worth considering include: The potential loss of income from tobacco duty – If you only count the direct costs of treating smoking-related illnesses than tobacco duty probably raises enough for the NHS to pay for it in principle (though it wouldn't cover the entire social costs, such as absenteeism, passive smoking and welfare). Much like switching to electric vehicles would result in a loss of fuel duty, there would be a loss of tax revenue from cutting smoking rates. That's not a bad thing in itself, but it's a good idea to keep the future duty on vaping products low enough to encourage smokers to switch for their own benefit. This would lead to a drop in tax income, however. Vaping in public – Based on the noises they've made in the past, if the Welsh Government believe they could introduce a ban on vaping in public indoor places they would do so. The issue is whether there's enough public health evidence to support restrictions because "passive vaping" exists in some way. We don't know for sure, so an indoor vaping ban could be considered a sensible precaution. You could also argue it would be an overreaction based on gut instinct rather than hard evidence, taking away one of the reasons why a smoker might switch from tobacco to vapes in the first place. Black market tobacco and vapes – As we've found out from narcotics, once you make something illegal or more difficult to get, criminals step in to supply the demand. There've been several reported prosecutions for selling counterfeit tobacco and vapes in Wales over the last few years and there are estimates that up to 10% of all tobacco sold in Wales is illegal . It's a tax dodge, but if you're not sure what's in the cigarettes they could be even more dangerous too. How do other countries approach smoking & vaping? [caption id="attachment_14800" align="aligncenter" width="2422"] Click to enlarge[/caption] Policies towards smoking are similar, particularly when it comes to regulating the sale of tobacco products. Smoking bans in indoor public places are universal too – though with differing tolerances towards designated indoor smoking areas. Vaping is regulated more lightly than tobacco products – though that might change eventually. There are also differing attitudes towards introducing an age cut-off to legally buy tobacco. Ireland has opted to increase the purchase age, while New Zealand (one of the first countries to consider it) has withdrawn its age cut-off. So as things stand, the UK might be one of the first nation-states to do it (assuming the Tobacco and Vapes Bill is approved). Should IndyWales ban smoking? The Welsh Government has a vision of Wales being "smoke-free" by 2030. By their definition, that means 5% or fewer of the adult population smoking by that point. Based on the current rate of smoking decline, that's unlikely to be achieved before the 2050s. As noted, the Tobacco and Vaping Bill will ban sales of tobacco products to those born after January 2009 from 2027. In that respect, a partial ban on tobacco is coming to Wales. However, legal sales of tobacco would feasibly continue (for those born before January 2009) for a long time. If the last "legal smoker" started smoking on their 18th birthday on 31st December 2026, then they would be aged 92 at the start of the 22nd century (assuming they live that long having taken up smoking). The question is, then, could/should tobacco be completely banned before that? [caption id="attachment_14801" align="aligncenter" width="948"] <img class="size-full wp-image-14801" src="https://stateofwales-com.stacktemp.com/wp-content/uploads/2024/12/smoking-ban-for-against.jpg" alt="Arguments for and against a total ban on smoking tobacco. Arguments for include the public health benefits, the impact smoking has on deprived groups and accelerating a switch to vaping. Arguments against include contradicting softening views on cannabis, civil liberties and increased crime and counterfeit tobacco." width="948" height="1126" /> Click to enlarge[/caption] As far as I know, there are few/no plans anywhere in the world for a total and immediate ban on tobacco, only the phasing out of legal sales based on age (as proposed in the UK). Once the proportion of smokers reaches the point where smoking is effectively non-existent in public life (currently sometime in the 2050s in Wales' case), then a total ban might be a realistic option. We should, nonetheless, heed lessons from our approach to illegal recreational drugs – which was looked at over the summer. Even if it's well-meaning, prohibition often doesn't work as intended. The entire tobacco trade would be pushed underground. I've seen the kind of damage smoking does to members of my family, so my heart says "ban it", but my head says, "a ban wouldn't work". Either way, a debate on whether to completely outlaw tobacco and smoking will happen sometime in the not-too-distant future.

IndyWales, Smoking & Vaping

As smoking gradually dies out, vaping emerges as its replacement. What could an independent Wales do?

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Owen Donovan

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IndyWales, Smoking & Vaping

As smoking gradually dies out, vaping emerges as its replacement. What could an independent Wales do?

4. How do other countries approach smoking & vaping?

4. How do other countries approach smoking & vaping?

IndyWales & Alcohol

Radical Wales: Open Source Nation

Owen Donovan

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