The poor and vulnerable have been left behind in the national effort to quit smoking

We all know how unequal and unfair our society is, and the gap between the haves and have nots continues to widen. New research by Cancer Research UK reveals yet another way this inequality plays out, smokers from the lowest income groups have twice the rate of cancer as those from the most affluent. The charity found 11,247 cases were diagnosed in the poorest groups compared with 6,200 earning the most.

While we have record-low smoking rates overall, at just 15.5 per cent of the population, the benefits of abstaining are not spread equally. Considerable effort went into achieving a reduction in population-level smoking, with investment in smoking cessation clinics and nicotine replacement therapy. However, this left some groups with significantly elevated rates of smoking. Prisoners, people using drugs, people with mental health problems and poorer people have all been left behind as the rest of the population quits the habit.

At a time when investment in smoking cessation is needed to help these individuals, budgets are being slashed. This is despite the obvious economic case for investing in services now to prevent or at least reduce the need for health intervention, including treating the inevitable cancers that will develop in years to come.

Even if the government can’t afford to invest in smoking prevention and cessation services, the tobacco industry should. The tobacco industry is all too aware of its core market and responds by targeting advertising towards them.

Those with a mental health problem consume an estimated 30 per cent of tobacco in the UK. For years, this group has had significantly higher rates of smoking than their peers in the wider population. It’s one of the main reasons they die two decades before the average person. The physical health problems they develop, including heart disease, lung problems and cancer, compound existing psychological issues. This has perversely meant that well-meaning health professionals have avoided initiating conversations about quitting smoking as they view the habit as a lesser problem than their mental health issues.

Smoking, like other drugs, is a symptom – not the cause – of a problem in society. This new data of unequal cancer rates merely points to the end of a journey marked by inequality at every point along the way. There is no randomness involved in who starts smoking and then persists with the habit. Being born into poverty, unemployment, mental health problems and unstable housing almost guarantee that you will take up smoking and will be the least likely to get support to stop.

This inequality in smoking rates and its consequences is not isolated to the UK; it is spread across the globe. As the tobacco industry has saturated western countries, it has moved onto developing ones, where smoking is – not by accident – viewed as aspirational and a status symbol, as it once was in the UK.

Without any sense of hypocrisy, Jacek Olczak, the chief executive of Philip Morris International, recently suggested that tobacco should be outlawed and viewed in the same way as petrol cars. A late conversion and acknowledgement of the harm the industry has caused over the last century. Of course, it seems likely this statement was part of a choreographed public image makeover as the company shifts its focus onto health products such as drugs for respiratory problems, a true case of poacher turned gamekeeper given the contribution that smoking makes to respiratory disease.

Don’t expect any government intervention on smoking or an attempt to reduce the harm it causes to the poorest in society. After all, what chance does public health have when it’s up against the might of industry lobbying?

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