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Smoking and the NHS

June 9, 2009

I was listening to a piece on 5 live Breakfast this morning about smoking and the NHS.

The basic thrust of the matter was that:

  • Smoking costs the NHS twice as much as we thought.
  • Should we charge smokers for their treatment (on the basis that they choose to smoke)?

The points raised included:

  • If everyone stopped smoking, they’d live longer, and so cost more?
  • Isn’t it “quality of life” and not “monetary cost” that should be used as the metric for the provision of NHS services?

Smoking has unique physical properties that make it particularly loathsome. Of all the vices, it’s the most invasive. I can’t walk to work without getting stuck behind some smoker and getting a good lungful of their smoke. At least if it’s some boozed-up tramp that I’m stuck behind, then it’s just the stench of cider and urine that I have to put up with; and last time I checked, neither of those gave me lung cancer.

In terms of the direct questions raised on the radio show, I would have thought that the best way to charge smokers is add it to the cost of the products; just as the best way to charge motorists for the socio-economic costs of running their cars to is to add it to the price of fuel. (Of course, we already do both of these things; I guess that the show was asking “should we charge them more?” as well as “should we charge them in a different way?”).

But I can’t help thinking that the debate missed some of the wider issues. For example, NHS costs aren’t the only smoking-related costs carried by the tax-payer. What about litter? One recent study found that “smoking detritus accounted for 90% of rubbish found on Wales’ roads and pavements“, and according to Keep Britain Tidy “smoking related rubbish is now the UK’s biggest litter problem, with cigarette litter reported to be found on 78% of our streets“.

It’s not just litter. What about the environmental cost of growing and manufacturing and producing and transporting cigarettes? I don’t know, but I’m guessing that the foam in the filter isn’t a naturally-occurring product. How much is all of that costing us? Again, it’s not just the monetary cost that’s important; and all to support a disgusting habit of no practical or positive use.

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5 Comments leave one →
  1. June 9, 2009 10:13 am

    I’m not that keen on the statistic that throws “90% of rubbish…” around. I assume that figure is based on a count of litter items which I don’t consider to be the most important metric. Are 10 cigarette butts 10 times worse than a used syringe or steaming doggy poop?

  2. June 9, 2009 10:48 am

    Hi Matt,

    Just because there’s something worse doesn’t mean that the bad thing isn’t bad.

    Even *if* I agree with you (and I probably do agree that it’s a fairly woolly statistic and that used syringes are worse) all you’re saying is that we should clean up cigarette litter *and* drug litter *and* dog litter.

    The bottom line for me is that a) the cost of smoking is more than just the cost to the NHS, and b) no-one should [be allowed to] smoke.

    Seriously, the cost (in the broadest terms) of smoking is way more than, say, the cost driving uninsured, or without seatbelts; it probably outweighs war. The only difference is that it’s a lot harder to garner support for something so attritious that just gradually screws us all over, compared to say a road-traffic accident that kills a child and step-changes someone’s life forever.

  3. June 9, 2009 11:50 am

    Ok, I agree with most of the things you’re saying, so I’m only going to write about the “diffs”.
    Do you think no-one should be allowed to smoke? Do you think it should be outlawed? I agree that Smokers Suck™ but not allowing that freedom is surely wrong. You can get the same effect by just making the right thing the easiest thing to do (make smokers smoke outside, pay more taxes etc.)

    I don’t have any stats, but I don’t think smoking will be around in 100 years just through better education, anti-social brainwashing etc. and good ridance to it.

    My main rant is actually about freedoms and the fact that your arguments would naturally extend to alcohol as well.

    And I like alcohol, it’s tasty.

  4. June 9, 2009 12:42 pm

    Hi Matt,

    Making smokers smoke outside *isn’t* the right thing to do.

    The key point here is that it’s not about nicotine, it’s about smoking. If I could get my caffeine fix by burning my teabags then that would be just as bad as smoking. The delivery mechanism is indiscriminate

    Alcohol is very different. The delivery mechanism is completely different. The health cost curve is completely different; a bit of booze is good, a lot is bad – with cigarettes, it’s all bad. The social costs are different; it’s perfectly possible to share a room with a drinker and not be affected at all by their drink. The environmental costs are completely different; we generally drink in our pubs and our restaurants and homes and put our empties in the bin, not strewn across the street (yes, some people do, but remember that just because something else is bad doesn’t mean that the original thing isn’t); we generally brew our drinks locally, not in far-flung countries to be shipped half the way round the world to us.

    It isn’t about freedom, it’s about responsibility. It is possible to be a responsible drinker, and many people are. I don’t think that it’s possible to be a responsible smoker; you might *try* to be (and that would put you in the minority), but ultimately you’ve got to admit that you’re failing; failing to keep your smoke out of other peoples lungs, failing to take appropriate care of yourself and others, failing to engage in responsible, sustainable activities…

    And I haven’t even got onto the whole subject of tobacco companies or their aggressive marketing to under-age consumers in second- and third-world countries…

  5. September 21, 2009 9:52 am

    I heard on the radio this morning (or at least, at some point over the weekend) that RyanAir are to sell smokeless cigarettes for use on their planes. What do you think the chances are of these replacing mainstream cigarettes? I’d hope that it’s high, but I fear otherwise…

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