How does smoking cause health inequalities?

Author and presenter:
Laurence Gruer
Director of Public Health Science, NHS Health Scotland, Glasgow, UK

Abstract
Smoking causes a host of serious diseases, with long term smokers being at risk of developing one or more, and dying on average ten years younger than equivalent non-smokers. Thus, health inequalities develop between population groups with different smoking rates. The main focus in the UK has been on socio-economic differences in smoking rates but there are also marked differences between ethnic groups. Contrary to popular belief, recent research shows clearly that low-income non-smokers live longer than high-income smokers. Over the past 60 years, smoking rates have declined much faster in higher than lower socio-economic groups. This may now account for as much as 80% of the differences in death rates between higher and lower socio-economic groups in the UK. Thus, focusing smoking cessation services on low-income smokers is key to reducing health inequalities in the UK.

Why do more people in lower income groups in the UK become regular smokers? Regular smoking usually starts in the teens or early twenties. Important factors include other smokers in the family, low parental supervision, friends who smoke, and lower intelligence and educational attainment. Young people not in employment, education or training have very high smoking rates, young offenders even higher. Increasing the cost of cigarettes, reducing their accessibility and visibility, and enforcing laws on legal age of sale are the most likely ways discouraging disadvantaged young people from starting to smoke. A comprehensive package of new Scottish legislation has this aim and its impact on health inequalities will be evaluated.

Source of funding: NHS Health Scotland

Declaration of interest: none

About the presenter
Dr Laurence Gruer OBE is Director of Public Health Science with NHS Health Scotland. He is interested in everything to do with preventing disease, improving health and reducing health inequalities. Scotland’s smoking problem has been one of his main concerns for the past eight years. He is the lead author of the reports on smoking-related harm and smoking prevention, which provided the basis for current Scottish Government policy and recent legislation, and of an influential recent study of smoking, survival and social position. He played a key part in the world-class evaluation of the Scottish smoke-free legislation. He is a member of the Scottish Ministerial Working Group on Tobacco Control and is the chair of its Subcommittee on Research and Evaluation.