Unequal society helps push people into smoking – it’s time for change

Sheila Duffy looks at some of the causes behind tobacco consumption and what action can be taken

ASH Scotland signed the recent joint letter calling on Scotland’s political parties to give robust support to the new Poverty and Inequalities Commission, and to guarantee its independence by giving it secure legal status and having it report only to the Scottish Parliament.

The focus of our work is tobacco and smoking, so what is noteworthy is that we as health campaigners felt able to sign a letter that centres on economic inequality. That may be challenging for some, but to me it feels like a natural development.

Smoking is not usually about free choice, and policy responses that treat smoking as a recreational pursuit are not fit for purpose. Some people do willingly choose to smoke, but that now counts for just 7 per cent of adults in Scotland, a figure that is falling year on year.

Yet smoking remains Scotland’s biggest cause of preventable illness and death and to respond to it we need to listen to what smokers are telling us, and really take on board the fact that far more of those who smoke say that they want to quit.

Central to any discussion about smoking is that nicotine is as addictive as heroin, and that cigarettes are engineered to be addictive.

Recently we have been exploring the number of other factors that push people to smoke and make it harder for them to quit. These include stress, anxiety and boredom, but also what is normal in people’s communities, such as a lack of alternative coping mechanisms or a lack of hopeful or optimistic plans for the future. This is where smoking becomes a social concern – and when some groups experience these factors more than others it should come as no surprise that they are statistically far more likely to smoke.

So, we are able to understand why smoking rates in the most disadvantaged communities are several times higher than those in the most advantaged, why we see that half of all people out of work long-term smoke, and how it comes to be that a third of all tobacco smoked in the UK is used by people with mental health issues.

This is the dominant narrative for smoking in Scotland today, with the casual fag with a drink at the weekend increasingly a distraction from the main concerns.

We want to reduce the harm caused by smoking. But when most tobacco consumers say they don’t want to be smokers, there’s no point just telling them people they should quit.

Looking at the factors that push them to smoke and prevent them from stopping, highlighting how the benefits from smoking are fleeting while the harm is ongoing, stressing that they have it in them to take back control of their health and well-being – there we might be on to something.

This narrative is all about inequalities. Scotland still has the highest health inequality in Western Europe. Which takes us back to the Poverty and Inequalities Commission. The Scottish Government has

“Central to any discussion about smoking is that nicotine is as addictive as heroin, and that cigarettes are engineered to be addictive.”

set a target for Scotland to be tobacco-free (meaning that the smoking rate is very low) by 2034. Meeting this target would deliver huge health, economic and social benefits to Scotland, but it will not be met unless many more smokers in disad- vantaged communities who say they want to quit manage to do so.

The skewed social distribution of smoking, and the factors associated with it, demand a targeted response. That is why the pledge to create smoke-free prisons, where smoking

The alcohol industry and the ‘responsible drinking’ bodies they fund, such as Drinkaware, are constantly working to protect their profits by keeping us in the dark about the health risks. They have recently been found to misrepresent evidence about alcohol and the risk of cancer, borrowing from tobacco company tactics to deny the evidence, confuse and distract consumers.

“Making alcohol more expensive or changing how it’s advertised won’t make any difference, Scots will always have a problem with alcohol.”

It is disheartening to hear that Scots are sore signed and accepting of alcohol harm. by tack ling cheap, available and heavily marketed alcohol, we can all benefit. Even though more of us describe ourselves as non-drinkers, those of us who do drink are drinking more. Last year, enough alcohol was sold in Scotland for each drinker to have the equivalent of 48 bottles of vodka, or 124 bottles of wine. Alcohol is one of Scotland’s biggest killers: 24 people a week die due to alcohol.

Often people reveal how alcohol has touched their own lives in some way, whether they’ve had problems themselves or seen the consequences of harmful drinking. It may be growing up with a parent who was emotionally absent due to drink; it may be a relationship that broke down due to a partner’s drinking; or it may be the loss of a family member due to alcohol. Half of us say we’ve been harmed by another person’s drinking.

We need to have grown-up, open conversations about alcohol and tackle the myths. We need to be honest with ourselves about how much we are drinking and to discuss what is driving us to drink. It’s time we recognised the true cost of our drinking culture and asked “Is it worth it?” Alison Douglas, chief executive, Alcohol Focus Scotland.