Labour and Conservative public health policies are good for gangsters and bad for smokers and kids

We have an acceptable substitute for cigarette smoking, one that is vastly safer and healthier than smoking, so the only sensible policy is that which the UK has been following, promoting vaping.

“As another tobacco shop burns in Melbourne, the federal government announces a $188 million crackdown on the tobacco black market, hoping to stop imports before they reach the Australian border.”

This is reported by ABC News in Australia amidst a growing black market for tobacco and e-cigarettes. This is entirely self-inflicted by Australia’s government coming as a result of their “tobacco control” policies including the world’s highest tobacco taxes and a ban on vaping other than via prescription. The new puritan urge to ban works, as it always did, hand in glove with the gangster. And the result is that, uniquely in the developed world, Australia has not seen declines in smoking by adults or the take up of smoking by children. The policies come about because of political fussbuckets buying the arguments of public health ‘experts’ who seem to be entirely oblivious to the realities of economics and, very often, real world evidence.

Sadly the UK, up till now an exemplar in reducing smoking harms, appears about to take the wrong route. The Prime Minister opted for a policy introduced (and now withdrawn) in New Zealand of gradually banning cigarettes by increasing the age at which they can be legally purchased each year. Reading that story from Australia we can expect that the consequence of this policy (imagine when you need to prove you are 35 to buy tobacco because 34 year olds can’t) will be a new and extensive black market. One, like all black markets, run by gangsters.

To make matters worse the Labour opposition in the UK supports this policy proving, yet again, that stupidity is not the exclusive domain of the Conservative Party. And Wes Streeting, Labour’s usually impressive health spokesman, rolls out policies taken from the more deranged sections of public health. On top of the rolling tobacco ban, we will get a ban on disposable vapes and flavoured vapes.

“To those in the vaping industry who have sought to addict a generation of children to nicotine with flavours like rainbow burst candy, you have been warned. A Labour government will come down on you like a ton of bricks”

This is a bad faith argument that derives from the well-funded moral panic about vaping led by Mike Bloomberg and his billions. While the numbers of young people taking up smoking has fallen to its lowest ever levels, millions have been spent by Bloomberg on creating false claims about the health impacts of vaping and the numbers of young people using e-cigarettes. It is this moral panic that lies behind repeated claims of there being a vaping epidemic among young people despite the evidence telling us that there isn’t. Here is what Action on Smoking and Health (ASH) say:

“In 2023 20.5% of children had tried vaping, up from 15.8% in 2022 and 13.9% in 2020 before the first COVID lockdown. The majority had only vaped once or twice (11.6%), while 7.6% were currently vaping (3.9% less than once a week, 3.6% more than once a week) and the remainder (1.3% in 2023) saying they no longer vape.”

The context for these figures is that in 2000, shortly before e-cigarettes became available, ASH reported that 19% of young people were current smokers. By 2018 this had fallen to just 5% and today has fallen further to 3.7%. There is no doubt that vaping has been one of the biggest factors driving this accelerated decline in children smoking. ASH also found that vaping is almost entirely used as a substitute for smoking and that there is no evidence of a gateway effect where using e-cigarettes leads to the adoption of smoking. Streeting’s claim that vape manufacturers use flavours to “...addict a generation of children to nicotine…” has no basis in fact and derives entirely from the febrile anti-vaping campaigns from some parts of the public health industry.

On top of this moral panic about children vaping, there is a continued claim that smoking costs the NHS enormous amounts of money making it uniquely evil (the uniqueness is, of course, challenged by public health who also claim that booze and burgers are a drain on society). Since 2011 rates of smoking in the UK have fallen by 36% yet the claims about its cost to society continue. Most of this decline is entirely the result of people substituting vaping for smoking and the flavours used in vapes are cited by adult ex-smokers as one of the big reasons for switching away from cigarettes - put simply vaping isn’t just much less harmful, it is also more pleasant. Despite this, ASH found that 40% of current smokers thought vaping is as harmful as smoking and, for young people, “most children wrongly believe that vaping is about the same or more harmful than smoking”.

Labour’s (and, in part, the current Conservative government’s) policy around smoking is based on a slightly snobbish disdain for smokers accompanied by a moral panic around vaping that has led to people believing the latter is as harmful as smoking and that the industry is using flavour to trap children into an addiction. None of the actual evidence says that any of these claims are true. The only beneficiaries from Streeting’s proposals will be the criminals who run black markets and the losers will be existing smokers and vapers who Streeting wishes to deny choice. We see from Australia that aggressive controls on vaping don’t eliminate their use but rather drive the market into the hands of criminals. The proposed rolling ban on smoking and flavoured vapes in the UK will do the same. Worse, the most likely outcome of these bans will be to stall the progress the UK has made over the last decade in reducing the harm from smoking.

Streeting’s proposals have been wrapped up into an ‘it’s for the children’ argument alongside other false claims (children being shorter and fatter, for example) as well as a selection box of new puritan policies about food, drink and dentistry. The benefits of vaping are almost entirely benefits for adult ex-smokers, yet we are proposing to limit or remove these benefits because of an almost entirely fictional scare story about the risks of vaping and its use by young people. 

There is, as these proposals from Labour show, a profound problem with public health policies, management and leadership. We saw how unprepared public health was for a pandemic and might have hoped that the response post-Covid would be to reappraise policy priorities within the sector. Sadly the leaders in public health simply returned to their obsession with food, drink and, increasingly, vaping. This obsession often seems, as with the latest panic about ‘ultra-processed foods’, to be motivated more by snobbishness than an evidence-based quest for a healthier environment. Vaping, a product developed by the private sector for consumer markets, suffers from what might be called ‘not invented here syndrome’. Public health management, having failed to reduce rates of smoking through state intervention, looked angrily as a consumer product provided a popular substitute for smoking and delivered a huge reduction in health harm from smoking. Their strategy of advertising bans, health warnings, plain packaging and price ramps had not worked because the only ‘substitute’ public health could offer was quitting entirely which many smokers could not achieve or would not consider. Worse, public health’s preference from using tax to reduce consumption created a huge opportunity for criminal arbitrage meaning that the biggest ‘tax dodgers’ in Britain weren’t big bad businessmen but rather the gangsters smuggling cigarettes and hand-rolling tobacco (often alongside other products like hard drugs).

Politicians need to look more closely at the actual evidence of harms rather than simply accept the sort of nonsense we saw from Henry Dimbleby about food and the persistent scare stories from Bloomberg-funded groups about vaping. We have an acceptable substitute for cigarette smoking, one that is vastly safer and healthier than smoking, so the only sensible policy is that which the UK has been following, promoting vaping. Similarly with obesity, the option of semaglutide is game-changing. Instead of snobby and pretentious attacks on ‘junk’ foods and evidence-light claims about ‘ultra-processed food’, we have a treatment-based response for obese people challenged by losing weight. And we should not be using children as the excuse for introducing policies that either have no real effect or else primarily impact adults.

It does not surprise me that Labour, as a left of centre party, is a fan of ineffective interventions around lifestyle choices but it remains the case, and the left ought to know this, that the best way to improve health outcomes is for people to be better off. We hear a lot about health inequalities but nobody seems to arrive at the logical position that economic growth is the best response to poverty and, therefore, the best response to getting a healthier population.