If the measure of the wisdom of a policy is whether or not it is popular, then Rishi Sunak’s proposal to introduce an elevating age limit for smoking is a good policy. British voters tend to like banning things at the best of times, especially if they’re only banning things for other people.
The Prime Minister may also have chosen his moment well; the libertarian wing of the party – the one which made a health secretary of the cigar-smoking Thérèse Coffey, specifically – is still regrouping from, and to some discredited by, the collapse of Liz Truss’s premiership. It may thus be able to rally fewer MPs in the promised free vote than in the recent past.
But of course, popularity is not the measure of wise policy, at least to anybody who distinguishes between that and good politics, and Sunak’s mooted ban on cigarettes is a deeply unwise policy for a couple of reasons.
The first is that it stubbornly ignores the existence of the black market and all the lessons western countries have been learning, very slowly, in the course of the so-called war on drugs – not least of which is the obvious fact that banning something does not actually stamp out consumption of it.
Over 18 per cent of British cigarette consumption is already serviced by the black market, and this share has apparently been growing rapidly since the pandemic; a ever-rising smoking age would promise a captive market to smugglers and organised crime that would grow year-by-year.
This would undermine harm-reduction efforts, as consumers would be buying imported or counterfeit cigarettes manufactured outside the European regulatory regime, which has striven to drive down tar and nicotine levels; it would provide another revenue stream for organised crime and thus cross-subsidise it’s other activities, as does the drugs trade; it would hurt the Exchequer, as the state would forgo the revenue from tobacco duty; and it could even drive up overall smoking rates, as once a consumer has made the leap into the black market cigarettes are vastly cheaper there.
Moreover, it is worth making the point that however noble the sentiments Sunak expressed in his speech, the nuts and bolts of his practical case for the ban is straightforwardly wrong. If it worked, this measure would not reduce long-term pressure on the NHS – it would do precisely the opposite.
This next argument sounds callous, but when politicians plead the Health Service’s budget to justify imposing restrictions on citizens, the logic must be able to run in both directions. And the fact is that the state, in fiscal terms, is far better served by smokers than non-smokers. Even assessed very narrowly, the sheer amount of revenue brought in from tobacco duty more than covers any additional expense incurred treating the 10-20 per cent of smokers who do actually contract lung cancer.
But this assessment is inadequate; it ignores the fact that there is in fact, in public health terms, no such thing as a “preventable” death. There are only postponable deaths: everyone is going to die of something, and the odds are that in the case of most people who quit cigarettes, that something is going to be more expensive.
The actual long-term pressure on the NHS arises for the most part from an ageing population dying slowly of degenerative conditions, many of which, at least for now, are part and parcel of a long senescence for which no cure is available. (The other is obesity, which anyone who has quit smoking can tell you will not have been helped by declining smoking rates.)
Public health advocates tend to more-or-less explicitly reject the true cost-benefit analysis of smoking, both because it sounds callous but also, one suspects, because “cost to the NHS” is a compelling argument with the public and an honest assessment demolishes it in the case of tobacco. But the Prime Minister, apparently a details man, ought to know better.
There are of course other, principled arguments against the move: the moral distinction between the NHS as a social safety net and a social straitjacket; the problems with offering different treatment to otherwise-equal adult citizens; and so on. My aim here has been to illustrate that even in bloodlessly utilitarian terms, this policy would fail.
Of course, that seldom matters in this space; advocates of the sugar tax have not seemed troubled that it didn’t work, nor those of the smoking ban by the subsequent collapse (contra strenuous promises from pro-ban campaigners) of the pub and nightlife sector in parts of the country. Likewise, one suspects that Sunak’s ban would stick, regardless of whatever evidence of its real-world impact eventually emerged.
Which perhaps suggests another motivation for this announcement: securing a legacy.
Barring a real annus mirabilis, the Conservatives are going to lose the next election. Sunak will walk out of Downing Street on some morning in 2024 and surely never enter it again.
If so, what could he point to as his proudest achievement in office? Steadying the ship after a disastrous predecessor is not something to boast of, nor is cancelling a railway or filling a load of potholes. His more ambitious plans for new roads and railways will have to fight their way through the planning system and may never happen; the Advanced British Standard will take time to be introduced and could be unpicked by Labour.
He needs something that will stick, and be enduringly popular with the hoi oligoi to smooth his path into the role of grandee. George Osborne was Chancellor for six turbulent years but is today happiest talking about the sugar tax; perhaps that will be Sunak and smoking in 2030.