With Hastings topping the charts for the number of women smokers, former GP Kathryn Vale questions whether the government is fully committed to eradicating the habit.

Recent statistics proclaim Hastings has the highest proportion of women smokers in the UK: 27.8% of the town’s women smoke, compared to a national average of 14.1%. This is not so surprising when you remember the survey two years ago that identified Hastings as the seventh worst place in England and Wales for being a girl, on economic, educational and health criteria. We know already the correlation of smoking with general disadvantage.

In World War I, cigarette rations helped keep young soldiers tranquillised. In World War II many women took up smoking as a coping mechanism. Doctors – I worked as one for 35 years – gave up smoking in droves in the 1950s when the evidence that it kills became undeniable.  So why do so many health workers still smoke?

In my experience high status, well off people tend not to smoke. The overworked and underpaid are more likely to smoke, including health workers that regularly witness premature deaths of smokers in their care. Smoking is the biggest cause of health inequality. The habit pushes many households into poverty. Cigarette addiction is rapid. Using what is essentially a dummy to cope with life’s difficulties is augmented by the addictive qualities of nicotine. Look at Winston Churchill (horrible childhood and severe depression), and rarely seen without a cigar. Ditto the Thomas-the-Tank vaping puffers, whose plastic tubes-in-the-mouth help them cope, at a price, with a challenging world.

Only 15% who try to stop, manage it for a whole year, with up to 12 failed attempts on
average before they succeed permanently. Withdrawal symptoms include weight gain, craving, anger, anxiety, depression, difficulties concentrating, impatience, insomnia, restlessness, constipation, coughing, dizziness, mouth ulcers, and often a ferocious chest infection as the lungs react in horror to fresh air. But benefits are considerable – you can improve your blood pressure, heart rate, carbon monoxide levels, sense of smell and blood circulation. Lung function will be better, and cough and risk of heart attack decrease within a year. Fertility goes up (impotence in men improves too) and, if you stay off for five years, your risk of a stroke falls back to non-smokers’ levels. Cancer risks decrease (bladder, cervix, mouth, throat, oesophagus), though the risk of lung cancer only halves after ten years’ cessation.

The conflict for government is this. Smokers pay a lot of tax, regardless of whether or not they are income tax payers. Even allowing for the guy down the pub who sells smuggled cigs and kill-you-quicker tobacco for roll-ups, the state still makes £12 billion a year out of those selfless smokers who pay all that tax and then die young. On the other hand the cost of smoking in lost productivity, fire deaths and cleaning up dropped fag ends added to NHS expenditure in treatment of underweight babies, cancer victims, amputations and infertility etc has been estimated to amount to around £14 billion. But at least, from the point of view of the state, smokers tend to die prematurely, often before taking their pension, and thus will cost less in expensive social care later on.

Well, women of Hastings – or at least the 27.8% of you who smoke – you have a choice. You can carry on paying all that tax that will support the rest of us into a healthier old age; or stop, and maybe live to see your non-smoking grand-daughter’s wedding day as a wise old woman. I’ve watched many brave women smokers do it. And bliss! It’s never too late.

•  In most countries men ‘outsmoke’ women by a considerable number.
In the UK the numbers are about equal.
The cost of a pack of 20 cigarettes in 1970 was 20p.
By the year 2000 the same pack cost £3.88.
In 2018 the average cost for 20 cigarettes is over £10.00.
In 2016 cigarettes raised £12 billion in tax.
The cost of a pack of 20 is made up of 80 to 90% tax.
A recent study published in the British Medical Journal suggested that putting the price up to £20.00 a pack would make millions quit. Others claim price increases merely fuel the already thriving illegal market.

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