Objective: To estimate the number of deaths that could be prevented in the UK by implementing population strategies to reduce smoking prevalence. Design: A prospective analysis of future mortality using recent national smoking prevalence data and relative risks of mortality in current smokers, ex-smokers, and never-smokers. Population: Smokers in the UK. Interventions: Population measures of proven effectiveness assumed to reduce smoking prevalence by 1 percentage point per year for 10 years, or alternatively by 13% over 19 years (1 percentage point per annum for seven years, 0.5 percentage point per annum for 12 years) as considered to be achievable in a recent report to the UK Chancellor of the Exchequer. S moking causes more death and disability in the UK than any other avoidable factor. About 24% of UK adults or 12 million people are current regular smokers, 1 and of those who continue to smoke, half will die prematurely from a disease caused by their smoking.2 Reducing smoking prevalence is therefore crucial to improving the public health. Major reductions in prevalence were achieved in the UK between 1960 and 1990, but throughout the 1990s there was relatively little change.
3The UK government has now banned all tobacco advertising and invested heavily in providing cessation services for smokers who want to quit. New surveys suggest that the prevalence of smoking has now begun to fall again, at about 0.4 percentage points per year. 1 4 Experience from other countries indicates, however, that much greater reductions could be achieved by implementing further simple but highly cost effective population measures to encourage cessation. These include progressive rises in cigarette price, sustained health promotion campaigns, effective health warnings on cigarette packs, and legislation to make all public and work places smoke-free.
5-11To estimate the potential public health impact of full implementation of these strategies we have calculated the number of deaths expected to be prevented according to three scenarios of prevalence decline over the next 10 years. These comprise first, a continued decline at the current rate of 0.4 percentage points per year, reflecting the likely maximum effect of no further intervention; second, decline at a rate of 1 percentage point per year, which we propose to be achievable if all available public health interventions were to be applied; and third, decline according to the ''fully engaged scenario'' defined in a recent report on future priorities for public health commissioned by the UK government, authored by Derek Wanless. 12 This report suggested that full implementation of available population strategies would reduce smoking prevalence by 1 percentage point per year for seven years, and then by half a percentage point per year for a further 12 years.
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METHODSWe used population data from the 2001 UK census 13 and smoking prevalence figures from the 2003 Omnibus Survey 1 to estimate the numbers of male and female smokers currently alive in the UK at each year of age up t...