Covid-19 has affected different groups in different ways and thrust the issue of health inequality into public debate. Whilst people are mistakenly concerned with inequality itself, there are good reasons to make it as easy as possible for those with worse health outcomes to lead healthier lives by expanding choice. This doesn’t have to come from top down state control or regulation, which is often unsuccessful, but can be driven by invention and the market.
In England those in the least deprived parts live, on average, 19 more years in good health than people in the most deprived areas. Some would jump for the easiest explanation, perhaps discrimination. However, the true causes are myriad and complex, but one thing that is clear is that those same groups with worse health outcomes are also more likely to smoke. ONS data suggests those earning below £10,000 per year smoke at double the rate to those earning above £40,000. Smoking is also expensive due to the high and regressive tax placed on the product. This further leads to a reduction in the money in the pocket of Britain's poorest: something confirmed by a 2019 University College London study which found that smokers could save around £780 a year by vaping instead. Vaping is therefore a win-win for both the health and income of Britain's poorest.
Despite the huge efforts from public health lobbies and vast amounts of taxpayer funding spent on cessation services, the most successful method for stopping smoking is vaping. A recent study found that smokers were able to abstain from smoking using vaping at nearly double the rate of those that used nicotine patches.
Ultimately, Britain's poorest have the most to gain from the innovations that are taking place in the new world of nicotine. But across the world, the freedom of individuals to vape is coming under attack: from Australia where vaping is effectively banned, to the Netherlands where a counterproductive ban on flavours is planned for 2021. The liberty for individuals to choose to improve their health by vaping is being constricted. The European Union is even considering taxing the product. Britain has largely been a force for good in promoting a harm reduction approach, with much of the world looking on at our ever-reducing smoking population with envy. However, these changes have not come about because of government mandates, but instead due to vaping technology being developed and sold by entrepreneurs.
This wave of innovation is not over. Entrepreneurs and businesses have developed other lower-risk nicotine products which may entice those that haven't chosen to switch to vaping. Swedish Snus (which to the EU's shame was banned in the 1990s) continues to save lives in Sweden where they have the EU’s lowest cancer rate in men due to its use as a safer alternative to smoking. Perhaps now we have left the EU and are free to make our laws the Government may decide to legalise its sale. Already though inventors have circumvented the ban on snus and introduced tobacco-free alternatives called nicotine pouches.
Inventors have also found ways to heat tobacco but avoid the dangerous combustion, therefore delivering nicotine to the user without many of the harmful health effects. One such product has recently been authorised by the U.S. Food and Drug Administration to be advertised in America as a modified risk product. The ability to inform the public about health risks is important because currently a large proportion of UK smokers and ex-smokers overestimate the relative harmfulness of e-cigarettes: misattributing smoking harms to nicotine rather than the combustion of cigarettes. A film to be released this year aims to try and combat these misconceptions.
The British Government has set an ambitious plan to be smoke-free by 2030. But the truth is that unless the Government stops preventing firms and individuals spreading the message about these reduced risk nicotine products then we will miss the target by some margin. It is frankly not good enough for the Government to do nothing on this issue, it actually needs to get out of the way.
Mark Oates is a Fellow at the Adam Smith Institute, as well as the Director of We Vape and the Snus Users Association.