Smoking – the great leveller

Research carried out in the west of Scotland, and published yesterday in the BMJ Online (BMJ 2009;338:b480), revealed that the morbidity and mortality associated with smoking wiped out all of the advantages of social class and environment, as well as the natural longevity of women over men, compared with “never smokers”.

The research, by Laurence Gruer, director of public health science1, Carole L Hart, research fellow2, David S Gordon, head of public health observatory division1, Graham C M Watt, professor of general practice3  (1 NHS Health Scotland, Elphinstone House, Glasgow G2 2AF, 2 Public Health and Health Policy, Division of Community-based Sciences, University of Glasgow, Glasgow G12 8RZ, 3 General Practice and Primary Care, Division of Community-based Sciences, University of Glasgow, Glasgow G12 9LX ), was a cohort observation study set in Renfrew and Paisley, towns which lie to the west of Glasgow.

The study concluded:

“Among both women and men, never smokers had much better survival rates than smokers in all social positions. Smoking itself was a greater source of health inequality than social position and nullified women’s survival advantage over men. This suggests the scope for reducing health inequalities related to social position in this and similar populations is limited unless many smokers in lower social positions stop smoking.”

This report has received considerable media attention and was widely broadcast on the BBC this morning. Scotland has had one of the worst records of smoking-related ill-health and early death in the developed world and this was one of the reasons for introducing the UK’s forst smoke-free legislation nearly three years ago. At the time, the Scottish Ministers stated that one of the outcomes of the legislation should be that people smoke less and that fewer people smoke.

Soon after the smoke-free legislation came into force – I dislike intensely “smoking prohibition” for its demonisation of smokers rather than their habit – the University of Dundee concluded that:

Scotland’s smoking ban has had an immediate and positive impact on the health of bar staff who were previously subject to high levels of passive cigarette smoke.

Scotland has followed the lead of Ireland in creating smoke-free public places, eventually being followed by Wales and Northern Ireland and, most reluctantly, England. It is to be noted that fewer public places are protected in England than in Scotland and the weasels were out when the legislation was being debated, creating sneaky loopholes to protect privilege over public health.

Research like this is vital to promoting good decisions by people with regard to their own health choices. There will be more as time goes on and I confidently predict that, in thirty years time, smoking-related ill-health in Scotland will be a fraction of what it is now.

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