smoking and inequalities
In terms of smoking, there are inequalities across ethnic minorities, gender, socio-economic status, sexual orientation and gender identity. Most of these sub-groups have worst health outcomes than the population average, with a higher smoking prevalence among these groups.
Tobacco use is a major contributor to, and a driver of, health inequalities across Wales, and as a consequence represents one of the primary reasons why Wales is struggling to achieve a healthy population.
Smoking rates among males in certain ethnic minorities, males more generally, the LGBT community and socio-economically deprived individuals are significantly higher compared to the population average. These higher smoking rates are a key factor behind worst health outcomes for most of these sub-groups. Some of these inequalities are persistent, for instance, the gap between smoking prevalence in the most deprived compared to the least deprived has not fallen below 18% for the past decade, while inequality in smoking prevalence across gender has been falling in recent years.
Data collected in Great Britain since 1974 has shown that the percentage of males who smoke is consistently higher than that of females. However, since 1990 the gender gap has decreased significantly, with the overall smoking prevalence across both genders decreasing. In 1974, 51% of men and 41% women smoked in Great Britain, compared to 20% of men and 17% of women smoking in Great Britain in 2014. Currently 20% of men and 17% of women smoke in Wales (2016/2017 figures)2.
NB: Since 2000 data have been weighted. Since 2012 figures are from the Opinions & Lifestyle Survey3; previous data are from the General Household / General Lifestyle Surveys4.
Health Inequalities by socio economic status
Smoking prevalence rates among the less well-off population are significantly greater than those of the more affluent population. There is a well-evidenced link between socio-economic status and smoking prevalence. In Wales in 2017/2018 the percentage of adults from the least deprived areas of Wales reported as being a smoker was 13% compared to a figure of 28% recorded among the most deprived adults within the Welsh population – gap of 15 percentage points. This gap was 19% in 2016-17. The fall in inequality however was due to an increase in smoking prevalence for the least deprived areas, rather than a fall in prevalence in the most deprived areas.
The difference in smoking prevalence between the most deprived and the least deprived decile was 18% in 2005/06, which was the same as the figure for 2015/16, meaning that inequality in smoking prevalence by deprivation level has remained unchanged for the past decade. The data for 2015/16 and earlier is not directly comparable to the 2016/17 figure and subsequent years, given that there was a change in the survey used to generate these figures, from the Welsh Health Survey to the National survey for Wales,
The link between poverty and tobacco use and purchase can be seen by the fact that a higher percentage of poorer smoker’s household income is spent on tobacco.
There are substantial financial gains that can be made for a young family or a single parent through giving up smoking.
ASH research shows that in the UK 1.7 million households which include a smoker are currently in poverty but around 28% (over half a million) could be lifted out of poverty if they stopped smoking. This means 365,000 fewer children could be living below the poverty line.
It is important to identify the problems faced by smokers in less financially rich populations, such as:
The belief that smoking is more common within the general population than it actually is, making it more socially acceptable for less wealthy smokers to continue to smoke and giving them less encouragement to quit. They are also more likely to disengage from smoking cessation programs7
The age someone starts smoking within a poorer population is much lower than those who are better off – the longer a person has been addicted to nicotine, the harder it is for them to quit
They are more likely to use smoking as a coping mechanism for difficult life circumstances, for example stress, pregnancy, unemployment, redundancy and mental health issues.
Sexual Orientation and Gender Identity
A report conducted by ASH Scotland investigated the rate of smoking among the Lesbian, Gay, Bisexual and Transgender (LGBT) people and communities. It is important to recognise that LGBT people and communities tend to experience greater health and economic inequalities. Higher percentages of the LGBT community smoke and are less likely to quit in comparison to the general population. It is essential that health care professionals who deliver smoking cessation initiatives are adequately educated about LGBT communities8. It is also important that health promotion campaigns are inclusive of this group.
1 ASH (2011). Tobacco and ethnic minorities
2 Welsh Government (2017). National Survey for Wales 2016/17
3 2014 Opinions and Lifestyle Survey. Office for National Statistics, Feb 2016
4 2011 General Lifestyle Survey. Office for National Statistics, March 2013. PSA Delivery Agreement 18: Promote better health and well-being for all. The Treasury, Oct 2007 (pdf)
5 Assuming a price per pack of 20 of £6.70 (the cost of 20 Sterling cigarettes, the most popular UK brand, in a supermarket). In practice, many smokers will be spending more, for example the price of 20 Marlboro in a supermarket is currently around £9.60. Average daily consumption of cigarettes in England is now about 11 a day. Statistics on smoking: England, 2016. The Health and Social Care Information Centre, May 2016
6 Average weekly earnings Office for National Statistics. Release date 15 February 2017
7 NCSCT (2013). Stop Smoking Services and Health Inequalities. Briefing: 10
8 Partnership Action on Tobacco and Health (PATH) (2010). Stop-smoking service provision for Lesbian, Gay, Bisexual and Transgender (LGBT) communities in Scotland