UK MPs have just passed the Tobacco and Vapes Bill by a 383 to 67 vote. If the measure becomes law it will ban the sale of tobacco products to anyone born after January 1, 2009. This is not just an age limit – this is a permanent phased ban. If the law passes and stands, anyone born after that date will never be able to purchase tobacco products in the UK.
The measure has sparked another round of the endless debate regarding the role of the government in protecting people from themselves. Even ardent defenders of SBM can have good faith disagreements on this issue, as ultimately it is a value judgment regarding competing principles. Personally I find the arguments in favor of the ban far more compelling, but I can understand those who choose to prioritize individual liberty and worry about government overreach into our personal lives.
Such debate should at least be based on some shared understanding of the facts, so let’s review some of them. In 2024 we shouldn’t have to spend too much time defending the overwhelming consensus of scientific opinion that smoking is a significant health risk, but here’s the data. I’ll give some UK and US numbers for comparison.
In 2022, 12.9% of adults 18 and over in the UK were current smokers. In the US the percentage is 11.5%. The health impacts are significant. “There were 506,100 hospital admissions due to smoking in 2019/20, and in 2019 there were 74,800 deaths attributed to smoking among adults aged 35 and over.” In the US, according to the CDC, “Cigarette smoking kills more than 480,000 Americans each year.” This makes smoking the leading preventable cause of death.
What about the cost to society? Again from the CDC – “Cigarette smoking cost the United States more than $600 billion in 2018, including more than $240 billion in healthcare spending and nearly $372 billion in lost productivity.” In the UK – “Smokers’ need for health and social care at a younger age than non-smokers also creates costs, with smoking costing the NHS an additional £2.4bn and a further £1.2bn in social care costs.”
Smoking, therefore, has a significant cost to society in both money and lost health, and it is entirely preventable. Much of this cost is borne by the government, which gives it a legitimate interest in reducing this cost.
Do smoking bans work? The short answer is yes. Social bans on smoking reduce smoking and its health consequences, as do taxes on tobacco products. There is also evidence that bans on smoking in public places reduce the negative health effects of second-hand smoke.
From what I can see so far, the debate over the phased ban in the UK is focusing on the issue of liberty, not contesting the science. This is good as that is where the debate should focus, because the science at this point is fairly clear. Tobacco use is a demonstrable health risk, it is very costly to individuals and society, and laws that make smoking more difficult are effective at reducing the behavior, improving health, and saving money. So the only questions that really remain are those surrounding personal liberty.
But there is one more science-based consideration that impacts the question of liberty – the addictive potential of nicotine and smoking. Nicotine acts upon the same dopaminergic system as other addictive drugs, in the nucleus accumbens. But it has neurological effects beyond dopamine, affecting the “GABAergic, serotonergic, noradrenergic, and brain stem cholinergic” systems.
Further, because of the mechanism of drug delivery, nicotine can affect the brain within 20 seconds of inhaling. This strongly reinforces the pharmacological addiction and also the behavioral addiction. The consensus is that nicotine is as addictive as heroin, opioids, and cocaine, and some argue it may be more addictive.
About 68% of adults who smoke report that they would like to quit but find it difficult because of addiction. In 2018 55% of smokers made an attempt to quit, but only 7.5% did. Further, most people who regularly smoke began smoking by the time they were 15 years old. This significantly complicates the argument that smoking bans are an infringement on the liberty of adults.
Essentially people start smoking when they are teenagers, and their ability to control their behavior and make strategic life decisions is not yet fully developed. They then become addicted to nicotine and smoking, which locks in this behavior into adulthood. When they are ultimately old enough to decide that they do not want to smoke, they are already addicted and find it extremely difficult to quit. It is highly problematic to defend this scenario as the liberty of informed adults to make decisions for themselves.
Even worse, there is evidence that the tobacco industry targeted teenagers, specifically because they understood the above dynamic. We are now seeing this cycle repeat with vaping.
This is an interesting more general question – how does addiction affect liberty and personal choice? Is a decision that someone makes under the influence of biological and psychological addiction truly a free choice and an expression of their individual liberty? I think there is a strong case to be made that the answer is no. But people generally don’t like to think of themselves as biological machines, or that our freedom can be so mechanistically compromised.
There is still room for debate about the proper role of government and where we draw the line on micromanaging individual behavior. But I don’t think superficial platitudes about “liberty” are sufficient. Any discussion has to account for the health effects of tobacco, the cost to society, and the role that addiction plays in individual behavior.
Framing is also important here. We can simply frame the issue as one of consumer protection. Tobacco is a harmful and addictive product. If something similar were introduced today, it’s difficult to see that it would garner regulatory approval.