Editorial
A tobacco-free generation: the end goal of the endgame
Last year The Lancet Respiratory Medicine published an sale; promoting vaping as an effective tool for quitting
Editorial discussing how the tobacco endgame initiative smoking; and lastly, improving prevention in the NHS
could best establish a tobacco-free generation, in which by offering advice on quitting smoking during every
less than 5% of the European population uses tobacco interaction with health services, including visits to
Voisin/Phanie/Science Photo Library
by 2040. A major goal to achieve this initiative will be to GPs, dentists, and optometrists. Jeanelle de Gruchy
ensure that children and adolescents receive adequate presented her modelling data which suggests that
help to avoid tobacco-related and nicotine-related there is a proportionate reduction in the demand and
products, in particular electronic nicotine delivery systems reliance on illicit products when legal products are made
which are highly addictive. less available. The counter-argument that these bans
These tobacco control discussions have continued infringe on the freedom of choice afforded to the public Published Online
February 12, 2024
and in January this year, The Lancet Respiratory Medicine on whether to smoke was also discussed. Although such https://doi.org/10.1016/
was invited to a panel discussion focused on policy an argument fails to account for the economic and social S2213-2600(24)00033-X
changes in the UK that would best serve those already burden that smoking imposes, as well as the freedom of This online publication has
been corrected.
addicted to smoking, and how to implement cessation choice to avoid exposure to the effects of second-hand The corrected version first
in the most at-risk groups. A key component of this UK smoke, and the need to protect children from harm. appeared at thelancet.com/
respiratory on
policy is in the tobacco control manifesto proposed by Much of the debate at the event focused on Europe, February 28, 2024
the Prime Minister, which will make it an offence for but New Zealand, who were leading the way in tobacco For the 2023 Editorial see
Editorial Lancet Respir Med 2023;
anyone born on or after Jan 1, 2009, to be sold tobacco control efforts, have seen their progress thwarted by a
11: 493
products. Other action points in the manifesto include new coalition government. The Smokefree Aotearoa 2025 The panel discussion on tobacco
establishing an Illicit Tobacco Taskforce, led by HMRC Action Plan had three initiatives due to be implemented control was organised by
The European Respiratory
and Border Force, to oversee the future evolution of this year that have now been axed. Smoking-related Society and held on
an illicit tobacco strategy, £70 million per year for local illness disproportionately affects the Māori population, January 23, 2024, at Imperial
College’s School of Medicine,
authority-led stop smoking services, and £10 million especially Māori women who have among the highest St Mary’s Hospital, London, UK
over 2 years for financial incentives to support pregnant lung cancer rates in the world. Speakers discussed the For the UK manifesto see
smokers to quit. In addition, there are efforts to make proposed decrease of licensed outlets, with only 600 https://commonslibrary.
parliament.uk/research-
vape products less attractive to children by introducing to remain across New Zealand that could sell tobacco briefings/cbp-9655/
restrictions on flavours, promotion, packaging, and products; a reduction of 90%. For Khan’s review see https://
www.gov.uk/government/
point-of-sale displays. The event served as a sobering The momentum towards the tobacco endgame gained publications/the-khan-review-
reminder of how lethal this legal substance is. One quarter thus far is due to the wholly unique alignment of the making-smoking-obsolete
of all cancers are linked to smoking, and smoking-related efforts of public health officials, governmental parties, and
cancer services costs the UK NHS £2·4 billion each year. medical communities. The proposed UK manifesto is a
Jeanelle de Gruchy, England’s Deputy Chief Medical Officer, comprehensive package and experts agreed that it needs
noted in the discussions that social disparities and the to be implemented before the next UK election to have
attributable mortality by economic deprivation—that immediate impact.
smoking exacerbates—can be readdressed with the A lasting message from the meeting was that for
implementation of the manifesto. the tobacco endgame to succeed across the globe,
Hazel Cheeseman, Deputy Chief Executive of each individual agenda needs a champion, no public
Action on Smoking and Health, led the first panel health charity or non-governmental organisation can
on actions for tobacco control and one of the gain enough traction on their own to enact change.
presenters, Javed Khan, Director at Grosvenor, UK, Various coalitions are already established and working
reflected on four crucial recommendations to achieve effectively and should be aligned with campaigners who
lasting change. These include increased investment, with can relentlessly push forward agendas. The smoke-free
£70 million in funding for cessation services sourced generation legislation will move us closer to making
by “the polluter paying” from a tobacco industry levy, smoking obsolete, which is not just the endgame, but the
or additional corporation tax; increasing the age of end goal. ■ The Lancet Respiratory Medicine
www.thelancet.com/respiratory Vol 12 March 2024 181
