The Khan Review: Making Smoking Obsolete

August 30, 2022

The publication of the Khan Review in June 2022 unleashed a torrent of articles and responses from the public. On one side of the aisle were health experts and concerned citizens praising its practical measures. But on the other side were critics wondering whether it was too little, too late for guiding the nation toward a smoke-free future. 

Regardless of which side of the debate readers fell on, it was clear the government would push forward with its programme to make England smoke-free by 2030. The Khan Review was a step forward in that endeavour of making smoking obsolete.

What is the ‘Making Smoking Obsolete’ Review?

The Khan Review is an independent review by Dr Javed Khan OBE to support the UK government’s ambition to extend life expectancy by five years by making smoking obsolete. 

In 2019, the government set a target for England to be smoke-free by 2030. The benchmark required that only 5% of the population would smoke by that deadline.

There is also a 10-Year Cancer Plan that aims to improve the diagnosis and treatment of cancer. 

Dr Khan found the nation could not achieve this commitment unless the government took further action. His review listed four critical actions to accomplish these objectives.

What Were the 4 Critical Recommendations?

1. Increased Investment

Dr Khan stated that extra funding of £125 million was necessary to develop the quality support smokers need to help them quit. The investment should include an extra £70 million yearly solely ringfenced for smoking cessation services.

In his review, the doctor suggested the funding could come from a tobacco industry levy or a rise in corporation tax. This investment is needed immediately to reach the 2030 deadline.

2. Increase the Age of Sale

Another crucial point that the government has been trying to achieve is to increase the age at which people can start buying tobacco products. Reports about raising the legal smoking age to 21 had already come out, but Khan took these measures one step further. He suggested that the government increase the legal smoking age by one year every year until, eventually, no one will be able to buy cigarettes in England.

Smoking amongst teenagers is declining slightly, with the highest smoking prevalence seen in the age group 25-34 years. 

That said, Dr Khan’s recommendation is to phase out the sale of tobacco products, not necessarily focus on young people. Despite this, data suggest that the earlier smokers quit in terms of age, the proportionally better their health will be and the lower the risk of mortality from smoking or smoking-related complications.

3. Promote Vaping

Vaping is not a silver bullet, but its use is an effective tool to help people quit smoking. Dr Khan acknowledges the risks associated with vaping but suggests the alternative is much worse.

Khan’s recommendations go hand-in-hand with the NHS, which advises using e-cigarettes for smoking cessation.

4. Improve Prevention in the NHS

Smoking costs the NHS £2.4 million every year. Khan says it's time for the NHS to deliver on the commitments made in its long-term plan.

The NHS needs to do more to encourage people to stop smoking and offer advice and support. He says smoking prevention must become culturally embedded in the health service.

Committing tangible resources for this purpose will produce substantial financial savings. Smoking prevention and support to quit should be evident in every interaction a smoker has with the NHS, be that midwifery, pharmacy, dental, optical care and, of course, GPs and hospitals.

Other Proposed Recommendations

Dr Khan delivered other recommendations to create an integrated and holistic response to Smoke-Free 2030:

• Introduce a government-led tobacco licence for retailers to limit the availability of cigarettes and tobacco products throughout the country
• Change cigarette packaging and design to reduce their appeal
• Increase the number of smoke-free locations in public places, like hospitality venues and places where children are present, to make smoke-free the norm and smoking the exception
• Invest in a multi-media campaign to create and support a smoke-free culture whilst encouraging existing smokers to quit.
• Raise the cost of duty by over 30% on all tobacco products so that smokers are discouraged by high prices.
• Abolish duty-free tobacco products at the border
• Accelerate the path to prescribed vapes
• Provide free Swap to Stop packs in deprived communities
• Actively campaign and pass legislation to prevent children and young people from vaping, including banning child-friendly packaging and product descriptions.
• Provide government support for the most deprived areas and groups disproportionately affected by smoking, such as those with mental health conditions and pregnant women
• Tackle illicit tobacco sales targeted at underage smokers and young people
• Invest government funds in new research on smoking-related health disparities

Conclusion 

The Khan review makes it clear a society-wide effort is necessary to reduce tobacco use. Only a multi-faceted approach will achieve the government’s aim to be smoke-free in England by 2030.

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