As part of a multi-pronged drive against smoking, one health authority is forging partnerships with a wide range of outlets that sell tobacco.John Middleton and Chris Saxon report

Smoking is estimated to cost the NHS£1.7bn a year in hospital admissions and treatment.

1Inreal terms, the poorest 20 per cent of households spend as much on tobacco now as they did in 1968.

2These facts strongly support the case for closer integration of economic development and public health policy.

Sandwell in the West Midlands is the seventh most deprived local authority district in England, based on the 1998 Index of Local Deprivation.

3As part of our efforts to reduce smoking, Sandwell health authority commissioned a study to identify relationships between the state of the local economy and the sale of tobacco products.

The results have enabled recommendations to be made to the health partnership regarding the most appropriate ways of pursuing antismoking policies. The study looked at all outlets which were potential retailers of tobacco products, from tobacconists to hotels.

The study was based on a postal survey of retailers, with follow-up telephone calls and interviews to aid participation. Interviews were also held with trading standards and customs and excise organisations. In all, 57 retailers returned a completed survey. Of these, 41 retailers sold tobacco products.

Tobacco accounted for approximately one-sixth of turnover for the retailers studied - the proportion was higher for smaller businesses. The profit margin on tobacco - approximately 6 per cent - was reported to be less than for other lines. Tobacco products were, however, considered to be important 'traffic builders'. In other words, people often bought extra items after entering a shop to buy tobacco. So helping retailers to identify new traffic builders may be useful for decreasing their reliance on tobacco sales.

There is a clear role for the health partnership in helping to develop a sense of corporate citizenship within larger retailers. A positive start has already been made, with large supermarkets saying they are unlikely to display tobacco advertising, due to company policy.

A number of large and small businesses expressed an interest in being part of a confidential panel of retailers, to help the health partnership monitor changes in retail tobacco sales.

Sandwell has a high ethnic minority population, which has a major presence in the business community. The health partnership is working with minority ethnic groups to provide culturally sensitive services to aid smoking cessation. This includes, for example, translating health partnership information into minority languages.

In our study, retailers generally felt that increasing the tax on cigarettes merely encouraged customers to switch to cheaper brands rather than stop smoking. Channelling some of the tax revenue from tobacco into help to enable poorer people to stop smoking is of considerable importance, and the government's recent investment in smoking cessation services is a welcome start.

The availability of cheap cigarettes due to smuggling is clearly a public health concern. We are building links with the customs and excise service so patterns of distribution can be targeted.

Retailers generally felt that smoking by children was increasing, and expressed considerable support for the local 'proof of age' initiative. This reinforces the view that most retailers do not wish to sell directly to children. Since the survey was carried out, the Sandwell proof-of-age scheme and the responsible retailer programme have started.

In participating areas, trading standards officers initially found that no attempted test purchases by children were successful. Recently, however, two test purchases did result in sales. In one case the shop had just changed hands and the new proprietor did not know about the scheme. In the other, a member of the owner's family was helping out in the shop.

While such initiatives are clearly useful, preventing children from starting smoking by improving education and decreasing poverty is the most effective long-term anti-smoking policy. In the short term, we must continue our efforts to reduce smoking in our communities. Our research indicates that this can be done without adversely affecting the local economy.


1 Smoking Kills - a white paper on tobacco. The Stationery Office, 1998.

2 Family Spending 1997-98. London, ONS& TSO Ltd, 1998.

3 The 1998 Index of Deprivation. Sandwell Trends, 1999. Research Unit, SMBC, Oldbury, West Midlands.