Are the measures in the tobacco white paper bold enough? Pat Healy reports

To reduce smoking by children from 13 per cent to 9 per cent or less by the year 2010, with a fall to 11 per cent by the year 2005.

To reduce adult smoking in all social classes from 28 per cent to 24 per cent or less by the year 2010, with a fall to 26 per cent by the year 2005.

To reduce the proportion of women smoking during pregnancy from 23 per cent to 15 per cent by the year 2010, with a fall to 18 per cent by the year 2005.

All health professionals will be expected to play a key role in the government's war against smoking, outlined last week in the long-awaited tobacco white paper which targets children, pregnant women and adults who want to quit.

GPs, practice nurses, midwives, dentists, pharmacists, health visitors and other health professionals will be asked to become proactive by offering advice on quitting as a matter of routine and at every opportunity.

'Smokers need to be aware that those who know about health, advise against smoking,' the white paper says.

Counselling patients against smoking will be part of what health secretary Frank Dobson described last week as 'the first ever comprehensive NHS service' to help adult smokers quit. He promised to invest up to£60m over three years in a campaign targeting the poorest adults living in health action zones.

They will be offered free nicotine patches for a week, because evidence suggests that those who avoid smoking for that time with the help of patches are more likely to quit for good.

Mr Dobson also wants health improvement programmes all over the UK to tackle smoking, particularly in the worst-off areas.

Young people will be targeted through a three-year£50m advertising campaign, backed by stronger measures to stop under-age children buying cigarettes. There will be a new criminal offence covering repeated sales to children, and restrictions on the siting of vending machines.

Tobacco advertising on billboards and in print will be banned in the current parliamentary session, and most tobacco sponsorship will end by 2003. A voluntary code of conduct has been agreed to reduce smoking in public places.

The government wants to cut the number of smokers by 1.5m by 2010 - a target that disappointed many health organisations as not bold enough, though the proposals themselves have been widely welcomed.

Association for Public Health director Donald Reid says the white paper 'is a huge step forward in reducing smoking-related disease'. But while offering free nicotine patches to the poorest smokers will help, what is really needed is to remove the desire to smoke. 'And that means an assault on deprivation.'

The NHS Confederation says the white paper is 'comprehensive', but adds that the programme is inadequately resourced and inequitable. Chief executive Stephen Thornton says it will do little to help people on low incomes quit or to reduce the burden on health authorities and boards, which spend about£1.7bn a year on smoking-related illnesses.Smoking Kills.


See Comment, page 17.