Smoking and Ill Health: Does Lay Epidemiology Explain the Failure of Smoking Cessation Programs Among Deprived Populations?
The resistance of disadvantaged groups to anti-smoking advice is remarkable. In relation to the study of differing cultures, there is a long-standing academic tradition assuming that behavior that may otherwise be difficult to understand is indeed rational within particular cultural contexts.
Persistent smoking among the most deprived members of society may represent a rational response to their life chances informed by a lay epidemiology. Health promotion initiatives designed to reduce smoking among members of these groups may continue to fail unless the general health and life chances of such individuals are first improved.
The study (from 2003) confirmed the fairly obvious observation that those on the lowest incomes are most resistant to anti-smoking campaigns. There is a strong social gradient to smoking prevalence which didn't exist fifty years ago.
Although not explored in this study, one result is that taxing cigarette is about the most regressive form of taxation imaginable. Anti-smoking campaigners argue that those on low incomes benefit disproportionately from higher tobacco duty because, since they are least able to afford it, they will be most likely to quit smoking. They say that "a disproportionately number of lives of the poor are likely to be saved by a cigarette tax." It's a nice piece of rhetoric and for most products it would hold true (price relative to income affects consumption).
But tobacco is not most products and this simple economic formula does not take into account why people smoke. The proof of the pudding is in the eating and history is a better guide than economics on this issue. Decades of experience have shown that raising tobacco duty widens both health inequalities and financial inequalities. And while smoking is obviously linked to poor health, so is poverty.
Few politicians are eager to acknowledge, let alone address, this thorny issue. Tobacco duty raises around £13 billion a year in the UK.