The years between 2006 and 2024 saw dramatic shifts in smoking prevalence across England. A major driver of positive change has been tobacco control, an essential public health measure. However, despite progress, regional inequalities and socio-economic disparities in smoking persist, with the North of England showing remarkable improvements while the South lags in certain areas.

This blog examines the trends of smoking prevalence in England from 2006 to 2024, evaluates socio-economic inequalities, and explores the impact of tobacco control initiatives.

Declining Smoking Prevalence Across England

Smoking prevalence in England steadily dropped from 25.3% in 2006 to 16.5% in 2024. This 8.8 percentage point (ppt) reduction highlights the success of national policies like high tobacco taxation, public smoking bans, and plain packaging regulations. Importantly, the data reveals that socio-economic disparities in smoking prevalence narrowed significantly during this time.

• Among less advantaged groups (C2DE), smoking rates declined from 33.2% to 21.4%, a remarkable 11.8 ppt decrease.
• Among more advantaged groups (ABC1), rates fell by 5.9 ppt (from 18.7% to 12.7%).
• This reduction narrowed the smoking gap between socio-economic groups from 14.6 to 8.7 ppts over the 18 years.

These results emphasise that focused tobacco control efforts can address health inequalities effectively.

Regional Disparities in Smoking Prevalence

Northern England Leads the Way

The North of England initially reported the highest rates of smoking in 2006, with a prevalence of 28.8%. By 2024, the North achieved the largest reduction nationally, falling to 15.8% (−12.9 ppts).

Key Regional Trends:

• Yorkshire and the Humber recorded the biggest decline, with smoking prevalence dropping from 30.0% to 16.0%.
• The North West region saw a decrease from 28.3% to 15.7%.
• Meanwhile, the North East, a region with consistent tobacco control campaigns, reduced rates from 27.4% to 16.0%.

Areas like Yorkshire not only achieved reductions in smoking, but also narrowed socio-economic inequalities significantly (from 17.9 ppts in 2006 to 3.7 ppts in 2024).

Midlands Stays on Track

The Midlands was in line with the national average, starting at 25.2% in 2006 and dropping to 16.0% in 2024 (−9.2 ppts).

• West Midlands excelled, reducing prevalence by 12.0 ppts (from 26.7% to 14.7%).
• East Midlands saw a smaller decline (from 26.9% to 16.4%).

Socio-economic disparities improved most in the West Midlands, where less advantaged groups saw significant reductions, narrowing the gap from 16.1 to 3.0 ppts.

Southern England Faces Challenges

The South began the study period with the lowest prevalence rates but achieved the slowest reduction, declining from 22.7% to 17.3% between 2006 and 2024—just 5.3 ppts.

Regional Highlights:

• London, with the lowest rates in 2006 (20.5%), recorded only a 3.4 ppt drop, ending at 17.0%.
• The South West showed positive trends until 2020 but saw a worrying increase from 16.0% to 18.7% by 2024.

Unlike the North, socio-economic disparities in London narrowed only slightly, with less advantaged groups experiencing limited improvements.

Tobacco Control and Its Impact

England’s uniform tobacco control measures—such as increasing cigarette taxes, banning advertisements, and running public health campaigns—have significantly contributed to smoking reductions nationwide. However, regions with additional, localised initiatives achieved even greater success.

Case Study 1: North East England

The North East maintained a robust tobacco control programme throughout the study period. This included media campaigns, improved quitting support, and community-mobilisation efforts. By 2024, smoking prevalence in the North East had fallen 13.3 ppts to 16.0%, outperforming regions with fewer local initiatives.

Case Study 2: South England

Conversely, areas in the South, such as London and the South West, lack consistent, targeted interventions. This inconsistency may explain why these regions reported slower progress and, in some cases, increases in prevalence.

The evidence underscores that sustained and focused tobacco control measures can amplify the impact of national policies and tackle smoking-related health inequalities effectively.

Challenges from 2020 to 2024

The final years of the study reveal diverse trends across England.

• The North continued a steady decline during this period, dropping from 17.5% to 15.8%.
• The Midlands improved slightly, moving from 16.8% to 16.0%.
• The South, however, saw rates rise from 15.7% to 17.3%.

The stagnation or reversal in regions like the South presents a clear call for action, highlighting the need for renewed focus on tackling smoking, particularly among less advantaged groups.

Crucial Lessons for Tobacco Control

This analysis provides valuable lessons for public health policymakers and practitioners striving to reduce smoking prevalence and health inequalities.

Key Takeaways:

1. Regional Tobacco Control Works

Regions with sustained initiatives for tobacco control, like the North East, saw remarkable progress. Investing in targeted campaigns and support services can yield significant benefits.

2. Focus on Socio-Economic Disparities

By prioritising disadvantaged groups through tailored interventions, policymakers can address the root causes of health inequalities.

3. Combat Stagnation in the South

Focused efforts are urgently needed in areas like London and the South West to prevent reversal of progress and ensure nationwide improvements.

4. Monitor and Adapt Strategies

Regular evaluations of tobacco control programmes are essential to identify gaps and adapt to emerging challenges.

Shaping a Smoke-Free Future

England has made substantial strides in reducing smoking prevalence and narrowing inequalities between 2006 and 2024. The North’s success story, driven by tobacco control measures, proves that focused efforts pay off. Yet the challenges faced by Southern regions highlight the need for renewed strategies and sustained action.

By maintaining tobacco control as a public health priority, England can continue its progress toward achieving the Smokefree 2030 target, ensuring healthier lives for all.

Source: Wiley. Online Library