Cigarette Tax Receipts v Cost of Running the NHS

Ian Walker made this Freedom of Information request to Department of Health and Social Care

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The request was partially successful.

Dear Sir or Madam,
My partner,trying hard to give up smoking, suggested that if every smoker 'gave up' then the NHS would be in even greater financial difficulty. I replied that the cost to the NHS as a result of smoking related illness would far out-weigh the Tax Income from cigarette sales.
Where-as we appreciate that cigarette Tax falls into the Revenue Tax bucket, as opposed to forming an identifyable money paid direct to the NHS, we all (as this was part of a pub discussion group) be interested in some hard financial facts relating to cigarette Tax Income and costs to the NHS resulting from smoking. Thankyou for your time.

Yours faithfully,

Ian Walker

Department of Health and Social Care

Thank you for your enquiry.

We aim to respond within 20 working days.
If there is likely to be any delay we will contact you to let you know.

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Department of Health and Social Care

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Dear Mr Walker,

Thank you for your recent email to the Department of Health about the
revenue generated from tobacco sales. I have been asked to reply.

It is very difficult to establish an exact figure on what smoking related
ill-health costs the NHS. However, smoking is the largest single cause of
preventable illness and premature death in the UK. It kills 106,000
people every year and costs the British taxpayer more than -L-1.7billion a
year in treatment bills alone. It causes 84 per cent of deaths from lung
cancer and 83 per cent of deaths from chronic obstructive lung disease,
including bronchitis.

The revenue generated from tobacco products is a matter for HM Treasury.
However, it should be noted that the Government, as a whole, has made the
decision to reduce smoking rates in England. In 2004, the Government
agreed an overarching target to reduce smoking substantially from 25 per
cent in 2004 to 21 per cent or less by 2010 and to reduce smoking among
routine and manual groups to 26 per cent or less. The Government expects
that reducing smoking rates will lead to a loss of revenue to the
Exchequer. However, any loss to the Exchequer is balanced by the fact
that thousands of lives are saved through the Government's tobacco control
Should you wish to contact HM Treasury about the revenue generated from
tobacco products, their email address is:
[1][email address]

I hope this reply is helpful,

Yours sincerely,

Cameron Gordon
Customer Service Centre

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Mark left an annotation ()

this question was addressed in a study in Australia several years ago. Doran et al. A cost-benefit analysis of the average smoker: a government perspective. Australian and New Zealand Journal of Public Health. Volume 20 Issue 6, Pages 607 - 611.

I guess the applicability of the results to the UK depends on differences in smoking habits and tax rates between Australia and UK.

In summary, keep on smoking, your country needs you.


Rob left an annotation ()

I have had a similar discussion with friends and wanted to try and find an answer to the question. People are always giving out to me for smoking saying that my fellow smokers and I cost them money in taxes. My belief being that more money is made by the government from cigarettes than smokers cost the NHS. I might not have the full answer but at least I think this gives some steer.

I want to quote the hard facts that the department of health. These things I accept. Smoking has health risks and I am not trying to escape them.

“smoking is the largest single cause of preventable illness and premature death in the UK. It kills 106,000 people every year and costs the British taxpayer more than £1.7billion a year in treatment bills alone. It causes 84 per cent of deaths from lung cancer and 83 per cent of deaths from chronic obstructive lung disease, including


Smoking “costs the British taxpayer more than £1.7billion a year in treatment bills”
(from this article)

And from elsewhere on the internet:

“Most of the expenditure of The Department of Health (£98.7 billion in 2008-9[4]) is spent on the NHS.”
(from Wikipedia -


UK Tax revenue from tobacco products - £10 billion (approx)
From tma website

NHS costs - £100 billion
Smoking makes the government £10 billion
Smoking costs – £2 billion

I know there are other issues to be added to this balance sheet, many of which are beyond financial. However, from my point for view, I know what I am going to be saying to the people who claim that I am costing them money from smoking.


Peter Eaton left an annotation ()

Smokers die earlier, It is estimated 5 years on average, therefore there is another saving to the government in pension or benefits payouts.
P. Eaton

V A Willis left an annotation ()

Whilst smokers are vilified and accused of costing the NHS, the figures do tend to point to a net gain to the exchequer of £8 Billion.

What is stunning is the cost of alcohol abuse to the country in general. The latest figures put the cost at £25 Billion,. Not to mention the carnage caused by drunk drivers and the cost to victims of drunken assaults.

It is strange that alcohol is seen as socially acceptable and smoking is frowned upon, when in fact alcohol is just as hazardous to your health and I don't recall any reports of an assault due to the over use of tobacco.

not_a_scab left an annotation ()

As of 2005/6 a cost to the NHS of £5.17 billion was estimated to come from smoking, and this was thought to be an underestimate if anything, meaning that smoking isn't that great a benefit

Joe left an annotation ()

The reason smoking is considered less acceptably than alcohol, is because it directly affects others, while alcohol *can* indirectly affect others (but often doesn't).

A non smoker in the vicinity of smokers will be affected by the unpleasant smell and toxic fumes. For people who suffer from asthma or other breathing related difficulties, passive smoking can be especially bad and can leave people gasping for breath.

By contrast, someone drinking does not cause any harm or discomfort to those around them. Moderate, sensible consumption of alcohol has little or no affect on other people, the only problem with alcohol is excessive consumption.

There is also the fact that many smokers smell even when not directly smoking... It is most unpleasant when someone with a strong smell, wether due to sweat, smoking or general uncleanliness is around you and this is especially bad in situations such as public transport.

Also the inefficiency of the process, consumption of alcohol involves the direct ingestion of it, virtually all of the alcohol is consumed by the drinker and none is generally wasted. Smoking on the other hand sends the majority of the chemicals up into the surrounding air, an extremely inefficient process. Drinkers generally do not evaporate their alcohol into the air and hope to inhale a small percentage of it.

David left an annotation ()

Someone stated that "Smokers Smell and its not nice to smell them"..Well my answer is this. Most people wear aftershave and perfume that I don't like they emit flatulence and cause bad odours, do we Kick them out side and tell them they are not humans any more?

What about the lost work days because people have caught colds and flu 's from being outside in the freezing cold? What about the well being of the Older generation who have been smoking in pubs and Clubs all their lives and are now being criminalized and made to freeze to enjoy their legally purchased cigarettes, Just cos someone doesn't like the smell of smoke.!

Back to the economic side of this, I studied the death rates from 2005-2008 and not one single instance of Smoking related death was entered into the register of Deaths in England and Wales in that period..! All the smoking ban has done is alienate smokers and allowed one part of society to control another, divide and conquer..! Divided we are and if we don't stand up for our rights we don't have any of em.!

Please notice that we are still allowed to buy cigarettes, if they were that dangerous we should not be allowed to buy them in the first place.

I don't see politicians banning Chelsea chariots that pump out More toxic fumes in one hour than 1000+ smokers do in one year.!

Its ridiculous..!

Des left an annotation ()

I would just like to advise David that cold viruses and the influenza virus are, as the normal intelligent person would know, are caught from viruses, not from being outside in the cold! In fact, you would be far less likely to catch a cold or flu if you stayed outside all the time and didn't interact with other people, though you would also be far more likely to become hypothermic.

David also doesn't understand why smoking has been banned in public places. It is not just because nonsmokers don't like the smell of smoke (though this is a reason - especially if you are in a restaurant). It is also because there are hundreds of toxic substances in tobacco smoke, which are inhaled by other people. Why should I, as a nonsmoker, have to put up with breathing in these toxins? It is well known that thousands of people die from smoking-related illnesses due to passive smoking. My wife is a smoker and she totally agrees with it.

You are still allowed to buy cigarettes - that doesn't mean cigarettes aren't dangerous. We have already established that the government make more money from selling tobacco than what they lose on treating patients with such illnesses.

I don't know what a Chelsea carriage is, but I suspect that they are used OUTSIDE which is where cigarette smoke should also be. Does David think electricity should therefore be banned as I suspect power stations produce considerably more toxins that a "Chelsea carriage."

As for his study on death rates between 2005-2008, that is absolutely ludicrous. Not ONE PERSON died from lung cancer, or COPD, or bronchitis, emphysema or any other smoking related disease in that time?? Really????? I suggest you look up what the smoking related diseases are, and then check again.

Andy mac left an annotation ()

We are all given the choice to smoke or not ,I know the tax is massive on fags but don't moan , smoke and enjoy ,pay your tax ,or not your choice .... I smoke but it is what it is and things won't change ,coz we are not really living in a free world are we?..

Abdul left an annotation ()

@Andy mac
Well actually I want to moan, because what is happening is just ridiculous, and because as you said we are not living in a free world. The only thing to stop me moaning is when the government admit that we don't!
And about can not change it, well we should be able. When there was a plan to introduce minimum price per unit of alcohol people went mad, and it did not go further!
The nice men in the parliament think people walk into Tesco or whatever and don't know what to buy. Then suddenly they see cigarettes and decide to buy some! So easy solution is just to block that attractive view of cigarettes! And we ended up having to stand in a long queue before we realise that what we want to buy is not available! I wonder what the future of the country will be if this how the decision makers think!

Jim Gillespie left an annotation ()

Getting back to the original question that was asked, I personally think it's a cop out on behalf of one government department to only answer their bit and suggest you contact the Treasury for their answer.

That is the problem with British politics these days - it would appear you just cannot get a straight answer out of MP's or civil servants.

I have just submitted a FOI request, via this website, to the Dept of Health concerning the use of electronic cigarettes in the UK. Let's hope I get a straight and concise answer!

David left an annotation ()

@ Des I did not say that Smoking does not cause or is not a contributing factor in the deaths of smokers.. I said that "Not one single instance of smoking related Deaths was recorded in the Public record to show this.."Smokers know the risks when they buy a packet of cigarettes..Non - smokers only Know what they are told they know..research you fool..And as for Chelsea Chariots..(Obviously you are a part of the "Upper class and have there fore no idea how Us "normal folk" look upon you) I take it you drive a 4X4 or a Gas guzzling car, my guess is a BMW or a High powered AUDI... And Yes Power stations Pump out about 1 million times as much "Dangerous to health toxins" as a smoker does each day never mind each year..! So you go and research and come back with facts not what you have been told by "Politically paid for main stream media propaganda"..!There has never been one single attributed death on a death certificate of "Death by Smoking too many cigarettes" nor has there EVER been a Death attributed to"Passive or second hand smoking from cigarette smoke"..There may have been many cases where Causes of death "MAY" (not factual in any way shape or form) have been significantly attributed to by environmental agents..! define this Please..!"Statistics"..There are Lies, Damned Lies,what ever comes out of a politicians mouth and then there are statistics..!

PeteM left an annotation ()

Yeah I agree with the costings on this smoking issue. Smokers collectively pay for, and then some, the NHS treatment they receive. Myself as a smoker of 40 odd years have cost the NHS one course of anti-biotics for a chest infection. Was it the smoking or something else that caused it? My prescription charge for the tablets was around seven quid, so I guess the NHS might even have made a profit on the tablets.

What I don't agree with is the ban on smoking in public places. Okay, it goes without saying that I as a smoker wouldn't dream of smoking in a school or where any kids are. I have a nine year old grandson, I never smoke around him, either in the house or car. In fact I don't smoke in the house or car anyway, it makes the place smell.

Okay, so smoking in public places is banned, I am particularly talking about Pubs. I excercise my freedom of choice and choose not to go to the Pub anymore. What I find offensive about this law is this - Why can't the Pub choose whether it is smoking or non smoking. If it chooses to be a smoking Pub, the non smoker can exercise his freedom of choice and not go into it. I call that equality.

Funny thing is the Non smoker has always had this freedom of choice, but over the years, when I did drink in Pubs, many non smokers chose to come in and enjoy the toxins from my tobacco smoke. Why? Nobody twisted their arm and made them come in.

john bramm left an annotation ()

johnb as a retired nurse I know of patients REFUSED treatment because as a smoker you suffer from a self inflicted condition and WILL undo the benefits of treatment, but if you go skiing/ absailing/ base jumping and break your leg you are not refused treatment yet this is just as much a self inflicted wound and most go back to skiing etc.. Also most activity/ winter sport means going abroad , therefore not spending in the uk but the NHS still has to foot the bill

Bob Fairmead left an annotation ()

That it's nigh impossible to get true amounts concerning tobacco revenue in and NHS costs out proves that smokers pay more tax than they cost, because if it was the other way around, the politicians would be waving the figures, and the proof, under our noses daily,
The UK smoking ban was obscene in a democracy. I was in Spain when their ban came into force, but their requirement was only that bars, restaurants, etc display clearly whether or not smoking was allowed inside. In Torremolinos, several premises chose to ban. Within a few weeks the majority rescinded. How ironic that a country not long out of a dictatorship should give us a lesson in democracy. Similarly, everywhere in Egypt are smoking areas offering signs saying, "Respecting choices". And so a third world country gives us a lesson in freedom of choice.
The high handedness of the UK ban was unacceptable. There could, with discussion and negotiation, easily, reasonably, and safely have been smoking rooms and non-smoking rooms everywhere. Fans exist which will happily draw smoke away from non-smoking areas - duh! No excuse. It was dictatorial and as far as it gets from democracy and freedom.

Ani Rose left an annotation ()

Just taking your original question, either way it makes sense to quit, im guessing your m8s at the pub were saying you might as well carry on smoking as it is giving more money to the NHS than it takes to treat cigarette related disease.

They may in fact be right, from a quick google search it seems they are. But that only takes into account NHS costs. Taking other economic factors into considerations, especially the cost (non and financial costs) of death and disease related to cigs, you would easily see cig tax recepits not covering the cost to society (negative externality cost) it causes.

p.s it would be a crime for me not to mention what David has said is not factually correct. Some facts i would like the state:

The link between cig smoking and all of the diseases mention by Des, plus many more, is a fact. Common cause of those mentioned is cig smoking.

When we sign death certificates (which is what goes on the register) we put the pathology down that killed them, not what caused the pathology, that's why David found what he found.

"The UK smoking ban was obscene in a democracy" - I can understand where you are coming from and would be with you Bob if it wasn't for the effects of second hand smoke. Plus we do live in a democracy (majority rules) where the majority of people do not smoke... Should we not therefore protect their health and social environments, and not let (a falling) minority dictate the terms of our environment. Don't care how many fans you have, your idea is unworkable when you think about how our social interactions would be affected, which PeteM talks about. Non smokers should not have to make the choice of inhaling 2nd hand smoke or not going to their local pub. Freedom to smoke is trumped by all other freedoms in the case. Sorry smokers.

Victor A Lampart left an annotation ()

When are you people ever going to learn that your tax's of any nature are there to mainly pay huge wages to a select few(Guardian reader's,politicians and there offspring,Council management)You get the picture.This goes for "The Human rights" issue's,the only people who gain are the Judges,Barrister's and solicitors.(Legal aid).Multiply this by all Government Department's and the results are all the same.So you will never know the real figures of any spending of any Government on any given thing because they do not want you to know.The only way is for the people to refuse to pay all tax's until all Government's are Transparent

Tony Mills left an annotation ()

Looking at figures for 2010, the cost was 13.74 billion pounds (this includes smoking related sick days, lost productivity from staff going on cigarette breaks and early deaths and their impact on the economy), excise (tax) raised was 10.5 billion for 09/10 or 11.1 billion for 10/11; best case scenario based upon these figures means smoking cost the English (not the UK) 2.64 billion pounds in 2010. The problem we face here is that if all smokers stopped tomorrow we would lose all that revenue but still be looking at caring for their poor health.

iow left an annotation ()

But yet nobody says anything about the 4 Billion that is spent on obesity within the NHS. They are not made to stand outside when they eat. Alot of them also need disability benefits as they are unable to work and they also put their bad habits onto their children causing them a huge amount of suffering. I agree that people should not smoke around food and I am a smoker.
So maybe we should look at all the groups of people that are a drain on the NHS instead of just picking on one that pays more than its fair share into the NHS just to be refused treatment when it is needed. All smokers know the risk and we dont ask for special treatment, just to be left alone and for others to stop thinking they are better than us.

Mr Morgan left an annotation ()

So to smokers that seem to think their rights have been diminished, think of it this way, before the smoking ban you could smoke anywhere (inside and outside) leaving non-smokers nowhere to get away from the smokers except their own home. Since the ban the only thing that has changed is that non-smokers can now go out to pubs/clubs/etc. without having to smell of cigarette smoke, breathing in the toxic fumes (which are harmful and has been proven to be harmful, Roy Castle was a non-smoker that died of lung cancer thought to have been brought on by smokers smoking in the clubs he played in, he was a trumpet player and comedian), etc. where as smokers still have free reign to smoke ANYWHERE else they choose. How can this not be fair?!
Smokers always want everything their own way, well why should you?!
The 4x4 argument is a bit flat really, you don't drive the 4x4s inside the buildings.

Smokers may pay a lot of TAXes but how how much actually goes to the NHS and have any of you taken in to account all the indirect consequences (Financial and non-financial) of smoking as well as just the direct consequences, probably not.

Personally smoking should be banned while driving, but thats another issue.

To the retired nurse, as a skier i know that the NHS wouldn't have paid for the care but my insurance company that covered me in the event of a skiing accident requiring hospital treatment. Most extreme sports taken up require insurance to cover the person incase of such events.

I have no sympathy at all for smokers that end up very ill, I also have no sympathy for binge drinkers and the obese (and other self inflicted illnesses) and personally believe that they should pay towards their NHS care (even a small percentage). You pay TAX on cigarettes, you pay TAX on alcohol, you pay TAX on foods, etc. so the argument is starting to lose here in regards to TAX.

I have a condition I was born with (Cystic Fibrosis, you can look it up if interested) which screws up most parts of the body, lungs, digestive system, liver, kidneys, etc. and this was no fault of my own, where as smoking causes otherwise preventable illness. To those smokers that enjoy and will continue with their selfish smoking habit, I hope you enjoy being out of breath (sometime gasping for breath), having your lungs clogged up, a constant cough that will not go, inability to walk that far, needing lots of hospital admissions, constant infections, etc. because that is your future unless you are very lucky or get killed by something else.

Fact is smoking costs more in the end (financially, non-financially and emotionally from friends and family).

Oh and so you know, i don't bother reading newspapers as they are full of one sided biased rubbish, i look at research papers from more than one source.

Mr Morgan left an annotation ()

Indirect consequences of smoking:

- Non-smokers health around you that inhale your second hand smoke
- Lost days at work due to smoking related illness
- Smokers not putting out their cigarette properly and causing their home to catch fire (and possibly others) meaning the fire service, police and ambulance have to be called
- Smokers throwing their cigarette butts on the floor (littering) meaning someone else has to go round and clean up their littering
- Wildlife dying or becoming ill due to ingesting improperly disposed cigarette butts
- Wildlife management terms being called due to illness of wildlife caused by improper disposal of cigarette butts
- Forest fires caused by improper disposed cigarette butts that set light to forests (mainly in summer and ore so in times of drought) meaning the fire services are required (and more) as well as houses and wildlife caught in the fires

and there are many many many more indirect consequences of smoking, there are none for non-smokers

Sazzle1175 left an annotation ()

Mr Morgan-

I am one if those "selfish" smokers.

In 25 years working I have never-
A) had time off for smoking related illness
B) had endless hospital appointments because of smoking
C) had a house fire, or any fire related incident because of smoking
D)discarded my cigarette end anywhere other than the pocket ashtray I have
E)caused a Forrest fire
F) gasped for breath and I actually skate 10 miles on most Sundays, pretty impossible being a disgusting smoker huh??

If you really want to get on your non-smoker high horse, then at least don't generalise.

You are obviously a very nasty person to know if you don't tolerate smokers, drinkers or the obese!!

Fine that they now want to slap pictures if charred lungs and people with throat cancer on cigarette packets. How's about at the same time, we see morbidly obese people pictured on anything but fresh grown healthy produce? Tucking into a biscuit and seeing a picture of someone so fat that they can't stand! Or a pretty little deseased liver that has been so kindly placed on your bottle of Gin?? Or a picture of someone with jaundice because their liver is failing!
While were at it, why not add pictures to everything?? Burning car wrecks on the side of your new BMW, or a mangle metal mess on the side of that lovely plane that's going to whisk you away on holiday??

Lay off us smokers, it's our choice and we know the concequences!! I'm a big girl and can make up my own mind thank you!

Tony Mills left an annotation ()

Not everyone who eats anything other than fresh produce will become obese.
Not every gin drinker will get liver damage.
Not every BMW will become a charred wreck.
Not every plane taking you on holiday will crash.
Almost every smoker (regardless of what you may be informed) will suffer as a result of their smoking at some point.

Perhaps you won't get lung cancer but look at the other cancers that smoking tobacco causes. There is also the cardiac issues caused by smoking, the almost inevitable COPD that will result and the circulatory problems (erectile dysfunction, stroke...) that occur; and how many of smoking's effects are reversible?

Sazzle, you are, perhaps, lucky or perhaps you haven't yet noticed the effects of your 25 years of smoking. Presumably you have had some time off of work with an illness? The effects of the illness are likely to have been longer because you smoke (cold not shifting, persistent cough...).
If your level of fitness is pretty good (and skating 10 miles on Sundays is going to be good) then that's really great, long may you continue to do so without gasping for breath. However your fitness would be better if you didn't smoke; if you exercise and smoke then you may maintain some health (there are members of the armed forces who smoke).
Ultimately, cigarettes, and tobacco in general, are one of the very few things designed to force addiction upon their users when used as intended and which will kill their customer base; successive generations of "the public" have to be coerced (willingly or otherwise) into taking it up as a habit.

Abdul left an annotation ()

Tony, what an ignorant thing to say! Show us your proof that every smoker will suffer! You are basing your discussion on personal assumptions. I see lot of smokers (long life smokers, not for few years) who are extremely healthy. The same assumption can go on alcohol drinking, that they will be healthier if they don't, they will suffer or cause harm to someone at some point. Sell takeaways will likely cause harm at some point.. etc! That's. That is not a valid argument.

S. Brittane left an annotation ()

Nash and Featherstone (2010) conservatively estimate the entire annual annual to society from tobacco consumption to be £13.74 billion. Conversely, HMRC estimate that revenues from tobacco taxation in 2012-3 were approximately £12.3 billion. Thus, every cigarette smoked costs the UK money and smokers bear a burden on society.

While the provision of healthcare through the NHS is calculated to be only a fraction of overall costs at £2.7 billion (with a higher bound of £5.4 billion), productivity losses through smoking breaks and work days lost through illness are estimated at between £915 million - £3.2 billion and £1.1 billion - £2.5 billion respectively, while the human capital approach of calculating economic output loss through early death is put at £4.1 billion. Smoking related fires and environmental costs of litter are further valued at £507 million and £342 million.

All of the above estimates are founded on standard methodology and estimates are always lower bounds, meaning in realit the costs are much highe stll! The details and results of these estimates are summarised excellently in their Policy Exchange report:

This difference goes against the common perception, perpetuated by many users here and in the original post,that government receipts from tobacco revenue, and other economic benefits such as industry employment, far outweigh the costs to society. Kenneth Warner (Tobacco Control, 2000) calls this the ‘first myth’ of the economics of tobacco and explains why this is consummately incorrect:

Furthermore, while the consensus of economic data is that tobacco costs society money, these costs are still only the ones that ae quantifiable. There are likely to be many more costs which represent even greater monetary burden instilled by smokers.

For a useful summary and explanation of the quantifiable costs smokers give us, please consult:

I should hope this will address any ill-founded opinions of smokers and help them realise their true cost to society. We can only be thankful we do not live in the United States, where annual tax revenues of tobacco sum to £17 billion but the costs to society are well over £300 billion ((Please consult report at the bottom of link for full information and methodology):



David left an annotation ()

Alcohol, Obesity and Smoking Do Not Cost Health Care Systems Money
It’s a common enough argument around the world at the moment, that various unhealthy behaviours increase the costs to health care systems. Thus those unhealthy behaviours should be taxed more heavily so as to pay for the costs to those health care systems. The only problem with the argument is that it is entirely gibbering nonsense, unhealthy behaviours reduce costs to health care systems: if we are to accept the initial logic then we should subsidise them, not tax them.

We see it in my native UK over smoking, alcohol and obesity. Rarely does a week go past without there being another report about how much this or that activity costs the NHS and thus taxes must be raised. You’ve got it in the US with the various people calling for taxes on HFCS, sugar, empty calories, soda pops and junk food.

Now there is no doubt at all that these unhealthy behaviours do have costs, that’s not at issue. The major cost is of course to the imbiber, smoker or lardbucket in the form of a shorter lifespan. However, it’s pretty much a given that in anything even approximating to a free or liberal society that consenting adults have to be left to make their own cost benefit trade offs.

But what about these costs to the health care systems? Well, the clue is in that shortened lifespan. Yes, certainly, there are costs to treating the diseases brought on by too much booze, tobacco or food. But there are costs to treating all diseases, all modes and methods by which we might possibly reach that undoubted destination, the grave.

The question is, are the costs of treating the illnesses and deaths brought on by those three indulgences higher or lower than the costs of treating those who live healthily but still inevitably die? We could argue it either way: Alzheimer’s costs more to manage than lung cancer costs, the cracked hips of age related osteoporosis perhaps more or less than fried livers from excessive bourbon. What we need to do is actually go and tot up the figures. Fortunately, that has been done:

Obesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to compare those to similar costs attributable to smoking, and to discuss the implications for prevention.
Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.

The actual numbers for lifetime from 20 years old medical costs were:

The lifetime costs were in Euros:

Healthy: 281,000

Obese: 250,000

Smokers: 220,000

There are excellent arguments in favour of taxing in order to reduce the occurrence of smoking, excessive boozing and obesity. We humans are subject to hyperbolic discounting, not taking full account of long distant future costs for current pleasures, sometimes those running the public health system really do know more than us, there are externalities associated with these behaviours (late night drunks, passive smoking and the visual pollution of someone 300 lbs overweight perhaps). But the argument we cannot use is that these behaviours increase the costs of health care.

The reason we cannot use this argument is that it simply isn’t true. Those who die young save health care systems money, not cost. Thus, if we really are to accept the argument about taxes and the costs of health care then we should be subsidising puffing, browsing and sluicing.

Which isn’t, I think you’ll agree, what we usually get told about these things, is it?

David left an annotation ()
This is the link from Forbes where the above was taken.

craig left an annotation ()

David, you seemed to have fallen into your own trap.
The health care systems monetary benefit of those who die younger by excessive smoking, obesity, alcohol, etc are not the only damages to be weighed up. It is an almost impossible task to calculate damages done by drunk fathers or mothers to their child's well being, possibly adding to social care costs, not to mention any psychological ramifications upon an individual leading to costs for aiding in mental health costs later in life.

I am only trying to illustrate that hidden costs of acts that damage not only the individual but others too cannot be accounted for until after the fact. Wouldn't it just be more pleasant to live in a place where these things were in less of a demand?

On a basic note however I wonder if any of these figures supplied have been adjusted for income related tax revenue lost if any of these people died before the pension age...

David left an annotation ()

My Point is if it is strictly for health reasons that the smoking ban was put in place, Why have Alcohol and Fatty food not been treated in the same way?

Tony Mills left an annotation ()

I would assume that you can't be seen to be doing too much all at once.
There are obviously moves to make some controls in the realm of obesity, control of sugary foods (fatty foods aren't really the issue), increasing exercise/movement of the population and curbs on alcohol consumption.
Baby steps!

Tim left an annotation ()

Well put David

Tim left an annotation ()

On the subject of 'NHS' costs, what about stress related illness costs? Imagine, if you can, being stuck on a planet where the locals still consider making paper out of trees as a viable option....I mean ...really? Are you serious? COME ON!....Try as you may to reduce the experience of life down to income/expenditure, no matter what you do it's yourself you face in that last moment, have fun.

Bob J Man left an annotation ()

The Health and Safety Executive employs 850 scientists, engineers, analysts and medical staff, and their seven Health and Safety Laboratory sites, which have an international reputation for high-quality research, employ over 350 scientific, medical and technical specialists, who are among the world's leading providers of health and safety solutions to industry, government and professional bodies, focusing on understanding and reducing health and safety risks and developing solutions for over 100 years.

What has this got to do with the issue at hand?

Well, the kind of risks their scientists study are things like the danger to people from toxic and irritant fumes in the air that they might breathe.

And what has that that to do with smoking?

Well, for quite a while after the Smoking Ban, until it was pointed out that it contradicted the government's advice on the harm to health from Passive Smoking, and the HSE advice was suddenly withdrawn, the HSE were telling their Inspectors not to try to prosecute employers for allowing their workforce to be exposed to Second Hand Smoke as no harmful effect could be proved, at most it could only be said to be an annoyance!

This advice ties up exactly with what the people who proved that actual Smoking Kills found: the Doctor famed for his work on this was adamant that there was no possibility of anything more than a trivial effect on Passive "Smokers" and he was quite happy for people to smoke in his presence.

But what would he know.

But if he knows nothing then it hasn't been proved that real Smoking Kills!

Bob J Man left an annotation ()

Can anyone explain why the "loss" to the economy of early death is included in the calculation?

And whether the "loss" to the economy of people emigrating because they don't like the nanny state, political correctness, loss of democracy (no one forces non smokers to go into smokers pubs, but smokers are forced out of pubs that want to be smoking ones) and loss of the right to use a legal substance in the company of consenting adults and with a consenting landlord's agreement, is also included for balance?!

I ask as a non smoker.

Bob J Man left an annotation ()

>> Mr Morgan left an annotation (21 January 2014)
>> "So to smokers that seem to think their rights have been diminished, think of it this way, before the smoking ban you could smoke anywhere (inside and outside) leaving non-smokers nowhere to get away from the smokers except their own home. Since the ban the only thing that has changed is that non-smokers can now go out to pubs/clubs/etc. without having to smell of cigarette smoke, breathing in the toxic fumes (which are harmful and has been proven to be harmful,"

No one stopped non smokers opening non-smoking pubs and bars.

The Scottish Smoking ban came in a year before the English one, and when the English one came in Radio 4 interviewed one of the leading lights in the Scottish smoking-ban campaign, asking him why, despite the campaigners insisting a ban would BOOST pub takings because all the non-smoking majority would start flocking to pubs, in fact takings had FALLEN and pubs were CLOSING.

The leading Pro Smoking-Ban Campaigner's response?

That pub landlords couldn't expect non-smokers to start using pubs just because they were now smoke-free: landlords would have to offer non-smokers a reason to go into smoke-free pubs!

In other words, the Banners never wanted to go into pubs in the first place, they just wanted to stop smokers going into them!

Looks like they actually wanted to ban smoking AND drinking!

>> "Roy Castle was a non-smoker that died of lung cancer thought to have been brought on by smokers smoking in the clubs he played in, he was a trumpet player and comedian), etc."

Roy Castle died of a form of lung cancer that is known not to have any connection to smoking whatsoever.

If that is the best argument the banners have: they clearly don't have an argument!

Especially as Roy Castle spent all his life in smoke-filled venues and *DIDN'T* die from it!!!

>> "where as smokers still have free reign to smoke ANYWHERE else they choose. How can this not be fair?!"

Smokers never stopped non-smokers from smoking anywhere they liked.

Smokers never stopped them going into smoking pubs.

Smokers certainly never kidnapped non-smokers and dragged them into smoky pubs, or broke down their front doors, forced themselves into non-smokers houses, and blew smoke on them.

And, as I said, no one stopped non-smokers opening non-smoking pubs, and if there was such a big market for them you would have thought that pub landlords would have gone non-smoking decades ago of their own accord.

So it is clear from all the above that there is no actual market for non-smoking pubs, only a demand from the anti-smoking lobby to stop smokers smoking in smokers pubs the non-smokers have never had any desire to patronise whether smoky or smoke-free!

Oh, and there are about a dozen diseases that are helped by smoking, and most studies on second hand smoke actually indicate that exposure to it might actually IMPROVE the health of children.

I wonder if these benefits are costed, and included in the cost-benefit analysis?!

Bob J Man left an annotation ()

A lot of people, especially women, used to smoke as an appetite suppressant, and the obesity crisis, along with all the associated costs to society in general, and the NHS in particular, are enormous.

Have the costs of obesity been included in the costs of the smoking ban?

Similarly, smoking was used to calm the nerves and reduce stress.

We are apparently suffering an epidemic of mental health problems which cost the NHS in particular, and society in general, a fortune:

Are the costs of workplace stress, domestic stress and violence (both ways), losses to the economy, NHS treatment, and early death through stress related strokes and heart failure, and associated hospital and drug costs, taken account of in the cost-benefit analysis?!

Joshua Flynn left an annotation ()

Firstly, it's worth noting your comparison of expenditure on smokers by the NHS versus revenue returned from smoking falls under a cherry picking fallacy regarding 'true cost'.

The £10 billion tax placed on cigerettes does not go exclusively to health. As it's a VAT, it goes into the government's general pot and can literally be spent on anything - including weapons of war.

You could argue parts of it go to health, but how much?

If it was less than 1.7 billion, you would be costing the NHS more even if you were paying the UK government £10 billion. In reality, only 7.7% of said pot (GDP spent on NHS) reaches the NHS, which would be a 'dismal' 770 million, basically less than half the cost required to support smokers. The only way smokers would contribute an equal worth to the NHS is if the GDP allocated to the NHS was increased (but it'd have to increase to at least 17% to match smokers' cost of £1.7 billion: 17% of 10 billion is £1.7bn), OR, if tax was raised on smoking to basically double what it is right now.

Regarding other missing details:
1) The figure only accounts for deaths directly attributable to cigerette smoke. As mentioned, second/third hand smoke can harm others (non-smokers), but if it does so, it will not be attributed directly to smoking because, of course, they don't smoke and there's no way to trace this unless it's extremely obvious (IE they state they live with smokers). It would mean the figure is far lower than it would be.

2) People who die earlier contribute less in national insurance taxes overall as, obviously, they work fewer years. Yes, no pension gets paid, but usually salary earnings are above pension payouts. Their salary, of course, gets spent on other products (goods with VAT not smoking related etc) and thus in the long term would generate more VAT in total. So you'd need to factor in the total overall contributions of a baseline individual non-smoker to tax versus that of a baseline smoker to tax. I think you'll agree that intuitively, a healthy person who uses the NHS not at all or very little always contributes more overall than an individual who uses the service as a chronic user but happens to pay more.

Remember, the cost is only covering treatment. It doesn't factor in costs for such things as administration, EG maintaining records (kept roughly for 20 years since last activity in-case of litigation). If you were looking for extrinsic costs (IE non-monetary), consider the pressure it puts on time resources and availability of organs (EG lungs). If you wanted to be even more unorthodox, think about the impact of smoking EG second/third hand smoke on non-smoking staff members (if they become ill, it becomes sick leave).