Ramped up support to help smokers quit, including the prescribing of vapes, could see the UK’s smoking rate halve within the next five to 10 years, a new report has suggested.

Meanwhile, the implementation of a sugar and salt reformulation tax, as well as efforts to make healthy foods more affordable and a mandatory calorie reduction target for the food industry, could mean four million people avoid becoming obese.

These are the suggestions in a new report led by public services expert Lord Filkin – flanked by other experts and the King’s Fund think tank – which argued poor health of the nation costs almost £16bn a year.

Those behind the report, published last week, suggested that committing to spending on preventative measures should ‘surprisingly’ be affordable and must become a cross-party ‘covenant for health’.

As such, it said the UK should commit to spending 10p out of every £1 of the NHS budget on preventative measures to improve the nation’s health within the next five to 10 years.

The experts narrowed down the key priorities to nine priority areas with specific intervention suggestions for each area: smoking; obesity; alcohol; children’s health; physical activity; air quality; mental health; early detection; and health inequalities.

This could achieve three million fewer smokers; four million avoiding becoming obese; four million people increasing physical activity; more children in general staying physically and mentally healthy; reducing 30,000 deaths a year from poor air quality; and five million people reducing their cardiovascular disease risk, they claimed.

The report recognised that ‘more funding’ would be needed to help reduce the number of smokers across the UK, but suggested that costs ‘could be borne by the tobacco industry’.

Among its recommendations on smoking, the experts said there was a need to prescribe vaping to help smokers quit.

Though this should be accompanied by ‘a fierce clamp down’ on the general marketing and sale of vapes, added the report, which also noted the ‘risk’ of vapes to children.

And for tackling obesity – an issue the experts described as ‘one of our greatest population health threats’ – the report suggested a ‘rapid implementation’ of a sugar and salt reformulation tax.

In addition, it suggested: mandatory calorie reduction targets for the food industry; making healthy foods affordable and available to poor families; public health campaigns, school-based interventions and regulations on marketing to children.

The experts claimed that most costs around these actions would be ‘one-off and borne by food manufacturers and retailers’. ‘There is strong public support for action,’ the report noted.

Other recommendations within the report suggested:


  • increasing duty by 2% above inflation every year
  • introduce minimum unit pricing in England, as in Scotland, Wales and Ireland
  • restrict alcohol marketing which leads people to drink more and at an earlier age
  • better access to treatment

Physical activity

  • planning and local traffic management actions to make walking and cycling easier
  • work energetically with local authorities and advocacy groups to create environments that support and encourage active travel

Air quality

  • reduce air pollution by purchasing cleaner vehicles for public services and public transport
  • set up clean air zones focused on places with high pollution and high population density

Mental health

  •  investing in health promotion, prevention and early intervention
  • a cross-government mental health and wellbeing plan
  • commission a report to identify practicable interventions to reduce the risks of mental illness with a
    particular focus on children and young people

Children’s health

  • focus on four topics: obesity, mental health, physical activity and early years
  • re-introduce an upper limit on the amount of sugar served to children in school meals and regulate excess sugar in baby and
    nursery food
  • launch a new ‘Eat and Learn’ initiative for schools; extend eligibility for free school meals; fund the holiday activities and
    food programme and expand the Healthy Start scheme
  • open access mental health hubs for young people and specialist mental health support in every school
  • ramp up the training and recruitment of mental health support for children
  • schools and colleges too need to support the mental health and wellbeing of pupils and to build youth resilience

Earlier detection and treatment of ill health

  • further development of regular health checks, focusing hardest on people and places with high risk of premature ill health
  • to be effective these checks must be matched with effective treatment and help with changing behaviour
  • regular offers of support for healthier lifestyles may be essential for people aged 20 and 30 before problems
    become entrenched
  • ICBs setting clear strategies

Health inequalities

  • identify the 20% of upper-tier authorities with worst risks and worst healthy life expectancy and mandate all national and local policies and programmes to bend their policy goals to help such people and places
  • fund £10m to every local authority with worst health
  • cross-government investment in the early years

The report authors summarised: ‘There is an opportunity to make significant improvements to the health of our nation in just five to 10 years, benefiting millions of people, society, our economy and our health systems. This paper explains where and how to do so.

‘It is urgent to act, the UK has among the worst population health in Europe, the highest levels of obesity, the worst excess drinking levels, very large health inequalities, and very many people become ill much earlier than they should.’

It added: ‘Our high level of premature, often avoidable ill health, damages lives, our society, localities and our economy. Without resolute action it will get worse. We must act so that lives are not degraded, and to sustain our health services and labour supply.’

A version of this article was first published by our sister title Pulse