There can be little doubt that since the NHS was born, nothing has done more to damage the health of people in Scotland than the cigarette. We now know that in the last 60 years, at least 750,000 people have died in Scotland from smoking related diseases and the annual toll is still around 13,000 deaths a year.

Typical lifelong smokers, starting in their teens, can expect to live for about ten years less than if they hadn’t smoked. For many, afflicted by chronic bronchitis, angina or cancer, death follows many months or years of suffering. We’ve also learned a great deal about the effects of breathing other people’s tobacco smoke. It increases the risk of sudden infant death in infants, chest and ear infections in young children and heart disease, asthma and cancer in adults.

Because of the nicotine they contain, cigarettes are highly addictive and can be very difficult to give up. Over 70 per cent of the million or so smokers in Scotland say they want to quit but most find it very hard to do. Nevertheless, slowly but surely, the proportion of Scots smoking is falling, down from well over 50 per cent of adults when the NHS was born, to about 25 per cent now.

With methods to help people give up improving and support from the NHS and elsewhere increasing, more and more are succeeding. The downside is that far fewer smokers in more disadvantaged circumstances have been giving up. As a result, smoking accounts for more than half the big differences in death rates between the richest and poorest areas. Tackling this gulf is one of our biggest challenges.

In the light of the growing evidence that breathing other people’s smoke is bad for you, many public places like cinemas, trains and planes were made smoke free. Finally, in 2006 the Scottish Parliament legislated to ban smoking in all enclosed public places. Not only has this moved proved hugely popular, but research has already shown a positive impact on Scotland’s health. Breathing second-hand smoke is now most likely to happen at home or in private vehicles: more action is needed there.

Despite the progress, far too many young Scots, especially girls and young women, are still starting to smoke and becoming addicted to nicotine. The Scottish Government has recently launched its first comprehensive smoking prevention action plan, with measures that include raising the age of legal purchase to 18, banning advertising at the point of sale and encouraging schools, universities and the media to promote anti-smoking messages much more vigorously. The challenge now is to implement fully this bold plan. Preventing young people from starting to smoke is undoubtedly one of the best ways to improve Scotland’s health.

In its first 60 years, the NHS has cared for countless thousands of people with smoking-related diseases. Many NHS staff have also helped shift attitudes so that smoking is increasingly seen as unacceptable. Let’s keep working to ensure that Scotland is smoke-free long before the NHS reaches its 100th birthday!

Dr Laurence Gruer OBE
Director of Public Health Science
NHS Health Scotland

Bay City Rollers anit smoking campaign, 1977. 
Credit: SCRAN