Existing socio-economic differences can be reduced through policy

Smoking is more prevalent among lower socio-economic groups, as is the burden of ill health caused by smoking (see also: EUphocus Health inequalities). Indeed, smoking-related disorders contribute substantially to European social inequalities in health. Also, lower educated smokers are less likely to quit smoking than higher educated smokers (Eurothine, 2007). Both opportunities for specific tobacco control measures aimed at these groups and possible government measures to increase their effectiveness have been identified.

Five types of policy interventions especially effective

Mackenbach et al. looked at specific opportunities for tackling socio-economic inequalities in smoking in the European Union. The authors identified five types of tobacco control measures that may be especially effective among lower socio-economic groups (Mackenbach et al., 2004):

• increasing tobacco taxation;
• banning of promotion of tobacco products;
• smoking restrictions in indoor workplaces;
• availability of smoking cessation therapies; and
• telephone help lines.

There is considerable overlap between this list and the six interventions advocated by WHO and the World Bank as highly effective measures for the broader population (also see: Effective policy measures).

Effectiveness of tobacco control measures could be increased

There is great potential to develop tobacco control strategies that are maximally effective among lower socio-economic groups. The effectiveness of specific tobacco control measures among these groups could be increased by (Mackenbach et al., 2004):

• strict enforcement of laws and agreements;
• removal of financial and other barriers;
• geographic or social targeting of services; and
• tailoring of communication approaches.

Increasing the price of tobacco products is a very effective measure

Increasing the price of tobacco products has been identified as an extremely effective measure in reducing cigarette smoking (WHO, 2003a; Joossens, 2004). Concerns that price increases may put a disproportionate burden on smokers from lower income groups have been shown by the WHO to be ‘either false or overestimated’. The resulting reduction in consumption compensates for the price rise. Evidence has been found that increasing tobacco prices reduces consumption among lower educational groups in England and Wales (Mackenbach et al., 2004). However, little comparable research has been undertaken in other European countries.