Being a (slightly rabid) non-smoker, I was very irritated by a conversation I had with a smoker friend, in which he claimed that the duty paid on cigarettes renders smoking cost-neutral to the NHS. He glibly waved away any personal responsibility that smokers might bear the health service, while accusing fat people of draining the NHS of its precious resources.
An argument ensued, fuelled by wine, and peppered by facts and figures largely pulled (on both sides) out of the ether.
A little post-argument research made me realise that smokers do, indeed, pay a lot of duty on their purchases; lobby group Forest claims that they ‘cough up' more than £9bn a year.
At the time, the cost of smoking to the NHS in England was estimated at 1.4 - £1.7bn a year, but a recent article in the BMJ suggested that the figure is probably three times this, coming in at £5bn. This represents more than five per cent of the overall health service budget.
Of course, my friend points out that the duty still exceeds the newly-calculated costs, while obesity is thought to cost the NHS around £6.2 bn a year.
Personally, I don't think these kind of costs to the health service can really be quantified. I will not pretend to know exactly what was included in the smoking study, but I'd bet it didn't take into account all the long-term chronic conditions that are caused or exacerbated by smoking, nor the effects of passive smoking (in pregnancy and otherwise).
I doubt it factored in health professionals' time in primary, secondary care and the community; palliative care for those with smoking-related terminal illness; benefits paid to those on long-term sick leave due to smoking-related illness, or to the relatives of those who have to give up work in order to care for their loved ones. I'm not sure it included smoking cessation clinics and NHS anti-smoking advertising campaigns.
(Warming to my theme): Did calculations tot up costs relating to depression, a very common side effect for people with conditions such as COPD, generating pricey prescriptions for anti-depressants, CBT and counselling?
What about erectile dysfunction? Smoking is a contributing factor in male impotence, so it could be said that we're subsidising smokers' sex lives by paying for their Viagra. Smoking can stop women conceiving, so there's also the cost of IVF for some patients.
Smoking is also linked to baldness; can damage eyesight; has been linked to hearing problems (a study has claimed that teenagers who smoke, or whose pregnant mother smoked, are at risk of hearing problems). It can worsen gum disease, so we'd better add dental costs to the overall bill.
Meanwhile, smoking accelerates the ageing process, so people go and have botched face-lifts and then expect the poor old NHS to fix them again.
Thinking (fairly) laterally, research shows that people who go on to take drugs often start as smokers, so perhaps we should include the cost of drug misuse services and even consider the financial impact of crime? Prisons are full of drug addicts, many of whom began with a smoking habit.
Smoking is also pretty expensive and some of the people who smoke cannot afford to do so; they get into debt partly because of their smoking and become a drain on taxpayer, claiming benefits.
Some spend their benefits money on fags rather than healthy food so may become overweight or obese as a result. (Given the damage smoking does to lungs, exercise may also be unappealing for a heavy smoker) There is therefore a knock-on effect on their health, and that of their families; the lessons learnt from parents influence the way their children behave in their own lives.
I could go on.....but don't worry, I won't.
My argument is NOT to blame smokers for the ills of the NHS, but to stress that smokers contribute to the burden placed on the health service. In my opinion this most certainly goes above and beyond the duty they contribute. There is, therefore, no moral highground to be had.
This goes for most people, since which of us does not have at least one habit that could lead us into poor health? It could be a preference for the sofa over exercise; a love of lard; a taste for boozy nights out; a casual attitude to one-night stands; or even a passion for running or skiing.
‘There but for the grace of God...' is therefore my motto, though I do try to be healthy and to take responsibility for my lifestyle. This is not just about being a good citizen, I am by no means convinced that the health service will exist in its current form by the time I'm old and all my bad habits have caught up with me.