Smoking related healthcare takes up a fair amount of healthcare budget, but it is dwarfed by far by elderly care for the 'healthy' elderly.
It's just that the anti-smoking and healthy lifestyle lobby is much more vocal about the costs than the elderly care homes. And they tend to omit the excise taxes collected by the state on tobacco and alcohol. Not to mention the health benefits of stress reduction and entertainment.
My smoking habits are paying for the elderly care.
When I was 4 years old some anti-smoking charity workers came into my primary school to teach about the hitherto relatively unknown dangers of second-hand smoking. The strategy was good - the adults that tended to quit smoking, usually did. The adults that did not, usually did not. But if you got their kids to annoy them everyday with puppy-dog eyes, you could flip that second category into non-smokers.
This chap gives a very lovely speech about a jazz musician who worked 20 years brass in the bars, who then went on to develop lung cancer despite never being a smoker himself. I agreed with him completely, yet I was a most difficult child who demanded evidence for everything and questioned everything, and without the cuteness of youth I probably would not have survived childhood due to the quantity and degree of things I questioned. He asks if anyone of us has questions, and being ordinary 4-5 year olds, no one does except me. I ask him an absolutely cruel question - I ask him if he has any clinical trial evidence that second hand smoking causes lung cancer. Now I didn't ask that question to be mean, I was just a young boy who wanted to find out how everyone thought, because I was in awe at the sheer number of ways people seemed to think differently. But it was a mean question, because I already knew the answer to the question - there was no clinical trial evidence yet, because the trials had not been done. He was blindsided by my question, either because he didn't know the answer or because he was perturbed by a 4 year old talking about "clinical trial evidence." He repeated his story about the jazz musician, which annoyed me because I thought he was insinuating I didn't understand the logic behind smoking = lung cancer so smoking exposure = lung cancer. When he asked if I understood, I told him bluntly "so you have no clinical trial evidence." The joys of autism lmao
After that, the anti-smoking chap stopped taking my questions. Afterwards the man asked my teacher if I was the son of some British-American tobacco lobbyists and my teacher in turn asked me - I found it very funny because my mother was a respiratory research nurse with a poor grasp of
simple English but a fantastic grasp of
advanced medical English, which also went to some length to explaining why I could talk about clinical trial evidence before I knew how to use a comma. In another life perhaps I'd be making big $$$ working for BAT, but alas, I ended up following in her footsteps to become an underpaid respiratory health worker.
In defence of the anti-smoking lobby; they are not vocal about obesity or age related costs on healthcare because they are laser-focused on one thing alone. Countering the smoking lobby. They have much less money than the smoking lobby and have much less access to well-connected talent, who have a tendency to end up employing ministers and diplomats after their political careers have ostensibly finished. It is also not the case that you have smoking-related costs
versus age related costs, as you end up getting both at the same time.
As per these digits 79% of premature smoking related deaths occur 70+ years old, 20% at 50-69 years old and 1% at 15-49 years old. This also fits in with what I've seen, I've only ever had one smoking-related patient <age of 40. Thus if we ignore the reality of the human cost and just focus in on the monetary cost, it doesn't make sense from a public finances point of view. Smoking related diseases like COPD are progressive, they trend towards a worsening of all conditions, and it takes a lot of medications to
maintain a reasonable standard of living. This is a cost you simply would not have if aforementioned patient was not a smoker. Things get worse when lung function goes below pred <20% and you have to start considering things like oxygen, and suddenly you're spending loads of money trying to keep someone in a state where they can still enjoy life, where if they had not smoked they would actually be more than capable of maintaining an excellent state of health and enjoyable state of life at a cost of £0.
Then there is the human cost of course, which is that smoking takes away a lot from people. A lot of money for starters, but I have had to experience too much already the painful inevitability of patients becoming aware that everything they took for granted is slipping from their fingers. First they can't do their sports anymore, then they can't do the gardening, then they struggle with stairs until they reach the point where they struggle with walking. This is a slow process, and what standard of living they continue with is completely determined on when they stop smoking, or indeed if they stop smoking.
Smokers, heavy-drinkers, great-eaters, people who do high-risk sports and a whole host of other behaviours which contribute to injuries and illness should, for moral reasons, not be penalised or judged. I have seen a lot of people who have been violently aggrieved because a loved one died on a waiting line for some vital surgery which was occupied by other peoples whose illnesses were incurred by their own living habits, but I don't think its a problem of patients vs patients, but a problem of funding for the healthcare industries. If a man got something stuck up his bum or another student scarred their cornea by vodka eyeballing, they are just as in need of healthcare as someone with an infection or injury. That's the point of healthcare - if a drink driver mounts the pavement and runs over a pedestrian, the hospital is going to treat both of them for injury. Let the courts assign blame, not the hospital. It seems strange then that public debate has started toying with the idea of unequal treatment for unequal blame.
I don't push people to quit smoking. The anti-smoking lobbyists are right, in that people inclined to quit smoking usually do so, and those who do not usually do not. All you can do is inform people of the inevitabilities so they know what they're going in for. Smoking is also more powerful in how it grips people, compared to say someone who has an eating disorder. I've had patients who desperately want to stop smoking, but cannot stop themselves. There is something very cruel in watching someone whose partner is dying of lung cancer and still smoking, they themselves have COPD, and any moment their condition improves from new medication - they recommence smoking, and their children are smoking, and their grandchildren are smoking. You could quadruple taxes on tobacco and still the people who are poorest in our countries would rather cancel their holidays than stop smoking, and it would in no way cover the loss to humanity. And then there is the horrifying shift overseas, where as anti-smoking lobbying efforts pay off in the industrial north, tobacco companies nevertheless continue to grow by preying on the youth in Asia and Africa, where domestic anti-smoking lobbyists have even less resources. From the child slave labour used to grow the stuff to the poor consumers who are wasted by the stuff, the entire industry is a chain of misery that benefits non-human entities holding shares in Imperial or BAT the most. That's it. That's all this is for. Make a hedge fund balance sheet go slightly higher, to acquire 1.1% more returns in dividends than if they had just invested in a health insurance fund. The imagination of humankind never ceases to amaze
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