"Smoking is the now the principal avoidable cause of premature death in Britain. It hits the worst off people hardest of all. Smoking is one of the principal causes of the health gap which leads to poorer people being ill more often and dying sooner"

Frank Dobson frames smoking as Britain’s leading preventable killer while drawing a sharp line to social injustice. “Avoidable” stresses that these deaths are not inevitable; they stem from an exposure we know how to reduce through policy and support. Yet the harm is not evenly distributed. The claim that it “hits the worst off people hardest” reflects a well-established social gradient: people in poorer communities are more likely to smoke, to begin younger, to be surrounded by higher retailer density and targeted marketing, and to live with chronic stressors, debt, insecure work, overcrowded housing, that make quitting harder. They often have less access to tailored cessation services, childcare, and time off work to seek help, compounding the challenge.

By linking smoking to the “health gap,” Dobson identifies it as a major engine of inequality. Tobacco drives cardiovascular disease, cancers, and respiratory illness, conditions that cluster in deprived areas and reduce both life expectancy and healthy life years. The effects ripple through families: secondhand smoke exposure, pregnancy complications, and financial strain from spending limited income on cigarettes, which can crowd out essentials like heating or nutritious food. Illness then feeds back into poverty through lost earnings and caregiving burdens, perpetuating a cycle of disadvantage.

The message is practical as well as moral: reducing smoking is one of the fastest ways to narrow health inequalities. Effective strategies combine population measures, high tobacco taxes, plain packaging, comprehensive advertising bans, smoke-free environments, retailer density limits, with intensive, culturally competent cessation support, free or subsidized pharmacotherapy, and proactive outreach where prevalence is highest. Addressing upstream determinants, poverty, housing, mental health, and job security, raises the odds that quitting will stick. When society lowers the ambient pressures that drive addiction and removes structural barriers to cessation, fewer people die too soon, and the gap between the best and worst off begins to close.