This paper demonstrates that smoking is the single biggest cause of health inequalities and is responsible for half of the difference in life expectancy between the richest and poorest in society. It is directly related to three of the 12 levelling up missions recently announced by the UK government in its Levelling Up White Paper, published February 2022.1 Significant action on smoking is essential if the Government’s ambition to add 5 years healthy life expectancy by 2035 is to be achieved. Indeed, action on smoking is likely to be the most single effective method of achieving this goal, and smoking is the most important and easily modifiable risk factor related to health inequalities.2,3 This is because it is often easier to help people to quit smoking than to address complex risk factors such as poverty and poor housing. 

The overall ambition to ‘level up’ health outcomes is welcome, yet the UK government is currently on track to miss three out of the four targets set out in the 2017 Tobacco Control Plan. It is also on track to miss its own 2030 smokefree ambition for England, which aims to drive smoking rates below 5%. Against this disappointing backdrop, without significant additional resources and action on smoking, these levelling up missions and improvements in healthy life expectancy will not be achieved. We need to be clear about that reality now, so that effective action can be taken.