Professor Luke Clancy:

Yes, this is very important, which is why I am delighted to return to it. Smoking is the biggest cause of inequality in health. In this context, poor people are now the main smokers. This is an historical thing because that is not how it started. If one considers tobacco as an epidemic, it has changed dramatically. What happened first was that well-off and educated people had tobacco. The trouble now is the information which is put out, as well as the manner in which it is put out, to get to people who are literate, interested and have a big motivation. We have not been reaching poorer people or targeting them deliberately. As I have stated, the only measures in tobacco interventions that really are effective and reduce inequalities are price and smoking cessation services. That is part of it and I believe it is because we are not focusing on them. Historically, that is the way it has gone. For instance, in new states and developing countries it is the rich who smoke, but as time evolves and the epidemic wanes, people with information and access to services, that is, people who have smoking as a disease and are well-off, access services, while poor people and pregnant women do not. The services and our interventions are not targeted and sometimes one must ask whether we really care.