Why I told the government to ban smoking outright for a generation
The Smoking and Vapes Act will make it illegal to sell tobacco — including shisha and paan — to anyone born in or after 2009
It’s not often that you get a direct call from the health secretary. It is even rarer for that call to ask you to lead a piece of work that could reshape public health for generations. But that is exactly what happened in January 2022, when the then health secretary, Sajid Javid, asked me to conduct an independent review of the government’s tobacco policy.
I had just stepped down from leading Barnardo’s, the UK’s largest children’s charity, and was beginning to enjoy some long-overdue rest. So when he asked me to lead this independent review, I did wonder, quite honestly: “Why now and why me?” Like many people, I assumed smoking was a problem largely solved — a relic of the past, not the defining health challenge of the present.
I could not have been more wrong.
My review — The Khan Review: Making Smoking Obsolete — was published in June that year. The resultant Tobacco and Vapes Act 2026, which received royal assent on Wednesday, will mean no one born on or after 1 January 2009 will ever legally be able to buy cigarettes, tobacco, shisha or paan.
Once I began reviewing the evidence, I was shaken by what I found. Smoking is one of the biggest drivers of preventable illness, health inequality and pressure on the NHS. It leads to 64,000 deaths a year in England; it causes hundreds of thousands of hospital admissions every year; two‑thirds of long‑term smokers will die from smoking‑related illness; and the economic cost to society, from NHS treatment to lost productivity, is estimated at between £21bn and £27bn a year.
Cigarettes remain the only legally sold consumer product which, if used as the manufacturer intended, will leave two thirds of users either critically ill or dead. That would be four million of the current six million smokers in this country. No other product sold legally to the general public has that effect.
If invented today, I believe cigarettes would never be legalised.
And the burden is not evenly shared. Smoking rates are highest among the poorest communities, people in social housing, and those facing unemployment or mental health challenges. In some of the most deprived areas, smoking prevalence is still above 20%. Without decisive action, these inequalities would persist for decades.
It became clear to me that incremental change would not be enough. The only morally and scientifically defensible goal was a smoke‑free generation.
Six months later, after speaking to experts across the world, reviewing global evidence, and working with an exceptional civil service team, I published my review. It set out 15 recommendations, presenting a comprehensive strategy to deliver a smoke‑free Britain.
Some of the proposals were ambitious. The most debated was a phased, year‑on‑year increase in the legal age of sale which will effectively create a generation that would never legally be able to buy cigarettes. Many told me privately that such a measure would “never happen”. Some advised me to be cautious, to avoid controversy, to think smaller. Indeed, some of the current celebratory messages are coming from those who showed little or no support at the time. But the evidence was overwhelming.
The journey from recommendation to legislation was anything but smooth. Sajid Javid showed real leadership in commissioning the review, but he left office before the work could progress. Momentum stalled. Later, prime minister Rishi Sunak revived the proposals and prepared to legislate, only for a general election to be called. Professor Chris Witty, the chief medical officer, remained a stalwart supporter throughout.
While in opposition, Labour made clear its support for the core recommendations. When the party entered government in 2024, the new health secretary, Wes Streeting, moved quickly. With the backing of Keir Starmer, he strengthened the proposals that have now been passed. A policy many said would never happen is now law.
This legislation is one of the most significant public health interventions in modern British history. It will save millions of lives, reduce pressure on the NHS, and narrow some of the starkest health inequalities in the country.
For decades, the NHS has repeated the mantra that prevention is better than cure. This law finally gives that principle teeth. It protects children, supports families, strengthens communities and safeguards the future of our health service.
And it shows something else: that bold ideas rooted in evidence and the public good can survive the turbulence of politics.
The World Health Organization has called these measures “game‑changing”. Public support is strong: recent surveys show that around 70% of adults back a smoke‑free generation policy.
There will be challenges ahead. Implementation will require vigilance, enforcement and continued investment in stop‑smoking services. The tobacco industry will not quietly accept the decline of its market. But the direction of travel is now set. A generational shift has begun.
And for me, it is a reminder that when evidence, courage and political will align, change that once seemed impossible can become inevitable.
Professor Dr Javed Khan is the author of The Khan Review: Making Smoking Obsolete and managing director of the thinktank Equi.
