I’d like to thank Dr Atherton for his report, and record my thanks to Professor Jones for holding the fort following Dr Hussey’s retirement. Dr Atherton makes it clear that the biggest health challenge facing our nation is tackling the health inequalities between the richest and poorest in our country. The fact that the gap in life expectancy between those living in our most and least deprived areas is growing should shock us all. We cannot stand idly by when the poorest in Wales can expect to live 11 years shorter than the most affluent.

The reasons for the existence of the social gradient in health are complex, but contributory factors include poor diet; a greater prevalence of smoking and alcohol misuse in our most deprived areas; poorer housing conditions; high-rise flats with no garden for children to play in, getting the much-needed exercise; damp conditions leading to respiratory problems; and also high unemployment rates in poorer areas. People in our most deprived areas are twice as likely to smoke as those living in more affluent areas of Wales. We need collaboration of services and partnerships to help with these inequalities.

While we are making progress in reducing the numbers of smokers overall, tobacco control measures have been more successful in reducing uptake than in encouraging existing smokers to quit. Children with at least one parent who smokes are 72 per cent more likely to smoke in adolescence, and if both parents smoke, children are four times more likely to start smoking than if neither parent smokes. Therefore, we must redouble our efforts to encourage parents to quit smoking.

A study for the British Medical Journal found that smokers underestimate the risk of lung cancer, both relative to other smokers and to non-smokers, and demonstrate other misunderstandings of smoking risks. This is put down to the fact that, as a species, we’re not very good at evaluating future risk. Telling someone that they may develop cancer in 30 or 40 years unfortunately doesn’t motivate them to quit smoking. However, we are much better at evaluating risks to our children. Telling a parent that their behaviour is encouraging their children to smoke may have the desired outcome.

We have to accept that many smokers find it nearly impossible to quit. Research by the UK Centre for Tobacco and Alcohol Studies found that approximately one in three smokers in the UK currently attempts to quit each year, but only about one in six of those who try to quit remains abstinent for more than a few weeks or months. Most smokers who try to quit do so without accessing professional help, and those who use over-the-counter nicotine replacement treatments appear to be no more likely to quit than those getting no help.

However, those who switch to e-cigarettes are far more likely to quit tobacco. The Royal College of Physicians states that

‘in the interests of public health it is important to promote the use of e-cigarettes, NRT and other non-tobacco nicotine products as widely as possible as a substitute for smoking in the UK. ’

Public Health England advocate the use of e-cigarettes as an alternative to smoking and issue guidance to employers stating that they may consider allowing people to use e-cigarettes at work if it is part of a policy to help tobacco smokers kick the habit. The Medicines and Healthcare Products Regulatory Agency has approved a brand of e-cigarettes to be marketed as an aid to help people stop smoking.

As the chief medical officer says in this report, the NHS should not make the social gradient worse. I therefore urge you, Cabinet Secretary, to adopt a similar approach to England when it comes to e-cigarettes and their role in reducing harm from tobacco. We should be encouraging those smokers who are unlikely to quit to switch to e-cigarettes, highlighting the fact that e-cigarettes are 95 per cent safer than tobacco products, rather than focusing on the potential harms of vaping. Thank you. Diolch yn fawr.