Every year, around 2,200 people die from smoking related causes in Northern Ireland (NI).  That is the equivalent of six lives lost every single day.  If this level of loss were linked to a new or emerging threat, it would be declared a national emergency.  Smoking should be treated with the same urgency.

The scale of harm caused by smoking is not only measured in lives lost, but in the pressure placed on our health system and economy.  Analysis from the Northern Ireland Audit Office highlights the extent of this burden. Each year, there are around 34,900 smoking-related hospital admissions in Northern Ireland (N), alongside approximately 60,000 hospital bed days linked to tobacco related mental or behavioural disorders alone.

The financial cost is equally stark. The Department of Health estimates that treating smoking related illness costs local hospitals around £218 million annually. When wider economic impacts are included, such as premature deaths and excess sickness absence, the Public Health Agency estimates that the total annual cost rises to around £450 million.

These figures underline a key point: smoking is not just a health issue, it is a system-wide challenge affecting healthcare capacity, workforce productivity, and public finances.

For decades, public health charities and organisations in Northern Ireland have recognised this reality and worked tirelessly to change it. In 1973, Cancer Focus Northern Ireland established Action on Smoking and Health NI (ASH NI) as a dedicated subcommittee of Cancer Focus Northern Ireland to drive forward tobacco control. Since then, ASH NI has played a central role in advocating for stronger policies, raising awareness, and supporting programmes aimed at reducing smoking rates across the region.

That sustained effort has delivered real change. Smoking prevalence has fallen significantly over time, and public attitudes have dramatically shifted. Smoking is no longer seen as a social norm in the way it once was. This progress did not happen by chance. It is the result of decades of advocacy, evidence-based policy, and persistent campaigning. It is also important to acknowledge that these advances were achieved in the face of strong resistance from a powerful tobacco industry with a long history of opposing and delaying regulations to protect its profits.

Now, a new chapter in tobacco control is emerging. At the UK level, the Tobacco and Vapes legislation was passed into law this week and will apply to NI.  It represents a major opportunity to further reduce the harms caused by smoking and address the growing concern around youth vaping.

At the heart of the legislation is a bold and transformative concept, the creation of a smoke free generation. This will be achieved by gradually phasing out the sale of tobacco products. Under the proposed legislation, it will become an offence to sell tobacco products, herbal smoking products, and cigarette papers to anyone born on or after 1 January 2009. In effect, children born from this date onwards will never be legally able to be sold tobacco. It is about breaking the cycle of addiction before it begins.

One of the strengths of this approach is that it does not impose new restrictions on people who can already legally smoke. Instead of raising the legal age of sale across the board, the legislation introduces a gradual, generational shift. For example, as of April 2026, individuals born on or after 1 January 2009 are just over 17 years old. When this group turns 18 in 2027, they will still not be legally permitted to be sold tobacco. Each year after that, the minimum legal age for purchasing tobacco will increase in line with the same birth date rule. This is a fair and proportionate way to phase out smoking over time.

The legislation also takes important steps to address vaping, particularly among young people. There is growing concern about its appeal to children. The legislation aims to ensure that vaping products are not marketed or presented in ways that attract young people, and that clear safeguards are in place.

Key measures within the legislation include a ban on advertising and sponsorship of vaping and nicotine products, as well as a prohibition on selling vapes, including non-nicotine products, to anyone under the age of 18. It will also outlaw the free distribution of vape and tobacco products and ban their sale through vending machines. Additional powers will allow for the regulation of flavours, packaging, and product display, as well as the introduction of updated product standards. In short, this is about closing the gaps that have allowed youth vaping to rise.

Importantly, the new legislation provides the flexibility to expand smoke free environments. This includes powers to designate certain outdoor public spacesand workplaces(including playgrounds, hospital grounds, and outside education settings) as smoke free, and to extend these restrictions to include vaping and heated tobacco products where appropriate. A licensing scheme has also been proposed, strengthening oversight and enforcement. These steps reflect growing public concern, with many arguing that everyone has the right to breathe clean air, free from smoke and vapes.

However, while progress is clear, significant challenges remain, particularly in addressing health inequalities. Smoking rates in Northern Ireland have shown little sustained improvement in recent years and although there has been a gradual decline, beneath this overall figure lies a stark and growing divide.

In the most deprived areas, 23.4 % of adults smoke, compared with just under 6% in the least deprived. This means that people in the most disadvantaged communities are four times more likely to smoke. The gap has widened dramatically, reflecting how smoking is increasingly concentrated in areas facing poverty, unemployment, and poorer living conditions. Smoking is not just a health issue; it is a marker of inequality.

Smoking during pregnancy also highlights the depth of inequality. It is one of the most pronounced health inequality indicators in NI, with rates in the most deprived communities reaching around three times the local average in some areas, reinforcing how disadvantage begins before birth.

Tackling smoking, therefore, is not only a public health priority, it is also a matter of social justice. Where you live should not determine how long you live.

Although the new law represents a significant step forward, the legislation alone is not enough. Effective implementation, strong regulation, and sustained investment in stop smoking services will be essential, alongside continued public education on prevention and targeted support for the communities most affected will also be critical if we are to close the inequality gap.

At the same time, it is important to recognise and celebrate progress. The passage of such ambitious legislation marks a pivotal moment in the journey towards a tobacco-free NI. What once seemed unthinkable, a generation that never legally be sold tobacco, is now within reach. This is truly a once in a generation opportunity to end the harm caused by tobacco.

It is a classic David and Goliath story, decades of determined public health advocacy standing up to one of the most powerful industries in the world. And while the fight is not yet over, this moment is a powerful reminder of what can be achieved through persistence, evidence, and a shared commitment to protecting future generations.

Nora Smith, Director of Policy, Research and External Engagement, Cancer Focus Northern Ireland

In her current role Nora leads and delivers high‑impact cancer policy and public affairs strategy in Northern Ireland, building strong relationships with senior policymakers, healthcare leaders, charities, and key influencers to drive legislative and system change.

Nora brings over 20 years of leadership experience across the charity sector, with a deep commitment to advocacy, equity, and systemic change. Her work has always centred on amplifying underrepresented voices and creating fairer, more inclusive systems, whether through lobbying for policy reform, leading research that reflects lived experience, or building trusted relationships across government and civil society.