OBJECTIVES: The UK Government has a target of increasing HLE by 5 years by 2035 and narrowing geographical inequalities in HLE, where smoking patterns are a significant driver. We explored the quantitative link between smoking and HLE by modelling and projecting the potential impacts of smoking interventions on HLE at local and national levels.

METHODS: We analysed variations in smoking prevalence across the 149 upper-tier local authorities (UTLAs) in England and compared these to variations in HLE. To attempt to control for confounding demographic factors and extract a direct link between smoking and HLE, we focused our analysis on pairs of UTLAs with similar geographic and demographic features.

We applied the Sullivan method to construct life tables with health and mortality components for current smokers, ex-smokers and never-smokers. We used these to convert age-specific changes in smoking prevalence into changes in overall population HLE at a local and national level. This provided a tool for quantifying the impact of smoking intervention programmes and evaluating to what extent these can help deliver the government’s target of increasing HLE by 5 years by 2035.

RESULTS: We found a strong correlation between levels of deprivation and smoking prevalence (+0.76), and between smoking prevalence and HLE (-0.73). However, we found that reducing smoking prevalence would likely have a relatively modest impact on HLE in the short term: even in an extreme scenario where everyone in the most deprived UTLA quits smoking overnight, the modelled gain in HLE in that UTLA is less than 3 years.

CONCLUSIONS: The link between deprivation, smoking and healthy life expectancy suggests that smoking intervention programmes have a role to play in reducing health inequalities. However, to meet the government’s ambitious HLE targets, smoking interventions would need to be combined with broader action across the multiple drivers of poor health outcomes in the UK.