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These people die 10 to 20 years earlier, and the biggest factor in this is smoking The annual cost to society of smoking in England is around 17 billion, with the cost to the NHS alone at about 2.4 billion this dwarfs the 10 billion of income from taxes on tobacco products 3 in 5 of all households containing smokers living in poverty are in the North and Midlands, while fewer than 1 in 5 are in London and the South East Perhaps because of the cultural ubiquity of smoking, or the fact that smoking related deaths relate to chronic long-term illness, which lacks the media shock factor of acute overdose drug deaths, we have seemingly become inured to the horrifying scale of smoking related health harms, and their deeply iniquitous impacts on the poor, marginalised and vulnerable