The ban on smoking in public spaces and workplaces is the greatest UK public health achievement of the 21st century, according to public health experts.

The move, which came into full force in all four UK countries by July 2007, has been credited with causing a fall of more than 20% in heart attacks and other cardiac conditions in the first 10 years after it was introduced.

Deborah Arnott, chief executive of ASH (Action on Smoking and Health), said: “The smoking ban rightly has top ranking as the most important public health achievement of the 21st century, and ASH is proud to have played a role in this. Smoking is no longer part of most people’s daily lives and politicians of all parties now share [our] vision of bringing smoking to an end. Indeed the Conservative government has given the tobacco industry an ultimatum to make smoking obsolete by 2030.”

However, she said smoking still kills more people than the next six preventable causes of death put together and is heavily concentrated among the poorest and most disadvantaged in society. Arnott urged tougher regulation and renewed funding for preventative programmes and those that help smokers quit.

The list was voted for by a sample of Royal Society for Public Health (RSPH)’s 6,500-strong membership, and then an expert panel of 33 senior public health professionals.

In second place was the sugar levy on soft drinks. In July, shortly before becoming prime minister, Boris Johnson questioned the effectiveness of such “sin taxes” and he was accused of attempting to suppress a Public Health England report that showed the levy, introduced in 2017, had led to a 28.8% fall in the amount of sugar contained in such beverages.

Completing the top three is the 2010 Marmot review into health inequalities and understanding of the social determinants of health. Earlier this year, the author, Sir Michael Marmot, warned that higher taxes on the rich may be needed to tackle widening inequality.

At number four is the impact of Sure Start children’s centres between 2000 and 2010, the year the coalition government came to power. Under David Cameron, it failed to protect funding for them as he had promised, and they bore the brunt of cuts to children’s services.

A place below is minimum unit pricing on alcohol in Scotland, which the government has resisted introducing in England, despite clamour from campaigners, and at number 17 is the reduction in homelessness between 2003 and 2009, again the year before the Conservatives entered government.

More recent achievements include HPV vaccination for girls and boys (the latter was introduced this year) at number six, the decriminalisation of abortion in Northern Ireland also this year, at number eight, and last year’s reduction of the maximum permitted stake on controversial fixed-odds betting terminals (FOBTs) from £100 to £2, which was number 15 on the list.

Shirley Cramer, RSPH chief executive, said: “We spend so much time discussing what needs to be done – and rightly so – but sometimes it is also important to reflect on how far we have come.



“This ranking really shines a light on the fantastic and inspiring progress that has been made through public health in the last two decades, and unambiguously makes the case that prevention is better than the cure.”