SMOKING is costing Wales an estimated £1.56 billion every year, according to a new Public Health Wales report that highlights the scale of the damage tobacco continues to cause to people’s health, public services and the wider economy.
Around £650 million is spent treating and supporting smokers who experience long-term illness and disability, representing about 5 per cent of Wales’ health and social care budget. The remaining cost is driven mainly by lost productivity (£670 million), as smoking related illness prevents people from working and contributing to the economy.
Environmental costs mount to £241 million, including the costs of fires, litter and air pollution. These figures underline the urgent need for sustained investment in prevention, tobacco control and support to help more people quit.
The report also shows that tobacco is not a normal consumer product. Smoking remains one of the leading causes of preventable illness and death, and its health, social and economic harms continue to place a substantial burden on individuals, communities and public services across Wales.
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It highlights stark inequalities with smoking rates in the most deprived communities in Wales remaining more than three times higher than in the least deprived communities.
They say these findings reinforce the importance of a whole-government approach to tobacco control, including full implementation of the Tobacco and Vapes Act. While population-wide measures are essential, the unequal burden of smoking in deprived communities means targeted support is also needed, to reduce smoking and tackle health inequalities in Wales.
Smoking prevalence in Wales varies considerably by area. Figures from 2022/23, upon which the cost analysis is based, show the following picture:
Ceredigion is the fifth-lowest county, with 10.9 per cent of over-18s smoking, rising to 12.4 in Powys and 13.4 in Carmarthenshire. Pembrokeshire is the ninth with 14 per cent of its adult population, while in Gwynedd it’s as high as 18.4, second only to the Vale of Glamorgan’s 19.3 per cent.
According to the report, a strong social gradient exists, with prevalence highest in the most deprived areas (22.6 per cent) and lowest in the least deprived (6.8 per cent).
According to the National Survey for Wales, published in August 2025, overall smoking prevalence has fallen from 13 per cent to 10 per cent, so the situation would at least appear to be moving in the right direction.
Again, marked geographic variation in smoking-related annual hospital admissions costs were noted, with Ceredigion experiencing the lowest cost.
Public Health Wales interprets this variation in the following way: “Highest costs occur in larger, more deprived local authorities (Cardiff £7.9m, Rhondda Cynon Taf £7.0m, Swansea £6.1m), while smaller rural areas have lower absolute costs, highlighting the need for targeted interventions in high-burden areas.”
In 2022, smoking-related GP service costs in Wales totalled £71.5 million, with males (£36.2m) slightly higher than females (£35.3m). Smoking-related lost productivity costs were estimated by summing the impacts of smoking breaks, absenteeism, presenteeism (the practice of being at work while physically or mentally unwell), and premature deaths among working-age adults, totalling £670 million across Wales but with smaller rural areas incurring a much smaller share of the burden. (Lost productivity costs in Ceredigion were estimated at £12.4m).
Chris Emmerson, Consultant in Public Health with the Tobacco, Vapes and Nicotine Addiction Programme at Public Health Wales, said: “With these figures revealing that 5 per cent of Wales’ entire health and social care budget goes on treating and supporting those harmed by smoking, the need for Wales to remain focused on the ambitious target of a smoke-free Wales has never been clearer.”
The law makes it illegal to sell tobacco to anyone born on or after 1 January 2009, helping to create a smoke-free generation, and gives Welsh and UK governments new powers to regulate tobacco and vape products.
Dr Jo Davies, Head of Health Economics, Advanced Analytics and Policy Modelling at Welsh Government, said: “Behind these figures are Welsh families affected by preventable illness, lost years of healthy life and the ability to fully participate in their communities.”
The Deputy Chief Medical Officer for Wales, Keith Reid, said: “Smoking is still one of the leading causes of preventable illness and early death in Wales. It causes cancer, heart disease and respiratory illness. It places a burden on smokers, their families, and on our health service in Wales. As smoking rates are highest in the most underserved communities, smoking is widening health inequalities across Wales – hitting the most disadvantaged hardest.
“While the number of people smoking is falling, there is still much more to do. We are working closely with Public Health Wales to prevent young people from taking up smoking and to support more people to quit, helping to achieve a smoke-free Wales and a healthier, fairer and prosperous future for all, leaving no one behind.”
Meanwhile, all four UK nations are consulting together on new rules aimed at making vaping products less attractive to children and young people. Proposals include plain packaging, shop display restrictions and limits on flavour names.
Data shows that over a quarter of 11–16 year olds in Wales have tried a vape and almost 7 per cent are vaping weekly. Among 16-year-olds specifically, over 45 per cent have tried a vape and weekly use is 16 per cent.
The proposals aim to reduce youth vaping while continuing to enable adults who wish to use vaping products to quit smoking.
Wales, England, Scotland and Northern Ireland are consulting on proposals under the Tobacco and Vapes Act 2026.
Deputy Minister for Public and Preventative Health – Nerys Evans (Welsh Government)
Deputy Minister for Preventative and Public Health – Nerys Evans said: “The rise of the number of children and young people trying and regularly using vapes in Wales is a real concern and one which we are determined to tackle.
“They are being deliberately designed and marketed to appeal to children – with bright colours, cartoon branding and sweet-sounding flavour names that have no place in products containing addictive nicotine. It is simply unacceptable.
“These proposals would strip away the gimmicks that make vaping attractive to young people.
“I urge everyone – the public, parents, health professionals, teachers, businesses — to have their say before October 2. Together, we can take a big step in protecting our children’s health.”
Wales has previously led the way in the UK on introducing smoke-free measures. It has already passed laws to restrict smoking in outdoor public spaces — including hospital grounds, school grounds and public playgrounds — to help ensure that people, especially children, are not exposed to harmful second-hand smoke.
Anyone who smokes in Wales can access free expert support through Help Me Quit, NHS Wales’ national smoking cessation service. Smokers can start their quit journey by visiting helpmequit.wales, calling Freephone 0800 085 2219, or accessing support in their local area through the national service.
