Campaigners warned this week that the Scottish Government had "lost its way" in tackling public health harms.

Scotland has long been branded the "sick man of Europe" and our ongoing position at the bottom of western Europe's life expectancy rankings is doing little to reverse that.

Yet there was a time when ministers seemed more willing to push the envelope.

In March 2006, Scotland was the first part of the UK to impose a ban on smoking in enclosed public spaces such as workplaces, bars and restaurants.

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This was not necessarily trailblazing - the Republic of Ireland had already done so in 2004 and was itself aping legislation previously adopted by the likes of California and New York - but it did mark the beginning of the end for pub smoking throughout Britain.

In 2012, the Scottish Government passed genuinely world-first legislation to set a minimum unit price for alcohol which eventually came into effect, after much legal wrangling with the whisky industry, in May 2018.

In September this year, the levy was raised from 50 to 65 pence per unit, although the Republic of Ireland - who enforced their own MUP law in 2022 - are already applying a tougher threshold of €1 (84 pence) per unit.

While it remains controversial to some and has coincided with a period when alcohol deaths in Scotland have reached a 15-year high, the evidence does suggest that the picture would be significantly worse if MUP had never been introduced.

In 2020, Wales also adopted MUP and Northern Ireland is actively considering it.

Smokers in Scotland have been forced to go outside since 2006's indoor smoking banSmokers in Scotland have been forced to go outside since 2006's indoor smoking ban (Image: PA) In recent years, however, there has been a sense of stagnation and a reluctance to take on the food and drink lobbies in favour of public health.

Proposals to curb alcohol marketing and legislation that would have clamped down on junk food deals have both been kicked into the long grass. Not abandoned, but in consultation limbo.

The target to halve childhood obesity to 7% by 2030 - announced in 2018 - is well off track.

As of 2022, the figure was 18% - the highest level for any point since 2010.

So what else could the Scottish Government do to improve population health?

A paper published on Tuesday by Public Health Scotland (PHS) might offer a clue: minimum unit pricing for tobacco.

Jenni Minto, Scotland's minister for public health, said the Scottish Government would "carefully consider" the findings.

For now, however, it is nothing more than a modelling exercise showing what the projected outcomes of such a policy are likely to be.

The percentage of smokers in the Scottish population has fallen from 28% in 2003 (and 51% in 1974) to 15% by 2022, but it is still the leading cause of preventable deaths.

The Scottish Government wants Scotland to be "smoke-free" (defined as a smoking rate of 5% or less) by 2034, but this also looks to be off-course.

According to the PHS report, on "current projections" smoking prevalence in Scotland is expected to shift from 14% in 2024 to 8.5% by 2034.

Smoking rates in Scotland, men and women, 1995 to 2022Smoking rates in Scotland, men and women, 1995 to 2022 (Image: Statista/ScottishHealthSurvey) Introducing minimum pricing at 80 pence per cigarette (£16 for a pack of 20, before tax) would nudge that goal closer, bringing smoking prevalence down to a projected 6.7%.

The report itself acknowledges that the reduction in smoking rates would be "modest" - a 2% reduction in smoking prevalence overall at 80 pence, rising to a 3.9% reduction in the most deprived areas - but that would still translate into fewer deaths and hospital admissions for the NHS.

The analysis uses the same modelling platform developed by Sheffield University to evaluate the potential effects of MUP for alcohol.

It examines various thresholds: 40 and 50 pence (which would only affect the cost of cheaper, hand-rolling tobacco) and 60, 70, and 80 pence, which would impact on factory-rolled cigarettes, and assumes that these would rise in line with Retail Price Inflation (RPI).

It projects that the 60 pence rate would result in 1,467 fewer hospital admissions over a 10 year period from 2024-2034, or 3,784 if the 80 pence rate was used.

In terms of mortality, it would prevent 285 deaths at 60 pence and 727  at 80 pence.

The highest effects are seen in the most deprived areas, and at 80 pence (Image: PHS) A total of 727 lives would be saved over 10 years at 80 pence, according to the modelling (Image: PHS) The effect on hospitalisations and deaths would be most pronounced in deprived areas where smoking rates and consumption levels are highest, and relatively cheaper tobacco products are more commonly smoked.

As with MUP on alcohol, the policy would be open to accusations of being an unfair "tax on the poor".

At the 80 pence rate, the average spend per week for a smoker in the most deprived areas who continues to smoke after minimum pricing would be projected to increase from around £26 per week to nearly £40, compared to around £7 to £17 for a smoker in the most affluent areas.

Spending on tobacco would increase most for smokers in the most deprived areas (Image: PHS) The flipside is that the poorest are also the worst hit by tobacco's harms.

Lung cancer, for example, is three times more common in the most deprived areas and survival rates are significantly lower compared to the most affluent. 

If not minimum pricing, then what else? 

In recent decades the UK has prohibited tobacco advertising and sponsorship (2003); banned indoor smoking in public places (England, Wales and Northern Ireland followed Scotland in 2007); and implemented  plain packaging legislation in 2017. 

Labour has pledged to reintroduce legislation tabled by the previous Conservative government to create "smoke-free generation" by gradually raising the legal UK smoking age by one year, every year. 

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Previously due to take effect from 2027, it would mean that anyone born on or after January 1 2009 could never legally buy cigarettes.  

The policy was pioneered in New Zealand in 2022, but controversially repealed in February this year to help fund tax cuts. 

Meanwhile, a mooted crackdown on smoking in outdoor public spaces - such beer gardens - looks to have been quietly ditched. 

The Scottish Government could lead the way instead if it were willing to face the wrath of hospitality. 

But the easy wins are over; achieving a "smoke-free" Scotland by 2034 is out of reach without something radical.