4. And feels reinforced by lived experience …..
Tobacco Atlas 2015
http://www.tobaccoatlas.org/
topic/tobacco-poverty/
5. Leading to support or tolerance
“The only enjoyment sometimes they have is to have a
cigarette.”
Rt Hon Dr John Reid as Secretary of State for Health
Actually research shows:
- smoking is associated with lower levels of pleasure
and poorer overall quality of life
- smoking is associated not just with poor health but
with feeling less well
- stopping smoking is associated with as much benefit
to mood and anxiety disorders as taking anti-
depressants
6. Smoking is not a lifestyle choice
Most people who smoke started as children
Most people who smoke want to stop
Four times higher in most disadvantaged areas
Almost half of those with registered disability or
unemployed and seeking work
Smoking rate very high amongst prisoners and
those with mental health issues
7. Which means ??
We must reject any narrative
that blames people for perceived
poor lifestyle choices
We should not seek prohibition
or punishment, but instead look
to change culture and context
A fair and compassionate
approach requires we address
the factors that lead certain
groups to smoke and make it
more difficult for them to stop
Tobacco Atlas 2015
http://www.tobaccoatlas.org/topic/tobacco-poverty/
9. In practice this means….
Sympathetic approach - carrot as well as stick
Clear lead on mental health – not a coping strategy
Engage financial support services on stopping smoking
10. A social model of smoking ?
Could we develop a social model of tobacco use that
might look something like…..
“The social model of tobacco use says that inequalities
in smoking rates arise from the way that society is
organised, rather than by free adult lifestyle choices. It
looks at the factors which lead people to smoke and
which prevent them from stopping and seeks to shift the
balance in support of people regaining control of their
own health, well-being and finances.”
Introduce self – ASH Scotland and what it is
policy and campaigns rather than research, perhaps reflected in presentation
The idea of smoking as pleasurable, relaxing and stress relieving is widespread and deeply ingrained.
Partly that has been a deliberate effort - tobacco companies were very willing to present their products as relieving stress
This was just yesterday – Daily Mail story suggesting smoking is helping Samantha Cameron to deal with the stresses and strains of political life
Now, people on the whole aren’t daft.
The idea that smoking relieves stress is so enduring because it is easy to reconcile with the day-to-day experience of smokers, who feel themselves relax when they smoke.
But relief from nicotine withdrawal symptoms is not the same as helping with underlying stress or anxiety – nicotine addiction adds a new boom-and-bust cycle of stress and anxiety, on top of any underlying issues
John Reid MP famously attracted the ire of grim-faced nanny state fanatics like myself by claiming that smoking was about the only pleasure left to many people and hence that they should be left to it. Admittedly this was back in 2004, but he was the Secretary of State for Health at the time.
If his intention was to say that smoking brought pleasure it seems he was falling into the same trap as those who believe it relieves stress. In fact we find that
“smoking is associated with lower levels of pleasure and poorer overall quality of life” (http://www.publichealthjrnl.com/article/S0033-3506(07)00007-8/abstract?cc=y=)
that it is associated not just with poor health but not surprisingly with feeling less healthy (http://www.gov.scot/Publications/2015/09/6648/downloads#res485587)
and that stopping smoking is associated with as much benefit to mood and anxiety disorders as taking anti-depressants (Taylor, G. et al. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ 348, g1151 (2014))
Whatever people take from daily experience, the research evidence is clear that in general smoking does not make you relaxed or happy.
we have known for some time that most people who smoke started when they were children and that most people who smoke say that they want to stop. The simple fact is that these are more representative of the smoking population than informed adults choosing to smoke.
The more we look into the figures the further we move from the picture of free adults enjoying smoking tobacco.
While the smoking rate has reduced to around 20% in the general population it is four times higher in the poorest areas than in the richest. (Scottish figures, but picture holds elsewhere in UK)
Almost 50% of people with a registered disability, or those who are unemployed and seeking work, smoke tobacco.
The rate is nearer three quarters in the prison population and amongst people with severe mental ill health. Crucially, in every one of these groups most of those who smoke say that they want to stop.
With the likelihood of smoking so determined by social and economic situation, this is not a matter of people making free lifestyle choices but instead about responding to their circumstances in a way that is immediately rational and understandable yet ultimately damaging, expensive and regressive. This is smoking not as lifestyle choice but as coping mechanism.
The clear implication is that we must reject any suggestion of blaming people for their “lifestyle choices”, health or poverty. Nor should we abandon people to an unfair distribution of the social and economic pressures which lead some groups to smoke and make it more difficult for them to quit. But we should question why so many vulnerable people are left without more effective, and less damaging, alternatives to reach for.
A line that is often thrown at us is “if smoking is so bad then why don’t you just ban it”. For me the answer to that is partly that I don’t like banning things and prefer to leave people to run their own lives. I accept that some people do choose to smoke. It also stems from
This analysis may help us resolve the perceived conflict between improving public health and respecting personal liberty – leave the very small number of informed adults who choose to smoke and address the factors which cause the majority of the smoking population to be drawn from young, unwilling or vulnerable groups.
Smoking is not a fundamental cause of health inequality. I’ve heard it said that we shouldn’t bother with smoking and should focus on the fundamental causes of inequality
Does this mean we leave aside issues like tobacco, alcohol, diet?
I don’t hear anyone saying we should just leave payday lenders to their business, or saying we shouldn’t have food banks because they don’t get to the root of the problem.
Smoking is an important mechanism through which inequality is translated into harm to the individual, the family and the community.
While seeking to reduce inequality there is much we can do to limit the way in which it translates into harm
Colleagues at Health Scotland set it out like this….
http://www.healthscotland.com/uploads/documents/25780-Health%20Inequalities%20-%20what%20are%20they%20and%20how%20do%20we%20reduce%20them%20-%20Mar16.pdf
High prices help to reduce smoking rates, but make matters worse for those who don’t manage to quit. We need the carrot as well as the stick – to understand why people keep smoking when they say they want to stop. To see what functions people are seeking from smoking and identify other ways of meeting those functions.
National mental health strategy, for example, provides a perfect opportunity to send a clear message that smoking is not a support mechanism, but part of the challenges and harms faced by this group. While most of these smokers say that they want to quit they also report that stress, boredom and social habits make it difficult to do so. How can we work with people to develop less harmful ways to respond to these needs?
Similarly financial support services are in an ideal position to incorporate blame-free discussion of smoking into their engagement with clients, helping people resolve their problems by breaking the vicious circle of financial stress that can push people to spend money on tobacco.
High prices help to reduce smoking rates, but make matters worse for those who don’t manage to quit. We need the carrot as well as the stick – to understand why people keep smoking when they say they want to stop. To see what functions people are seeking from smoking and identify other ways of meeting those functions.
National mental health strategy, for example, provides a perfect opportunity to send a clear message that smoking is not a support mechanism, but part of the challenges and harms faced by this group. While most of these smokers say that they want to quit they also report that stress, boredom and social habits make it difficult to do so. How can we work with people to develop less harmful ways to respond to these needs?
Similarly financial support services are in an ideal position to incorporate blame-free discussion of smoking into their engagement with clients, helping people resolve their problems by breaking the vicious circle of financial stress that can push people to spend money on tobacco.
