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Health Inequalities and Smoking, Dr. Helen McAvoy


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Health Inequalities and Smoking, Dr. Helen McAvoy

  1. 1. Health Inequalities and SmokingDr. Helen McAvoy, Senior Policy OfficerInstitute of Public health in Ireland
  2. 2. 2European Week Against Cancer 2013Aviva Stadium , Dublin2Tobacco and Health InequalitiesDr Helen McAvoyInstitute of Public Health in Irelandwww.publichealth.ie2
  3. 3. 3www.publichealth.ie3All-island bodyo Inequalities in healtho North-South cooperationThree work strands:o strengthening public health intelligenceo building public health capacityo policy and programme development and evaluation
  4. 4. 44OutlineCancer & inequalities in life expectancyInequalities in tobacco-related harmInequalities in smoking behaviours Social & commercial determinants Time to develop a more comprehensiveapproach to addressing inequalities intobacco-related harm?4
  5. 5. 55Source:NI Health and Social Care InequalitiesMonitoring System – 2013An overview of changes in NI lifeexpectancy 2001-03 to 2008-10Comparison of life expectancy‘deprivation gap’ in NorthernIreland- most deprived vs. leastdeprived
  6. 6. 6Sweden and the World - Stockholm-May13/14 2013 6Source:NI Health and Social CareInequalities MonitoringSystem – 2013An overview of changes inNI life expectancy 2001-03to 2008-10Contribution of the lifeexpectancy gap of 7.6years between NI most& least deprived areas2008-10 by cause ofdeath (males).
  7. 7. 7Source: Cancer in Ireland 2011. National Cancer Registry of Ireland. www.ncri.ie7Age-standardised incidence of cancer by deprivation category of patientresidence 2007-2009 – Republic of Ireland
  8. 8. 8Source: National Cancer Registry Ireland, 2011 – Lung Cancer Incidence,Mortality, Treatment & Survival in the Republic of Ireland 1994-2008.8
  9. 9. 99Source: Cancer in Ireland 2011. National Cancer Registry of Ireland.
  10. 10. 10Source: Cancer in Ireland 2011. National Cancer Registry of Ireland - 105 year survival for cancers diagnosed during 1994-1997, 1998-2002, 2003-2007
  11. 11. 1111Source: Cancer in Ireland 2011.National Cancer Registry of Ireland.www.ncri.ie5 year relative survival forcancers diagnosed in menand women 2003-2007
  12. 12. 12Behind the lung cancer statistics Delays in presentation? (men especially) Knowledge & differentiation of symptoms Shame, guilt and stigma Inequalities in multi-morbidity Choices about where to die ( Sharp et al, IMJ, 2010) Fewer empowered survivors to carry theflag for early detection, research, politicalattention and investment
  13. 13. 1313Cancer inequalities are multifaceted Risk – incidence, type, age of diagnosis Finding out – achieving a timely diagnosis Health system, social and economicassets for optimal treatment, survival andrecovery
  14. 14. 1414Inequalities in tobacco-relatedharm Health harms Social and economic harms Socio-economic disadvantage associatedwith life-course accumulation of cancerrisk
  15. 15. 15Sweden and the World - Stockholm-May13/14 2013 15Smoking in pregnancy by deprivation in Northern Ireland 2005 – 2011Source: NI Health & Social Care Inequalities Monitoring System 2012
  16. 16. 1616Risk profile of the lowincome smoker- Exposure to tobacco inutero and SHS inchildhood-Grew up in family andcommunity with highsmoking rate-Early initiation-Heavier smoking-Equally likely to attemptquitting (?)-Less likely to succeed atquitting - definitely
  17. 17. 1717SHS exposure in childhoodYoung Persons Behaviour and AttitudesSurvey 2010 Northern Ireland – 49.8% of11-16 yr olds report adults smoke insidetheir homeISAAC study – Ireland sample 2007 – 45%CHETS study Northern Ireland – SHSexposure is socially patternedIndoor Air Pollution and Health – STRIVEreport 2013 - Mean 24-hour level in smokinghomes of 143μg/m3 4 times higher than USEPA ‘ unhealthy’ level for sensitive groups
  18. 18. Percentage of boys who report theyare current smokers18Source: The Irish Health Behaviour in School-Age Children Study
  19. 19. Percentage of girls who report theyare current smokersSource: The Irish Health Behaviour in School-Age Children Study
  20. 20. Adult smokers by social class (2007)Source: SLAN 2007 Survey of Lifestyle, Attitudes and Nutrition in Ireland: Main Report 20
  21. 21. Percentage of cigarette smokers who reportedtrying to quit in the previous 12 months21Source: SLAN 2007 Survey of Lifestyle, Attitudes and Nutrition in Ireland: Main Report
  22. 22. 2222Tobacco industry role Recruiting ‘FUBYA’ a priority PPACTE report – adapting price strategies Roll your own tobacco Illicit tobacco
  23. 23. 23
  24. 24. 24Source:Irish Independentnewspaper2008
  25. 25. 25Sweden and the World - Stockholm-May13/14 2013 2525
  26. 26. 2626Tobacco control through an equitylens How would we judge success/failure? Health intelligence requirements Regulation of tobacco industry and supplychain Education, health promotion Smoking cessation services, monitoringand review
  27. 27. 2727Dr Helen McAvoyInstitute of Public Health in