National challenges, local delivery : reducing smoking
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Presentation by Hazel Cheesman and Jim McManus at the English Public Health Stakeholder Forum 2015
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National challenges, local delivery : reducing smoking
- 1. National Challenges, Local Delivery - reducing smoking Jim McManus, Director of Public Health, Hertfordshire County Council Hazel Cheeseman, Director of Policy, Action on Smoking and Health
- 2. Reducing smoking • Overview of national challenges • Overview of national opportunities • Lessons from local delivery • High impact local actions – discussion
- 3. Tobacco – the national challenge • Pressure on the NHS • Cost to society • Loss of healthy life • Driver of inequalities
- 4. Cost to society £217.0m £390.7m £1.1bn £1.1bn £1.7bn £3.1bn £5.4bn £0 £1,000 £2,000 £3,000 £4,000 £5,000 £6,000 Passive smoking Smoking-related fires Smoking-related social care Lost productivity (sick days) Smoking-related disease (NHS) Lost productivity (early deaths) Lost productivity (smoking breaks) Cost to society (£millions) Estimated cost of smoking in England (£millions)
- 5. Loss of healthy life References: 1. ASH Factsheet, Smoking Statistics: illness & death, October 2011 (http://ash.org.uk/files/documents/ASH_107.pdf) NB area represents value Obesity: 34,100 Smoking: 81,400 Alcohol: 6,541 Suicide: 5,377 Drug misuse: 1,738 HIV: 529 Traffic: 2,502 Each year smoking causes the greatest number of preventable deaths
- 6. Driver of Inequalities Smokers from the highest social class have a lower life expectancy than non- smokers in the lowest social class 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 I+II IV+V Social Class Relativemortality Male non-smokers Male smokers Highest Lowest The life expectancy between rich and poor smokers is similar Richer smokers have a lower life expectancy than poorer non- smokers
- 7. Driver of inequalities 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 Year 0 10 20 30 40 Cigarettesmoking% 35 33 32 32 34 31 31 30 29 30 28 29 27 32 Routi ne & manual 20 21 20 19 17 19 18 17 17 16 16 15 16 16 Non-routi ne 11. 3 25. 3
- 8. Tobacco – a national opportunity • We know what works • Comprehensive approach • Strong leadership • Good partnerships • Implementing the evidence base • Embracing innovation
- 9. Supporting what we know works 0 5 10 15 20 25 30 35 40 45 1978 1982 1986 1990 1994 1998 2002 2006 2010 2013 Smoking prevalence Doll and Peto publish 20 year study showing 1 in 3 smokers die Majority in the UK not smoking Illegal to sell tobacco to under 16s Tobacco Advertising and Promotions Act Smokefree legislation comes into force Tobacco Control Plan for England published Smoking Kills published
- 11. Supporting what we know works • Comprehensive approach • Leadership • Partnership • Implement the evidence
- 12. Supporting a Comprehensive approach • Originally developed by ASH, in partnership with others. PHE has tool under licence from ASH until 2015 • Self-assessment can be supported by a peer review led by a tobacco control expert. • The CLeaR model is based on the 3 domains of: • challenge for existing tobacco control services, based on the best evidence • leadership for comprehensive action to tackle tobacco • results demonstrated
- 13. Local Authority Date signed Newcastle City Council 01-May-13 Manchester City Council 10-Jul-13 Hartlepool Borough Council 05-Aug-13 Liverpool City Council 09-Sep-13 Bath and North East Somerset Council 12-Sep-13 Coventry City Council 21-Oct-13 London Borough of Southwark 28-Oct-13 Rochdale Metropolitan Borough Council 31-Oct-13 Southampton City Council 04-Nov-13 Gateshead Council 07-Nov-13 Somerset County Council 21-Nov-13 Thurrock Council 27-Nov-13 Warrington Borough Council 02-Dec-13 North Tyneside Council 02-Dec-13 Calderdale Metropolitan Borough Council 03-Dec-13 Birmingham City Council 11-Dec-13 Lancashire County Council 12-Dec-13 Mendip District Council 16-Dec-13 Blaby District Council 13-Jan-14 Halton Borough Council 15-Jan-14 Durham County Council 17-Jan-14 Supporting local leadership
- 15. Supporting partnerships The NHS will therefore now back hard-hitting national action on obesity, smoking, alcohol and other major health risks. We will help develop and support new workplace incentives to promote employee health and cut sickness-related unemployment. And we will advocate for stronger public health-related powers for local government and elected mayors.
- 18. Local delivery
- 19. High impact local actions 1. Comprehensive local strategy…? 2. Targeted approach to health inequalities…? 3. Harm reduction…? 4. Smoking in Pregnancy…? 5. Political engagement/ leadership…? 6. Building partnerships…?
- 20. For discussion 1. Delivering high impact actions 2. Barriers to local delivery of tobacco control 3. Opportunities for national support
Editor's Notes
- Ill-health caused by smoking is much more common amongst the poorest and most disadvantaged in society: smoking is the primary reason for the gap in life expectancy between the rich and the poor. The poorest in our communities smoke at higher rates and smoke more on an individual level – their habit is the single biggest reason for the difference in their life expectancy compared to the richest in our communities. To reduce health inequalities, we must specifically target poor smokers and smokers in marginalised and deprived communities. The cost of tobacco use affects everybody. Tackling tobacco use at a population level using community initiatives and targeting young and poorer smokers, as well as certain minorities, evidence shows is the most effective way of reducing youth up-take. References: 1. Gruer L et al. BMJ 2009;338;bmj.b480 (Relative mortality assessed at 2nd 14 year follow-up between male smokers & non-smokers of highest & lowest social class) 2. Insert the bit about Wanless from the Islington report.