This presentation was given to the national Public Health Stakeholder Forum for England on 21 January 2015. It covers my take on tobacco control priorities and work we need to do

1. www.hertsdirect.org
Tobacco Control –
changing the game
together
Jim McManus
Director of Public Health, Hertfordshire County Council
Public Health Stakeholder Forum 21st
January 2015

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The context for an endgame on
tobacco control – changing the game
• Not just systems but
culture and landscape
changed
• E cigarettes, Stoptober
and their impact on stop
smoking services
• Digital services and
platforms (probably lower
impact than above)
• Confused Landscape –
who should do what?
• What does good
look like in the new
world?
• Mental health
• Rise of inequalities
and hard end
smokers
• Harm reduction

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PHE suggested game changers
1. Behavioural science in the digital age, allowing us to reach people we
haven’t been able to reach before and providing personalised support on a
mass scale.
2. Place-based approaches, developing local solutions that draw on all the
assets of an area, integrate public services and build resilience in
communities.
3. NHS preventative services implemented at scale, working with NHS
England.
4. Transparency, so that everyone can access information on performance or
need and evidence on what works, to make better decisions. This will
include a partnership with the Chartered Institute of Public Finance and
Accountancy to focus on the return on investment from public health
interventions.
5. The contribution of employers to improving mental and physical health.
6. Using the concept of wellness (and developing measures of wellness) to
give a broader view of health.

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My take on PHE suggested game
changers
1. Behavioural science in the digital age, - focus on national tools which
can be disseminated locally
2. Place-based approaches, developing local solutions - this is our job,
you need to be clear what your role is
3. NHS preventative services implemented at scale, working with NHS
England – need for greater clarity about who does what
4. information on performance or need and evidence on what works – yes
5. The contribution of employers – you do national, we do local
6. Using the concept of wellness (and developing measures of wellness) to
give a broader view of health – do we even know what this means?
What about resilience and coping?

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My suggested additional game
changers
1. Behavioural science approaches not just digital
2. Contested marketplace – Stoptober etc
3. E cigarettes

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Local Ambitions
• Reduce Smoking Prevalence
to 18.5% or less in each
district
• Reduce the uptake of Smoking
in Young People to less than
9% by 2015
• Reduce Smoking in Pregnancy
to 7% or less by 2015
• Reduce the harm from second-
hand smoke
• Promote Smokefree public
sector organisations and
healthy workplaces

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Local authority investments in tobacco
• At this moment in time hitting local
authorities about their pension funds is a
distraction and you are not going to win
overnight

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Tobacco Control Progress:
Reducing Adult Prevalence
Reduce smoking in every district to 18.5% or less by 2015
0
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25
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England Hertfordshire Stevenage Hertsmere Welwyn
Hatfield
Broxbourne Dacorum NorthHerts St Albans Three Rivers East Herts Watford
PercentageofSmokers
Percentageof adults who smoke
Source: Integrated Household Survey published by Public Health England

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Tobacco Control Progress:
Reducing Prevalence in Young People
Reduce smoking in young people, so that less than 9 per
cent of 15 year olds smoke by 2016
0
5
10
15
20
25
2008
2010
2012
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Hertfordshire Broxbourne Dacorum East Herts Hertsmere NorthHerts St Albans Stevenage Three Rivers Watford Welwyn
Hatfield
Percentageofchildrenwhosmokeregularly
Percentageof children aged 15 who smoke regularly
Male Female
Source: Health Related Behaviour Survey

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Tobacco Control Progress:
Reduce the number of women who are
smoking at the time of delivery to less than
7% by 2015
130 142 134 119 122 125 126 124
0%
2%
4%
6%
8%
10%
12%
14%
2013/14Q1
2013/14Q2
2013/14Q3
2013/14Q4
2013/14Q1
2013/14Q2
2013/14Q3
2013/14Q4
2013/14Q1
2013/14Q2
2013/14Q3
2013/14Q4
England ENHCCG HVCCG
Percentageof women smoking at the time of delivery (by CCG)
% women smoking at time of delivery Target Source: Health & Social Care Information Centre

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What we have done since arriving in Local
Government:
1. Public Health Strategy adopted Nov 13 with clear priority
commitments on tobacco
2. One of the HWBB 9 Priorities
3. Hertfordshire Tobacco Control Policy approved by Cabinet (based
on LGA declaration but goes further) Nov 13
4. Established PH board – advocates of Tobacco Control and route to
sharing best practice and advocacy
5. Collaborating with national agencies on harm reduction and e
cigarettes in tobacco control

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What we have done since arriving in Local
Government cont.
1. Tobacco Control Strategic Plan 2014-2016 approved by
Public Health and Localism Panel May 2014
2. Detailed profiles for every District and CCG locality on
impact of tobacco as part of JSNA
3. £2m investment in District Council led public health.
Tobacco one of top priorities
4. Smoke free homes, cars and playgrounds

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Hertfordshire Tobacco Control
Strategy Group
• Tobacco Control Strategic Plan 2014-2016
developed with stakeholders
• Responsible for delivery of each of these
priorities working with TC Alliance partners
• Reports to Public Health and Localism Panel
and to HWb Board
• Project management approach to delivering
ambitions

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Work underway now
• Refresh ambitions
• Director of Public Health Report 13-14 focus on ‘Early
Avoidable Death’ and prioritises smoking-related
behaviour –
• New NHS contribution plan in development on back of
NHS Statement of Support
– “Three big wins for the NHS” System Leaders sign up
– Work with CCGs and JCT to include Tobacco Control and
Smoking Cessation in NHS targets (mental health, NHS
Hospital Trusts and Community Provider)
• Include Tobacco Control in PH communication and
marketing plan 2014-2015
• Develop harm reduction guidelines - to include e-
cigarettes guidance

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E cigarettes are a game changer in
tobacco control
• We have thought, read and reflected long and
hard on this
• The evidence points to the benefits being
greater than the harms
• We will keep evidence under review
• We will treat e cigarettes as a tool for public
health gain not a threat unless credible scientific
evidence says otherwise
• Most vapers care about their health, we cannot
ignore this important trend

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E cigarettes 2
• Gateway theories and fears on e cigarettes are
not supported by the evidence so far
• Yes lets protect children proportionately
• Is public health at the forefront of making the
trend to vaping the healthiest it can be, and if
there is evidence of harm, reducing or
protecting the public from it?
• Or are we in denial?

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Harm Reduction
• Our new harm reduction guidelines are
approved and working
• They include a range of harm reduction
strategies including working with e cigarettes,
cutting down to quit etc
• Our watchword is effectiveness and cost-
effectiveness. If it works for our population and
is safe, what legitimate reason do we have not
to engage with it?

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thank you