THE CASE FOR ACTIONon TOBACCO USE & SMOKINGHarms caused by tobacco use & an overview of local tobacco policies to aid commissioning

for Directors of Public Health

NORTH EAST

Version 9.0

5TH October 2012

1. Scale of the challenge

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seEach year smoking causes the greatest number of preventable deaths

References:1. ASH Factsheet, Smoking Statistics: illness & death, June 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

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seDecline in national smoking rates has stalled

References:1. Integrated Household Survey 2009 (mid-point estimate for locality given small sample size and large confidence interval)

23%

22%

21% NB Illustration: please click on the

chart to enter your regional and local data: in this illustration the NW and Liverpool are used for comparison

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seChildren’s rates of smoking

References:1. Smoking, drinking and drug use among young people in England in 2009. National Centre for Social Research, 2010: NHS Information Centre for Health and Social Care.

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1982 1986 1990 1994 1998 2002 2004 2006 2008 2009 2010

Boys Girls Total

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seSmoking-related diseases

Smoking attributable deaths from major diseases (2009)

References:1. NHS Information Centre (2009), Statistics on smoking: England 2009 available at www.ic.nhs.uk/webfiles/publications/smoking09/statistics_on_smoking_england_2009.pdf

Total deaths: 87,000

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£16.

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£11.

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)*Passive smoking: lost productivity from early death (not including NHS costs and absenteeism)

Estimated cost of smoking in Blackpool (£ millions)

Smoking costs the local economy millions every year

References:1. Cough Up, Policy Exchange, 2010

Total cost of smoking to England’s

economy & health service is

£13.74 Billion

Using the slide on local costs of smoking:

1. Double click on the chart to open the Excel spreadsheet.

2. Click on the “Reckoner” tab at the bottom of the chart.

3. Scroll to the top of the spreadsheet to select your region and Council. The spreadsheet should automatically calculate the costs for your area.

4. Print page 2 of the spreadsheet for a handout to use with your presentation.

5. Click on the “Chart 1” tab at the bottom of the spreadsheet and simply click outside the chart area. To return to the slide presentation.

6. You should now have a chart of your local data displayed. The chart may need to be repositioned on the slide.

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£63.1m

£54.3m

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Total costs to society

Smokers' spending ontobacco

Millions (£)

Estimated cost to smokers and society in Blackpool(£ millions)

Cost of smoking to smokers

References:1. Cough Up, Policy Exchange, 20102. HMRC

Over three quarters of the cost of tobacco is tax & national tobacco tax revenue is c£10bn – this is £4bn less than the total national costs of smoking.

Using the slide on local costs of smoking:

1. Double click on the chart to open the Excel spreadsheet.

2. Click on the “Reckoner” tab at the bottom of the chart.

3. Scroll to the top of the spreadsheet to select your region and Council. The spreadsheet should automatically calculate the costs for your area.

4. Print page 2 of the spreadsheet for a handout to use with your presentation.

5. Click on the “Chart 1” tab at the bottom of the spreadsheet and simply click outside the chart area. To return to the slide presentation.

6. You should now have a chart of your local data displayed. The chart may need to be repositioned on the slide.

9Public

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seHealth cost of smoking in your area

NB please use your local data from

http://www.lho.org.uk/LHO_TOPICS/

ANALYTIC_TOOLS/TOBACCOCONTROLPROFILES/

profile.aspx?

Copy from the ‘pdf’ as this provides the clearest image.Because of the detail on this slide may be more effective if accompanied by a “handout”.

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seIf we do nothing – smoking rates will rise

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2011

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Actual

Forecast trend

Projected trend for smoking rates if investment in tobacco control is

ceased

References:1. UCL, ‘Pipe Model’, smokinginengland.co.uk

Since first undertaking this analysis in 2009 our

predictions have turned out to be too positive; showing that

more concerted and reinvigorated action is even

more of a priority

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seLocal smoking rates differ greatly

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All across England there is more room for progress:

In California smoking rates have fallen to a historic low of 11.9%

References:1. Smoking & drinking among adults, 2009. General Lifestyle Survey, ONS, 2011. 2. http://www.cdph.ca.gov/Pages/NR11-031.aspx

2. Smoking attitudes & behaviours

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seThe different ‘stages of smoking’

Take-up smoking

Quitting attempt

Relapse

Decision to quit

Take-up smoking

Quitting attempt

Relapse

Decision to quit

Take-up smoking

Quitting attempt

Relapse

Decision to quit

Reduce the appeal and supply of tobacco

Encourage more quit

attempts each yearSupport quit

attempts

Protect families &

communities

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seChildren not adults start smoking

• Children not adults start smoking: 90% of smokers started before the age of 191

• 99% of 16 year old regular smokers live in a household with at least one other smoker2

• Children are three times as likely to start smoking if their parents smoke1

References:1. Smoking Attitudes & Behaviours (200(), ONS 2011 2. Dr Susan Woods, The Liverpool Longitudinal Study on Smoking : Experiences, beliefs and behaviour of adolescents in Secondary School (2002-2006), Liverpool John Moores University, August 2008

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seSmoking, pregnancy & inequalities

Socio-economic group: % who smoked before or during pregnancy

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Managerial & professional Intermediate occupations Routine & manual

Age: % who smoked before or during pregnancy

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Under 20 20 – 24 25 – 29 30 – 34 35 or over

Pregnant women in the lowest socio-economic group smoke at almost three times the rate of those in the highest.

Smoking rates for teenagers are almost four times higher than those over 35.

References:1. Infant Feeding Survey, ONS 2011

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seEach year thousands of children are treated for exposure to second-hand smoke

References:1. Passive smoking and children, A report by the Tobacco Advisory Group of the Royal College of Physicians, March 2010

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seSummary – impact on families

Smoking in pregnancy is responsible for two fifths of excess infant mortality

Smoking at home is responsible for 15,000 children hospital admissions each year

Children who live with smokers are up to three times more likely to start smoking themselves

Children who live with smokers are up to three times more likely to get lung cancer, even if they don’t smoke

References:1. Passive smoking and children, A report by the Tobacco Advisory Group of the Royal College of Physicians, March 2010

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seOur poorest citizens are twice as likely to smoke

Smoking rates by socio-economic group (England, 2009)

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Managerial andprofessional

Intermediate Routine and manual

References:1. Smoking Attitudes & Behaviours, ONS, 2010

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seBenefits of quitting

20 Minutes

Your blood pressure & pulse return to normal. Circulation improves – especially in your hands and feet.

8 Hours

Your blood oxygen levels return to normal and your chance of having a heart attack falls

24 Hours

Carbon monoxide leaves your body. Your lungs start to clear out mucus and debris.

2-12 Weeks

Circulation is now improved throughout your body. It’s easier to exercise.

3-9 Months

Lung efficiency is up by 5-10%. Breathing problems are gone.

5 Years

You have half the chance of getting a heart attack than a smoker.

References:1. West R. Shiffman S. S Fast Facts, 2nd Ed. Oxford Health Press, 2007

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seMinority groups

Indian

Chinese

General population

Black Caribbean

Pakistani

Irish

Bangladeshi

0 5 10 15 20 25 30 35 40 45

MenWomen

% smoking

Self-reported cigarette smoking percentages by sex and minority ethnic group, persons aged 16 and over, England, 2004

References:1. Passive smoking and children, A report by the Tobacco Advisory Group of the Royal College of Physicians, March 2010

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seSmoking causes half the difference in life expectancy between richest and poorest

The poorest never-smokers have much better life expectancy than even the richest smokers.

Even if the socio-economic circumstances of poorer smokers improve, their health gain is likely to be minimal if they continue to smoke.

To reduce health inequalities every effort must be made to enable the less well-off to stop smoking or never start.

References:1. ASH UK, Beyond Smoking Kills, 2009 / Gruer L. Smoking and health inequalities: new insights from Renfrew and Paisley (http://www.ashscotland.org.uk/ash/files/Laurence%20Gruer_Smoking%20and%20health%20inequalities.pdf)

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seTobacco packaging & marketing

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sePlain packaging

By the end of the year the Government will consult on requiring plain packaging for tobacco products.

Research shows that that plain packs are• Less attractive to young people

• Less likely to mislead smokers into thinking “mild” brands are safer

• Give greater impact to health warningsThis is the

suggested ‘plain pack’ the

Australian national government is considering.

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sePoorer and younger smokers are much more likely to buy illicit tobacco

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Social classes & illicit tobacco consumed (Smoking Toolkit)

References:1. West R, Smoking Toolkit, www.smokinginengland.org.uk

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seWhere do children get their cigarettes from?

Success rate of sales of tobacco to children (2007-08 LGG survey)

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0% 10% 20% 30% 40% 50%

Total sales tobacco 2006-7

Total sales tobacco 2007-8

Vending machines

Independent newsagent

Other (e.g. cafes)

Large national retailer

National newsagent

Small retailer

Petrol station kiosk

Off licence

References:1. LACORS http://www.lacors.gov.uk/lacors/NewsArticleDetails.aspx?id=19686 (2007/08 Survey)

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seWhat motivates smokers to quit?

References:1. E Vangeli, R West, Sociodemographic differences in triggers to quit smoking: findings from a national survey, Tobacco Control 2008

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Concern about futurehealth problems

Health problems at thetime

Knew someone whowas ill or died (from

smoking)

Socioeconomic Group 'A' Socioeconomic Group 'E'

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seHelping quitters succeed

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No medication orsupport (reference)

NRT over-the-counter

Medication onprescription

NHS support andmedication

Odds ratio (relative to no aid)

References:1. West R, Smoking Toolkit, UCL www.smokinginengland.org

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sePoorer smokers: as likely to want to quit and try to quit but half as likely to succeed

Success rate in quitting by socio-economic class

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Social gradient and nicotine dependence

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Nicotine dependency scores

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seSmoking & public opinion (YouGov 2011)

NB You can replace this chart with regional data

produced with this toolkit.

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The law banning smoking in public places is good forthe health of the general public

The law banning smoking in public places is good formy health

Smoking should be banned in outdoor children's playareas

Government policy should be protected from theinfluence of tobacco industry and its representatives

Smoking should be banned in cars carrying childrenunder the age of 18

Putting tobacco products out of sight in shops

Requiring plain packaging with standard lettering fortobacco products

Disagree

Agree

References:1. YouGov Survey 2011

3. Tobacco policies

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seSummary - policies & aims

• stopping the promotion of tobacco; •making tobacco less affordable; • effective regulation of tobacco

products; • helping tobacco users to quit; • reducing exposure to secondhand

smoke; and • effective communications for tobacco

control.

References: Healthy Lives, Healthy people: A Tobacco Control Plan for England. HM Government, 2011

Six internationally recognised strands for tobacco control form the backbone of the DH Tobacco Control

Plan

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seStopping the promotion of tobacco

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seEffective regulation of tobacco products

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se The ‘Smokefree’ law is popular and has reduced heart attacks; “On & Off sales” licences increased 5% the year England went smokefree.

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Reduction exposure smokefree

Reducing exposure to secondhand smoke

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Effective communications

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seTo reduce health inequalities, prioritise helping poorer smokers to quit

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seSignificant & growing role for Local Authorities

Presently LA responsibilities include enforcement on:

Age-of-sale

'Smokefree' places

Smuggled & counterfeit tobacco

Advertising ban

From 2013, Local Authorities will also have the responsibility to commission services to also encourage & support smokers to quit their habit.

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seWorking together for better health

1. Local Government & related agencies enforcing current regulations, inc. Police & Fire Brigade

2. Local NHS, Health Professionals (such as ‘Health Visitors’) & Stop Smoking Services staff

3. Organisations that work across neighbouring localities within a region

4. Employers, particularly retailers & small businesses

5. Voluntary organisations, advocacy groups, academics (inc. Public Health Observatories)

And, not least: Smokers (particularly routine & manual; minority groups with high rates)

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seBenefits of working across local boundaries

Particularly in the current economic climate, there are some activities that definitely benefit from cooperation between neighbouring local authorities;

A few important examples are:

• Marketing & mass media – to ensure ‘health messages’ are supportive, clear & do not conflict

• Tackling smuggling – criminal gangs don’t pay heed to local government boundaries

• Surveys, research & data collection – cost savings can be had from collectively commissioning research & surveys, & sharing the results

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seRegional roles & organisations

• In North East since 2005 regional specialised tobacco control programme- FRESH, Smoke Free North East

• All 12 Primary Care Organisations commission FRESH to provide multiple components of work, delivered in partnership with all localities and key regional (e.g. Association of North East Councils) and national agencies (e.g. Smokefree Action Coalition)

• Small dedicated office, regional strategy, long term campaign, vision ‘Making smoking history for the North East’

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seRole of FRESH

• Providing specialist leadership, expertise, practice sharing, training and development on effective action to tackle tobacco with support to all 12 local tobacco alliances and other key partners e.g. Association of North East Councils

• Cost effective campaigns; expertly designed, procured and evaluated to deliver integrated mass media campaigns & public relations (over £3m earned media in 2010/11)

• Advocacy around strong evidence to influence key legislative and policy decision making to benefit the population of North East

• Tailored technical support to commissioners and providers of stop smoking services & secondary care

• Delivering region wide programmes on specific tobacco related issues

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seCurrent Regional Programmes

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seNorth East made good progress since 2005- biggest regional drop in England

North East Smoking Prevalence - General Household/Lifestyle

Survey

2005 2009% fall in

prevalence

Estimated reduction in number of smokers

All Adults 29% 22% Down 7% 148,400

Males 28% 20% Down 8% 77,200

Females 30% 23% Down 7% 71,200

11-15 year olds (Smoking, Drinking, Drugs Survey- ONS)

14% 10% Down 4% 5,900

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seKey messages

1.Local Authorities have a key & important role to play; the NHS alone cannot reduce smoking rates

2.Smoking is the single biggest preventable cause of health inequalities; reducing rates will bring general improvements in health & cost savings in other areas

3.To reduce smoking we need to increase the number of quit attempts & the quality of each attempt; we should target the poorest smokers to narrow the gap in life expectancy between the richest & poorest