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THE CASE FOR ACTION on SMOKING &TOBACCO USE

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Presentation on theme: "THE CASE FOR ACTION on SMOKING &TOBACCO USE"— Presentation transcript:

1 THE CASE FOR ACTION on SMOKING &TOBACCO USE
Smoking is the leading cause of preventable death in England; costly to individuals, the economy, and is the greatest single cause of health inequalities. It also places a huge burden on local finances. The evidence base for intervention is probably stronger than for any other intervention for 'lifestyle behaviours'; and there is a strong national Tobacco Control Plan for England attracting cross party support. 2014

2 Scale of the challenge Smoking attitudes and behaviour How do we reduce tobacco use? Delivery at local level

3 Scale of the challenge

4 Smoking is the leading cause of preventable death
Obesity: 34,100 Smoking: 79,100 Alcohol: 6,669 Suicide: 5,377 Illegal drugs: 1,605 HIV: 504 Traffic: 1,850 These figures are for England. Each year smoking causes the greatest number of preventable deaths There are still over 8 million smokers in England, more than one in five of the adult population. Tobacco is a uniquely dangerous product: used as the manufacturer intends it kills half of all life-long users. Smoking remains the principle cause of preventable premature death - killing more people than the combined total of the six next largest causes put together. 1 Half of all long-term smokers will die of a smoking-related illness. 2 References: 1. ASH Factsheet, Smoking Statistics: illness & death, October 2. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years observations on male British doctors. BMJ 2004, 328: 1519

5 Deaths from the most common smoking-related diseases
References: NHS Information Centre (2009), Statistics on smoking: England 2009 available at Source: Estimates of the cost of smoking to the National Health Service range from £2.7 billion8 to £5.2bn a year. 4 In England, it has been estimated that in , among adults aged 35 and over, around 459,900 NHS hospital admissions were attributable to smoking, accounting for 5% of all hospital admissions in this age group. 3 For every death caused by smoking, approximately 20 smokers are suffering from a smoking-related disease. 1 2 Total deaths in England = 79,100 every year. (Source – see below) Allender, S et al. The burden of smoking-related ill health in the United Kingdom. Tobacco Control 2009; 18: Statistics on Smoking. England The NHS Information Centre for Health and Social Care, (http://www.hscic.gov.uk/catalogue/PUB07019) Cigarette smoking-attributable morbidity – United States, MMWR Weekly Report. 5 Sep. 2003 U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010. Total annual deaths = 79,100

6 Smoking prevalence in England
21 22 23 16 17 19 Prevalence was 19% in 2013. Peaked at 45% in 1974. Prevalence is substantially higher amongst lower socio- economic groups, people with a mental illness and certain ethnic groups. Prevalence is lowest amongst higher income groups and those with higher levels of education. Ireland % 6 Australia 19% 5 Canada % 4 N. Ireland 24% 3 Wales % 2 Scotland 23% 1 Prevalence in other countries National smoking prevalence in England fell below 20% for the first time in 2013. 2. General Lifestyle Survey, ONS, 2011. References for English Regional prevalence: 1. Smoking & drinking among adults, 2009. Smoking rates in other jurisdictions demonstrate that it is not only possible to bring rates down even further, but also it is possible and realistic to aim to end all tobacco use. Smoking rates in California are now down to just 11.9%, whilst 17% of London’s population smoke compared with 23% of people in Yorkshire and Humber. It is possible to go further with a faster rate of decline and we also have international obligations as a Party to the WHO Framework Convention on Tobacco Control (FCTC). Source: Health Service Executive, Ireland. Cancer Council, Victoria Australia. Dept of Health, Canada. Dept Health, Social Services and Public Safety, N Ireland Welsh Health Survey Scottish Household Survey

7 The decline in smoking prevalence has stalled
Note to customise this chart: Save this presentation to your computer Double click the chart to enter values for your region and your locality Local data can be found at Delete these instructions Save the revised presentation. [Use the spreadsheet embedded in the slides to calculate rates for your local area/region and add to the slides and these notes] Smoking rates have fallen dramatically over the past four decades. However, there is more to do: data shows that rates have plateaued over the past three years and more concerted action is required to further reduce the prevalence of smoking and harm caused by smoking. References: 1. Integrated Household Survey 2010 (mid-point estimate for locality given small sample size and large confidence interval) Smoking rates have been falling steadily since the 1970s however this has stalled in recent years.

8 The financial cost of smoking
Annual estimated costs of smoking to the individual and society Smokers do not “bankroll the NHS”. £9.5 billion is collected by the Treasury every year in tax, but the costs to society have been estimated to be £13.74 million every year. 1 2 Costs to smokers In 2013, a 20 a day smoker of a premium cigarette brand will spend around £2,900 a year on cigarettes. Estimates for the total amount spent on tobacco in the UK in 2011 range from £15.3 billion to £18.3 billion The proportion of total household expenditure on tobacco has decreased from 3.6% 1980 to 1.9% in In 2012, tobacco was 27.9% less affordable than in Costs to society Costs to the NHS include the costs of hospital admissions, GP consultations and prescriptions. The government also pays for sickness/invalidity benefits, widows’ pensions and other social security benefits for dependants. There are wider costs such as increased absenteeism, productivity lost due to smoking breaks etc. The loss of economic output from the premature death of smokers costs £4.1 billion every year. Cost of cleaning up cigarette butts every year = £342 million. Cost of fires = £507 million every year. Cigarettes are the leading cause of fatal accidental fires in the home: in 2008 smokers’ materials accounted for 113 deaths and 932 non-fatal casualties from fires in the home. Costs to society from house fires also includes increased insurance premiums. References: 1. Tobacco Bulletin. HM Revenue & Customs, Jun. 2012 2. Nash, R & Featherstone H. Cough Up: Balancing tobacco income and costs in society. Policy Exchange, 2010 3. AC Nielsen Market Track cited in The Grocer, 18 Feb 4. Statistics on smoking: England, The Health and Social Care Information Centre, 2012. This figures is the highest estimate and includes £9.5 billion in tax.

9 The local cost of smoking
Annual estimated costs of smoking to the individual and the community Note to customise this chart: Double click on the chart to open the data sheet to input values for your locality. The example of Blackpool is used in this illustration. Open the Local Costs of Smoking spreadsheet to calculate the costs in your locality – instructions on how to use the spreadsheet' are contained within it. Paste the chart from the spreadsheet into this presentation. The spreadsheet also allows you to print off a handout to use with this presentation. Use the embedded spreadsheet to calculate costs for your local smokers and add to the slides and these notes. A significant proportion of a smoker's disposable income is spent on tobacco and, of course, the poorer the smoker the larger the proportion. On average a smoker smoking 20 a day spends over £1,800 a year – low income groups are disproportionately affected by the costs of smoking and spend more of their disposable income on smoking as they tend to smoke at higher rates. In 2006, the total UK household expenditure on tobacco was £16.1bn. References: 1. Nash, R & Featherstone H. Cough Up: Balancing tobacco income and costs in society. Policy Exchange, 2010 2. Tobacco Bulletin. HM Revenue & Customs, Jun. 2012 3. 'Reckoner' spreadsheet for calculated estimated local costs (ASH, 2011)

10 Smoking costs the local economy millions every year
The annual cost of smoking in this local area (£millions) Note to customise this chart: Save this presentation on your computer Delete the sample chart Open the Local Costs of Smoking spreadsheet to calculate the costs in your locality – instructions on how to use the spreadsheet are contained within it Select a chart and paste it into this document The spreadsheet also allows you to print off a handout to use with this presentation. [Use the embedded spreadsheet to calculate costs for your local area/region and add to the slides and these notes] The economic case for action to reduce smoking unequivocally demonstrates that not only does smoking cessation save the NHS and local government money in reduced sickness and increased productivity, but it also saves the individual both a considerable amount of money and immeasurable benefits in the health and life years gained. Nationally smoking costs the economy nearly £14 billion each year in terms of absenteeism, lost productivity and treating smoking-related disease. Reference: 1. Cough Up, Policy Exchange, 'Reckoner' spreadsheet

11 Smoking not social status is the leading cause of health inequalities
Smokers from the highest social class have a lower life expectancy than non-smokers in the lowest social class 3.50 3.00 2.50 The life expectancy between rich and poor smokers is similar 2.00 Relative mortality 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. Richer smokers have a lower life expectancy than poorer non-smokers 1.50 1.00 0.50 0.00 I+II IV+V Highest Social Class Lowest Male non-smokers Male smokers

12 If we do nothing… Evidence and experience show that when anti-smoking campaigns cease, fewer adults are prompted to quit and more children start smoking. The impact is greatest amongst those on low incomes…… Nearly 200,000 new smokers are recruited every year. If local government, the NHS and partners were to cease our tobacco control efforts prevalence would rise rapidly and would continue to rise. To reduce national smoking rates to under 5% within 20 years would require an annual reduction of c0.8 percentage points (ppt) – this is achievable given that the average annual reduction since 1970 has been c0.9ppt. However, if upward forces acting on smoking rates (including the effect of the recession) are ignored and the ‘foot is taken off the pedal’, smoking rates could start to rise again. References: 1.Monthly survey for smoking rate in England, Smoking Toolkit, UCL 2011l, smokinginengland.co.uk

13 2. Smoking attitudes & behaviours

14 It is children not adults
who take up smoking 90% of smokers started before the age of 19 18 is the age at which you can legally buy tobacco Young people are more likely to smoke if their friends smoke and generally exhibit greater ambivalence about the present health dangers of their tobacco use than do adults. 200,000 new smokers start each year and two thirds are under 18, the legal age of purchase. References: 1. Smoking Attitudes & Behaviours, ONS 2011

15 Smoking Prevalence: Young People (11-15)
Smoking prevalence amongst young people is falling, however 463 children try smoking for the first time every day in England, (or 207,000 every year). 1 Half of all long-term smokers die of a smoking-related illness so many of these children who go on to become regular smokers will eventually die of a smoking-related disease. These figures are for regular smokers – defined as smoking at least one cigarette a week – but 25% of young people have tried smoking at least once. Source: Smoking, drinking and drug use among young people in England in Published by NatCen Social Research with permission of Health and Social Care. 1. Hopkinson NS, Lester-George A, Ormiston-Smith N, et al Child uptake of smoking by area across the UK. Thorax Published online 4 December 463 children take up smoking every day in England.

16 Children are three times more likely to start smoking if their parents smoke
99% of 16 year old regular smokers live in a household with at least one other smoker Smoking prevalence in year olds by number of smokers they live with. 1. Smoking, drinking and drug use among young people in England in 2010, ONS 99% of 16 year old regular smokers live with another smoker: Children are three times more likely to smoke if their parents do: References: Source for graph: 1. Smoking, drinking and drug use among young people in England in 2010, ONS Personal: young smokers are much more likely to live in families that smoke and have friends who smoke. Social & Cultural: the availability of cheap illicit tobacco encourages consumption as young people are more price sensitive and more likely to buy illicit tobacco; Factors influencing take-up: Children living with smokers suffer from secondhand smoke and are much more likely to become smokers themselves. Centers for Disease Control and Prevention. “Exposure to secondhand smoke among students aged 13–15 years – worldwide, 2000– 2007”. Morb Mortal Wkly Rep 2007; 56: 497–500. Passive smoking and children. A report of the Tobacco Advisory Group of the Royal College of Physicians. London, RCP,

17 Where do children get their cigarettes from?
Usual sources of cigarettes for year olds in England (Note that 10% of regular smokers are given cigarettes by their parents.) Children who smoke are most likely to get their cigarettes from other people, usually friends. Efforts to stop children taking up smoking are much less effective for children surrounded by people who smoke and think it is normal. The best way to stop from children smoking is to get those around them, particularly their parents, to quit. Source: 1. Smoking, drinking and drug use among young people in England in https://catalogue.ic.nhs.uk/publications/public-health/surveys/smok-drin-drug-youn-peop-eng-2012/smok-drin-drug-youn-peop-eng-2012-repo.pdf

18 Smoking rates amongst pregnant teenagers are substantially higher than in other age groups
Teenagers are more likely to smoke throughout their pregnancy. Pregnant women who smoke are most likely to be in the key high smoking prevalence groups – smoking rates in pregnancy are almost double the national average among women in the routine and manual group. Overall smoking prevalence amongst pregnant women is 12%. Source: The Infant Feeding Survey 2010

19 Women in low-paid work are 3 times more likely to smoke during pregnancy
Socio-economic group: % who smoked before or during pregnancy Smoking is one of the few modifiable risk factors in pregnancy, and can cause a range of serious health problems. Smoking during pregnancy is estimated to contribute to around 40% of all infant deaths. Babies of smoking mothers are, on average, 200g lighter at birth – birth weight is a key indicator of a newborn’s overall health. More than a quarter of the risk of sudden unexpected death in infancy is attributable to smoking. Source: 1. Infant Feeding Survey, ONS Download dataset: https://catalogue.ic.nhs.uk/publications/public-health/surveys/infant-feed-surv-2010/ifs-uk-2010-chap1-intro.pdf Prevalence amongst pregnant women has fallen from 23% in 1995 to 12% in 2012/13. (Infant Feeding Survey) National prevalence for pregnant women “smoking at time of delivery” was 12% in 2012/13. The national ambition set by the Government is for 11% or less by end 2015 so we are on track for that. Figures vary dramatically between areas: Blackpool % Westminster 2.3% However, it is important to note that these figures are likely to be underestimates as the data is from self report surveys. Source: Health and Social Care Information Centre. https://catalogue.ic.nhs.uk/publications/public-health/smoking/stat-wome-smok-time-deli-eng-q /stat-wome-smok-time-dele-eng-q rep.pdf Further info:

20 Every year nearly 10,000 children are treated in hospital for exposure to second-hand smoke
Hundreds of thousands of children are exposed to secondhand smoke in cars and in the home every year. Evidence shows that children in smokey cars are exposed to very high levels of particulate pollution. There will be legislation banning smoking in cars covering in children coming into force by 2015 but more needs to be done to educate parents about the harm caused by secondhand smoke. Reference: 1. Passive smoking and children, A report by the Tobacco Advisory Group of the Royal College of Physicians, March 2010.

21 Smoking prevalence is higher in routine and manual groups
Deprived groups who smoke may also exhibit other unhealthy behaviours such as unhealthy eating, physical inactivity and alcohol abuse. References: 1. General Lifestyle Survey, ONS 2010.

22 Smokers from lower socioeconomic groups are more likely to purchase illicit tobacco
Illicit tobacco consumed by social group Increasing the price of tobacco above the rate of inflation is recognised as the most effective means of reducing tobacco consumption. (Jha P Chaloupka FJ. Curbing the Epidemic: Governments and the economics of tobacco control. Washington DC, The World Bank, ) Because poorer people are more likely to be tempted by cheaper prices, the availability of illicit tobacco undermines a key measures to encourage smokers to quit which, in turn, exacerbates health inequalities. Research commissioned by ASH found that one in four of the poorest smokers buys smuggled tobacco compared to one in eight of the most affluent. (Beyond Smoking Kills, Protecting Children, reducing inequalities. London, ASH, 2008.) Also, children are more likely to buy illicit tobacco as these sellers don’t follow age of sale laws. Some children may also be drawn into the criminal gangs which sell these cigarettes. Reference for the chart: 1. Robert West, Smoking Toolkit,

23 How do we break the ‘cycle of smoking’
Protect families & communities Reduce the appeal and supply of tobacco Smoking is highly addictive and quitting can be difficult but there are now as many ex-smokers as current smokers. On average smokers make 8 to 10 quit attempts before quitting for good. Examining the 'smoking life-cycle' throws up the following issues: Take-up The motivation for taking-up smoking are down to a wide range of complex social, cultural and economic factors. What factors normalise smoking habits and increases the motivations for taking the habit up? Decision to quit Over 7 out of 10 smokers say they want to give up, but fewer than half will actually make a quit attempt. The motivations around making a quit attempt differ from person to person, but health is cited as the most important reason for quitting. What triggers a quit attempt and which local interventions will influence different groups (socio-economic and ethnic) to make an attempt? Quit attempts Only 5% of smokers make a quit attempt with specialist NHS support. About half of all quitters use other self-bought medication but evidence suggests that often NRT is used incorrectly. The remainder quit cold turkey – without support. How can access to the most effective treatment and the effectiveness of all treatments be improved? Relapse Most quitters will have to make repeated attempts. Factors to be considered when evaluating likelihood of success are: Demographics – who is most likely to quit? No. of quit attempts – what can be done to increase motivation? Quality of quit attempts – how can this be improved? Encourage more quit attempts each year Support quit attempts

24 3. How do we reduce tobacco use?

25 The World Bank has developed a ‘six strand’ approach for reducing tobacco use
Stop the promotion of tobacco; Make tobacco less affordable; Effective regulation of tobacco products; Help tobacco users to quit; Reduce exposure to secondhand smoke; Effective communications for tobacco control. To reduce smoking rates in the population we need to understand the barriers to achieving our objectives and how they can be overcome. The World Bank's Six Strand Tobacco Control Strategy provides us with a framework. This framework is used in the DH Tobacco Plan. NB There is a national ban on advertising tobacco products, except in trade magazines. Taxation on tobacco products is set by national government and is the most effective means of reducing smoking prevalence. Reference: 1. World Bank, ‘6-Strand’ Tobacco Control Strategy (found via And from the World Bank

26 Local action: councils enforce tobacco laws
Local authorities enforce restrictions on the promotion of tobacco.

27 Local Authorities’ enforcement responsibilities include:
Purchase of tobacco by under 18s Proxy sales Chewing and smokeless tobacco sales Smokefree legislation Illicit tobacco Shisha cafes Advertising ban Smoking cessation is not solely the consideration of the health service, it is the concern for local government particularly because the benefits (economic and social) are felt across the whole of society and government. Just as Local Authorities have a great and growing responsibility to safeguard the public health of their communities, they now also have a role to promote healthy lifestyles by discouraging tobacco use. This is especially so, now the mantle of public health protection (as defined by ‘lifestyle behaviours’) has passed from the Department of Health and the NHS to Public Health England and local government ‘Health & Wellbeing Boards’. Local government has a critical role in the fight to reduce smoking rates and improve health and save lives, especially within the poorest communities. The role of councils in public health is unique and irreplaceable, although their responsibilities are still being defined.

28 Local Authorities commission Stop Smoking Services
NHS Stop Smoking Services are the most successful route to quit and the most cost effective NHS treatment there is Data from based on smokers who tried to stop in the past year who report still not smoking at the survey adjusting for other predictors of success (age, dependence, time since quit attempt, social grade, recent prior quit attempts, abrupt vs gradual cessation): N=7,939 Using NHS support to stop smoking is the most effective way of quitting – it's nearly 4 times more effective than going 'cold turkey'. Although only a small percentage of smokers access NHS support, because it is so effective the NHS Stop Smoking Services are responsible for hundreds of thousands of successful quitters each year. This NHS support saves local health services and local government millions of pounds each year.

29 Smokers are nearly 4 times more likely to quit using NHS support than going ‘cold turkey’
Quitters have a far greater chance of success using NHS support compared to going ‘cold turkey’. Examining routes smokers take to quit can highlight areas for action. Using NRT increases success rates. However, about half of all quitters use NRT bought over the counter and without professional guidance may not use it appropriately. For example many smokers stop using the products too soon, increasing the chances of relapse. Local action to provide better information on the use of NRT would aid quit attempts. References: 1. West R, Smoking Toolkit, UCL

30 Poorer smokers want to quit but are only half as likely to succeed
Success rate in quitting by socio-economic class All smokers, rich or poor, make similar numbers of attempts to quit, but poorer smokers are half as likely to succeed. The reasons for this are complex and are bound up in issues of health inequalities, although we know that poorer smokers take up smoking earlier and are more addicted. As well as commissioning clinical support to help poorer smokers successfully quit, local government should look at wider societal factors in a bid to 'denormalise' smoking and 'normalise' quitting. References: 1. West R, Smoking Toolkit, UCL

31 Harm Reduction Nicotine is highly addictive. Some smokers are highly dependent on nicotine and: may not be able (or want) to stop smoking in one step may want to stop smoking but are unable to give up nicotine may not be ready to stop smoking but want to reduce the amount they smoke. However it is the toxins in the tobacco smoke – not the nicotine – that cause illness and death.

32 The NICE approach to harm reduction
For highly addicted smokers, NICE recommends a “harm reduction” approach which advocates either temporary or long-term substitution of tobacco with safer forms of nicotine: Stopping smoking, but using NRT to prevent relapse. Cutting down prior to stopping smoking with or without the help of NRT. Smoking reduction with or without the use of NRT. Temporary abstinence from smoking with or without the use of NRT. NICE = National Institute for Clinical Excellence. Local authorities should commission Stop Smoking Services to offer a harm reduction approach to heavily addicted smokers.

33 Since the introduction of smokefree legislation, more people are making their homes smokefree
Percentage of adults reporting that their homes are smokefree Smokefree law has immense public support and provides protection for millions of workers. It also incentivised additional quit attempts and led to around an additional 300,000 smokers quitting, suggesting that its implementation will avert up to 40,000 premature deaths over the next ten years. Local Authorities have a role to play in not only enforcing smokefree legislation but providing public health messages, highlighting the danger of smoking in the home and car, particularly for children.

34 There is strong public support for tobacco control measures
NB You can replace this chart with regional data produced with this toolkit. Policies to reduce the harms caused by tobacco enjoy widespread public support. Tobacco policy is a good example of how effective public health can be. More than 8 in 10 people are concerned about children and young people starting to smoke (84%) and a similar proportion agree that the government should do more to discourage children and young people from starting to smoke and help those that do, give up (82%). Anti-tobacco policies also enjoy considerable support from smokers, two thirds of whom want to quit their habit. Accusations of 'nanny stateism' and calls for the protection of individual liberties are largely over stated, particularly by pro-tobacco groups and those funded by the tobacco industry. References: 1. YouGov Survey 2011

35 Effective communication is essential
Marketing and mass media play a key role in motivating people to quit smoking and there is room to do a lot more. Mass media and marketing and communications is best tackled at a regional level to avoid conflicting messages and achieve economies of scale. Key messages should focus on the following points: All tobacco use is harmful and quitting smoking reduces the risk from smoking-related disease. Quitting using support increases your chance of success. Using illicit tobacco funds organised crime. And mass media should: Focus on smoking cessation in the routine and manual group, tackle issues of importance to them using channels accessible to them.

36 4. Delivery at local level
Smoking cessation is not solely the consideration of the health service, it is the concern for all local government agents particularly as its benefits (economic and social) are felt across the whole of society and government. Local government has a critical role in the fight to reduce smoking rates and improve health and save lives, especially within the poorest communities. The role of councils in public health is unique and irreplaceable.

37 Local Authorities can mount effective local campaigns
Local campaigns can focus on raising awareness about the dangers of secondhand smoke, littering, illicit cigarette sales etc.

38 Health cost of smoking in your area
Note to customise this chart: Values for your locality are calculated in the 'Local Tobacco Profiles' Copy from the ‘pdf’ as this provides the clearest image. Due to the amount of detail on this slide, a printed “handout” will probably be necessary for your audience. [Look up your local smoking health profiles on the London PHO website, update the slide and provide hand outs for the audience] The individual, social and human cost of smoking is great – on average a smoker will lose 10 years of life.

39 Tobacco industry attempts to influence policy at local level.
The tobacco industry has a long history of using front groups to influence the policy process and undermine tobacco control measures. The Tobacco Control Plan for England states explicitly that local government should take action to protect their public health policies from the interests of the tobacco industry. Front groups may claim to represent shopkeepers, retailers and publicans but in fact promote the interests of the tobacco industry. Now that Local Authorities are responsible for public health, it is likely that the tobacco industry representations to Councils via these groups will increase. The Tobacco Control Plan for England: https://www.gov.uk/government/publications/the-tobacco-control-plan-for-england This clause is to ensure that the UK satisfies its obligations under Article 5.3 of the Framework Convention on Tobacco Control (a global treaty on dealing with tobacco). Article 5.3 states that: “in setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law”. Guidelines on implementing Article 5.3 were subsequently developed and approved by the Parties to the FCTC, including the UK. The guidelines require Parties (and by extension, national and local Government organisations): Not to enter into partnerships, non-binding, or non-enforceable agreements with the tobacco industry Not to accept voluntary contributions from the tobacco industry Not to accept tobacco industry-drafted legislation or policy, or voluntary codes as substitutes for legally enforceable measures Not to participate in “corporate social responsibility” or related schemes funded by the tobacco industry Not to permit tobacco industry representation on government tobacco control bodies There are also transparency measures established under the Article 5.3 Guidelines: To ensure transparency over any interactions with the tobacco industry, through public hearings, public notice of interactions, and disclosure of records. To ensure disclosure or registration of tobacco industry affiliated entities, including lobbyists To ensure that applicants for government positions related to health policy disclose any current or previous work with the tobacco industry, and of plans to work for tobacco industry by former public health officials. Recent example of front group activity include using retailers to argue the case against tobacco display bans or that plain packs for cigarettes will lead to an increase in the illicit trade in tobacco (evidence from Australia has shown that this is not likely to be the case). References: Tobacco Industry history of deception and using front groups: 1. Smith P, Bansall Travers M, O’Connor R et al. Correcting over 50 years of tobacco industry misinformation. Am J Prev Med 2011; 40(6): 690–698 2. Tobacco Products Liability Project Public Health Advocacy Institute 3. Big Trouble at Big Tobacco. Organized Crime and Corruption Reporting Project, 2011

40 Things to look out for…. In 2013 the tobacco industry subsidiary “Nicoventures” attempted to meet with local authorities to discuss the implementation of the NICE guidance on harm reduction. Planting stories with exaggerated claims about the impact of illicit tobacco sales in local press. “Responsible Retailer” programmes purporting to address underage sales. Offers to fund sniffer dogs, scanners and other “resources” for combating illicit tobacco. Funding conferences for local government officers. The tobacco industry have no interest in programmes which will reduce smoking prevalence – their “support” will always have the aim of protecting their own particular brands or undermining legitimate programmes aimed at reducing underage sales. Corporate responsibility programmes are an attempt to distract attention from the fact that they sell a lethal product by presenting themselves as companies which do good in the community. Accepting resources from the tobacco industry also gives them an opportunity to have a seat at the table in discussions about policies which ultimately are aimed at reducing smoking prevalence. They will use every opportunity to delay and hinder such measures. For further information about tobacco industry attempts to influence government policy, see the ASH Briefing “Tobacco Front Groups and Third Party Lobbying Tactics”

41 Working together for better health
Local Government, inc. police & fire brigade Local Health Services Organisations that work across neighbouring localities within a region Employers Voluntary sector organisations Children’s and youth groups Smokers (particularly, groups with high rates of smoking e.g. routine & manual smokers) Health commissioners An effective public health strategy to reduce and prevent tobacco use is a comprehensive strategy for social and clinical interventions that are accessible to and used by the wide range of agencies and organisations that sit under the 'local government umbrella'. A collaborative approach involving cooperation across agencies and between health and social government organisations is a necessary prerequisite for a comprehensive and holistic commissioning strategy. Public sector agencies, such as Trading Standards, the police and the fire brigade, are important partners in a local Smokefree or Tobacco Control Alliance. This type of partnership working has made a substantial contribution to the success of tobacco control measures at both national and local level.

42 Benefits of working across local boundaries
Marketing – would it be more cost effective to split marketing costs with other Local Authorities? Tackling illicit tobacco – criminal gangs don’t pay attention to local government boundaries. Surveys, research & data collection – cost savings can be had from collectively commissioning research & surveys, and sharing the results. There are some issues which can only be tackled in partnership with others, e.g. combatting the trade in illicit cigarettes. Local councils are well placed to tackle the illicit trade. However, unless they work across wider geographical boundaries the problem is likely to move to neighbouring areas. Tobacco smuggling is an area where councils should work together to be more effective, making it easier to engage key partners, such as HM Revenue & Customs, police, the NHS, local businesses and the public.

43 Key messages Local Authorities have a key role to play: the NHS cannot reduce smoking rates alone. Smoking is the single biggest preventable cause of health inequalities: reducing rates will bring significant improvements in health as well as cost savings. To reduce smoking we need to increase the number of quit attempts & the success of each attempt: we should target the poorest smokers to narrow the gap in life expectancy between the richest & poorest and improve the health of the poorest, fastest Stronger bonds and more effective working relationships will be forged with the NHS. Commissioning should be evidence-based and tailored to meet the needs of the local population; as with the commissioning of all services, an assessment of needs should be undertaken to achieve the correct mix of tobacco control interventions.


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