1. 1 Maintaining downward pressure on smoking prevalence Robert West University College London All Party Parliamentary Group on Smoking September 2015

2. Declaration of competing interest I undertake research and consultancy for companies that develop and manufacture smoking cessation medicines. I am a trustee of QUIT. I am an unpaid advisor to the National Centre for Smoking Cessation and Training. My salary is funded by Cancer Research UK. 2

3. Smoking remains England’s most important public health problem 3 Each death involves average of 10 years loss of life Half of deaths occur before retirement age Cost to society £13.8 billion

4. Maintaining downward pressure on smoking prevalence is essential 4 Cigarette smoking prevalence Current rate of decline: 0.66% - comprehensive tobacco control policies Lost 5 years in 1990s when only used tax escalator

5. ‘The Smoking Pipe’ model for England 5 Models inflow and outflow of smokers in 2014 Net outflow of 349K smokers

6. International comparisons 6 Prevalence in France and Germany has not declined – no tobacco control beyond EU directives

7. Efficient and effective tobacco control policies save lives and money Reduce affordability of tobacco (tax and illicit) Mass media and social marketing campaigns Enforcement to restrict youth access Smoking cessation support Smokefree places Programme administration and management Monitoring and surveillance 7 Best Practices for Comprehensive Tobacco Control Programs — 2014.Atlanta: U.S. Department of Health and Human Services, Centers for Disease Cornerstone of tobacco control strategy: Do what is known to work and do it efficiently

8. What is the right level of investment? 8 US Center for Disease Control’s current best practice recommendation for spend on tobacco control:$10.53 per capita. For England this is equivalent to about £375 million.

9. Key choices for government Three areas in this presentation: 1.Taxation and control of illicit supply 2.Mass media 3.Clinical support for cessation 9

10. Taxation and tobacco control investment 10 5% annual increase in taxation above inflation + investment in tobacco control 0.57 percentage point reduction in prevalence: 250,000 smokers

11. Mass media campaigns Increase quit attempts Reduce prevalence Need to be intensive and sustained 11 Stoptober

12. Clinical services to support quitting 12 Brief advice from clinician Specialist services + Offer evidence- based support to all smokers Provide medicines and behavioural support

13. Dramatic fall in numbers using Stop Smoking Services since move to Local Authority control 13

14. Use of aids to cessation in the past 12 months Data from smoking toolkit study: www.smokinginengland.info 14

15. Fall in number of smokers being offered support by GP 15

16. Conclusion England has a very strong track record in tobacco control This has driven a prevalence reduction of 0.66 percentage points each year It has been achieved by combining a range of strongly evidence-based policies It has delivered both economic and health benefits. Three key areas that now require strong government action 1.increasing the financial cost of smoking 2.effective and sustained social marketing campaigns 3.reversing the decline in clinical services 4.Sustained investment in tobacco control 16