1. THE CASE FOR ACTION on TOBACCO USE & SMOKING Harms caused by tobacco use & an overview of local tobacco policies to aid commissioning for Directors of Public Health South West Version 8.0 5 TH August 2011

2. 1. Scale of the challenge

3. Public health: tobacco use 3 Smoking is by far the greatest cause of preventable deaths References: 1. Information Centre, Statistics on Smoking in England 2010 2. Department of Health analysis of Office for National Statistics death registrations, 2007. Suicide 11,108 Alcohol 8,758 Road Accidents 8,162 Other Accidents 6,846 Diabetes 5,128 Drugs Misuse 1,584

4. Public health: tobacco use 4 Decline 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

5. Public health: tobacco use 5 Children’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. 6% 5% 4%

6. Public health: tobacco use 6 Smoking-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

7. Public health: tobacco use 7 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.

8. Public health: tobacco use 8 Cost of smoking to smokers References: 1. Cough Up, Policy Exchange, 2010 2. 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.

9. Public health: tobacco use 9 Health cost of smoking in your area NB please use your local data from http://www.lho.org.uk/LHO_TOPIC S/ANALYTIC_TOOLS/TOBACCOC ONTROLPROFILES/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”.

10. Public health: tobacco use 10 If we do nothing – smoking rates will rise 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

11. Public health: tobacco use 11 Local smoking rates differ greatly 22 23 22 19 22 19 18 19 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

12. 2. Smoking attitudes & behaviours

13. Public health: tobacco use 13 The different ‘stages of smoking’ Reduce the appeal and supply of tobacco Encourage more quit attempts each year Support quit attempts Protect families & communities

14. Public health: tobacco use 14 Children not adults start smoking Children not adults start smoking: 90% of smokers started before the age of 19 1 99% of 16 year old regular smokers live in a household with at least one other smoker 2 Children are three times as likely to start smoking if their parents smoke 1 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

15. Public health: tobacco use 15 Smoking, pregnancy & inequalities 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

16. Public health: tobacco use 16 Each 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

17. Public health: tobacco use 17 Summary – 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

18. Public health: tobacco use 18 Our poorest citizens are twice as likely to smoke References: 1. Smoking Attitudes & Behaviours, ONS, 2010

19. Public health: tobacco use 19 Benefits 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, 2 nd Ed. Oxford Health Press, 2007

20. Public health: tobacco use 20 Minority groups References: 1. Passive smoking and children, A report by the Tobacco Advisory Group of the Royal College of Physicians, March 2010

21. Public health: tobacco use 21 Smoking 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)

22. Public health: tobacco use 22 Tobacco packaging & marketing

23. Public health: tobacco use 23 Plain 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 warnings This is the suggested ‘plain pack’ the Australian national government is considering.

24. Public health: tobacco use 24 Poorer and younger smokers are much more likely to buy illicit tobacco Social classes & illicit tobacco consumed (Smoking Toolkit) References: 1. West R, Smoking Toolkit, www.smokinginengland.org.uk

25. Public health: tobacco use 25 Where do children get their cigarettes from? References: 1. LACORS http://www.lacors.gov.uk/lacors/NewsArticleDetails.aspx?id=19686 (2007/08 Survey)http://www.lacors.gov.uk/lacors/NewsArticleDetails.aspx?id=19686

26. Public health: tobacco use 26 What 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

27. Public health: tobacco use 27 Helping quitters succeed References: 1. West R, Smoking Toolkit, UCL www.smokinginengland.org

28. Public health: tobacco use 28 Poorer 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 Social gradient and nicotine dependence

29. Public health: tobacco use 29 Smoking & public opinion (YouGov 2011) NB You can replace this chart with regional data produced with this toolkit. References: 1. YouGov Survey 2011

30. 3. Tobacco policies

31. Public health: tobacco use 31 Summary - 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

32. Public health: tobacco use 32 Stopping the promotion of tobacco

33. Public health: tobacco use 33 Effective regulation of tobacco products

34. Public health: tobacco use 34 The ‘Smokefree’ law is popular and has reduced heart attacks; “On & Off sales” licences increased 5% the year England went smokefree. Reduction exposure smokefree Reducing exposure to secondhand smoke

35. Public health: tobacco use 35 Effective communications

36. Public health: tobacco use 36 To reduce health inequalities, prioritise helping poorer smokers to quit

37. 4. Delivery

38. Public health: tobacco use 38 Significant & 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.

39. Public health: tobacco use 39 Working 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)

40. Public health: tobacco use 40 Benefits 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

41. Public health: tobacco use 41 Making Smoking History for our Children: a collaborative approach All 14 SW Directors of Public Health collaborate to commission a large scale programme to tackle tobacco related harm Smokefree South West launched March 2009 as a specialised programme to drive and coordinate action e.g. on tackling illegal tobacco Maximise impact through effective partnership working with both local areas & national agencies (e.g. Smokefree Action Coalition)

42. Public health: tobacco use 42 Role of Smokefree South West Providing specialist leadership, expertise, training and development on effective action to tackle tobacco Cost effective campaigns; expertly designed, procured and evaluated to deliver integrated mass media campaigns & public relations (over £4m earned media to date) Advocacy around strong evidence to influence key legislative and policy decision making to benefit the population of South West Tailored technical support to commissioners and providers of stop smoking services & secondary care

43. Public health: tobacco use 43 South West and pan-regional programmes

44. Public health: tobacco use 44 Progress South West adult smoking rates now lowest in UK at 18% (General Lifestyle Survey, 2009) SW NHS Stop Smoking Services helped 34,350 successful quitters in 2009/10 (7% over target) Smokefree South West working with all Acute Hospital Trusts in all 14 SW localities to help higher risk smokers to quit with their local NHS Stop Smoking Service

45. Public health: tobacco use 45 Key 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