1. Action to cut smoking rates and reduce tobacco use needs to take place locally, nationally and regionally if we are to have the most cost effective policies in place. What can been achieved at regional level Analysis undertaken by NICE has shown that tobacco control at a regional level is very cost effective. Interventions that can be best delivered at a regional level include tackling illicit tobacco and the delivery of cost effective communications and marketing campaigns. In addition to these issues, regional tobacco control has also played a vital role supporting regional and local activity, sharing good practice, encouraging the development of effective interventions and coordinating networks. History of regional tobacco control in England The first locally commissioned comprehensive regional tobacco control programme was set up in the North East in 2005 with funding from all Primary Care Organisations and additional funds subsequently from the Strategic Health Authority. Similar programmes were launched in the North West in 2008 and the South West in 2009. All English regions had some level of tobacco control delivery from 2005-2010 with central funds from the Department of Health. Such central funds ended in 2010 across the country and investment in the regional function has only remained in the original three regions with local authorities providing funding. The regional programs have had a powerful impact, particularly in places that have an appropriate level of investment, as recommended by NICE. In the NE, for example, smoking prevalence significantly declined at a time when UK rates were relatively static. Some levers can only be effectively implemented regionally Value for money can be found through supra-local activity Making a long term impact on norms requires interventions at every level Smoking: Regional Tobacco Control

2. Regional Action on Illicit Tobacco The ongoing North of England Tackling Illicit Tobacco for Better Health programme was the first of its kind in the world. Similar work has also been undertaken in the South West with good results. The programmes have taken a comprehensive approach to tackling the demand for and the supply of illicit tobacco in communities through the development of partnerships between health and enforcement colleagues, groundbreaking social marketing campaigns, generating and sharing intelligence, and delivering enhanced enforcement against the illicit tobacco trade. There is a strong evidence base to demonstrate the effectiveness of regional tobacco control delivery in reducing smoking rates. Localities can achieve greater impact and return on investment by working across larger footprints and having an overarching collaborative programme in place to enhance local delivery. This 'overview' is an introduction to regional tobacco control delivery. It is supported by separate handouts on the following: Smoking: cost Smoking: children Smoking: health inequalities Smoking: quitting Smoking: illicit tobacco Smoking: working together May 2014 “Regional structures have played a vital role in supporting local delivery of tobacco control, and today they play a key role in agreeing and monitoring local priorities.” Department of Health, 2011 Similar activity in the South West has also produced strong results. In the SW:  Smokers admitting to buying illegal tobacco dropped from 20% in 2010 to 16% in 2013  Proportion of all adults classified as ‘very uncomfortable’ with illegal tobacco increased from 31% in 2010 to 49% in 2013.  Illegal tobacco share of the market dropped from 11% in 2010 to 7% in 2013  Proportion of smokers who are ‘often offered illicit tobacco’ dropped from 12% in 2010 to 8% in 2013