1. Your logo here 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 Common Version 11.2 12 th October 2011

2. Your logo here 1. Scale of the challenge

3. Harms caused by tobacco use 3 Each year smoking causes the greatest number of preventable deaths References: 1. ASH Factsheet, Smoking Statistics: illness & death, June 2011 (http://www.ash.org.uk/files/documents/ASH_107.pdf) NB area represents valuehttp://www.ash.org.uk/files/documents/ASH_107.pdf Obesity: 34,000 Smoking: 81,400 Alcohol: 8,724 Suicide: 5,377 Murder: 648 HIV: 529 Traffic: 2,946

4. Harms caused by tobacco use 4 The decline in smoking rates has stalled References: 1. Integrated Household Survey 2010 (mid-point estimate for locality given small sample size and large confidence interval) Note to customise this chart: 1.Save this presentation to your computer 2.Double click the chart to enter values for your region and your locality 3.Local data can be found at http://www.lho.org.uk/viewResource.aspx?id=16649 http://www.lho.org.uk/viewResource.aspx?id=16649 4.Delete these instructions 5.Save the revised presentation.

5. Harms caused by tobacco use 5 National children’s rates of smoking (age 11 – 15) 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. Harms caused by tobacco use 6 The majority of smokers are from manual and routine occupations 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. Number of smokers by occupation (millions, 2010)

7. Harms caused by tobacco use 7 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

8. Harms caused by tobacco use 8 The annual cost of smoking to smokers (compared to additional costs to our community) References: 1. Cough Up, Policy Exchange, 2010, 2. HMRC, 3. 'Reckoner' spreadsheet for calculated estimated local costs (ASH, 2011) Annual estimated costs of smoking to the individual and society Note to customise this chart: 1.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. 2.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. 3.Paste the chart from the spreadsheet into this presentation. The spreadsheet also allows you to print off a handout to use with this presentation.

9. Harms caused by tobacco use 9 Smoking costs the local economy millions every year References: 1. Cough Up, Policy Exchange, 2010 2. 'Reckoner' spreadsheet The annual cost of smoking in this local area (£millions) Note to customise this chart: 1.Save this presentation on your computer 2.Delete the sample chart 3.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 4.Select a chart and paste it into this document 5.The spreadsheet also allows you to print off a handout to use with this presentation.

10. Harms caused by tobacco use 10 If we do nothing… References: 1.Monthly survey for smoking rate in England, Smoking Toolkit, UCL 2011l’, smokinginengland.co.uk Evidence and experience show that when anti-smoking campaigns cease: Fewer adults are prompted to quit, more children start smoking, the effect is heaviest on the poorest Following Ireland’s smokefree legislation (2004) smoking rates declined sharply. When smoking was allowed to become more affordable and support for smokers to quit diminished smoking rates began to rise again. The decline in smoking resumed following above inflation tax increases in 2008

11. Harms caused by 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... … and international experience shows more can be achieved: in Smoking rates in New York City has fallen from 21% in 2001 to a historic low of 14% within a decade References: 1. Smoking & drinking among adults, 2009. General Lifestyle Survey, ONS, 2011. 2. http://www.cdph.ca.gov/Pages/NR11-031.aspx

12. Harms caused by tobacco use 12 2. Smoking attitudes & behaviours

13. Harms caused by tobacco use 13 Actions to break the ‘cycle of smoking’ Reduce the appeal and supply of tobacco Protect families & communities Encourage more quit attempts each year Support quit attempts

14. Harms caused by tobacco use 14 Children not adults start smoking References: 1. Smoking Attitudes & Behaviours, ONS 2011 Age smokers start smoking: 90% of smokers started before the age of 19 18 is the age at which you can legally buy tobacco

15. Harms caused by tobacco use 15 Children are three times as likely to start smoking if their parents smoke 1 99% of 16 year old regular smokers live in a household with at least one other smoker 1 References: 1. Smoking, drinking and drug use among young people in England in 2010, ONS Smoking prevalence in 11-15 year olds by number of smokers they live with 1

16. Harms caused by tobacco use 16 Women in low-paid work are 3 times more likely to smoke during pregnancy References: 1. Infant Feeding Survey, ONS 2011 Socio-economic group: % who smoked before or during pregnancy

17. Harms caused by tobacco use 17 Teenagers are almost 4 times more likely to smoke whilst pregnant compared with those over 35 References: 1. Infant Feeding Survey, ONS 2011

18. Harms caused by tobacco use 18 Each year nearly 10,000 children are treated in hospital 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

19. Harms caused by tobacco use 19 The poorer you are the more likely you are to smoke References: 1. General Lifestyle Survey, ONS, 2010

20. Harms caused by tobacco use 20 Smoking not social status is the greatest cause of health inequalities 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) Smokers from the highest social class have a lower life expectancy than non-smokers in the lowest social class 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 I+IIIV+V Social Class Relative mortality Male non-smokersMale smokers HighestLowest The life expectancy between rich and poor smokers is similar Richer smokers have a lower life expectancy than poorer non- smokers

21. Harms caused by tobacco use 21 Certain minority groups & ethnic groups smoke at higher than average rates References: 1. Passive smoking and children, A report by the Tobacco Advisory Group of the Royal College of Physicians, March 2010

22. Harms caused by tobacco use 22 Quitting is the best way for smokers to improve their life expectancy References: 1. Doll R, Mortality in relation to smoking, BMJ 2004 Years of life gained by stopping smoking at different ages, 30 to 60 Age at which stopped smoking Years of life gained 3010 409 506 603

23. Harms caused by tobacco use 23 Benefits of quitting bring improvements in wellbeing regardless of age 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

24. Harms caused by tobacco use 24 The tobacco industry uses pseudo economic arguments to divert attention from health issues 1.Small businesses and workers’ jobs are lost 2.Criminal gangs profit from increases in smuggled tobacco 3.Tobacco control measures don’t work and are a waste of public money Claims on the economic impact of policies to reduce smoking:

25. Harms caused by tobacco use 25 Packs are ‘silent salesmen’ for tobacco brands 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.

26. Harms caused by tobacco use 26 The majority of children who smoke get their cigarettes from a ‘friend’ References: 1. Smoking, drinking and drug use among young people in England in 2006 Usual sources of cigarettes for 11-15 year olds in England

27. Harms caused by tobacco use 27 Smokers from lower social classes are more likely to provide an immediate and tangible reason for making a quit attempt References: 1. E Vangeli, R West, Sociodemographic differences in triggers to quit smoking: findings from a national survey, Tobacco Control 2008

28. Harms caused by tobacco use 28 Using NHS support is nearly 4 times more successful than going ‘cold turkey’ References: 1. West R, Smoking Toolkit, UCL www.smokinginengland.org

29. Harms caused by 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. Harms caused by tobacco use 30 Poorer smokers are as likely to want to quit and try to quit but half as likely to succeed Success rate in quitting by socio-economic class References: 1. West R, Smoking Toolkit, UCL www.smokinginengland.org

31. Harms caused by tobacco use 31 3. Tobacco policies

32. Harms caused by tobacco use 32 The World Bank has developed a ‘6 strand’ strategy for reducing tobacco use References: 1. World Bank, ‘6-Strand’ Tobacco Control Strategy (found at http://web.worldbank.org) 1.stopping the promotion of tobacco; 2.making tobacco less affordable; 3.effective regulation of tobacco products; 4.helping tobacco users to quit; 5.reducing exposure to secondhand smoke; and 6.effective communications for tobacco control.

33. Harms caused by tobacco use 33 Local action: councils enforce tobacco laws

34. Harms caused by tobacco use 34 Local action: Councils will commission stop smoking services Data from www.smokinginengland.info; 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=7,939www.smokinginengland.info NHS Stop Smoking Services are the most successful route to quit and the most cost effective NHS treatment there is

35. Harms caused by tobacco use 35 Working together councils can mount effective local campaigns

36. Harms caused by tobacco use 36 Smokefree environments enjoy increasing public support Percentage of adults reporting that their homes are smokefree

37. Harms caused by tobacco use 37 Effective communications will direct smokers to the most effective route of quitting

38. Harms caused by tobacco use 38 Helping poorer smokers to quit is the most effective way of reducing health inequalities Poorer 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

39. Harms caused by tobacco use 39 4. Delivery

40. Harms caused by tobacco use 40 Significant & growing role for Local Authorities LA responsibilities include enforcement on: Age-of-sale 'Smokefree' places Smuggled & counterfeit tobacco Advertising ban From 2013, Local Authorities will take on responsibility to commission services to motivate & support smokers to quit their habit.

41. Harms caused by tobacco use 41 Health cost of smoking in your area Note to customise this chart: 1.Values for your locality are calculated in the 'Local Tobacco Profiles' 2.Copy from the ‘pdf’ as this provides the clearest image. 3.Due to the amount of detail on this slide, a printed “handout” will probably be necessary for your audience.

42. Harms caused by tobacco use 42 Working together for better health 1.Local Government, inc. Police & Fire Brigade 2.Local Health Services 3.Organisations that work across neighbouring localities within a region 4.Employers 5.Voluntary sector organisations 6.Smokers (particularly, groups with high rates of smoking e.g. routine & manual smokers)

43. Harms caused by tobacco use 43 Benefits of working across local boundaries 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

44. Harms caused by tobacco use 44 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 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