National Challenges, Local Delivery - reducing

smokingJim McManus, Director of Public Health,

Hertfordshire County Council

Hazel Cheeseman, Director of Policy, Action on Smoking and Health

Reducing smoking

• Overview of national challenges

• Overview of national opportunities

• Lessons from local delivery

• High impact local actions – discussion

Tobacco – the national challenge

• Pressure on the NHS

• Cost to society

• Loss of healthy life

• Driver of inequalities

Cost to society

£217.0m

£390.7m

£1.1bn

£1.1bn

£1.7bn

£3.1bn

£5.4bn

£0 £1,000 £2,000 £3,000 £4,000 £5,000 £6,000

Passive smoking

Smoking-related fires

Smoking-related social care

Lost productivity (sick days)

Smoking-related disease (NHS)

Lost productivity (early deaths)

Lost productivity (smoking breaks)

Cost to society (£millions)

Estimated cost of smoking in England (£millions)

Loss of healthy life

References:1. ASH Factsheet, Smoking Statistics: illness & death, October 2011 (http://ash.org.uk/files/documents/ASH_107.pdf) NB area represents value

Obesity: 34,100

Smoking: 81,400

Alcohol: 6,541

Suicide:5,377

Drug misuse: 1,738

HIV: 529

Traffic:2,502

Each year smoking causes the greatest

number of preventable deaths

Driver of Inequalities

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+II IV+V

Social Class

Re

lati

ve m

ort

alit

y

Male non-smokers Male smokers

Highest Lowest

The life

expectancy

between rich and

poor smokers is

similarRicher smokers

have a lower life

expectancy than

poorer non-

smokers

Driver of inequalities

2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020

Year

0

10

20

30

40

Cig

are

tte

sm

ok

ing

%

35

3332 32

34

31 3130

29 3028

29

27

32

Routi ne & manual

20 21 2019

1719 18

17 1716 16

15 16 16

Non-rout i ne

11. 3

25. 3

Tobacco – a national opportunity

• We know what works• Comprehensive approach

• Strong leadership

• Good partnerships

• Implementing the evidence base

• Embracing innovation

Supporting what we know works

0

5

10

15

20

25

30

35

40

45

1978 1982 1986 1990 1994 1998 2002 2006 2010 2013

Smoking prevalence

Doll and Peto publish

20 year study showing

1 in 3 smokers die

Majority in

the UK not

smoking

Illegal to sell tobacco

to under 16sTobacco

Advertising and

Promotions Act

Smokefree legislation

comes into force

Tobacco Control

Plan for England

published

Smoking Kills

published

Lessons from elsewhere

Supporting what we know works

• Comprehensive approach

• Leadership

• Partnership

• Implement the evidence

Supporting a Comprehensive approach

• Originally developed by ASH, in partnership with others. PHE has tool under licence from ASH until 2015

• Self-assessment can be supported by a peer review led by a tobacco control expert.

• The CLeaR model is based on the 3 domains of:

• challenge for existing tobacco control services, based on the best evidence

• leadership for comprehensive action to tackle tobacco

• results demonstrated

Local Authority Date signed

Newcastle City Council 01-May-13

Manchester City Council 10-Jul-13

Hartlepool Borough Council 05-Aug-13

Liverpool City Council 09-Sep-13

Bath and North East Somerset Council 12-Sep-13

Coventry City Council 21-Oct-13

London Borough of Southwark 28-Oct-13

Rochdale Metropolitan Borough

Council31-Oct-13

Southampton City Council 04-Nov-13

Gateshead Council 07-Nov-13

Somerset County Council 21-Nov-13

Thurrock Council 27-Nov-13

Warrington Borough Council 02-Dec-13

North Tyneside Council 02-Dec-13

Calderdale Metropolitan Borough

Council03-Dec-13

Birmingham City Council 11-Dec-13

Lancashire County Council 12-Dec-13

Mendip District Council 16-Dec-13

Blaby District Council 13-Jan-14

Halton Borough Council 15-Jan-14

Durham County Council 17-Jan-14

Sheffield City Council 28-Jan-14

Supporting local leadership

Supporting partnerships

The NHS will therefore now back

hard-hitting national action on obesity,

smoking, alcohol and other major

health risks. We will help develop and

support new workplace incentives to

promote employee health and cut

sickness-related unemployment. And

we will advocate for stronger public

health-related powers for local

government and elected mayors.

Supporting Partnerships

Implementing the evidence

Local delivery

High impact local actions

1. Comprehensive local strategy…?

2. Targeted approach to health inequalities…?

3. Harm reduction…?

4. Smoking in Pregnancy…?

5. Political engagement/ leadership…?

6. Building partnerships…?

For discussion

1. Delivering high impact actions

2. Barriers to local delivery of tobacco control

3. Opportunities for national support