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Tobacco Control – changing the game together

Jim McManus

Director of Public Health, Hertfordshire County Council

Public Health Stakeholder Forum 21st January 2015

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The context for an endgame on tobacco control – changing the game• Not just systems but

culture and landscape changed

• E cigarettes, Stoptober and their impact on stop smoking services

• Digital services and platforms (probably lower impact than above)

• Confused Landscape – who should do what?

• What does good look like in the new world?

• Mental health

• Rise of inequalities and hard end smokers

• Harm reduction

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PHE suggested game changers1. Behavioural science in the digital age, allowing us to reach people we

haven’t been able to reach before and providing personalised support on a mass scale.

2. Place-based approaches, developing local solutions that draw on all the assets of an area, integrate public services and build resilience in communities.

3. NHS preventative services implemented at scale, working with NHS England.

4. Transparency, so that everyone can access information on performance or need and evidence on what works, to make better decisions. This will include a partnership with the Chartered Institute of Public Finance and Accountancy to focus on the return on investment from public health interventions.

5. The contribution of employers to improving mental and physical health.

6. Using the concept of wellness (and developing measures of wellness) to give a broader view of health.

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My take on PHE suggested game changers

1. Behavioural science in the digital age, - focus on national tools which can be disseminated locally

2. Place-based approaches, developing local solutions - this is our job, you need to be clear what your role is

3. NHS preventative services implemented at scale, working with NHS England – need for greater clarity about who does what

4. information on performance or need and evidence on what works – yes

5. The contribution of employers – you do national, we do local

6. Using the concept of wellness (and developing measures of wellness) to give a broader view of health – do we even know what this means? What about resilience and coping?

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My suggested additional game changers

1. Behavioural science approaches not just digital

2. Contested marketplace – Stoptober etc

3. E cigarettes

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Local Ambitions

• Reduce Smoking Prevalence to 18.5% or less in each district

• Reduce the uptake of Smoking in Young People to less than 9% by 2015

• Reduce Smoking in Pregnancy to 7% or less by 2015

• Reduce the harm from second-hand smoke

• Promote Smokefree public sector organisations and healthy workplaces

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Local authority investments in tobacco

• At this moment in time hitting local authorities about their pension funds is a distraction and you are not going to win overnight

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Tobacco Control Progress: Reducing Adult PrevalenceReduce smoking in every district to 18.5% or less by 2015

0

5

10

15

20

25

30

2010 2011 2012 2010 2011 2012 2010 2011 2012 2010 2011 2012 2010 2011 2012 2010 2011 2012 2010 2011 2012 2010 2011 2012 2010 2011 2012 2010 2011 2012 2010 2011 2012 2010 2011 2012

England Hertfordshire Stevenage Hertsmere WelwynHatfield

Broxbourne Dacorum North Herts St Albans Three Rivers East Herts Watford

Percentage of Smokers

Percentage of adults who smoke

Source: Integrated Household Survey published by Public Health England

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Tobacco Control Progress: Reducing Prevalence in Young PeopleReduce smoking in young people, so that less than 9 per cent of 15 year olds smoke by 2016

0

5

10

15

20

25

2008 2010 2012 2008 2010 2012 2008 2010 2012 2008 2010 2012 2008 2010 2012 2008 2010 2012 2008 2010 2012 2008 2010 2012 2008 2010 2012 2008 2010 2012 2008 2010 2012

Hertfordshire Broxbourne Dacorum East Herts Hertsmere North Herts St Albans Stevenage Three Rivers Watford WelwynHatfield

Percentage of children who smoke regularly

Percentage of children aged 15 who smoke regularly

Male FemaleSource: Health Related Behaviour Survey

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Tobacco Control Progress: Reduce the number of women who are smoking at the time of delivery to less than 7% by 2015

130 142 134 119 122 125 126 1240%

2%

4%

6%

8%

10%

12%

14%

2013/14 Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2013/14 Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2013/14 Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4

England ENHCCG HVCCG

Percentage of women smoking at the time of delivery (by CCG)

% women smoking at time of delivery Target Source: Health & Social Care Information Centre

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What we have done since arriving in Local Government:

1. Public Health Strategy adopted Nov 13 with clear priority commitments on tobacco

2. One of the HWBB 9 Priorities

3. Hertfordshire Tobacco Control Policy approved by Cabinet (based on LGA declaration but goes further) Nov 13

4. Established PH board – advocates of Tobacco Control and route to sharing best practice and advocacy

5. Collaborating with national agencies on harm reduction and e cigarettes in tobacco control

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What we have done since arriving in Local Government cont.

1. Tobacco Control Strategic Plan 2014-2016 approved by Public Health and Localism Panel May 2014

2. Detailed profiles for every District and CCG locality on impact of tobacco as part of JSNA

3. £2m investment in District Council led public health. Tobacco one of top priorities

4. Smoke free homes, cars and playgrounds

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Hertfordshire Tobacco Control Strategy Group

• Tobacco Control Strategic Plan 2014-2016 developed with stakeholders

• Responsible for delivery of each of these priorities working with TC Alliance partners

• Reports to Public Health and Localism Panel and to HWb Board

• Project management approach to delivering ambitions

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Work underway now• Refresh ambitions

• Director of Public Health Report 13-14 focus on ‘Early Avoidable Death’ and prioritises smoking-related behaviour –

• New NHS contribution plan in development on back of NHS Statement of Support

– “Three big wins for the NHS” System Leaders sign up

– Work with CCGs and JCT to include Tobacco Control and Smoking Cessation in NHS targets (mental health, NHS Hospital Trusts and Community Provider)

• Include Tobacco Control in PH communication and marketing plan 2014-2015

• Develop harm reduction guidelines - to include e-cigarettes guidance

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E cigarettes are a game changer in tobacco control• We have thought, read and reflected long and

hard on this

• The evidence points to the benefits being greater than the harms

• We will keep evidence under review

• We will treat e cigarettes as a tool for public health gain not a threat unless credible scientific evidence says otherwise

• Most vapers care about their health, we cannot ignore this important trend

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E cigarettes 2

• Gateway theories and fears on e cigarettes are not supported by the evidence so far

• Yes lets protect children proportionately

• Is public health at the forefront of making the trend to vaping the healthiest it can be, and if there is evidence of harm, reducing or protecting the public from it?

• Or are we in denial?

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Harm Reduction

• Our new harm reduction guidelines are approved and working

• They include a range of harm reduction strategies including working with e cigarettes, cutting down to quit etc

• Our watchword is effectiveness and cost-effectiveness. If it works for our population and is safe, what legitimate reason do we have not to engage with it?

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thank you