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Tobacco Control – changing the game together

Jim McManusDirector of Public Health, Hertfordshire County Council

Elizabeth FisherHead of Stop Smoking ServiceHertfordshire County Council

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An endgame for tobacco

• The prize is still ever diminishing death and disease due to tobacco

• E cigarettes in this context are important• The world of tobacco control has changed

– 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)– Diminishing returns and niche sub populations

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The Long tail of smoking quitting...

Kreuter et al (2014) AMJPublicHealthDiagram from http://www.longtail.com/about.html

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Harm Reduction and the Long Tail• NICE Harm reduction guidelines • Our local guidelines

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

– The 4Es duty: Economy, Efficiency, Effectiveness and Equity.

– If it works for our population and is safe, what legitimate reason do we have not to engage with it?

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An uncertain world...• Needs science that can cope with change and

complexity• Needs to take a different view of risk and

precautionary principle without at any time sacrificing peoples

• Needs a situation where people debate from evidence not fear

• Needs science that can plug the gaps in our knowledge

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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 very much about their health, we cannot ignore this

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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? Because if we are, it will happen without us