Tobacco control in North Yorkshire
Smoking is still the primary cause of premature mortality and preventable illness in North Yorkshire and in 2011-13, 16.9% (3128) of all deaths in the county were attributable to smoking, this equates to over 1000 deaths a year. Tobacco is linked to more than 200 diseases and is the primary cause of lung cancer and Chronic Obstructive Pulmonary Disease (COPD); almost half of smoking-related diseases are cancers. The smoking prevalence for the county as a whole is lower than the national average (15.6% compared to 18% nationally). However, there is wide variation across the districts; Ryedale currently has the lowest prevalence at 10.9% and Richmondshire the highest at 25%. In North Yorkshire we are left with the more complex smokers, requiring more time and support to quit and have recently adjusted our requirements for our stop smoking service to reflect the changes to our population.
Smoking is the single biggest cause of inequalities in death rates between the most and least affluent communities in the county. The lowest income groups in society suffer the highest burden of smoking-related illness, with 29.8% of routine and manual workers still smoking in North Yorkshire. The lowest income groups often find it harder to quit as they are more likely to live in a community where smoking is perceived as normal. People on low incomes are twice as likely to smoke as the more affluent, to have started younger and to be more heavily addicted.
Social care costs and smoking
The costs of smoking to the NHS and to the economy in general are well understood. However there are costs to the social care system, which are less well known, and have not previously been quantified. The burden on smokers as a result of illnesses caused by their addiction is significant. It has been estimated that for every smoker who dies, 20 are living with a smoking related illness. Research now shows that smokers are likely to need care on average nine years earlier than non-smokers.
Smoking in pregnancy rates also continues to be a major concern, particularly in Scarborough. Smoking at time of delivery ranges from 8% in Harrogate and Rural District CCG to 21% in Scarborough and Ryedale CCG. The county average is 12.9% compared to the national prevalence of 11.4% in 2014/15.
The Scarborough District has four indicators significantly worse than the England average:
•Smoking attributable mortality 2011-13
•Smoking attributable heart disease 2011-13
•Smoking attributable strokes 2011-13
•Smoking attributable hospital admissions 2011-13
North Yorkshire Tobacco Control Strategy 2015-2025: Smoke Free North Yorkshire
The Health and Wellbeing Board’s new strategy aims to ‘inspire a smoke free generation’ and focusses on the following priorities:
1.Prevention for children and young people
2.Normalise a smoke-free lifestyle
3.Reduce illegal tobacco in the community
4.Support smokes to quit and reduce smoking in pregnancy
5.Carry out marketing and communication programmes
The strategy mirrors the regional campaign ‘Breathe 2025’ which aims to create a smoke free generation by 2025 across Yorkshire and the Humber.
New challenges
Excellent progress has been made in reducing smoking prevalence on a national scale, particularly since the 2006 legislation banning smoking in enclosed public places. However, progress has been slower amongst routine and manual groups and deprived populations. The new Smokefreelife North Yorkshire service has a clear drive to target 8 priority groups, routine and manual occupations, residents in deprived areas of the county, pregnant smokers, people with mental health problems, drug and alcohol users, parents who have children under 16, long term conditions and planned hospital admissions. Only 6 per cent of smokers access a stop smoking service when they try to quit but when they do success is four times more likely. Furthermore, as the prevalence of smoking in the general population decreases, there is now a population of ‘hard core’ smokers requiring more intensive support.
The rise of popularity of e-cigarettes is also changing the face of tobacco control, with the UK MHRA announcing its intention to regulate e-cigarettes as medicines in 2016, therefore requiring medical purity, controls on advertising and high levels of delivery standards.
Data
The total number of successful 4 week quits in North Yorkshire was 1247 in 2014/15, compared to 3,050 in 2011/12. Over the last 4 years the number of quits per year have reduced dramatically mainly due to a reduction of activity from Primary Care. This is not just a local issue but the national picture. 64% of smokers setting a quit date were from routine and manual occupations. The number of pregnant smokers quitting smoking during pregnancy has remained at 82 for the last 2 years, with the majority of these in Scarborough.
Commissioning principles for comprehensive local tobacco control
Statement of principle
Local authority public health commissioners work closely with all relevant partners to commission high-quality, evidence-led comprehensive tobacco control interventions.
What will you see locally if you are meeting the principle?
Effective integrated commissioning of services that achieve positive outcomes for individuals, families and communities by:
•having well-functioning partnerships between local authority-led public health, the NHS (clinical commissioning groups (CCGs) and NHS England local area teams (LATs)), acute health services, mental health services and adult social care, regulatory services, children's services and criminal justice agencies
•operating transparently according to assessed need
•bringing partner agencies and services providers together into cost-effective delivery systems
•fully involving service users and local communities, including through Healthwatch
All people who smoke tobacco are offered a cessation intervention suited to their needs.
Tobacco control is a prominent action within strategies aimed at addressing health and social inequalities.
Key commissioning recommendations:
Evidence based stop smoking service targeting locally identified priority groups
Implement NICE guidance PH 48 in secondary care
Smoking during pregnancy – NICE guidance PH26
Tackle illicit tobacco and underage sales
Prevention activity for children and young people
Communication and marketing activity – national, regional and local
Normalise a smokefree lifestyle - environments
NICE guidance / evidence base
Smoking cessation - acute, maternity and mental health services (PH48) (2013)
Quitting smoking in pregnancy and following childbirth. (PH26) (2013)
Supporting people to stop smoking, quality standard (QS43) (2013)
Tobacco Harm Reduction (PH45) (2013)
Smokeless tobacco cessation - Helping people of South Asian origin to stop using smokeless tobacco (PH39) (2012)
Identifying and supporting people most at risk of dying-prematurely (PH15) (2008)
Smoking cessation services in primary care, pharmacies, local authorities and workplaces, particularly for manual working groups, pregnant women and hard to reach communities (PH10) (2008)
Varenicline for smoking cessation (TA123) (2007)
Workplace interventions to promote smoking cessation: Public health intervention guidance (PH5) (2007)
Brief interventions and referral for smoking cessation (PH1) (2006)
Public Health / Smoking Prevention
Local government public health briefings (PHB1) (2012)
School-based interventions to prevent smoking (PH23) (2010)
Preventing the uptake of smoking by children and young people (PH14) (2008)
Gaps in knowledge
There has been an increasing number of complaints and intelligence regarding illicit tobacco across North Yorkshire. To establish a clearer picture as to the extent of the problem we are undertaking a full county wide survey that will help shape future action in this area.
Please visit the Public health England Tobacco Control profile below;
http://www.tobaccoprofiles.info/tobacco-control
Download the data here:
https://www.datanorthyorkshire.org/dataset/jsna-data/resource/32120e06-f3f3-4fc9-bac5-2fb45606e145
Author: Emma Davis
Date published: 16/03/2016