Agenda item

To receive a report from the Cabinet Member for Adult Social Care and Public Health and the Director of Public Health, which sets out the approach being taken to improve health and reduce health inequalities. The committee is asked to endorse this approach and support the enhanced Smoking Plus model and the revised ambition to reduce the number of smokers in Kent by 2022.

Ms C Mulrenan, Public Health Speciality Registrar, was in attendance for this item.

1.               Ms Mulrenan introduced the report and explained that, since reporting to the November meeting of the Cabinet Committee, the ambition to reduce the number of smokers in Kent had been increased from 45,000 to 58,500. Another issue which had arisen at the November meeting was the absence of chewing tobacco from the needs assessment, which, Ms Mulrenan explained, was because smoking tobacco contributed a far greater burden of ill health locally, nationally and globally.   Smoking tobacco was the biggest risk factor for ill health, far greater than chewing tobacco, so this was the focus of the needs assessment.  Ms Mulrenan undertook to supply a link for the Tobacco Dependency Needs Assessment for inclusion in the minutes of the meeting:

file://invicta.cantium.net/kccroot/users/shq/shq6/MulreC01/Desktop/Smoking%20Needs%20Assessment/Smoking%20NA%20Final/Tobacco%20Dependency%20NA%20Final%20accessible%20merged.pdf.

The Smoking Plus model presented the best chance of reaching national targets for smoking quits, together with initiatives such as smoke-free school gates, shops, prisons, etc.

2.               Ms Mulrenan and Dr Duggal responded to comments and questions from Members, including the following:-

a)  asked if sufficient information was available about people’s reasons for smoking, Ms Mulrenan explained that, although the majority of the population now understood that smoking was not a healthy choice, this knowledge would not necessarily lead to people making a healthy choice by avoiding smoking. The smoking ban in shops, pubs and workplaces in 2007 had made a difference in encouraging some people to stop smoking and it was hoped that the various smoke-free initiatives would continue to encourage quitters. Some groups resisted quitting, however, and it was known that some 30% of manual workers were smokers. It was believed that the current service model did not appeal to all groups and that the proposed three-tier model would offer alternatives to those smokers who did not wish to access traditional smoking cessation services. Dr Duggal added that more targeted work was needed to tackle pregnant women who smoked.  GPs would be sent a ‘script’ to support them in having a conversation with smokers to raise the issue of them quitting;

b)  concerns was expressed that, as vaping was not permitted indoors in many premises, and people were required to go outside, once outside they might then choose to smoke a cigarette instead.  If people could vape inside, more might turn to it.  Ms Mulrenan pointed out that vaping had been shown to be 95% less harmful than smoking and was a useful aid to quitting smoking. A Kent and Medway STP paper had recently been drafted in support of smoking cessation services taking an ‘e-cigarette friendly approach’ for those who wished to use e-cigarettes as a quitting aid. Dr Duggal added that Public Health England was currently lobbying the Government about vaping being permitted indoors. Vaping had not been mentioned in the 2007 smoking ban as it had not been a recognised practice at that time;

c)  concern was expressed that many medical staff, to whom many people would look as role models of healthy behaviours, could be seen smoking outside hospitals. Ms Mulrenan advised that NHS premises should now be smoke-free as part of national public health strategy and that there had also been a move to have smoking cessation support housed in acute trusts on a full-time basis, both of which should encourage staff to quit. Dr Duggal undertook to investigate statistics for the number of NHS staff known to be smokers;

d)   asked about the number of women smoking at the time of delivery (SATOD), and concern expressed that, according to the graph in the report, the figures had risen in 2017 and significant inequalities remained, Ms Mulrenan highlighted that the confidence intervals given in the graph meant that officers did not believe this was a true rise in smoking rates in pregnancy. However, it was agreed that rates remained too high. Efforts to improve SATOD data may also be contributing to any apparent rises. She concurred that smoking remained a significant source of health inequalities. Dr Duggal added that pregnant women who smoked would be targeted by working with maternity services to encourage expectant mothers to quit during their pregnancy;

e)  a question was raised about the effectiveness of such campaigns and what statistics were available about how achievable and effective it could be to give up smoking at various stages of pregnancy.  Dr Duggal undertook to look into this and supply statistics to the committee, and advised that the health benefits of giving up smoking were presented to expectant mothers at pre-natal appointments. The recording of the number of women smoking at the time of delivery was a national requirement, but Kent would always strive to tackle the issue earlier in pregnancy;

f)as many smokers had already given up, those remaining were the hardcore smokers who would find it harder to give up.  Concern was expressed that some people giving up smoking would need something to help with anxiety and stress and may turn instead to illegal drugs and other substances;

g)   a suggestion was made that, far from getting parents to give up as a way of preventing children from taking up smoking, children could be used a tool to get their parents to give up. Duggal acknowledged that this may well be a good way forward and advised that behavioural science had highlighted the need to identify the right campaign message for the right population.  Ms Mulrenan highlighted that, as part of the needs assessment, a literature review had been undertaken to look at interventions to prevent smoking initiation among children and young people. Although it was known that one of the best ways to reduce smoking rates in children is to reduce parental smoking, public health were also considering education and prevention programmes for young people;

h)  the cost of cigarettes was highlighted, with the average smoker spending over £2,000 per year on their habit. This cost could be targeted in future campaign work; if people would not give up to improve their health, they might be encouraged to save their money, especially if the cost over a lifetime of smoking were to be highlighted. Ms Mulrenan advised that the smoking cessation programme did look at costs with current smokers accessing the service, but she was not aware of a campaign targeted solely at cost. Dr Duggal added that campaign work had identified the help which could be gained by raising the tax on tobacco;

i) the continued focus on discouraging young people from starting to smoke was welcomed, with the message seemingly now established that it was not cool to smoke. It was cool to vape, however, and this had become a recreational activity among young people. Concern was expressed that this could lead to smoking in later life as young people would become accustomed to nicotine from vaping. Ms Mulrenan advised that current evidence suggested vaping was not acting as a ‘gateway’ to smoking for young people, but agreed that public health should continue to monitor the situation closely. Dr Duggal advised that vaping products did not all contain nicotine. Retailers of vaping products operated under a strict code of practice which prohibited nicotine products being sold to anyone who had not previously used nicotine, and this would prevent vaping from being used as a gateway to smoking;

j) the inclusion of the costs of a smoking habit was welcomed, and a move to increase the tax on tobacco was supported. It was stressed focus should not be solely on quits to the detriment of preventing initiation, and Ms Mulrenan agreed. Smoke-free initiatives aimed to make smoking initiation less attractive, and the public health team were also looking into education programmes for young people;

k)   reference was made to the ‘One You’ campaign which included a smoker whose body appeared to ‘rot’ from the inside as he inhaled nicotine, while the voice over described the effect of nicotine on the human body; and

l)  questions were asked about whether quit rates among pregnant women changed at different stages of pregnancy. Dr Duggal highlighted that smoking was brought up with women when booking appointments, and that SATOD data was collected as it was a national statistic. She would be happy to clarify with public health colleagues about whether any ‘pinch points’ existed for quits within specific stages of pregnancy. 

3.            It was RESOLVED that:-

a)    the overall approach to improve health and reduce health inequalities be noted and welcomed; and

b)    the enhanced Smoking Plus model and the revised Kent ambition of achieving 58,500 fewer smokers by 2022, in order to achieve Kent’s prevalence target of 12%, be supported.